Ask Us Anything About…COVID 19 Variants

Scott Gilbert – From Penn State Health, this is “Ask Us Anything About COVID-19 Variants.” I’m Scott Gilbert. Well, for months now we’ve been hearing about how the COVID-19 vaccines show promise of finally moving past the pandemic. But now comes word that the virus that causes COVID-19 is mutating. Today we’re going to learn what this process means for the pandemic that has lasted for over a year now. Are the mutations another roadblock to getting our lives back to normal? We’ll get some answers today to all of our questions from Dr. Mohammad Ali, he’s an infectious diseases physician at Penn State Health Holy Spirit Medical Center, and from Dr. Wallace Greene, he’s Director of the Diagnostic Virology Laboratory at Penn State Health Milton S. Hershey Medical Center. Gentlemen, thank you both for being here today. Dr. Ali, I want to start with you and ask, you know, despite a steady increase in COVID vaccinations, and we’re seeing the vaccine really get out to a lot of communities, case numbers are also rising right now across Pennsylvania and the US. Do we know why and to what extent are variants to blame?

Dr. Mohammad Ali – Yeah, I think there’s little doubt that COVID-19 cases are going up in several states and I think there are a few reasons for it. First reason would be that this surge is driven by a UK variant, which is doing the same in many other countries, which is perhaps more transmissible, causes a more severe disease. And I think, secondly, we have let our guard down. There is a COVID fatigue which is setting in. It’s been a year, more than a year. States are opening up. There are lifting, some of the states are lifting mask mandates or, you know, the capacity at which the businesses and restaurants are running. So perhaps a few things that are kind of sort of causing this surge at this point of time.

Scott Gilbert – Dr. Ali, another physician told NPR this week that it’s, quote, a race between vaccinations and variants. Do you agree or disagree with that assessment?

Dr. Mohammad Ali – I agree, but there is another part to it. I agree that the more people we get vaccinated, the vaccine gives great protection against even the variant, and we have to realize that people who are vaccinated are really very well protected. But people who are not vaccinated or haven’t had the natural infection are very vulnerable because this variant is more transmissible. So yes, the more we vaccinate, the more people are protected against this virus and the less transmission there would be. But then we have to realize that until we have that number, that magical number that will kind of sort of [inaudible] the transmission, we have to keep our guard up. We have to keep masking. We have to avoid overcrowded places. And we have to [inaudible].

Scott Gilbert – Because Dr. Greene, is it safe to say the more the virus is allowed to keep passing along, the more it’s allowed to mutate? Is there a correlation there?

Dr. Wallace Greene – Absolutely. If the virus is not replicating, obviously, it can’t mutate if it’s not growing. Another thing with this, too, to keep in mind is that this strain is much more infectious and also, we’ve seen this in a number of cases, even though you are fully vaccinated, there have been a number of people who have been reinfected. Mild symptoms, but they, too, could be infectious to people who have not been vaccinated. So even though you are totally vaccinated and you’re going to be around people who are not, all the more reason to be sure and wear a mask, because even though you feel fine, you could still be spreading this virus, especially this UK variant.

Scott Gilbert – A very important message and one that we’ll be reinforcing throughout this interview. It’s “Ask Us Anything About COVID-19 Variants” from Penn State Health. I’m Scott Gilbert alongside Dr. Wallace Greene of Penn State Health Milton S. Hershey Medical Center and Dr. Mohammad Ali of Penn State Health Holy Spirit Medical Center. As with all these programs, we welcome your questions in the comment field, so add them, again, as comments below this Facebook post. If you’re able to do so while watching this live, we’ll pose the questions to our experts live here. And if it’s after the fact, say you’re watching it on playback, we’ll get you a written response. Dr. Greene, virus mutation is nothing new. Is SARS-CoV-2, the virus that causes COVID, simply doing what other viruses do, or are there some differences, here?

Dr. Wallace Greene – Well, yes. Particularly, viruses are divided into two groups, DNA viruses like herpes, and a few others are RNA viruses. RNA viruses are very sloppy when they mutate. They mutate all of the time. All of them do, like, say, with flu, one of the reasons we have to update our flu vaccines every year to get the new mutants. The main difference here with the SARS-CoV-2 is that a mutation, it makes it easier for it to jump to someone who has no immunity whatsoever. The main difference, like, say, between what we’re facing now in flu is most everyone has some immunity to flu. But with the COVID-19 virus, not so much. So a little mutation can either make it bind better to the cells, or it can make it evade the immune system. There’s a number of things these mutations do.

Scott Gilbert – Not sure who to direct this next question to. Dr. Ali, I’ll start with you. Currently, how many known variants of COVID are there in the world? And of those, how many have been detected in the US and even here in Pennsylvania? Do we have kind of a grasp on what that number is?

Dr. Mohammad Ali – Well, not all mutations are important, because not all mutations can make a virus smart, let’s put it this way, in a simple way of saying it. But there are certain variants of concern that the WHO and CDC is looking at. There are several variants of interest. The variants of concern are the UK variant, the South African variant, there is a Brazilian variant, and there are two variants in California. All of them have very good evidence that they are more transmissible and perhaps they are able to evade the immune system. And there are certain variants of interest, like the New York variant, which is also considered to evade immunity to some extent. A variant, which is a P2 variant, which also is considered to evade immunity. But the evidence still is not as good as in variants of concern. So these are the variants that we are, or WHO and the CDC is looking at, and there are some variants which are regional variants which are present in some parts of the world, but they’re not really worldwide, but these variants have shown up in many countries, whichever genetic sequencing and genetic surveillance is happening.

Scott Gilbert – So Dr. Greene, it sounds like the key takeaway from what Dr. Ali just said is that not all variants are created equal. They’re not all equally dangerous. There’s some that we’re looking at more carefully than others, here.

Dr. Wallace Greene – That’s correct, and they’re more common in different areas, like in California there’s two variants there that are causing people in that state a lot of problem. And these, you know, I mentioned these can spread very easily. It was two weeks ago we saw our first UK variant here, okay? That was one out of ten that we had randomly looked at. In the last two runs that we’ve, or actually, three runs, all this week, that’s the predominant strain. It went from one to well over half in two weeks.

Scott Gilbert – You’re watching “Ask Us Anything About COVID-19 Variants” from Penn State Health. We welcome your questions for Dr. Wallace Greene. He’s director of the Diagnostic Virology Laboratory of Penn State Health Milton S. Hershey Medical Center, and for Dr. Mohammad Ali, an infectious diseases physician at Penn State Health Holy Spirit Medical Center. Add those questions to the common field and we’ll pose them, because we know you’ve been hearing a lot about these so-called variants. And what we’re trying to learn more about today is what they mean for the pandemic, going forward. And you know, we did touch a little bit on vaccines earlier, and Dr. Ali, I’ll kind of pose this related question to you, you know, are there any variants of the COVID virus, rather, the virus that causes COVID that are currently circulating that are beyond the reach of the current vaccines that are available? Do we know that?

Dr. Mohammad Ali – So the data about this is still coming, you know, because we’ve just discovered these variants and we’re seeing if the vaccine that totally will work against these variants. What the data we have is that this UK variant, the protection is very good with these vaccines, especially the vaccines that are present, that are being used in the United States, the Moderna and the Pfizer and the Johnson & Johnson. There is a variant in South Africa which some data is there that it might be able to evade some of the immunity and the [inaudible] ability of the antibody that are produced when the vaccine is given is perhaps a little bit low, but it will still give enough protection that it will protect against the severe disease. But this, all of this is initial information. We’re looking at it and similar kind of information is available on the California variant and New York variant, that it’s a possibility that they might be able to evade the immune system, whether it’s through vaccine or if it’s through a natural infection that person had and then developed immunity against COVID-19.

Scott Gilbert – Dr. Greene, how different from the initial virus are these variants? Are any of them vastly different in terms of how quick they spread, who they affect, those sort of things? Because we’re hearing that some of them could be more deadly and more infectious, but I just wonder what your take is on that.

Dr. Wallace Greene – Yeah, particularly the UK strain, that’s our problem right now, you know, if I had to point to one thing, that’s the one to be most concerned about. It’s somewhere between 50 to 70% more infectious. So things that may have been minor risk before, you know, if folks are fond of going into restaurants or whatever, well, the chance of getting the virus if you’re not fully immunized, your chance just went up quite a bit. You know, we hear about the six-foot distance and all of that. I’d much rather think about this as each person with the virus has a cloud around them and the more you share air with that person and their cloud, the more likely you are to become infected. The six foot, that’s a bare minimum. It’s much more, like I say, it’s much more useful to think about a cloud of virus and how long you’re going to remain in that person’s cloud.

Scott Gilbert – Yeah, and I was going to ask about that. Dr. Ali, when it comes to that cloud, I mean, how much of it relates to being around that person, the amount of time that you’re around somebody. I mean, you know, transient contact with, say, a grocery-store clerk versus sitting down at a table and eating a meal with somebody across the table for an hour or so. A big difference there, Dr. Ali?

Dr. Mohammad Ali – Right. I mean, the time that the CDC says that is enough for the virus to actually transmit to a host is about 15 minutes, and that’s cumulative time. Like, if you spend 5 minutes with somebody, then you go away and you spend another 5 minutes with that person and that person infected, that means you spent 10 minutes. That’s a cumulative 15 minutes’ time. So if a variant is more transmissible, perhaps this time will also come down. Maybe if you spend only 5, 10 minutes with somebody who has this infection, you will get the transmission. Distance, yeah, it’s important to realize that even though six feet distance is touted because the respiratory droplets that are considered to be the usual mode of transmission, they can’t travel beyond six feet, but in in my opinion, these viruses are also transmitted by aerosol, which are smaller particles and can go to a distance way beyond six feet. So staying in overcrowded places which are poorly ventilated, you know, puts you at risk, too.

Scott Gilbert – You’re watching “Ask Us Anything About COVID-19 Variants” from Penn State Health. We welcome your questions for Dr. Ali or Dr. Greene. Just add those to the comment field and we’ll get to those here during the course of this interview. We have a question now from Jessica. She’s asking, there are a lot of mixed messages about getting the vaccine if you have had COVID and tested positive for antibodies. What are your thoughts? Dr. Ali, what are you advising patients in this regard?

Dr. Mohammad Ali – If you had COVID-19 and you have recovered from your acute illness and you have done your isolation period, then you can get the vaccine. There is no harm in getting the vaccine. In fact, I’m seeing data that even a single shot after getting a natural infection boosts your immune system way above and beyond the person who has received two shots of vaccine, so it actually gives you more protection. So yes, if you’ve had COVID-19, you’ve recovered, please get the vaccine.

Scott Gilbert – We have another question in the chat and, you know, I’d like to get an answer from you, Dr. Greene. And Kirk just generally is, I can tell he’s a little skeptical of some public health authorities and I don’t think he’s alone in that. People are wondering, where can they get reliable information? The CDC, the World Health Organization, the PA Department of Health? A lot of these organizations seem aligned on a lot of the messaging, but sometimes I think people feel like some things are in conflict. How can people make sense of all the information that’s out there?

Scott Gilbert – Well, even personally, I’m saying some different things than I said a month ago. You know, the CDC, the World Health Organization, as we learn more, we get more data, things change, then we have to upgrade our story. When I go looking for information, the very first place I go is the CDC. They keep things up to date. They’re not afraid to put out a different message once they learn more. World Health Organization, to look what’s happening around the world. Of course, the NIH. Our health department has a very good website where you can get answers to all kinds of questions, particularly about what is the prevalence in your county. So those are my main places that I go. Yes, they have changed their messages, just as I have, because we learn more. This is a brand-new virus. We’ve never seen anything like this before.

Dr. Wallace Greene – So sometimes messages and guidance and even what we learned from the research changes along the way when we’re dealing with a brand-new pandemic.

Absolutely.

Scott Gilbert – Dr. Greene, you mentioned earlier that we’re seeing the emergence of variants not just in Pennsylvania, but actually in our health system. Can you walk us through the process of testing for variants? I mean, in lay terms, what does it look like behind the scenes in your laboratory? How do those tests play out?

Dr. Wallace Greene – Okay, well, at the medical center there’s two ways that we have used for doing this. It’s possible to sequence the entire genome of that virus and look for mutations in there. That has the advantage of you can, any new mutation you’ll be able to pick it up. And then, there’s what do we do in my lab to where we look for specific genes that have that mutation in it. So I’m looking for known variants, okay? I won’t find anything new, but I’m looking for known variants.

Scott Gilbert – Alright. And when you do that, then, can you give us an idea of the types of equipment that you and your staff use for that? I mean, again, without being too technical, which I realize is tricky, but I’m sure a lot of folks kind of wonder, what does that look like behind the scenes?

Dr. Wallace Greene – Okay, well, we’re fortunate in my lab. We’re actually out on the cutting edge, which is where I rarely like to be. I always say, “That’s where the blood is.” But for this virus, that’s where we had to go. You have to take the specimen and you have to extract the RNA. It takes about an hour. Then you have to amplify all of these different gene mutations that you’re looking for. That takes a couple of more hours. And then you prepare that to, actually, we’re using a mass spectrometer, to where that will, all these different little genes, the variants, they will have different molecular weights, and it’ll give you peaks. So then we look at our printout and it, depending on where the peaks are, that will identify the specific mutation. It didn’t take me long to say that, but that’s about eight hours of work.

Scott Gilbert – You summed it up well, very succinctly. Dr. Ali, I’m curious to get your take as an infectious disease physician, what does the future of COVID vaccination look like? You know, just as the flu vaccine is different each year, will COVID vaccines in the future, will there be COVID vaccines in the future, I guess I should ask, and if so, will they be changed to keep up with the newest strains and how much of a challenge will that be?

Dr. Mohammad Ali – I think it’s difficult to compare flu or influenza with COVID-19 because they’re kind of sort of different viruses and flu mutates more often than COVID-19 virus. But what I think needs to happen is that we need to do more generic surveillance of this virus to find these variants early and to find out what properties they have, if they are more transmissible, if they cause severe disease. And if we are ahead in this process, then we can eventually tweak our vaccines accordingly. But at this point of time, I don’t really feel that we’re doing enough genetic surveillance, and perhaps it’s kind getting better now. We’re doing more specimens now as a country, so perhaps it’ll get better. Genetic surveillance is very important, but yes, of course, with this mRNA platform that we are using, it’s relatively easier to tweak these vaccines. But still, it has to go through the process of, you know, the clinical trial, phase one, phase two, and phase three. But it’s a possibility that we will have to tweak our vaccines and, in fact, Moderna just announced that they are, or I think both the manufacturer, Pfizer and Moderna, they’re in the process of doing a separate vaccine for the South African variant.

Scott Gilbert – We have a question now from Shannon. She’s asking, have any of the vaccines for COVID actually passed the FDA yet? And I think perhaps what she’s getting at is maybe the difference between emergency-use authorization, which these vaccines have, correct? Versus a more permanent form of approval. Dr. Greene, what do we know about that?

Dr. Wallace Greene – It’s my understanding that the vaccines are all emergency authorization so far, and as far as the diagnostic test, only one has full FDA approval out of dozens. That’s a high bar to cross but, you know, we have vaccinated millions of people, and absolutely people should be getting vaccinated. It doesn’t matter which vaccine, either. Don’t wait around to choose. Whichever one’s available, that’s the one that you want.

Scott Gilbert – So Shannon sent a follow-up comment. She said, “Wondering, because as far as I’ve heard, they’ve not been approved by the FDA.” She says, “Until they are, I will not get anything put into my body.” I don’t think Shannon’s alone in that. Again, you hear this concern. You see it on social media. Dr. Ali, what is your response when patients express skepticism and say, you know, emergency-use authorization, wait, this vaccine came about really fast. Are we sure it’s safe?

Dr. Mohammad Ali – Well, I tell you what. The full FDA approval requires a lot of time, perhaps 18 months, 24 months, because they will have to follow the vaccine and the adverse effects for 2 years, maybe, maybe 18 months, to give it a full approval. We really do not have that luxury of time, you know. We are seeing spikes. We have had, what, 30 million cases in the United States. So we cannot wait for the full approval to come, because people will fall ill and people will die. And with these new variants, surely it will amplify. So in my opinion, what we have seen in the previous vaccine is that if you’ve not seen side effects initially in first few weeks after the vaccine, usually these vaccines are safe. There’s no long-term issues with these vaccines. But the full approval requires time and requires surveillance, months and months of surveillance that we are doing. And we’ll get there, but at this point of time, really don’t have the luxury to wait until the full FDA approval comes along.

Scott Gilbert – Dr. Greene, looks like you have something to add.

Dr. Wallace Greene – Let me throw in with that, right now, where we live, we have the variant, the UK, that is far more infectious, causes more severe illness, and it also causes it in younger people than what we saw with the original. And we know that all three vaccines are very effective in protecting against that. I would certainly take my chances with the vaccine over that particular variant.

Scott Gilbert – You’re watching “Ask Us Anything About COVID-19 Variants” from Penn State Health. We welcome your questions for Dr. Mohammad Ali. He’s an infectious diseases physician at Penn State Health Holy Spirit Medical Center. And Dr. Wallace Greene is director of the Diagnostic Virology Laboratory at Penn State Health Milton S. Hershey Medical Center. Add your questions in the comments section, as so many have done. We appreciate the comments that have come in so far. I like that we’re seeing some honest concerns and questions come in, because we know that people are worried, people are downright scared, not just about the virus, but about the vaccine. The whole reason we’re doing this forum is to try to get those concerns addressed, so thank you again for bringing those questions forward. What does the emergence of COVID variants tell us about the importance of continuing to wear masks and socially distance? Dr. Ali, if I remember what you said earlier correctly, you’re advising that people still do this, but then that raises some questions about guidance, that even the CDC has come out and said it’s okay for grandkids to hug their grandparents. My kids just hugged my parents last weekend. Is that still a safe thing to do, given what seems to be the increasing presence of variants?

Dr. Mohammad Ali – What they’re saying is that if people are fully vaccinated, they can gather in small groups and they don’t have to wear masks, if people are fully vaccinated. And if you are fully vaccinated, you can meet other people, perhaps just one family, but you have to be sure that none of them are at a high risk of getting severe infection, and you can meet with them without masks. As we have more information and we get more information that perhaps the vaccine also prevents against any kind of infection, and perhaps decreases transmission of virus, then perhaps things will open up, but until that happens, please just follow the guidance and just follow the CDC or the NIH guidance on it. At this point of time, we cannot just let our guard down and open up the society, as we’re seeing in some parts of United States.

Scott Gilbert – We have a question now from Deb. She’s saying, “I’ve heard a lot about different side effects with the shots. How do the side effects affect people who have low immunities or have some health concerns?” So I think what she’s asking is if people have some immune issues, could the vaccine actually cause worse problems for them?

Dr. Mohammad Ali – Are you asking me?

Scott Gilbert – Sure, yeah, I’m sorry. I didn’t really direct that anyone, but if you’d like to take a stab at that.

Dr. Mohammad Ali – Yeah, so the reaction that you get with the vaccine, it’s called reactogenicity, which means that the body is recognizing the spike protein, the message that we have sent the cells to make. The immune system is working to produce antibodies against it. And whenever you have such kind of reaction in your body, you will have some side effects. And side effects usually are pain in your arm, low-grade fevers, aches and pains. These side effects starts any time, like, 12 to 24 hours after the shot and then go away in a few days. But as far as the contraindications are concerned, the only contraindication is that if you’re allergic to any of the vaccines or any of the ingredients of the vaccine, then you should not get the vaccine. Other than that, there are no absolute contraindications. Again, here’s the question. If you’re worried about getting some mild adverse effects after getting the vaccine, what would we feel about, you know, getting the actual virus, which is a very unpredictable virus. It can put you in the hospital. You can have bad outcomes with it. So essentially, the vaccine has some side effects with it, but nothing that will stop someone from getting vaccinated.

Scott Gilbert – A good follow-up question from Deb. Actually, I’d like to direct this to you, Dr. Greene. If I become fully vaccinated, can I get it again? Can I get COVID again?

Dr. Wallace Greene – Yes. Well, you can have symptoms of the virus again. We have seen that there at Hershey, symptoms that the people, the employees have gotten have been very mild, a little stuffiness, maybe a mild headache, but we have found that they are infectious. And also, with the previous question about if you’re, have immune issues, like, I am 66 right now. That means my immune system is not what it used to be. And we looked at this in my lab. I’ve got techs that are in their 20s and then I’m at the top of the chain there, but when we look at antibodies, the younger techs had more severe, well, yeah, they were really sore. They had headaches. Some had a mild fever for a day, less than a day. I had absolutely nothing. When you look at my antibodies, I had lower antibodies than they did, so a good immune response. It’s worth being down for a day to get a great immune response. That actually is a plus.

Scott Gilbert – I know that the stated purpose of this program is ask us anything about COVID variants. We’re talking some about the vaccine, though, and there’s some really good questions in the chat about the vaccine, so I do want to ask another question. That is, Dr. Ali, if someone’s had the virus and recovered. how long after symptoms subside should they go forward and get the vaccine? Because we know that someone who has had the illness should still get vaccinated, correct?

Dr. Mohammad Ali – Yeah, so the recommendation is that once you have you passed the acute illness, you don’t have any fevers for 24 hours or 48 hours and you have passed your isolation period. And the isolation period would be different for somebody who had a mild infection. The isolation period would be 10 days. Versus somebody who had a severe infection and ended up in the hospital, the isolation period would be three weeks. Once you have passed that stage and you do not have any symptoms of COVID-19, you can safely get the vaccine without any issues. And I also wanted to add that vaccine protects against symptomatic infection 95% of the time and protects against severe infection 100% of the time. That is a big difference. You can get asymptomatic infection. You can get mild symptoms like a cold and they’ll go away. The major problem with this virus is that it puts people in the hospital, make some very sick, and that is, the protection with these vaccines is great. That’s what we have to focus on, in my opinion.

Scott Gilbert – You know, we’ve had a couple of questions in the chat, or I should say a couple comments, noting something that people bring up from time to time, and that is, hey, COVID’s got a survival rate of well over 99%. But Dr. Greene, can you talk about kind of why it’s still something we’re taking so seriously, even if the survival rate is that high?

Dr. Wallace Greene – You know, in my whole life, flu has been my main concern in the wintertime. A normal year, we would lose 30,000 people to flu. On a really bad year, it could be 60,000, and I thought that was horrible. Here we are headed at 600,000. And survivability, that’s not the only marker. People who are in the hospital, they recover, they often have permanent organ damage, the lungs, kidney, neurologic issues. There’s more to this after you recover than just death. Well, if you’re dead, you don’t recover. But there’s more to it than just life and death. This can have long-term permanent sequelae.

Scott Gilbert – So-called long-hauler syndrome.

Dr. Wallace Greene – Exactly.

Scott Gilbert – Dr. Ali, are you seeing a lot of that in your clinic?

Dr. Mohammad Ali – Yes, I mean it is very important to realize that getting COVID is not a binary thing, either you survive, or you don’t survive. You know, people who get ill, they have these symptoms for weeks and weeks. Fatigue, not able to do whatever they were doing before, shortness of breath, wheezing. And I’m seeing many people who come to me, they connect to me over emails or send me messages that they’re still not 100%. They’re not there. And there are lots of them that have this issue, and even people who had mild infections end up with long COVID symptoms. So again, we have to not think about this disease in in binary terms. I don’t think that’s the right way to look at it.

Scott Gilbert – And even if you do look at the death rate, as Dr. Greene pointed out, 600,000 deaths in just over a year is staggering for any illness. We have a question now from Eric. He says, “I got my first Moderna vaccine almost four weeks ago. My next shot is on Monday. How protected am I today?” So approximately four weeks after shot number one, maybe he has plans for this weekend and he wants to know how protected is he? Dr. Greene, what’s your take on that?

Dr. Wallace Greene – Well, we do know that there is some protection. The main thing is we don’t know how long-lived that is and it’s not as good as it can be. You do have some, like you say, some, I know in Canada they were thinking about, well, let’s just spread this out and give everybody one shot and we’ll get the second one later. We chose not to do that here because we have good data that if you get two shots, your protection is much better. But there is some after four. Now, having said that, you know, this is like I said before, we know that from the original strain. I don’t know how that works with this UK strain.

Scott Gilbert – I do want to go one more question here before we wrap up, and that’s a good question from Sean asking, are you noticing different symptoms with different variants? We did touch on this a little bit earlier. Dr. Ali, I guess it probably still takes a test, though, to determine what variant or what variant of the illness somebody has, is that correct?

Dr. Mohammad Ali – That’s exactly right, because until we know that the certain patient was infected with a different variant, we won’t know that upfront. And we probably are not doing as many gene sequencing or genetic surveillance as we should be doing. So I really, I’m not sure about this because I haven’t really seen patients with, or I knew that they had a variant, that I would go over these symptoms and find out if they’re different symptoms. But what I’ve read about from other places, other countries who are doing these variant surveillance or genetic surveillance more often is that there is not a whole lot of difference in the symptoms, but it is affecting the younger population more severely than the wild type. That’s the take-home message that I’ve seen in other countries.

Scott Gilbert – Well, I want to thank you both for taking the time here. This has definitely been one of our longer ask-us-anything-about interviews, but also one of the most informative. So thanks to both Dr. Mohammad Ali, an infectious diseases physician at Penn State Health Holy Spirit Medical Center. Dr. Wallace Greene, Director of the Dynamic Diagnostic Virology Laboratory at Penn State Health Milton S. Hershey Medical Center. Thank you both for your time today. Thank you for the great questions. If there are any questions that are still coming in that we didn’t get to, we will address those and response in the comments section. So again, thanks to both of you for your time and thanks to everybody for watching “Ask Us Anything About COVID-19 Variants” from Penn State Health.