When could we reach herd immunity?

The clinic was first set up for teachers and child care workers, but since there are slots left, they're opening it up to those 50 or older.

Video Transcript

BILL MCKEON: Thank you all for joining us. As we've done all along, as there's changes in vaccinations that are available to the public, we thought it would be really helpful, as a service, to bring some of our experts from the Texas Medical Center to share their thoughts with you and their expertise on the topic.

I'm joined here today by Dr. Paul Klotman. He is the President, CEO, and Executive Dean of Baylor College of Medicine. I'm also joined by Dr. David Persse. He is the Chief Medical Officer for Houston Health Department. And also by Dr. Esmaeil Porsa, who is the President and CEO of the Harris Health System. So thank you to my colleagues for joining us.

I'd just remind the media that there are-- the two visines-- I'm sorry, the two vaccines that we started with, both-- the Pfizer was intro-- was approved in December 11th of 2020. We also had the Moderna vaccine in December 18th. And just recently, February 27th, we have the J&J vaccine. And I thought we'd start off with Dr. Klotman taking us through the technology behind the J&J vaccine.

PAUL KLOTMAN: Sure, thank you, Bill. So it's exciting to have the Johnson & Johnson vaccine available. It's a different technology from the Pfizer and Moderna vaccines. It uses a very common DNA virus, adenovirus, that we often get as children. It's very common in daycare settings.

But that is to the most common adenovirus, adenovirus-5, that comes in many, many varieties, many, many varieties. So they-- Johnson & Johnson used a fairly rare one that people usually don't get, adenovirus-26. And the reason for that is when you want an immune response, you want it to-- the protein, the thing you care about, which is a spike protein, you don't want a big immune response to the adenovirus itself.

But it's a great delivery vehicle. It is like a transport, jumbo-- as cross-molecular virologists, we love to use it because you can put anything in it. It's like an empty airplane. You just fill it up with your-- whatever you want to fill it up with.

And so what it's carrying is a double-stranded DNA molecule that encodes the spike protein. So the adenovirus attaches to a cell, an immune cell, and injects this double-stranded DNA. That has to be transported into the nucleus, where it is transcribed into RNA and then transported back out into the main part of the cell, the cytoplasm, where it then produces the spike protein.

Whereas, the Pfizer and Moderna, there are just RNA molecules that are carried by fat droplets infused with the cell. The RNA goes directly into the cell cytoplasm and creates the protein. So there's a little extra step that has to be trans-- for the adenovirus, DNA molecule has to be transported into the nucleus and then out to the cytoplasm.

The good news is it's incredibly easy to create-- make these. It's the easier manufacturing process. Much more stable. It's stable in a freezer for a long period of time. And it can be kept in a refrigerator for three months. So it can be stable in a freezer for two years.

So the ease of giving this out and broadly distributing it to local pharmacies, and grocery stores, and other community vaccine distribution sites, it's so much easier, which is why it's desperately needed. I mean, it's been great to have this new platform of RNA technology.

It's-- it's really cool. It's great to be able to change it very quickly and manufacture these. But it's very difficult to give-- to give out, because of the ultra-cold storage requirements, which is why it went to hospitals and medical centers first.

So having the Johnson & Johnson vaccine is a real game changer. It's really, really important. And the data are pretty equivalent. There's some-- some data that says it's slightly less effective for mild-- mild symptomatic data. But it's comparing-- they're not the same studies.

This-- the adenovirus Johnson & Johnson vector was-- that vaccine was tested in a number of different countries, including South Africa, where the South African variant is prominent. And all the vaccines are equally effective at keeping you out of the-- keeping you out of the ICU and preventing death.

So it's a real game changer. It's fantastic to have it available for physicians and for the patients. And I'm very excited to have it finally introduced. And I'll stop and take questions later.

BILL MCKEON: OK, great. Thank you, Dr. Klotman. Dr. Persse, you've been leading us relative to the city and county coming together with FEMA and delivering this vaccine to the market. And I think you've done a very clever job in the way in which you presented-- communicated to the public, obviously, the difference of a one shot versus the Moderna and Pfizer two shots. Can you tell us how that is proceeding?

DAVID PERSSE: Sure, but first, Bill, I'd like to thank you and the entire TMC leadership for all the work you've done, really for a year now, in bring us all together and having all the medical institutions across the area function as one team. And we've had a lot of synergies.

And so here's another example today, as we're talking about the Johnson & Johnson vaccine. But one thing I want to point out is that we're-- we're having this conversation at a time when the landscape is changing a little bit.

And when I say that, what I mean is for the last number of months, we've been dealing with one form of the virus. Now, we've come to know that there are variants that are in our community. And in particular, the UK variant, which we're finding in our wastewater.

And that's another example where Houston and Southeast Texas have really led the way in many respects in this pandemic response. So our community was the first, probably in-- well, we helped develop-- our colleagues at Rice University and Baylor helped to develop a new technology of being able to examine wastewater samples to see how much viral load there was in there and the particular types of viruses.

And so what we're learning now, over the last month or so, is that we've been able to detect the UK variant. We've also detected the Brazilian and South African variants as well. We aren't at the point yet where we can quantitate that, but we've noted that we've got up to 19% of the virus that has been found in the wastewater does have the mutation that's consistent with the UK variant.

That does not mean that 19% of the people in Houston are infected with the UK variant. That's-- that's a-- that would be an assumption which we cannot say. But what we can say is that there's a fair amount, there's a respectable amount of it out there.

And so this is important as we talk about the J&J vaccine, because we have to consider the fact that, and [INAUDIBLE] the race is on, right? So we do have a solution finally here in the United States and across the globe, and that is vaccines.

And as Dr. Klotman pointed out, there are several advantages to the Johnson & Johnson vaccine from a production standpoint, from a distribution standpoint, and from a public use standpoint. And so what we at the city of Houston have done is we've recognized that there is some confusion in the public about the different vaccines. That's why activities like this that we're having today, working with the TMC leadership to educate the public, is so important.

So I want to reinforce something that Dr. Klotman said. At the end of the day, all three vaccines that are available now are very, very effective at keeping you from being sick enough to require hospitalization and keeping you alive. So there may be nuances that we-- that deal with-- that statistics look at.

But as Dr. Klotman pointed out and I want to reinforce, the studies were not designed exactly the same. So the numbers that you get, when you start comparing the 72% to 94%, you're not doing apples to apples. Well you, may be doing Granny Smiths to some other kind of apple, but it's really not a fair comparison.

And then the other thing, and Dr. Klotman pointed out this too, is that the Pfizer and Moderna vaccines were being tested prior to some of the variants that had came out. So another reason to not get too lost up in the numbers, but what Dr. Klotman said, and what we've learned, and is so very important is that, at the end of the day, all three of these vaccines are very, very effective at protecting you from getting sick enough to require hospitalization and from protecting you from dying. And that's really the important thing.

So we understand that. But we also understand that people want to have a choice. So we, at the city of Houston, what we've done is we've now created two different wait lists that you can sign up for. The one that we've had ongoing, where you can get the Moderna vaccine, which is the one that we got initially, but instead of mixing things up, and having it so that people didn't know which vaccine they were going to get, and if they really had a preference, we've actually set up a separate waitlist for the Johnson & Johnson vaccine.

Now, a couple of things to keep in mind. Right now, we are still getting a lot more of the Moderna vaccine than we are the Johnson & Johnson. So it's going to take people maybe a little bit longer to get that. But the federal government and the manufacturers are doing a really good job of getting us more and more vaccine coming into the community every week.

So this is how we've chosen to address the public's needs and their desires, while at the same time doing everything we can to get people vaccinated as quickly as possible. Because as I said earlier, the race is on. Now back to you, Bill.

BILL MCKEON: Thank you, Dr. Persse. We look at the statistics today, that 9.4% of the US, of Americans, have received one dose. And now it's 18% have received two doses, which led to many questions and asking for guidance of the CDC for those of us that have had vaccines. And I thought Dr. Porsa could take us through some of the new guidance that the CDC came out with just two days ago. Dr. Porsa.

ESMAEIL PORSA: Sure, and thank you, Bill. Let me start, as I always do, by thanking all of our frontline staff, but more specifically our health care providers-- nurses, doctors, techs, everybody else in our hospitals and clinics that have been the front face of our health system, taking care of our patients over the last 12 months. Their work is really nothing short of heroics. So I want to take this opportunity and thank all of them on behalf of our communities.

To your point, Bill, and actually very, very exciting, the CDC recommendations just came out recently. Really, in a way, two things-- recognizing what you heard from Dr. Persse and Dr. Klotman about the effectiveness of the vaccines that are currently in use, all three of them, number one. And then the science behind it.

But number two, in a way incentivizing the behavior of folks seeking the vaccination. I think everybody-- all of us heard-- have heard folks complaining, well, nothing changed. And they'll be getting vaccinated, and you're still telling us to wear face masks, and social distance, and this and that, and absolutely true.

So these new guidelines that just came out informing those who have been fully vaccinated, and they're describing that by anybody who is post two weeks after their second dose of the Moderna or Pfizer vaccination, or two weeks after the vaccination by J&J, if you're in a community, a small community of everybody is being fully vaccinated, you're no longer required to wear face masks or socially distance, which is great news.

But also among those who-- there is a combination of folks who are vaccinated or aren't vaccinated, as long as folks who are vaccinated are mingling with unvaccinated people from a single household, who are also at low risk for severe COVID-19, it is also OK for them to interact without the face mask or social distancing.

And really, also important is those who have been fully vaccinated, based on the definition that I just mentioned, if you do [INAUDIBLE], but there's a potential of them coming in contact with the COVID-19 patient, ie, you've been exposed to COVID-19, there is no need for quarantine and testing after an exposure.

All of these are hugely positive and are great news. And I know I was very excited when the recommendations came out, but for the same reasons that was just mentioned. And if I may, Bill, just very quickly, to echo what Dr. Persse said about the race that is on, and the opportunity and the challenge that we have right now at this juncture in time.

We now have three very, very effective vaccine. The number of people who are getting vaccinated is going up. I just mentioned, the CDC guidelines. However, we are still in a situation where the number of cases, new cases of COVID-19, are more than twice of what they were before this new third wave of the COVID-19 pandemic, both in the hospitals and in our community.

So while it is true that we have the vaccines, and people are getting more vaccinated, and we have the new CDC guidelines, to the mantra that the race is on, this is a really, really important time for us to continue doing things that have allowed us to be successful up to this point-- wearing of the face mask, social distancing, washing our hands, remaining home when we don't need to be out there, remaining home when we're not feeling well, all of those things. Until we get to a point where a high enough percentage of our population has been vaccinated so that we can more and more experience the quote-unquote normalcy prior to the COVID-19 pandemic.

And just one more additional point, Bill, if I may. I am thrilled about the fact that the city and the county are able to vaccinate large numbers of people in their mega sites, the vaccination. But as I think everybody can acknowledge, there are some issues with that in terms of the people who may be at the very high risk of COVID-19 infection, who may not be able to use the transportation that is needed to-- to get to the megasites.

And that is the importance of safety net institutions, like ourselves, Harris Health System. We currently have 11 vaccination sites that have been strategically and historically placed in the communities that have high percentage of the same population that has been negatively impacted more severely from COVID-19. Those are the racial minorities, the indigent, the under-insured, the uninsured.

So I think you having the megasite is part of the solution. And when you bring into it that the safety net institutions, like Harris Health System, where we are integrated into the communities that are most negatively impacted by COVID-19, when you put them together, that's a comprehensive solution to this problem. Bill, I'll stop here. And then, like others, I'm happy to answer any questions.

BILL MCKEON: Sure. Thank you for that, Dr. Porsa. And just for staff-- for our colleagues in the media, just in the last month, we've gone from 90,000 vaccinations a week up to now we're over 232,000. And what's exciting about that, and to Dr. Porsa's comment, is you remember that the original mRNA vaccines, the Pfizer and Moderna, showed up at the hospitals because we were first going after health care workers.

And that's great in the sense of targeting that audience first and then, obviously, our sickest patients. But as Dr. Porsa and Dr. Persse have mentioned, the strategy to really make sure that we have an equitable distribution is really important.

And so what's great now, and you can see it through the federal programs and in the state, that the pharmacies are now coming online. And the pharmacies have much greater breadth and reach into those communities for people that cannot travel, cannot have access. So we're delighted to see those numbers coming on board.

We hope that these infusion of new sites will stay on much longer. Many of them are designed to be three or four weeks and then do the second dose for three or four weeks. Dr. Persse and Dr. Porsa are working hard to make sure we continue with those sites, because they're really important for this in this race to vaccinate as many people as possible in Houston.

So with that, I want to make sure, because in our style that we've done for all these media briefings, we want to really cater to the media. We think you've done really an amazing job. On the education and the data that we see brought out to the public, I think it's been admirable. And so we hope that this discourse of us sharing with you the details and the facts will continue.

So I want to open it up, Diana, to you, back to you, to really kind of lead us through the questions and answers.

DIANA: Terrific. Two questions about vaccination rates in the greater Houston area. One, what impact did the recent winter storm have on vaccination rates? And two, approximately where are we right now in percentage of Houstonians or folks in the greater area that have been vaccinated? That may be for Dr. Persse.

DAVID PERSSE: Sure, thank you, and I appreciate the question. So the winter storm actually impacted pretty much every aspect of life, right? There's not one of us who didn't feel some sort of pain with that. And so for us, it did, it shut on our vaccination programs for several days. And we had to reschedule people. And that was a bit of a challenge.

And some folks became quite concerned that they were going to get their second dose on time, but fortunately we've learned that there's a larger window. So it did, it set us back several days worth. And now that we're vaccinating-- and this wasn't just the city of Houston, this was all those who were providing vaccine.

Across the community, it probably set us back thousands of doses per day that we were doing, so at least two or three days of vaccine-- vaccinations which weren't done. But we're catching up. And that's OK, right? This happens. There's-- it was the weather. And we're going to catch up and we're going to move on forward. So it did set us back a little bit.

The other thing that it did was it also caused us to shut down our testing sites. And we've also seen that a lot fewer people are going to get tested. So I'd like to reinforce to folks it's still important that people go ahead and get tested, certainly if you've not yet been vaccinated. But even for folks who have been vaccinated, remember these vaccines are not 100% protective. So certainly, if you've been vaccinated, and you develop symptoms, you really need to go get tested.

And I continue to get tested even though I've been vaccinated, because again, now that I've been vaccinated, I'm actually at greater risk for having-- for developing a really mild illness should I become infected. And I don't want-- I still don't want to spread it to my family members. So I'm going to continue to get tested and I would recommend that everybody else continue getting tested as well.

DIANA: Terrific. Another question. As it relates to the different waiting lists between the Johnson & Johnson vaccine and the mRNA vaccine that the region has set up, have you seen a difference in what people are looking to sign up for?

DAVID PERSSE: So I'll take that one again. So we really have-- what we've seen is that the [INAUDIBLE] are coming very-- they're filling up pretty briskly, pretty robustly. What I don't have is, because we just haven't done the demographic yet, because we won't get it until people come and get vaccinated, I don't know if there's any sort of segment of the population that's gravitating more towards one vaccine or the other.

We just don't have that yet, because we've only set up the two different waitlists recently. When you sign up, you only have to have given minimal information. We get the rest of the information when you come and do your pre-booking to get vaccinated. So I don't have that information yet.

But we'll wait and see. And that will then help guide us as to how we move forward. Because, again, and this goes to Dr. Porsa's comment, is we're pursuing two things at once. One is that we want to get as much vaccine out into the community as quickly as possible because of the race against the UK variant and the other variants. But also, we want to make sure that people who would have difficulty getting vaccinated, that we've still solved those problems so that they can get vaccinated.

And this is something we deal with with the flu vaccine every year as well. It's just-- it's just-- that problem is a little bit on steroids right now. And so we're going to take what information we get from the sign-up lists and learn how to better target our efforts to make sure that everybody can get vaccinated as quickly as possible.

BILL MCKEON: Diane, one question I want to ask Dr. Klotman, because it comes up often, and it's interesting when we're looking at how many of our citizens in the greater Houston area have been vaccinated. They often subtract out people that have already been infected with the virus.

And I think it's important to understand that from Dr. Klotman. And would you speak to that? Because it's a topic that I think is often misunderstood in those that have been infected with the virus. Should they be vaccinated and why?

PAUL KLOTMAN: So the natural infection with this virus leads to your body getting a number-- developing the antibodies to all parts of the virus. There's the envelope, that's the surface of the virus. There's the protein that attaches to the cell. And that protein is in three or four different confirmations.

Some of them are not important, others are really important. And so you've got this whole panoply of antibodies that develop, some of which are very effective at stopping infection. And that's how you get over it. And then your natural immunity wanes over time.

We don't know how long immunity lasts. So far, there's been not a huge number of second infections reported. Although there have been many reported, it's not, considering the global pandemic, not that many. So we think natural immunity lasts for probably at least a year, at least since the time of it.

But the point is when you get a vaccine that is directed only to the spike protein and only to the confirmation of that protein that attaches to the receptor, you get this ton of antibodies generated just for the most important part of the virus. And it's much more effective in preventing infection.

And so even if you've been infected, yeah, you have a low level. It's kind of like-- it's OK. It's enough to prevent you from getting really sick. You've recovered from it. But it may not prevent you from carrying the virus. There's all these long haulers, this kind of stuff. You don't know that you're not sort of just chugging along with the virus living in you for a while, months even.

So the vaccination really appears to be very good at clearing the body of-- of the virus completely and giving you a much more robust immune response. So even if you've been vac-- even if you've had the disease and gotten over it, we recommend that you get vaccinated. Because it's a much more targeted antibody response.

And the same thing for the memory response. Memory response is very important. There's another part of resistance that is in cells that remember the formation of that particular spike protein and can generate other cells that make antibodies in the future. So that memory response is also very important to develop. And again, it's more robust with the vaccination. So that's why.

BILL MCKEON: Thank you.

ESMAEIL PORSA: Diana, I wanted to add to what Dr. Persse said to your last question about the J&J vaccine, kind of a different viewpoint. Again, Harris Health System, as a safety net hospital, there are points of care where having a single dose vaccine just is hugely advantageous. For example, our homeless population, that it may be very difficult to bring the same person twice for a vaccination.

The folks who are coming to our emergency rooms for non-related issues to COVID-19, the folks who are being discharged from inpatient care at a hospital, those are all opportunities that present themselves as operationally advantageous for having a vaccine that is just one and done, especially-- especially since this vaccine, again, to echo everything that you just heard, is just as effective as are two-dose vaccines against severe disease, against hospitalization, against death.

DIANA: Thank you, Dr. Porsa. A question as it relates to the race to get vaccinated and the variants. How do those two things interplay with one another? Why is speed so important right now as it relates to the variants?

PAUL KLOTMAN: So maybe I'll take that one. The-- the variants are more infectious. One of the reasons they developed-- remember there are trillions of viruses reproducing all over the globe. And they're random mutations.

And occasionally-- and the vast majority of the mutations are not good for the virus. But occasionally, one allows it to be more infectious and transmit to more people. And just through a founder effect, just because it's infecting more people, becomes the dominant strain.

And when we say more infectious what we mean is if one person who's infected walks into a room with 10 people, this particular virus will infect-- you, as an index case, will infect 3 out of 10 other people in a room. Well, you get the mutations and maybe it's now 5 out of 10 or 6 out of 10. And that becomes a real problem in the community because it's spreading much faster.

There's some suggestion also that it might be more severe illness. There's a recent paper on that. It's-- it's a little bit-- it probably does cause a little bit more severe illness, but not enough where I'd say that's the major issue. The major issue is it's spreading faster.

And so our race is to get you vaccinated so we can reduce the spread around-- around the community. We know the morbidity and mortality is really based on the number of infections. And so the more people who are infected, the more problem there's going to be, the more hospitalizations there are going to be, and the more death there's going to be. There's going to be more people dying from this.

So it's a race to get people vaccinated before we get more and more infectious viruses taking over the community. And that's the reason. And the other good thing is, it seems like all of the vaccines are effective against the variants, including the Brazilian variant.

It may be slightly less effective, but it's effective. It's just like the-- the J&J vaccine was tested in South Africa, which is a very infectious virus, and it seems to be effective there too. So it really is a race to get as many people vaccinated as we possibly can before these other variants become dominant strains here.

DIANA: And there was a follow-up question on that, that I think you answered, Dr. Klotman, but it's worth repeating. Many people, or some people at least, are saying, why should I bother getting vaccinated? These variants are not going to be impacted by the current level of the vaccines so maybe I should just wait. But that seems not to be the case, based on what you just said.

PAUL KLOTMAN: That's like the opposite of what you should do. The variants are-- the vaccine is effective against the variants. Whether it's 95% versus 70%, or 80%, or 65%, it doesn't make any difference. Flu vaccines are about 60% effective. And they're very effective at keeping people out of the hospital.

So you want to get a vaccine as fast as you can. And I'd get it absolutely the most, the soonest you can. So that would be my choice. If I'm signing up, I'm going to the place where I can get the first vaccine I can get.

DIANA: And then one last question in this-- oh, Dr. Persse, before I go on.

DAVID PERSSE: I was just going to add something to what Dr. Klotman said. The other thing is that, and Dr. Klotman pointed out, the mutations occur, right? So the sooner we can get the pandemic under control, not only nationally, but globally, the less likely that we will have a mutation that actually does get around the vaccine.

So right now, the vaccines we have are highly effective. So we need to use them now, and put this genie-- well, actually, it's a dragon-- put his dragon back in its bottle before it figures out a way to get around us.

DIANA: You answered the next question, Dr. Persse, thank you. This question may go to Dr. Porsa, but also possibly Dr. Klotman or Bill. What is the TMC and its members doing to support the equitable distribution of vaccines? And Dr. Persse, that can probably also be used as well.

ESMAEIL PORSA: Yeah, that's a great question. Again, going to what I said at the introduction, as a safety net hospital system, Harris Health, I think we are-- we are designed to-- to address exactly what the person is asking about, making sure that there's equitable distribution of the vaccine.

But I'm really proud of what you heard at the very beginning I think Dr. Persse is the one who mentioned it, that the TMC hospital systems, now for about a year, have really come together as a team. It is really not a competition. I think everybody understands it, that the good of the community comes first.

That has been our guiding principles through the first treatment of COVID-19 and how we always kept each other aware and informed about our hospital best situations, our PPEs and whatnot, and how we were able to share those resources.

More recently, because of the vac-- for the vaccination, I can tell you that specific example of Harris Health System sharing our most vulnerable patient populations, our 75 years and above, who needed to get the vaccination as fast as possible, faster than just us, Harris Health System, alone could provide to them.

We shared that information with St. Luke's Hospital, and Memorial Hermann, and Methodist Hospital. In a partnership, tried to get the most vulnerable vaccinated as quickly as possible as a team. It was not our patient, their patient. It was this community that needed to get vaccinated as quickly as possible. And I hope that answered the question.

DIANA: Anyone else? Great. We have-- Bill--

BILL MCKEON: Just to echo Dr. Porsa's comment, that's been something that Dr. Boerwinkle, who is the Dean of the UT School of Public Health, has done an amazing amount of analysis of our underserved communities. And so many of the strategies that Dr. Persse leads up, of mobile units, and moving to the communities, not waiting for the communities to come to us, has been really effective.

We also look at the lists of people we have. And we're starting to make sure that we target the most vulnerable communities that may not have the equal access to that. So it's really a culmination of those efforts. And they're happening at the county as well. To really make sure that we don't want distance to sites to be the-- the factor that gets in the way of vaccines.

Now, there is also an education problem. There's a lot of concerns about people using vaccines. And there's a lot of historical reasons why people did not trust vaccines. And so our communication campaigns that we have are always about educating people about these are modern miracles.

When you look at the speed in which we've been able to develop these vaccines in a global crisis. And I think that all of those things have been unified. We do-- we share our communications when we're-- we share our list of patients.

And the strategic targeting that Dr. Persse has led, and out of the county judge's office as well, and Dr. Porsa, who's been extremely effective in moving towards those communities. But the work isn't done. We have a long way to go on that front.

DIANA: Terrific. The next set of questions is around general eligibility. We are still in 1A and 1B. When are we likely to move into 1C? Who do we think is likely to be included in 1C? And there has been a little bit of a rumor that if you go to Excel, you can get your vaccine no matter where you are in the eligibility pool. So if folks could speak a little bit to eligibility.

BILL MCKEON: Dr. Persse.

DAVID PERSSE: Yeah, so I'll take a stab at that. So there's the Expert Vaccine Allocation Panel, which is a state level panel that sets the allocations. And our own director of the health department, the Houston Health Department, Stephen Williams, actually is a member of that.

And so I think we just saw something come out, just in the last 24 to 48 hours, that we anticipate that 1C will be coming out soon. Now, we won't know what's in it until it comes out, but it should be coming out pretty soon.

And one thing that I think that we can take from that is that they aren't going to release the 1C until they feel that there's enough of the vaccine and the machinery, if you will, the systems in place, the process to get people vaccinated for us to go to that next level, right?

Because-- because the second part of your question really has to do with the confusion about-- about 1A, 1B, 1C, what about me, right? And so we-- the 1A, and the 1B, and even the 1C, when it comes out, there is a lot of thought that has gone into it.

So the 1A, as you all know, these were predominantly health care workers, frontline health care workers, taking care of COVID patients. Well, that is a infrastructure in our community we cannot afford to get sick and lose from the workforce. So that's one reason why they were 1A. And then also the nursing home patients, because they are the single most vulnerable population of people at risk of dying, and the staff that takes care of them. That's why they were 1A.

And 1B, again was looking at trying to minimize the death in our community. So this is why people over the age of 65, because they were at the highest risk of dying, followed by those over the age of 18 with certain medical problems that put them at a highest risk.

So there is a lot of thought that goes into it. So 1C will come out pretty soon. But it's a balancing of what is the priority to save the most lives, balanced with not releasing it so soon that we have people trying to jump in line ahead of a bunch of 1As that still haven't gotten vaccinated yet.

So I think that what I'm reading between the lines that the state is pretty confident that we've got a lot of vaccine coming and we've got the infrastructure in place to get it into people's arms.

DIANA: Terrific. Have the TMC hospitals scene any impact yet on the vaccinations on the number of ICU hospitalizations?

BILL MCKEON: I guess I'll take a lead on that and my colleagues can lean into it. It's hard to draw a direct causal relationship because we are seeing a slight decrease. And now, we're flattening out. Which is-- what you're hearing around the country, is we're-- we may be preparing for yet another surge, particularly with these highly transmissible variants that are now in our community.

So-- and also one of the things that has been lagging is the amount of testing has dropped off significantly. And that's not just because of the Arctic freeze. It has been dropping off for a significant period of time.

And that's why the brilliant work that Dr. Persse and-- and is also being done by Baylor and Rice, this early warning system of waste management has been a really great indicator of the level of the virus in our community when testing drops off.

Because testing-- we would see, based on testing, when it was stable, we would see the causal relationship somewhat 10 weeks later-- I'm sorry, two weeks later, we'd see the hospital effect. So when we saw a huge surge in positivity, we would see that.

We still have 13% positivity rate right now in the city and county level. So there's a lot of disease that's still out there, and actually, much more infectious out there. So we've seen a slight drop off. And some of that was probably due to the Arctic freeze.

But we are at caution, because we're flattening it out. And as Dr. Persse has mentioned in the past, we are in a much larger base of disease than we were ever at back in June and July. So we are not seeing the rapid decline that we would like to see.

Now, we're opening the faster and the more that we vaccinate in the community, we're hoping that will start to drop off. But we're not seeing that now. So that's the race that we describe to you often, is getting as many people vaccinated as possible so that we prepare ourselves for yet another surge, which is now being predicted nationally and around the world. Maybe, Dr. Klotman, you want to comment on what you're seeing from the data.

PAUL KLOTMAN: Yeah, the-- the best, or one of the important modeling groups is out in University of Washington. And right now, it looks like it-- at best we were going to see sort of a plateau. And if people really followed rigorous public health measures, the masking and social distancing, all the things we do to kind of substitute for vaccination, and they were really important.

And even if it's only 50% effective, that 50% is important enough when you think about 20% to 30% of the population has probably already been infected. Together, those efforts, we're seeing it-- seeing the numbers drop pretty significantly.

The problem is that as we sort of loosen our public health focus, the numbers will start to rise again. Because until we get 50% of the population vaccinated, we need that 50% effectiveness of masks and social distancing. And that's-- I think everyone's concerned about. It's-- it's-- if we stop being rigorous over the next two to three months, right at the finish line-- well, we're never finished, but right as we're approaching really achieving herd immunity in some fashion, we'll see a big surge.

So it's really going to be up to communities like ours. If we can continue to be rigorous in mask wearing and public health measures, physical distancing when appropriate, we'll be OK. But if not, we'll see a surge. And remember, every surge is larger than the previous one because the base is bigger. So every surge gets bigger.

And as Dr. Persse had mentioned earlier, we're at a baseline of 1,000 infections a day. We were-- we were excited when we were down at around 150. But now, we're 10 times higher than that. So you get a surge on top of that and it could be bad.

So luckily, the governor gave us room to act responsibly individually and as businesses. And they Greater Houston Partnership came out strongly that businesses are going to continue to support-- I was really excited that HEP is going to continue to require masks.

We need to be vigilant for the next two to three months to prevent a surge. But if we're not-- if we don't do that, we will have one for sure.

ESMAEIL PORSA: Yeah, and Bill, I just wanted to add to what you said, and make it clear for folks on this call, that it's really-- it's dangerous and unwise to try to draw any conclusions between the number of people who are vaccinated and what is happening in our hospitals at this point. Because we are nowhere close to the number of people that need to be vaccinated to really have an impact on this.

So we-- everybody, I think, across the country said the number of people in the hospital has dropped off very nicely, or kind of early in January for about a month and six weeks. But unfortunately, for the last two and a half, maybe three weeks, the numbers are staying the same. And they are more than twice what they were right before the current surge occurred.

So this is a really very scary situation. This is really the time for everybody to hunker down and realize that we cannot afford another surge on top of where we are at the baseline right now. I really just want to emphasize that point, that this is-- we are far from a point that we can be celebrating our successes. This is really the time to be very cautious.

DIANA: The questions about the plateau-- one, about how long has it been since there has stopped being a significant decline in the number of cases? And two, what do we think might account for that?

ESMAEIL PORSA: Yeah, I can tell you that it's been about two and a half, three weeks since the plateau. I honestly don't know the answer to why this could be due to. You can-- perhaps for retired people who are not observing the social distancing, this and that, [INAUDIBLE].

PAUL KLOTMAN: Esmaeil, I think part of it is the emergence of the variants also.

ESMAEIL PORSA: The variants-- I was just going to say, or the emergence of the variants, yes.

PAUL KLOTMAN: The drop is-- so you have these two competing things-- how infectious are people and how rigorous are we following the rules. I would say people haven't changed that much, until there's like a change in an order, like everybody's going to lose their masks today.

Before that, the last two weeks, I'd say behaviors have been probably pretty constant. So that what's changed is the variants are emerging. And this is what happened in the United Kingdom. So it's not new. This is exactly what happened, what accounted for their giant surge in December, was it became 60% to 70% the dominant strain. And it's almost twice as infectious.

So it was fine until we started seeing the emergence of a more infectious virus. And so instead of declining, it's staying flat. Luckily, it's not going up. And it's because our public health measures are effective. But they're not-- if we don't use them, we will have-- we have a more infectious virus that's in our community. And that's the real issue.

DIANA: What do we think the number is to achieve herd immunity in terms of the percentage of the population that needs to be vaccinated? And when do we think the general population will get that vaccine and will be in a better position to reach that number?

PAUL KLOTMAN: So, I can answer that one. It's actually not a made up number. It's based on how infectious the virus is. And the amount to reach herd immunity is a calculated amount.

So for example, measles, which is probably the most infectious virus and has an R number, that number that if one person could go into a room and infect a bunch, it's like 18-- 14 to 18. It takes 95% herd immunity.

And so you wonder why, when people get lax in vaccines, why is there a measles outbreak? Well, it's because it's the most infectious virus. So with a R value of 2.7 or 3, which is the original strain, it is 60%. You need 60% to 65%, is required to reach herd immunity.

With the new variants, it's maybe 70% or 75%. You'll hear Dr. Fauci say 85%. I'm not sure where he came up that number. But I'd say if we get to 65%, along with the following public health measures, we'll be in great shape.

That's going to be mid-September-- or I mean-- sorry-- mid-July, July, mid-summer. If you look at the fact that probably close to a third of the population in the United States has probably been infected already, if we can get to 50% of the population vaccinated, the combination of vaccinated and people who've been infected, there's been some-- some graphs of that, we would be OK by July.

And if-- but if we-- if we-- if we stop public health measures-- and this is paradoxical. This is very counterintuitive. We'll get to herd community a lot faster because we'll have a lot more people infected. But that's not the way you want to go.

This was like early on, when Dr. Atlas from Stanford was saying, well, let's get everybody infected, we'll reach herd immunity quickly. True, but we'd have a lot of people die in the interim. So the idea is to get there gradually as we're-- as we have increase in vaccinations, not to get there because everybody's getting infected.

But if we stop public health measures now, we-- you can predict we would have between 1,500 and 7,000 additional Texans that would die from this disease by July. So we'd like to not have that happen. So our goal here is to let us get to herd immunity through a vaccination program while we maintain public health measures.

BILL MCKEON: I would add too that one of the things that all of my colleagues have seen as a direct causal relationship is when we had large events in the past-- Memorial Day, 4th of July. Two weeks later, our hospitals were-- were not overwhelmed, but were at a maximum capacity.

And now we are on spring break again. And there is some people out there that believe that something's changed, that suddenly it's-- that they cannot wear masks and to-- we're really concerned that we're going to get a large surge from the people that are not continuing with those public health measures to really put a huge flow of the infection in patients into our hospitals. So we're hoping that people stay-- stay vigilant in those public health measures.

PAUL KLOTMAN: I like-- I like one of the questions. Are you considering the mask mandate has been lifted? I think I can answer that with, yes.

ESMAEIL PORSA: Very.

PAUL KLOTMAN: That answer is, yes.

DIANA: Terrific. I think we have covered most of our questions today in one form or another. Are there any closing thoughts that folks want to share? Dr. Persse.

DAVID PERSSE: Yeah, there's one thing I want add. And it really goes to the question about the mask mandate, is I want to remind folks that Einstein said, you can't solve a problem using the same level of thinking that created it. And so, I've used that as something to get me to try to solve complicated problems.

And a pandemic is a very complicated problem. In this country, we've politicized a lot of the pandemic, which is really not at all helpful. So I want everyone to remember the virus is the enemy.

Mask wearing is a strategy, a very effective strategy to minimize the spread of virus. Reducing the number of people in restaurants and other things, those are very effective. But let's trying to get away from the politicization of it. Because that just winds up with people arguing with each other at the grocery store-- why aren't you wearing a mask? And why do you wear a mask?

And the point is, we need to remember that this virus doesn't care about any of that. This virus is an opportunistic entity. And if you give it an opportunity, it will take it. And we just need to not give it the opportunity.

Because as Dr. Klotman pointed out, and I want to remind people, we'll get to herd immunity one of two ways. One way, people get a lot of needles in their arms. The other way, a lot of people die. And these are-- I can't remember the quote, but it's-- a statistic is a statistic, but when it's a person, it's a tragedy.

Well, these are real people. And they've got families. And they're not all-- forgive me in advance for what I'm about to say, but there-- I've heard-- there's been some conversation where people think, well, they're all just old nursing home patients.

Well, A, that is not at all true. And even if it was, that's not OK either. So let's remember, the virus is the enemy. When we come together as a community, we have defeated so many things. With all the disasters we've had in the last 25 years that I've been here, this community has come together, and stood up shoulder to shoulder, and just really survived some horrible things, right?

And we're in it again. So let's remember the virus is the enemy. Mask wearing works. Social distancing, these things work. The vaccine will work. It's coming. Let's not take our foot off the brake just yet. Let's keep on going. We will save lives.

ESMAEIL PORSA: And then I just want to support what Dr. Persse just said by saying that we don't want to end up in a situation where we are living with the COVID-19 pandemic. We want to be done with it. In order to be done with the pandemic, all the things that Dr. Persse just said have to be observed without taking our foot off the pedal.

We need to continue doing everything that has been proven scientifically to be effective-- wearing the face masks, social distancing, washing our hands, staying home when you're not feeling well. Those are fantastic.

In addition to that, now we have the vaccine. We've got to get the vaccines into the arms of as many people as quickly as possible while we continue to do what has saved us to this point. So that we don't end up in the scenario that Dr. Klotman just mentioned, where we have hundreds, if not more-- thousands of more people in our communities who are going to be sick or die because of COVID-19.

BILL MCKEON: And I just-- one closing thought that-- I want to thank Dr. Persse, Dr. Klotman, and Dr. Porsa. A lot of people don't recognize this, but when we turn out these-- these COVID documents every day, which is pulling together the data across, and it's done at the city level and the county level, they have been doing this now for over a year and three months.

I remember when we first came together in a board room, right over my shoulder, that-- and this was when the virus was in Wuhan. It had not arrived into Europe. It has not arrived here. And it was really the sacrifice that these three individuals have made for over a year, seven days a week, meeting on this, focusing on it, sharing on this, best practices.

And as Dr. Persse said before, this is probably the best example during the largest public health crisis in our history. But the sacrifice that these three gentlemen have made all along, as well as our incredible frontline workers that have put themselves at risk every day. It's a different feeling of a person driving to the office every day knowing they're walking into that fire.

And so as Dr. Persse said, it's this virus doesn't care. It's like a fire. And each of us are kindling to it. And those public health measures that we take every day as a decision we make, not just for ourselves, for our neighbors. So we've got to stay together and stay strong. But thank you to Dr. Persse, Dr. Klotman, and Porsa for all you've done for this community.

DIANA: Thank you to everybody who was able to join us today. We will be distributing a link to the video of this session to media after our call. And we appreciate your time. Have a good day.

BILL MCKEON: Thank you all.

DIANA: [INAUDIBLE] panelists.