This interview originally aired on In the Moment on SDPB Radio.
Shankar Kurra, MD, was formerly with Monument Health in Rapid City. He was a frequent guest during the pandemic, joining almost weekly with a medical update.
He returns to the show with another update. He'll discuss the effectiveness of face masks, the possible origins of the virus, long COVID-19 symptoms and more.
Dr. Kurra is the chief medical officer of Sentara Virginia Beach General Hospital.
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Lori Walsh:
You're listening to In the Moment on South Dakota Public Broadcasting. I'm Lori Walsh.
Well, longtime listeners to In the Moment will recognize our next guest. Dr. Shankar Kurra was formerly with Monument Health in Rapid City. Week after week during the pandemic, Dr. Kurra joined us on air to answer a question that wasn't always so simple: What do we know about COVID that we didn't know before?
Now Dr. Kurra is chief medical officer of Sentara Virginia Beach General Hospital, but he returns to the show because some of the things we're talking about are old hat to Dr. Kurra. We've talked about them for months.
Dr. Kurra, welcome back to the program. Thanks for being here.
Shankar Kurra:
Lori, delighted to be back on SDPB.
Wearing a face mask can help prevent COVID-19 transmission
Lori Walsh:
Let's start with masks because you and I have had dozens of conversations before masks were even available. Back when we were asking people to not go out and buy N95 masks so they could get to the health care providers who needed them most.
And to the ongoing study about whether or not masks work. Plus, we have this new study coming out of Oxford that said they never worked in the first place. It's more complicated than that.
Where do you want to begin with the effectiveness of the mask?
Shankar Kurra:
Great question, Lori. So I will start and end the same way: masks work.
And let's talk about the Cochrane Review, which is a very well respected Oxford institution. What it does is gathers all the reports, the studies, and then kind of synthesizes them using a statistical analysis called meta analysis.
So what they did was take 78 trials and of which only two were actually trials that were during the pandemic. The rest were all pre-pandemic mainly around respiratory illnesses like in influenza.
And their conclusion is correct. And what they said was, what they were looking at is, "Do the intervention of masks used by people work?" So in other words, they were looking at the effectiveness of intervention. If you were to encourage people to wear masks and then you check to see if that has stopped the spread of the disease, that's what they were doing.
And that's where the studies were about. They were not actually checking the effectiveness of the masks themselves.
This is what causes a lot of confusion because if you look at the actual effectiveness of the masks, and if you look at the lab studies that have been repeated very meticulously, if you were to wear an N95 mask, you have protection greater than 95% against all viruses. It filters out very effectively when worn correctly.
So all the studies, the 78 trials that they synthesized, looked at interventions where they would encourage people to wear masks. And then the actual results were dependent on how good folks were in following through with wearing the mask because it's voluntary. It's not forced or mandated.
And so the conclusion, and if you'll read carefully and it shows there's anywhere from 16% to 28% reduction in spread of the disease, viral illnesses including COVID and influenza, when masks were worn. And that is when we say 16 to 28%, that's the confidence interval that's all these studies together, that's the result. So that can't be considered no difference. I would say it's moderate. In fact, when asked for comment, the editor-in-chief of the Cochrane Review, Dr. Weiser said, "It is wrong to conclude that they don't work, that masks don't work."
Lori Walsh:
Yeah. So I think back to the conversations we had. This seemed very consistent with what you were saying really all along. And then I remember a conversation I had with then-Secretary of Health for South Dakota, Kim Malsam-Rysdon, and pressing her on why there wasn't a greater effort to institute mask mandates. And her response was, "If it were that easy to just put out a mask mandate, we would've already done it."
And that seems to hold up with this Oxford study as well. We had the information about what worked and what didn't. And we also knew how really difficult it would be to convince everybody to wear the right mask properly all the time consistently in such a politically-charged environment.
Do I understand all this fairly well or is there something you'd like to add to that?
Shankar Kurra:
Yeah, the important takeaway is masks work and the unfortunate outcome of any poor reporting or incomplete reporting would be people who are vulnerable may not use the mask, and that puts them at risk. If you are talking about immunocompromised folks, even regular folks, but definitely those folks that are high risk.
Lori Walsh:
If you were getting on a plane today, for example, and you just wanted to reduce your chances of getting infected, would you wear a mask?
Shankar Kurra:
Absolutely.
Possible origins of COVID-19
Lori Walsh:
Let's talk now about the origins of COVID. I'm not even convinced sometimes why this one is so political because the information and data is coming from China. And obviously they have not been the most open nation with sharing that data.
We have a new list of suspects for where this virus came from. The raccoon dog is a fluffy animal with an iconic bandit mask. What do we know about the raccoon dog?
And better yet, Dr. Kurra, what do we know about the origins of COVID-19, of the SARS-CoV-2 virus?
Shankar Kurra:
Lori, great preface. So it's been three years, a little over since this pandemic broke out. And what is clearly emerging is this is a zoonosis. To put it in lay terms, this is a disease that spread from wild animals to an intermediate host, and then on to humans.
And this is kind of not very difficult to see. We kind of knew that the hints were there all along because in 2002 when the first SARS-CoV-1 broke out, it was traced to infected animals in Guangdong province in China. And the similar story is emerging and it takes a while to do the epidemiological investigation, or detective work, to get there.
The preponderance of the evidence right now is so strong in favor of an animal origin, unlike the other theory, which is lab origin. And there are several key pieces to this.
Number one, the entire pandemic, clearly looking back now, the evidence is very clear about this. The fact remains it broke out in the market right there, and then spread out to the province of Wuhan around the market, then spread out to the rest of China and then abroad to the world. That part is very clearly established.
And the lineages, the genomic makeup is so clear that it's not lab origin. These are very closely related to the virus that is infecting wild animals. And now we've got the raccoon dog, and we know that the raccoon dog is susceptible to SARS-CoV-2. And the samples obtained, environmental samples obtained and reported were a exact match for the SARS virus that caused the pandemic.
Additionally, they found large amounts of genomic material that connect the raccoon dog to SARS-CoV-2.
Now, we can't conclude that that is the case until you actually capture a wild raccoon dog with the virus in it, but the evidence is strong.
Lori Walsh:
What is your hypothesis for why this is still so captivating for people who are looking to create a story that sort of divides things? Like is it just the politics of that moment?
Shankar Kurra:
Lori, you started out correctly. When you have governments not being very transparent, and being secretive, and not being open, and letting scientists both in China and abroad and all over the world, it's an international group of scientists who are eager to understand this pandemic so that we can anticipate and prevent hopefully the next. It doesn't help and that's what leads to the kind of stories we see.
Long COVID & lingering symptoms
Lori Walsh:
Let's move on to one of the big problems that we're facing today, which is long COVID.
It can be difficult to even talk about it, whether or not people believe it exists. How many people are experiencing COVID symptoms? What are we learning about long COVID and the challenges that we may have for decades?
Shankar Kurra:
Good news and bad news for long COVID, I'll start with the good. Initially during the pandemic, there were some reports, and this is the first disease I might say that was discovered by patient reports, not by scientists, or doctors or virologists. Patients reported strange symptoms that linger long past their infection.
And what we are finding out is it's not as prevalent as we thought it was. At one point we thought one in three individuals with COVID-19 would end up having lingering long-term effects. What we now know is that's probably a high number. It's probably below 10%, which is the good news.
The worrying news is that there are a large number of these 10% or so that continue to have these symptoms and research is undergoing right now. The NIH has funded a $1.1 billion research initiative that are two large trials right now, and we will hopefully understand this better over the next year.
Is COVID-19 now endemic?
Lori Walsh:
All right. So is the pandemic endemic? Help us understand that transition. Is it over? Is it not over? Help us define that scientifically.
Shankar Kurra:
Yeah. So the epidemiological data suggests that we are at least in the endemic stage now. So to make it clear when we say something is a pandemic, it means that the disease is prevalent everywhere. In other words, there is no country spared. There's no regional continent that is spared. So anywhere where there are people, the disease is present. So that's a pandemic. And it happens rarely as we've seen.
Endemic is when we say that the disease now has reached a steady state. So many people are infected and many others have had immunity either from the infection or from vaccines to the point when you have a lingering baseline rate.
Most of the time, endemic is usually defined in retrospect. So when we look back, we can say five years from now, "Oh, that was a time and it became truly endemic." Because you can't define the baseline rate of infection for COVID.
We know that for influenza, for instance, we can say every year the flu season on average, about 35,000 people die or succumb to flu. So that would be the baseline rate.
For COVID, we are beginning to see that where we are today is very close to the baseline rate. So in that sense, we're in a stable state. The disease is still prevalent. And again, getting vaccinated and taking precautions is the best way just like for influenza.
Lori Walsh:
What is our baseline rate looking like? How bad is this going to be going on compared to influenza?
Shankar Kurra:
Yeah, at least at the current moment it's somewhere in the region of two to threefold higher than influenza's base rate. But like I said, we're still at most of the time we define endemicity in retrospect. So I think we'll probably see the baseline rate kind of match influenza when we're done, hopefully. But we'll have to wait and see for that.
COVID-19 vaccination schedules
Lori Walsh:
So that brings us back to the vaccine conversation, and it's fairly easy to know when to get your influenza vaccine because in South Dakota, at least, there is a season. But COVID, it's a little harder because we all got shots at different times. Some people got more boosters than other people.
How should we think about vaccines for COVID right now?
Shankar Kurra:
I think if you've had your primary series and the booster, for now you're OK. We haven't seen a change in Omicron variants.
There are so many of them, but the good news is there is not a complete sea change. So the protection that's afforded even if you've had the booster a while back is significance. You won't get severe disease from it.
What we don't know is seasonality and that should become apparent by the end of this winter. And that should give us a baseline to say every winter, which is at least my suspicion, that you will need a COVID vaccine. And that would be similar along the lines of influenza vaccine.
COVID-19 super dodgers
Lori Walsh:
Yeah. What do we know about people who have not yet tested positive for COVID? Especially if they're really paying attention to it and they're testing when they have symptoms, but they have super dodged it up until this point. Do we know anything more about people who have not been impacted by this virus?
Shankar Kurra:
Yeah, that's still a mystery. Some of it could be that they've been exposed to previous SARS viruses and not necessarily the one from 2002, which is possible. We had cases in Canada and the United States as well. So you could have had a non-serious infection that afforded cross-immunity to the current virus.
That's one theory. We'll have to wait and see. We don't know the answer.
Lori Walsh:
Yeah, more and more I'll see somebody around here on Twitter who will post their COVID test and say, "It got me at last." So a lot of people who had no problems for three years eventually it caught up with them and all of them as far as I know, are doing quite well because of their vaccination status, thankfully.
Dr. Shankar Kurra, is there anything else that you have your eyes on regarding COVID that you would like to leave us with today?
Shankar Kurra:
I would just say stay safe, get your vaccine, mask if you are susceptible and do your best.
Lori Walsh:
Well, I have missed you personally. Thank you so much for all you have done for us and for the listeners of South Dakota Public Broadcasting.
Dr. Shankar Kurra, thanks for being here once again.
Shankar Kurra:
My pleasure, Lori.
