Coronavirus (COVID-19): Press Conference with Barry Bloom, 04/16/21


You’re listening to a press conference from the Harvard School of Public Health with Barry Bloom, the Joan L. and Julius Jacobson research professor of public health and former dean of the school. This call was recorded at 12:00 p.m. Eastern Time on Friday, April 16th.

Transcript

MODERATOR: Dr. Bloom, do you have any opening remarks for us?

BARRY BLOOM: No, it’s been a busy week for people concerned about vaccines. So happy to answer any questions.

MODERATOR: Yes, it has been. Thank you very much, Dr. Bloom. All right. Does anybody have any questions? I’m assuming you have a question, somebody. Otherwise, it’s going to be a very short call. All right, first question.

Q: I got you. OK, so I saw this morning that the IHME is predicting a fall surge. Do you agree with that prediction?

BARRY BLOOM: You know, it is the most common question one gets, and there’s absolutely no scientific way that you can predict what’s going to happen in the fall with any degree of certainty, it is likely that things will diminish over the summer because that’s the seasonality of respiratory viruses. And it appears that that will be true to some extent for this. That will be countered by everybody opening up after April and assuming everybody gets vaccinated, but everybody is unlikely to get vaccinated. So we have a continuing, susceptible, transmitting population. And then we have a current variant taking over much of the country, including places like Michigan and new variants spreading around the world. So it really is not possible with any degree of credibility to predict what’s going to happen in the fall. If you look at the history of influenza and all other respiratory diseases, you will probably guess that it will go up. But how much, how seriously? Whether it will be the current or a new variant, whether vaccines will work against it well or not, and whether people will take the vaccine by then. One simply can’t say.

Q: This may be another vague and kind of bewildering question then, but what range of effects could we possibly see from the hesitancy created by the pause of the J&J vaccine?

BARRY BLOOM: It is puzzling to me that put it the other way in previous versions of this, when hesitancy was really high. I think most of us in the science business would say, you know, it’s reasonable for people to ask for data on safety and effectiveness before volunteering for a new vaccine, particularly one produced under the framework of something called Operation Warp Speed, which just led lots of people to be worried about how much scientists knew about what they were doing. The prediction would be as more people got vaccinated, as fewer adverse effects would be seen. That number of hesitancies would go down and the answer is it has gone down quite dramatically. There are pockets that are really hard to get to in minority communities, political parties, religious evangelical groups, and what that means is we have to simply work harder to get information out to those people in a way that is credible, which is less likely from professors at Harvard than it is from respected members of their communities, religious leaders, and people they trust. Most disappointing is that the people elected to lead this country are so skeptical of science and vaccines because these are people who should know better and should be leading the charge, not contributing to the hesitancy.

Q: Thank you.

MODERATOR: Does anybody else have any questions? Otherwise, I can start asking Dr. Bloom questions, too. There we go.

Q: Hello, thank you very much for your time today. I appreciate it. Can you tell us in this moment and forgive me if this is a repetitive question, but what is the data telling us right now about cases and what should we be worried about in the coming week or two weeks?

BARRY BLOOM: Sorry, repeat the question, please.

Q: Of course. I’m sorry. Are you able to hear me?

BARRY BLOOM: Yeah.

Q: OK, great. Sorry. You know, limited at home capacities. If you could please tell me what the data is telling us right now about cases and who is becoming sick. And then also if you could use your crystal ball a bit and tell us what we should be worried about in the coming week to two weeks to month.

BARRY BLOOM: So the cases have been over all in the country plateauing when they should be going down as vaccines are being rolled out. That’s been a puzzle. There are places that where they’re really going up at a at a worrisome level. And that would be in the upper Midwest, like Michigan, where the hospitals are somewhere between 80 and 100 percent at capacity, treating patients with COVID, which is quite a serious situation. And the causes of that are, at least not to me, absolutely clear. Michigan opened up probably sooner than Tony Fauci would have liked, or Rochelle Walensky would have liked, but so did Texas and Florida. And Texas is doing much better than one might have expected in that circumstance, one doesn’t know what the distribution and this is a fundamentally important issue. I can’t tell you because I went to the CDC website and asked the question, what’s the percentage of the English derived B.1.1.7 variant that we know spreads about 50 percent faster than the original strain? What do we know? What’s the percentage of that in Michigan versus Texas or Florida or New Mexico? And the answer is the numbers were not on a database that I could find at CDC. So a fundamental issue that is really frustrating is when you ask for numbers, we do not have a data collection system across 50 states, territories and Native American tribes that is rapid, real time goes to a single place, is vetted and is available to anybody who wants to know. So I would guess there would be more of the more rapidly spreading strain in Michigan than the states that are not spreading so rapidly. I would predict that the states that have a higher percentage of vaccinations, places like New Mexico and some other states that are doing very well, I would expect that they would have controlled that virus or limited the number of viruses that can allow the new variants to grow. Do not have data on that.

Q: Thank you very much. I appreciate it.

MODERATOR: Next question.

Q: Hi. Thank you so much for your time. So I wanted to know what you were talking before about vaccinating, hard to reach population. And I was wondering, how about how much of a blow is the fact that the Johnson and Johnson vaccine has been put forth and that even if this is the vaccine, it might be hard to explain why maybe this type of vaccine is being sent to these areas. Even if it’s completely safe at the end or I mean, what even what the CDC says, how much of an obstacle will this mean for the vaccination process, especially reaching this population that might be hard with a two-shot vaccine might be hard to reach.

BARRY BLOOM: That’s a really important question. And a somewhat discursive and perhaps more complicated than you want to answer. The real appeal of the Johnson and Johnson vaccine is that it is easy to deliver, it doesn’t require freezer temperatures. It’s quite stable for a period of time at room temperature. And it’s easy to get out there. And it’s a one-shot vaccine, which means let’s start with the homeless in Los Angeles, for example, the probability of finding people a month later, if you found them the first time to get a vaccine is really problematic. And a one-shot vaccine has tremendous appeal, particularly one that doesn’t require fancy freezing stuff. So that’s the real appeal of the Johnson and Johnson vaccine assessment process. And that’s only been available in small amounts, about five percent of all the vaccines given. But the anticipation was that it would be scaled up and become available more widely than the other vaccines and used in places that didn’t require deep, freezing and very limited time the vaccine vials could be out. On this one bit of good news, and that is that we know that the Moderna vaccine can be stored at freezer temperatures like your freezer and my freezer in a household or your doctor’s freezer in his office, whereas the Pfizer vaccine had originally been proposed, that requires really minus 80 degrees centigrade, which is really cold and only available in really hospitals and special places. They’ve now changed the regulation on that, and they’ve shown that it’s quite stable at the same temperature as the Moderna vaccine, which is ordinary freezers. So while J&J is held up for a bit and we could come back to the question of what’s likely to happen there and why it’s being held up, I’m more optimistic that the Pfizer vaccines, such as the commitments we already have, will be much easier to deliver than they were in the beginning because they will be as easy to deliver, stored in local freezers and available in pharmacies and doctors’ offices, not just hospitals and big medical centers that have the deep freeze.

Q: Thank you so much. And following up what you were saying, what do you think is going to happen with the Johnson and Johnson vaccine? I mean, what do you expect would happen?

BARRY BLOOM: What I think will happen is, you know, there are two concerns that I think the medical and scientific community have, and there’s probably no right answer or we won’t know for a long time. What do you do when you’re putting out millions of doses of vaccines and there are reports of an adverse effect and we know some numbers on the adverse effect and they’re somewhat surprising? I think people have real trouble coping with numbers and risks. But, for example, if you look at this peculiar syndrome, so put it this way, there are three hundred to six hundred thousand cases of clotting every year in the normal population with no COVID around. So we’re now looking at six cases in America out of six point eight million people who receive vaccines, six cases in a background of three hundred to six hundred thousand. And how do you know whether those six cases are related to the vaccine or are just available in a statistical analysis of people who get clots all the time? So that’s the dilemma that the Advisory Committee on Immunization Practices that met Wednesday has to worry about. And you’re faced with two things. What we know for sure is whatever the numbers we have on clotting, they are trivial compared to the number of people who are dying, which is one hundred and twenty-five per million a week. And we’re talking about cumulative. A tiny amount, six cases in the United States, so that doing nothing and not continuing vaccination puts a lot more people at risk from COVID for clotting problems as well as other problems, then the risk of getting a low incidence of clotting. What made the CDC, I believe, slow down is this is an unusual kind of clotting. It’s not the usual kind that starts in the legs. And whatever this one hits a part of the brain that is a very specialized kind of clotting that is hard to calculate in the normal population. So to make a long story short, what they’ve decided is you have two choices. You continue with the vaccine as England is doing. You take your hits and say there will be continuing people who get clots. We won’t know why they get clots, but it’ll be a lot less problematic than getting sick with COVID. In the United States, if we did that, it is absolutely clear the anti-vaccine movement would say the government is holding up data, it’s being secretive, it’s not being transparent. And I take the view, which I think was shared by the committee, is it is really important in a skeptical, hesitant anti vaccine environment, to come through with science as being data driven, transparent, as honest as possible, and there are enough unknowns about this particular kind of clotting problem that the committee decided to take a week to get some data to understand better whether there are more people out there that have the problem, whether you can relate the problem and get better numbers on people who didn’t get vaccines. What is the incidence of that particular brain kind of clotting? Is it the same or different than the problem seen in Europe, in which case it would be very relevant to any adeno virus vaccine and very different than the RNA vaccines that have not shown this? And finally, you would like to be able to know why, with all of the millions of vaccines, even of Johnson and Johnson that have been given out six point eight million doses, only six people seem to have this. Is there something about those people that could be predicted in advance so that it would go from six to zero? And their decision, I believe, was let’s get some data and scientific evidence on each of those questions. So I would predict all the arithmetic says it is far safer to get coronavirus vaccine in terms of clots than it is to get COVID. Far greater safety in the vaccine than the actual infection. It is thirty-two times less risky to get a clot than if you have a pregnancy. It is about ten times less risky than taking oral contraceptives, so the risks of the vaccine are lower than the risks that people take every day in their normal lives, either with contraceptives or having a pregnancy or getting the disease. So I’m pretty confident they’ll have answers for that in a week. My guess is they will have a better idea how to either predict who’s going to get it or how to respond quickly if they do. And I would guess they would resume because the risks from the vaccine are so much less than many of the risks that people take in their daily lives and certainly much less than getting COVID itself. I hope that’s not too long winded an answer, but I think that’s what’s happening now.

Q: Thank you so much.

MODERATOR: Next question. Is the pause by the FDA and CDC of the change in vaccine and overreaction as the cases are very rare?

BARRY BLOOM: I think if everybody knew the numbers that I just rattled off about the risks, I think people would have been more trusting of CDC if they allowed it to go forward. From my perspective, it isn’t just trust in COVID vaccines. The issue that I’m concerned about is trust in all vaccines, the 14 childhood vaccines that kids have to get. And unless CDC and the government is absolutely honest, transparent and provides the best evidence available, people are not just going to distrust COVID vaccine from Johnson and Johnson. There will be distrust or greater hesitancy for all vaccines, and that would be catastrophic for the health in this country. So I would think spending a week, yes, it will result in a few more cases of COVID, which in much of the country is down over the last two weeks except for a few places, I think coming back with armed with lots of information and data and more precise information on clarifying for the public what the risks are and how low they are relative to the disease and the fact that the government takes safety as the highest priority, you know. It’s not obvious to think about, but it’s an obvious point when people are sick, they get drugs, all drugs have adverse effects, but we’re willing to tolerate an adverse effect for a drug, for a disease, because the disease is worse than the adverse effects of a drug wouldn’t have been approved. Vaccines are quite different because we give vaccines to healthy people. And the first rule in medicine from hypocritic zone down is to do no harm and for the government not to do its best and to be seen doing everything possible to protect the safety of the people and provide evidence on safety and vaccines. I put as a very high priority and I take it that CDC did they will come back with data. They will point out there will be risks, but a lot lower than I think people would really expect or think and that we would know better how to handle the problem.

MODERATOR: Is there any scientific hypothesis about the link between the adenovirus technology used in J&J and AstraZeneca and the blood clotting cases as Pfizer and Moderna vaccines do not have such cases?

BARRY BLOOM: Yeah, so this is a very, very rare form of thrombosis, so of the three hundred to six hundred thousand people who get clotting problems, it is on the order of 10 per million. Which is really, you know, almost impossible to measure accurately, that are thought to have this so-called cerebral venous sinus thrombosis, which is the part where blood that comes from the brain is supposed to get back in the body if it can’t get back, because the blood vessels, the veins are blocked, you get pressure and you pump little blood vessels and you get little strokes. So we we’ve seen that before. And one of the characteristics that is known about that is that infections with viruses of multiple kinds leads to an increase in that particular kind of thrombosis. So it may not be even specific to adenoviruses, but any virus contact. And the question is, what triggers it and what one knows is that in needs six people that have been looked at, four of them had blood taken before they were sick. And the evidence suggests that those who had no antibodies to a factor called Platelet Factor four, which is involved in triggering the clotting mechanisms, none of them had it before they were sick and four that were measurable, haven’t afterwards. And that suggests that as a possible result of either infection in the real world or that these six people with the vaccines they produced an aberrant immune response that somehow reacted with this platelet factor and triggered the clotting cascade and the clotting cascade is a really complicated biological phenomenon, because when you start to bleed, you have to produce a whole lot of reactions quickly to stop bleeding. That’s the requirement of the clotting mechanism. So it leaves as a cascade of reactions that requires a trigger. And once the trigger starts, you start making clots. And it’s a very elaborate process. This is an occasion where something has caused that to trigger in a peculiar place at the sinuses, in in the veins, in the brain. Not clear why they’re not everywhere, but once it starts, it’s tough to stop. And that’s what people are finding. And the standard way of stopping it turns out to react also with platelet factor four. So the common treatment for clotting is heparin. You don’t want to use that here. So that’s why they’re taking their time to figure out whether it is an aberrate immune reaction that occurs in that tiny number of people or whether some people just have a genetic predisposition that we don’t yet know how to measure. And importantly, if you can’t use the standard way to stop clotting, what are the best tools to prevent people who get clots from getting seriously ill and dying? And my guess is we’ll know a lot more next Friday.

MODERATOR: Thank you. Next question.

Q: Hi, so I know the J&J vaccine was a small part of our vaccination program here in the US, but will the cause make an impact in our speed reaching our vaccination goals?

BARRY BLOOM: So the president says, and his is COVID vaccine team, whom I respect, says that we will have enough vaccines of the Pfizer and Moderna to get us probably till June or July, where the vast majority of people who want to get vaccinated are willing to get vaccinated. Well, have had the opportunity to do so. But apropos of honest question earlier, those vaccines are tougher to deliver in rural places, in inner city places where the single shot J&J would be really very useful. So I think the question will be answered next Friday. I would guess, as in the UK, they will have gotten a much clearer idea of the risks. They will find them less than the disease and they will add J&J probably back in but may be restricted to only people over 60. None of the people who’ve had this disease are elderly people. All of the people who’ve gotten the serious issue or six are women between 25 and 50. So there are ways to use J&J to supplement the other vaccines if we need to, and still protect the group at highest risk for the clotting problem. If, in fact, it can be shown it’s actually related to the J&J vaccine. They had no vaccine, which is not yet, I think, scientifically clear.

Q: Thank you.

MODERATOR: So I have a couple of questions as well about the pause. Do you see this as affecting vaccine uptake in other countries around the world? Do you think this will have a negative impact?

BARRY BLOOM: I think that is a huge worry because of all of the vaccines, because of its temperature stability and because of its potential. If it’s AstraZeneca, it’s two shots. If it’s JNJ, it’s one shot. This has tremendous appeal for getting out in buckets. It’s easier to produce. It can be produced in India, for example, which at the moment the RNA vaccines, which have a very specialized, complicated technology. It’s not available to most of the world. So this is a really important vaccine for getting out into low and middle income countries. And if the frequency of clotting is as low as one hopes it will be, then I think governments will have to decide and persuade their people that the risk from vaccination is at least tenfold and may be greater, less than the risk of any serious adverse from the J&J and the AstraZeneca vaccines.

MODERATOR: Thank you. Does anybody else have any questions? Otherwise, like I said, I’d be happy to keep asking questions, too.

BARRY BLOOM: Let me just if I could, Nicole, raise a question that hasn’t been asked, but I haven’t seen much in the press about. I think it goes back to the answer to the last question. There is a major thrust among certainly progressive advocacy groups and legislators for expansion of immunization in low- and middle-income countries to get rid of the patent rules and the reason that vaccines are not being there’s no vaccine producer in Africa, none, zero, I am stunned by that figure. There is a company that does filling and finishing, which means that if AstraZeneca sends them a comp concentrate of their produce product, they have the ability to label it and put it in bottles, which is valuable. It means you can send the vaccine in bulk and make it easier to get there, but they aren’t able to produce the actual vaccine itself. Very few countries are, and it is absolutely clear to me, one, producing vaccines is really complicated. And if anyone is skeptical of that in this group, I would urge you to ask to visit your nearest vaccine production facility and spend the morning wearing caps, gowns, booties and masks and walk around a vaccine production company and realize how one fungus, one viral contamination could ruin millions and millions of doses. This is a really high tech, complicated business that you can’t just say let’s pass a law to eliminate patents and believe Burkina Faso is going to build a plant to make RNA vaccines. So the fact of the matter is, it is not easy to transport these technologies. And where I think the effort should be is not worrying about patents, which at this point are not limiting anything in Africa or anywhere, but figuring out as a global community, how do you produce modern vaccine production facilities in Africa, in places in Asia other than China and India, so that they have their own capacity? Or even better, they can license the technology from one of the major companies like Moderna or Pfizer that have produced it will abide by intellectual property rights but have the ability to produce new vaccines. And I think RNA vaccines is a technology that is now being used in trials by Moderna and Pfizer against respiratory syncytial virus, against influenza viruses and several viruses, all of which are viral diseases, desperately in need of safe and effective vaccines. So this is a technology that isn’t just for COVID and I would put my emphasis on setting up perhaps international vaccine production facilities where multiple companies will have access training people in those companies. And one of the things that is a problem in a vaccine company is you can’t turn it on and off. Once you have a production line it has to keep making vaccine. Otherwise, people lose their skills and the security lapses and has to be reinspected all the time. So one of the issues to solve is how do we provide some self-sufficiency to low and middle income countries? Because I think Pfizer, Moderna and Johnson and Johnson and Sputnik five and Cameleer and Russia are doing their best to make enough vaccines and the Chinese companies as well. It may be for the wrong reasons. It may be for national self-aggrandizement, but they are providing vaccines. But that’s not sufficient and the same as having the independent ability and technical skills to make your own vaccines.

MODERATOR: Thank you, Dr. Bloom. Yeah, that is something I have not heard very much about and it is a very important point. Anybody else have any questions? If not, then I have a couple of questions about boosters. We’ve heard that both Pfizer and Moderna are working on boosters for their vaccines to counteract the variants. How important do you think these boosters will be? Have you gotten the sense that it’s mainly to counter the variant? Or is it to counter a waning immune response? Or what is your take on the boosters and their importance.

BARRY BLOOM: Sure. So there are two things. The good news is that the variant that is spreading in the United Kingdom and Europe and is now somewhere around the third to a half of strains in many states in this country, and that really does spread more quickly and is probably responsible if we could get real numbers from DNA sequencing data, which we don’t have yet organized in this country. The good news is all three existing vaccines produce immune responses in people in the trials and now in real life in the world that protect against that strain. The best data from Israel, where most of the virus is the B.1.1.7 English derived strain and the vaccines that have been tested, which is particularly Pfizer, but Moderna elsewhere has come comparable data. We’re in the 90 percent protection range against that variant. So it spreads faster, but it is still susceptible to vaccines. The one that people are worried about is the one that arose in Africa and one very similar independently arose in Brazil. Brazil is called P1. The one in Africa is B351. They have a very big mutation that enables it to escape a lot of antibodies. So the good news thus far is people who’ve been immunized and their antibodies have been tested in a test tube have all had antibodies that neutralize that so-called escape mutant. So it is resistant to antibodies, but not completely. So it takes more of the antibodies to give you protection than it does to protect against the other variants. It is not difficult for the RNA companies or the adenoviruses companies to produce a modified variant, and they’ve all been doing it for months. So if that variant or those variants with a specific mutations that render it resistant to many of the antibodies produced by vaccines, if that comes to the states and starts to spread, we know it’s here, but it hasn’t spread very quickly. If it does, then we’ll have new vaccine boosters in the fall and they will be effective.

BARRY BLOOM: The long-term question, which is part of the reason I can’t answer the first question on what’s going to happen in the fall, is are we going to have forever new variants that keep escaping the existing vaccines when we add a booster to the last new strain? Will that select four variants that are resistant to the booster? And will this be a game of catch up forever? The alternative is to say the vaccine has a lot of chances for mutations, most of them are deleterious as all mutations are. They make whatever organism less good than it was before. It made a mistake, but a very small number make it a better pathogen. And the question is, will this go on forever? Or if you look at the new variants, the P1, the African variant, a new one in Tanzania, they have a lot of new mutations that don’t seem to have much to do with the immune system, but those that are resistant to the antibodies all have the same mutations. So my best hope is that if we catch up with that, there is a limited amount of wiggle room in the binding site and that the virus are testing us out and they will exhaust the number of possibilities that can elude antibodies and still enable them to bind to the host cells and cause infection. And if that’s the case, we’ll keep getting new variants, but they won’t have very many new ways to get past the immune response, in which case maybe one booster for the most resistant strains will protect against all variants. That’s the most hopeful possibility for the fall.

MODERATOR: Well, I thank you for some hope. One of the other things that I’ve been hearing about this fall is that there may be the children’s vaccines that are going to be made available. Do you have any sense of what where that is currently at that process for approving the children’s vaccines?

BARRY BLOOM: Which vaccine?

MODERATOR: The children’s vaccines for kids who are I think there are two ranges. There’s like 10 to 16. And then there’s the two to I guess three, two to 10, and then there’s two to 12.

BARRY BLOOM: So I’m very optimistic that these vaccines will be safe in kids, but that has to be tested. They will not be tested, I think four, hundred fifty-thousand-person randomized control trials to look for protection so much. I think the concern in kids is kids are not little adults. You can’t just reduce the dose of vaccine based on the fact that kids weigh less than adults do. So one really has to test safety very carefully in children to be able to make sure you give them enough vaccine to make an antibody response that neutralizes the virus in a test tube, just like we do for humans, but not enough to make them sick. And kids can react to things that adults, because we’ve been exposed to many things as we grow up, maybe more resistant to them little kids. So that’s all in the works. And the existing vaccines are being tested in them. And the expectation is we will know, possibly not by the beginning of the school year, except maybe for a couple of vaccines. They’re working hard at that, but certainly by the mid to end of fall, we will know what the right dose is and how safe it is for kids at school age, which is the critical age, because there are two things you want out of a vaccine. We’ve been focused on preventing people from getting hospitalized and dying, which is a pretty good goal. But the other goal, if you want the virus to go away, is you have to block transmission. And while kids in general don’t have the severe disease consequences of catching COVID that adults do, it is clear. Kids can transmit. And if you want to keep schools open, the ideal would be to protect teachers with vaccines and protect kids, and particularly high school kids, where social distancing is not on their agenda as a high priority. And so the more people you get vaccinated, the closer you come to protecting everybody. What the press likes to call herd immunity, whatever that is.

MODERATOR: OK, speaking of that, a lot of people getting vaccinated and what that can mean, so I’ve also hearing about breakthrough cases with people who have been vaccinated, fully vaccinated, and they still develop the disease. That seems to be it’s about fifty-eight hundred cases out of the seventy-seven million people have been fully vaccinated in the US. From what you know about the vaccines in there, I guess efficacy. Is that about what you would expect for the number of breakthrough cases?

BARRY BLOOM: No, it’s less than I expect. Far less.

MODERATOR: That’s good.

BARRY BLOOM: In the clinical trials, you know, these numbers are always soft. It depends on how many people in the trials, what the denominator is. So whether there is in real world the difference between eighty five percent, ninety five percent protection, those are statistical variables that depend on how big the trials are and what the numbers were. But it says they’re highly protective. So if it were 95 percent protection. You would expect five percent of the 72 million people who have been vaccinated not to be protected. And the fact that that number is now ninety-nine-point nine five percent, suggests that this is a real phenomenon, people who’ve been vaccinated, small numbers do not respond to the vaccine for reasons for any vaccine that we do not know. And then unpublished studies where a few people have studied a few of those people. What has been striking is they have made antibodies in the adeno case in Europe to the nuclear capsid protein, a protein on the outside of the virus, the major protein in the virus and in the vaccine. But anti-nuclear capsid antibodies do not protect against the virus. So they’re making antipode, some of them, but not to the spike protein, for reasons not clear, another set of people who got sick are not making antibodies, period, to the vaccine. And again, it’s infinitesimal, a thousandth of a percent, and they just have some genetic or otherwise, where they don’t see the antigens on the spike protein. But I think overall, I am completely surprised that the breakthrough numbers of people in this state is as low as it is. And we should be grateful for that.

MODERATOR: Are you expecting the number of breakthrough cases to increase then as the number of people get vaccinated?

BARRY BLOOM: The number of breakthroughs will increase. It was expected, and I wish the public were prepared to take that five percent figure from the trials and say we would expect five percent not to be protected. And then when you look at the real data, it’s going to be a lot less than five percent. It’s going to be less than one percent maybe on the order of a tenth percent. And that’s all-good news.

MODERATOR: Great, thank you. And just to open it up, if anybody else out there has a question, just raise your hand or get in touch with you by Zoom chat or email or feel free to just chime in. Pretty quiet group today.

Q: Hi. I was wondering, with the new variants and kids, are kids being more affected or getting sicker because of the new variant, or is it the same as the original virus?

BARRY BLOOM: So I like to look at things in a kind of Darwinian survival of the fittest sense. And the Darwinian struggle here is not between us and the virus, it’s between individual virus variants and other strains. So the virus is trying to survive and any mutation that gives it a small edge in being able to be more rapidly transmittable, more stable in the atmosphere, spread easier from the nose, any advantage that a variant has given it an advantage over the existing virus and it will take over. So two studies published recently in England where they’ve been able to study this very well, have indicated that the strain that we’re most that is rising most rapidly in the strain, the variant B.1.1.7 in the states really does spread 50 percent or so more quickly, more efficiently than the original virus. And that’s why it’s spreading. And that’s why Europe and India are seeing real surges right now. What is comforting, as I said before, is if you are vaccinated against the old virus in the vaccine strains, you are highly protected against this variant. So it spreads better. It doesn’t cause more severe disease. That was a concern in the beginning. There are two studies that followed up the clinical course of people with that strain, they have the same clinical outcomes as people with the original virus. It is not more virulent. It is just more transmissible. The ones you worry about are those that escape the immune response, and that’s what I think the booster shots are being designed to prepare for.

Q: And I’m sorry, I’m just wondering about the fact that for kids and young adults that are not being vaccinated between two one eight, a 16-year-old, that by the time we have a new vaccine for them, I mean, how in the meantime, how they’re being affected by these variants? You know, or if any of them could get sick or what, then it will be more easily transmissible between them to the younger ones.

BARRY BLOOM: You know, there aren’t data on that. The number of kids who get sick with any of the COVID viruses is relatively small relative to all the people that one studies are those that are people that go to a hospital or a clinic or a doctor. If people are asymptomatic, they are infected. If you did a coronavirus test on them, they would have virus in their nasal pharyngeal cavities. But if they’re not sick, we don’t see them. So we really don’t know the extent in children and whether the variants are better or worse in children. What we do know is that the cases coming in with the variants that are increasing in the states are increasing in people twenty-five to fifty-five. Old people are mostly vaccinated already in this country and if they’re not there, protecting themselves with masks and staying indoors. So the age distribution of COVID case is showing up in hospitals has now shifted to a younger population. Again, kids are not prominent in that population. So I don’t see any reason at the moment to believe the variants are more severe, cause more disease in children than the original virus. We do know all three vaccines protect against all the variants that we know about at the moment.

Q: Thank you very much.

MODERATOR: Any other final questions for Dr. Bloom? Dr. Bloom, do you have any final thoughts you’d like to share with us before we go?

BARRY BLOOM: No, I think the group, small as it is for their questions, they were good questions.

This concludes the April 16th press conference.