Well Wisconsin Radio

Listen in as host Morgan Meinen welcomes back Dr. James Conway, Medical Director for UW Health Immunization Programs, to give us an update on COVID-19 including new variants, vaccines for children, boosters and more!

Show Notes

Thanks for listening! Below are some links we hope you find helpful. 

UW Health Coronavirus information: https://coronavirus.uwhealth.org/
CDC COVID Page: https://www.cdc.gov/coronavirus/2019-ncov/index.htm
Wisconsin DHS COVID information: https://www.dhs.wisconsin.gov/covid-19/index.htm

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Take Care, 


What is Well Wisconsin Radio?

A podcast discussing health and well-being topics with experts from all around the state of Wisconsin

Morgan Meinen 0:11
Hello and welcome to Well Wisconsin Radio, a podcast discussing health and well being topics with experts from all around the state of Wisconsin. My name is Morgan meinen. My guest today is Dr. James Conway. Dr. Conway is a Professor of Pediatrics at the University of Wisconsin Madison School of Medicine and Public Health, where he serves as the pediatric infectious disease Fellowship Program Director and Director of the Office of Global Health, as well as the medical director for UW Health immunization programs. He also chairs the American Board of Pediatrics, pediatric infectious disease support. Dr. Conway has spent much of his career working to improve immunization systems and access to vaccines, both in the US and abroad. He is a fellow of the American Academy of Pediatrics, where he serves as a global immunization sustainability adviser, and received an AAP Special Achievement Award in 2019 for his global immunization projects, and another in 2016 for his HPV vaccine advocacy. Throughout the pandemic, he has served on the UW system and UW Madison Emergency Operations committees, as well as the state Disaster Medical Advisory Committee on COVID-19 vaccines. He is an advisor to multiple pharmaceutical and public policy organizations, and engaged in clinical trials for a variety of COVID 19 vaccines. Dr. Conway, welcome back to well, Wisconsin Radio. I'm so grateful to have your time today.

Dr. James Conway 1:43
It's great to be back with you, Morgan. Thank you very much.

Morgan Meinen 1:47
So today, we're here to give Wisconsinites an update on where things are at in the COVID 19 pandemic. So the first question I have for you is, you know, summers in full swing, and like many people, I've noticed a lot more invitations coming my way in the form of social gatherings and weddings. And I wondered what advice you have for people as they make decisions on whether or not to attend?

Dr. James Conway 2:08
Yeah, that's a great question. I mean, I think last summer, we did have this brief reprieve. And I think people do have this mindset that, you know, even if this pandemic is still unfolding, and things are still continuing that summer is this sort of window of time where they can get back to normal. And unfortunately, this summer is a little different from last summer, and that we've had this constant evolution and ongoing mutations of the Omicron strain, where we've now seen the reemergence and the emergence of some new strains that actually are starting to cause more trouble, they're a little bit more transmissible, and they certainly are breaking through the immunity of people that haven't had boosters. So I do think that people need to be a little bit more cautious this summer than we were last summer. I think the way to think about this is to be practical about it. I mean, I think we still need to do what we need to do to get back to being somewhat social creatures. I think everybody's mental health took a big hit. And so I do think it's important for people to have some opportunities to socialize. So the way I think to think about it is two things. What's the setting, you know, so I think outdoors, obviously, is much more conducive to being able to be real social, if you're indoors, especially in close contact with others in concerts or sporting sporting events with strangers especially, I think that masks indoors are still something that are very prudent, I think for social engagements where it's with people that our loved ones and friends and family. And I think it's a little bit more comfortable to be able to actually find out people's approaches themselves, including their immunization status. And I think people have started to get used to the fact that people can make inquiries and say, you know, is everybody going to agree to get an antigen test before we all go to this event? I think if people agree to do that, and are responsible and pull themselves out of the event, if they do test positive, I think that can give you a lot more reassurance. I think if it's known that people in that grouping are universally vaccinated, and ideally have been boosted, including invitations actually including, please be sure you're up to date with boosters, I think that people can have a little bit more confidence that these are safe events. I think the other big thing is that people really do the just need to remain responsible, even if they're antigen negative, about just recognizing symptoms of illness themselves. You know, I think we've started to see that a lot of these viral pathogens aren't going to respect the old seasonality that they used to do. Because we were all shut down for so long that as people are coming back into social engagements, things are circulating that didn't used to circulate it in various times of the year. So I think that we all need to kind of come to some agreement that if you've got respiratory symptoms, runny nose, cough, sore throat, that you really owe it to everybody else to just be responsible and stay home. You know, certainly if you test positive after an event, I think the other pieces then letting people know that they've potentially been exposed so that they can take appropriate precautions. You know, I think we can manage this as a community together. But I think we need to do it in a way that is both responsible and hopefully engaging in a way that's not threatening It just recognizes that we're all in this together, and we need to all pull in the same direction. So that's kind of how I've been thinking about this, and counseling friends, family and organizations that I work with, and how to do these things in a way that really makes sense and still allows people to feel like they're getting reengaged with their friends and family.

Morgan Meinen 5:17
Yeah, a lot of great things that you said there. And one of the things I kind of wanted to pull out was, you're talking about different strains. Throughout the pandemic, there's been, you know, many sub variants that we've heard about, it's been tough to keep track, I wondered what you could tell us about some of the new variants that we're seeing now.

Dr. James Conway 5:33
Yeah, it's been really interesting, because I think early on, there was such limited ability to do strain testing that it was happening only periodically, and only in certain areas of the world. And so these new variants would just sort of seem to suddenly emerge. And we started working our way, rather quickly through the Greek alphabet, to the point where we actually were starting to discuss Well, what are we going to do, when we get to the end of the alphabet? I think now that there's pretty abundant testing for sub variants, we now get into this situation where everything seems to be derived from Omicron. And so we're now working our way into primarily be a foreign VA five here in the United States, you know, almost 70% of the cases now, are those variants here in the US. And I think What's tricky about them is that, you know, the vaccines against the original strains, the alpha strains, you know, just don't seem to give quite as robust and immunity to these viruses that have mutated. And so that's the reason that we've really had to get into boosting people's immunity back up to a point where it did still offer some neutralization against these new strains. The newer strains, you know, I think, in general do seem to be more transmissible, they seem to replicate more quickly. So the symptoms come on more quickly, people are contagious earlier than they were previously. And so I think everything is seemingly compressed. And that's actually part of the reason that, you know, the newer guidelines allow people to test positive, to basically isolate for just five days. And then if they still have any symptoms, you know, to extend that isolation out to the 10 days that it used to be, but also to continue to be cautious for those latter five days. But those early five days are really the critical ones. With these new sub variants, we're really watching closely, and we're starting to see some other kind of newer variants, there's a ba 2.75, it's emerging in China or in India right now. And it started to spread and pop up, there's a ba 2.1 2.1. And so we're getting into all this kind of additional numbers. And I honestly think that at some point, we're gonna get to the point where these are different enough from the original Omicron that we're gonna have to move on to the next Greek Greek letter and call it pi. The other thing I think that is interesting to think about is that I honestly think that is both the population immunity has changed, as well as the viruses have changed. It's almost in some ways a misnomer to continue to call it COVID-19. And in many ways, these newer variants actually are different enough, that it's almost like we should call this COVID 21 or something because much shorter illness, much more transmissible, people need to understand though, that that does not mean that these are less virulent or cause less serious disease. I think that was out there for a little while in the media, giving people this idea that things were lessening as far as the severity, and certainly Omicron in January, February was really quite severe for a couple of different populations. So we continue to track these things, I think this is going to be an ongoing process. And so I think that's where the discussion is going to then lead to how do we make sure that the vaccines are appropriate for the strains that are continuing to circulate?

Morgan Meinen 8:36
Yeah, that makes sense, you know, and to your point, like, now we're starting to see more and more people that are experiencing, you know, their second or even their third time of having COVID. Sometimes, regardless of if they've been vaccinated or not, I wondered, you know, what you could tell us about reinfections, or, you know, getting COVID, after you've been vaccinated, does that kind of speak to what we just talked about with the sub variants?

Dr. James Conway 8:56
Yeah, I think that's part of it, Morgan, and I think you're, you're on the nose about how we need to start thinking about this. You know, I think there's a couple of things that are are interesting observations that people should recognize, you know, one is the coronaviruses have been around forever, and, you know, have continually been part of the buffet of viruses that actually cause respiratory illness. And in humans, you know, 15, or 20% of colds throughout the year are actually a variety of Corona viruses. And what we know from those previous ones that have been circulating is that the immunity that people develop against them isn't very long lasting and doesn't really hold up. And so it's pretty easy for people to get reinfected with those strains. And so I think we predicted pretty early that with wild type infections that people might undergo with these types of newer more virulent Coronavirus variants, that the same thing was going to be true and that the immunity wasn't going to last very long after the infections. And so you're absolutely right. We are now seeing people especially those that haven't been boosted, having, you know, I know people that have had their Third, and even fourth, infections. And I think that's a sign that the natural immunity just isn't particularly good with these viruses. And as they keep mutating the leftover immunity you have from a previous infection probably doesn't hold up very well. I think, you know, we're also realizing that the vaccine immunity, while it's certainly superior to the immunity you get after a wild type infection. Now, those original vaccine strains aren't quite as good as they were for those original alpha and even the beta and delta variants. And so now that we're sort of farther down the Greek alphabet, the immunity from those original vaccines just doesn't hold up nearly as long as it wants to.

Morgan Meinen 10:41
Sure. Another thing I've been hearing a lot about is, you know, long COVID, it seems like every day, there's kind of a new article coming out with people experiencing all of these different symptoms. I wondered if you could talk a little bit about that, if you have any experience with it, or what you could help us understand about long COVID?

Dr. James Conway 10:57
Yeah, long COVID, I think has been really a lot of lessons. But really, more importantly, a lot to be learned still. And I think it's been clear that unlike a lot of other coronaviruses, that the SARS cov two virus really does spread throughout the body in most people that actually have the infection. And well, you know, young healthy people do seem to clear the infection pretty readily, and older people and people with immune compromising conditions, you know, struggle a little bit to shake it off, that the only illness is really not just that respiratory illness that it starts with. And so the these viral strains, and then the immune response to these viral strains really happens in many organs of the body. And so I think what we're still learning is trying to sort out how much of that damage that happens in those organs, is directly related to the virus itself, and how much of it is related to the immune response to the virus. But what we do know is that there are lots of different variations of what people report and what they complain about after they've recovered. You know, some people have more neurologic symptoms with this brain fog and this inability to concentrate. I think that's fairly common in the short run, even for most people that have a SARS cov, two infection, but there are an unfortunate subset where it really does persist, and seems to almost become a persistent and lifelong problem for them, as they can tell right now, and even for a couple of years, but we've certainly seen effects in heart, liver, kidneys, you know, many other organs, Gi, you know, people that have chronic abdominal complaints, chronic diarrhea and things like that. So I think the bottom line is that, you know, it's very individualized, different people do seem to have different versions of long COVID. And I think the hard part has been that there's no unifying version, and therefore there hasn't been really any success at coming up with a unifying response that can make people uniformly better. I think that what ends up happening is people really need to find the specialists that can deal with their particular version of long COVID, whether it's a neurologist or a gastroenterologist, or a cardiologist, or a nephrologist, that can help them really sort of understand what the impact has been and what they need to do to hopefully be able to turn the corner eventually. And so I think what we've really tried to recognize and help people understand is that even if they consider themselves in a relatively low risk group, for having severe primary infection with COVID, with the respiratory version, that it's really unpredictable what the long term effects can be. And so plenty of these younger healthy people that decided to forego vaccines, because the risk of them ending up in an ICU or on a ventilator was low, unfortunately, are having long term problems related to these. And so the lesson I think we've learned is that these unpredictable viruses need to be respected. And we really do need to do everything we can to try to prevent infections, or prevent reinfections. Because we're now even seeing people with long COVID, who were previously infected, and actually did okay with an initial version, and then with a subsequent infection actually then end up with longer term problems. So this is just unpredictable. And we continue to learn every day about these things. Yeah, that

Morgan Meinen 14:07
makes sense. And that's exactly where I wanted to go next year with vaccines. Recently, there was some big news for parents panel of advisors for the Center of Disease Control and Prevention voted to recommend vaccinating all children six months to five years. So I just wondered what you could tell us about this decision and when parents can expect these to be available?

Dr. James Conway 14:25
Yeah, I think it was an interesting process that, you know, for a number of people were kind of frustrated by because it seemed in many parents minds to take forever to the point where kids were able to be vaccinated. But, you know, I think there were a couple things at play here. You know, one is that as a new pathogen with a new vaccine, and with the primary population being affected most by the initial versions of this being the elderly and those with immune compromised skin conditions and sort of older individuals, that really the attention was focused on trying to get that group protected. I think people also realize that even though we weren't going to cut corners on what the safety and efficacy outcomes, were going to need to be to approve these vaccines, that we had never used the emergency use authorization process. For vaccines. Previously, we used it for drug approvals. Most notably, the early AIDS pandemic, when the usual eight to 10 years to develop new drugs was just not tolerable for people and act up and other public voices really insisted that we come up with a way to get these to be available for patients. And this was the first time that had been done with vaccines. And so I think people recognize that, you know, while we weren't cutting corners on the process, I think people were much more comfortable that that was appropriate initially, for adults, especially because adults were dying and suffering such severe consequences. But the other part of it was really, you know, that we still needed to understand the immunology of the disease, as well as the vaccines. And so we needed to really understand the side effects. And, you know, as we recognized as we moved into young adults and adolescents, we realized that the the immune response in those younger individuals was really much, much more robust, much more brisk. And so it gave us the opportunity to actually shave down the amount of antigen and the amount of stimulation that the immune system needed to actually develop the protection that the kids would need. So, you know, we went from 100 micrograms of the Maderna vaccine, you know, realizing you only needed 50 micrograms for the boosters for that vaccine. But then recognizing that, you know, in the younger kids, a 25 microgram dose was actually plenty to get a similar immune response, somewhere with the Pfizer mRNA vaccine, you know, 30 micrograms for the adults and for the boosters and the older and full size people, that we could get away with just 10 micrograms in, you know, the younger kids, six to 11. And then in the very young kids, you know, take it down even three micrograms. Now, with that, you know, again, trying to avoid some of those side effects that the young adults were having, we discovered that that was actually maybe a little bit too much of an adjustment, and then realize that that immunity wasn't good enough, especially against some of these new variants. And so those studies needed to be extended to the point where we now realize that they needed three doses. So we know, we know that parents were frustrated by the sort of long delay, but we really needed to do this in a safe way that made sure that we were, you know, giving kids the protection they needed, but also doing it in a way that really protected them against side effects that were unnecessary. So this all finally has kind of come to fruition, throughout the spring and early summer. And as you mentioned, you know, Virbac gave their thumbs up. And then the FDA approved these with that immune emergency use authorization, approval, you know, although recognizing that, you know, we've got hundreds of millions of people that have gotten variations of these vaccines, both in the United States and around the world. So I think people were very comfortable that, you know, that is kind of a formality for kids. And then, you know, moved into the ACP, and the CDC, ultimately, then deciding who should get those vaccines. And so, very quickly, they, you know, approved those vaccines to be routinely recommended now, for all kids down to six months of age. And we also, you know, learn throughout this pandemic, that, at least in some of the studies that have come out that, you know, there's a fair number of kids that did contract COVID, throughout this pandemic. And we have, you know, some evidence, at least in some studies that as many as three out of four kids in certain school systems that didn't ask and didn't restrict people very much, you know, three out of four kids may have actually gotten the infection. But I don't think that people understand that that immunity, then isn't enough to continue to protect them against, especially these new variants. And so the timing is actually quite good for kids, as we think about getting into summer, and then back to school, that, you know, most of the kids as they're getting doses of the vaccine may actually be getting more of a boost to their immune system, rather than just their primary immunity. So the timing is quite good to get moving on this rather quickly for people to try to get, you know, as many doses into the kids as possible in time to be able to go back to school when obviously, we put kids into close proximity, you know, especially in closed rooms and, and in much more confined setting so that there's a lot more transmission opportunity. But you know, even with that said, we're already seeing outbreaks and camps and, and other places, even that are outdoors during the summer. So I think it's a lesson that that natural infection that many kids had during the past couple of years of school exposures are holding up. And so these vaccines are really routinely recommended now, basically, for everybody, six months and above at this point, and I do recommend people do it because I think if our major goal is to both get kids back into school and keep them in school, you know, one of the ways that that's going to go well, is if we actually have the majority of those kids vaccinated, because I think what nobody wants is to Get schools wide open again and then have outbreaks that lead to school closures again. And getting back to where we started with all this, I think kids really did. You know, while we wanted to protect them early on with the closures of schools, I think we all know that they and their families really suffered quite a bit from that lack of socialization, as well as just lack of regular learning, and then really impacted families, especially working mothers, who really, you know, did the heavy lifting on this, and really took the biggest hit in helping manage these kids when they were out of school. So I think, again, people need to think about the benefits individually for their own kid. But also the greater benefits of having a very immune population of kids that everybody then hopefully, can minimize the number of, of outbreaks and minimize transmission in those schools, and keep the schools open.

Morgan Meinen 20:46
Yeah, that makes sense. You know, as a parent myself, it was great to listen to talk about, you know, the process, the behind the scenes around, you know, all that's gone into the decision making, and the studies and the testing into, you know, really trying to figure out, you know, the plan for vaccines for younger children. So I really appreciate your perspective on that, and sharing, you know, all of your knowledge with us on that topic

Dr. James Conway 21:09
was more than just a, you know, a reflect on that quickly. You know, I think people really should be reassured by the process. You know, if you think about it, I mean, Pfizer started to release their data back in February and sort of make signals that they were thinking about submitting it. And when that data became public, and, you know, me and my peers started to look at it, you know, we really were very clear with people and saying, look, look, this is not sufficient immunity, you know, this isn't really done yet. And so I was very pleased that both the regulatory agencies and the pharmaceutical companies working in conjunction with those of us in academic research, all very quickly agreed that, you know, this needed more time and, and needed more study. And so I think people should be very reassured that there's a lot of checks and balances in the system, to make sure that things only come out and become widely available when everybody's in real agreement that it's the right time for it.

Morgan Meinen 21:58
Yeah, no, that's great to hear. I've also heard of a couple of new vaccines, the by Vaillant and now Novavax, and I wonder to what you could tell us about those.

Dr. James Conway 22:07
Yeah, there's all sorts of exciting things happening behind the scenes with, you know, updates to these vaccines that are gonna really, I think, take us into a very different place, as we move into this next phase of the pandemic. You know, there's a lot of companies that are working on Omicron specific vaccines that basically include the altered antigens that kind of build on the original vaccines, but really kind of focus that immunity in a much more organized way against the current viruses that are circulating. And so Maderna is working on one that's a bio valence vaccine that includes essentially 50% Omicron, immunity plus 50% of the original strain to kind of keep boosting that original immunity, but also shifting that immunity a little bit more directed towards these newer strains that are circulating. Pfizer, bio Entech, has something very similar. You know, some names from the pharmaceutical industry that we haven't heard much from Sanofi and GSK actually got together, and they're working on a combined vaccine. That is, you know, just going to be a booster against Omicron. And then there's a lot of really kind of very new stuff happening. That's, I think, really exciting, where there's a bunch of companies that are working on what we would consider a universal vaccine. In other words, they're looking at parts of the virus that don't seem to mutate quite as much as the spike glycoprotein. And trying to work towards having a vaccine that basically provides immunity that holds up even as the viruses keep changing. You know, this has been kind of the holy grail idea for flu vaccines for many, many years. You know, we have to get the flu vaccine every year, because the the viral strains keep changing, and we have to update the vaccine, and change, you know, both the A types that are in there, and the B types that are in there. People have dreamed for years about having a universal vaccine that developed immunity against parts of the virus that don't seem to change as much. The problem has been that those parts of the virus just don't stimulate the immune system very well on their own with a wild type infection. But there's been gradual progress, including some happening here at the University of Wisconsin, that has raised a lot more hope that a universal flu vaccine could be possible. And there's work coming out of some of the California universities as well as some of the BioPharm pharmaceutical companies that really looks promising for developing more universal Coronavirus vaccines that would work not only against SARS, cov. Two, but maybe against some of these seasonal coronaviruses. And maybe even some of those other ones. I think people remember SARS cov one and MERS cov. And so maybe a universal vaccine would be a possibility. But I think in the short term, what we're really looking at is going to be updated vaccines that include antigens that stimulate immunity that's more directed towards these more recent Omicron strains. And I think most of the signs are pointing towards those moving into, you know, sort of final clinical trials. analysis of the data moving ahead pretty quickly. And I think there's potentially going to be the some availability, potentially, as early as October, you know, I would expect that there will be supply limitations initially. So that will probably end up directing those, again, towards the same group that we're recommending second boosters right now, those high risk individuals, probably over 65, or maybe over age 50, along with immune compromised folks, and then eventually, hopefully, having enough supply available that, you know, then we could get into offering those more widely for the general public. So we're gonna time will tell and things are moving quickly. But, you know, I think most of us are pretty optimistic that not only is that the reason, that's the direction we need to move into. But I think that there's lots of reasons to be hopeful that that's the direction we're moving, and that those will be available, hopefully, sometime this fall.

Morgan Meinen 25:51
Yeah, exciting things on the horizon. And, you know, you've mentioned boosters a couple of times, you know, just during our conversation here today, and that was something I wanted to, you know, kind of touch on here is, you know, what are your recommendations in terms of boosters, I hear kind of people going back and forth, you know, what if I recently had COVID? You know, am I then am I just, you know, kind of naturally boosted? What are your your considerations when thinking about boosters, and what people should be doing and following in terms of guidelines?

Dr. James Conway 26:18
Yeah, first of all, I gotta reflect that, I totally understand why people are confused. Because, you know, the messaging has been, you know, coming out in both drips and drabs as well, as you know, in huge volumes. It's almost like drinking from a firehose trying to keep up with it. Sometimes, and I kind of understand and, and part of this, I can only imagine, for the general public how challenging it can be, to sort this out and really to try to understand like, which parts pertain to me, versus which parts are, you know, pertaining to other populations. So to really tried to keep it as simple as possible, you know, I think basically, everybody ages, you know, above age five, who has gotten a primary series, whether that's a single dose of Johnson and Johnson, or whether that's two doses of Maderna, or Pfizer needs to have gotten at least one booster, the viruses really have changed enough, as we got into delta and then into the Omicron strains, that though those original vaccines that we got, no matter when you got them just aren't enough. And this is true for most other vaccine preventable diseases, you know, most vaccines, we give some primary vaccines you get as a little kid, and then periodically throughout your life, whether it's flu or shingles, or tetanus or pertussis. You know, people would need boosters periodically, just to keep their immunity up. So, simple answer is everybody needs at least a single booster at this point. And then for those people that are, you know, still at higher risk, that being everybody over age 50, and people with immune compromising conditions, which are really broadly defined, I mean, it's, you know, it's somewhere between eight and 11 million people in the United States alone make that category, plus everybody over age 50, should have gotten a second booster. And a lot of people, I think, when we sort of thought we saw a little bit of a lull coming in the spring, you know, kind of made a conscious decision, if they even if they were eligible for that second booster, saying, you know, maybe I'll wait a little bit until I get towards the end of the summer or the fall when things are going to pick up again. And unfortunately, those are a lot of the folks that you and I both heard about, who even though they're vaccinated and boosted, has still been getting sick with these new aroma, Crown strain. So people really should, I think, be wise about this and get, you know, as many boosters as they're eligible for and so again, everybody over age 50, or with an immune compromising condition, should be on their second booster. But you know, and if people have questions, obviously, you know, reach out and whether through a my charter, or other resource or just calling and asking their primary providers if they fit into one of those categories. But I think the default is, you know, there's a lot of people, you know, we calculated somewhere between only 30, or 40% of the people that are eligible for that second booster have gotten it. And it really is important. You know, I think the proof in the pudding is that if you look at that January, February Omicron surge, you know, I think there was a narrative that the primary people that were suffering through that were going to be immunized. But it turned out that a lot of those were, again, these high risk populations that had never gotten even that first booster that sort of were depending on their primary vaccines, plus the fact that they had maybe gotten infected at some point along the way. And so there were a lot of people in that surge that got infected, hospitalized, and unfortunately, quite a few died. So I think boosters really are probably going to be one of the critical things in addition to what we talked about in the beginning, which is every buddy trying to be responsible and practical about testing themselves recognizing when they're getting sick and being a little bit extra cautious if they're going to be in group gatherings.

Morgan Meinen 29:46
Yeah, that makes sense. You know, and lastly, here, I just wanted to shift to talk about treatment is could you give us an update on on kind of where treatments are at what treatments are available, and if there's any new ones that we should be aware of?

Dr. James Conway 29:58
Yeah, good question. You know, I think it'd be Beginning, you know, the best we had was convalescent plasma from people that have recovered, and then some of these monoclonal antibody, you know, attempts at trying to boost people's immunity. But I think that now we've had vaccines available, and people have had an opportunity to get those long enough that, you know, most people at least have a little bit of that monoclonal antibody themselves, either from vaccines or being infected, or both. And so we've really shifted, you know, primarily into antiviral therapies, you know, there were a couple of different ones that were available for a little while. But it turned out that some of them just didn't work as well for some of these newer variants. And so really, the primary antiviral that's available currently goes by the name of packs low COVID, which actually is a very interesting drug, because it's a combination of actually two antivirals, one of which is actually there to basically help keep the levels up high enough for the one that actually really works well against these viruses. You know, the, the administration at the federal level, has really been working very, very hard to try to make those more and more available. And I think just recently, in the last couple of days, they've actually approved that pharmacists can now provide these without even having a physician prescription for people to test positive. You know, we certainly recommend these for people that are behind on vaccines, because those people are clearly at higher risk for having more severe outcomes. But in addition, I think people that still have underlying comorbidities, pre existing medical conditions, even if they're fully vaccinated and fully boosted, you know, it's really rolling the dice if you get infected, and don't at least reach out to your provider and talk to them about whether adding on an antiviral, like Paxil COVID, might be helpful for you, and, again, further diminishing your risk of something bad happening, you know, I think that this is still an unpredictable enough virus and an unpredictable enough pandemic, that I think we do need to work harder and having these antiviral agents much more readily available, and much more easily available for people as quickly as they get tested. You know, because really, ideally, you get started on those drugs, you know, within the first five days of getting diagnosed, and hopefully as early as possible within that. So that's, I think, really where we're going to be hanging your hat in the near future. There are a number of other antivirals that people are working on both here in the United States and abroad. It's a little bit of kind of a leapfrog game, because I think they're frantically trying to develop them. But in the meantime, the virus keeps changing. And so it's been a little bit of a challenge. So, you know, unfortunately, right now, Pax Lovitt, is probably the best we're going to have. For the time being, you know, we're hopeful that things will get better with other treatments eventually. But, you know, I go back to the same story over and over again, the best defense we have against this is just not getting that infection by doing everything we can to prevent it.

Morgan Meinen 32:51
Sure. And we kind of walked through all those steps today, right, from, you know, deciding whether to go to social events to you know, staying up with your vaccines and your boosters, understanding prevention, and really just understanding how this pandemic has changed over time. So as we wrap up, as we wrap up today, Dr. Conway just wondered if there was any other updates or information that you wanted people to know, as you know, you said we battled this together?

Dr. James Conway 33:16
Yeah, I think a couple of things. As you know, we've gone through this. And I've been through pandemics before unfortunately, between starting my career around the HIV pandemic, and then the h1 and one pandemic in 2009. And obviously, previous SARS infection that started to look like pandemics and died out. So, you know, I think about these things a lot. And I think, you know, one of the things that's really important, is that, I think people need to think about this beyond just themselves and their own families and really think about things as far as the impact of their community. And I think that we've seen more and more people, instead of just kind of keeping their thoughts about protection and immunity to themselves. I think it is important for people to talk about these things, you know, as I started out, saying that, especially if you're with a group of trusted friends and family, I think being open about how people feel about these things. And what they've been doing personally, is really important, because I think that one of the things that people can get misled by is thinking that the decisions they're making, you know, are actually both acceptable and also appropriate. And I think that we need to normalize the fact that we all really believe that we need to be protected in whatever ways those are. And so I think the more we can sort of be public about that and talk about what we're all doing individually to stay safe. You know, how often we were testing ourselves, you know, what things were deciding to do and not to do what we're doing about boosters, I think the more people that talk out loud about that and share their thoughts and their own practices. I think it makes it more comfortable for people to both raise questions, but also to feel, you know, that this is really what we all need to be doing. And then the other thing is that I think, you know, what we've really understood is that there's a lot of information out there and unfortunately, you know, especially on the internet, there's no referee that takes down inappropriate or inaccurate information once it's up there. And so I think that people need to be very careful about both the sources of information as far as where they're finding it. But also, you know, when it was put there, you know, I think we've all acknowledged that the messaging even from the authorities on this stuff, has been a little wonky as things have gone along. Because, you know, as we learn more, we've changed what we've recommended. But I think that it needed to be clear to people that, you know, for instance, masking is a classic example, in the beginning, because most of these types of respiratory viruses, masks don't make a whole lot of difference. The recommendation was, let's save the masks for the health care providers and not use them up. But I think people needed to acknowledge that we learned more, and I think, you know, Fauci and others needed to say, Look, I know I said X before, but now we no different. And now why is the truth. And so I think people need to understand that this is still evolving, and that we need to be careful about both the source of the information but also when that information was generated, because things keep changing, the CDC has done a very nice job of trying to make sure that their websites are not only updated, but there's a date on the bottom that says when it most recently was updated. And similarly, you know, the state health departments and the county health department's that's become a very normal thing. I think the other thing is that hopefully, this version of vaccine development is going to be the new normal, that from the very beginning, you know, I think people recognize that the old way of doing things of eight to 10 years, which a lot of it was just bureaucratic log jams, and you know, really unnecessary logistics stuff was just unnecessary, and that we really should be able to do these things in a more timely fashion. And so I think this is going to be the new normal, as far as how we develop vaccines, review them and approve them. So, you know, for people that continue to think that this has all been done too quickly. You know, I would argue that this has actually been done too slowly in the past, and that this really needs to be how we do things. As business as usual, going forward. You know, I'm very optimistic, I always am that we've learned a lot. And I think we've changed a lot of how we do things, certainly the ability to work and play, and communicate virtually is going to be really helpful going forward. But I think also, we all want to get back to something resembling normal. And I think we're starting to see the path to doing that. But a lot of it is going to include people continuing to be responsible and continuing to be thoughtful about how they circulate and interact with others. So I appreciate the time. You know, it's always fun to talk to you about these kinds of things. You always ask the right questions. And you know, I encourage people to continue to ask those questions. And when in doubt, you know, ask your own medical providers, I think those are the people that know you and your family best, they can really answer your specific questions.

Morgan Meinen 37:35
Yeah, really great advice. Well, thank you again, Dr. Conway, for joining me for the second episode that we have done. We really appreciate your partnership, we appreciate your time. Clearly, you've been so involved in instrumental and helping the state of Wisconsin and really the United States at large and even globally, through this pandemic. So I just want to take a minute to celebrate you and the impact that you've had and the fact that you're take your time here to be with us today and to share this information. So thanks again.

Dr. James Conway 38:00
Thanks so much, Morgan. We're all in this together.

Morgan Meinen 38:06
Thanks so much for listening today. We hope this information was helpful. For those of you listening in as part of the well Wisconsin program. The code for this episode is COVID. For a transcript, to take our survey, or to find previous episodes, you can visit WebMD health services.com/well Wisconsin radio. You can also subscribe on the podcast platform of your choice so you never miss an episode. Until next time, take care

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