S3E1 2020 – What just happened? and what to expect in 2021 with Dr Jonathan White

Geoff Allix  00:01

Welcome to Living Well with MS, the podcast from Overcoming MS, for people with Multiple Sclerosis interested in making healthy lifestyle choices. I’m your host, Geoff Allix. Thank you for joining us for this new episode, I hope it makes you feel more informed and inspired about living a full life with MS. Don’t forget to check out our show notes for more information and useful links. You can find these on our website at overcomingms.org/podcast. If you enjoy the show, please spread the word about us on your social media channels, that is the kind of viral effect we can all smile about. Finally, don’t forget to subscribe to the show on your favorite podcast platform so you never miss an episode. Now, without further ado, on with the show. Today’s episode is a catch up of what’s been happening in 2021, and how that affects people following the OMS protocols. Returning for this episode is Dr. Jonathan White; Medical Advisor and Event Facilitator for OMS. Before starting this episode, I should mention that people who suffer from severe allergic reactions should avoid the Pfizer vaccine and it’s always worth speaking to your health care provider before getting any medical treatment. So Johnny, welcome back to the podcast.

 

Dr. Jonathan White  01:16

Thank you very much, Geoff Pleasure to be back again.

 

Geoff Allix  01:19

And we’re starting off this season; 2021, slightly different circumstances to previous ones. So I’d like to start by asking what just happened in 2020? And could you put it in the context of the health and well being perspective?

 

Dr. Jonathan White  01:40

Just starting off with an easy question. I think to do that succinctly is a really difficult task, to be honest. I mean, certainly for those of us living in the UK and Europe and parts of the US, we’re still, to my mind, really in the eye of the storm of COVID, or it certainly of feels that way. I sometimes feel it’s pretty hard to see through trees to be honest, but in a sort of a soundbite way, I really consider this to be the single greatest global public health event in a century or certainly since the end of the Second World War; that wasn’t technically a disease. As I said, in most people’s lifetimes, there just has not been a significant event as this in terms of their impact on their daily living, their home life, working life, school, restrictions on where they can travel to, who they can socialise with, where and when, with whom they can exercise, and couple that with massive economic impact on a global scale, who knows how long it’ll be before that comes round and recovers, and what the world will look like afterwards. And undoubtedly, unfortunately, many jobs and many businesses will simply not survive. In terms of just hard, terrible numbers, I looked last week on the WHO site, globally there have now been 100 million reported cases of COVID-19, 2.1 million deaths and in the UK last week, we passed the extremely grim milestone of 100,000 deaths. At the simplest but yet most tragic level, it’s a story of just huge personal suffering and grief, you’ve loved ones lost, families torn apart, livelihoods destroyed and sometimes those people aren’t even able to be with their loved ones to say goodbye in their final moments or to have a proper funeral service and it’s just awful, and that’s my perspective on it.

 

Geoff Allix  03:39

And so specific to this podcast, then, how do you think that COVID-19 has impacted people with MS? Yeah, well, you know, somebody within the MS community for me, it’s there’s been a lot of fear, there’s been anxiety, there’s been times of huge uncertainty. For many of us, it’s involved physical isolation, social isolation, and all of the negative impacts that come with that to our mental health or physical health and our sense of well being. It’s meant huge changes to our home life, working lives for those of us working. For lots of us, there will be changes to the way that our condition is managed by the medical community, by our neurologists around us; nurses and the allied health professionals, missed appointments you’ve been waiting for that might have been cancelled or revoked or cancelled again or changed location, MRI scan might have had to be delayed if it wasnt safe to be in the hospital, you may have been waiting to try new treatment and perhaps an infusion medication that has impact on when or if you can get a vaccine, you know and remember as well the MS community in general would be considered by many health bodies to be a more vulnerable one for many clinical reasons, but also very vulnerable to the virus of course itself and some people but also vulnerable, that we’re relying on services, and many of them are simply not there in the same way at the minute. So there’s been a huge impact for people with MS. Yeah, when they say that so many people died, but 99% had underlying health conditions, It does bring it home, when you think, yeah, I have one of those underlying health conditions and I know so many people that do and it’s like, we’re not expecting to die in the next year, we’re not on death’s door, these people with underlying health conditions, some of them obviously will be on death’s door, but I mean, a lot of them have got a condition, which is just listed as an underlying health condition and it could be that they’re expecting to have a long, fulfilling life and live for many, many, many years. Yeah. Just to be clear, for the majority of people with MS, we now have quite a lot of data on people with MS getting COVID, the majority of them will do very well, and will recover, but there are risk factors, of course, within the MS community that would increase your risk of a poor outcome from COVID, and the same is for many other people, so obesity, advancing age, increased levels of disability, we’re seeing increase your risk of mortality and morbidity from COVID. So, yes, there are people within our community who are very vulnerable to COVID and their lives are on hold, essentially, as many of ours are right now. So there have been some problems in how the the pandemic has been dealt with, specifically in the UK, US and some other specific countries. Other countries have done very well, I mean, the likes of Australia and New Zealand, Vietnam has done very well, but the countries have had these problems; UK, US France, do you think that they’ve improved their approach? Have they righted the shift, if you like, and have improved situation going forward? Well, thankfully, I’m not a politician, but, you know, I believe in the fullness of time and the inevitable public inquiry, without doubt, it will show things that could and should have been done quicker, better, or different, you know, the UK as an example, In my own opinion, I think locked down too late last March, and probably again, this time, we’ve never really got a workable track and trace system that’s fit for purpose, we be too slow to respond often and probably not respond as strongly enough, certainly with regards to things like border controls quarantining. So there are definitely, in my view, things that could have been done better. I think, probably the success story if there is one at the minute, and it’s early days within the UK itself, and with the vaccine story, that we’ve had over 9 million people given their first dose, and some given their second dose, although there are different issues there, with regards to timing. So I think that there are things that are getting better, you know, I can’t speak for lots of other countries, except to say that there are issues with some of them and the supply and distribution of vaccine, which seems to be an issue, but yeah. So do you think that 2021 will see a change? I just remember at the start of 2021, that thank goodness that 2020 is over, a few days later, they stormed the capitol in the US and then thought okay, 2021’s got some things up its sleeve as well. But do you think 2021 in terms of the pandemic COVID-19 we’ll see a massive change and you mentioned vaccination, and so by the end of 2021, we will be in a dramatically better situation?

 

Dr. Jonathan White  09:06

Well, it’s not going to happen overnight. You know, this is not going to be a magic fix and people are saying, Oh, by the Spring, as in March, April time, we will back to normal, I’m not sure that that’s the case at all, really. But to be clear, in my view, vaccination is the way out of this unholy mess, two greatest global medical successes, history and public health level have been clean water and vaccinations. And I understand that some people out there do not share my view of the issue of vaccination, but I wholeheartedly believe it to be true, nonetheless. The data is very clear that all available vaccines and of course there there are differences in different parts of the world, but they are extremely effective at reducing severe COVID infection. They significantly, massively reduce hospitalisations and death rates and hopefully, within the next few weeks, we’ll start to see data on those people being vaccinated, having reduced transmission rates of the virus amongst vaccinated populations. And that’s the unknown at the minutes, when you’ve been getting the vaccine, does that stop you passing all the COVID? It seems that it would make sense, but we of course need to prove that. So there’s definitely light at the end of the tunnel with regards to the vaccination program, and hopefully, in other parts of the world. There’s also the fact that the medical treatments if and when you do have COVID are improving rapidly, you know, a couple examples the very cheap, widely prescribed steroid Dexamethasone. We now know, from a UK trial, it has significant impact, positive impact for people with severe COVID. So there are lots of things as with any new disease, there are things we are better at getting better at, there are things that are we are learning and we are advancing and there is without doubt there is light at the end of this tunnel, but it’s just not quite yet.

 

Geoff Allix  11:43

And so people who’ve got MS is there risks specifically for them getting vaccinated?

 

Dr. Jonathan White  11:52

Well, at present, huge number of the global MS charities and the regulating bodies working in MS are almost universally saying that anyone with MS should take any vaccine as soon as it’s offered to them, regardless of time. The consensus at the minute is there’s absolutely no reason that the vaccines should cause relapse or worsen your symptoms and it’s always worth remembering that COVID infection certainly could cause relapse and worsen your symptoms and, of course, you’ll have to bear in mind that we’re learning that long COVID, this phenomenon of the sort of post viral syndrome that some people are getting, and probably that’s about 10% of people after COVID infection, is remarkably similar to some of our MS symptoms in terms of cognitive functioning and fatigue. To my mind there’s a very, very strong case for getting the vaccine and somebody who has MS, there will be other people who feel that that is not a risk that they want to take, that’s their decision, but there are risks with anything that we do. Of course, the risk of the vaccination are extremely small and the risk of COVID, In my mind, certainly if you are older, if you’ve had MS for a long time, if you have a greater level of disability, then personally speaking, vaccination is the way to go.

 

Geoff Allix  13:19

And so is there any differences between the vaccines? Do they work in different ways? And does that affect people with MS and specifically people with some of the treatments which are the stronger medications, if you’d like that might affect their immune system? Should they try to get a particular type of vaccine or change their approach?

 

Dr. Jonathan White  13:49

Yeah, so the advice is to take any one you’re offered regardless of brand, MS type, age, level of disability, or whichever DMD your on. That’s the sort of headline take home message. But obviously, there are caveats to that and so it needs to be under local guidance, you know, and then probably, for people on the infusion medications, I’m thinking things like Ocrelizumab or Natalizumab. There will be specifics regarding, for example, the timing of doses or how long you need to leave it before or after a dose before you would get the vaccine for example, and different jurisdictions have different guidance on that, but that guidance is there. But generally speaking, some of the more potent if you like, infusion medications may blunt your vaccine response, but you will still very likely develop a significant vaccine response and derive benefit and protection from that. In terms of differences between the vaccines, if you like, there are a few different brands out there, but there are essentially two different ways in which they work. So one is mRNA technology, and the other is the Viral Vector technology. So if we start with Viral Vectors first; that’s the sort of people’s fashion if you like, traditional way of vaccine, you take a little piece of virus or whatever it is you’re trying to protect against, a little bit of its code and you put it into a harmless virus. So in the case of, of the AstraZeneca Oxford job, it is a chimpanzee cold virus or an adenovirus, which has a little bit of Coronavirus, injected into, the COVID-19 virus injected into it, and then it’s injected into the body where the immune system recognises the vaccine as a foreign invader and it makes an immune response to that. And that’s the way that many vaccines work and that’s not a live vaccines. There are concerns with live vaccines and MS, but it’s not a live vaccine, so you can have it with MS. The other is the mRNA technology, which is the one that everyone has been talking about, the new kid on the block if you’d like. mRNA technology has been around for at least a decade in the treatment of cancers like melignant melanoma, it’s very safe, and it’s very effective in that and it’s a very clever way of working, to explain it as simply as I can, because I’m not an immunologist. Basically mRNA or messenger RNA is a variation of DNA. So the genetic code and all of cells and what you’re doing with COVID vaccines using mRNA is you create a little piece of the code for COVID-19 and you inject it into our muscles and muscles, usually the arm and the muscle cells themselves absorb that code, and then start another code within the muscle creates essentially, the little piece of what we call antigen or the bit that your immune system recognises as Coronavirus, so it’s not Coronavirus, but the body recognises this antigen code as Coronavirus and it then makes the antibody response to it. The advantage of the mRNA technology is, it’s very fast, so it’s very, very quick to make, the viral vector ones usually take a lot longer. So it’s very quick to make, it’s cheap to make, relatively speaking, it’s a very effective way of finding antibody response and the other huge advantage it has, is that it’s relatively easy to slot in different bits of code. So for example, should they need to change the vaccine for a new strain or variant, you can slice out bits of code and put in other bits of code relatively easily and that is a huge advantage in a vaccination program, certainly when you want to vaccinate a huge global population against an endemic virus. So there’s in simple terms, there’s the two current differences.

 

Geoff Allix  17:41

But it wouldn’t make a major difference, so you wouldn’t say well, I’ll wait for vaccine X?

 

Dr. Jonathan White  17:47

Absolutely not. So I think it is worth elaborating on slightly because I know that some people out there have raised concerns about the Oxford AstraZeneca vaccine. So within the trial, there were two suspensions of the trial, when patients in the vaccine group develop symptoms of transverse myelitis, which as we know, can be a precursor to MS. Now, if you’ve 45,000 people in the trial, two people develop symptoms of transverse myelitis and within the UK, the risk of MS is roughly about one in 500 to 600, then both of those events could have happened purely because they were going to happen anyway, If that makes sense, because MS is common in the population. Both the trials stopped, it was fully investigated, they were satisfied, it was nothing to do with the vaccine, and the vaccine has been considered and should be considered safe in people with MS and you know that’s not me saying that, that’s come from the neurologists, the MS Society in the UK, many of the bodies around the world representing MS, really, so both, either technology should be considered safe.

 

Geoff Allix  18:58

Okay, so obviously there is a major vaccination push going on worldwide, and a remarkable proportion of the population already vaccinated, but most people are not. So people with MS, Is there anything they should do to stay healthy while they’re awaiting vaccination? Because obviously, things have changed somewhat. We we can’t necessarily do all the sports we used to do and, and yeah, our lifestyles have changed quite dramatically.

 

Dr. Jonathan White  19:29

Yeah, absolutely. I mean, I think for those of us new to the OMS program, dive in and get to it. For those of us who’ve been on it for a while, please keep at it, you know, you take a sort of piece by piece; Vitamin D and COVID, you know, there’s now perspective data is going forward in Spain showing that giving people high doses of Vitamin D when they are at early stages of COVID infection prevented a large large proportion, being significantly unwell. So Vitamin D and COVID, no downside there, keep taking vitamin D. We know that nutrition undoubtedly plays a role and many, many diseases, COVID, I don’t see being any exception to that. So eating well is protective for your physical health, but also eating well is massively protective for your mental health. You know, we know that the gut communicates with the brain at an extremely effective level, what we eat directly impacts on how we feel. And, you know, I think that that’s a huge part of this is there’s keeping ourselves as physically well as we can, doing all the things that we normally do from an MS point of view, or an OMS point of view, but in terms of the mental health aspect, and this got to turn to the mainstays of the program for me, and I know I certainly have done that has helped me hugely throughout this. So keeping up your regular meditation exercises, it’s, you know, it’s journaling, it’s writing down the things that sit there or may plague us in the middle of night, it’s getting it onto a piece of paper and out of your head. There are a multitude of resources on the OMS website and actually, I saw it this morning a really nice blog, on probably the processes and the benefits of reflection with some really nice exercises in that I saw a recent post about new breath meditations, there’s Veronique’s yoga posts, there’s all the recipes that are coming on rapidly and of course, there’s your wonderful podcast, Geoff, for all the latest info on the worlds of MS as well. So yeah, you know, turn to us. You know, there’s, a lot, there’s a lot on the OMS website and all of our platforms, but also there’s the community and don’t forget that it’s hard, the OMS program really is a community, it’s you know, it’s your circle, and if you can’t be physically with them, you can be remotely with them. And if you don’t have a circle in your area, well then you know, connect with us online, and there are lots of like minded people are trying to get through this as best we all can.

 

Geoff Allix  22:04

Saying that actually just on the side, yeah, so the circle I’m a member of, one of the guys decided, because of exercise being a little bit more problematic, he’s worked out a mileage per hour of exercise you do a week and he’s adding together the amount the whole circle do and we’re doing a world tour. So he’s posting pictures of the cities and he’s got this route on Google Maps and so actually our time of doing not normal exercise necessarily, and maybe more house bound and not getting out as we used to has changed into which which city we’re getting to next and it gives us a bit of impetus to do a little bit more, because we’ll get a few more miles and get somewhere nice.

 

Dr. Jonathan White  22:55

Yeah, that’s really, that’s fun and It’s different and I think that’s a fantastic idea. For me, it’s become lots of YouTube yoga, Turbo trainers and all sorts of things like that. So yeah, I’d quite like to go on a virtual world tour myself.

 

Geoff Allix  23:14

Rather than watching Joe Wicks all the time? So has this affected researcher, cause obviously billions have been put into COVID vaccine research and other COVID research as well, because it’s not just the vaccine, there is as a lot of treatment research going on. So has that slowed MS research in any way?

 

Dr. Jonathan White  23:40

I think it’s probably quite hard to quantify at the minute but undoubtedly, there will be an inevitable knock on effects throughout research entanglements, not just MS, but not least in terms of recruiting people into clinical trials, there’s lots of trials that have had to be paused. So for example, the MS Stat 2 trial, which is looking into statins and progressive MS. So that’s had to pause recruitment temporarily, hopefully, just simply because it’s not feasible for lots of reasons to bring people into hospital or to have the researchers doing that at the minute. So there’s the recruitment side of things, but there’s also I suppose that the financials for research for governments and the charitable sector, which has been hit massively, of course, by COVID. The positive is that so much MS research was ongoing and in advanced stages, that I personally would be very hopeful that there’s going to be new and exciting results in the coming months and years and I don’t think I don’t believe that people with MS are going to lose out.

 

Geoff Allix  24:42

And could there actually be any positives from the amount of investment that’s gone into COVID-19 efforts so that you could there be some positives out of this for the wider medical community and MS specifically?

 

Dr. Jonathan White  24:56

Well, yes, potentially. You know, knowledge is always power and specifically, it’s very early, but there has been some data to show that the mRNA technology that we talked about, there’s been a study in mice that shows huge promise when essentially mice were injected with a part of code that essentially tells the consistent to tolerate myelin against myelin, the fatty sheath runs on nerves, the immune system is incorrectly, inappropriatly attacking in MS and that’s what causes the symptoms. So if you can teach the immune system to tolerate myelin again and stop attacking, that’s a potentially massive thing and in the mice, so the mice had EA, which is the sort of mice model of MS, It either stopped or reversed disabilit in those mice, which is pretty important result. And also, really importantly, there was no evidence of systemic effects on the immune system, you know, so many of the current disease modifying treatments have side effects and knock on effects for normal functioning of our immune system. So if it leaves the rest of the immune system untouched, if you’d like, that’s a fantastic thing. And it’s also fast and cheap to make. So, you know, and of course, the study answering with what we need to do some humans sign up and of course they do and of course, it’s early days, but that still, that is the positive that has come out of all the interest system in mRNA technology. So that is a positive. So fingers crossed that will be a benefit for us all.

 

Geoff Allix  26:29

Mice always get the best MS treatment, it seems

 

Dr. Jonathan White  26:32

They do but they are all the guinea pigs. It is exciting.

 

Geoff Allix  26:41

And there’s talk about mutations because there’s a well, in the UK as the two of us are, we’ve obviously got one of the problem strains of COVID at the moment, and there’s also South Africa strains and, you know, round the world, different strains and mutations are coming. So are you concerned about potential mutations, and that there could end up being a new Super COVID 21 or something, and that that could then blunt the effectiveness of a vaccine?

 

Dr. Jonathan White  27:19

So the first thing to say is, that’s, you know, it’s completely expected that a virus will mutate, that’s what viruses do. So it’s not something specific to COVID itself. Scientists have been very clear on this so far, that coronaviruses is not going away and it is possible In the future, the vaccines may have to be altered to deal with a strain or a new variant, but at present, the data that we’re seeing are largely encouraging about the effectiveness and protection level. So to put in perspective, the World Health Organisation says a vaccine is effective if it reduces infection by around 50% or greater than 50% and you know, we’ve sort of seen 85 and 90%, 95% effectiveness from these vaccines. So they are very, very effective. There’s been some new information within the last week or so regarding the South African and the South American variants that people are right rightfully concerned about and they seem  to offer protection of around 65% of the minutes, so they are still effective, they’re not as effective, but they are still effective against the COVID strains that are presently available, so that is reassuring. I guess probably given that the virus is likely to continue to mutate, and it’s going to be around the same way, think of it hopefully the same way as flu annually. You know that there’s a different strain each time and there’s a slightly different flu shots for each flu season. That hopefully identifying new strain early adaptive vaccine is required, we’re ensuring that the population is vaccinated and we’ll keep community cases low, transmission low and that will start the snowball if you like coming down the mountain and the avalanche that we’ve had in the last year you know, if you if you halt this in it’s tracks in the future, then hopefully we will not be having this discussion again in 2022/2023.

 

Geoff Allix  29:27

So the flu vaccine presumably they’re not starting again each year, would they would they be starting again from zero?

 

Dr. Jonathan White  29:34

No. The way that the flu program usually works is that obviously Australia’s winter comes before the northern hemisphere, so they they look at what happens with flu and winter’s down their and they adapt our flu vaccine if you’d like to that, so what you do is you look at where it now and currently and then you adapt, but we know you would not be starting from zero. That’s not that we don’t have to throw it all our hard work, absolutely not, as I said, you know, particularly the mRNA vaccines are relatively easy and quick to to adapt and to change to new strains or variants. It may not be that that needs to happen, but it can happen if it needs to. And remember, you’ll have significant protection, hopefully, in lots of these countries, when the vaccination program gets out to the populations of all that you’ll have, you’ll have such a wide base of herd immunity, which is a phrase we hear a lot these days along with things like social distancing, and social bubbles and all sorts of things. But if there is immunity in the community at large, then it’s simple as the virus can’t take hold in the same way that it did before. Because last year, nobody had any immunity to COVID whatsoever, it was an entirely new virus. So we’re not starting from scratch, absolutely not.

 

Geoff Allix  30:53

And just to wrap up, on a more positive note, what are you most hopeful about for 2021?

 

Dr. Jonathan White  31:01

Well, I’m really looking forward to hopefully seeing my family and my friends again, really looking forward to be able to hug people. Strangely, I didn’t think I was a hugger but I obviously am. I’m very excited about a pint of cold Guinness whilst watching a rugby match in my local pub. It feels like forever since that happened, and being able to go on a trip with my family. Professionally, I want to continue to grow and develop our local early prgnancy and pregnancy loss services in my real day job. Of course, I’m very, very excited by all the new and exciting OMS developments and initiatives that we have throughout this year, so please continue to watch this space. Actually Geoff if you wouldn’t mind indulging me if that’s okay, I just wanted to share with your listeners a poem that I saw this week that I think sums up how i feel about this. It doesn’t specifically refer to Coronavirus, but I sort I’d quite like to as you know, I like a little quote or usually from a film but this time I’ve got a poem. It’s called ‘Time to be slow’ by an Irish bloke called John O’Donoghue; This is the time to be slow, lay low to the wall until the bitter weather passes, try as best you can not let the wire brush have doubt scrape from your heart or sense of yourself and your hesitant mind, if you remain generous time will come good and you will find your feet again on fresh pastures of promise where the air will be kind and blessed with beginning’. And I think that you know for me, you know there is hope, there is light at the end of the tunnel. The night is always darkest before the dawn and I certainly see little rays of sunlight coming up over the horizon. So until then I hope that all your listeners can stay safe and well and look after themselves.

 

Geoff Allix  32:52

Thank you and thanks for that poem, that was excellent. I’m hoping that in a year’s time, we could have a wrap up for 2021 which goes back to talking about more normal things.

 

Dr. Jonathan White  33:03

That would be excellent, I would like that a lot.

 

Geoff Allix  33:07

Thank you for joining us Johnny. Thank you for listening to this episode of Living Well with MS. Please check out this episode shownotes at overcomingms.org/podcast you’ll find all sorts of useful links and bonus information there. Do you have questions about this episode or ideas about future ones? Email us at [email protected] we’d love to hear from you. You can also subscribe to the show on your favorite podcast platform so you never miss an episode. Living Well with MS is kindly supported by a grant from The Happy Charitable Trust. If you’d like to support the Overcoming MS charity and help keep our podcasts advertising free, donate online at overcomingms.org/donate Thank you for your support. Living Well with MS was produced by Overcoming MS, the world’s leading Multiple Sclerosis healthy lifestyle charity. We are here to help inform, support and empower everyone affected by MS. To find out more and subscribe to our e-newsletter please visit our website at overcomingms.org. Thanks again for tuning in and see you next time.