Ep25: COVID-19 Vaccine Updates & More with Dr. Kevin Chung, Chief of Medicine at United States Military

Hills and Valleys is a podcast that uncovers stories from leaders in healthcare, tech, and everything in between. Straight from the heart of Silicon Valley, we give you a look at the good, the bad, and the future, one episode at a time. Brought to you by Potrero Medical.

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About Dr. Kevin Chung, Chair of Medicine at Uniformed Services University

COL Kevin K. Chung is a graduate of the United States Military Academy at West Point and Georgetown University School of Medicine. After finishing a fellowship in Critical Care Medicine at Walter Reed Army Medical Center, Dr. Chung was assigned to the US Army Institute of Surgical Research (USAISR) where he has served in the capacity of Medical Director of the Burn Intensive Care Unit, Task Area Manager of Clinical Trials in Burns and Trauma, and the Director of Research for the USAISR over the last 12 years. He is currently serving as Chair, Department of Medicine, at USU. 

Courtesy of Twitter

COL Chung holds academic appointments at the Uniformed Services University of the Health Sciences as Professor of Medicine and Professor of Surgery. In his career, COL Chung has authored over 180 manuscripts in peer-reviewed journals, authored 13 book chapters, and has been an invited speaker for over 85 lectures internationally. 

His research interests include burn resuscitation, critical care, and organ failure. Specifically, COL Chung is researching the use of CRRT for reversing the negative effects of kidney damage in burn patients.

You can follow Dr. Chung on Twitter @chungk1031 .

 ? Interviewer: Omar M. Khateeb, Director of Growth at Potrero Medical

? Interviewee: Dr. Kevin Chung

Khateeb: Hey everyone! It’s Omar M. Khateeb, Director of Growth at Potrero Medical with another great episode of Hills and Valleys. We have a special guest who’s come back on. This is a vintage guest from our early days that we had the pleasure of meeting a couple years ago. He’s Colonel Kevin Chung, the Chair and Professor of Medicine over at the Uniform Services University.

Dr. Chung, thank you so much for joining us.

Dr. Chung: Thank you Omar for inviting me back. I guess the first episode went okay.

Khateeb: It’s a great episode. I still get a lot of comments from physicians and healthcare leaders on it because it was a fantastic episode. I’m going to leave that in the show notes for those of our audience who haven’t actually listened to it yet. We have a great topic today, but we want to hear about what’s going on with you and how your time has been at USU and also talk about updates and COVID.

I have to call this out. I knew you when you didn’t have a whole lot of Twitter followers many years ago, and now, you have thousands of people who follow you not just in the medical community. There’s plenty of people who I know who are in government, politics and other arenas who follow you as a trusted source on Twitter.

I will leave your Twitter handle down there. It seems like the Twitter community has really embraced you. How does it feel?

Dr. Chung: Yeah, thanks Omar. I still consider myself a bit of a novice in terms of Twitter compared to many of my colleagues that are out there with hundreds of thousands of followers. Just having a few thousand isn’t that big of a deal. I’m fortunate to have experienced what I’ve experienced through this pandemic. Unfortunately, all of us got thrown into the wolves, and we’re drinking from a fire hose trying to deal with a disease that nobody knows anything about.

Twitter was really my source for information for me. I relied on many of my colleagues and their posts. Really, I just started tweeting my experience taking care of patients within the setting of Walter Reed and other hospitals that I work at. It’s just kind of grew from there. I’m happy to share my experience, but I get much more out of Twitter than what I’m able to contribute.

Khateeb: I think we all definitely feel that way. What I think is interesting is that, this pandemic is new for all of us, but you’re very much well-versed in dealing with crises like this. I remember you mentioned that you were really influenced in your training early on because you lived through critical care medicine during 9/11. I think hearing from you and your perspective is going to be incredibly valuable. Before we launch into this interview, one thing I do have to mention is that we’re at one week post Veteran’s day, so happy belated Veteran’s day.

Thank you very much for your service. I do want to mention to our audience that it’s great to thank our veterans on the Veteran’s day, but I don’t think it should be limited to one day. I think that we should always find a way to thank our veterans because at the end of the day, we have brave people like you who sign up and whatever our country asks you to do, whether it’s plant flowers or go off to war or be on the front lines, you do it and serve our country. So, I’m very grateful and appreciative of that.

Dr. Chung: Well, I appreciate the support Omar. Thank you so much.

Khateeb: Absolutely. Give us a quick update on things at USU. You’ve done a lot of great things there as the Chair so, tell us, what’s new?

Dr. Chung: Thanks Omar. Since our last conversation, things were progressing pretty nicely within my department. I was trying to set up multiple research efforts tied around diagnostics and therapeutics in sepsis. I think as we were gearing up to get a number of programs up and running, the pandemic hit.

It really changed everything and all of a sudden, we had to rally around this crisis that all of us were facing and help address it as a team. It was an all hands on deck situation across the country. Since you follow Twitter, you’ll know that everybody was galvanized and united in helping prepare healthcare workers and the public for this crisis. As we were hearing stuff from Italy and mind-blowing reports from China about hospitals being overrun and triage conditions that were occurring in Italy, that really woke us up as a medical community. The military medical system was no different.

We all prepared as best as we could. We’re a global health system. We’re different in that the military as a health system has hospitals all around the globe. One hospital is in Bowdle, and over 300 clinics. So, trying to prepare globally as a military health system was a bit of a challenge as well as trying to standardize care. We’re not talking about one city or one region, we’re talking about globally. How do we begin to communicate and how do we begin again to standardized care across the board? We initially created a practice management guide. We wanted to call it a clinical practice guideline, but there are certain rules involved with declaring that something is a clinical practice guideline, and we didn’t have time to have the document go through all the checks and balances for it to be officially called the clinical practice guideline.

Over a weekend, I enlisted the help of 30 of my colleagues and we put out a guidance document that we called the Practice Management Guide. We really just went things like how you screen, how you initially treat, how you triage patients for the ICU, some baseline guidance for treating patients who are critically ill, and so on and so forth. It initially was about a 60-page document. We tried to make it as concise as possible, but as we started writing the document, we realized that we wanted to cover broad areas to include deployed medicine and care in the osteo environment and other things like, obviously infectious control, PPE posture, surge capacity which talks about how to deal with when your hospital and ICU get overwhelmed. So, we created this document initially with about 30 providers and released it immediately. Like the burn resuscitation guidelines that we disseminated widely overnight long ago, this was a document that we disseminated through Defense Health Affairs (DHA) and it was well received because it helped put everybody on the same page.

Fast forward to now, we are on our sixth version with over 150 pages. It pretty much encompasses the entire gamut of COVID care from outpatient care to inpatient care, post discharge, radiology, special populations like pediatrics, obstetrics, and so on and so forth. It has evolved into this huge document that is a one-stop shop for information about caring for COVID patients within the scope of the military health system. It’s now available on the USU website and also on the DHA website.

Simultaneously, as an intensivist, I needed to stay in touch and reach out to all the intensivists in the military. So, we started a WhatsApp COVID group, and within a couple of weeks, it grew to about 250 individuals.

Khateeb: Fantastic!

Dr. Chung: The way that we communicated was whenever someone said they were starting to see an uptake in patients in their area, we’re comparing notes and exchanging treatment protocols, and sharing emerging data as it came on. What I did was I scanned my Twitter feed and looked for any valuable information and basically cut and paste my Twitter feed into WhatsApp to amplify information to those folks who weren’t hard on Twitter. That really helped a lot.

On top of that, we also started having weekly case conferences that was hosted by the joint trauma system. I don’t know if we talked about this in the last podcast, but one of the ways we continue to evolve and improve during combat operations was by talking about how we managed certain patient treatment and so on and so forth. We also share that information across the entire system. By discussing these cases, we were able to identify gaps in our knowledge, fill those gaps and continue to improve and modify and refine our processes over time. These case conferences were an avenue for us to be able to continuously improve our processes, identify areas where we were weak, disseminate information when new information came online, so on and so forth. That was a very powerful tool for us to, number one, get on the same page and, number two, share our experiences and learn from each other in the military health system.

That’s evolved tremendously now. We started out as a military taking care of patients within our own health system, right? But also, as a military, we’re getting pulled out of our own institutions. We’re trying to take care of COVID patients amongst our beneficiaries, but we’re also at the same time getting pulled to go on missions to help support the civilian population. And so, that was a constant tension because you don’t want to deplete an entire hospital. If you have 90% military physicians, you can’t take all the military physicians away because then you don’t have a hospital to take care of the patients that you’re assigned to.

When the Jarvis center got stood up and the comfort was deployed-that’s the hospital ship that went to New York-that was a big deal because it pulled a quarter of our physicians and nurses out of, for example, Walter Reed. This happened across the military and that was something to deal with. Then when Texas got hit, Southern California, and Florida, we got tasked again. The military ended up sending a bunch of teams, augmentation task forces, and rural rapid response teams to a variety of different locations in Southern Texas in the border. Boy, the experience that they had taken care of those patients in those small community hospitals in the civilian sector. It’s just unimaginable what they had to go through. That was an evolution of our role as a military medicine system in support of COVID.

Now we’re dealing with the third wave and we’re all bracing for that next mass deployment to wherever we’re needed. The problem is that geographically it’s not confined to one state or another, it’s widespread. We’re all scratching our heads, trying to figure out what’s going to happen now. There’s a lot of uncertainty for sure.

Khateeb: The interesting thing is that a year ago you encouraged me to write about some of my approaches in medical devices not just in medicine, but on the marketing side. I think COVID accelerated a lot of trends that were already existing, but instead of doing this over a span of 10 years, it accelerated them within a year. I think this is the first time in human history that everybody in the world is rethinking everything. How do I take my kids to school? How do I stay healthy? How do I communicate with peers? How do I work out from home? I think coming out of this at least here in the US, we’re going to really redesign our world and society, and upgrade our systems because a lot of the systems we’re living in were designed by people who are all dead. I think that’s the benefit, but the most important thing is that we’ve got to make it through this really tough period right now.

And again, it’s inspiring to see healthcare leaders like yourself and all the nurses, doctors, and medical staff who are putting themselves at risk on the front lines to help with things. But it is scary to see the spike.

You mentioned earlier in our conversation about some of the approaches around blood purification. I learned a lot from you about ECMO. You had this fascinating approach about using ECMO when it came to cytokine storms and a lot of people aren’t familiar with the cytokine storms with COVID.

Can you tell us a little bit about how USU is approaching that and what you’re starting to find?

Dr. Chung: Thanks, Omar. Your comment about technologies and capabilities being accelerated during times of crisis is something that I truly take to heart. The things that we’ve seen happen in wartime, we’re now seeing it during a pandemic. People are desperate for solutions and we don’t have time to wait for certain therapeutics to come online, whether logic or otherwise.

As we all know, COVID elicits a host response that’s characterized by uncontrolled inflammation that is primarily focused on the lung, but then goes on throughout the entire body. And so, with regards to blood purification, this is a story that actually starts about 10 years ago, believe it or not. I don’t know if you know about DARPA. It’s Defense Advanced Research Program Agency. DARPA was founded in the 50s after United States experienced Sputnik. Sputnik represented a technological defeat for the United States, where the Russians beat us to space. At that time, the government vowed to never lose technologically ever again to foreign adversaries. So, they created this agency called DARPA. You may not know, or may know, but DARPA provided seed funding for the internet, and the DaVinci robotic system.

Khateeb: I was just going to say that surgical robotics came out of the military. That’s where it started.

Dr. Chung: Yeah, it came out of a DARPA seed program. DARPA also started a very little, not well-known program called ‘Dialysis like Therapeutics’. It’s a small program in relation to the others which DARPA started with $150 million. The program called for technologies that could identify pathogens, regardless of whatever pathogen it was-bacteria, virus or whatever-and remove them from the bloodstream real-time to treat the patient. I think I talked to you about blood purification in the burn unit, studying high volume hemofiltration and how I did a multicenter trial, and so on and so forth.

Believe it or not, what I learned over time is that that’s just not enough. Blood purification for cytokine removal, for example. Anyway, that’s more like laying the foundation there. I was involved as a DOD representative for this program because they’ve been trying to be fair and they’re trying to get input from all aspects of government to include DOD medicine.

I was involved as the subject matter expert on the DOD side. This five-year program resulted in two technologies that were able to get close to transition into commercialization because of the investment. They basically were the last two technologies standing after evaluation within the aspect of this program. The goal was that both technologies would do relatively the same thing in terms of pathogen removal. One of them called Seraph 100 was manufactured and invented by a company called Exthera. It’s a heparin sulfate-based technology where heparin sulfate, which is a relative to heparin, is bound to a bunch of beads. It’s basically a hemo-perfusion cartridge. Heparin sulfate is negatively charged, and it happens to be a major component of the vascular endothelium and the glycocalyx. The glycocalyx exists to target foreign substances like pathogens and present them to the host immune cells. This is considered a biomometric extra corporeal blood purification device targeting pathogen removal specifically.

Khateeb: Fascinating. Essentially, you’re purifying the blood and at the same time, arming the blood with the right tools to identify and eliminate pathogens.

Dr. Chung: It is basically removing the pathogens directly.

Khateeb: Oh, directly. Even better.

Dr. Chung: So, as blood passes through this filter, if there’s any pathogens circulating in the blood, whether it’s bacteria from a bacteremia like Staph. Aureus, or in the case of COVID-COVID viremia-it will attract those pathogens and cause them to bind to this filter. This way, it provides intravascular source control that’s non-pharmacologic and pathogen agnostic.

Khateeb: That’s unbelievable, because essentially you get all the benefits of a pharmaceutical without detoxing of the body or eliciting the side effects, and it’s immediate.

Dr. Chung: Essentially, that’s the concept. Seraph 100 is one technology, there’s a second technology that’s based on a protein called FCMBL. It’s a proprietary protein. This technology was created and invented by the WYSS Institute in Boston that’s affiliated with Harvard. This protein is essentially mimicking naturally occurring opsonins. If you think back to biology, opsonins are present in the body circulating in the bloodstream to tag on to foreign invaders, like bacteria and present them to host immune cells.

So, they took this protein and combined it with an FC portion of immunoglobulin. Now they encoded this entire hollow fiber filter with this protein so that as blood is going through this filter, pathogens are attracted to the protein. It turns out mannose binding lectin is the opsonin protein. Mannose is present on pretty much every non-mammalian pathogen including gram-positive and gram-negative bacteria, viruses like CMV, Ebola. They all have mannose on their cell wall and so this protein captures it. That is a second technology.

Fast forward, as these technologies were coming into transitioning to the commercial sector, they’re going through the Investigational Device Exemption (IDE) studies, first-in-human and so on and so forth. The Seraph 100 was a little bit further along in that they had already received the CE Mark. I knew about these technologies, obviously because I’ve been involved with the DARPA program for 10 years. I remember distinctly having a conversation with one of the company folks in November of 2019. They were talking about how to get the product studied and whether it is filling a need.

I was shaking my head and I told them, guys, this is an excellent technology that’s looking for a problem to solve. I said this specific quote, “what you need is a pandemic for your technology to take off”.

[Khateeb laughs]

Dr. Chung: The next thing I know is three months later, the pandemic just takes over the country. As we were preparing for the wave of patients in March, I gave the company a call and said, Hey, what do you think, are you guys ready for human use? Obviously, it was not FDA approved, so we had to go through the expanded access pathway.

Khateeb: Are you able to share the name of the company?

Dr. Chung: Yeah, Exthera is the name of the company and the technology is Seraph 100.

Khateeb: Got it.

Dr. Chung: I connected the company and the technology with our nephrologists. This is an extra corporeal blood purification therapy, and who knows that better than the nephrologist, right? I got some nephrologists on board. Colonel Jim Oliver, as well as Stephen Olson got involved. They evaluated the science behind what we were trying to do, and learned about the DARPA program and they became excited. They were like, let’s be ready to treat patients if we need to.

At that time, if you remember, we had nothing in terms of the therapeutics. Convalescent plasma was not in existence, we were still unsure about steroids, and Remdesivir was not available. We had Hydroxy chloroquine, which doesn’t work. For my first 10 patients we had everybody on hydroxychloroquine, and it just didn’t do anything.

So, we were desperate for a potential solution and we hypothesized that patients were probably getting sick, transitioning from isolated pneumonia to multiorgan failure because of viremia. That was still a hypothesis at that point because we weren’t sure. We didn’t have any studies to point to and Coronaviruses don’t typically work that way. The cold doesn’t disseminate intravascularly like that. Viremia is not a big deal. Since then, investigators have determined that there’s a clear link between severity of illness and detection of virus RNA in the blood. The higher the level of viral RNA, the sicker the patients.

Back then, we didn’t know this. So, without that information, we hypothesized that there’s likely a virus in the blood. This technology was invented exactly for a pandemic scenario like this. It’s a medical countermeasure. As we started taking care of patients, we identified one patient who was in bad ARDS, in multi-organ failure and shock. We approached the family and also talked to the FDA and they said that there’s a compassionate use pathway. We went through that pathway, did all the paperwork, and got consents, obviously. The family was willing to do it, because we had no other options. We were desperate and treated the patient and got remarkable clinical improvement.

The pressure just went from really high to very low. It was pretty temporarily related to the initiation of this extra corporeal therapy. We treated two additional patients with the same kind of deal. We reported our case report in critical care exploration and it’s out for the general public to see. As a result of our very limited experience, due to the lack of randomized control trials in the middle of the crisis right now, the company lumped in prior safety data of 20 patients that have been treated in Europe and submitted it to the FDA for an Emergency Use Authorization (EUA) application. It was granted and now it’s available for use if the clinicians believe that it will help. There have been over 70 therapies thus far.

The outcomes are pretty remarkable in a select patient population that we’re interested in. You can’t just release a product like that is quasi experimental with no randomized controlled trials, and not take that opportunity to study it. If we have a therapy that we’re using on patients, we have a responsibility and obligation to see what’s happening and collect data. Our group submitted for a grant with health affairs. The cares act which was the first supplemental that was released to a lot of those funds went to operation work speed. It was a billion plus dollars.

Khateeb: Wow!

Dr. Chung: We got a very small investment of about $15 million to evaluate not only this therapy, but also the DARPA technologies. We’re calling it the purify program after blood purification, it just makes sense. We’re systematically evaluating not only this technology, but also plan to evaluate the Garnette, which is the FCM BL technology, over time. First for COVID, because we’re in this emergency and we don’t have a vaccine yet. We don’t have reliable therapies that are reversing things dramatically. Remdesivir is good, but it decreases hospital days for patients that are on oxygen and it doesn’t seem to help as much in patients that are already intubated. So, that’s a problem. Steroids is something that has also been found to be helpful.

We’re doing those things, but this could be an adjunct to all that. We’re going to evaluate it during the period of COVID, and then we’re going to take this technology to the next level. We’ve applied for an investigational device exemption to do a pilot study in general sepsis, with evidence of circulating pathogens. You have to have either a gram stain or a PCR that detects some pathogen in the blood with septic shock and, we’re going to randomize them to therapy versus standard of care.

That is going to be the pilot. Then if that’s successful, we’re planning on a pivotal trial to bring this on the market. It takes a while for that to happen. If this was in non-pandemic conditions, the trials probably would take 5-8 years, with funding and planning the trials. With all that condensed into eight months, we have a protocol for the observational that we’re purify OBS to collect data on the 70 plus patients that have been treated thus far. We’re probably going to compare that to a retrospective contemporaneous cohort since we couldn’t do a randomized controlled trial from the get-go. That’s going to provide us some information.

What we’re talking about here is an entirely different way of attacking sepsis. Most therapies are antimicrobials excluded. Antimicrobials and antivirals are basically addressing the pathogen. However, we know that with the emergence of drug resistance, we have lots of extremely drug resistant pathogens out there in terms of bacteria. When we’re dealing with a virus that is a novel virus, you don’t have any immediate therapies. So, I see this as an adjunctive therapy to either existing or proposed pharmacologic solutions that can be synergistic in terms of addressing and achieving source control in the bloodstream. If this type of approach is helpful, then it could be among the first tech therapies that could be our first line of defense for unknown emerging pathogens in the future.

Khateeb: It’s amazing.

Dr. Chung: We don’t have therapy because it’s new. You know what I mean?

Khateeb: Right.

Dr. Chung: Again, because this therapeutic is a non-pharmacologic, pathogen agnostic, extra corporeal blood pathogen removal device, it doesn’t matter what the bug is, it doesn’t matter what the virus is, if it circulates in the blood, it will remove it.

Khateeb: That’s unbelievable.

Dr. Chung: That’s the concept behind this entire program that is now just coming to fruition as a result of this incredible crisis that we’re all experiencing.

Khateeb: Right. It wasn’t much of a prediction, but I predicted many months ago, in the early spring that we would see unbelievable American innovation and ingenuity as a result of the pandemic, and we’re seeing that now. We’re suffering a lot of loss because of it, but in the future, who knows what will happen. I’m sure there’s going to be another threat of a pandemic of some type in 10, 20, or 30 years from now. It may not even have a dent on our society because we’re able to use these types of approaches, which is just remarkable.

You helped me out here because, when I posted earlier this week about having you on, Dr. Asheesh Connor who’s the Head of Research for Anesthesiology and Critical Care at Wake Forest, specifically asked about innovation and therapies in the septic shock area. So, we got that one for you, Dr. Connor.

[Both laugh]

Dr. Chung: That’s awesome.

Khateeb: Absolutely. What’s really interesting is that Northwell did a study with about 9,000 patients recently and found that about 38-39% of them end up with acute kidney injury. Who would have thought that while that was coming out months prior that you were able to think about this therapeutic approach to dialysis with nephrologists. I don’t believe in coincidences anymore.

Dr. Chung: We were ideally positioned to do this and bring in the nephrologist, but to address that point specifically, this technology potentially prevents AKI. This is because AKI occurs within the context of the host response to circulating pathogens and the dysregulated host response that results in end organ injury. We’re trying to nip that in the bud before it happens. Out of the 70 patients that have been treated, I alluded to a subpopulation that seemed to benefit the most. I’m not going to divulge any secrets now, but there was a cohort of patients that were initiated on this therapy as they were transitioning from high flow nasal cannula to mechanical ventilation somewhere during that period and placed on that therapy, and it seems to have an impact in that population specifically. In generalities, there was a clinician who was sick with COVID, who happened to know about this technology and asked for this therapy in place of being intubated. Guess what, he was able to leave the hospital a week later.

Khateeb: Fascinating.

Dr. Chung: He was getting ready to be intubated, and he asked them to wait. That was a light bulb moment. Everybody started paying attention because that case was shared with everybody that had an interest in this technology. Also, in that specific center, another healthcare provider was treated prior to getting intubated. Then more and more, and that’s how it grew. I never imagined that that would be the patient population. In the majority of those cases, if those patients were not on the vent that prevents intubation, and they had an event that gets them off the ventilator quickly, none of them have extra pulmonary end-organ damage like AKI.

We believe that it’s because we’re able to achieve source control. This is as an adjunctive therapy to Remdesivir. We believe that an antiviral plus this therapy, is better than an antiviral alone. There’s a synergy that exists. Hopefully, when we look at the data, we’ll be able to report our results of the purify groups of studies. As I said, the first phase is purify OBS, and it’s on clinicaltrials.gov website. It’s already registered.

In fact, I should probably mention this. I don’t know if you know about kidney 360, it’s the open access journal to the American Society of Nephrology.

Khateeb: Yeah, they just launched that.

Dr. Chung: Yeah. Steve Olsen and I were invited to write a pro editorial piece on why we thought extra corporeal blood purification could be helpful in COVID and beyond. It’s probably going to be released any day now, and it should be available to read.

Khateeb: I want to be respectful of your time. One other thing I want to touch on which we can spend many hours discussing, but I just want to get your feedback on it.

There’s a lot of discussion about a vaccine coming out. There are different opinions about that. And then of course, the concept of herd immunity. These are two really big topics, but for the most part, what’s your take on it as a physician, and a healthcare leader who’s dealing with this on the very front lines?

Dr. Chung: I should probably make this statement right off the bat that herd immunity without a vaccination program is going to kill a lot of people.

Khateeb: Tell us why, because I want people to understand this.

Dr. Chung: In order to achieve herd immunity, a certain percentage of the population has to get infected so that they can have their natural immune system be the defense and thus acquire immunity. For us to achieve that, 60-70% has to be infected in the population. Let’s say mortality is 1%. We’re talking about millions of deaths, right? There’s no way we can tolerate that.

A better way of achieving herd immunity is by having a mass vaccine campaign like we’re doing. Vaccine is what achieves the immunity. Enough of a percentage of the population become immune as a result of that vaccine and the vaccine protects them from dying. This way, we can get closer to herd immunity and snuff out the virus because you can’t transmit it to anybody. That’s how you achieve herd immunity; by vaccination, not by natural ways. That is a very flawed way of thinking because you’re completely disregarding how many patients will die as a result of that approach.

Khateeb: I think you said something so important. Again, I haven’t monitored everybody talking about this, but you’re the first person that I’ve heard who conveyed it this way. It’s not only herd immunity, and not only the vaccine, but it’s the combination of the two. Coincidentally, it’s similar to what we just discussed, where it’s not the therapeutic method by itself, and it’s not the pharmaceutical alone, but it’s a combination of the two. There’s a synergistic effect. I think the sooner the American public starts to understand this, then they’ll start to really appreciate it.

I’ve always said that medicine and healthcare has always had a marketing problem and hopefully, this is something that can be solved. I love that in a few seconds, you literally conveyed it in the most convincing and understandable way.

Dr. Chung: One thing I should say also about the vaccines that are coming out, is that there’s a lot of misinformation out there not only about the effectiveness of vaccines, but also the side effect profile of vaccines. There’s an entire movement, as we all know, the anti-vax movement, that has really caught a lot of momentum. I see comments of folks that don’t really trust vaccines in general, populate my feed. They plan to not trust the vaccine that’s coming out.

What I can say about the FDA and these companies that are producing these vaccines is that, although the studies have been accelerated, they’re not taking any shortcuts. They did phases one and two, and they’re doing their phase three. They’re collecting data, they’re looking at all the side effects. Yes, they’re going to apply for an Emergency Use Authorization, but that’s because people are dying left and right, and we need to do something. So, I’m a little bit concerned that people are going to be very hesitant to take the vaccine.

However, there’s one thing that is encouraging. I’m technically and officially not political because I’m in the military. What I’m seeing is a celebration of this advance from both sides. Everybody celebrating this has being a huge advance, and that gives me a lot of hope. Maybe, just maybe, we could all have a unified campaign to push this vaccine and make sure that everybody’s covered so that we can save lives. I was having a virtual meeting with Dr. Bob Watcher, the Chair of UCSF, and Dr. Mark Anderson from Johns Hopkins. We’re talking about this and we said, maybe what we can do as a community is that healthcare providers are probably going to be among the first people to get these vaccines. Maybe we should start a mass social media marketing campaign showing ourselves getting the vaccine. We should literally show people and say, Hey, we’re healthcare providers, we’re getting the vaccine. If it’s safe for us, it’s going to be safe for you. We should just spread it that way because we need to do something to get everybody on the same page. I think that was a great idea.

Khateeb: Absolutely. It’s funny you mentioned that. One of the great books that I love to read, which is an older book, but it’s called Diffusion of innovations. Even though this gentleman has since passed away, he studied a lot of how innovation diffuses, and one of those big things is social proof. You have to see other people adopting it. Like you, I’m very neutral and moderate. I claim no political party. I’m just a cynical observer of American politics, but I think I can understand why the Americans were skeptical.

Unfortunately, in a pandemic it’s something that’s hurting us, but something that’s a feature of being an American is that we don’t listen to authority. We have a lot of entrepreneurs and business because of that. But again, in a pandemic that has hurt us a lot. I think that there’s been an even bigger resistance because I see it on Instagram and Facebook, where private companies like, movie theaters or other places will say, we will not allow you in or do business with you, unless you show proof of that vaccine.

I think most Americans get tense saying, well, what do you mean? Are you going to tell me what I can do? Again, on both sides, seeing Joe Biden and Donald Trump celebrate a vaccine, I think having more healthcare professionals educate the public about it, that’s what needs to happen.

At least from a marketing standpoint, those are the people that need to be leading this, not the private sector. This is because if there’s something that every American feels, it’s that they don’t trust private industry or corporations. It makes me very happy and hopeful to hear you say that because, at least, there’s a way that the majority of the population will be open to vaccinations. And those who choose not to be, hopefully there’s enough of the people who get vaccinated, so that we can get closer to herd immunity. Again, I’m very relieved and happy to hear that it’s going to be a combo of these two things.

From a risk management standpoint, that’s the better way to go instead of saying it’s only this, or it’s only that.

Dr. Chung: It’s definitely encouraging and there’s hope on the horizon. I hope that a year from now, the economy is going to be completely opened up, COVID numbers are going to be near zero because of that herd immunity that has been achieved, and we’re going to be moving on with our lives. Boy, it’s hard to really imagine that happening right now, isn’t it?

All the stress and what we’re seeing in the hospitals all over the country is just heartbreaking. Reading about what my colleagues are going through is sad. And I’m about to start my five nights of ICU shifts here this weekend, and I already know that they’re already starting to get an increased uptake in COVID patients that’s pretty significant much more so than it was in the spring.

Khateeb: It’s really unfortunate. It’s hard to see the light at the end of the tunnel, just because we’re in the fog of war right now, so to speak. I told my wife that it hasn’t even been a year, but it feels like we’ve been doing this for a long time. Maybe I’m too optimistic, but I really believe that what we’re going through in 2020 as a world, but for us as a country, is ushering in a golden age of how we look at our systems from healthcare to economics, to businesses, communications, and everything.

As soon as we make it out the other end, I think we’re going to see the next level of what America can be. I think it’s going to be really fantastic, but we’ve got to unify as a country and make it through this as well.

Dr. Chung: Yeah, I agree with you.

Khateeb: Dr. Chung, thank you so much for spending some time with us. I’m going to selfishly have you back on again, just because if there’s ways that we can amplify thought leaders like yourself, people who we should be listening to when it comes to how we should think about medicine and science, it’s incredibly invaluable. We appreciate your bravery and service and leadership in our country during these times.

Dr. Chung: Yeah, thanks Omar for the opportunity. I very much enjoyed it.

Khateeb: Absolutely. Thank you all for listening, this has been another episode on Hills and valleys. Check the show notes because I’m going to leave some of the links that Dr. Chung mentioned along with his Twitter handle. So, be sure to follow him and we will see you next time. Bye for now.