An historic day at the MUHC

This week on Health Matters, Tarah Schwartz speaks with Dr. Tamara Mijovic, the surgeon who performed the historic first cochlear implant surgery at the MUHC. Dr. Zachary Levine discusses how emergency rooms are handling a difficult season and tips for when to visit the emergency room. And, the Kraken COVID-19 variant is making headlines. Dr. Donald Vinh shares what you need to know and what researchers are still hoping to discover about the virus and its newly emerging variants. 

 Cette semaine à Questions de santé, Tarah Schwartz discute avec la Dre Tamara Mijovic, la chirurgienne qui a posé le tout premier implant cochléaire au CUSM. Le Dr Zachary Levine explique comment les urgences font face à une saison difficile et propose des conseils pour déterminer si une visite à l’urgence est justifiée. Et le variant Kraken de la COVID-19 fait les manchettes. Le Dr Donald Vinh partage de l’information importante à connaître et précise ce que les chercheurs espèrent encore découvrir au sujet du virus de ses nouveaux variants.

Transcript

Tarah Schwartz: 0:00

Hello there. Thank you for joining us. I'm Tarah Schwartz and this is Health Matters on CJAD 800. On today's show, many of Montreal's emergency rooms are over-capacity. It's been a challenging difficult period in our health care system and finding a way out isn't always clear. But patient care is the primary focus for all health care workers. So later in the show, we speak with an emergency room physician who will share when you absolutely need to go to the ER to try and alleviate some of that pressure. And there are so many respiratory viruses circulating around including a new COVID-19 variant. We speak with an infectious disease specialist about what you need to know about the Kraken variant and what interval you should be getting your booster doses- if you have had COVID since your last shot, and if you haven't. But first, it was an historic day at the MUHC on Friday, January 13. The very first cochlear implant surgeries were performed in Montreal at the Glen. The MUHC is now the second cochlear implant clinic in the province. This marks a significant step in better serving patients who are deaf or hearing-impaired and could benefit from this type of procedure. Dr. Tamara Mijovic specializes in otology neurology and skull base surgery. She was part of the team of doctors who performed that first cochlear implant at the MUHC, and she joins me now. Thank you so much for being here.

Dr. Tamara Mijovic: 1:26

Thank you so much for an invitation.

Tarah Schwartz: 1:29

So tell us what was it like to be part of such an historic procedure?

Dr. Tamara Mijovic: 1:35

It was a very exciting day at the Royal Victoria Hospital on Friday. It's been coming for a very long time. And we've known that we'd have a program at the MUHC, three years ago. Due to the pandemic, it took three years to get there. But everybody was very excited to finally see the fruits of our labor.

Tarah Schwartz: 1:56

And how many people are involved? How many medical staff are involved in a procedure like this?

Dr. Tamara Mijovic: 2:02

It requires one surgeon. It's not a very laborious surgery in that sense. But it's very technology-involving so there are many actors in the room. There's one surgeon and I had a colleague with me as well, because everybody was more excited about it. And then it involves one or two audiologists and our team of nurses. Our trainees and students were watching more than participating. But the excitement was real.

Tarah Schwartz: 2:30

I have no doubt I'm excited about it. I was super excited to hear about this story. How long does it take to perform a cochlear implant?

Dr. Tamara Mijovic: 2:38

The surgery itself lasts two hours. So we took a bit longer to train our team in the process. But the procedure itself is not very long, and it's a day surgery patients come in and leave the same day.

Tarah Schwartz: 2:51

Wow, that's an I'm surprised to hear that actually. Because when you hear surgery, and you think a Cochlear device going into the skull, I would think it would take longer than that. But that's I guess that's health care today, isn't it?

Dr. Tamara Mijovic: 3:03

Indeed. When the surgery was developed in in the 80s, the first surgery was done actually at the old Children's by Dr. Melvin Schloss. Then, it was so complex that the government decided to put it only in one place to develop the expertise. So for the last 35 years, it was only done at CHUM Quebec in Quebec City. All the deaf patients from everywhere in the province would have to go to Quebec City to get their surgery. But the science has gotten so streamlined and the technology so well-developed that now it's more a standard of care that can be offered elsewhere. So we're very excited to have it in Montreal now.

Tarah Schwartz: 3:37

So the significance, as you mentioned, because everyone had to travel to one place. This is clearly a way to better serve patients when you can perform this kind of surgery at an incredible hospital like the MUHC.

Dr. Tamara Mijovic: 3:48

Yes, definitely. You cannot imagine these are patients who already have a challenge that of being deaf, and having difficulties with communications and getting around. Being displaced to a new health care system; in a new city, mostly in French, was definitely a challenge for several patients and some actually decided not to go through it because of the difficulty that it would imply for them.

Tarah Schwartz: 4:13

We're speaking with Dr. Tamara Mijovic. And we're talking about the first cochlear implant surgeries performed at the MUHC. How long after the implant is put in are patients actually able to hear?

Dr. Tamara Mijovic: 4:29

A week to two weeks after the surgery, we double check that the wound has healed well and then they proceed with quality activation. So a processor is placed on the implant and now we start transmitting electrical current through it to start stimulating the cochlear nerve. But then it's a whole process of relearning to hear. Because the new type of hearing, it's an electric type of hearing. So several months of training and rehabilitation are needed to get a hearing that's useful for are things like hearing a noise or hearing music, which requires quite a bit of time.

Tarah Schwartz: 5:06

Maybe just give us a bit better of an understanding. We talked about it a bit last week. But these kinds of procedures are so complicated. So it helps to revisit the information. Explain to us a little bit, you mentioned it's an electrical procedure, how does it work the cochlear implant and what is it doing to those who are receiving it?

Dr. Tamara Mijovic: 5:28

Basically, the patient's themselves, those who are candidates, have the type of hearing loss that's called sensory neural hearing loss. It's either their cochlea hair cells that are dysfunctional, and they no longer make a current that stimulates the cochlear nerve. Sometimes it's the connection between the nerve and the cells that is problematic, and it requires more energy, so more current for the information to go through. In the surgery, we go behind the ear, we go through the bone and make a small opening in the cochlea. Through the cochlea, we thread several electrodes, they're all in one line or one thread. And that thread then can transmit current to the cochlea, and then that current stimulates the nerve directly. Then we place a processor under the skin that is able to transmit what type of current goes into the cochlea. And that's all involving a large amount of engineering and processing that's needed to analyze the outside sound to make it into an electric current to then transmit it to that thread. And then the brain needs to understand that as sound. So it's a definitely big challenge from the audiologic and processing standpoint.

Tarah Schwartz: 6:44

Dr. Mijovic, what is it like for you? When you see patients who are going from not being able to hear or not being able to hear well to being able to hear? What is it that like, as a surgeon, as a physician, as a caregiver to these patients?

Dr. Tamara Mijovic: 7:01

I mean cochlear implants have changed how we practice as an otologist and neuro-otologist. There's many things that I can fix prior to. We do surgery for bones of hearing, but sometimes when the evolution is such that no matter what we do, the hearing declines and becoming deaf slowly is a huge source of anxiety to patients. You can imagine that suddenly the way you communicate, the way you interact, is all being compromised. And to know that there are solutions, that won't need to learn sign language to be able communicate later in life is a big relief to patients and to us. To know that no matter where we are in the spectrum will always do the best we can. And then if we reach that point, we have solution to bring the sound back.

Tarah Schwartz: 7:49

And what drew you to this particular aspect of health care, Dr. Mijovic?

Dr. Tamara Mijovic: 7:56

Can you repeat the question? I'm sorry.

Tarah Schwartz: 7:57

Yeah, I'm wondering what drew you to cochlear implants to this kind of surgery to this aspect of medicine. What drew you here?

Dr. Tamara Mijovic: 8:06

It's been a long time coming. When I was a medical student, I enjoyed ENT as a specialty. And then within ENT, there's something about hearing that the just so wonderful and so unique. The type of surgery is microsurgery, it's very precise. It requires a certain degree of attention to detail to be a good ear surgeon. I think it fit with my personality. So I definitely enjoy it and I love that patient population because it's all about interaction and remaining social and involved.

Tarah Schwartz: 8:42

Dr. Tamara Mijovic has done the first cochlear implant surgery performed at the MUHC. But Dr. Mijovic, we're catching you in Salliut where you're seeing patients. What are you doing there? Tell us about that experience.

Dr. Tamara Mijovic: 8:54

So the McGill University has a long standing tradition in going and working in Nunavik. When I was a resident, the first trip I did up here in Nunavik was in 2011. And I definitely loved it. It's a wonderful place to go and the patients really need us. The Inuit patients have chronic ear problems that are extremely advanced, and they require high quality care for their ears. So ear surgeons from McGill have been going up here for over 40 years. So I'm continuing that McGill tradition. I go twice a year and we have a full team of surgeons attached to the MUHC who go. We cover around 12 weeks of service to the Inuit patients so that they don't have to travel down to Montreal for their care, which is expensive and time-involving and after an ear surgery patients are usually not allowed to fly for around a month and a half. So if we do all these surgeries down in Montreal, we strand these patients in Montreal for very long periods of time. It's easier to fly the surgeon and provide care on site and we've been able to build a beautiful setup here.

Tarah Schwartz: 10:09

Wow. I feel like we need a whole show just to talk about that, Dr. Tamara Mijovic. We'll bring you back, that sounds extraordinary. Thank you so much for joining us on the show today.

Dr. Tamara Mijovic: 10:18

My pleasure.

Tarah Schwartz: 10:19

Coming up next on Health Matters. Last week, the MUHC's emergency rooms were well over-capacity. What do you need to know about going to the ER? I ask the Chief of Emergency Medicine. I'm Tarah Schwartz, you're listening to Health Matters. We have all heard the numbers. Many of the emergency rooms in Montreal are well over-capacity trying to take care of our community. Many of us are nervous about going to an ER and not completely sure about when we should or shouldn't be visiting one. Dr. Zachary Levine is the chief of the Department of Emergency Medicine at the mea to thank you so much for joining us today. Dr. Levine.

Dr. Zachary Levine: 10:56

My pleasure.

Tarah Schwartz: 10:57

How do you describe the state of the ERs at the MUHC? And if you can tell us how you feel about them just generally around the city and province? What is the state of them at the moment?

Dr. Zachary Levine: 11:09

I think everyone knows they're busy. We talk about percentage occupation. And it's a bit complicated what that refers to; but it gives a reflection of how busy we are. So often at the MUHC adult sites or the Royal Victoria Hospital and the Montreal General, the sites that have emergency departments. We're frequently at the Royal Victoria Hospital at about 200% to the Montreal General Hospital about 150%. So we're over capacity, typically.

Tarah Schwartz: 11:38

And what are some of the more common issues that you're seeing in the ER right now? Are they COVID-related? Is it something different? Help us to understand who are these people that are making up this 200% capacity?

Dr. Zachary Levine: 11:51

Sure, like any emergency department, we see all comers, of course, so whatever people come in with. Although it's true that we do reorient people who we find don't necessarily need to be in the emerge and we're wait a long, long time; we do you have associations with clinics who can see them the same day. So it can reorient people. I would say the Montreal General, as people may know, is a trauma and orthopedic Centre. There's a few things that the Montreal General specializes in and those are, those are two of them. So traumas are going to come to the Montreal General. I should mention also psychiatry also is at the Montreal General and thoracic surgery. The Royal Victoria Hospital is also a very specialized center. Again, people can come in with anything but we see a lot of oncology patients, getting treated for cancer, and transplant patients; transplants of an organ like a kidney or a liver or what not. So that's just to say that in addition to what people come in with normally any kind of injury or infection- and if you want, we can talk about those- we do have this special set of skills and serve a specialized population. And so these people need kind of special care.

Tarah Schwartz: 13:23

I think a lot of people, when they hear these numbers are worried about going to the ER. They don't know when to go if they should go, what is your advice on that? In what sort of situations should someone go to the ER?

Dr. Zachary Levine: 13:38

It's a very reasonable question. People do worry about it. And I certainly don't blame anyone for coming to the ER. I think people come because they feel that's where they need to be. And, unfortunately, oftentimes, because they don't feel that there's another option. They don't have a doctor who they can see quickly, or they don't know where they can go quickly. So that's a whole other thing. The reasons to come to the ER are if you think you have something that may be life-threatening. Now, it's not always that obvious-that's the problem. But certainly things like significant difficulty breathing, significant chest pain, neurological symptoms, like significant changes in your vision, suddenly, or severe, severe headache. Weakness, especially if the weakness is on one side, difficulty speaking, new confusion or new seizures, and then maybe, of course, but if you're exposed to something like poisoning. And then severe injuries, some clinics can take care of even fractures, but any severe injuries really should go to a trauma center like the Montreal General Hospital.

Tarah Schwartz: 14:47

Okay. We are speaking with the Chief of the Department of Emergency Medicine at the MUHC, Dr. Zachary Levine. Are there some steps that people can take before going to the ER? For example, should they try walk-in clinic if they don't have a family doctor? Call 811? What do you suggest?

Dr. Zachary Levine: 15:05

Yeah. So some people are fortunate to have family doctors and family doctor groups that cover for each other. So there's someone who covers on weekends and off-hours. That's great and they can do that. The government certainly encourages that. And, there's incentives for doctors who not only do that, but also who keep spots open during the week, in order to see patients who need to see them urgently. So that's very good. Now, a lot of people don't unfortunately, as everyone knows. You could certainly go to a local walking clinic, I think if you know of one that's near you, by all means. I understand that many of them fill up quickly in the morning. So the other thing that probably people know about is 8-1-1o which is info sante and so they can give people information. But also, more recently, the government has made changes and has created something called the "Guichet d'accès à la première ligne" which is also known as the GAP program. So basically, it's a way to get people access to primary care in an efficient manner. So you call 8-1-1, and they're connected with the clinics across the city and across the province. And they have slots specifically for more emergent type presentations, and they can get you in within a few days to see general physician.

Tarah Schwartz: 16:42

Oh, interesting. Now, as the chief of the Department of Emergency Medicine at the MUHC, you're dealing with this situation. You're right on the forefront of it. You're dealing with an exhausted staff that I think the population has great empathy for. How do you help your colleagues, your staff, get through this difficult period of massive overcrowding?

Dr. Zachary Levine: 17:04

You're absolutely right. It's been a very difficult time, and especially with COVID, and overcrowding. I think that makes me think of two things. Number one is fostering a team atmosphere where people feel like they're part of a team, and they're appreciated. That's one thing, I think it's very important for people to come to work and feel like they're appreciated and feel like they're part of a team that appreciates them and like being there; even if the conditions are difficult. The other, this is more on an individual level. But what I try and do and I try and encourage people to do is not lose sight of the importance of what we're doing. Frankly, of the luck, the fortune that we have to actually be doing it. We're in a very privileged position to be able to help people who are vulnerable, and are in very difficult states. And we have the ability to potentially help them. I think most of us, in health care, doctors, nurses, RTs, everyone went into it to help people. One of the issues that happens is, with time and stress and whatnot, people can lose sight of that and they don't focus on their interactions. If you can get right down to it again, and focus on your interaction with that one patient who you're helping, that can bring some of the joy back to why you initially went into the field.

Tarah Schwartz: 18:38

I think that is a lovely way to put it, a lovely way to see it. And I think it's a great note to end on. Dr. Zachary Levine, Chief of the Department of Emergency Medicine at MUHC, thank you so much for your time today. And good luck during this continued difficult period.

Dr. Zachary Levine: 18:52

Thank you very much.

Tarah Schwartz: 18:54

Next up on Health Matters, Kraken is the latest COVID-19 variant and it's a doozy. What you need to know about how to avoid it. I'm Tarah Schwartz and this is Health Matters. Kraken is the latest COVID-19 variant to be making headlines. It is more contagious than Omicron and is currently circulating in North America, along with colds, the flu and RSV. So what do you need to know about this latest variant? And how can you avoid catching it? Dr. Donald Vinh is an infectious disease specialist at the MUHC and the Research Institute of the McGill University Health Center. He has been our voice of reason throughout the many years of this pandemic. Dr. Vinh, thank you always for being with us.

Dr. Donald Vinh: 19:34

Thank you for having me, Tarah.

Tarah Schwartz: 19:35

So tell us about this new COVID-19 variant. What do we need to know about Kraken?

Dr. Donald Vinh: 19:42

Sadly, when we're talking about the current COVID situation we have to acknowledge that we are actually dealing with multiple variants. Based on provincial data, the predominant variant identified and sample is BQ 1.1 and its lineage. So this makes up about 55% of what's being identified. However, the one that we're hearing about a lot in the news right now is this variant called X BB 1.5, which has gotten the nickname, Kraken. Now, the Kraken, we have to remember, it's that mythical sea monster that it was essentially a colossal octopus or maybe a squid. But it's the nickname given to X BB 1.5 to help the public understand that this new variant could be a real problem. In the US, according to the CDC, X BB 1.5 currently accounts for 43% of the circulating strain. It went from about 4% to the current 43% in about a month. In Quebec and the other provinces, data from about two and a half weeks ago has X BB 1.5 at 2.5% of isolates and data just from this morning, now has it at about 12% in Quebec and 20% in Ontario.

Tarah Schwartz: 20:51

So what makes this variant different? What makes it worrisomely more contagious?

Dr. Donald Vinh: 20:59

When we're talking about Omicron, we have to think about this like a family tree. When we had Omicron, we first had BA 1 and then we had BA 2. From BA 2, we had a branch of the family that veered off and led to the development of BA 5. And from that we got BQ 1, which is the ones we're dealing with predominantly now. On the other hand, X BB 1.5, this Kraken, it's from a different branch coming off of BA 2. It's a mixture of actually two previous BA 2 strains. It's a distant cousin of a BA 5 or BQ 1. Now why is that important? Well, the fact that it is a distant cousin, rather than a sibling tells you that it is quite different genetically. It's got mutations that increases the virus's ability to tightly attach onto ourselves, making it more infectious and theoretically more contagious. In fact, as you said, it's predicted to be the most contagious variant that we've seen so far. The other problem is that the mutations it has, it's in this famous spike protein, or the s protein, which is what it's targeted by vaccines, and by a type of treatment called monoclonal antibodies. And because of these mutations in a spike protein, the monoclonal antibodies that we use, or that we used to use, to treat or even prevent against infection, they're no longer effective. So these variants are rendered these kinds of treatments futile. And because of the same mutations in the spike protein, the antibodies that we've generated either from previous vaccinations or from previous infections, they may not be sufficient to protect us against this X BB 1.5 variant, especially if that previous vaccination or infection was from a long time ago.

Tarah Schwartz: 22:37

Wow. Okay. So I'm sure everybody's wondering, does that mean that the vaccines that we're getting now, that we got last month, that we have booked for two weeks from now, are those going to protect us? Protect us from some?

Dr. Donald Vinh: 22:53

In fact, the current bivalent mRNA vaccines that are available for booster doses, actually have data. In fact, there's an increasing number of studies that show that they're actually able to induce antibodies against the major variants that are circulating now, much better than the previous monovalent mRNA vaccines or the original mRNA vaccines that we're using. And more so than some of the other non-mRNA vaccines that we've also used in the past.

Tarah Schwartz: 23:28

So get your booster. Don't hesitate to get your booster just because people are worried about this particular variant.

Dr. Donald Vinh: 23:37

The COVID pandemic is not over. There's definitely a lot of circulation going around. And the bivalent booster dose is a good protection against disease.

Tarah Schwartz: 23:46

You know, Dr. Vinh, when I hear you talking over the last couple of minutes, what's sort of going through my mind is that this virus is doing whatever it can to survive. Is that how you see it like whether it's a sibling or a cousin, it's branching off of this one or that one... To me, I feel like I hear you talking, I think, oh, it's fighting for its survival. Is that what's happening?

Dr. Donald Vinh: 24:07

I don't think it's fighting for survival. I think it's got carte blanche, because of the fact that we actually haven't done anything to threaten its survival. And that's the problem. It has gotten so rampant, that it's out of control and it's led to all these variants in different parts of the world. I think the concern has been; on the one hand, to deal with the psychological fatigue of this virus. On the other hand, you also battling that true virology, what's going on. There's this misconception that if we let it become rapid enough, it'll play nice. It'll be benign, or some people will use the word endemic. There is nothing to suggest that the virus has become benign. If we look at what happens on a mass scale of loosening of public health measures, we don't have to look further than China who just did that recently. Especially in the context of a perhaps a sub-optimal or incomparable vaccine, and we're seeing deaths in the 10s of 1000s, maybe even the hundreds of 1000s in the span of a few weeks. So, the virus is not becoming more benign. And the diseases that were that it causes; well, we can mitigate it because of advances in research and medicine, but not because the virus is playing nicely. So what kind of advances in research and medicine are happening here at the MUHC, the Research Institute, and with your colleagues around the world? Like what are people focusing on? What are the experts focusing on? When we talk about the research at the MUHC, and also at McGill, there's a variety of avenues that are being taken. There are people who are looking specifically at the virus, at the trajectory of the mutations that we're anticipating and the effects of those mutations on how it impacts the virus. And as we've talked about before, some of those mutations, empower the virus to be more infectious, more contagious, they can reproduce faster. And so that gives us a bit of a heads-up as to what's going on. There's also research into the immunology against the virus, which is what I'm focusing on. And we're looking at understanding the different components as to what makes somebody at risk. Because let's face it, when were we dealing with policies that require people to self-diagnose their risk; that's a very gray and poorly accurate process. Some of the things are very obvious. You can say, well, I know that I'm a transplant person and so therefore, I know that I'm at risk. But then there are softer areas where people will say, obesity is a risk factor. But some people don't consider themselves obese. Or maybe there are even other risk factors that we don't quite understand. But that can be determined by blood tests, which is what we're focusing on. So there's a lot of different aspects. And of course, there's also clinical trials where people are trying to do studies to show that this drug that seems so far-fetched and ridiculous as a potential treatment for COVID is, in fact, far-fetched and as a failure of therapy. Whereas other ones are promising and it allows us to expand the armamentarium that we can use in the clinic to treat these infections.

Tarah Schwartz: 27:20

Dr. Donald Vinh is an infectious disease specialist, we're talking about the ever-continuing COVID-19 pandemic. I'm sure you get asked a lot, considering how close you've been and the research you're doing throughout this pandemic. What do you say to people when they say- what are my best chances of not getting it? Is it the same thing we've been saying right from the beginning?

Dr. Donald Vinh: 27:39

In terms of the chances of not getting it? Well, two different aspects. There's the aspect of not getting infection and not getting disease. And I think we have to make the distinction between the two. Because when we talked about the disease of SARS COV2 or COVID, a lot of people focused heavily if not exclusively, on the respiratory infections. The infections of the airway where you get a lung, they get the pneumonia, and they get sick enough and need to be hospitalized and very sick that you need to be ventilated or in the ICU. That is definitely one form of COVID. And that we're still seeing, but we're seeing it less often and certainly less dramatically than we were at the beginning of the pandemic. But we also know that that SARS COV 2 is causing other types of diseases. So yes, there's a lung disease we just talked about. But we also know that there's this post infectious complication where you can get things like blood clots, or heart failure, or strokes that are linked pathophysiologically to the virus. In other words, the virus triggers the process in the body that led to that heart disease, or that blood clot, or that stroke but it's not attributed statistics-wise, as an, Oh, that's a COVID infection. And that's a problem, because that still leads to a burden on our health care system. And then, beyond that, there's also this long COVID. And that's even more concerning, because that's something we really don't understand but it seems to be affecting an increasing number of people. So that's the disease part. And once we understand the spectrum of disease, you say to ourselves well, let's face it, some of the stuff that we have now doesn't necessarily protect against all of these different forms of COVID. So what can we do to protect ourselves? Well, you can protect the upstream component, which is getting infected. You can protect yourself from getting infected. And the way to do that is going to be by having a good mask on your face when you're around other people or when you're in closed spaces. That really is the tried and true thing that no variant has been able to go around. And so we keep that in mind. Those are the strategies or the tools that we should use to try to protect ourselves.

Tarah Schwartz: 29:48

All right now as Dr. Vinh mentioned, research has never stopped on the COVID-19 virus. There are certain things researchers will be fascinated by such as if you've never caught the virus even if you've been seriously exposed. If that's you or someone you know, Dr. Vinh might want to speak with you. That's next. I'm Tarah Schwartz Welcome back to Health Matters on CJAD 800. When you think about how much we have learned about COVID-19, in the past three years, it is rather astonishing. It was a brand new virus that had a global impact. And since it first appeared, researchers have learned about the virus developed vaccines, better treatments, and continue to study its immediate and long-term impact. We continue our conversation with Dr. Donald Vinh infectious disease specialist at the MUHC and the Research Institute of the MUHC, who has a number of research projects about COVID-19 on the go. So you mentioned just before the commercial break, what you're studying. What is something that is really a focus that you're finding of great interest right now?

Dr. Donald Vinh: 30:45

We're focusing on two major avenues. The one that's really fascinating is this concept of what we call auto-antibodies. Now we know about antibodies, because when you get a vaccine or when you get infected, your body makes antibodies to what's in the vaccine or what was trying to infect you. And those are essentially bullets of your immune system that that are sort of primed, so that the next time you see that bug, you are ready to kill it quickly before it causes any problems. So those are regular antibodies, but what we're studying is what we call auto-antibodies. And these are sort of rogue antibodies that instead of targeting the thing in the vaccine or targeting the germ that's trying to infect you, it targets parts of your own body. And the ones that the auto-antibodies that we're particularly focused in, are the ones that actually attack parts of your immune system, and sort of paralyze or cripple it to prevent it from being able to respond to that infectious threat. We saw that that was actually important, these auto-antibodies to what we call interferon, that was actually contributing to a large number of elderly people who are getting a severe COVID. Now we're looking at different demographics, and characterizing how often those auto-antibodies are found. And of course, we're also looking at different targets of auto-antibodies, not just interferon, but other components of the immune system that may explain the risk factor in other people. And then the other thing that we're focusing on is the genetics. Why do some people get severe COVID? Is it genetically determined? It looks like it is, at least, in the people that we study. And the corollary is, why is it that there's some people who don't seem to get COVID at all? Some of it has to do with the vaccine. But even with that, there are still people who have never ever gotten infected with COVID. And we're looking to see if there's a genetic reason for that.

Tarah Schwartz: 32:31

Yeah, I find that really interesting. Because at the beginning of the pandemic, I had a friend whose husband caught it, and her children caught it, and they're all living in the same house, and she's not isolating, and she never caught it. And she has still never caught it, despite being at work. I find it fascinating. And what is going on within her system that is allowing her to sort of avoid it?

Dr. Donald Vinh: 32:55

Absolutely. So the thing about the pandemic over the last three years is, as we've had new variants, those new variants have become more contagious. So in a way, each new variant or each new wave is like a chisel to a block of marble. And it sort of chisels away to the point where we get to a core number of people who, despite whatever number of waves- eight ways or whatever it is that we're at- despite that they have not been infected. And that allows us to really pinpoint or at least increase our chances of pinpointing it to the genetic basis for why they're resistant.

Tarah Schwartz: 33:31

Well, it really is. Is talking to those people... Is that something that you want to be doing? I think I saw on social media that you were like, if you haven't had COVID, contact me. Is that something that you want people to get in touch with you about?

Dr. Donald Vinh: 33:46

Yeah, absolutely. Because as you said, we are talking to these people, but we're also studying these people. Let's face it, in our field of genetic or rare diseases, there is something that's been called the experiment of nature. Nature's natural experiments and this is unfortunately one of those situations. If we wanted to the glass half-full in this pandemic, one of the things we're going to look at is exactly this. Yes, we're going to try to focus on the virus and making sure people don't get sick. But we're going to look on the flip-side and say, wait a minute, there's some people who aren't getting affected. What are the lessons that we can learn scientifically, to not only understand those people, but to try to take those lessons to help other people? And that's the beauty of the pandemic has given us an opportunity to take these wildly imaginative ideas and to actually pursue them scientifically. And you may say, Well, that's just so weird. It is weird, but at the same time, it is captivating. We've all seen those kinds of cases. And instead of just observing them, let's study them so that we can learn something from it.

Tarah Schwartz: 34:49

Dr. Donald Vinh is an infectious disease specialist at the MUHC and the RI-MUHC. Dr. Vinh with everything that is happening now with this new variant that is a cousin versus a sibling. that it's so contagious. I know that experts and specialists, like you have to stay focused on the science and what we can do. But I think there's a growing fear in society about where this is going to go and how it's going to end. How do you talk people off the ledge of that?

Dr. Donald Vinh: 35:18

Yeah, I mean, if I understand you correctly, you're asking like, what's the end game? I think this is a question that a lot of people have asked us. On the one hand, there are people who are particularly vigilant against COVID. But even them, despite their efforts are getting fatigued, they want to know, what's the end game. There are other people who have become disinterested, and they just don't even want to hear about it anymore. And we have to balance these acts. We've had these questions, asked ourselves- when can we take off the masks? Do we need to continue with the masks? Do we need to continue the booster doses? And that's the issue, we have to remember that nothing will remain static here. We will need to continue to improve. And how do we improve? One aspect, in terms of vaccines, is we need to continue to do research and development so that we can get we can get better vaccines. The vaccines we've had so far have been fantastic. They've done their job instead of protecting against death. But now we want to protect us longer term. So we need to develop better types of vaccines. The other thing we also have to do is invest in infrastructure. If we want to have safe indoor spaces, we have to invest in safe indoor infrastructures. And that necessarily means improving ventilation. We also have to remember that there are people who are at risk. Those are fluid demographics, they are constantly changing and as a result, we have to ask ourselves, do we accept as a society that we put a portion of the population -that's a bit unpredictable as to who they are- at risk for life-threatening disease or for complications? Again, these are these are some moral questions as well. I think we have to sit down at the table collectively, and come up with a road-map of what the what the end game is, because right now, all we're doing is reacting in an inconsistent or, inhomogeneous manner. And it's just leading to new variants, which just means that the hole is getting deeper, rather than us getting out of the hole.

Tarah Schwartz: 37:24

Always the voice of reason. Dr. Donald Vinh, I want to thank you so much for your time today and always helping us understand it put things into perspective. So thanks for your time.

Dr. Donald Vinh: 37:32

Thank you, Tarah.

Tarah Schwartz: 37:33

I'm Tarah Schwartz. Thank you for tuning in. What would you like to hear about on the show? Write to me at healthmatters at MUHCFoundation.com. You can also follow the MUHC Foundation on social media. I hope you'll join me again next Sunday. Thanks so much for listening to health matters and stay healthy.