Oakland Rotary News

Before letting Past Pres. Peter Sherris introduce our headline speaker, Pres. Dudley felt obliged to recite Peter’s own credits – his distinguished service as a Kaiser Permanente physician and his later work in the field of public health after earning his Master’s Degree from UC Berkeley.

Peter then introduced our speaker, Dr. Monica Gandhi.  She is a Harvard Medical graduate and a member of the UCSF faculty.  In recent years, she has achieved national prominence as the Associate Division Chief (Clinical Operations/ Education) of the Division of HIV, Infectious Diseases, and Global Medicine at UCSF/ San Francisco General Hospital and as the Director of the UCSF Center for AIDS Research (CFAR) and the Medical Director of the HIV Clinic at SFGH.  From the outset of the Covid pandemic, she has lectured and published extensively on the science behind the spread of the disease, mitigation strategies, and natural and vaccine induced defenses.

Her observations and opinions can be seen in their entirety on the Rotary Club of Oakland YouTube Channel, August 26th broadcast.

In response to Peter’s questions, here are the highlights:

Covid pandemic can be compared to the 1918 flu pandemic which killed more people and ended only through herd immunity of survivors since no vaccine was available.

We will get through this due to available vaccines and accelerated natural immunity brought on by the virulent Delta variant. California and Bay are infection rates are relatively low compared to other parts of the country that remain largely unvaccinated.

FDA’s final approval of vaccines is a welcome development. It may encourage 30% of the hesitant population to get vaccinated now. It will also spur many local governments, private employers and other organizations to adopt vaccination mandates.

Our immune systems are composed of B memory cells and T cells.  The memory cells – antibodies that remember and combat pathogens -- naturally decline in number over time.  However, we still retain enough to recognize and adapt to the Delta variant as necessary to ward it off entirely or, at least, to spare the patient from serious illness.  In addition, T-cells that are activated by alarms sounded by the memory cells, are quite effective in killing the Delta viruses even though their outer “spike” configuration differs somewhat from the earlier, less virulent versions of the virus.

Virtually all deaths during the current Delta surge have been among the unvaccinated. Although the number of cases has increased in California, death and hospitalization trend lines have not shown a similar increase.  In short, there is strong evidence that those who are fully vaccinated have no risk of death. 

“Breakthrough” infections among the vaccinated are still rare and, when they occur, cause only mild symptoms in otherwise healthy patients. 

The risk of fully vaccinated adults transmitting the Delta virus to young, unvaccinated children is small.  Originally the CDC thought that vaccinated people could not transmit the virus.  Then it switched to the contrary view last July.  The CDC’s July policy statement is misleading because it is based on viral load investigations that measured the viral loads only at a single point in time early in a vaccinated person’s infection.  Later studies examined serial viral loads and found that the loads significantly declined in three days.  Similar reductions were discovered in culture responses.  In short, an infected, vaccinated person is infectious at most for four days, versus the ten-day infectious span that generally applies to the unvaccinated.

We will not encounter another highly virulent Covid virus because a virus mutation loses some properties when it mutates.  Or, as Peter added: the Delta mutation is the “fittest” in the evolutionary battle for the “survival of the fittest” Covid mutation.

Dr. Gandhi is personally opposed to administering “booster” shots because the vaccine dosages already received per the original emergency use prescriptions are still very effective for the reasons given above.  However, she agrees that boosters should be given to the immunocompromised and to older people who suffer from obesity and similar debilitating conditions.  There is also the ethical issue of sharing existing vaccine inventories with those countries that lack vaccines for initial shots.  Ethics aside, she said “We will get through this faster if the entire world is vaccinated.”

For people wanting to receive a booster, Dr. Gandhi recommends the Moderna or Johnson & Johnson vaccine because there is evidence they are somewhat more effective than the Pfizer vaccine.  This applies to those who received the Pfizer vaccine during the first round.  (When Peter was asked, he added that the issue is probably academic since boosters appear to be unnecessary in providing adequate protection for healthy people against the Delta variant.  Also, even a Pfizer booster will still provide a substantial boost over the already powerful protection of the initial Pfizer shots.)

During the current Delta phase, we should mask up in-doors and seek optimal ventilation.  There is no need to mask outdoors unless in a crowded setting.

To overcome vaccine hesitancy, show compassion rather than demeaning condescension; acknowledge those who are Covid survivors with natural immunity; and support the use of vaccine mandates and passports.  (In 1905, the U.S. Supreme Court held it was legal for a state to mandate vaccination against small pox.)

There is no undue infection risk while flying in a plane. Turn on the ventilation valve above you and wear a mask.  (Peter later added that the other passengers have probably received recent negative Covid tests and planes have superior ventilation systems.)

Later in the meeting with additional time available, Dr. Peter Sherris answered a few more questions:

He advised us to get our annual flu shot regardless of whether we choose not to get the Covid booster shot.

Covid vaccines for children under 12 should be available by the end of the year.  The FDA is undergoing a thorough investigation of this at this time.