COVID-19 Vaccine Town Hall special guest Dr Peter Antevy

So now I'm going to move forward to our guest speaker. And one of the things that we wanted to make sure that we did is as we continue to transition in this, in this world of COVID we are in this transition now trying to figure out what does the vaccination process look like and how do we make sure that not only our community at large is taking advantage of these opportunities, but you, all our employees. Because I know that there are questions out there around what the process will be like and what number am I in line? And I have the same question. So I'm very excited about being able to introduce Dr. Antivi. But let me first thank Dr. Nora Powell, who was able to recruit Dr. Antivi for this opportunity and for this important opportunity for our institution.

Dr. Antivi is a pediatric emergency medicine physician practicing in hospital emergency medical care at Joe DiMaggio Children's Hospital, a level one trauma and tertiary care center in South Florida. He's board certified in pediatrics, emergency medicine and the complex sub specialty of ems. And he is also the founder and chief medical officer of Cantivi Pediatric Emergency Standards Inc. And he served as the medical director of Davey Fire Rescue, Coral Springs park and Fire Rescue, Southwest Ranches, Fire Rescue and United Medical Transport, all in South Florida. Dr. Antivi also serves as a associate medical director for several other agencies including Palm Beach County, Florida. And he's also the long standing medical director for Broward College's highly regarded paramedic training program, as well as several mobile integrated healthcare programs in Greater Broward County. Dr. Antibes also also heavily involved in COVID 19 research and is the principal investigator on two large antibody trials across seven municipalities in South Florida. His expertise in EMS and emergency medicine has positioned Dr. Antivi on the front lines of the pandemic and his deep knowledge surrounding COVID 19 testing. And he has been critical and has been critical in a rapidly changing medical environment. Dr. Antivi, welcome and we are grateful for your presence.

Thank you, President Hale. Good afternoon everybody. My name is Peter Entebbe. I appreciate the very warm introduction. Also, a big thanks to Dean Powell, who I just, you know, I love working with and she's been an amazing addition to Broward College's EMS program over the last several years.

And by the way, I must mention that I, when I, you know, I actually started my college career, if you will, in Broward College. So this is, you know, really full circle for me to be able to make this presentation to everyone today. I'll try and be brief. I know I have about 45 minutes, but I'll try to leave room for some questions. And you can see, you know, President Hale mentioned some of the politics of our day. Unfortunately, the politics have creeped into the medicine. And that's why I kind of jokingly labeled this talk COVID 19 vaccine. Should I take it and will they able to track my every move once I do? Obviously, that's a joke, but it's the number of calls that I've gotten related to many conspiracy theories related to the vaccine is really the reason that I created this talk. And hopefully you find some value in it today.

So this is the way that I see it. There's three, three categories of people who are watching this presentation today. Let's see where you fit in. You're either in the hell yes category or you're in the hell no category, or you're in the not sure category. And I'm hoping that those of you who are in the hell yes category are the ones calling, waiting in line, trying to get your parents in to get vaccinated. The people in the hell no category are just. They just are sure that something is going to go wrong. And I'm not so sure I can help those people. We'll try. If you don't leave the webinar, if you haven't left the webinar yet, you may be in either one of these two categories. So if you are in the not sure category, like I was early on, then you're thinking about it. And this is Rodan's the thinker. And like many of you, I had these same questions. And I just have done a ton of research, been heavily involved in Covid since the inception when it came here to South Florida. So hopefully this talk will provide some color so that you can then make your own decision. Right. We're not going to force you into doing anything you don't want to do, obviously. And trust me, I've had issues even getting my own family members to understand where we are with COVID little agenda. I do want to go over an important historical aspect of vaccinations that I think will help really provide some context as to where we are today, how we, how we even got here. And we'll talk about the Human Genome Project. How does this vaccine work and why is it so different than all the other vaccines we've ever seen and why? I think it'll be the best technology we've ever had with vaccinations. What's in the vaccine? Is it safe? Is it efficacious? What are the side Effects. Lots of people want to know that. And then of course, there are the myths that are going around the Internet. I think we should address those as well. And I'm going to throw in an analogy a little later on to what my son, one of my sons loves the most, which is chick Fil A chicken nuggets. All right, so we'll try and fill that in later.

So I like to start with this virus and again, I cannot hear you guys, but I'm sure that some of you know what the virus on the left hand side is. It's smallpox. And the gentleman on the right hand side is Edward Jenner. And he was around in the late 1700s and he figured out how to cure smallpox. That story, I think, deserves a little bit of a mention here. And back in the day, it wasn't called vaccination, it was called inoculation. Why is inoculation different than the word vaccination? It's because instead of using a.

You know, a form of the virus that's not fully live, when you inoculate someone, you're using the actual virus itself. So it's a really great story that started back in about 1790s when there were milkmaids. Okay, I don't think we know what milkmaids are today, but a milkmaid basically went and collected the milk from the cow. Now, on the udder of the cow, the cow would have a little virus called cowpox. And the milkmaids, it turns out they ended up almost across the board getting this very mild disease, not harmful at all, called cowpox. Now, vaca is cow in Latin, and so vaccinia is cowpox in Latin. So someone put two and two together. When smallpox was killing millions and millions of people, they noticed that the only people who didn't get smallpox were the milkmaids. And so Edward Jenner said, wait a minute, so what if I take a needle and I take some of the pus out of one of these pox, inject somebody and give them cowpox, the mild form of it, and then we'll give them smallpox a month or two later and see if they die. Right. So who did he find as his volunteer? His gardener's son in 1796. I'm not sure if he agreed, there probably wasn't informed consent back then.

But he essentially convinced this little 8 year old boy named James Phipps to do the following. And here it is. He found the milkmaid named Sarah Nelms, who had the cowpox, the mild form, took the Pus out of that cowpox virus, injected James Phipps, who then got cowpox, the mild form, waited about a month or two. Then he went to somebody who had smallpox, took the pus out of the smallpox, went back to the little boy, and. And injected him with the deadly smallpox, which, by the way, had an 80% death rate in children, a 60% death rate in adults. Ultimately killed 500 million people across the world. And this kid did not get smallpox. It worked. This was the first series of figuring out how to cure a disease using something else. And this is where vaccination comes from, vaccinia, meaning cowpox. And that's how this happened. And this again, took thousands of years until we figured that out. Amazing. Now you'll probably say to yourself then, well, if this cure was figured out in 1796, how could it be that smallpox ended up killing 500 million people and was finally eradicated in 1979? Just think of how many people died unnecessarily. And it turns out when the vaccine was available.

Nobody wanted to take it. Does that sound familiar? And when the vaccine was available, primarily the American population was the most reluctant. Does that sound familiar? Something happened around the 1960s where the world Health Organization came into play and said, you know what? We are going to mandate this vaccination. And that is the only thing that got rid of smallpox, and that's why your children didn't get vaccinated, and our children's children will not get vaccinated against the smallpox virus because it was eradicated with a concerted effort worldwide. Just remember that story, because my prediction is the same thing will happen here, and ultimately you will end up seeing a mandate. Probably it'll take a year or more for that to happen. Now, let's go to what we know. We know about these virus vaccines. Measles. We know about the flu. And we start off with the measles, which was a virus that's live. They attenuate it, meaning they don't kill it, but they essentially using a form of the live virus. The beauty of that is it's a strong immune response, doesn't require a booster. However, the safety profile is not that good because it's essentially just mildly attenuated. Moving then to the next generation of, okay, let's kill the virus, then the immune response decreases, A booster is required, but the safety increases, and that's influenza, hepatitis A. These viruses, as we're talking about here, all use other live tissue for the viruses to actually be made and then injected into the human body. Remember that as I talk through the next generation of vaccinations, which was a genetically modifying a microorganism. And you may know this in hepatitis B vaccination, where they take the DNA from the hepatitis B virus, they insert it into a bacterial DNA. Now you're using bacteria, remember, and then you're putting it into a big fermentation tank to get it, you know, to get the yeast to ferment. So you have a lot of kind of other items being used to finally get that vaccination into a vial. And then when your infant child, newborn is two weeks old, they get this first dose of hepatitis B vaccination. So this was a step up in the technology in 1995, but still you will always find reactions to these flu and measles and hepatitis because of what is used, the vector that is used to actually get these vaccinations into the human body.

Now I say welcome to the future, because the scientists said, hey, wait a minute, all along we've been taking the protein, making it in the laboratory through these bacterial vectors or virus vectors, using yeast and fermenting tanks, making the protein and then jabbing the person in the arm. Why don't we take the code for the protein, not the protein itself, and let the body itself create the protein? Okay, on so many levels. That's so much safer because we don't like abnormal protein being entered into the body. However, if our body makes the protein in question, it's a whole different story, right? And so the best analogy I can use for MRNA is the following analogy. So I don't know if you can see my screen here, but I'm sitting at my computer and my printer is back in that cabinet over there. So when I press print, all I'm doing is I'm taking a document which is basically software, if you will, and it's beaming through the air into the printer, and the printer makes the end product. And let's use the end product here as the protein or the, this, this.

This protein that's part of the flu virus or the measles virus, or in our case, the COVID virus. Well, in the past I told you that this printed paper would be made in a lab and then they would inject it into the body. But now here we have, and I'm going to go through some basic biology here for a second. Now we have the cell, and inside the cell, the cell has its own printer. And we call that the ribosome. And the ribosome is basically the printer of the cell, it just takes this MRNA information that's kind of wirelessly going in there, if you will, and the ribosome ends up making the the antigen or the protein, in this case, it's making a piece of COVID So this is a very important distinction. Whereas in the past we would make the protein in the lab, we would jab it into your body, as opposed to now, all we're doing is sending in this code which is not made in living tissue. I'll show you how that's made in a minute. But once that code gets in, the body's machinery makes the protein by the cell. So you're asking yourselves, well, why did they only come up with this 10 years ago? It's about a decades old technology. It's because once they figured out how to make the mRNA, this thing is so fragile that as soon as it gets put into the system, unless it's covered up and protected, the body will just consume it. The MRNA is very, very fragile, and they have to figure out how to get it inside the cell.

Now, for those people who have heard, oh, I don't want to take this vaccine because it will then affect my own body's DNA. Back to some basic science. The nucleus of every cell contains the DNA of your body. MRNA cannot go through the nucleus. It cannot penetrate. That nucleus has a very structurally sound cell wall. Your DNA is not being touched at all. Here, let's delete that thought from your brain. Now, here is where the science comes in. Here's the mRNA, here is the muscle cell. So all the action that takes place when you get vaccinated is in your arm. Right. Everything I'm about to talk to you about right now doesn't take place in the liver, doesn't take place in your blood vessels. Everything takes place in the cell wall, Sorry, in the muscle cells of your arm, whatever arm you choose.

The scientific breakthrough was the fact that they figured out how to protect the mRNA, which is this strand here. And they figured out how to do it with what they call a lipid nanoparticle. This is the chicken nugget. Chick fil a analogy where because my son loves chick fil a. So I have to fill that in where imagine taking the mRNA, very fragile thing, putting it into a fatty substance, the chick Fil a nugget. It goes through the cell because the cells love chick fil a too. Of course. They release the mRNA, which is now in the muscle cell in your arm. It goes to the printer, the ribosome, and then it makes the Protein of COVID One small piece of that little spike. And so now, the reason this is such a clean process, there's no bacteria, there's no viruses, there's no yeast. There's nothing except this MRNA strand, which we'll discuss in the next couple of slides. Once that protein is made in your muscle, the muscle then takes that protein and presents it on the cell wall. And then the body says, hey, wait a minute. That spike protein I've never seen before. Let's go ahead and make sure that we can kill that. And the antibodies start to form, all because of what's happening in your shoulder.

Beautiful process. Very clean. Magical, in a sense. We'll talk about why this is a safer vaccination, and it will prove to be the safest vaccines we've seen in a long time.

How do we get here so fast? We talked about smallpox, thousands of years. Then the next advances in science, hundreds of years. Measles took 10 years. How did we get to MRNA? And we have to go back to Watson and Crick to the DNA helix, the double helix. Many of you know that you have base pairs of A, G, T and C that connect. And we now, through the Human Genome Project, are able to know exactly the human genome. We can map out every one of you very simply. But that didn't take overnight. That happened from 1990 to 2003. Many of us didn't know what was happening. $3 billion. It was an NIH project. And today I can come and take a swab in your cheek. I can go to a lab, I can give them the swab that has your DNA in it, and in 24 to 48 hours, I can have your entire genetic code, which is 3 billion base pairs, or 6 billion bases, completely mapped out and effectively make another one of you. That's where we are now, thanks to the Human Genome Project. But how does that relate to Covid and MRNA? I'll tell you. I told you. The human has 3 billion base pairs, or 6 billion bases. Look at Covid. Covid only has 3,000 bases. So when I took the DNA from your cheek and I took it to the lab, they give me a USB drive with 6 billion AGT and Cs. That's it. It's on a computer program. It's on a usb. When the scientists in China figured out what this was, they got the COVID.

Base definition, if you will. They put it on a thumb drive and they sent it to the nih. Once the NIH got that code, they said, let's take the spike protein, which doesn't change in coronaviruses over the years, it doesn't mutate. They pick that part of the coronavirus and they said, let's figure out the base pairs for that. We're going to create the MRNA strand that codes for that protein. That strand again, it's just a code, will be sent to the printer in the cell, in the muscle cell, and we'll let the printer print the spike protein. So remember, that MRNA is covered up. As soon as it gets released into the cell, it gets zapped like a Snapchat message. So that MRNA that they're putting in you has no life tissue, no fetal tissue, no yeast, no bacteria, no nothing. The only thing that it has is things like polyethylene glycol. We'll talk about that later, some sugars, lipids, and in order to protect that RNA strand. So let's move this forward a little bit and kind of, here's the full picture. There's your chick fil a nugget and your MRNA on the inside of it. That lipid layer lets it get into your muscle. This is all in your shoulder here going on. It releases the mRNA, it finds the printer, it makes the protein right here. And the protein then shows up on the muscle cell itself. And then your body forms antibodies to it. And then seven days after your second dose, you are now fully protected. So this is important, that this is not a virus. It's a genetic code that does not hit your own DNA. It has been used before. This is not new. This is a decade old in that it's been used for people with cancer. Now, when you hear the word cancer vaccine, don't be confused. It's not to prevent cancer. Cancer vaccines are therapeutic, meaning that if you have a melanoma, God forbid, on your skin, they'll take that melanoma. They'll get the base code right. They'll then create an MRNA piece of it. They'll give you the vaccine. Your body then attacks that vaccine, and then at the same time, it attacks the melanoma. This has been life savings. So we have about a decade's worth of experience with these vaccinations. But the beauty of it is, the day they got that code from the Chinese folks at the NIH to the NIH, within two days, they already had the vaccine. Within 62 days, they already had the first person volunteering to get that vaccine in their shoulder. So think of where we've come with smallpox. 62 days after we get the code, we now have a vaccine. Our children will look back at us and laugh that it took 10 months for us to finally get the population vaccinated, because it'll end up being 10 days in generations from now. This is a huge turning point in science. We will always remember this in these days because this technology is here to stay. Look at the effectiveness of this vaccine. Remember, flu is a killed vaccine, not that good. Chickenpox is live. Measles and polio live. Now look at Moderna and Pfizer. You're getting from an MRNA vaccine the same efficacy as you would from a live virus. Unheard of. This is science and history in the making. In a week and in a year where we have had a whole lot of history being made, this is good history. Let's go now into Pfizer. You want to know the data. If you want, before you take a vaccine, you better know the data. And I'm going to give it to you right here. 43,448 participants, 16 years and over 150 clinical sites, six different countries. Now, the data I'm going to show you now are in people who have received two doses and then had at least a week after that second dose. Nine cases in the vaccine group. So imagine cut the 43,000 in half. That's how many people got the vaccine. And of those, nine people got the virus. Still, none of them had a bad outcome. Only one of them ended up in the hospital. Compare that to 171 cases in the placebo group. That's a big difference. Huge difference.

This is going to come up, and my prediction is that sometime after January 20th, someone's going to come up with the idea of let's only give people one dose and let's hold off on the second dose. That day is coming.

Which I don't know how I feel about that just yet, but I will tell you that one dose will get you covered to the tune of 52%. But we don't really have real data on if we extended that out, because every person in this trial got a second dose and then 95% efficacy after two doses. Now, what does that mean? It means that 5% of people after their second dose and after seven days later still got Covid.

And so there is still a possibility. So if you're asking the question, should I wear a mask after the vaccine? Yes, you have to wear a mask after you get the vaccine, because you potentially could still get Covid. The theory is, is that you probably aren't going to be transmitting Covid to anyone, but we don't know that just yet. The jury's out on that one. So we'll get back to you on that safety data. This is from the study. And now we have a few weeks now of safety data, which I'll present to you in a minute. The nice thing is that they looked at a very kind of wide swath of the population. They didn't restrict it to healthy people. These are the side effects. Pain at the. In the arm, fatigue and headache. And then in a small percentage, fever. But here's the important part. All of these symptoms resolve within 48 hours across the board mRNA like a snapchat message gets zapped. And I have young children, so I know what Snapchat is. The fatigue and the headache go away after 48 hours. The younger you are, the worst your side effects. The older you are, the better your side effects. Okay, better side effect profile. MRNA vaccinations are very clean. The side effect profile only lasts a very short time. Let's keep going and talking about more of the data. And the reason I put up this kind of scientific slide here is because if you're watching this, you want to know who exactly was in that trial. So half and half, male and female, you could see, you know, white, black or African American, Asian, Native American, they included, you know, look at the percent Hispanic. And so you could see here that they included under 55 and over 55. So they got off to this in a very nice way. And I think they did it really, really well. I'm happy about that.

Let's talk about the side effects. Remember I told you it's mild if and less common if you're older. Most all of you will get pain in your arm. Half of you will get fatigue and headache, which may require you to take a nap or a dose of Tylenol. If you're under 55, you have a 16% chance of getting a fever. If you're older than 55, your chances of getting a fever are lower. So there is a chance, albeit small. Here's a very interesting point, which my favorite topic of the slide here, which is when they looked at the serious adverse events, there was no difference. That means people who got saline recorded a serious adverse event. And in all these cases, it was an allergic reaction. We'll talk about that in a minute. You won't see this very frequently in science, where they gave this many people a vaccination and the serious adverse event profile was similar to the placebo group.

Just to recap, Pfizer, which is what we have now, we also have now Moderna here in our county. We'll talk about that in a minute. Next.

Great. As far as efficacy, safety profile, very good. All resolved within a couple of days. Now, this is another important slide because a lot of people have made a mistake that they've gotten their first dose and then they go out and about, no mask, and then they get Covid that week. And here's the, here's what you got to look at in blue are the people in the placebo group. You could see that as the days went on, more and more people got Covid. Then you could see the red are the people who got the vaccine. And let's move up to this box. That blows it up a little bit more. You could see something magical happens right here at day 11 or 12, which is all of a sudden they stop getting Covid. You could see the people in the red bubbles here still got Covid. And these are the people who are in the trial as still having gotten Covid. But you first start to get your immunity after the vaccination. I'm going to call it on day 12 to 14. Let's kind of just, just let's say two weeks. How's that.

Important to know? Because don't go get your vaccine and then tell your friends you're fine. You or not. The people who got the vaccine, nine of them, like I told you, after seven days, after the second dose, still got Covid. One went to the hospital. That person did fine. So in essence, the nine people who got Covid all did well. Right. So some people would say in my book that's 100%, but statistically we're going to call it a 95% efficacy for that Moderna. I'll kind of run through this because it's basically a mirror image. Less participants. You can see the breakdown if you want to scan this really quickly, very similar to exactly what you saw in Pfizer. So they did a very nice kind of swath of the population. And again, they don't have. The graphic is not as nice as the other one. But you can see here that the folks who got the vaccination dose number one and dose number two, there were, there were. You could see how many cases of people still got Covid.

After dose 2, 12 people still got Covid with the Moderna vaccine. So you're not out of the woods yet even after dose number two for either vaccination. Okay, let's keep moving on. In the, in the Moderna trial, not one person ended up in the hospital. The 11 people who got Covid all stayed home. They had symptoms, but then nothing happened to them. Compare that to the placebo group. My friends, this, this is beautiful science right here. And I think it's going to follow through with real life when we move it ahead. Not to get too much into this, but we were promised a whole lot of doses.

40 million doses by the end of the year. That didn't happen. Right. So we probably have only given, let's say under 5 million doses so far. And we're already in the second week of January.

This is an update as of this morning. I put this slide in Pfizer. We've had 21 allergic reactions in 1.9 million doses. That's a risk of 0.0011% or 11 per million. All of these people had allergic reaction that either responded to Benadryl or a steroid or needed an EpiPen.

Eleven of those people already, or, sorry, I believe it was 17 of those people already had known allergic reaction type history. That's important. But they all did well.

A lot of the reactions we're seeing here, Memorial, where we having our site, is vaso vagal, meaning people are just anxious. We had one lady go down at the site, the ambulance came, three more people went down right after her. So understand that there's a real allergic reaction and then there's the anxiety type reaction, which we're going to see. There's no. Especially with all the things going around in the news. What is the likely culprit of these side effects? Polyethylene glycol. If any of you have had a colonoscopy in the GI doctor told you to drink some fluid before the day before, which is no fun, right? Or if you have constipation, you're taking Miralax. If you had had a reaction to this medication, you're probably going to get a reaction or you have a likelihood of getting the reaction. This is the ingredient. Okay. We now know what it is. So. And again, these are not severe reactions. These are all reactions that may require epinephrine. But if that's. If you are someone who has had allergic reactions before, make sure you're in a location that they know what they're doing.

People who have had fillers, it turns out that Moderna is showing inflammation at the filler itself. Okay, so my fillers are doing okay. I haven't had any reaction. But in all seriousness, if you've had the fillers, make sure you talk to your surgeon. So other questions, if I'VE had Covid already. Do I still need the vaccine? The answer is yes. But you can wait 90 days and let someone who really needs the vaccine take it. But you ultimately should get the vaccine because the vaccine does a better job of protection than the actual virus itself. Depending on how serious your virus was. Can you still take this if you're pregnant? The answer is yes. Talk to your doctor. Okay. But the answer will be yes. And the good news is your antibodies get. Protect. Get passed along through the placenta to your unborn child. And they are now protected for six months. Double bonus. Once I'm fully protected, Will I still have to quarantine if I have an exposure? Yes, because we still don't know the infectivity of those people who do get Covid after their second dose. So remember that quarantine is seven days, then a test, or just 10 days, and then you're out of quarantine. That just changed. Do we still have to wear a mask after we get vaccinated? Yes, for the same reason. Can I get the vaccine if I'm immunocompromised? Yes. Unless, you know. So basically, they're saying no matter who you are, unless you have an allergy to the polyethylene glycol or something else, you can.