The Future of the COVID-19 Pandemic – Part Two of our interview with Dr. Panagis Galiatsatos
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In the first part of this two-part series, Hola Cultura spoke with Dr. Panagis Galiatsatos, assistant professor of medicine at the Johns Hopkins University School of Medicine. A specialist in lung health, Dr. Galiatsatos explained the impact of COVID-19 on the lungs and highlighted the differences between past variants and Omicron.
In this second part of the series, he’ll discuss the future of the pandemic and how COVID-19 has affected Latinx and other minority communities. To read part 1, click here.
Do you think many people who had severe cases of COVID-19 will face lung cancer in the future? Is there any way to prevent this?
When I read a story about someone who was brave, I learned those values of being brave without ever having to experience the war or the famine that the main character experienced in the story. I know how to be brave, I’m feeling that. I’m hoping if I’m ever put in that situation, I would be like that [brave] protagonist. What I’m alluding to here is a vaccine that gives that playbook to our immune system without ever having to go through the disease. It knows how to react to it if we see it again. That’s what stories are great for: They can build you that sense of appropriate character without having to go through the war, without having to go through horrible human engagements and interactions. …
I wouldn’t wish this virus on anyone because regardless if it left you in a hospital or not, what this virus does other than infect the lungs [is] it ravages a very specific type of immune cell, the T cells. Like when patients come into the hospital, one of the early ways we were detecting these (ravaged T cells) is by something called lymphopenia. So, lymphocytes are these memory cells, T and B cells, and we’ve noticed this virus can infect them and deplete them, destroy them, kill them off. … We developed cancer cells every day, you’re developing them right now as we speak. Those T cells go kill them off — never worry about them. But if we deplete [the T cells], sometimes cancer may run amok [afterward]. My biggest fear isn’t cancer because of how bad COVID was to you. My fear is if you got this infection, because of how bad it was, it depleted some of your T cells, and especially, the depleted ones that were keeping certain things in check like cancer cells, etc.
My biggest fear is we might see these same patients who survived COVID only to succumb in a few years to cancers. … HIV is another one that depletes your immune system, so when we think of opportunistic infections, we don’t also realize a lot of lymphomas happened because of AIDS. If you wipe out enough of your immune cells, you’re gonna let cancers just kind of go haywire. So, actually my bigger fear is we’re going to see a generation of people having more prevalence of cancers because of COVID.
Do you have any expectation for how long you foresee this lasting and new variants circulating? Do you see more variants coming this spring?
My family is so mad at me because when this all started, they were like, “What do you think, [by] Christmas we’ll be OK?” This was 2020. I told them in 2020, I was like, [the pandemic will take] three to four years. Right now, we’re in year three. So, where I’m at [now] is that we have to recognize COVID won’t go away, COVID will stay around. However, the pandemic can end.
The way the pandemic ends is we make COVID no longer disruptive to the health system, especially, specifically, to the health system. If it interrupts our lives, fine. It may come with some interruptions. We may have to wear face masks when we go out. We might have to do some testing. We might have to do some quarantining, because we know how to not catch it, we know how to not spread it and we know how to keep it as a mild infection. If we all abide by [all that we’ve learned], this pandemic ends. I always tell people, six to eight months now, I think we’ll be in the last throes of it. That’s the best hypothesis.
The challenge is, we may allow more variances to occur. There are people who’ve never seen COVID, especially those who have not been vaccinated. So, if we don’t have a global equitable vaccine strategy, we’re allowing this virus to continue to make newer and newer variances. …
We’re all genetic mutations. We’re the same species. We’re all humans, but we are different from our parents. Why I’m saying that is when the SARS-CoV-2 goes in us, when it leaves, [it’s] genetically changed, takes a little bit of us with it, a little bit changes. So, every time we breathe it in and breathe it back out, the virus always changes. Definitely if our immune systems have never seen it before or don’t have any antibodies or memories to it, when a genetic change happens … it may make it easier to spread or more deadly. We call it a variant of interest. If then, those genetic changes become the big one — the epidemiological, the high percentage one in the community — then, we call it a variant of concern. To date, we’ve only had five: Alpha, Beta, Gamma, Delta and Omicron. There have been other ones in between Delta to Omicron that just never became big key players.
Do I foresee other variances? Yeah, one hypothesis is if this is as good as we get, yeah, you may have some fertile ground for new variances. That would be horrible because Mother Nature is not someone who follows a linear path, she may throw us a curveball [that] sets us all back. But if we get some good global equity of vaccine access to people, yeah, we end it. We contain COVID. We forced COVID into an evolution of a mild infection. Obviously, that’s not bad for COVID, COVID loves that. COVID just wants to infect us and move on.
I always tell my students, “Ebola, how horrible does Ebola sound?” Yeah, 80% to 90% mortality. And I ask them, “Hey, will Ebola become a pandemic?” I get a lot of people raising their hands, and I’m like, you’ve seen too many Hollywood movies. Ebola will never become a pandemic. It kills us. If it takes us down, it goes down with us. That’s not advantageous for a virus. A virus wants us to live, so it can keep spreading. So, if we make this into a bad cold, we’ve won. COVID can live with that and move on with life. …
I think this is it. I think the pandemic ends this year. It’s not an ending to COVID. We’re going to learn how to live with it. … Face masks, fine. I test, I’m positive, I’ll quarantine, fine. But it doesn’t disrupt our lives. It doesn’t result in us going into the hospital [and] doesn’t overwhelm the healthcare system. That’s when the pandemic ends, when it’s no longer disruptive. An inconvenience? Whatever. We have many things that inconvenience us.
What impact do you expect new variants to have on infected patients? For example, Omicron is regarded as less severe on lungs but more contagious than previous variants — do you expect this pattern to continue?
The one blessing we have with the coronavirus is that our original vaccine to the Alpha still is working. Woohoo! That’s great. Doesn’t mean that our pharmaceutical companies and our scientists aren’t investigating vaccines specific for the variances. We should, because, that way, it keeps us kind of, hopefully, in step with Mother Nature. Now, I have no idea how to predict Mother Nature, she doesn’t follow a linear path. What I’m alluding to is just as we saw these changes in Omicron, doesn’t mean I know how to predict the next one. We really don’t. It’s all conjecture to say what we think the next one will do.
If the virus comes across people who have antibodies — from prior infections or being vaccinated or a combination of the two — and we are putting pressure on it to stay as is so we can keep it from ever becoming a new variant — we can do that with our own vaccines and so forth. However, if it’s going to find people that it’s never seen before, it’s gonna start stretching its legs a little bit, letting evolution take its place and maybe make a different variant. So, it’s hard for me to say what will happen.
What I can tell you is what can happen in the best case scenario. [If there is] plenty of immunity to go around, the virus finds those people [without immunity and] can’t do much else. [It] stays as is. We put the pressure on it to stay [the same] because that’s advantageous to the virus to infect us and then leave us without killing us. Think of the bat where the coronavirus originated. Bats live with over 1,000 different species of the coronavirus. That’s the optimal finding for the coronavirus, to permanently live with a host that doesn’t have to worry about it killing it off. We have viruses like that in us. … My suspicion is we have the tools now to put the pressure on the virus to just be one [virus living] among us. But if we don’t achieve more global vaccine equity to countries that need it, then we are gambling with Mother Nature. She may create something else more sinister than the Omicron or Delta [variants].
There has been a lot of news coverage of how Latinos and other people of color have been disproportionately affected by COVID-19. Is that only due mostly or exclusively to socioeconomic factors such as job type and vaccination rates? Or are Latinos and other patients of color (or a subset of these groups) more susceptible to severe COVID illness or lasting lung damage? If yes, why?
If we see differences in groups, the first thing we lay out is differences. Let me give you a kind of comical example. Men have more prostate cancer than women. Yeah, that’s a difference. You know what I mean? It’s not a disparity. That’s a genetic difference. Women will never get prostate cancer … A disparity implies those differences [caused by] a malleable, adjustable factor that’s also unjust.
Early-on, disproportionate impact of racial minorities and minority ethnicities, yeah, those are because of unjust factors. Living conditions were multi-generational homes, so someone walks in with COVID [and it] spreads like wildfire. Jobs: I can be at home with Zoom. Others didn’t have that opportunity. If you’re a carpenter and you have got to go out. … If your job security was these kinds of jobs that required you to go out, you didn’t have the luxury of staying home.
So, a lot of social factors contributed to COVID being caught by these individuals. The other one is pre-existing conditions. … The Black African American community had established diabetes, high blood pressure, etc., so when they caught the virus, [it] ravaged them. The Hispanic and Latino community, interestingly enough, their saving grace was age. A lot of them were younger. The risk factors that ultimately culminate in diabetes and high blood pressure take time to develop. So, the Hispanic Latino community that was ravaged by COVID as well and developed severe symptoms resulting in hospitalizations, many survived it, mainly because of their age. [Latinos] have all the pre-existing conditions that an older African American, Black community had, but [the Black community] had established diabetes, all those risk factors eventually morph into those pre existing conditions. This is not new to COVID. [Have] you guys ever researched something called sepsis? You see the same thing happening. Black individuals: worse outcome. Sepsis is an infection that escalated out of control and resulted in organ dysfunction and damage. That’s what severe COVID is, an infection resulting in organ damage and dysfunction. So, from my standpoint, those reasons why people develop diseases like diabetes and high blood pressure is because of environments, only access to processed foods or neighborhoods where you can’t really walk around because of high homicide rates or housing conditions where you’re sitting there breathing in mold [or], constant secondhand smoke exposures. … If you have marginalized communities, minorities of ethnicity and minorities of races in those communities for years and institutional racism, etc., yeah, you add COVID.
There’s a reason why COVID in Baltimore, for instance, [had the] same rates in two populations, higher hospitalizations in ones that are socioeconomically poorer than those that are more socioeconomically fluent, even though they have the same rates of COVID. So, yeah, this is a disparities conversation. One way we mitigated [those disparities], by the way, … was vaccine equity. We got the vaccines to those populations, first and foremost, as an armor of protection. … [Disparities research] was kind of a fad during the pandemic … and many of us are trying to grab that moment and make it into a true movement. My fingers are crossed that it will become just that.
This interview Q&A has been edited by Hola Cultura for length and clarity.
This story was produced by Hola Cultura’s Storytelling Program for Experiential Learning. S.P.E.L. brings together young people between 16 and 25 and the organization’s professional staff to produce stories and special projects for Hola Cultura’s online magazine. Aimée Eicher and Denise Casalez The society and culture group conducted and edited the interview.
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