Dr. Steven J. O’Day, executive director of the John Wayne Cancer Institute and Cancer Clinic, and Director of Providence Los Angeles Regional Research, spoke at the Optimist Club’s Zoom meeting on December 1.
Recognized as one of the preeminent melanoma specialists in the world, O’Day focused on Covid-19, before the Pfizer vaccine was approved by the FDA.
“We as a country should take amazing bows for the steps that were taken towards [fighting] this virus since January,” he said. “We know much about the virus now, about how it enters cells and maneuvers. The fatality rate is dropping dramatically. There is a light at the end of the tunnel.”
O’Day, who was trained at Johns Hopkins and the Dana Farber Cancer Institute in Boston, came to Los Angeles in 1994 and founded the Medical Oncology Division of the John Wayne Cancer Institute.
In his Optimist talk, he went through a brief history of Covid-19 in the U.S., saying the virus was sequenced in February, March and April.
“We were unaware then if it was more like a measles virus,” he said, noting that the Covid-19 virus has proven to be highly contagious. To catch it, you only need to be in the same room with someone who has it.
Scientists also didn’t know if Covid-19 was like an influenza virus, which is airborne and can also be contacted from surfaces.
“Covid is an intermediate airborne,” he said. It’s not as contagious as measles, but the likely spread is closer than six feet. “It is important to understand your risk.”
Things to consider are the extent of the exposure of the viral load, the duration, one’s age and comorbidities. “It’s masks and social distance, together, that protects,” O’Day said.
Currently the experts know that about 20 to 40 percent of persons who are exposed will not get sick and one is most contagious a day or two before one is symptomatic.
As far as rapid testing, O’Day says it gives a false negative 15 to 20 percent of the time. “When a community spread is less than one percent, then you can do contact tracing,” he said. The reason for testing would be that if less than one percent of the population is positive, the virus could be traced.
Yet it has been said that as high as 40 percent of the population might have the virus. “Just assume everyone has it,” the doctor said. “Treatment has been the biggest success.”
O’Day described the symptoms as like having “the worse flu” and said that older individuals have much worse symptoms. “The fatality rate used to be 10 percent for those hospitalized,” he said. “Now it is less than one percent.”
The initial treatment for the disease involved putting patients on ventilators. “We learned [this could] damage lungs even more,” O’Day said. “Now high-flow oxygen given through the nose works better. Doctors also learned that patients placed on their stomachs tended to do better.”
Additionally, an antiviral called remdesivir, used to fight Ebola, is now being used successfully for coronavirus, and it can lessen hospital stays.
O’Day also said that a steroid (anti-inflammatory) dexamethasone has also been successful.
He explained how the virus works. “It kills in two ways: it transmits itself in the host and it manipulates the immune system to overreact. This virus is tricky because it turns the immune system into attacking its own immune system.”
O’Day said that research into the causes of cancer has taught doctors better how to deal with Covid.
“We’ve learned so much,” he said, noting that people who recover from the virus develop antibodies.
“Eli Lilly and Regeneron have genetically engineered antibodies,” O’Day said. If these are used earlier when someone is diagnosed with Covid, they have a better outcome. Both drugs have been approved by the FDA.
The next step in dealing with the pandemic is the vaccines and “they are thought to be highly effective,” O’Day said. “The short-term safety looks quite good. And 70 million people could be vaccinated in December and January.”
He was hopeful that, through vaccinations, we can have herd immunity by summer.
One Optimist said that he had heard that about 40 to 50 percent of the people in Wisconsin are asymptomatic and wondered what it could be in L.A.
“The Midwest could be anywhere from 20 to 50 asymptomatic. Florida is approaching that,” said O’Day, who speculated that L.A. County could be from six to eight percent. “What’s more important is the hospitalization rate.”
“We should be able to reduce mortality because we know what to do,” O’Day said, but he warned the problem could be keeping hospitals staffed.
One Optimist asked about President Donald Trump’s Covid-19 treatment.
“He got the best treatment possible” [using antibodies and steroids], said O’Day, “and it turned around completely.” He also noted that if Trump had contacted this at the beginning of Covid-19, he might have had a different outcome.
Asked about Governor Gavin Newsom’s statement that California would have to evaluate the vaccination for safety before it was given here, O’Day said, “That seems unnecessarily political. Get the vaccination — it has exceeded expectations by far.”
He was asked about future viruses. “We’re always at risk for a new virus. We will have pandemics in the future. We need to look at how best to work civilly as a population.”
The December 15 video topic is speaker Sir Ken Robinson, who will address “Do Schools Kill Creativity?”