Intermittent Fasting: Effects On Health, Aging & Disease (Part 2)

To me, I remember reading this article, and
thinking this is a big step because up until now you sort of saw it in a bunch
of other places. You saw it in really in some really good science magazines, like
Nature magazine but finally hits the New England Journal. It's like, okay, no matter
how conservative and old school the doc might be, it becomes really hard to argue
with the point. And so as you start going through this article, it wasn't
original research. It wasn't studies as you know. It was more of a review, and
then really, it became more of a policy statement. Actually, I should have been
showing this image when you were describing what you were describing
because this is the image that gets into… okay,
there's you've got the mitochondria which are the powerhouses.

You've got a
bunch of different metabolic processes going all the way back to the genetic
components. And a recognition that you know what we have the same genetics in
our 20s that we have in our 50s, why are we getting insulin resistant in our 50s?
Maybe it's because you know that I think there's two things I think. There's some
inherent aging, but I also think it's clear that it's not just aging causing
insulin resistance alone.

I think the habit of eating 3 meals a day
minimum for 60 years or 55 years has a little something to do with our
epigenetics, and that's a major component of what happens. Here, we go back and we
start changing the signals, changing the the librarian that has to go back and
look for different enzymes, different genes. If we start getting our body used
to knowing that we're gonna have episodes where we need to pull energy
out of storage and out of trash stimulating autophagy as you know,
it's just a slightly different and a little bit more of an aggressive form of
using internal energy than just burning the glycogen that's in your liver, the
you know, the sugar stores in your liver, and glycogen more so than burning fat.
You're actually burning old beat-up dead mitochondria that if that are just no
longer working and other things as well. So yeah, it did a great job in terms of
describing a lot of the metabolic changes which are attributable to this
process of developing more of a catabolic as opposed to anabolic phase or
getting ketotic.

A couple of points about about that terminology – catabolic and
anabolic. Catabolism is where you're burning stuff that's already stored, you know the three things I mentioned: stored glycogen, stored fat
energy, and stored cell trash. Anabolic is you know you recognize that term
from anabolic steroids. That's where you're wanting to build muscles up, build
cells up. And as long as we're not going through any of these intermittent
fasting states, our body is in a constant anabolic mode. And that may be good for
growth, but it's not good for our basic metabolism, our basic avoidance of the
chronic diseases which are almost all vascular related. It was interesting some
of the points they made about the microbiome in there. And what was also
interesting to me was how they ended up the article talking about, okay, you know
what, we need to have much more of an organized… we need the standard medical
community out there now talking about intermittent fasting.

So that is
interesting. I am curious to see how long they'll take any comments about that.
Well, I'm smiling because you and I both know that's going to be a tough road to
hoe. It is tough sledding to get entrenched behaviors, and so doctors are
just like regular people when it comes to behavior change. Any of us with
entrenched behaviors whatever those are that we talked about for
some furniture, it's hard to change, and the medical establishment is no
different.

And it may be harder because it's so much bigger. But I loved this
chart that was in the article because it is prescriptive for what we should be
doing. So we've had a lot of people ask about how to get into the CIMT event.
We've got a whole schedule on the membership page. I'm gonna take you
some through that real quick.

First of all, you go to PrevMedHeratRisk.com.
That takes you to our website. Click on the membership login page, and membership
is free. You just have to give your email address. Then you'll see you've got a
menu over on the left. Live webinars. Second live webinar. CIMT events. Click
that button, then click the gray button, and you see all of the schedule for
getting a good reliable CIMT near your area. Orlando. Central Western Ohio, just
west of Cincinnati. Austin, Texas. Detroit, Michigan. Rochester. Memphis. Lots of
places. And most of these are thanks to our good friend David Meinz. And again,
CIMT done reliably has got a lot of advantages. Very good way to screen, much
better than stress test, and a lot more comfortable than going to the cath lab.
Thank you for your interest. Go get a good CIMT you near you.

As found on YouTube

Lesson 1: Global Health Security and You

[TEXT: Young African Leaders Initiative:
Online Training Series] Hi, my name is Dr. Edmund Rutta, Senior Technical Advisor on
Tuberculosis in USAID’s Bureau for Global Health, [TEXT: Edmund Rutta, Senior Technical Advisor on
Tuberculosis, USAID Bureau for Global Health] and this is
Global Health Security and You. [TEXT: Effective Communication for Healthy Outcomes, Global Health
Security and You] [TEXT: Learning Objectives: Global Health Security and You] In this
lesson we will focus on global health security and the critical
role that health information plays in [TEXT: What is global health security?] surveillance, prevention
and mitigation of infectious disease outbreaks. [TEXT: How to collect, analyze and disseminate health information]
We will look at the key elements necessary for the collection,
analysis, and dissemination of health information. [TEXT: How to use digital tools to collect health data]
And finally, we will examine the importance of giving citizens access to digital tools to support the collection
and use of reliable health data.

As a TB expert, I know first-hand how easily an infectious
disease can spread from a localized threat to one that puts at risk entire populations in multiple cities and
even across regions, countries, and continents. [TEXT: Diseases do not respect borders.] Diseases don’t respect
borders. Credible information, a resilient health system and contingency
planning can stop an epidemic and prevent it from turning it into a
pandemic. The West Africa Ebola outbreak in 2014 could have been contained but
poor health infrastructure, weak surveillance systems, lack of reliable health data and often
contradicting health messages turned it into an epidemic of global
proportions.

The international community was caught
unprepared and the consequences were grave: [TEXT: Over 30 thousand Ebola cases … 11 thousand deaths] over
30,000 Ebola cases, including approximately 11,000 dead from the
disease, another 10,000 estimated deaths due to
other health conditions going untreated, [TEXT: Poor coordination and communication] and millions of dollars
lost in duplication of efforts due to poor coordination and
communication across the global system. Further impacts on
food security, employment, healthcare, and education were felt for
months after the end of the outbreak. Many survivors
still struggle. Rumors, which tend to increase during any crisis, were not promptly
addressed via credible sources of information, a factor that
contributed to speculation, misinformation, and increased
infections. [TEXT: Ebola outbreaks exposed major gaps in global health crisis
management.] In many ways, the Ebola outbreak was a wake-up call
that exposed major weaknesses in the global system for addressing epidemic threats. But this tragic event also brought forth a commitment to a new
collective paradigm centered around global health security. We will look at the communication challenges and lessons learned on
the digital front from the Ebola outbreak later in this lesson. But first, I’ll outline the
Global Health Security Agenda. [TEXT: Global Health Security Agenda] The Global Health Security
Agenda or GHSA was launched in partnership with countries from
around the world.

[TEXT: Improve the capacities of countries to protect people against
infectious diseases.] The GHSA seeks to improve the capacities of
countries by strengthening health systems to protect people around the world
against infectious diseases. It also aims to attain a world safe and secure from global health
threats posed by infectious diseases through multilateral and multi-sectoral collaboration and the sharing of best practices
and metrics between partners – both those in government, as well as private and non-governmental stakeholders. As one of several implementing agencies for the United States’ GHSA
programs, [TEXT: USAID, from the American People]
the U.S. Agency for International Development is actively
working with our interagency partners around the world to channel resources to issues like animal health
and addressing existing and emerging zoonotic pathogens. [TEXT: Did you know? New outbreaks originate in
animals.] Are you aware, for instance, that 60 to 80 percent of new
infectious disease outbreaks originate in animals? With our partners, we are working toward the prevention of animal to
human infections, as well as anti-microbial resistance by promoting
the rational use of antibiotics.

By doing this we will be better prepared to work with governments
and communities to prevent and mitigate future health threats. Furthermore, USAID supports the preparedness and response to
infectious disease outbreaks at the community level including training health care workers in how other sectors can
influence disease transmission. The unifying theme of our work is to bring together the sectors of
animal health, human health, and environmental health to address the
burden of disease on communities. Strengthening
health systems and enhancing critical infrastructure also serves to
provide better access to healthcare for citizens and improve the quality and reliability of available health information. [TEXT: Collecting, Analyzing and Disseminating Accurate Health
Information] With the frequency and intensity of infectious disease outbreaks and
events increasing, there will be a continued need for global health
security resources. [TEXT: Safe, secure and strong laboratories … Well-trained
workforce] All countries need safe, secure, and strong laboratories;
a well-trained workforce; [TEXT: Multi-sectoral collaboration … Reliable disease surveillance
systems] multi-sectoral collaboration; reliable and sensitive
real-time disease surveillance systems; [TEXT: Command structure] and a command structure to coordinate an
effective and focused response that includes health practitioners and other professionals, along with the general
public.

Strengthening the surveillance, laboratory, and workforce will be
critical as countries build the capacity to respond on their own to
new disease threats. [TEXT: What is your role in preventing the next disease outbreak?]
So, you have a role to play in making sure your country is
supporting approaches to prevent the next disease
outbreak and promote global health security, including prioritizing capacity building for these kinds of
resources before an outbreak strikes. As health communicators, you have a vital role to play to ensure
that accurate and timely information is delivered to the public to [TEXT: Inform … Raise awareness … Respond effectively during an
outbreak] inform, raise awareness, respond effectively during an
outbreak, [TEXT: Teach best practices to communities] and teach the best
practices for the community to take action. For instance, to help prevent the spread of zoonotic diseases,
educate yourself about food safety regulations in your country and why it is important to vaccinate
animals against certain diseases.

The collection, analysis and dissemination of accurate health
information is also critical for making effective policy and programmatic
decisions that will ensure that resources get to where they are
needed most. Unfortunately, communities must often deal with an array
of disconnected and parallel data systems; weak governance on enforcing information system standards; and
insufficient capacity of data use in health care. For example, a recent assessment of
Tanzania’s information systems [TEXT: 153 disconnected information systems across the health
sector] found 153 disconnected and separately financed and
implemented health information systems operating in various
programs and geographies across the health sector.

This is particularly troublesome during a health
crisis, when the health infrastructure is under siege and basic
health services are disrupted due to a surge in demand. [TEXT: Fighting Ebola with Information] In 2016,
USAID published a report entitled Fighting Ebola with Information:
Learning from the Use of Data, Information and Digital Technologies. A number of factors contributed to the “fog of information” that
characterized the collection and use of data in the early days of
the epidemic to capture how Ebola spread. [TEXT: Weak infrastructure … Absence of baseline data]
These included: weak infrastructure, such as gaps in reliable
electricity and digital connectivity; an absence of baseline data on populations; [TEXT: Lack of comprehensive maps … Lack of
machine-readable data] comprehensive and accessible geographic maps,
and the lack of machine-readable data.

Given the lack of data in communicaton infrascture, rumors about how
the Ebola virus was transmitted and inaccurate health information on
what constituted safe or unsafe behaviors caused panic and fueled
the epidemic. Training local journalists on how to responsibly
report a health crisis became a priority as efforts to contain the
epidemic increased and people realized that existing public messaging was not sufficient. Adequately
trained local journalists have a role to play in fostering dialogue,
addressing rumors and providing accurate health information.

[TEXT: Bridging the Digital Divide: Investing in Healthy
Communities] Building strong digital health systems and integrating social and
behavior change approaches are vital steps to advance global health
security and be better prepared to contain the next epidemic. As outlined in
the Fighting Ebola with Information report, key recommendations
include: [TEXT: Key Recommendations: Investing in digital
infrastructure] One, investing in the physical infrastructure that
extends digital connectivity. That means building more digital
towers to connect people who live in remote areas; [TEXT: Conducting baseline ICT
assessments] Two, conducting baseline, countrywide information and
communication technology assessments to gauge the reach, quality,
and access to mobile and broadband connectivity; [TEXT: Leveraging digital systems and real-time data] Three,
building staff capacity and data literacy as well as institutional
capacity to leverage digital systems and real-time data in support of operations, programs, and decision-making; [TEXT: Increase network access for emergencies] and Four,
negotiating preparedness protocols with key actors to increase telecommunications network access in emergency situations. By doing all of this and more, we will be better prepared to respond
effectively to a health crisis in the future. One of the positive
examples that came out of the Ebola crisis is
the mHero platform, [TEXT: mHero] a two-way, mobile phone based communication platform
that supports dialogue between ministries of health and health
workers.

This tool contributed greatly
to improving the collection of accurate health data and the
dissemination of reliable health messaging in the affected countries. Going forward, we must strengthen the technical, institutional, and
human systems required to rapidly gather, transmit, analyze, use, and share health data that is
essential to promoting global health security. This is critical both to keep pace with diseases that
spread with the ferocity and velocity of Ebola, and to be more resilient in the face of future global health
threats. [TEXT: Test your knowledge … YALI.state.gov … YALI Network]
After you have completed all the lessons in this course at [TEXT: Photo credits: USAID … HRSA at U.S Department of Health and
Human Services] YALI dot state dot gov, you can test your knowledge
98
00:11:23,683 –> 00:00:00,000
[TEXT: Centers for Disease Control and Prevention … Produced by the
U.S. Department of State] and earn a YALI Network Certificate..

As found on YouTube

ABC21 Chats w/ Founder of the Institute For Integrative Health And Healing

september is national yoga awareness month and you've probably all heard about the benefits of yoga john hopkins university cites benefits to the heart stress and even your mood did you know that it could also help with side effects of cancer treatments well with me this morning jennifer freemian and she's the founder of the institute of integrative health and healing she's here to talk about her program and how it works and how it helps the patients first of all good morning jennifer we're glad that you're here with us tell us a little bit about first of all what is integrative cancer therapy integrative cancer therapy is an online platform so it's a library it's a growing library of videos that patients have 24-hour access to so it's therapeutic movement it's mindfulness meditation sound healing so at any point in time patients can use it for side effects of chemotherapy radiation postoperative any any sort of side effects so this will help with like any type of cancer treatment that one's maybe going through correct what inspired you to create this i work as an oncology nurse so and i've been a yoga practitioner for 25 years so combining the two and really seeing the benefits especially with anxiety depression nausea pain there are just so many benefits and it tied it in so perfectly with oncology so what are some of the stories or maybe you know testimonies that you've kind of heard from this type of therapy have you had a lot of those testimonies and stories so many yeah i work directly with patients and have been for many years so that's really the why this was created so patients could have access to this 24 hours a day as opposed to just having a couple of classes a week so one of the biggest benefits is anxiety relief they you know it's meditation they can kind of tune into themselves tune into their breath really getting into their bodies and connecting to their breath in that way and we've seen a lot of the arise it seems like in the awareness of the importance of addressing mental health getting help asking those questions do you think now i mean even with this pandemic the stress has put that it's important now than ever to get your mental health checked out absolutely yeah and my focus really with the institute and integrative cancer therapy is bringing wellness to the forefront of health care and cancer care so that's that's really what we all need so if there are people sitting at home asking themselves does this apply to me should i be one to sign up how can people do so they can go to tiih.com and there's all of the information on the website if they have any questions they can go to support tihh.com and we'd be happy to answer any questions all right jennifer freeman thank you so much thank you yes and we know that look you guys if you need this type of help if you could use this type of help definitely make sure that you go on and sign up thank you again for being good thanks so much all right let's go ahead and take another look

As found on YouTube

7 Balsamic Vinegar Health Benefits | + 2 Recipes

Balsamic vinegar is a deep brown vinegar that’s
made from unfermented grape juice. It’s known for having distinctive, bold,
complex flavors and a tart aftertaste. Real balsamic vinegar is aged in barrels for
months or even years, and it can be quite expensive. Balsamic vinegar has become a popular ingredient
in food preparations, especially salad dressings and marinades. People use it as a low-fat additive and part
of a heart-healthy diet. Some people believe that balsamic vinegar
is good for you all by itself. It’s been suggested that balsamic vinegar
can contribute to weight loss, low cholesterol, and even a glowing complexion. It helps lower cholesterol! Of all of the benefits of balsamic vinegar,
this one is perhaps the most well-documented. Balsamic vinegar is an excellent choice for
those looking to maintain or lower their cholesterol levels. The antioxidants found in balsamic vinegar
target the “scavenger cells” that are toxic to your body and inflate your LDL (unhealthy
cholesterol) levels. By consuming balsamic vinegar as a dressing
or glaze, you can consume enough to help your body protect itself against clogged arteries. It aids in healthy digestion! The main active compound in balsamic vinegar
is acetic acidTrusted Source, which contains strains of probiotic bacteria.

These probiotics don’t just preserve food,
they can also enable healthy digestion and improve gut health. There’s also positive immune system benefits
to having these healthy bacteria called gut biome. The probiotic compounds in acetic acid could
be part of the reason some people swear balsamic vinegar makes them feel full. It supports weight loss! The vinegar family is known for its anti-obesity
characteristics, and balsamic vinegar is no exception. As mentioned before, balsamic vinegar contains
probiotic compounds that help you feel fuller, longer.

Unlike other flavoring agents like butter
and mayonnaise, balsamic vinegar is fat-free. Though it isn’t a magic weight loss potion,
there’s reason to believe that incorporating balsamic vinegar into your diet will help
you reach your weight loss goals. It’s diabetes-friendly! Balsamic vinegar is an anti-glycemic. In a 2006 review, studies even indicated that
after consuming vinegar, people with insulin resistance experience a blood sugar plateau
for up to five hours.

Using balsamic vinegar as a condiment can
make your meals more diabetes-friendly, and help you avoid blood sugar spikes that happen
after eating. It improves blood circulation! Balsamic vinegar contains polyphenols, which
are under investigation for how they help your cardiovascular system. You might not think about it often, but balsamic
vinegar is a fruit product because it’s made from grapes. Grapes have been found to keep your blood
platelets from aggregating, which may prevent cardiac diseases.

This might be part of the reason why Mediterranean
cultures have been using balsamic vinegar for centuries as a “healing” and “anti-aging”
ingredient. It may help with hypertension! Balsamic vinegar’s benefits for your cardiovascular
system extend to your blood pressure, too. A laboratory study from 2001 revealed that
rats with hypertension had better blood pressure after consuming vinegar over a long period
of time. By consuming 1 to 2 teaspoons of balsamic
vinegar as a dressing or marinade, you’re not only making your food more delicious,
you’re helping your heart health, too. It can improve your skin! Other types of vinegar, like apple cider vinegar,
might appeal more as topical acne remedies because the smell of balsamic vinegar is quite
pungent. The dark, stain-prone color of balsamic vinegar
might also put you off from applying it directly to your face. But balsamic vinegar contains both acetic
acid and antimicrobial compounds, as well as antioxidants.

Consuming balsamic vinegar as part of your
regular diet might make your skin look clearer and your complexion brighter. Risks and side effects! The risks of balsamic vinegar are low compared
to the potential health benefits, according to one review of the literature. If you drink raw balsamic vinegar, your throat
may become inflamed and your esophagus could be damaged. There are instances where drinking vinegar
can cause stomach pain or hurt the lining of your stomach. Be careful to monitor how much vinegar you’re
consuming. Stop using balsamic vinegar right away if
you feel it’s contributing to heartburn or gastric issues. Recipes! Balsamic glaze! A balsamic glaze is an easy way to start including
balsamic vinegar in your diet.

All you need is sugar, salt, and a high-quality
bottle of balsamic vinegar. Mix 16 ounces of balsamic vinegar in a saucepan
with a 1/2 cup of sugar and 1 teaspoon of ground sea salt. Turn the saucepan on medium heat and let it
boil. The mixture should cook down to about 8 oz.
as you stir it occasionally. The resulting glaze will be thick and syrupy. Let it cool and store in an airtight container. Caprese salad! For a dose of antioxidants, vitamin C, and
vitamin K, try this classic antipasto recipe. You’ll need: 2 – 3 beefsteak heirloom tomatoes,
8 oz. mozzarella cheese, 2-3 tbsp. balsamic vinegar,
2-3 tbsp. olive oil, fresh basil leaves,
sea salt. Slice the beefsteak tomatoes length-wise. In between the tomato slices, add thinly sliced
fresh mozzarella cheese. Layer basil over the tomatoes and mozzarella. Drizzle with olive oil, sea salt, and balsamic
vinegar to taste.

As found on YouTube

Qigong Exercise for Health-1

hello everyone my name is hi young today I would like to share some the Chico exercise with you today we will practice the first one okay let's let's keep the seat apart at shoulders back and then gradually raise up your arms your palms then I stand like an eyeball and then focus on the space between the hands so focus on the space between the hands you can gradually close your eyes oh you keep your eyes open this after you then then after we focus on this area then gradually slowly extend our arm and then post toward each other then let's repeat this movement so extend the palms arms shoulders and the chest then in the end pull inward so we still focus on a space between the hands then crack these days slowly you can keep your eyes closed Oh keep your eyes open then at this moment that you have to keep your mind relax keep your facial muscle relax and breathe naturally you can make coordination between the breathing and your movement oh just just focus on the moment we stop focusing on your breathing that's the first point second point one after well after focusing top of sections you can coordinate the movement with the body motion for example when the palms extend outward then imagine the body is expending at the same time then when the palms push toward each other then just a sense of just imagine that your body is is the country as well so for calls under space and the coordinates the breathing and the body movement which the move with the physical moment with time so in the beginning just focus on a space just focus on the moment gradually you coordinate your movement with your breathing with the body movement with the body breathing in the end you can repeat this movement slowly for I say five or ten minutes then in the end you can put your palm put your palm toward your stomach then just put the palm up on your stomach relax the shoulders sing down the shoulder and then Foucault's are the space behind your palms for cotton space behind your palms and at the same moment you can keep a seat standing posture on the seat on the chair you can keep this posture or sit on the chair but relax the whole body at this moment normally you can close your eyes close your eyes breathe with your nose and the phone calls and the space behind your poems then eventually after few minutes then move palms downward then from here you can work on other movement so it is the first exercise so nice let's repeat again first keep your body relaxed second relax the mind third raised naturally then start from focusing on the space behind your arms then move the palms opening of hollow opening and the flows and slows emotion then this which time you can coordinate your hands movement with your breathing and your body movement on motion as well eventually we put palms toward the stomach and the focus on his face behind your palms then very important that you relax the shoulder relax the face of muscle and relax the wine try not try not force any movement with time there will be some sensation we test incision between between your parties I mean your problems on your arm on your body maybe even you feel certain circulation but try to ignore this in the beginning so don't focus on any sensation in the beginning for the first week just focus on the moment and the space between your palms that's the first moment and the first time thank you very much I hope you try this

As found on YouTube

Sauerkraut Making Recipe in Crock, Probiotics, Health, 2 of 4 Fast Easy

Hello Vanessa. Hello Dean. How are you? What are we doing here? Well, it's a continuation of yesterday's… The sauerkraut? Sauerkraut, yes. Okay. We salted the sauerkraut, put it in here. How long does it stay in there? Overnight.
Overnight? Overnight, yeah. And you cover it with a cloth, right? Covered with a damp cloth and it's salted with sea salt. We talked about that yesterday. Yeah.

Okay. Now, one
thing, this cabbage is not very juicy. Okay. Because we are a little early, but I wanted
to have it done, you know, for the fall. Okay. So I can put. So? And, we need certain things
now to do the cabbage, and you see me standing here on this white cloth with absolutely clean feet. Clean feet okay. Very clean feet. So what we do is we take a little bit of dill,
fresh dill. Yeah. And put it down here, and…That's a cockatoo screaming. And three pieces of horseradish. Horseradishes, okay yeah. And now, just a minute, that's just our cockatoo
screaming there. Chucky, yep. So, now I'm filling in the cabbage. Just a piece. Filling
the cabbages in? Yeah.

To the crock. But, not more than that. Alright. Yep. Now the best way, you can also do it with your hands, but you just won't get it as good as when you step in and do it with your feet. And you just, because you are injuring the cabbage, so you're really, really getting the juices going here, right? Okay. So, now, next one.

Yeah. Some more dill, okay, yeah.
Put another sprig of dill. Yeah. Now, people do it differently. Some people like quince
instead of the horseradish. The horseradish is only in because it prevents the cabbage from going mouldy. Okay yeah. Right? Put another three in. Yeah. Put this in. Doesn't the horseradish give a little flavour? Yeah, it gives a little flavour to it. So, now, second one, and a little more. A little more salt? No. A little more cabbage. A little more cabbage, kay, right? Yeah. It's actually not too bad. Right. A little more. So, and now, going to go in it again, and you can see already. Yeah. Want to come here? It makes a lot of juice.

Can you see it, already, it makes a lot of juice? And don't worry about it, that's how they used to do it in the old farms. Yeah? Yeah. That's how cabbage was done. Well, it ferments like. Yeah, it will
ferment. Which will make it all… And here, we have another piece of dill. Okay, the whole stalk and everything? Just tear it up, just throw it in. Yeah. Okay, and now we put the
last part of the cabbage in here. Yeah. Now, I'm not making huge amounts, you know, but
I make enough so we have a few jars. Yeah. And then in the fall I will make some more. Okay. So, It's not a big deal, you know, to make sauerkraut. Okay, yeah, let's do the
cabbage dance again. The cabbage dance! Ha ha ha! Yeah. You know what? This is totally totally
watery. Yeah, yeah. And you only get that… look at this. Yeah, when you step in it. And that's only the water from the cabbage.

Yeah okay. Now what I did is, because it looked very dry to me, I made myself some lightly salted water, just in case I need it, but I don't think I need it, so now I put some more dill. Yeah. I'm done with this. Yeah. Little more
peeled horseradish. Yeah. Okay. You grow that in your garden? Yeah.

I have that in the garden, but you can buy it in the stores, you know, they sell, you know, those stalks. Okay. And a little more, right? How long does it take before it… Depends on how warm it is. Yeah. It shouldn't be in too warm of a place because then it just goes mushy really quick. And you have to check it every day, whether it has enough water. Yeah. And every day, if it starts to get mouldy, like, on the outside, you have to take that off. Yeah. Clean it off. Yeah.
Maybe a little more salt. Okay. Now I put a plate upside-down. Yeah yeah. And I put a weight on it, and I'm using my… Your salt pestle, yeah. …my mortar from Carrera. Carrera marble. Yeah. And just to make sure, I'll put a little water in. Yeah. A little salted water. Yeah. And it's cold.

Yeah. Just to make sure. Okay. Yep. So, we'll be back. Can
I say two more words? Yeah. After a few days, it will start to bubble and to ferment. Yeah. And when it's done fermenting, after about a week or so. Yeah. Then it goes back down. Yeah, okay. Okay? And then it has to be bagged and frozen because you cannot can it.

Okay. You cannot can sauerkraut. Okay. Okay, otherwise you lose all the goodness. Okay, thank you Vanessa. So that's it! Have fun. Ha ha ha. Do the cabbage dance… Cabbage dance! Ha ha ha! Thanks a lot. You're welcome. Can hardly wait to taste it. Yeah, oh oh. You
have to put a cloth over it. It's very good to taste. A wet, you know, a damp cloth over
it. Okay. Okay? Okay. Thank you. Yep. Closed Captioning by Kris Brandhagen. brandhagen@gmail.com.

As found on YouTube

Ministry of Health’s Virtual Media Conference – Wednesday 12th January 2022

A pleasant good morning and welcome to the Ministry of Health's update on the national COVID-19 response for Wednesday 12th January twenty twenty-two. Our panelists for this morning's update are the honorable Terrence Dialsing, Minister of Health, Doctor Miriam Abdul Richards, principal medical officer institutions and Doctor Avery Hines, technical director epidemiology division, Ministry of Health. I am Al Alexander, senior corporate communications officer in the Ministry of Health and the moderator for this morning's update. Doctor Richards will begin with the latest clinical update for the parallel healthcare system.

Doctor Richards, good morning. Good morning. Thank you very much. Al. Good morning to the honorable minister, to my colleague Doctor Heinz, to all members of the media, and to everyone who has joined in regionally, locally and internationally. This morning, I'd like to present the update in two parts. I'll start with the information on the COVID-19 dashboard number nine hundred and sixty-six As of the 11th of January, 2022, and then I will provide a brief update on the status of the parallel healthcare system as of 8 AM this morning. as per COVID dashboard update number 9 hundred and 66 There were an additional five hundred and forty cases recorded. This now takes the total number of active positive cases to sixteen thousand two hundred and twenty At present, there are six hundred and sixteen patients hospitalized in the parallel health system.

And this number accounts for persons in the hospitals as well as the step downs. I will give you a breakdown of the persons as of this morning. Unfortunately, an additional 20 deaths were reported yesterday. And this now takes the total number of persons who have succumbed to covid-19. To 3 thousand 102. And we extend our sincere condolences to the families and friends of the deceased. The honorable minister will provide further information on the vaccination status. But at present our population has a a forty-eight point 3% rate in terms of full vaccination. I'd like to now shift the presentation to a summary on the status of the parallel healthcare system. This morning, there are six hundred and thirteen persons hospitalized in the parallel healthcare system. Across Trinidad and Tobago. 480 of those persons are in the hospitals while one hundred and thirty-three are in the stop down facilities. And this us an occupancy level of 69%. Now, I'd like to share with everyone that the trends that we speak about in our press conferences have been consistent for the past eighty-five days.

The trends that we have noted include high occupancy levels which means that the hospitals continue to have many severely and critically ill patients being managed COVID-19. We've also noticed that in the intensive care units which take care of our most ill patients, they tend to be most filled. And this morning, across Trinidad and Tobago, the ICU occupancy is 83 percent. In Trinidad, 63 of the 71 beds are currently occupied and in Tobago, three out of the nine available beds are occupied. There are 96 patients across the four accidents and emergencies who are being treated for covid-19 and at at the RHS I'm sorry in being treated for covid-19. And of those 23 are ICU level patients. Ladies and gentlemen. This situation in the hospitals in the parallel healthcare system continues to be very serious. We are now proceeding on an 85 day trend.

We have the Omicron variant, you know, being introduced through travel into our country at this point in time. And globally, we have seen the impact of COVID-19 and new variants of concerns such as the Omicron on the healthcare system and ultimately the population. We continue to inform the public of the status of our hospitals so that you can make informed decisions regarding vaccination. Vaccination continues to be a safe and effective way to reduce the risk of being hospitalized. Even if you do get covid-19 and requiring ICU care. We also would like to inform persons and to continue to request that if you are confirmed with COVID positive or you have covid-19 symptoms, please seek medical attention early. And please desist from using medications or therapies that are not approved by the Ministry of Health. Ladies and gentlemen, this brings an end to my short presentation. But as I leave, I would like to to encourage you to please take up on the offer of vaccination. Thank you very much and over to Al.

Thank you very much Doctor Richards. I now invite Doctor Hines to provide the latest covid-19 epidemiological update. Thank you Mister Alexander. Good morning to the honorable minister, to my colleague, Doctor Abdul Richards. Good morning to members of the media, members of the viewing and listening public. If we go straight to my second slide, I believe it is. We can in the epidemiology update and we begin by looking at those weekly trends that we have been tracking since the start of the pandemic.

This current frame shows all of twenty twenty-one and the first two weeks of 2022 as we progress. And what we're seeing is that the red buzz which are the ones just to the right side of the of the graphic. Uh those bars for the weeks in December. We do that that last week in December seemed to have a big drop but that big drop as we kept as we keep saying it's more likely due to smaller numbers of people accessing care during that holiday period and with what we saw therefore is unaparent rebound to more of the on-trend decrease that we are seeing for the first week in January so that green bar that follows is closer to the height of the bars that we expect around this in time. So we are seeing a slow and hopefully we will be maintained ah downward trend in the week to week. But we want to juxtapose that against the ongoing looming threat of the introduction of a highly transmissible variant.

The Omicron variant. And the potential for large increases as has been demonstrated in other countries. Moving to the next slide that basically just shows the week on week ah changes and the percentages for those who are keeping track ah numerically and what we see is that compared with week 52 of 2021. Week one of 2022 had a 53% increase. But as we said that's really just a rebound from those artificially low ah figures that we may have been seeing in week 52. We will see what week two of 20 twenty2 brings in terms of establishing a direction for the current trend. If we move to the next slide we see the same data now aggregated at a monthly level. And what this he shows us is in number of cases that would have been accumulated month by month for all of 2020 and so far sorry for all of twenty twenty-one and so far for January of twenty twenty-two. Um note December has had the highest total of cases that we've had for the pandemic and that's twenty thousand five hundred and thirty-eight. Uh much higher than November which was the previous record holder. November had 14, 032. We will see what trend brings for January.

But to date with just a week and a half or so. Gone in January of twenty twenty-two. We've accumulated nearly 6, 000 cases. So the rates haven't dropped significantly. And we do want to continue to encourage the population to adhere to all of the preventive guidelines to help to reduce the rates of transmission. And beyond the preventive guidelines to adhere to the protective advice and protective resource that we disposal in the vaccinations. Which as Doctor Abdu Richard said help both to reduce your risk of hospitalization and your risk of fatality. So we do want to drive that point home yet again. If we move to the next slide we look at the demographics of those positive. And those haven't changed significantly even with the increasing numbers.

The shape of this graphic has maintained itself and we continue to see that the largest number of individuals is in that 25 to 14 nine year age group and the male female balance is just about equal. Right now we have forty-eight point seven percent men among the positives. And fifty-one. 3% women. If we move however to the fatalities, we do note that the pattern is a little different on the next slide. And that pattern shows that there's a predominant of the fatal outcomes in those over 60. And beyond that in data not shown on this graphic. We continue to re says that those risks are higher in individuals with pre-existing comorbidities and also the risk is higher in those who are not vaccinated. So we want to continue to encourage those who have been vaccinated and who are due for their boosters to make sure to get your booster as scheduled to keep that immune response as strong as possible. Those who have not yet been vaccinated want to encourage you to be vaccinated as it reduces your risk of death significantly. as we look at the threat of ah highly transmissible variant getting into the population.

We do want to take every precaution that we can to reduce our own personal risk. And the risk to those around us. So with that I'm going to conclude the epidemiological update and turn you back over to Mister Alexander. Thank you very much doctor Heinz. And now Minister Dial Singh will provide us with the latest vaccination figures and address current issues relating to the national covid-19 vaccination camp beam. Thank you very much Al. Good morning to doctors Richards and Doctor Hines. Good morning ladies and gentlemen of the media and all persons viewing and listening wherever you are. Uh good Wednesday morning. I'll start off by just giving the vaccination numbers updated as of last. Last evening. Persons who have access two doses of a two dose vaccine. Or one dose of the one shot and done G and G vaccine. Six hundred and 7 seven thousand and twenty persons, which represents about 48. 4% of the population.

So we are we are going up in increments of point one percent per day. yesterday we did notice a slight dip. We were averaging roughly between a Monday and a Friday. of around 15, 16 hundred doses per day. Uh yesterday, we dipped the one thousand three hundred 2. Let's hope this is not the start of a pattern but let's hope this is just a blip on the screen and that we could get back up to around fifteen, 16, 17 00 and hopefully as much as 2, 000 a day. So, we could increase in increments of more than point 1 percent Ah at the point1% is about fourteen hundred Ah considering a population of one point four million. The numbers of persons who are who have accessed their booster shots. That continues to climb by about 2, 000 a day which we are grateful for. It's now ninety-four thousand two hundred and fifty The number of posts, the number of public sector officers who we are tracking are the two sides dedicated to public officers at the campus government plaza campus and Sapa now stands at one thousand five hundred and ninety-six.

Um so that's a good sign. But remember some public officers are accessing vaccines at other sites where we are not tracking that particular data. Uh so that the state of play with vaccinations? Can I have this slide a body booster program please? I want to reiterate to the public the need to be boosted. And the need to be boosted is particularly important now. With the global threat of the Omicrum variant which for those who are paying attention to international news. You will see the Omicron variant is surging dramatically. In in other territories. Um countries are seeing COVID positive cases that they have never seen in two years. We are now in some countries reaching new heights that have never been reached before. And all the evidences suggesting that one of the best ways to protect yourself against the Omnikram variant is to be boosted. Is to be boosted. So the message is for who have already received their vaccination schedule whether it's AstraZeneca or Sinopharm between the first of July to the 30th of July.

Your schedule started on the 8th of January and will run until the 5th of February. All of this information has been published in the newspapers. It is on the Ministry of Health's website. And we have blasted it or put it out on social media. So those who receive AstraZeneca and Sinopharm between the first of July to the 30th of July, please go and get boosted as soon as possible as you schedule allows. For Johnson and Johnson, if you receive your dose between the seventh of November, and the seventh of December, you can go and get boosted again between the 8th of January, which we started last week, Saturday, and the 5th of February.

And you can be stood with either Johnson and Johnson or sinopharm. for some reason a person in the last cycle missed their missed their timetable to go in during the month of January to be boosted. You are quite welcome and we encourage you to come in and still get boosted. So these simple messages if you missed the schedule weeks that you were supposed to be boosted in January. Come and get boosted. And for those who are due to be boosted between the 8th of January and 31st of January. And the eighth of January to the 5th of February sorry, come in and get boosted. Boosting it has been proven worldwide to be effective at giving you that further layer of protection especially with the Omnikrom variant. So, please come in and get boosted and I'll thank you very much and we can now take questions. Thank you very much, Minister. So, our media representatives are reminded to state their name and the name of the media house that they represent. They would be invited to post two brief questions in the first instance.

Please identify the panelist to whom you wish to address each question. Time permitting, we will accommodate a second round of questions. Please note that during this segment, we will be taking a few questions submitted by the media association of Trinidad and Tobago. Relating to the national COVID-19 campaign. We will take our first a question from the Newsday. Right. Morning. Clint Sean. Talk of news. Stay here. Um my questions are for anybody on the panel who can answer them. Uh firstly, is there any sound or scientific justification that you could find regarding the call by not to to close all covid-19 safe zones. Um because they are contending for some reason that this is actually increasing the spread of COVID rather than the opposite. And secondly at the same on an event hosted yesterday. They brought forward. Three people who claimed to be experiencing adverse effects from covid-19 vaccines.

So and that in that context are those cases concerns of these persons. Are they have they been confirmed to be legitimate and is the or is this perhaps some kind of subtle way of pushing a a non-vaccine type of agenda rather than raising genuine the kinds? Okay, with respect to the first part of the question. Uh there is no logical or scientific basis on which to make the claim that the measures to reduce risk during public interaction would be conversely increasing the risk of transmission. What you would see is that if the measures aren't adhered to, if the people trying to find loopholes to escape the various requirements that that would increase the risk but we are going to hope the doers aren't in the majority and to reempha is that all of the requirements for the operation of a safe zone are basically added layers of protection to reduce the risk of an infected individual being in a gathering space in the public while trying to allow for some measure of economic activity and social activity in the midst of the pandemic.

So any attempt that we make, any restrictions or requirements that are put in place to reduce the risk of positive individual interacting cannot lead to an increase. So that that the science behind that doesn't doesn't really make a lot of of sense. Now let the minister respond to the second part of the question. Thank you. I just want to add something because you asked a very good question about NATA score to close down safe zones. I would think as a country we are happy that people are being employed in safe zones. I think as a country we should be happy that are finding ways as we say to live with the virus, to co-exist with the virus.

Um I was quite taken aback by that call because who is going to pay the rents? Who is going to you know put food on the table if we take that court to shut down safe zones. So it's a matter of if I could paraphrase what Doctor Hines is saying. Risk and reward. And at this point in time the reward of having people employed in a safe environment far out re whatever risks there are. To the other part of the question, because you you phrase, you phrase the question properly. Was this genuine or not? So first of all, if it is genuine, we express our concerns. But we have no way of knowing. Because no medical evidence was put forward. There was no doctor's certificate. There was no medical evidence put forward. and that is complicating the conversation unfortunately. And I am hoping that the same way causation was tried to be made with two early deaths a gentleman from Princestown and Franklin Can.

Trying to unfortunately link their deaths. To the vaccine. Which was mentioned on the MFO report as leading to vaccine hesitancy. I'm hoping that these unconfirmed reports and what we would appreciate is the medical evidence, the doctor's certificates that demonstrate or that make a causal link and when I'm finished with my answer, I want Doctor Hines to talk about the difference between correlation and causation. Because two, just because two things happen, close to each other. Which is correlation does not necessarily mean causation. So he would talk a little bit about it. We do have at the Ministry of Health and have had for decades a reporting system to report adverse events brought about by vaccination and immunization. It is not new. What is new is the public interest in it for which I am happy about. So there are three pathways to which we trace these events. Path one is something called E S A V I. It's an acronym which simply means events supposedly attributable to vaccines or immunization.

We also have another pathway AEFI. This is coincidental events. And adverse events of special interest AESI. How do systems work. There are three pathways that we track this. Over the decades, but as I said, because of COVID vaccines and the renewed interest. So if a patient has come down with any adverse event, not side effect, not necessarily peanut, the injection site or simple fever which is resolved. Uh event private sector doctors over the years, report that to the county medical officer of health. Those reports then go to Doctor Heinz's unit, National Surveillance Unit, and it is copied to the expanded program of immunization. It also goes to the Chief Medical Officer and Paho. And depending on if what is being manifested by the patient is an un adverse event not listed in the literature that is put out. It is also reported to the manufacturer. So that's a private sector pathway. In the public sector if you go to an A and E or a clinic it will be reported in the same fashion. Um, through the A and E, the community liaison unit, the public health observatory, it goes to Doctor Hines's unit and so on.

So they are clear pathways for any patient who suffers an adverse event or an unusual adverse event that the doctors and nurses in both the public sector and private sector can send these reports and they will be treated with. So what is interesting is that I I am I am not doubting the the veracity that's something may have happened. But in the absence of a medical certificate stating what happened, it is difficult to make a determination. I will now hand over to Doctor Hines to further clarify the difference between correlation of two events and causation. Okay, thank you minister. I believe you did creditable job in in making the initial distinction. And that is really that you may have two events that occur in relative proximity with respect to time. One happening after the other. But just because that's the sequence does not mean that the thing that happened first necessarily was responsible for the thing that happened. Second. And what would be needed in order to establish that causal link would be really some specialist review of the sequence of events, the types of symptoms, the actual unfolding of the medical event and the test results that would suggest whether or not this is actually related to the pre-existing vaccination event or not.

So there's a lot of additional specialist review that would be required to make that sort of determination. Nonetheless wants something like that is reported. It is clearly one of the things that will be investigated. But while that is happening what we would like to encourage is that individuals not take these reports unconfirmed or otherwise as a reason not to access the vaccination program. Because as I believe you had pointed out recently we've had more than 1. 3 million vaccine doses administered. In that time frame. And by contrast we note that three and maybe every 100 individuals who get the virus will have a fatal outcome. So if we have a small number of adverse events that haven't yet been confirmed out of 1. 3 million, it is clearly much of a higher risk to have the virus than to have the vaccine.

We want to encourage people to continue to be vaccinated because it's definitely providing protection against serious illness and against death. Thank you very much minister and doctor Heinz. We move to TV six for your questions. Good morning. Good morning Alicia. Good morning. Good morning. I just want to follow up on on Clint's question. Now Minister you mentioned the absence of a medical certificate and so on. But one of the claims made by one of those persons would have been she tried to get health officials to report the matters on adverse event. And they refused to do so. So much so that she had to reach out to Pfizer herself. And Pfizer responded. So I wanted to find should we be concerned at least about our claim that it it that event or those events were not being reported to Paho and WHO and what could be some of the reasons as to why health officials would not report such incidents.

So that's my first question. Second question is based on that NATA press conference as well. Um Mister Anna said called for a vaccine compensation fund minister. Um well the establishment of one at least. And I wanted to find out what is your take on that? you. So let's deal with the first issue. Again I I I just want to reiterate that I do not doubt that something may have happened. But in the absence of confirmation it is difficult only impossible to verify the claims being made. Whether the claim is that the vaccine did a BOC or whether the healthcare professionals did not do their job. It is impossible for me. What I can say is that if you ehm if you have the names and addresses on phone contacts of those individuals, we will be more than willing to contact them and uncover the facts.

I think facts are important in dealing with this, rather than claims. Um, I am not downplaying it. We take it seriously, but we need the facts of the matter. So that's my response to question number one. On Question number two, this is not something that I will say only to on the air. This is something that the government will have to consider. Look at the merits, demerits, and proceed. But the conversation now and it and it's unfortunate. That with 20, 30 deaths per day. The conversation in this country is not about getting more people vaccinated. We have had no known deaths and I just did a rough calculation Between first dose, second dose, and boosters. We have administered one million four hundred and forty-four thousand one hundred and seventy-one doses of vaccines. One point four four million. One point four four million with no deaths attributable to vaccination. But every day and 30 people are dying. So unfortunately, the way the conversation has now been framed in the public domain is that vaccinations are something not to be trusted.

And I don't know why that agenda is being pushed. But declare evidence around the world is that vaccination does three things. Because people are asking for guarantees. There are no guarantees. What vaccination does and it promises of vaccination is one is significantly reduces your chance of being infected. And being able to transmit. Two. Significantly decreases your chances of ending up in a hospital and an ICU. And when you look at the dashboard we print every day. The last tile shows you that the vast, vast majority of deaths are amongst the unvaccinated. So if I could use this opportunity Alicia to respectfully ask that we all refrain reframe not refrain. Reframe. R E F R A M E. Reframe the discussions. About the beneficial aspects of vaccination. It saves lives. And with the Omnikrum variant it is showing that boosting is now we need as a society all players and all members to be pulling in the same direction because we are not tug of war with the virus.

We are pulling one way the virus is pulling another way. But if all of us don't pull in the same direction against the virus the virus will win. The virus will overcome us. The virus will overwhelm the healthcare system. lives will be lost, livelihoods will be lost. So if I could just ask the national community and every player, every leader in the national community to pull together against the virus and frame our conversations around the beneficial effects of vaccination. The fact that we must continue to wear a mask because I am noticing when I walk and drive through areas That the population seems to be tired of wearing masks and social distancing and so on. But those things are still important. And there's a growing worldwide tendency amongst the vaccinated. Not only internal Tobago. To think that once you are vaccinated you no longer have to wear a mask and take precautions. No. If I could just give you an analogy and I'm sorry to be so long but I think it's important.

When we travel abroad to the wintry. countries. You put on layers of clothes. You just put on a jacket alone. You put on a shirt, a sweater, you layer up. So think about the public health measures as layers to keep you warm. But then your final, your final protection, that heavy coat you put on. That is vaccination. So let us layer three W's vaccination and we could do very very well with this pandemic. Thank you very very much and I apologize for being a little bit long but think it needed a long answer. Thank you very much. Understood minister, one oh three FM, we are ready for your questions. Good morning. Good morning, everyone. This is Sierra Chandu from 103 FM. Uh both my questions are for the help of minister. Uh first of all, is the health ministry or the CMO's office regularly following up or checking on these private labs or that are accredited to do PCR testing.

The reason I ask is we have a report of a lab mixing up results. So, the lab sent the person a positive result but called and said that he was 100 percent negative. when he persisted in asking if they were sure they did a check and admitted to an error and that he was indeed positive. My second question, there are persons, citizens who do not have the idea of even a birth certificate.

So, what do these persons do if they want to be vaccinated? Thank you. Thank you. So again, the the issue you raised about this one person, it is difficult to verify that type of claim. I suggest you do is send us you can send it to Al. Uh the name and phone contact of that person and we could verify. Uh there are 11 private labs I believe. That are doing COVID-19 testing. It is impossible for me to see what may have led to that. It could have been a false positive, a false negative administrative error. But I cannot here be judge jury and execution on say the lab was at fault. Because I simply don't have the information. So if you send it us. Um we can do that. Um what was the second part of the question? Persons who don't have IDs and wants to be vaccinated.

We are vaccinating persons without IVs. Because we recognize there will be persons without IDs that is more important to vaccinate them than to stand on ceremony and be overly bureaucratic. So you can be vaccinated without an ID as we have been doing. Okay? But those numbers are fairly fairly small. Thank you. Thank you Minister and Chando, you can send your email to corporate dot communications@health.gov dot TT. Uh with that we go to AZP.AZP News.com. We are ready for your questions. Good morning. Privately Harry, ESGP News.com. My first question is for Doctor Hines and my second question I'm already funneled. There are concerns Doctor Heinz that the the 21 day quarantine period might be a bit too long because people who who initially test positive they they are negative long long before that and then secondly people who are primary contacts and and in quarantine. They they feel that they they they're waiting too long after we release. Is anything can anything be done to to get that preorder a much much shorter. And my second question, there was, a study done in Singapore, where, where they, the, the, the, the, the people who had passed away, due to covid-19, and, any type of vaccines that they took.

Um, hopefully vaccinated. And, and passed away. Um, and what I found was that the mRNA vaccines seem to be more effective as opposed to the ones with the own technology. Is that a concern for for and Tobago and is the ministry looking at that issue. Thank you very much. Okay, thank you for the two questions, Mr. Bihari, with respect to the first, we continue to review the evidence, the data globally, internationally on the durations of infectious periods, and the durations of incubation that have been demonstrated as the pandemic unfolds. The isolation period for those who are infected, have been set at 21 days ready to minimize the possibility of someone who is still infectious. Meaning, shedding virus. Being out and about and continuing to contribute to the spread of the virus. While they are ill. Even if they don't feel ill. Now people may test negative prior to that.

But as the WHO itself has actually pointed out the best use of the testing resource at this point in time is not to utilize it for out testing as in testing to release individuals from isolation. So what you do is you create a system that may on the side of caution but reduces the risk of infectious people moving around to the greatest extent possible. We continue to review the data if there's enough evidence to suggest that we would want to shorten the period based on the international information then the period will be adjusted accordingly. That's a continuous review process. Similarly for the period for which individuals are quarantined. When you are exposed not yet infected but you're exposed to an infected person you have the possibility of becoming infected yourself and of manifesting symptoms or a positive test. And the time frame during which that is likely to happen extends to as far as 14 days. Therefore the quarantine period matches that incubation period for the virus. And you were asked to remain out of circulation pending that potential development.

So again as we look at the data if there's any evidence to suggest that It is safe to shorten that period without increasing the risk of transmission. than those those adjustments will be made. But they're not they're not unnecessary and just because people feel inconvenienced by them doesn't mean that they're certainly not valid. Now the second question with respect to the mRNA will assist other vaccines. I think the best answer to that is that whichever kind of vaccine you have the response of your immune system is strengthened by getting your booster. So once you've been vaccinated, you reach full vaccination whether it is with the mRNA, whether it is with the the killed virus, the whole virus.

Whichever vaccine is available and is given to you. Your effectiveness is going to be boosted by continuing with the booster schedule. And therefore the concern that may arise from whether or not one or the other gives you a longer protection. It's mitigated by the fact that there is a booster program and are enough vaccines to provide boosters to all those who have been vaccinated. So we can keep that protection going and we encourage individuals to continue to follow with the with the schedule with the initial doses with the vaccination with their booster vaccinations to maintain the best possible outcomes. Um I I just want to add to what Doctor Hines is saying. Um prior I'm I'm looking here. Singapore's Minister Ong He said, be mindful responding to your question about the report.

This is not a scientific report and these are his words. This is the these are the words of the health minister of Singapore. And it's so unfortunate the way the national conversation has been phrased. He says, be mindful. We are calculating this based on quite a small sample of two hundred and 47 deaths. And this is key lime. These rates are only indicative since they do not account for other factors which can affect mortality such as the age and timing of vaccination. So ladies and gentlemen, I just want to urge us, when we are reading reports, not a cherry pick something to fit a narrative. Look at the entire report. let us make reasonable conclusions and not assumptions And this is these are his words.

These are the words of the health minister of Singapore. Be mindful. We are calculating this based on a small sample of two hundredand 47 deaths. And Doctor Heinz could tell you making assumptions based on small numbers is actually quite counterproductive. And it is worth repeating. The rates are only indicative. Not conclusive, indicative since they do not account for other factors. So, you have to consider everything prior. So, please, I, I, I really appeal to us when we are reading these things. That we read them in the round. And and not make conclusions. Which cannot be supported by the evidence Thank you very much. Thank you minister. We go to Guardian Media Limited. We are ready for your questions. Good morning to the panel. Good morning. So my question is through ah the Minister of Health. So yesterday Guardian Media carried a report that pharmacies were selling rapid anti-gen tests to the public.

Now I noticed one week after you announced that importers could send requests for approvals. So my question is well approvals for this sale given by the Food and Drugs Division in less than a week. And if not how this pharmacy was allowed to sell these tests. Although the pharmacy board had yesterday set a wholesale already had the test. So I wanted to find from the Minister of Health Weed or not, he received these reports and if not, how did it get past customs? Okay. So, the issue of customs is not under the remit of the Ministry of Health. Customs is under the Ministry of Finance. So, I wouldn't be able to answer that. As I have stated, several times, the process for registering rapid antigen tests is a very simple process. It could be done at a couple of days. My information is that chemistry, food drugs has in fact approved rapid antigen tests maybe a week or two ago. So if it's that rapid antigen test it is legal. It is legal for sale. Um so that's the information I can give you at this point in time.

Thank you Minister. Uh we quickly go across to the express. We are ready for your questions. Good morning. Kimball Drum from the Express Um Minister of Health was also either doctors appreciated to weigh in. First of all, just to come back to the vaccine issue. Minister, why we do have an adversary reporting effects thing in place and that's a requirement but for others, you know, we've we've not on we are not unknown for any type of medical strides out there in the world. Why not establish something that is a little more, when I say personal to try not a research center that could take on these types of cases because in media does get a lot more reports and people are not always willing to come forward as these three other young people were and make themselves public but they're claiming to have these severe and well less severe adverse effects for vaccines.

So why not establish something that is our own that is a putting us in a bed would put us eventually in a better position to give better answers to people like this. Also the antigen testing kits they are out there. They are becoming available. A very specific question about that that is happening. What happens when people get there is a margin of falls and positive results of course with those. But what happens when people are getting positive antigen tests at home and negative PCR tests when they test mostly privately that I'm aware. What advice to give to people like that? Because there's a perception that there's a move away now from PCR tests.

Tests towards the antigen test in terms of reliability. It's causing some confusion. So I was hoping for any kind of clarity on that. Thank you. We have a lot to get there. So I have a different perspective. You started off as you and we are not renowned for medical advancements. Um I think the doctors in our public healthcare system and private healthcare system will have a different view. We have pioneered a lot of medical procedures over the years.

I wouldn't go into them. The reporting system is a global system. We are part of a global community. What you don't want is individual countries setting their own standards because all of this information has to go to a global repository. That will feed the purpose of having a global monitoring system. This system is robust. The system has worked for decades. It is just that with the as I said with the COVID-19 vaccine. It is it is it is in the news. But these systems are part of a global monitoring system. And that is what we do. We are part of a global system that reports adverse events of the chain to powerhole WHO and the manufacture us if need be.

On the issue of rapid antigen testing, I don't know if Doctor Hines wants to come in here but I have said and we have all said that the gold standard for testing is PCR. But there is a place for rapid antigen testing. However, the advantages of rapid antigen testing is one price. It's relatively cheap. Two, it's quick. But what you get that you sacrifice and accuracy. And what we ask people to do especially if you get a negative because they are prone to false negatives is that you follow the what a PCR. So I'll turn over to Doctor Hanks to give you a more technical answer on that. It was important to note with the different forms of testing is A when you use them and B how you interpret the result. And one of the important things to notice specifically about the rapid antigen test is clearly it performs better in individuals are symptomatic in giving you an indication of what could be happening with this individual at a given point in time. If you're symptomatic, meaning you're having any of these symptoms that could possibly be COVID.

You have an a rapid antigen test and it's negative. It doesn't mean we'll ignore the possibility of COVID and go about your business. You still would want to then continue on to have some confirmatory result with the PCR. So that you can be guided accordingly. And even in the absence of any test result. If you're symptomatic taken having deteriorating, signs deteriorating symptoms with or without either PCR or a rapid test. We would encourage you to seek healthcare where they can provide a support for you and B the relevant confirmation. So you're not being guided strictly by test results but you're also being guided by the clinical condition of the patient. And just to reiterate that all of this is in the context of interpreting that epidemiological situation. Is the person symptomatic? Were they etcetera. There's a lot that that is factored in beside the test results in making a decision on what to do next once you have tested. And this is why we seek the guidance.

We encourage the population to seek the guidance of the health professionals in both interpreting and then in responding to whatever result they have from whichever test they have done. So I'm hoping that provides a little more context in terms of the testing. Thank you very much Doctor Hines. We'll now move to address some the math questions that were sent to us. First, if the COVID-19 If covid-19 can spread from dry spit. The concern is people spit on the streets all the time. Can COVID be spread in this way? Sometimes you'll take that one. Okay, I think I will take that one. It's an interesting question.

It's one that we had addressed quite earlier on in the pandemic. With regard to the existing public health laws against what we call public expectoration or spitting on the streets. The regulations that have been in place since tuberculosis was a concern. Yes, speaking Streets is a nasty and B against the public health laws and it should be discouraged. But this may not be the most important factor in terms of the public spread of covid-19 at this point in time. So while it is something to be discouraged, we still need to focus importantly on contact with ill people and the hygiene around touching can potentially contaminated surfaces that would be really a little more germain to of risks of transmission and here we want to reemphasize those three Ws. The mask wearing reduces the risk of you putting droplets into the air. And if you have a mask on and you can't spit on the pavement.

The second thing is the hand washing which reduces the risk of touching contaminated surfaces. And they're watching it distance. And on top of that of course we want to continue to encourage vaccination which reduces your risk of being A infected. B ill and C having a fatal outcome. So yes the there's minor concern around that and there is a law against the public expiration but let's keep focused on the three Ws and the very important fee. Alright, thank you Doctor Heis. I want to invite Minister to add the response. No, no, okay. Okay. Okay. Alright. Okay. So, we go to the next question. There's speculation that a young woman who had been hospitalized for three to four months after taking the vaccine died yesterday. It is said that she became paralyzed from the vaccine. Is this true those that report has reached any of our offices through any of the channels that the minister would just have outlined in some detail. Of course, if additional information is available and they wish to provide that through the reporting channels including through the corporate communications division, then, you're free to do so and any such information will be followed up and investigated accordingly.

Thank you, Doctor Hines and again, the Email contact is corporate communications@health.gov dot TT. We move to another has the Ministry of Health being contacted with with respect to the reopening of the beaches in Tobago and the concerns of reef tour operators in light of Tobago's tourism thrust. Thank you. I think I think that one falls in my side of the court. Yeah. So Trinidad and Tobago beaches across both islands are currently open from a BD 5 AM to twelve noon. All beaches across Trinidad and Tobago are open. it's it's it's one country and all beaches are open from 5 AM to twelve noon. Take advantage of it. Um what we are trying to do is to prevent the congregation that tends to happen on evenings with the but you know you know what happens when the sun starts to go down.

And especially with the army cram variant. We have to be careful. So go and take your sea bath. Whether it's for exercise. Just to decompress. Um the whatever. It's it's good. Um on the issue of reef tours. Um that is something that we are always looking at to see which sectors of the economy can be opened up. Um and and we continue to monitor all of these things. So that we could put people back out to work. But in a safe manner that will not overwhelm the healthcare system. Right? So thank you very much Al. Mister final question. There has been a debate on the length of days after testing for the covid-19 virus. Before the virus is detected. Has there been a shift of variance in the number of days of quarantine and the number of days the virus has detected after testing.

Okay so I think we addressed that partially when Mister Bihari's question was answered. Now one of the things that this question focuses on is the time frame between you becoming infected and you having a positive test. And that really just emphasizes the importance of that incubation period that we have you quarantined for. The period during which you may be infected and subsequently become infectious. But initially your test may not show up as positive. So no there hasn't been a shift for all the reasons that we have just described and explained in detail. But we continue to look at the data internationally.

And if there is evidence for a change then changes will be made according way. Thank you doctor Heinz and that's all the time we have for question and answer segment. We thank the media for their engaging questions, our panelists for their responses, and you are viewing and listening public for tuning, tuning in to this update. In closing, we ask that you please continue to protect yourself and your loved ones for and for up to date and reliable information on covid-19, please go to the Ministry of Health's website WWW dot Health dot TT or visit us media handles.

If you haven't received your covid-19 vaccine as yet, please get yours now. Don't delay. Get vaccinated today. We do have two testimonials which we will show right now but for now, from our panelist, we say goodbye. Hi, I'm Anastasia Blackman from Mayaro. And I took the COVID-19 vaccine because I miss my social life. I would soon like to get back to some form of normality. Don't delay. Get vaccinated today. A message from the Ministry of Health. My name is Roberts. I live at Road, New Grant. I'm a member of the Brothers Road Chronic Disease Exercise Class. I took the COVID-19 vaccine because I believe in the science and was afraid of getting sick and hospitalized for COVID. Don't delay. Get vaccinated today.

A message from the Ministry of Health. Hey, yo. Your boy Tim Tim here again. This time, we came to a public park just to ask, what is people's why? Why did they take the covid-19 vaccine? Yes, yes, yes. You might call it .

As found on YouTube

Public Health in an Era of Endemic COVID-19

Hello, I'm Dr. Preeti Malani, JAMA Associate Editor. I'm also the Chief Health Officer
at the University of Michigan and a Professor of Medicine in the
Division of Infectious Diseases. I'm joined by three guests who recently
published a series of viewpoints that describe a national strategy for COVID and
the idea of a new normal as we enter the third year of the coronavirus pandemic. First, I have Dr. Zeke Emanuel, who is the Vice
Provost for Global Initiatives at the University of Pennsylvania. Welcome Zeke. Great to be here. Thank you. And then I have Dr. Michael Osterholm, who's the Director for
the Center of Infectious Disease Research and Policy at the University of Minnesota.

Thank you for joining us, Mike. Thank you. And then finally I have Dr. Luciana Borio, who's the Senior
Fellow for Global Health at the Council on Foreign Relations. Welcome Lu. Thank you so much, Preeti. It's so great to be here. So all three guests are deeply
involved in policy efforts around the pandemic and have served as advisors
to the Biden transition team from November 2020 to until January 2021. The three viewpoints were published online
January 6th and are titled A National Strategy for the New Normal of Life With
COVID, A National Strategy for COVID-19 Testing Surveillance and Mitigation
Strategies, and third, A National Strategy for COVID-19 Vaccine and Therapeutics.

So thanks for joining me. I know it's been such a busy time. If you had asked me last January what
things might look like this January, I would've predicted that things would be a
lot better in terms of COVID case numbers than they are, certainly at this moment,
but even as efforts are focused on getting us through this most recent surge, most
public health experts feel that we are in fact marching towards endemicity and
that vision, the idea that transmission will eventually drop from the current very
high levels, but COVID is not going away is the premise of these three viewpoints. What I'd like to do is explore
some of the practicalities, including how to operationalize
some of the strategies presented. And the first viewpoint outlines the
idea that we are moving from crisis to control and the national strategy
needs to be updated accordingly. Zeke, you and your co-authors write,
“infectious diseases cannot be eradicated when there is limited long-term immunity
following infection or vaccination or non-human reservoirs of infection. The majority of SARS-CoV-2 infections
are asymptomatic or mildly symptomatic and SARS-CoV-2 incubation period is
short preventing the use of targeted strategies like ring vaccination.

Even fully vaccinated individuals
are at risk for breakthrough SARS-CoV-2 infection. Consequently, a new normal with
COVID in January 2022 is not living without COVID 19.” So tell me about
the vision for this new normal. And practically speaking,
how do we move forward? Well, I think the “new” there is supposed
to emphasize we're not going back to 2019, where there was no COVID, we're
going to be in a situation where COVID is going to be around us, it's going to
be one of the multitude of respiratory viral illnesses that we face and it's
going to wax and wane just like flu does, just like RSV does, just like rhinovirus.

And so we need to take that into account. Getting there, we're in far from that
situation at the moment with about 1600 deaths a day, but getting there is
going to require reducing transmission. And that's mainly going to be
done through things like air quality improvements indoors,
wearing asks, and some vaccination to get the incidents level low. Then making sure people
have fewer complications. That's partially the vaccines, which
really are very, very good at reducing hospitalization and death, as well
as the new therapeutics we have. And then it's going to look, COVID
should begin looking like a flu, you get it, you stay home so you don't
infect other people and your family. When you're feeling better, you
can go into work, probably wearing a mask for a few days to again
reduce the chance of infection. And that is going to be more common. We're simply going to get back
to the life that we've known largely with some modifications.

Thank you. So Mike, the US health system does a lot
of things well, but public health is not at the top of that list, yet rebuilding
public health is a key aspect of the strategy described in the viewpoint. What can be done realistically to build
the type of capacity you described? And is this something that should happen
nationally or is it more likely to be successful at the state and local level? First of all, we have to understand
that what we have really seen happen over the course of the past two years
is our healthcare system has been laid open publicly in a way people can see
just the challenges we have in terms of providing care of documenting outcomes
and understanding how we bring those data together to make public policies that
basically are primarily public health related and as well as treatment related.

I think what really is the challenge
here is we've lacked creative imagination to understand what a pandemic could do. A year ago, as I think Zeke just
pointed out and you did, most people thought that we were out of the woods. Some of us said, "Well, with the
variants, maybe we're not, maybe the variants are going to give us some
new challenges we hadn't anticipated." I'm not so sure that's not
the case in the future. I hope it's not, but
hope's not a strategy. And so I think that we still have to
remind the medical care system there is that you'd provide on a day-to-day
basis and there's that you provide on a day-to-day basis during the crisis. And that includes public health. And so I think if nothing else, the
silver lining, if there is one to this pandemic, is it gives us every reason
to go back and reevaluate what are we doing with healthcare or disease care? What are we paying for? What are we not paying for that
could make a difference from a public health standpoint? And so I find this as potentially
either going to end up becoming a forgotten moment we just want to move
on from or it could be a renaissance moment in which we actually go back
and ask ourselves these hard questions.

And now the lessons learned
are right in front of us. They're not imaginary. So to me, I think this is a very
critical time to look at how do we improve the public's health. The final piece, I would say I'm an
infectious disease epidemiologist, but I am very aware of all the adverse health
outcomes that have occurred because we have deferred medical care, we have
deferred many of our public health programs around the world, whether it
be HIV or malaria, polio eradication. And the cost that's occurred
there has been substantial. And so we're also going to have to
understand how to rebalance public health back to a time when basically
many of these issues were not forgotten like they have been during COVID.

And do you think this could
happen nationally or is it going to be more of a local phenomena? Well, I think it has to have
national leadership, but as like with politics, all healthcare is local
in a sense, even though it may be paid for by the federal government. And so I think what we have is
a balance of how do we bring local related activities. And right now, look at what's happening
with our healthcare systems in terms of responding to all these cases of COVID. It turns out in the end, it's local, it's
what assets and resources do you have? Which people do you have that can come to
work today or can't come to work today? So I think it's going to
be a combination of both. It can't be just a top down. And surely, the importance of resources
and national planning are going to be critical for any local group or groups
to come together and say, what is it that we can and should do so that
this doesn't happen in the future? Great.

Let's move on to the second viewpoint. And I'd like to delve into some
of the suggestions outlined, with respect to testing and surveillance. Now, a number of concerns come
to mind, and we clearly need a convenient, easy-to-access testing
infrastructure that also links results to other important data; so
the socio-demographics, vaccination status, and certainly clinical outcomes. But we're a long way from this. So, Lu, what do you think testing
needs to look like for this new normal, and in particular, how do
you build a robust system to deal with the positive results that arise? Yeah. So, that's the hard work. Sometimes we focus so much on
developing the task, the vaccine, or the drugs, but linking the
assets we have, it's the challenge. And I envision that. First of all, I think it's remarkable
that we have now a situation where people are able to do these verily sophisticated
tests at home, and understand whether they might be infected or not.

That's remarkable. I don't see us going back. I think it's going to open up a lot
of novel ways to diagnose diseases at home, at the convenience of the home. But the key, the work of government
I would say, is that they need to… We have to develop a system
around this, so that we can adequately capture the data. And it may require some incentives. There must be an incentive to report
the test; and then, somebody's going to have to aggregate this data, and
create information from this data. I think that in the near future,
one of the great urgencies is to get the results of these tests, and link
them to an action; whether it's to isolation, or whether it's to access
to treatment, as soon as possible.

Because we all know that having a result
is just the beginning, and not the end. Indeed. It'll be interesting to see
how those systems are built. And surveillance goes
hand in hand with testing. So Mike, I'm going to come back to you. What does a comprehensive surveillance
program look like in 2022? And maybe you could talk about
what would be ideal, versus what is going to be realistic. Well, we don't have to capture every case
in disease surveillance to understand what's happening in our communities,
both in terms of the actual number of cases, or the impact that it's having. But we've got to have a representative
sample, and hopefully most cases, to really make that work.

And right now, we have a
system that is so broken. It's hard to believe, but there are
health departments in this country that still receive their reports
on disease cases by fax machine. Right now, I have no sense at all that
the numbers we're getting are reliable, in terms of case reports every day. I've been talking to state and local
health departments around the country, and some of the health departments are
backed up thousands and thousands, tens of thousands of cases, that have not
yet been reported out over weeks and months, just because of the backlog.

And so, one of the things we have to
understand is, big data means also something to public health, in a way
that most people don't think of when they think of clinical medicine. We've got to have a much better way
to both document who's infected, when we do document it, and then to
be able to aggregate that quickly, just like the clinical information. That has been a priority for
public health for the last decade. And yet, it has received little attention. And I think during this particular
couple of weeks with Omicron, it's only become more accentuated.

We've had to go to alternative measures
to understand what's going on in our community: number of hospitalizations,
number of people on oxygen in hospitals, and then unfortunately, even deaths. So I think again, as we pointed out
in the earlier discussion, now is the time for Renaissance thinking,
as it relates to public health. What could we do if we had much
more timely information, and we had more accurate information. So this is going to be something that
is going to be a combined effort of the federal, state, and local governments. And it's got involve the private
sector in a big way, particularly our healthcare systems around the
country, who in the first instance, are where most of these data come from. Thank you. So, Zeke, in the Viewpoint, you write
about encouraging the use of N-95s or KN95s rather than cloth or surgical masks. And, to me, masks have been
really, probably the most interesting part of mitigation.

And if I think back to the beginning,
the message was, "Don't wear a mask. Save the masks." Even, "Masks might transmit
virus if you touch the mask." And then within a few weeks, I also
remember in the hospital, healthcare workers going to universal masking;
and that was a really extraordinary thing, because we were actually very
low on personal protective equipment. And using that mask felt a
little bit like a luxury. And we have learned that masks
are, in fact, super effective when worn properly, especially with
people around you who are masked. But masks are also perhaps the most
contentious aspect of mitigation, maybe even more than vaccines. And there's some practicalities
around distribution and training, but more simply, I just want to ask
more simply, how do you get people to actually do this, especially
when they won't wear a cloth mask? Do you think they'll use an N-95? Well, look. I think this is a case of social norming.

What is expected in society, and what
are you doing as a responsible citizen? Unfortunately, this has become, as
you point out, politicized, and made a matter of a badge of culture; and
that is the wrong way to look at it. It really is, as you
point out, protective. It reduces transmission substantially. But in 2022, we have to be clear:
wearing an N-95, KN-95, KF-94, those are the best masks, and they
ought to supersede all others. How can we social norm that? Well, one thing I have suggested, and
we suggested to the government is, what if you sent out a voucher, so people
could go to a pharmacy or grocery and get 3, 4, 5 of these masks, so that
they could use them free of charge. That would certainly improve the
thinking of the public around them. They would make them easily accessible,
free, and I think much more used.

I would say the other thing
that's very good is a mitigation measure which we have not heavily
discussed, is indoor air quality. We don't have an assurance that
when we go into a building, the air quality is of a very high standard. And if we are going to really improve
for the long term, as Mike points out, the public health around a respiratory
viral illness, is upping the air quality indoors to MERV 13 or better,
is going to be really important. And in the interim, people can use
HEPA filters in school classrooms, in other public places, while we're in
the process of getting these better air filtration handling systems.

Can I just make one other
point, which is to go to this issue of the healthcare system. One of the things that I think
is very, very important, is how we think about telemedicine. We are going to have these crises and
these workforce shortages in different places, and the overwhelming of systems. One of the ways we can pretty much not
address all of that, because a lot of medicine requires face-to-face contact,
especially if you're doing procedures. But there are a lot of things we
can do via telemedicine that we have been resistant about adopting. Medicine across state lines, where
people are able to do it if they're licensed in a state, making sure
liability insurance covers it, making sure you're going to be paid for. But for many, many things, primary
care, a lot of primary care, a lot of mental health; we need to begin
to make that standard, and make permanent the changes we did around
the regulations for telemedicine. I think that'll help us
relieve some of the pressures when a system gets overtaxed. So the third viewpoint focuses on
vaccines and therapeutics, and again, as an infectious disease doctor, this is
one that I'm thinking a lot about this.

In the U.S. at this moment, nearly a quarter of the
vaccine eligible population has still not had a single dose of a COVID vaccine. That number has come down a little
bit, mostly due to the younger kids getting their first doses. But there's very, very little
movement among adults who have not yet been vaccinated. Lu, regarding variant specific
vaccines, you and your co-authors write, "To reduce virus transmission
and infections, next generation COVID-19 vaccines that match circulating
SARS-CoV-2 variants need to be deployed. Genomic surveillance coupled with
nimble vaccine technology allow for rapidly adapting vaccines to
emerging variants.” As I read this, vaccines based on the latest variants,
they sound really great in theory. But to me, the reality feels
different, at least right now. Again, the example that we are in at
this moment, in late November, we are still in the throes of a Delta surge, and
within weeks, we're now seeing Omicron.

Of course, we're not doing
sequencing on everything. But again, who knows
what's going to come next. Is variant vaccine something that
we could do quickly and short term, especially during this phase
of the pandemic where we're still having such large numbers of cases? Yeah, it's difficult to know right
now, because the future is a little bit unpredictable, but I think that it's
important to be able to plan a parallel approach, or we have planned for variant
specific vaccines, because they are the most effective against prevailing
variants, and we have a lot of experience with influenza, for example, should
the virus become a more seasonal virus.

But we also need to pay attention
to more broadly neutralizing or universal vaccines. For one, because this is likely not
going to be the next pandemic, and it's possible that we have another coronavirus
surprise, and it would be really great to have vaccines that would work
against several types of coronaviruses. But also because we can't predict
completely how this virus will evolve. But there are trade offs, right? One type of vaccine is quite effective
in preventing all infections in addition to severe disease and
hospitalization, but very narrow in scope. Others that are broader, there may be
trade offs that may be very effective in preventing serious disease,
hospitalization, and death, but less effective in dealing with all
infections and decreasing transmission. So at this moment, because there are
uncertainties about how this is going to evolve, I think we need to go full steam
ahead with this parallel effort, and it's very important, again, for government,
for the work of government to help these companies establish a framework for how
these decisions are going to be made.

Who makes the decision about what variants
should be included in the vaccine mix, or how are we going to track that? What are the correlates of protection that
would allow us to do a rapid authorization for a strain change, if you will? That work is ongoing. You mentioned the universal
coronavirus vaccine, and you write about that in the viewpoint.

Is this something that you think is
likely in the near future, or do you have an estimated timeline on that? Oh boy, estimated timelines. You're asking somebody who spends
so many years at the FDA, and I'll say they should be as fast as
possible, but no faster than needed. You have to be very careful because
vaccines are given to healthy people, and also, in fairness, what does it
mean to have a universal vaccine? We know that it's not truly universal.

But I think the science is there for us
to develop vaccines that are very good at inducing cell immunity and protecting
us from the worst of this virus. I think the science is there also to
select the epitopes very carefully that will maximize the desired impacts. So, there's always a silver lining, right? I mean, I think that vaccinology has
dramatically progressed in the setting of COVID, because it was necessary to use all
the tools in the box that we have in 21st century science, and I can't think of any
other time recently that we had this type of scientific effort around vaccines and
immunology and manufacturing, et cetera. Agree fully, and if you just step back
and reflect on really what a miracle of science the vaccines have been and
the timeline and the safety and all the surveillance for adverse effects,
it is truly one of many several silver linings from a scientific standpoint.

Well, I would say we should
think about a year ago. A year ago, we just got the vaccines and
they weren't deployed, and we've got very effective, the most effective vaccines
in the world, and we're in the midst of developing variant specific vaccines
very rapidly in just a few months. We've got therapeutics, including
oral therapeutics that we didn't have, we've got these lateral flow at home
tests, which we didn't have a year ago. I mean, there has been a lot of
scientific and diagnostic progress, and sometimes I think in the midst of
it, when we are confronting a million cases and 140,000 hospitalizations
and 1,600 deaths, we often forget how much has changed over time. That doesn't mean we should pause and
be congratulatory, sit on our laurels. We're still in the midst
of a terrible pandemic. But we do need to appreciate the rapidity
with which those things have come online.

Yeah, truly it was unimaginable
in March of 2020, so this is really good to reflect on. Zeke, I want to come back to something
that's more mundane, which is the vaccine verification methods. Again, this is being used increasingly
as an admission requirement to performances, athletic events,
restaurants, and it's layered on mandates at workplaces and schools. Do you think we'll move to a national
electronic vaccine certification platform? We've been resistant to it
under a lot of pressure. I'm not sure I fully understand
the resistance to it. There are platforms out
there in a number of states. But we have very, very good
certification systems up and running in states, and they do work well. You're not required to get an electronic
certificate, you have to access in and download the information, but it is pretty
secure, because you have to use your phone and only you have your phone, so
I think there is some hope that it'll be widespread, even if it won't be national. Yeah, and for people listening
in, I'd encourage you to take a look at the viewpoint.

I think it was really laid out
nicely in terms of the systems. Having been on the other end of doing some
of these vaccine verifications for our students, it's very labor intensive and it
would be great if there was an easier way. We agree. Can I add? Just I think one of the important
considerations here is not what is doable in the sense of science, but what is
doable in the sense of everyday life.

I for one would love to see some
kind of a system where we could know, in fact, what one's immunization,
or for that matter, even if they've previously been infected what their
status is in terms of being protected. But I don't think that'll ever be a
reality just because of the politics. Having served for 25 years of state
and local public health, I have a sense of what plays on the ground.

This one will not play in Peoria. So, I think we've come to
understand what that means. The same reason why we have governors
today who refuse to put into place new mandates around public
events, masking, and so forth in the height of the omicron, because
they'll tell they just can't do it. The public would not accept it. So I think we have to learn from that. We have to understand what that
taught us about what we can and can't do and how we do it. I think the other piece of that is
though, and this is the humbling part about these vaccines, remember
last year, when the vaccines first were approved, we were euphoric. We had these vaccines that were going to
protect us 95% of the time, two doses, we were home free, and then we realized
over time what happens, with potential waning immunity and the potential
need for additional doses of vaccine, we begin to understand more and more
about challenges of what is protection? If you have been previously
infected, what does that mean? And so I think, in a sense, it's a
moment of great humility also, where we have to say, we still have some
really major unanswered questions about what can a vaccine do for us.

How often do you have to be vaccinated? Everyone I think on this screen would
agree, if we ended up having to vaccinate people multiple times a year, which I'm
not suggesting will be the case, but at least some are hinting towards that,
that is simply not doable for the world. It would set up an incredible
double standard that I don't think would ever be allowed. More importantly, look at the fact
that we almost have two thirds of those individuals who have received two doses
of vaccine, they're surely not vaccine hesitant or vaccine hostile, who've not
gotten their recommended third dose.

Why? We have more and more data showing
the improvement and outcomes with that third dose versus the first two,
particularly now against Omicron. So I think part of the sociology of this
issue, the psychology of this issue, is almost as important as the immunology
or the data-driven questions we have and I don't see, right now, that's
there, but I think this is another important part of how we evaluate what
we've been through with this pandemic. Yeah, those are great reflections, Mike. I think it gets back to that notion
too, that the vaccinations are really about protecting everyone around us,
not just a intervention to protect us, and that has also gotten lost sometimes,
although they do protect us very well too.

Yeah, and briefly, I'd like to add that we
have about 25 million children under five years of age in this country, and about
seven million people that are living with immuno compromising conditions, so even
though we'd like to be able to move to the new normal as soon as possible, I think
that one of the barriers to get in there is the fact that we have people that yet
cannot access vaccine yet, and there are people that, despite being vaccinated,
they do not mount a protective immune response, so until we have ample supply
of effective therapeutics, a way to link testing to diagnosis, to therapeutics,
that is going to slow us down to feeling like this is now a new normal.

Yeah, for sure, and that's a great segue
to the last topic I want to talk about, which is oral therapeutics, and this
is another place where we've seen great progress, and I think in the long term, I
am really hopeful that these agents will help decrease the risk of hospitalization
and death in those medically vulnerable patients especially, and for monoclonals,
we've been doing this for more than a year with a lot of success and there are new
data to support outpatient Remdesivir use. That's a little harder, because
the logistics in of course. Just in the last few days, oral
antivirals are starting to become available, but the demand is super high,
and right now, supply and resources for administration are limited. So not just the supply, but the
actual physical ability to get these therapeutics to people. So my last question is really
about how to make this work. These therapeutics are most effective,
as we know, early, so you need early testing, you need to connect people. So how do we do a better job, just
from a practical standpoint, right now, linking the COVID19 testing systems,
with an eye on equitable allocation of these limited resources, and Lu, I'll
start with you, and then maybe the others can add in some of their thoughts.

This is something that the three of us… The six of us, actually, the advisors
have talked extensively about, and it'll be very important, I think, as we
move forward, to make sure that there is access that is facilitated, whether
it's at the infusion center, that somebody can self-refer upon a positive
diagnostic test, if they meet criteria, they should be able to self-refer and
get assessed and treated right there, without having this need to go through
a physician, that, frankly, no, this has taken a lot of time right now for
patients, even when the drugs were in more ample supply, the monoclonals,
sometimes several days elapsed between a patient being diagnosed and then
being referred to an infusion center. So I think that's the key,
of course, in addition to increasing supply significantly. If I could just add a
piece here of perspective. We've all, on the screen here, remember,
unfortunately, very painfully, those early days in the 1980s, when an HIV
diagnosis was in essence a death sentence.

Today, we know that we can do amazing
things with therapeutics to make HIV much more a long term chronic condition,
and that ability to do that can't be lost in what I think can happen with
COVID, and the SARS‑CoV‑2 type illnesses. On a global basis, if we could do, just
as Lu just pointed out, and we can do it if we put our minds to it, understanding
with that creative imagination of just how different the world could be with a one,
two punch of vaccines and therapeutics.

We could do, I think, a tremendous
amount to reduce serious illness, hospitalizations, and deaths,
and what more can we want for? So, I think that this is
an exciting time coming up. It's our opportunity. If we miss it, people will die
unnecessarily and we will continue to deal with the social, economic and
political fallout of this disease. If we do it right, we can do
so much to bring this horrible virus under better control. One of the things that seems to me
that would work well, and it's not going to be stood up overnight, but we
need a system where someone who tests positive, initially it'll be PCR, but
then hopefully, we can get the at home test linked to, if they test positive,
they get a robo-call that tells them how they can get the therapy or the number to
call, as well as how they should isolate themselves, the mask wearing, what they
need to do to take care of themselves.

That's not impossible, right? When you go in, at least I recall, when I
got vaccinated or tested, I had to leave a telephone number and I had to leave
a email, and we could automatically, without human intervention, you've
got a positive, you get not just the result, but information about how to
get the therapy, as well as what to do in the interim to protect yourself. We haven't built that infrastructure. It's not complicated. We know that. Lots of companies bombard you with emails
or text with relevant information, and I think that would be enormously helpful. Yeah, thank you, and again, I
think this is one where different states are doing it differently. In Michigan, there is an effort to
try and provide these antivirals at point of care with testing. I hope that we can get to the
point where we are able to scale this with our community pharmacy
partners, sooner than later. So thank you for this great
conversation and thank you also for the work all of you continue to do. Thank you. Thank you. Thank you so much for having us.

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