Demystifying COVID-19: Vaccines, variants, masks, and mandates with Dr. Don Kosiak

Dr. Don Kosiak (00:00): No pandemic has ever cured itself. We have to have immunity in order for this pandemic to end. The way we get immunity is through vaccine and through natural infection. And the lesser of two evils to get there as we talked about before is through a very safe, very tested vaccine protocol.

Bridget Bell (00:28): Welcome to MindSET. I'm your host Bridget Bell.

Katea Murray (00:31): And I'm your host Katea Murray. Today we're talking COVID-19.

Bridget Bell (00:35): We're 18 months into the pandemic, so we discuss variants, vaccines, masks, and what we might see in the future to move past it. Welcome to MindSET. Today we're speaking with Dr. Don Kosiak, Chief Medical Officer at Leidos. Welcome Dr. Kosiak.

Dr. Don Kosiak (01:02): Hey, thank you for having me. Fun to be back on the show.

Bridget Bell (01:05): So we spoke with you at one of our first MindSET episodes. So it's last year in March of 2020 at the very start of the COVID-19 pandemic. We are now a year and a half into this and it's changed the world in ways we never expected. So what do you see as the strategy for exiting the pandemic.

Dr. Don Kosiak (01:30): Well, if I had the answer completely, I would be paid a lot of money, and I would share it with everyone, but I don't. So unfortunately, we still have a ways to go with the pandemic. I think originally, people were looking at the fact that we might be able to suppress the virus, meaning we would totally eradicate it, and that's just not the case. We have been successful in that pathway in the past, but not with this virus. And corona viruses themselves tend to need to become endemic. What does that mean? Endemic means it's something that we deal with like other common colds. So really, the way out of this pandemic for all of us is through immunity. That immunity could come in various ways. It could come from getting COVID in the past and recovering, it could be from getting the vaccine and gathering immunity there or a hybrid of those, getting the vaccine and having COVID infection. And until a large percentage of the global population, not just that of the United States has one of those three things happen, we'll be reading about COVID and dealing with COVID for the foreseeable future.

Bridget Bell (02:41): So what can we learn from past pandemics in history that could really apply here?

Dr. Don Kosiak (02:47): Well, throughout history in the 1600s, the 1300s, the 600s, we've dealt with all sorts of pandemics and most of those pandemics, the good news is all of them eventually come to an end. But those pandemics in history, a lot of them happened and lots of people had to get ill, and lots of people unfortunately had to die for it to quote "burn through the population." So if you think of things like the plague, the plague wiped out entire villages and families, and eventually enough immunity happened in the population in order for it to get under control.

Dr. Don Kosiak (03:26): And even things like smallpox, there would be areas pre-vaccine, where it was under control, and then if people would move to a new island like the United States and spread the smallpox here, it took off again like wildfire until enough of that population that was being impacted would build up immunity, and that happens when a variety of people: old, young, immunocompromised, really healthy immune systems, when a variety of people get exposure, there tends to be this word that we've been hearing a lot about herd immunity that develops. It allows us to make sure that the immune system doesn't have to try to recognize things from the front, it has some innate ability to remember it's seen this pathogen before or a pathogen like it, and it can mount a response. And when we get to that point, things like COVID-19, maybe 10 years from now or five years from now, nobody knows for certain, will be more like the common cold that we've been dealing with, and less about this deadly killer that it is today.

Katea Murray (04:31): I think many people felt like they got a respite from COVID this summer, but now we're seeing new surges across the country, what do those mean? What could you tell us about the Delta variant?

Dr. Don Kosiak (04:43): Yeah, great. So it felt so great to get sort of back to normal, if you will. There was this euphoria that was coming in about we've gone through that long, hard winter, the spring was coming, the vaccine was made available, and I remember as a healthcare frontline worker, as emergency medicine physician, I got a vaccine in the first couple of days that they were available. And I remember, it felt like I was running on the field at the Super Bowl, it was set up in an arena, and there's this, you walked in and people were clapping and celebrating, and everybody was just so happy that finally, finally there was going to be something that would help us get there.

Dr. Don Kosiak (05:21): And as we went through this spring, lots of people in the United States got vaccinated, near 50% of the population and in 90 days, which if you think about it is incredible to have that kind of logistics to happen. And those that had recovered from COVID also brought some immunity to the fight, if you will. And so we felt pretty good. Those previous wild type and variants seem to be under control. However, the public health folks kept warning us that if you look to Israel or UK who tend to be a little bit ahead of us, in other parts of the world like India, this variant called Delta was causing lots of trouble. It was just different enough that it could cause some breakthrough infections in people that had previously been vaccinated or perhaps have had COVID and recovered. And for those that didn't, it was much, much more contagious. So I describe it a little bit like if the regular virus was something that would just stick to you, think of the virus being able to stick to your hands or nose or when you inhale it, this new Delta variant is kind of covered in honey, and so if it gets on you it sticks pretty well.

Dr. Don Kosiak (06:26): And so the previous viruses, all had a spread capability of about one to three, so if I got COVID, I could give it to two or three other people. This new variant Delta variant, if I get COVID, on average, I give it to nine people. And so that exponential ability to spread is what we see now. So what we're seeing is those that are unvaccinated, a better term would be those that are non-immune, so either immunity through prior infection or immunity through vaccine, those that are non-immune, are now having COVID impact them greatly, and that is young kids who weren't eligible for a vaccine, that certain populations that have a lower vaccination rate or previous COVID infection rate that was lower.

Dr. Don Kosiak (07:12): Again, if I use that analogy, if you look at what Australia is dealing with now, Australia did a really nice job of locking down pre-COVID, one or two cases they would lock down the entire island, and they were back to normal very soon; however, that's just not a sustainable practice, right? So Australia lacks natural immunity to the disease, and now they're finding that in order to gain that immunity to really go back to normal, they'll have to vaccinate 95% of their people to gain the immunity, because there is no natural immunity circulating.

Katea Murray (07:47): And with the information that we have on variants, how do we prepare for future variants?

Dr. Don Kosiak (07:53): Yeah, great question. These viruses have an ability to mutate, so if you think about a human, when we replicate our DNA, we have lots of spell checkers, if you will, and the ability to put out code and then check to make sure it's right, it's something that our body does really, really well and we've adapt to that. And sometimes when you think of things like cancers developing, it's because we've missed-coded something, and that can be why there's cancer in your body. The virus just likes to replicate really fast, and it really doesn't have any spell checkers, if you will. And its idea is to throw out a lot of it out there and survive, if you will. And so every once in a while, it gets a random miss-type, and that miss-type sometimes is awkward, and causes it to die off or not be as infectious and sometime that miss-type randomly causes it to be better. And when it has a better evolutionary chance of being sustained, it's easier to spread and might be more contagious for some reason, or it's mutated enough that the immune system just can't quite recognize it immediately as being foreign, it has a chance to take off, and so that's what happened with Delta.

Dr. Don Kosiak (09:06): Delta had a random mutation that made it a little bit more difficult for the immune system to detect, and made it more contagious, and because of that, it had an advantage over the other variants of Delta, or excuse me, of COVID and allowed it to spread. There's other variants out there that the World Health Organization, CDC, FDA types are watching, and so far, they seem to be that Delta is still the biggest challenge for the global population certainly here in the United States, but we'll continue to monitor those. There could be a chance that there is a mutation that happens that makes our vaccines or immunity gained through infection or previous infection, not work or maybe not work as well, there's a chance, but the fastest way to eliminate that chance is to get immunity. And again, we've talked about the ways to get immunity.

Dr. Don Kosiak (09:59): So what I'm telling people is certainly, if you had to pick between getting COVID or getting the vaccine, get the vaccine every single day, right? There's maybe some known side effects or risk factors, but certainly none compared to those risk factors of COVID. COVID doesn't care about you, it doesn't care about your socio-economic status, it doesn't care if you're young and healthy or old with lots of chronic diseases, it randomly impacts people. Sometimes people will get a minor cold, some people will get really sick, some people will die from it. The vaccine has some known challenges, perhaps, but certainly nothing as compared to COVID. So if you had to choose between getting COVID, or getting the vaccine, get the vaccine every single day.

Bridget Bell (10:44): So on that note, the vaccine is very hotly debated, and you see various news stories all the time, so I'm curious, what can you tell us about the vaccines and their effectiveness?

Dr. Don Kosiak (10:56): Right, great question. The vaccines have suffered from a little bit of political football, a lot of early misinformation about something that was unknown, and certainly it's easier to talk about the bad things that happened than the 3 million people that were vaccinated that had no problems happened to them in those early days, we just wanted to focus in on the one person that maybe had a weird thing happened to them, because that's the way we sell newspapers and clicks. It doesn't read well that you say 100,000 airplanes landed safely today, nobody wants to read that, right? So a similar process early in the vaccines, lots of stumbles with communication and outreach. And when there's a void in information, because we were waiting for gold standard information, and medicine tends to hold on to really high standards of science, right? It has to be peer reviewed, double blinded studies, and that just isn't the case, those take a long time to do sometimes. It can take six months to a year. And so when you're looking for early information, and there wasn't any lots of other information flooded into the marketplace, and it made people just not be able to trust the new source in which they were getting information.

Dr. Don Kosiak (12:08): So what do we know about the vaccines? Well, the messenger-RNA vaccines commonly known as Moderna, and Pfizer, they're not a new technology, that's sometimes a misnomer that we hear, they're a brand new, untested technology. The technology has been around for decades, literally. The use case for COVID, and particularly corona viruses is what's new. It's like a new bullet for a gun has been developed, the gun has always been there, the messenger-RNA vaccination, that new bullet is targeting COVID and so that's the part that's been new. And so we talk about what is the bullet? What is the thing they're putting into me? And there's lots of myths about, they're injecting COVID, or they're injecting microchips or all sorts of stuff. So what's really in that bullet? That bullet has some instructions to make a portion of the messenger-RNA, that is what the virus is, a portion of the spike protein that we've all been hearing about. So you get the instructions to make that, then that's wrapped with a fatty layer, think of it like the outer layer of like dumpling, and then it's got some water in it, and that's what they inject into your arm. So instructions, fat layer, water, nothing else.

Dr. Don Kosiak (13:28): Your body immediately absorbs that. Well, we'd like to absorb fat and I think everybody can agree that our bodies like fat, right? And so we absorb that, the instructions are there that says, "Hey, you should make this." We go, "Oh, that's cool. We'll make that." And we immediately start to make it and then our body goes, "Wait, that's not supposed to be here." And it starts that immune response. So if you've had the vaccine, and perhaps about eight or nine hours after getting the vaccine, you start to feel a little bit ill, that was your immune system kicking in saying something's not right. That's when your arm might have got really sore or red, maybe you got a little bit of chills, maybe you got a little fever, that wasn't COVID causing that, that is how your immune system responds. So your immune system said, "This isn't right." It sends out these cells that say, "This isn't right," and it starts to make antibodies for it.

Dr. Don Kosiak (14:20): The instructions disappear in 48 hours or so, that fatty layer and all that water gets absorbed and removed from the body. So you have nothing left but the antibodies for it. And then somewhere about three or four weeks later, you get another injection of that same stuff, and guess what, about eight or 10 hours afterwards, you get a really sore arm, you might get some fever, you might get a little body aches, your immune system says "Oh, I've seen this before and I don't like it here, it's not supposed to be here," and then attacks with those antibodies, and then you get the memory B and T cells that come in behind it. So we have this opportunity to really, really, really make things better by getting the vaccine and allowing the immune system to be exposed to it.

Bridget Bell (15:04): And so what about the Johnson & Johnson vaccine that we also hear a lot about?

Dr. Don Kosiak (15:08): Another great question. So I get a lot of emails from our employees and others about the Johnson & Johnson vaccine. There tends to be a lot of in the media about the messenger RNA of vaccines, but less about Johnson & Johnson or vaccines like it. So the technology for Johnson & Johnson has been around for 50 plus years, right? It takes a different kind of virus that looks a little bit like the coronavirus, it dresses it up with a synthetic spike protein, if you will. It's killed, the virus is no longer alive, it's attenuated virus they call it, and then they inject it like any other vaccine that you've got over the last 50 years.

Dr. Don Kosiak (15:47): The same thing happens, you get an injection, the body recognizes as it is formed, it attacks that thing that is formed, and then has some memory to it. So if people were saying the reason I didn't get a vaccine is because the science is too new for the messenger RNA vaccines, I'd say, "Well, that's not true, but let's have a conversation about it." And if you're still not ready to get over the hurdle then I'd say, "Well, perhaps the Johnson & Johnson vaccine might be better for you. It's "older technology," and it will allow you very similar protection. Again, the goal is to get to some kind of immunity.

Katea Murray (16:23): As we're talking about vaccines, we know that there's hesitation into getting vaccines, what would you recommend we could say to encourage those who are hesitant?

Dr. Don Kosiak (16:32): Well, the number one reason we've talked about already, and that's generally something like the vaccine science is just too new, or it was rushed, or some variety of that. So we've talked a little bit about the sciences of new, it's just a reloading of the tool. So I think that's one way you could explain it. The science was rushed, is another very common one that I get, which is a little bit different but similar context. And I'll explain kind of how drugs come to market place.

Dr. Don Kosiak (17:02): Usually, if I'm let's say Johnson & Johnson, because we talked about Johnson & Johnson, if I'm Johnson and Johnson, and I want to bring 50 new drugs to the market this year, I have to spend my own money and invest in those 50 different drugs with clinical trials, usually called pre-clinical trials first, but let's say we've already decided to use them in humans. I do a phase one clinical trial, I spend less than a million dollars of my own money but times 50, that's 50 million projects, right? And then I say, "Okay, here's all the results, now I want to decide which of the 25 of those 50 do I take to the next level," and then you can see it repeats itself. Again, I do the study, I get results back, I have to decide what I'm going to invest in next, and generally, then I can bring a couple of them to market every year. Hundreds of millions of dollars spent in the research process.

Dr. Don Kosiak (17:54): And then once I get through that hurdle, then I have to decide to manufacture them and retool my plants to manufacturer and have a supply, so that's the usual process. What happened with COVID, in the vaccine process is the federal government did a great thing here, and so did many across the globe. They said, "We don't care what it costs, you take money off the table, we're going to just fund everything as if it was going to go forward. And if the science works, we're just going to have to start manufacturing it now knowing that we might buy stuff that we have to throw away as a country, right?" So the money question got taken off the table. When you take the money question off the table, the science can go pretty fast, right? I can do phase one, phase two, phase three clinical trials, review the results, and then be able to say whether or not this might be something that is working. What if I don't have to pause and then have to pause for manufacturing, and then retooling and all the things that we just talked about.

Dr. Don Kosiak (18:52): So the money was the issue that made this go fast, faster than ever in history, not that the science had any shortcuts. They did the exact same science just didn't have the pauses, so that's the second thing that I hear a lot about is the science. The third, and one that I hear a lot of topic about is the infertility issue. And the infertility issue is one that is very scary for lots of people and it's a holdout for lots of people, and so I want to talk about how that got started. So early on in the process of looking at COVID-19, we talked about that spike protein, again, there's a chain of amino acids on that spike protein that they say are very similar to the chain of amino acids of the placenta, the part that keeps the baby alive in the mother's womb when the other is growing. And because there's a similarity, if we made antibodies to the spike protein from a vaccine, we'll have that crossover to cause infertility because it has a potential to attack the placenta, and so that was the concern early on.

Dr. Don Kosiak (19:57): But when they started to study it, it would be like saying, "You and I both have an A in our name, so therefore we're the same thing, right? There's so much different, it was just a little bit of similarity that it doesn't turn out to be that way. So there is not a crossover to the placenta from the antibodies, right? And then I say, well, even if that was true, what if there was crossover from the vaccine creating antibodies that attack the placenta? The same thing would happen if you got COVID, natural COVID, and your body made antibodies and then attack the placenta, right? So either it's true that antibodies attack placenta, and it would happen with a vaccine or natural infection, or it's not true. And it turns out, it's not true. We're not finding that in the science and the literature.

Dr. Don Kosiak (20:45): Now that people have been getting the vaccine millions and millions of women have been having babies and the pregnancy rate and carrying on to term has been very similar pre and post or those that have had the vaccine and haven't, the miscarriage rate is the same in the vaccine group versus the non-vaccine group. So it appears that both natural COVID, getting the infection or the vaccine does not cause infertility in men or women that is long lasting or long term.

Dr. Don Kosiak (21:15): And then the last one that I hear a lot about is a theme around, "I've already had COVID." And there's been a lot of discussion on natural immunity in the last few weeks. Early in the pandemic, we really didn't know how long natural immunity was going to last, right? We kept hearing maybe it's 90 days, maybe it's six months, and as we started off this broadcast, we said, "We've been doing this for 18 months, guess how long we've known about COVID? About 18 months, right?" So we don't have any long term studies to point to say this is how immune you're going to be in five years from now is when you're going to need your next booster, we just don't have that data. So we use surrogates, like similar viruses and antibody counts and the like, but the answers we just don't know.

Dr. Don Kosiak (21:59): But what we do know out of studies that are coming out of Israel and out of the UK, a couple of good things about natural immunity and vaccines. The first good news is for serious illness like hospitalization and death, both natural immunity from a previous infection and the vaccines are doing incredibly well even among Delta variant. We are seeing more breakthrough cases than we did before, and we've been hearing a little bit about waning of vaccines, and maybe we'll talk about boosters in a minute. But for the most part, the vaccines have been doing exactly what they've been designed to do, keep our hospitals from getting overrun with COVID-19 patients. So do some people get breakthrough infections? Yes. Do some people have challenges with even hospitalization? That could be true.

Dr. Don Kosiak (22:50): However, as you get more data about natural infection, you may see some modifications to the vaccine requested or required, if you will. It seems that there's some good evidence to say if you've had natural COVID, and you get a vaccine dose, one single dose of messenger RNA, so the Pfizer and Moderna stuff, your antibody level, again, used as a proxy for immune response is way, way higher than anyone that had natural infection or got two doses of the vaccine without ever having an infection so you kind of become super immune, if you will. So back to my original discussion about if you've never had COVID, and you're deciding between COVID and the vaccine, I take the vaccine every single day, now what if you're in a different camp? I've already had COVID and I'm not sure if I need the vaccine? I would say the science says that you should at least get one dose of the messenger RNA vaccine, and then you get super, super high antibody levels. That second dose while has some risks to it, doesn't have a lot of risk factors, and it might move you from let's say the 99th percentile to the 100th percentile.

Dr. Don Kosiak (23:58): So you're not going to get a lot of gain out of that second dose perhaps, but certainly at least one dose is going to be there. And I suspect maybe we'll see the federal government shift to covering prior infection plus one dose of a messenger RNA equals full immunity are fully vaccinated. I can't promise you that, but that's where I think the science is headed.

Bridget Bell (24:19): So you had a few different points that I think we're gonna want to come back to and dig into, first one is on boosters. So there's a lot of discussion on if a booster is needed and when, what can you tell us about that?

Dr. Don Kosiak (24:33): We can look across the globe and see different countries, again, I'll use Israel who's been using boosters for a long time. The UK has also started boosters and parts of Europe. The United States has been debating the concept of boosters for a little while. It seems like the CDC and the FDA have settled on boosters are a good idea for anyone over the age of 65 or those that have had some kind of chronic disease or weakened immune system known as immuno compromised. So let's give a few examples of why at age 65 or older? Why not 50 or why not 40?

Dr. Don Kosiak (25:11): Well, you have to have a cut off somewhere, right? And so we're going to start with 65 and above and that's what the sciences is showing us, that if we looked at studies done in Israel, Israel was the very first to start using vaccines, the advanced countries, if you will, and they use primarily Pfizer as their dosing. So we have some early data from early December of people that are being vaccinated. And if you imagine like any country outside of their health care workers, they prioritize the really sick or really frail as their priority, so now they've had their highest risk population fully vaccinated for greater than eight months now. And so they can look back at that high risk group and see they're having some breakthrough infections in that group and that is pretty natural, so let's take COVID word out and put in herpes zoster, chickenpox, you get it once, when you're a kid it goes away, or you get the vaccine is your kid, it goes away, you never speak of it again, until it comes back, and it comes back as shingles. And when does that usually happen? In our 50s and 60s.

Dr. Don Kosiak (26:15): Our immune system has been keeping it at bay for a long period of time, tries to come out, we fight it off. As we get older, our immune system doesn't respond quite as well, particularly if you had some chronic disease burden on it and then you have shingles happen. So the same thing is happening with COVID-19, the immune response isn't maybe as robust as it would if you gave a shot to a 25 year old, healthy female compared to an 86 year old with chronic disease problems female, see there's a little difference. So that breakthrough is happening in those or the immune system needs a little boost, if you will, in that older group.

Dr. Don Kosiak (26:51): And then there's the chronic disease or immunocompromised. Those might be people that their immune system always hasn't worked very well or perhaps they're taking medications like cancer therapies, or steroids that you might take for various conditions that are suppressing your immune system from responding. And in those groups, if you've got the vaccine, your immune system was suppressed, perhaps or it doesn't respond as well and so they may need another reminder. Other countries are going down, you'll see all the way down into the 40s for their vaccine and that may happen as more data comes out here in the United States, but for now, they're talking about that recommendation, 65 and above or those that are immunocompromised, and it's been six months since their second shot, or six months since their Johnson & Johnson shot receiving a booster.

Katea Murray (27:40): You've mentioned breakthrough cases, what do we know about breakthrough cases? Do breakthrough cases mean that the vaccine is no longer working?

Dr. Don Kosiak (27:48): It does not. So breakthrough cases are something that happens with every single vaccine that we give. We try to do our best to prevent that from happening, right? We try to science or engineer it, so it doesn't happen and we actually got really lucky with the first couple variants of COVID, that it did extremely well just keeping it away from us. However, viruses get tricky, and they tend to mutate and so sometimes they disguise themselves a little better than they did before, so let's define the purpose of getting a vaccine in the first place. The purpose of a vaccine is not to keep us from ever getting the virus, it is to keep us from getting seriously ill and end up in a hospital or worse from the virus that we're trying to protect against. So an extra benefit is never getting it if you happen to be in that group.

Dr. Don Kosiak (28:40): So in the breakthrough cases, let's say it's as high as 30% of people are getting breakthrough cases, a vast majority of those breakthrough cases are fairly mild, sore throat for a few days, fever, body aches, want to stay home, some people will even say they stayed in their bed for a couple days. Some are a little bit more severe, maybe that's 14 days of laying in their bed, but they're starting to recover, and they're not in the hospital and they're not in the ICU and they're not on a ventilator. And those numbers of people that are having breakthrough cases compared to the similar population control groups of unvaccinated or non-immune from this are really high like in the unvaccinated group or no prior infection, their numbers are 10x or 12x or 25x of being in the hospital and being in the ICU, compared to those that are breaking through.

Dr. Don Kosiak (29:31): So the vaccines are working great, they're actually working as designed, and we'll hope to continue to tailor those. So if we have a new variant that comes up, that's the beauty of the messenger RNA vaccines, the delivery system remains the same, the bullet that we put into that delivery system can change pretty rapidly with a tweak of the instructions that need to be given, wrap that in a fatty layer, put it in some water and then check that in into the population, right? So that's how we hope to get around variants that might be causing trouble in the future, but today, the good news is with Delta variant, no matter which vaccine you received, you still are getting great, great protection from the reason they were designed in the first place, which is to keep you from serious illness, hospitalization and death.

Bridget Bell (30:24): So what about vaccines for ages five to 11? That's the other one that we see in the news quite often, so what can you tell us about vaccines for children?

Dr. Don Kosiak (30:34): It's an important topic because of course, right now, kids are going back to school and they're intermingling and parents are worried about what might be happening as they mix, and bringing at home to loved ones or high risk individuals. Additionally, it's a large chunk of the population, 8% or 9% of the population is in that age group, but that's considered experimental and they're going to be filing for. So what do we know about the early data hasn't been reviewed fully, it hasn't been through the peer review process, but what I'm seeing is they're lowering the dose, the amount that's going into the arms is different and is much lower than that an adult is receiving, and they're getting good results. So a safety profile that seems to be pretty good at first blush, and antibody levels that are extremely high, higher than most adults that are getting based off the same kind of conclusion.

Dr. Don Kosiak (31:24): So what will happen, that raw data will be analyzed by really, really smart people and they'll see if it matches the summary that's been provided by someone like Pfizer, or Moderna, also doing their studies, and that age group, and then they'll decide if it's safe. If they come to that conclusion, it looks like perhaps before Halloween, in October, we may have a vaccine approved for emergency use for that age group.

Katea Murray (31:52): So, so far, we've talked about vaccines and the role of an individual in our exit strategy, but what do you think the role of companies or private organizations and helping us move past COVID would be?

Dr. Don Kosiak (32:06): Right. So we just heard the President a couple weeks ago, talk about stepping up the vaccine effort, if you will. The President of the United States is has mandated through executive order, those that are in health care, so you think of home health agencies and hospitals and in nursing home as a long term care facilities, mandating that they get the vaccine. You've also heard that from the Department of Defense and federal health care worker or federal workers, that there's going to be a mandate. So today, all of those use cases do have the ability to have a waiver, a waiver for medical problems like I'm allergic to a component of the vaccine, so I can't get one, or perhaps a religious exemption because your religion or deep found moral convictions don't allow you to get those vaccines.

Dr. Don Kosiak (32:55): Those mandates will help move the needle, I think. I'm not always a big fan of mandates. I like to talk to people on an individual level and it's easy to do as a frontline healthcare worker, but harder to do when you're talking about let's use lattices, a population of 42,000, or 43,000 employees really hard to have individual conversations. So what does a mandate do? It helps with the people that are kind of on the fence, they just needed a little extra nudge, and now that their employer says that they have to do it, it may be an enough of an excuse to get them. I still think even though that will move the needle some, we're going to need to have individual conversations with our employee base, with our friends and family, and help demystify this vaccine that is very similar to vaccines that we've had in the past that has a safety profile that's just as good, if not better than many of the other vaccines that we've been doing for a long time and haven't had protests about having to do.

Dr. Don Kosiak (33:59): And so for me personally, I think if we can get that moved by some mandates, cool, so be it. I think having some options are things that people like, so I do think that people are willing to hold on to their wanna wait a little bit by giving them a testing option, and so you're seeing that now.

Bridget Bell (34:19): So we're coming up on time, but I think the one topic we haven't addressed that we need to as we're talking about COVID-19 is face masks. What can you tell us about their effectiveness? And they in themselves have become a controversy over the last 18 months, so can you talk to us a little bit about that?

Dr. Don Kosiak (34:39): Absolutely. So what do we know about masks? We know that masks have been used in the hospital setting, in the healthcare setting for decades and decades and decades. And what the cloth masks do, or the simple surgical mask do, they really protect your patient or your coworker from getting the virus from you. It is not 100%, it might be as good as 30 or 40% reduction of you if you were asymptomatic but shedding virus of you giving it to somebody else. So we'll use the example the three of us, let's say we were in a room together, and I didn't know that I had COVID, I'm asymptomatic, if I was wearing a mask, the chances of me giving that to you are diminished, not zero, but diminished because I was wearing a mask, and I was putting less virus out into the world.

Dr. Don Kosiak (35:33): And there's some question and some science now behind how sick you get is correlated with what viral loads you received. So walking by somebody, is that different than being prolonged contact for six hours in a room with somebody and they're sharing lots of virus with you? It looks like perhaps if you're sharing lots virus with you, your chances of getting sick really go much higher. So for that reason, we want to try to cover ourselves. If you're also wearing a mask, then of course, it makes it harder for that virus load to get in and it depends on what kind of mask you're using. So the cloth mask sign says, "Yeah, they're okay." They're not great, they do some protection on both sides, the surgical mask, those disposable ones that are blue or black, little better, not great, but better and provide some protection. And then last but not least, you have the N95, or KN95 masks.

Dr. Don Kosiak (36:27): I see a lot of people with the KN95 masks, so they're not healthcare grade, they're the kind that go behind your ears. They are designed to protect both you from getting the virus from somebody else, and you giving the virus to somebody else, so they're a little higher caliber, if you will. They don't get a great seal, so they're not medical grade. A true N95 masks comes over the top of your head, doesn't hook behind your ears, it gets a great seal, and those are really good again, for preventing me from giving it to you and from you from giving it to me. And those are becoming more readily available, I would say it's still pretty hard to find a true N95 mask, but a KN95 mask is there.

Dr. Don Kosiak (37:06): The last thing I'll say on masks is wasn't it great when we got to put them away if you were vaccinated, and then they said, oh, you have to put them back on? So the theory was that there was some evidence that vaccinated people were getting sick, so breakthrough cases that we talked about before, and that their viral load was just as high as those that were unvaccinated. When you cultured their nose of what was growing in there, you found just as much virus and therefore, that means they could have the potential to give it to other people, just like an unvaccinated person might be. And so for that reason, everybody put back mask on in the indoor setting, for sure, and in some cases, depending on where you live in the outdoor setting as well.

Dr. Don Kosiak (37:50): Well, now more studies have come out, and it looks like if you're fully vaccinated, you do indeed, you could shed some virus but your virus load that your shedding is way, way less, even though you might have it in your nose, the stuff that's coming out is less, or the stuff that can be infectious. And if you're in a room full of other fully vaccinated people, the chances of passing on the infection gets really, really small. It's not zero, but it's small. In a hybrid workforce, though, where there's some unvaccinated or some immune that didn't have natural infection yet, and they haven't had a vaccine, I could give it to you. So anytime we have a mixed workforce, we're going to likely see masks for a long period of time. If we get to a fully immune workforce, you might see that masks Band-Aid be lowered down.

Dr. Don Kosiak (38:35): And those cases that we're hearing about where fully vaccinated people are giving it to other fully vaccinated people tends to be in households where there's lots of prolonged contact. So think of it like my 22-year-old son has COVID and I'm taking care of him or I'm side by side with him for six or eight hours because we're working on a project, he's given me enough viral load even though he's fully vaccinated, that he could impact me to get enough viral load. Remember the last topic of it, this is a respiratory virus, so the virus can get in your nose can get into your mouth and start to replicate. In our antibodies although we have some in our nose in summer mouth, they're really good once it enters the blood system.

Dr. Don Kosiak (39:16): So breakthrough case, people say, "Well, how can we only get a little bit stick with breakthrough cases?" And here's the theory that I think works best. The theory says, I have some of my nose, I get a little bit sick, my immune system starts to respond, that's when we feel the body aches, the fever, it's really your immune system responding. And by the time it enters my blood system, where I have lots of circulating antibodies or the ability to do it, it fights it off right away, and that kind of ends the illness. If I don't have antibodies circulating, it grows in my nose, I start to get sick, then it overwhelms my system and that's when you end up in the hospital. So that's how the difference is even though you might get the cold sinus and pressure sore throat, by the time it gets systemic, your antibodies have had a chance to respond, and respond in a very, very high fashion so you have fewer and fewer breakthrough cases or serious illnesses because of that situation.

Bridget Bell (40:08): So as we wrap up any final thoughts that you want to share with our audience?

Dr. Don Kosiak (40:12): Well, we've covered a lot of topics today, and I know we've stayed at the 50,000 foot level with them, I would say a couple final thoughts. First, if you're having questions, reach out to a trusted healthcare provider in your life, that may be your family doctor that you've been seeing for a while, that could be your OB-GYN doctor, that could be a family friend, or a trusted health care advisor. They'll answer your questions, because there's so much information out there and it's just hard to sort through it out, so that's the thing. One thing too, no pandemic has ever cured itself. We have to have immunity in order for this pandemic to end. The way we get immunity is through vaccine and through natural infection, and the lesser of two evils to get there, as we've talked about before is through a very safe, very tested vaccine protocol that will get you to that natural immunity, that will protect you from serious illness, and hospitalization and death from this virus, the coronavirus COVID-19.

Katea Murray (41:13): Thank you, Dr. Kosiak so much for your time. This has been a great pleasure I know for me, myself and for Bridget. And thanks to our audience for listening to MindSET. If you enjoyed this episode, please share with your colleagues and visit Leidos.com/MindSET.