The IDWeek presentation in 2022
CLINICAL MATTERS
I write this on the plane going back to Manila after attending my first face-to-face international convention since the start of the pandemic. IDWeek is the premier infectious diseases convention in the world, organized by the Infectious Diseases Society of America (IDSA) together with the Society for Health Care Epidemiology of America (SHEA) and the Pediatric Infectious Diseases Society (PIDS). The last time I attended IDWeek in person was in 2019, at the same venue in Washington DC. During the pandemic, there were two virtual IDWeek conferences and this one is the first physical gathering since then.
As a researcher and academic, I have been attending this conference and its precursor (the IDSA annual conference) since 2008. We have been presenting abstracts of our research in the Philippines every year since 2011 and this has only been interrupted by the first two years of the pandemic. Tens of thousands of research abstracts are submitted from all over the world every year, and only a select few are chosen. Our unbroken yearly streak of accepted abstracts prior to the pandemic is an affirmation that the work we do at the National Institutes of Health in the Philippines is at par with the world’s best.
This year’s program included state-of-the-art updates in infectious diseases and a dedicated Covid-19 track. There were also tributes to the heroes of the pandemic, and Dr. Anthony Fauci had a new annual award named after him in recognition of his tremendous contributions to the field of infectious diseases. It was great to see colleagues from all over the world. I was glad many of them survived despite being on the frontlines, and we all took a moment to remember those who did not.
This year we had two poster abstracts accepted and I was also invited to give a talk on the BugHub stage. BugHub talks are meant to be a platform for infectious diseases specialists to highlight other aspects of infectious disease work beyond the usual academic content typical in these conferences. The format is similar to a TED talk—no more than 20 minutes, and accessible even to lay audiences. My talk on the BugHub stage was entitled “How a TED Talk saved 200,000 lives.” It spoke about how we convinced the government to shut down Metro Manila early in March 2020 by presenting a very succinct and easy to understand talk on what would happen if we did not. I’ve written the specifics of that fateful day in a previous column (https://mb.com.ph/2022/04/26/how-my-ted-training-helped-me-save-filipinos-from-covid/). The most dramatic part of the talk was how I convinced the Philippine government officials to listen to the science by using these iconic lines: “Every disaster movie begins with everyone ignoring the scientist. I’m a scientist. Let’s change the ending.” It still gives me goosebumps thinking about how close we came to losing hundreds of thousands of Filipinos if we had not locked down when we did. New data on excess deaths clearly shows that even a 10-day delay in closing would have resulted in more than 200,000 Filipino lives lost. The talk was well received and was well attended, with a special boost from the Filipino delegates.
The first poster abstract we presented was about whole genome sequencing of early SARS-CoV-2 infections showing how these lineages spread in the first few months of the pandemic. Our data confirmed that the initial cases of Covid-19 from the three Chinese tourists in January 2020 were contained and did not proceed to community transmission. These three cases were made of one lineage A and two lineage B genomes. These lineages have no numbers in front of them because they are the ancestral lineages from Wuhan. The subsequent lineage implicated in community transmission in March 2020 was B.6, a Southeast Asian/ Indian lineage. There was no evidence of any A or B ancestral lineages in any of the genomic sequences in our samples or from other groups who did similar work. This means that the measures to contain Covid-19 in place in January 2020 worked and delayed community transmission by nearly two months. Tens of thousands of lives were saved by those early heroic efforts by our health care community and the government.
The second poster abstract we presented looked at long term outcomes of antiretroviral treatment of Filipino HIV patients. This cohort of over 200 patients followed over the last five years is unique in that their viruses underwent whole genome sequencing to definitively determine that there was no pre-existing drug resistance. Among those who religiously followed up over, less than five percent failed treatment in the first year and only 11 percent developed drug resistance after five years. This isn’t too bad because we were using efavirenz-based regimens as first line treatment until recently, and efavirenz has a relatively low barrier to resistance compared to the new dolutegravir-based regimens. The most disappointing finding was that if dropouts are included in treatment failures, the failure rate in the first year of treatment is about 35 percent. This implies that we need to exert more effort in retaining Filipino HIV patients in care, especially since our current antiretroviral regimens work very well when taken properly.
Since this was, after all, an infectious disease conference, wearing a mask was required to attend the sessions. IDWeek may have been the only place left in the US where there was a mask mandate, and this spoke volumes on how important the role of masking is in fighting Covid-19. With the emergence of immune evading variants such as Omicron and its sublineages, the infection-blocking properties of vaccines have decreased dramatically. The good news is that our vaccines continue to protect against severe disease. The risk of death, however, is not zero and remains substantial for vulnerable populations. If we truly wish to use all the tools to maximize lives saved and to prevent the virus from mutating into potentially more problematic sublineages, nothing beats the combination of a mask and a vaccine booster.
Indeed, mask + vaccine > any Covid-19 variant.