What did a virologist see in the first weeks of COVID-19?
In March 2020, I spoke with David Vigerust, PhD, a virologist who was busy setting up new laboratories to test for the novel coronavirus. Cities were locked down, businesses were closed, and testing was hard to find. I wanted to hear from someone working on the problem directly.
This is an archive episode, recorded when the show covered addiction, recovery, and the news of the day broadly. It is a record of what one scientist was seeing and expecting at that moment, so it is best heard as a snapshot of that time rather than as current guidance.
How does a lab start testing for a new virus?
At 0:50, David described the effort to open four separate labs, two in Scottsdale and two in New Orleans, with another possibly in Nashville, where he lives. There were not enough tests, and people needed answers.
From 1:13, he explained how it works in practice. Fortunately, the large companies that make laboratory reagents and equipment had moved quickly, and the labs were receiving the materials for test kits. The next step was to validate those tests. In his view, it had become a collaboration among manufacturers racing toward a test cleared by the Food and Drug Administration.
Were the lockdowns an overreaction?
At 1:49, I asked whether people were overreacting. David said perhaps a little, but he understood the reasoning. The virus is highly transmissible, and Nashville, usually a busy town, had gone quiet.
At 11:44, he explained why broad testing mattered so much. Someone who feels fine can shed as much virus as someone who is very ill. So, the more people are tested, the more those who test positive can stay apart and break the chain of transmission. I added that more testing could bring us back to normal life sooner, and he agreed.
Can someone who already had the virus be immune?
At 2:58, I asked about a person who might have been infected in January. David said that person should have gone through recovery and developed antibodies. He expected that some people had already been infected without any symptoms.
Why were some younger people getting so sick?
At 5:01, I raised something I had been reading about, a possible link between the tuberculosis vaccine and how hard the virus hit different countries. I said plainly that it may or may not mean anything. David had not seen that work yet. Still, he expected that researchers would find many factors no one had thought of, beyond smoking and underlying conditions.
From 5:53, he talked about the younger people being infected, some of them severely. He wondered whether vaping, which can damage the lungs, might be part of the answer.
At 6:49, I described how that conversation was changing my own visits. I was treating people with opioid dependence, and I did not usually push the issue of cigarettes right away. Yet I was now telling patients they may want to quit smoking. When one asked whether switching to vaping would help, my answer was that it probably would not.
At 7:11, he added that unless they had obesity, diabetes, or heart disease, he would not expect someone in their twenties to become very ill.
How is this virus different from the flu?
At 7:56, David explained that the coronavirus belongs to a different family from influenza. It attaches to a receptor called ACE2, which is part of the body’s blood pressure control system. That receptor sits on cells deep in the lung, but also in the upper airway and in blood vessels.
Interestingly, he described early data suggesting that people express more of this receptor as they get older, which might help explain why older people seemed more vulnerable.
Should people change their usual medications?
At 9:08, I asked whether people who take blood pressure medicines that act on this same system should worry. David was clear. In his view, anyone with blood pressure problems should stay on their medication, or talk to their own doctor first, and not stop it without a good medical reason.
Unfortunately, at 10:02, David described a death in Phoenix the day before, when a couple tried to protect themselves with a product meant for an aquarium. It was a different compound. I suggested the best course was to wash your hands and stay away from people. David agreed, and at 10:57 he added keeping clean, covering your mouth when you sneeze, and staying home if you are sick.
What stood in the way of more testing?
At 13:27, David said he was part of an initiative to set up drive-through testing in Kentucky. The labs were ready. However, the basic supplies to collect a sample were short, much as physicians and nurses were short of protective equipment.
From 14:06, he explained why not just any swab will do. The swab has to be long enough to reach the back of the nasal passage, and it has to go into a liquid that carries the sample to the lab. Most of these supplies had come from China, so the lockdown there had slowed everything down.
At 15:18, I mentioned that many medical offices had closed and were holding supplies they no longer needed. David said he had seen tattoo parlors in Nashville donate gloves, gowns, and masks to local hospitals. People were trying to pull together.
How long does the virus last on surfaces?
At 16:29, I asked about cleaning surfaces, and whether anyone really knew how much the virus spreads that way. David thought the main route was probably coughing and shared droplets between people who are close together. Of course, someone can cough onto a surface, and another person can touch it and then touch their eyes or mouth.
He described a report from that morning of live virus found in cruise ship cabins long after the passengers had left. In his view, how long the virus survives depends heavily on the conditions. At 18:24, he said that simply waiting a few days is not a reliable way to make something safe.
Will the virus change over time?
At 18:36, David explained that viruses of this kind tend to mutate often, and that sequencing was already showing small changes as the virus spread. His hope was that it would adapt toward causing milder illness, as the other common coronaviruses do.
He compared it with the flu of 1918, which in his account slowly settled into a balance with people over the following century. In fact, he said, that is the balance the virus already has in bats, where it causes no illness but can still spread.
Who is David Vigerust?
David Vigerust, PhD, is a virologist based in Nashville. When we spoke, he was setting up laboratories to test for the novel coronavirus and working on drive-through testing in Kentucky. Earlier in his career, at St. Jude, he studied influenza in the lab.
What can listeners take away from this conversation?
What stands out from this conversation is how plain David’s advice was, even in the first weeks. He stressed wide testing, keeping distance, washing hands, staying home when sick, and staying on blood pressure medication unless a doctor advises otherwise. Much was unknown when we spoke, and David was careful to say so.
How do I approach this today?
Today my practice focuses on helping people come off benzodiazepines and other medications gradually, and on medication for alcohol and opioid dependence. Physical dependence is not addiction, and the safest way off is usually slow.
This page is educational. It is not medical advice, and listening to the episode or reading this page does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
Full transcript
A note from Dr. Leeds: my guests speak from their own experience and expertise, and the terminology they use is their own. Whatever the topic, this show holds to one distinction: physical dependence on a prescribed medication is not addiction. This transcript is educational content, not medical advice, and nothing here creates a doctor-patient relationship.
Read the full transcript (21 minutes)
Dr. Mark Leeds [00:09] Welcome to The Rehab on the Mental Health News Radio Network. I am Dr. Mark Leeds and I will be your host. Join me in exploring the world of addiction treatment. How can we improve the ways that we help individuals to overcome addiction? The goal of treatment is to save lives and help people to get back on track to a path towards success and happiness in life. Dr. David Vigerust, welcome to the Rehab Podcast. Thank you for joining me. So you must be pretty busy now. You’re doing testing, right?
David Vigerust, PhD [00:50] It’s been pretty active, yeah. We’ve been trying to spin up four separate labs, two in Scottsdale and two down in New Orleans, and another one maybe here up in Nashville to try to accommodate this lack of testing. So we’ve been pretty busy.
Dr. Mark Leeds [01:06] How did you get that going? How do you start doing testing for this kind of a virus?
David Vigerust, PhD [01:13] Well, fortunately, a lot of the companies that provide reagents and equipment have been spinning up their research and development. So we’re getting test kits, or at least the reagents for test kits, from Thermo Fisher, Roche, and some of the other big manufacturers in the last couple weeks. So now we’re actively trying to validate those so that we can send out test kits and start giving some answers to people. So fortunately, it’s a collaborative between all of the different manufacturers trying to race to get an FDA cleared test.
Dr. Mark Leeds [01:49] Do you think people are in any way overreacting? I mean, everybody seems like they’re on lockdown in their house. All the businesses are closed down.
David Vigerust, PhD [01:57] Well, I mean, a little bit, but I understand, you know, the desire to try to keep this from spreading as much as possible. It’s highly transmissible. So, you know, there’s a rationale there that makes sense to have these lockdowns. I’m in Nashville and Nashville is essentially closed down. We’re not allowed. We’re not supposed to be going anywhere except for the grocery store and essential, you know, essential services, pharmacy, grocery store, things like that. Other than that, the roads are pretty, pretty quiet. You know, usually this is a pretty bustling town and right now it’s pretty quiet. Yeah. So hopefully this helps to, you know, to dampen the spread. It’s moving really fast. And even testing right now is probably testing someone that was exposed, you know, 10 days ago. So, you know, we’re maybe a week to 10 days behind, you know, catching people that are newly infected. These are people who are probably somewhere in the middle of the incubation period already.
Dr. Mark Leeds [02:58] What if someone had this in January? Would they be immune to it now?
David Vigerust, PhD [03:02] They should have gone through a convalescent period and they should have immune antibodies against it. Yeah. So there are a number of assays out there to determine that as well, to show if someone has IgM response, which means they’re kind of early in the exposure, or IgG, which is the more long lasting, takes usually 30 to 45 days to generate. So there will be people who have already had an asymptomatic infection who will have antibodies. And there’s been a couple of good studies out recently that convalescent serum from patients who have recovered is useful to dampen down some of the effect in patients that are very sick so it’s kind of passive immune transfer right so someone who recovered taking their antibodies passing them into someone who is in the midst of the infection can help to quell that infection
Dr. Mark Leeds [03:55] Okay. And also they’re talking about using anti-malarial drugs to treat it?
David Vigerust, PhD [04:00] Right. So chloroquine in combination with azithromycin, which is a Z-Pak that we get oftentimes for upper respiratory infection, seems to have some promise. There’s a lot of arguing back and forth, at least within our FDA, about whether it’s safe or not. But that drug has been on the market since the 40s. It’s got a fairly good safety profile. You’re not prescribing above you know, what’s recommended for malaria. And there are a number of patients who have successfully been treated with it’s helped, you know, that, you know, in connection with a number of other things can help to mitigate the symptoms and maybe accelerate the recovery and the clearance. So, yeah, I’m hopeful. I did some work when I was at St. Jude with chloroquine and influenza, and it worked great in the dish, but didn’t work so well in the animal or in a human. So I’m really interested to see how this research bears out. So far, it seems like there’s some good evidence that it could be very useful.
Dr. Mark Leeds [05:01] I had read that there might also be some scientists studying the BCG vaccine, the anti-tuberculosis vaccine.
David Vigerust, PhD [05:09] I hadn’t seen that. I hadn’t seen that yet. But that might be an interesting take. Take.
Dr. Mark Leeds [05:16] One interesting thing, when I looked at it, I was curious about what countries actually give the BCG vaccine, because I know they give it in the Caribbean, but not in the U.S. And not in Canada. Europe gets it, but the interesting thing was that Italy, I think it was Italy, Belgium, and the Netherlands don’t get it. And I brought it up in a discussion group, and someone said, well, it might not be relevant because Italy did get it until 1981. So that may or may not mean anything. But, you know, it just seemed interesting. I looked at the map and there’s Italy colored orange that they don’t get that particular vaccine.
David Vigerust, PhD [05:53] But I think we’re going to find that there are a number of factors that we probably never even thought of that are at play and causing people to have, you know, no symptoms, you know, all the way up to very severe symptoms beyond just, you know, the smoking and underlying conditions. There’s, you know, more, an increasing number of people that are younger, at least here in the States, that are infected, sometimes infected to a fairly severe degree. You know, don’t quite understand why that would be unless they have some underlying condition. I think perhaps it might also, you know, relate to vaping since it can potentially damage your lungs through the vape. So, you know, I think we’re going to find a lot of really interesting things about this in terms of pathogenesis of the virus. I hope it brings us to a place where we can develop an effective vaccine and assuming we don’t all generate good immune responses.
Dr. Mark Leeds [06:49] Yeah, and I’m glad you brought that up because that’s something that as far as when I’m seeing patients now, I’m treating people with opioid addiction and I don’t normally push the issue of cigarettes right away. You know, I, over time, you know, we start talking about that, but I’m telling people now, you may just want to quit smoking. And just yesterday, some patient said, well, can I switch to vaping? Well, that’s probably not a good idea either.
David Vigerust, PhD [07:11] Yeah, it’s probably just as better worse, right? Yeah, yeah. It’s going to be interesting. I’ve been curious about why we’re seeing younger people. And, you know, unless they have obesity or diabetes, or, you know, cardiovascular disease, I wouldn’t expect 20-year-olds, 25-year-olds to be severely sick from this. They should have fairly robust immune response. But yet something’s going on in those patients that we’re not quite understanding yet.
Dr. Mark Leeds [07:41] Yeah. And the thing, tell me if this is correct. This virus is different from, say, a regular flu virus. I’ve read that it’s smaller and it latches on to receptors deeper down in the lung or something like that.
David Vigerust, PhD [07:56] That’s right. So this is a different family of virus from flu. So flu is an orthomyxovirus. This is a coronavirus. They are some of the largest RNA viruses. This particular virus latches onto an ACE2 receptor, which is part of our blood pressure control mechanism. So it’s attacking some cells down deep in the lung that are fairly well expressed. They express that ACE2 receptor fairly well. Is alveolar type 2 cells they’re down low but then we have this receptor in the upper part of the airway and in blood vessels also so it’s a fairly wide expressed receptor and there was some data out of china that suggested that the receptor increased over time so the older we were the older we are excuse me the more receptor we express and a little bit also and that might have explained at least in that group Y, there were more people who were on the older side, in addition to having underlying conditions that might have been more susceptible. And the younger you are, you know, the thought is you probably don’t express as much of that ACE receptor unless you have blood pressure control issues.
Dr. Mark Leeds [09:08] Yeah. Now, should people be concerned if they take like an ACE inhibitor or an ARB, like lisinopril or that kind of thing?
David Vigerust, PhD [09:15] No, the current evidence is to continue taking those meds until we have more data. There was some rumor out there that, you know, you should discontinue your ACE and your ARBs, but I don’t think that’s a smart move. If you have blood pressure issues, you need to stay on those meds, or at least go back to your doctor and see if, you know, if something else could take the place, but don’t discontinue the meds unless you have a really good scientific and medical reason to do so.
Dr. Mark Leeds [09:43] Yeah, and also I’ve heard people saying that you shouldn’t go out and start asking your doctor for, you know, the anti-malarial drugs just to try it out or have it around or anything, because I guess we’re taking them away from people that need them for other reasons. And, you know, also it’s not good to, there’s, I guess, cardiac risk also taking these drugs.
David Vigerust, PhD [10:02] Yeah, yeah, it can, it can have an effect on your QT interval. So, I mean, there is some arrhythmia potential problem from it. And there was, you know, a fatality yesterday in Phoenix. Somebody decided to go out and self-medicate with chloroquine phosphate, which actually came in the form of a fish cleaner. So this gentleman and his wife both took that chloroquine phosphate. He died as a consequence, and she was significantly sickened by it. So, I mean, they were just trying to fight, you know, way they could the virus and they had an aquarium and realized well I remember seeing that on one of our you know treatments for the aquarium so it’s a different it’s a different compound and unfortunately that’s a fatality.
Dr. Mark Leeds [10:48] So if you didn’t go play around with this the best thing is wash your hands and stay away from people.
David Vigerust, PhD [10:57] Pretty much yeah yeah try to keep your immune system as healthy as possible. You know, vitamin C, I think there was some, some messaging yesterday about the benefits of vitamin C, which certainly doesn’t hurt. Vitamin D, which doesn’t hurt. So I mean, people are coming up with a lot of different avenues to try to boost their immune response, try to stay as healthy as possible. Just, you know, but above and beyond, you know, keep, keep clean, hygiene, wash your hands, cover your mouth when you, when you sneeze, cover your mouth if you’re sick stay at home you know at this point there’s probably not much else we can all do except try to be mindful and there’s plenty of people who are not being mindful of that message
Dr. Mark Leeds [11:37] And from your end I guess testing as many people as possible is the most important thing also just to know where this thing is spreading spreading
David Vigerust, PhD [11:44] Where it’s spreading you know who are the people who are carriers you know so if you’re asymptomatic and you’re feeling just fine you could be shedding just as much virus as someone who’s severely ill. So, you know, you look at someone, they look healthy, they could very easily be shedding copious amounts of virus. So the more we can test, then we can quarantine those people who are test positive and try to short circuit the transmission of it that way as well.
Dr. Mark Leeds [12:12] The more testing we can do, the more likely we can get back to normal life sooner. That’s right.
David Vigerust, PhD [12:19] Right. Exactly. You know, even, you know, we’re in a lockdown here but I’ve been to the grocery store in the last day or so and the grocery store is packed right so it sort of defeats the whole purpose of keeping our distance and you know everyone’s running to try to get anything that gets restocked on the shelves so yeah it that sort of violates that directive to keep six feet from people and stay at home and you know when there’s dozens of people in the grocery store it’s necessary but it’s also another vehicle perhaps for transmission
Dr. Mark Leeds [12:54] Yeah our local grocery store surprisingly inside the grocery store people are being pretty respectful of each other but outside on the sidewalk people are just standing around talking together and a guy was outside smoking and yeah it was just people aren’t really yeah they’re getting more locked down here in south florida as far as shutting down all the parks and shutting down more businesses and I’ve heard there’s a hospital in Miami, at least it’s one guy is promoting it, that they’re testing as many people as possible. And I know one of the parks they left open to have drive-through testing.
David Vigerust, PhD [13:27] Yeah. So I’m part of an initiative for the state of Kentucky to try to do some drive-through testing. But the problem is, you know, there’s a number of companies that have spun up the testing, but the supplies are still short. You know, just like physicians and nurses are missing PPE, we’re missing the swabs and just the basic supplies to take the test, you know, to take the sample. So labs are ready to test and to run those samples, but without the supplies, we’re hamstrung in the process.
Dr. Mark Leeds [14:01] And can you use swabs that were meant for other kinds of tests, repurpose them for this?
David Vigerust, PhD [14:06] You can to a degree. There’s some swabs that, you know, that worked with a work just fine. And then there’s some that you know won’t work for the purposes where you know we’re trying for back in the back part of the throat or up into the nasal pharynx you need to have swabs that are long enough to get all the way back to the you know the rib you know rear of the nasal pharynx so we’re trying to source these swabs from everywhere even going overseas to south korea to try to source some of their sample kits just to try to get us back up to speed on testing efficiency. Unfortunately, most of these supplies came from China. So that lockdown has prevented much of those supplies from getting to us here.
Dr. Mark Leeds [14:50] Yeah. What about like individual doctor’s offices that may just have boxes of stuff in the back that they don’t even use?
David Vigerust, PhD [14:56] Like, you know, a typical nasal, a typical swab probably is not going to work that well because it needs to go into transport media. So we still need to have some extra things to go along with the swab, either viral transport media, normal saline, something to suspend the sample into while it’s being transported to the lab. So those are in short supply as well.
Dr. Mark Leeds [15:18] And that’s another point that so many doctors’ offices are closed down now. All cosmetics, at least here, has been shut down. So, you know, a lot of offices are not using supplies, you know, including things like ventilators and masks and gloves and, you know, things that they have no need for now that can be shared with other medical facilities.
David Vigerust, PhD [15:36] Are you saying that they’re doing that?
Dr. Mark Leeds [15:39] I know that there’s people have been calling out for it, you know, appealing to them. And, you know, I’ve seen things on LinkedIn and Facebook of doctors appealing to other doctors to please contact them and share their supplies. I don’t know how much of that is actually happening, but I’ve seen some communication of that kind going on.
David Vigerust, PhD [15:56] Yeah. I’ve seen here in town that a number of the tattoo parlors had donated their gloves and gowns and things like that to the hospitals here so that they could at least have some additional, you know, protective equipment, masks, you know, some of these places had masks that they were donating, you know, to the hospitals here locally. So people are trying to pull together. But, you know, there’s still such a shortfall in some of these supplies that, you know, hopefully we get somewhere close soon where, you know, some other manufacturers start producing.
Dr. Mark Leeds [16:29] Yeah. And just I want to ask you one more thing, as far as surface cleaning. And I’ve heard that, you know, we know the virus lives on surfaces for a few days. I’ve read cardboard 24 hours and plastic and metal maybe three days. But I also read somewhere that it’s possible that we don’t even know if it transmits that way, that it may not even transmit from our surface or it may, I don’t know if anybody knows that, definitely.
David Vigerust, PhD [16:54] Right, right. The fomite or surface transfer is not probably not that much of a, it’s a vector but I don’t know how much of it is it’s probably going to principally be coughing sharing aerosol droplets with you with someone close to you but I mean there’s always the possibility someone coughs on a surface or near a surface and you pick up some of that and you know touch your eyes or your mouth so it better to be safe and try to clean all of those surfaces but you know there was a report this morning that said that some of those cabins on one of those Princess Cruises had viable virus 17 days after everybody evacuated. So I think it’s tremendously variable depending on the environmental conditions as to how long it stays viable on a surface.
Dr. Mark Leeds [17:42] So it’s much longer than just a few days.
David Vigerust, PhD [17:44] It could be. You know, that was a report that came from the CDC this morning that 17 days they still found viable virus. So all the more reason to try to get it. To clean you know as frequently and as often as you can. Now assuming you can get access to Clorox and you know all that kind of thing, cleaning supplies, they’ve been in short supply here as well. So you know you do a great job at the beginning and then once those things start to become scarce, you do the best you can right?
Dr. Mark Leeds [18:16] I’ve heard mention of people saying sterilizing things by time of leaving it out long enough after a few days has passed and you know but that’s not definitely true then?
David Vigerust, PhD [18:24] No, it could potentially stay viable for much longer than we’re expecting.
Dr. Mark Leeds [18:28] What about mutation? I’ve heard someone refer to it as being a slippery virus that it can mutate very quickly and easily.
David Vigerust, PhD [18:36] Yes, these RNA viruses have a tendency to mutate quite often, and we’ve seen that there’ve been a number of phylogeny trees that have looked at each of these viruses that get sequenced, how close they are to the original one from China, how close they are to the ones that first introduced in the US, and it’s diverging. There are subtle changes that are occurring in the virus. My hope would be that we find a place where the virus is becoming more adapted to us. Doesn’t cause us quite the same level of illness. And then that might allow us to have what we have with these other coronaviruses, which would be a fairly mild illness, if any illness at all. And perhaps we can generate some herd immunity if enough of us get exposed. Tackle the virus, clear it without having significant or severe illness. So it’d be nice if the virus learns to adapt. Flu has done that. Over the last hundred years, the 1918 flu has adapted slowly over the decades to be less virulent to us, still causes some disease in some people. But for the most part, it’s come to a place of balance with us. Ideally, that’s what we would want. And that’s what the virus would want if you want to ascribe a human quality to it. That’s how it exists in the bat. It has a balance with the bat. It doesn’t cause the bat illness and can still transmit. But hopefully maybe we can get to that place if this continues to evolve, which I expect it probably would.
Dr. Mark Leeds [20:04] The work you’re doing, I mean, thank you for what you’re doing. It’s really important to get all this testing done as much as possible.
David Vigerust, PhD [20:11] Thank you. Appreciate it.
Dr. Mark Leeds [20:15] Thank you for joining us today on The Rehab on the Mental Health News Radio Network. I hope that you have found this show to be interesting and useful. If so, please subscribe to the Rehab Podcast and share on social media. I appreciate your taking the time to listen to the Rehab. Thank you.
