Treating and Preventing COVID-19, Including Vaccines and 'Long COVID'

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Brian Lehrer: Brian Lehrer on WNYC. Ask the mayor coming up at 11:30 this morning. Right now, the race between vaccines and variants continues, as we all know. While we're learning about how the virus works and how to protect ourselves against it, it is also learning, in its way, about how we work and how to protect itself from our efforts to avoid it. Dr. Daniel Griffin has been on the front lines of the pandemic with his patients and advising other doctors as an infectious disease clinician and as a researcher at Columbia and chief of the division of infectious diseases at the ProHEALTH medical group. Dr. Griffin, thank you for joining us. Welcome to WNYC.

Dr. Griffin: Thank you so much for having me, Brian.

Brian Lehrer: Has your role been primarily to treat patients once they're sick enough with COVID to be in the hospital?

Dr. Griffin: Brian, I think that's hopefully what I can bring to this. I always refer to myself as a physician-scientist, physician first. I've been taking care of, well, hundreds and hundreds of COVID patients. The whole spectrum, Brian, from the outpatient setting all the way into the hospital, into the ICU, and then out the other side.

Brian Lehrer: I'm curious what you're seeing in your practice and, in particular, what you see and what you hear from other doctors at ProHEALTH when it comes to hospitalization in ICUs. Are we winning this war?

Dr. Griffin: Right now we're in a holding game. We're sitting here on this plateau and we say it's the virus against the vaccines. As we're ramping up our vaccines, we're doing everything we can, unfortunately, to help the virus with the opening up, some of us think, a little bit too quickly. We're sitting at this holding pattern and people can look at the numbers nationally and in the New York area, we see it and hear it. We're sitting with about 4,000 to 5,000 people in the hospital. We've been there for about a month now. We're seeing between 50 and 100 people die every day, and that's been what's been going on for the last month.

As the vaccines ramp up, the virus is getting an opportunity to change. We're having challenges how that impacts some of our therapies. There's every reason to be optimistic, but we're still in the middle of this pandemic. We still have across the country over 1,000 people dying a day. We are not where I wish we were at this point.

Brian Lehrer: Listeners, we can take a few calls for Dr. Griffin. Your COVID treatment questions, your COVID research questions, vaccines versus variants. 646-435-7280 or tweet a question @BrianLehrer. Long-haulers, you were in the news recently because you noticed that some of your patients experiencing COVID's long tail have gotten relief following vaccination, which we usually think of as to prevent COVID-19. Tell us what you're seeing.

Dr. Griffin: This is a shocking new paradigm, right? Vaccines as therapeutics, as opposed to vaccines just for prevention. I was a little dismayed and continue to be dismayed since, I guess, April, May, when I started noticing this ritual of clapping patients out of the hospital with the idea that now they were all better. Then I've continued to take care of those patients for months and months. Now I think people are becoming more aware that, for a significant chunk of individuals COVID is not just two weeks they suffer. Back in December, when we first started vaccinating healthcare workers first, a lot of them with long COVID that I care for, we were really pleasantly shocked to see that about 30, 40% felt significantly improved. That seems to be holding.

Some of them, it takes that second shot, but this is really encouraging. A virus that has always thrown surprises our way, almost all of them terrible, this is the first time I have to say this is a really pleasant and positive thing that we're observing.

Brian Lehrer: You know what? We have a caller right away on the phones who seems to be having that particular experience. Chris in Manhattan. You're on WNYC. Thank you for calling in.

Chris: Thanks, Brian. Sorry about the technical troubles this morning. I used to do audio live audio engineering so I felt all of your pain. I was waiting, I was so hopeful that you got the phones working because this is huge for me, doctor. I just wanted to tell you that I'm one of those people. I worked in grocery services for the last year, March 19th is my anniversary when I first started to show a temperature and I stayed sick for three weeks. I got better and I thought everything was going to be great. After that, I learned to live on kombucha and HDL tablets because my digestive system just didn't want to do anything anymore.

I would get ridiculous muscle cramps out of nowhere that would lay me up in bed for days. I was brain fogged. I was paranoid. I felt unlike myself, I hadn't been myself for a year. I got the Johnson & Johnson virus a few weeks back.

Brian Lehrer: Vaccine.

Chris: I don't remember the date. I really should. Sorry. Vaccine. I got sick for four days. I felt like I was going to be the first person to die from the vaccine. Then I'm happy, I'm better. I feel 75, 80% of what I was before I got sick. That is beyond amazing. I can't speak the phrases about getting the vaccine enough for people who may have long-term effects.

Brian Lehrer: Dr. Griffin, do you want to ask Chris anything as a patient or just a caller.

Dr. Griffin: I think first, thank you, Chris. This is I think the way medicine is supposed to be, it's supposed to be a dialogue. We're supposed to learn as much from our patients as we can teach them. Early on, Chris, we saw this with the RNA vaccines. We didn't know is J&J going to work as well. This is great. Here you are giving a firsthand account. It looks like all the vaccines are providing this improvement. Now I don't want to oversell it, Chris, because unfortunately, as you probably know, there's about half the folks that are still suffering, but my gosh, 30, 40% feeling better like this. This is tremendous.

Chris, I guess I'll ask you. Early on, we were a little worried about the vaccines were going to set people back. Are they going to get a vaccine and then lose whatever improvement? Did you have that fear of going into this or were you going in with that positive, hopeful attitude?

Chris: Positive and hopeful and really, really, really, really, really well-researched. I'll tell you what my theory was. Maybe you can tell me if I'm having fun or just maybe I'm onto something. I had thought that somehow because of the exposure in the grocery store environment, where we were under maximum exposure, I mean the numbers of people that got sick in my store alone are just staggering. I did the research and I was keeping up with as much discussion groups as I could. I wasn't really paranoid, but I was super hopeful because what it felt like is the digestive and neuromuscular and really my brain fog sounded like a virus in hiding, almost like a herpes virus.

It was evading the immune system. When I would get stressed out or paranoid or overwork too much, I'd only been working one or two days, it was the maximum amount of physical activity I could endure. I was thinking it acted like a cold sore. It would pop up and lay me out for days at a time. I was super hopeful that the vaccine would give my immune system a boost against variants or other mutations that were hiding and go out and seek and destroy.

Brian Lehrer: What do you think Dr. Griffin, has he nailed the mechanism or does he have a good theory there?

Dr. Griffin: We're going to name it after you, Chris, the Chris mechanism. No, you are right. We have two main theories. We, and I think it is we, it's a lot of us talking and putting our heads together. I was reading an article by Akiko, fantastic researcher up at Yale. At the very end, I was waiting for them to mention they had quoted me because it was exactly what I was thinking. No, it was her words. A really prevalent theory is that the virus is not fully cleared. Either the virus is still replicating at a low level or there's just remnants that are still provoking our immune system, making us still feel sick. The leading theory is you give this vaccine, and particularly now that we're seeing with the J&J and the other vaccines that don't really give such a huge jolt, that maybe now we're finally clearing this out of our system. No, Chris, you are right on with the leading theory. We're still trying to sort this out. There's a lot of research underway to understand this. That's right up there.

Brian Lehrer: Chris, I'm glad you're feeling better. I'm really glad you called in. Maybe we will have the Chris theory and it'll be Chris and the Chris theory when they figure out exactly why the vaccines helped the long haulers. Thank you so, so much. Let's do one more, because this is a whole new category. We haven't heard these stories before, at least on this show and we have at least one more coming in. Vicki in Manhattan you're on WNYC. Hi, Vicki.

Vicki: Good morning. I'm going to echo Chris. I had what they called mild symptoms in January of last year. It put me in the ER. I mean, mild symptoms. I didn't have to be intubated, but I was sick for eight hours with a lot of different nausea and disorientation and dizziness. After I got the vaccine, the Pfizer on March 10th, I had felt better in this last, just over a week than I did in all of 2020. I would have fatigue. I would have muscle ache. I would have slight colds, slight cough, sore throat, swollen glands, fatigue that came out of nowhere that I would have to have a nap for two, three hours at a time. I'm going to just echo what he said. I feel great and I feel grateful.

Brian Lehrer: Can I ask you, Vicki, if that started after your first Pfizer shot or only after the second?

Vicki: It started after my first because my second won't be until the 31st of this month.

Brian Lehrer: Even the first shot did that. Dr. Griffin, talked to Vicki briefly.

Dr. Griffin: Now this is great Vicki. I take care of a lot of patients with long COVID. When we were having these shared decision-making sessions back in December, we were worried, are people going to get better or worse? We saw a chunk of people just like you, Vicki, who they got their first shot and it was really either a few days or a week or two when they started feeling better. Some people are feeling better after the second shot and some people who feel, we'll say 70, 80% with the first shot, they get that extra with the second shot. This is excellent. I was going to say Vicki, you're in Brooklyn, right? Isn't it pronounced Pfizer?

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Vicki: Well, I'm in Manhattan, so we say Pfizer, but I'll go with Pfizer because I love all the New York accents. It's a huge difference. My COVID fog has gone. I can't tell you, I feel better than I felt in the last whole year.

Brian Lehrer: Thank you so much. Well, more anecdotal evidence that this is really happening. By the way, I get you are doing your Fauci there, right? Pfizer.

Griffin: Yes. Your Fauci ouchie, your Pfizer.

Brian Lehrer: We have just a few more minutes left with Dr. Daniel Griffin from Columbia and ProHealth. I want to touch at least one last thing before we run out of time. I know you do weekly updates on the podcast This Week In Virology. This Week In Virology is has such a good reputation, I should say to our general audience. I think of This Week in Virology is to COVID as C-SPAN is to government. You got to be pretty wonky to watch a whole Senate hearing or house hearing on C-SPAN. Same thing if you want to, as a layperson, listen to the conversations about the virus at that level, but This Week In Virology is amazing in that way.

Last week you mentioned your concern about COVID-19 in children. Give a quick update on what you think is new there.

Dr. Griffin: What I think is new there, again, is probably the long COVID angle here. We look at statistics and any even, Brian, when you start, you're asking about COVID in the hospital and I've had a lot of conversations where people look at what's the percent of people that end up in the hospital. What's the percent of people that die. For most individuals COVID is an outpatient disease. When we look at kids, when we say, "They're at low risk of ending up in the hospital, they're low risk of dying. Boy, half of them don't even have much in the way of symptoms."

What we're seeing more and more of large studies great data out of the UK. Great in the sense of robust, but not great in the sense of positive, that kids can develop long COVID as well. We're starting to see more and more of that on the ground here. Kids who either didn't even have a strong case or maybe it was a mild case of COVID, now a couple of months later, struggling in school, unable to play sports with their friends. As we're looking at getting the kids back in school, I think the message where we're realizing is kids may be at low risk, but they're certainly not at no risk.

Brian Lehrer: Just one follow up on that, because we've been wondering on our team if there's more disease in children now, really, or just more testing of children. For example, Nassau County Executive, Laura Curran, suggested this week, that one reason their positive test results are staying the same, that is that plateau that you were talking about before, there's a consistent too high positivity rate in Nassau County, but hospitalization rates are dropping. The County executive thinks maybe the reason or a reason is that they recently started routinely testing student-athletes. Plausible?

Dr. Griffin: It's definitely plausible. Brian, we're definitely seeing a shift in the positives from the older population. We've now done a great job of vaccinating our seniors in long-term care facilities. We've done a great job of getting people over the age of 65 vaccinated. With that feeling of complacency, shall I say, the kids are getting more exposures. I think it's a combination. Not only are we testing them more, but they're actually getting more infections. I relate this to a conversation I had with Jay Berger, the head of our pediatric group at ProHealth New York.

When he does, when he's the sick doc, so to speak, and they see those acute visits we're, every time, seeing multiple kids coming in with acute COVID symptoms. It's not just a testing phenomenon. That's part of the numbers, but we're also seeing more symptomatic infections in kids as well.

Brian Lehrer: We just saw some COVID-19 breaking news and we were talking about kids, so it's relevant. I'm going to throw it at you. The CDC just revised their guidance for how socially distanced kids have to be in class from six feet to three feet. We knew this might be coming and now it's come. Do you support it?

Dr. Griffin: I actually do Brian Lehrer, I'm going to a little bit of granularity here. I tweeted about this morning, because I knew this was coming. There was a recent study, and I'm going to say it was not a great study. I talk about it on TWIV on Saturday, but there was a good study back in June. There's been a lot of studies looking at this. When you get individuals about three feet apart, about a meter apart, you get about an 80% reduction in the risk of transmission. You go to two meters or six feet, you drop it to 90%. You get that most bang in that first three feet in that first meter. You throw masks, get about an 80% drop there.

When you start putting this all together, you get the desk three feet apart, you get the kids wearing masks, you improve those ventilation systems and open the windows, you, dare I say, add testing to reduce the chance of infectious kids in the schools. I think this is all going to work together to hopefully get our kids back in school so the moms particularly can get back in the workplace. I think women have suffered disproportionately during this because of the impact on our kids, and our kids have suffered. No, I think that we can do this safely and I think the CDC is updating the guidance based upon the science.

Brian Lehrer: We will emphasize the part of it that you said in the middle there, which is, this is assuming that everybody is still wearing masks. From the NPR write-up of the story, just breaking, the new guidelines still call for six feet of distance between adults and students, as well as in common areas such as auditoriums and when masks are off, such as while eating, and the six-foot distancing rule still applies for the general public in settings such as grocery stores. Can you explain that? We'll extend for one more question. That's going to confuse people. Why six feet of distance between adults and students or six feet of distance between students in common areas of the school, assuming they're all wearing masks, but not in the classroom? Do you get it?

Dr. Griffin: I do. It's okay. I think we were always told to dumb down our message, but I don't think we have to do that anymore. I think the American public can be brought up, but I think we have for the first time as science nerds, people want to listen. People are willing to take the time. That's really what it is. We're balancing things. There are harms to keeping kids home. It's really difficult for most schools to open up if we demand six feet separation among the desks. You can keep adult six feet apart at the grocery store and these other venues.

We're really balancing risks here. If the kids are three feet apart, they're wearing masks, we focus on hand hygiene, we focus on ventilation. You can do that safely, but in other situations, if you've got the six feet, let's go from an 80% reduction to a 90% reduction. I think this is reasonable. The schools will have their three feet. We'll be able to do this, I think, very safely. As much as we can, if we've got the space, let's use it.

Brian Lehrer: Listeners, if you want to geek out on science, you can hear Dr. Griffin and his colleagues on TWIV. He called it TWIV there a minute ago, which stands for This Week in Virology, that podcast. He is a researcher and an infectious disease clinician at Columbia and Chief of the Division of Infectious Disease at the ProHealth Medical Group. Thank you so much. This has been so informative. We really appreciate it.

Griffin: Thank you, Brian, for all you do. Everyone, be safe and follow the science.

 

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