In this week’s episode we speak with Claudia Wallis, an award-winning health journalist for Scientific American, about what it is about a person’s genetic make-up that could make them more at risk to COVID-19 than others.
Jeffrey Freedman: Hello and welcome to the RP HealthCast by RooneyPartners. I am your host Jeffrey Freedman.
Jeffrey: As our children head back into the classroom and we find ourselves trying to gain a sense of normalcy and routine in this continuing pandemic, our global experts in science are still trying to determine the best way to combat this virus and to reduce its symptoms. In fact, we have thirty-seven vaccines currently in human clinical trials and at least ninety-one preclinical vaccines under active investigation. So, with all this research and billions of dollars, we should be hopeful that some sort of vaccine is on the near horizon.
Jeffrey: But the reason there are so many different compounds and different approaches to combating the virus is that we still do not know all there is to understand about it. Why are some people super spreaders? Why do some people get much sicker than others? We understand that pre-existing conditions could affect some people’s immune systems, but could a person’s inherent genetic makeup make them more vulnerable?
Jeffrey: Well, to answer some of these questions and explain the science behind this is our guest today. She is an award-winning science journalist, Claudia Wallis.
Jeffrey: During Claudia’s long career at Time Magazine, she served as a science editor and editor at large. And in fact, she authored over forty Time Magazine cover stories in addition to hundreds of other articles. She was the founding editor of Time for Kids magazine. She also served as managing editor of Scientific American Mind from 2015 to 2017 and Claudia is currently a contributing editor at Scientific American.
Jeffrey: Claudia, thank you so much for joining me today.
Claudia Wallis: Oh, it is my pleasure.
Jeffrey: Great. Now, as a science and healthcare writer, you have obviously been covering the coronavirus story very closely. But as I learned from one of your articles, the pandemic became very personal for you right away. You are a New Yorker and you live in New Rochelle. Now, for our listeners not in the area, New Rochelle was the epicenter. It was the first real hot zone in New York. And you wrote about this experience in early March before our shutdown in an article entitled “Life in the Containment Zone.” Can you take us back about six to seven months and tell us how your community changed almost overnight?
Claudia: Well, it was pretty scary. All of a sudden, we got reports that not only was there an outbreak in my city of New Rochelle, which is a small city. I think it is the seventh-largest in the state, but it is not a big city. We got word that there was an outbreak of the coronavirus illness and it was centered less than a mile from my house. There happened to be a synagogue called, I think, Young Israel. An attorney, who was a member of the congregation there, was one of the early people to contract the coronavirus and get sick with COVID-19. He and his family got the sickness and I guess he has spread it to that community within that Jewish center. The governor declared it to be a containment zone with a one-mile radius extending from that synagogue and I happen to live within a one-mile radius.
Claudia: That was pretty dramatic. That was the first half of March, but it was closer to mid-march. Everything that we went through, everyone else has gone through since. It was just that we were a little bit on the leading edge. Anything that I would describe to you, which seems so dramatic then, they shut down all the businesses, no large gatherings, and we were asked to remain at home. Masks, as I recall, were not even part of the picture yet, which in hindsight was a mistake. They even sent in some National Guard to clean certain public buildings. It was really the early dose of what was coming with this pandemic.
Claudia: Personally, I did not feel terrified or anything because I was not part of that community that had the exposure. But it did make me think very long and hard about going to something like a CVS Pharmacy that was just a block or two from the synagogue. I did not set foot in there and normally that was kind of where I go.
Jeffrey: It must have been so scary right in the very beginning. New Rochelle had something like five to ten times the amount of people with the virus than all of New York City, I believe, at that point.
Claudia: Well, I think the statistic I had was of a hundred and seventy-three cases in New York state, a hundred and eight were in New Rochelle. That is well more than half. We were off to a big start. We had three times as many cases as New York City, even though we are less than a hundredth the size of New York City. It was pretty dramatic, but, sadly, the city soon caught up and surpassed us and so did so many other places.
Jeffrey: Absolutely. But your personal connection to the pandemic response does not end there. I understand your daughter is a New York City Contact Tracer.
Claudia: Yes. That is true. I am quite proud of her. She spends her days making phone calls to people who have either received a positive test result and then she has to find out who were their contacts within the previous two weeks and also calling the contacts of people. It is challenging. Not everybody wants to cooperate with those kinds of questions that people feel like they should be more private. But it is really important that people cooperate. I think the contact tracing is one reason New York has done quite well.
Jeffrey: Well, I agree. Hats off to her and the team that she works there. It is almost a thankless job in a sense, but it is so important. I very much appreciate her. Thank her on our behalf.
Claudia: [chuckles] Okay.
Jeffrey: Personally, I head up the Medical Communications Department at RooneyPartners and I am always working on and interested in educational programs for physicians and the health care community. You wrote a fantastic article- Well, you wrote many, but the one, in particular, it says “Why Some People Get Terribly Sick from COVID-19: Beyond factors such as age and sex, underlying aspects of biology and society influence disease severity.” I want to dive deep into this story. You start the article off very broadly with different categories of people who face a greater risk of getting sick from COVID-19. Before we dive into the specifics, you took broadly what are the categories.
Claudia: I think, at this point, a lot of people are familiar with the categories. Being an older person is the single largest risk group. There was a time when the CDC specifically spoke about, I think, people over sixty or sixty-five. We do not really have a hard cutoff anymore. It is kind of like your risk goes up with your age. And then another group, frankly, is men. Men are much more apt to have a serious case and to die of COVID than women are. That has been consistent around the globe.
Claudia: And I think a lot of people are familiar with the idea of what doctors called comorbidities. This means existing conditions or illnesses like heart disease, obesity, diabetes, hypertension, and several others that put people at greater risk. This includes anything that involves a suppressed immune system like people who have had a heart transplant, lung transplant, kidney transplant, and are taking drugs that suppress the immune system. That is another group. There is that whole group of people who are more vulnerable there.
Claudia: More recently, there has been a question about whether pregnant women should be considered to be at higher risk. Of course, there are groups of people who are at higher risk for sociological reasons such as African Americans, Hispanic Americans, and some Native American groups, particularly the Navajos, who have been hit very hard. This is not really due to biology but more other kinds of factors that put them at risk, which we can talk about.
Jeffrey: Yeah, I definitely want to break that down with you. One of the analogies you used, which I thought was great to get this mental picture about all this stuff up, you wrote that an individual’s risk factor stack up like the layers of a Russian nesting doll. I thought that was fantastic. Explain to everybody what you mean by that.
Claudia: Yeah. That idea came to me because I was trying to think about all the things as an individual. If you are one person, you are thinking about yourself, and if you picture yourself as a Russian nesting doll, what is on the inner core of who you are? Your inner core, part of it is going to be your genetics. Whether you have an extra Y chromosome, which is relevant to risk. And a part of your inner core is your age because all your cells are aging according to how many years you have lived. People do age at slightly different paces, but you cannot really escape Father Time. That is part of your inner core, your age. That is gender, age, and genetics. At least three components there.
Claudia: And then as you go outward to the next level, I was thinking of things that you have acquired that were not part of who you were in the beginning, but maybe you have acquired diabetes, heart disease, you have got a lung condition or obesity. That is sort of the middle layer.
Claudia: And then on the exterior, the outer layer of who you are, the you that faces the environment around you. Your exposure to toxins; your exposure to air pollution; your exposure to, in the case of some ethnicities, prejudice, discrimination, and stress that is related to that; and poverty and crowded living conditions. All of those things, including even your occupation. What is your occupational exposure? All those exterior, on the outside of that Russian doll, also play a role.
Jeffrey: That is great. We discussed already a little bit about how age impacts immunity. Can you talk about your research? Do you think this is changing at all as the virus mutates? Are you talking about the severity of illness versus the actual chances of getting the disease? We have heard in the beginning that the elderly are more at risk, but now it seems that a larger percentage of the people that are getting it are a younger population. The kids in college now, for example.
Claudia: Let me answer that in a few different elements. The elderly remain at the highest risk of having a severe case and not surviving. That is for multiple reasons. As we age, our immune system starts to lose some of its oomph. Our ability to generate antibodies takes a bit of a hit. We do not produce them as effectively or as efficiently. They do not work as well. That is why, for example, for people who get the flu shot, if you are over sixty-five, you get a stronger dose. In general, some of my sources said to me that elderly people do not have much of a response to the flu vaccine at all. Our ability to generate these antibodies becomes much lower, and so does our ability to fight illnesses with other elements of our immune system. That is sort of an unavoidable truth except if you really do a great job maintaining your health and exercise a lot, you could probably sustain the strength of your immune system a little bit longer.
Claudia: But the other elements for the elderly, and I will come to the college students in a moment, are just the conditions in nursing homes. We did a poor job as a country protecting people in nursing homes. I think that a huge percentage of cases we have were in nursing homes. I read something like forty percent of deaths, but I am not entirely sure of that statistic. But it is a huge hit and that is because you have people who are not physically strong, so they are vulnerable. They may have a lot of comorbidities. They may have all these different kinds of ongoing chronic illnesses. They are living in very close quarters, in very close contact, and with low paid workers who go in and out, coming and going, and maybe going home to crowded conditions at home because many of them are barely paid a living wage. They are also picking up exposure at home. So, all of that combines to make a pretty dangerous situation for the elderly.
Claudia: However, we have kind of caught up with a lot of it in recent months and there are better procedures in a lot of nursing homes and far more aware of how to protect people. The pandemic has gone on for so long that the warm weather came in, bars began to open up, and all kinds of fun things that young people like doing started to open up. I think that is the reason we have seen numbers get so much higher in young people. Although they continue to have a lower risk of any kind of severe outcome, numbers have gone higher in young people just because of all these loosening up that has happened in the colleges. That is why we see a shift in cases.
Claudia: But still, to emphasize, the young people have a much lower risk of becoming severely ill.
Jeffrey: Got it. You talk about that, also, from a biological front. You wrote about the importance of how B cells and T cells work in the elderly population. You touched upon that. As you get older, the T cells are not there, and are not working as hard. Do you think that is going to have an impact on coming out with a universal vaccine? Are they going to be testing enough on the older population or are they afraid that it is going to skew the results?
Claudia: Let me answer the first part first. I think, among the experts on immune system aging that I spoke with, there definitely was a concern that the vaccine, when we have one, will be much less effective in older people because, basically, all vaccines are less effective in older people. So, why would this one be any different? It is probably not going to work as well in the elderly. But if we get enough people vaccinated and the vaccine is really effective, we will have herd immunity. That will really help the elderly. That will help protect them because there just will not be as many viruses in the environment. There will not be people walking around with active cases.
Claudia: Again, there are a couple of cautions. The vaccine has to be effective, it has to generate a good antibody response, and people have to be willing to take the vaccine, which is another ball of wax that I am worried about. And then the other part, in terms of the elderly, I do not know if there is not enough testing. I doubt very much we will be testing a lot of elderly people to see if they have generated a good immune response. That might probably only happen in a formal trial. That is my guess. The trials, hopefully, will tell us what kind of response people in different demographic groups have.
Jeffrey: Okay. Let us switch topics a little bit. Something you mentioned earlier, I found interesting and, honestly, a little bit scary. Men were twice as likely to die from the infection as women. Can you talk about that data and do you have any hypothesis as to why?
Claudia: Well, I am a mere journalist. [laughs] But I have absorbed some hypotheses from people who would know far more than I know. I can share those. But yes, men are roughly twice as likely to die of the infection as women, but the exact numbers vary from place to place. In Italy, seventy percent of the people who died by the spring were men. In the U.S., it was closer to sixty percent. There is a little bit of bouncing around with different places. However, as to why, it is actually probably a combination of biological factors and social factors.
Claudia: Biologically, we know that the female immune system is simply stronger than the male immune system. Estrogen, the female hormones, tend to amp up the immune system. Androgens, the male hormones, tend to dial it back. Women have a stronger response to an infection in general. There is an interesting hypothesis as to why this is the case. The people I spoke to said that the reason for it is probably because women, when they give birth, have to pass a lot of antibodies and immune warriors over to a newborn. Maybe that is why women evolved with such a strong immune system, perhaps.
Claudia: The downside of the strong female immune system, though, is that women have a much higher risk of autoimmune diseases where the immune system attacks our own cells. That is part of it. Also, men do have more of those comorbidities. They have more heart disease, hypertension, and diabetes at younger ages than women do. When men start to get to about their fifties, they tend to develop a lot more of these conditions, which puts them at greater risk. Whereas women develop these ailments a little bit later. Those are some of them. There may also be genetic factors. There are a lot of genes on the X chromosome that are related to the immune system. There could be other things going on.
Claudia: But just to take a moment to say what the non-biological factors are, there have been studies that show that women are fifty percent more likely than men to wear a face mask, wash their hands, and to avoid public transit during a respiratory disease epidemic. During this pandemic, actually, we have seen that women, just in surveys, seem to take it a little more seriously. I think we cannot discount that kind of element as well.
Jeffrey: I have not had anybody explain that to me like that before regarding the women’s health. That was fantastic. Thank you for that.
Claudia: There are some very smart researchers out there.
Jeffrey: That is very well said. I think that was great. The last topic I want to talk about, you touched upon issues and hazards of inequality and racism. Now, it is tough to understand at times how prejudice or racism can affect health in a pandemic. Can you talk a little bit about this? Do you feel that this is mostly a U.S. issue or has this been seen globally as well?
Claudia: I know it has been seen in the U.K. It was documented there. I would suspect that anywhere where you have a disadvantaged population, it might not be Black-White, it might be Hutu-Tutsi, it might be some other Hindu. I am just expecting. I have not seen the data that anywhere where you have a disadvantaged population, you would see these kinds of discrepancies. But it is definitely documented in the U.S. and England.
Claudia: The person who just did such a great job explaining this to me in my interview with her was Camara Phyllis Jones, who is a family physician and epidemiologist. She is an expert on this. She said racism puts you at risk through two mechanisms. One is a greater risk of getting infected because of exposure at home, on the job, and in the community. I will break that down in a moment. The other is that people of color are less protected. Once they get infected, they are more likely to have a severe case and more likely to die.
Claudia: Why are they more exposed? Well, think of the jobs that a lot of people of color have. Think of where they are living. There is a much greater proportion of them working in low-paid but public-facing jobs. These jobs are all high-exposure jobs and put people at risk of getting an infection. And then if you consider where people of color are more likely to live, a lot of people of color live in high-density, low-income neighborhoods. You might have a large family packed into a small space. There might be multiple generations, grandmother and grandchild living in a small-ish apartment or home. Someone in that household may be going out and doing these high exposure jobs and coming home and bringing the virus home. You have got all of that going on in terms of exposure. Let us say you have got the virus. What happens next?
Claudia: We know that Black Americans have poor access to medical care and that they face discrimination within the American health care system. To be specific about COVID-19, many of the testing sites early on were located in more affluent neighborhoods or required access to a car for drive-through testing. That was not helpful to people who did not live in those neighborhoods or did not have a car. And I would add, also, that Black Americans do have a lot. They have a forty percent higher rate of hypertension, a sixty percent higher rate of diabetes than white Americans. They are also carrying a burden of disease and a lot of those diseases, Camara Jones would tell you, are diseases that are related to poor environment, poor opportunity, poor living conditions, no safe place to exercise, and food wastelands where there is nothing but junk food.
Claudia: There are all these things that come together. There is actually this stress of discrimination as well. And there is a body of research that looks at this. It is almost like premature aging. If you are living with constant discrimination, nothing brings at home more than we have seen recently with the police attacks on young Black men. There is an atmosphere of discrimination and inequity. That takes a tremendous toll on physical health and mental health.
Jeffrey: That stress was certainly brought to light based on those issues. Thank you for that explanation. Thank Dr. Jones for explaining it to all of us. The last couple questions I want to ask you about is a completely different topic, if you will. I know you are a big advocate of stopping the spread of misinformation about the disease and you are also a huge proponent of ensuring that politics stays out of science, and science dictates the decisions of the FDA the CDC of the HHS.
Claudia: Yes. [chuckles]
Jeffrey: You have written about and have known Dr. Anthony Fauci for years. What is your take on all the news right now about the politicization of finding a COVID-19 cure? Do you believe sound decisions based on science will reign supreme at the end of the day?
Claudia: I cannot believe that we are in the position of having to worry about this. I have been interviewing people at the CDC for more than thirty years, and I have noted that with every administration, not just this one, it is more layers of protection there, more difficulty getting to the experts, and finally it got to the point under the Trump Administration where if you want to talk to a CDC expert, your request is relayed to Washington DC HHS rather than going through Atlanta. At least that was what I have been told off the record. It is very politicized, yes. Sunlight, no. I have been shocked by some of the things that have happened in the last few months because as a medical and health reporter, I always thought the CDC was pretty sacrosanct. Sure, they are going to make mistakes, but they are going to correct them as better data comes along. They are trustworthy and always operating in the interest of the American people. That is how I saw it.
Claudia: The FDA has long been subject to the influence of the pharmaceutical industry that it regulates. There has always been tension there. But still, some of the things that we have seen in the last few months, the overblown statement about the benefits of convalescent plasma, for example, was absolutely a wrong statement from the head of the FDA. Completely misstating the data on that when we do not really know how good convalescent plasma is. Maybe it is good, but we do not know that it is great. He had to walk that back. And then we are getting advice, the pressure that was put on the FDA to grant a temporary approval of hydroxychloroquine and that they cave to it for a while. That, also, just blew my mind. That was sheer political pressure on the FDA. There was nothing to support that in terms of high-quality data and that had to be walked back to.
Claudia: And now, with the vaccines, we really already have in this country something like thirty percent of people who say that they will not take the vaccine. We have the Anti-Vaccination Movement that has been going on for years. I have written a lot about that over the years. Now, we have a real need for a vaccine and we need people to believe in it. We need for people to trust it. We need enough people to be willing to take it that will get to herd immunity. But the political games that have been going on with promising a vaccine before election day, frankly, terrifies me. Not only because I personally would not trust such a vaccine, but all sorts of other people will not trust it and it kind of adds to an already bad situation in this country where people are not trusting of vaccines. Vaccines are just about the most powerful thing we have got as a public health tool. If you are going to further undermine belief in vaccines because the coronavirus vaccine gets politicized, that is just a disaster.
Jeffrey: Listen, you are passionate and you are passionate for a reason. We do not want to undermine the words of our leaders and our scientists. If we do not have trust in this, we are not getting out of it. With that, I want to say thank you. Thank you for your passion, for your writing, and for your articles. It is very much appreciated. Great job today. Thank you.
Claudia: You are very welcome. Thank you for asking such good questions. [chuckles]
Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you and we hope you enjoyed the RP HealthCast.