[00:00:00] Joel Berg: We are here today with Dr. Purnima Kumar. Dr. Kumar is a professor of Periodontology at the Ohio state university. She received her dental degree from Annamalai University in India and her masters in Periodontology and PhD in molecular microbiology from the Ohio state university. She is a diplomate of the American board of Periodontology. In addition to her clinical practice, Dr. Kumar maintains an active research program in human microbial, ecology that is funded through the NIH and oral health care corporate partners. She has authored over a hundred papers and book chapters. She's the editor and chief of clinical advances in periodontics and editor of the journal of Periodontology - Nature's scientific reports and microbiome. She is currently the co-director of the DDS PhD program and the co PI of the institutional  training grant and has served on several grant review panels for the NIH. She has mentored several pre dental, dental, masters doctoral, and post-doctoral students and junior faculty colleagues.

[00:01:02] She is a fellow of the executive leadership in academic medicine or EELAM program. She presently serves as the chair of the continuing education oversight committee for the American Academy of Periodontology. Is a member of the task force for women in periodontics. She is a member of the council of scientific affairs of the American dental association, and is also their official spokesperson on e-cigarettes and vaping. Dr. Kumar has also served on various committees of international association for dental research and is presently the vice-president of the periodontal research group. Dr. Kumar, thanks so much for being with us today.

[00:01:40] Purnima Kumar: Really such a pleasure being here too, Joel. 

[00:01:43] Joel Berg: Well, it's great to talk to you again, because during our annual session in 2020, in May, you were a big hit. You talked to us about infection control and actually you gave us sort of a virology 101, I believe we called it and had raving reviews, our members just loved hearing the accurate, but very clear approach to understanding viruses. And today we're going to follow on that and talk about a little bit about COVID and our focus will end up being on vaccines, but I wanted to start by asking you, what have you learned about COVID-19 since, since that conversation in May?

[00:02:15] Purnima Kumar: Wow. Oh, we've learned that the virus is a very smart virus. We've also learned that humans can be really stupid. Okay. So I'll tell you why.  

[00:02:25] Joel Berg: some examples. 

[00:02:28] Purnima Kumar: So let's talk. So, think about this, right? So what the virus is doing, this is a zoonotic virus. This is a zoonotic virus, right? Which means it didn't know anything about us. It didn't know anything about human beings at all. Which was great, which meant we had an entire adaptive immune system to work against this virus. We were absolutely brilliant. We had this entire adaptive immune system that we could bring to bear against this virus, but guess what?

[00:03:03] The virus mutates and it rotates at a much faster rate than, you know, we previously thought was possible. We know how many variants are coming out now. And the reason the virus mutates it's because it's learning about our adaptive immune system and you know, how it learns about our immune system by living in us. So the more number of people who get infected with the virus, the more opportunities the virus has to learn about us. And so for all those people who wonder about, you know, Google and Facebook looking at their data, getting their personal data here, they're handing it for free to a virus by simply not wearing a mask.

[00:03:42] Joel Berg: So the mask wearing thing. And at another time, actually, I want to talk to you about mask wearing because as we get into influenza seasons and what the implications are from, COVID on influenza. That's another subject. So I want, I want to talk to you about aerosols briefly, and we're going to get into the vaccine topic, in a moment. But you know, when this first started and I was talking to large audiences of practicing dentists and pediatric dentists included. The main topic of interest was aerosols. You know, how are we spreading this in the office, through these aerosols, not just droplets that apparently drop off within six feet. And so talk to us a little bit about what we've learned. And I think you told me about this recent ADA study that talked about transmission in the office as it relates to aerosol. So please give us an update. 

[00:04:29] Purnima Kumar:  We did a review article for the journal of Periodontology. We looked into aerosols a little more closely, especially aerosols from the dental operatory. I mean, yes, it is true that infectious agents can be transmitted through aerosols. But a lot of that work comes from occupational aerosols and from medical literature. Right. So when you're, when you have a Bronco scope stuck down someone's lungs and you're sucking up all this gunky, you know, mucus.

Yes. There is a lot of potential for that aerosol to transmit. Pathogens infectious agents, but in dentistry, we are aerosols are largely irrigant fluid either. It's your dental unit waterline or it's your saline or it's the reservoir that you're using. And saliva gets diluted one in 42, one in hundred.

[00:05:20] So when we did a review article and we looked at all of this data very, very carefully and very critically, we found that that study has never been done. The study to ask, what is the source of the microbiota found in dental air assaults has never been done. I'm going to give you a sneak peek and say, the study is now done and the results are in press, but I'm not going to tell you anymore.

[00:05:45] Joel Berg: I can't get anything? I can't squeeze something out of you on that one. I'd love to hear that. 

[00:05:49] Purnima Kumar:  Um, not just yet. We'll wait. It's under review and I hate to, I hate to hijack the peer review process. So it's under review, but the findings, I mean, I'm excited as a practicing dentist, I'm really excited about the findings, but the ADA, the meantime did this wonderful, I mean, excellent work. The health policy Institute of the ADA. They did a fantastic project. And they looked at the spread of disease of SARS COV2 specifically in dental offices. And they found it to be less than 1% of dental personnel. This is not simply looking at dentists alone. Right. It's looking for all kinds of, in office personnel, in operatory personnel. I would say doesn't, didn't look at front desk, but it certainly did look at people who were inside an operatory. So dental operatory personnel had less than 1%. Point nine in fact, or less than 0.9, something like that. So the data is very encouraging.

[00:06:50] The dentists have always been, yeah,wWe've always been at the forefront of infection control, right? Since the HIV pandemic, we've kind of evolved with every disease as it came along and, and we've improved and tightened our infection control protocols. And not just that, it's not only the people in the operatory, it's, it's the entire office wide, right? So everyone in the office follows these protocols and we hold our patients to it, to enforce us for our patients. So I think they've been very good and the results are showing that well I think.

[00:07:23] Joel Berg: you know, you mentioned mask wearing, which we're not going to get into in detail today. However, You know, I think as I understand and correct me if I'm wrong, these results show that even the formerly used lesser than PPE, like the regular surgical mask, not N95s were protective and was working. Is that fair to say?  

[00:07:43] Purnima Kumar: I would say yes. I mean, we are not looking at the efficacy, right. We're looking at. So at 95 is 95 because it's 95% effective in removing, um, preventing anything less than, you know, 0.3 microns. So, so that's the ninety-five, we're not looking at efficacy, but on a population level, the simple act of wearing a mask reduces aerosols generator from speech sneezing and coughing, yes. 

[00:08:08] Joel Berg: And it's going to help us with seasonal influenza, which is more impactful for kids in the case of pediatric dentistry. So I think a lot of lessons learned here. I want to move into the vaccine arena. So there's so much to talk about. We have limited time, but maybe you could start out Dr. Kumar telling us the different types of vaccines. I know, you know, originally the Pfizer was first and then the Moderna, they're both MRNA. Just briefly at a high level. Tell us about what that MRNA means and then maybe getting into the Johnson and Johnson and some of the other ones beyond that. Tell us just technically what you'd like to say about the different vaccines.

 [00:08:43] Purnima Kumar: So in the MRD vaccine, as you know, the big headline, right? So we we'll start by spending a little bit of time on that. And everybody talks about work speed. And the concern is that if something was developed at warp speed, maybe there were shortcuts taken, maybe, you know, people leapfrog certain things well am RNA that the development of marinade itself is not never happened at ward speed.

[00:09:07] It was just, you know, co-opted for this vaccine purpose. So the original reason, the main reason why people were looking at MRNA as a delivery device is for diabetes. And this was over 50, 40, 50 years ago. Right. For 40 50 years, people have been saying, if I can, what does an modern day? It's a messenger, right?  It's truly a messenger. Where is it? A messenger from the DNA? So it takes your genetic code. D codes, your genetic code, and then brings that code to a protein making factory, which is your ribosome. And then your rival zone. Being a factory, simply turns out the protein people were saying, Hey, if your DNA is saying, make insulin. But you're right. The zone cannot make insulin because the message is being lost in translation. Can I give you a new, a messenger that will now decode the message from DNA and have your eyelids have Langer hands make dive incident. So that's what they're really looking for. And they've been trying to do this for 40 years.

[00:10:11] Joel Berg:  What's the status? What's the status of that? In the case of diabetes if that works.  

[00:10:16] Purnima Kumar: It’s not there yet. You know, they, I think, I don't know. I don't want to say it's not there. I don't know. I don't know, but I think, now let me tell you what the problem was, why they couldn't be successful in that because,  RNA, any kind of RNA will degrade as you look at it. There's so much enzymes called RNs everywhere. That MOSFET, right? So your hands are full of RNs. If by chance you touched RNA, it will, it will just curl up and die in front of you. Right? So that's the problem with RNA. And so they couldn't find a way of not degrading it, of protecting it from degradation because we have so many enzymes.

Once you send it into the bloodstream, you have to protect it. And that protection was what the biggest log jam here. Right? So once they figured out how to protect the RNA in this case, the simplest thing, they just tucked two giant fat molecules on either side of the RNA. And because these are lipid molecules, they can move into a cell because the cell is as a buyer lipid bi-layer right. So once that discovery was made, then what speed happened? Right. So there was no need for Watson. Bead, so to speak. So no step was, was cut off. Okay. Let's now talk about the MRD vaccine itself. What does MRNs and coding? It is encoding a teeny tiny, and I want to say this again Dr. Berg, a very, very tiny fraction off the tiniest protein on SARS COV2.

[00:11:46] The spike protein has three domains. It's got three parts to it. So the MRD is encoding 500 base pairs of the smallest part of the tripod. It's not the entire virus. It's not encoding the entire virus. It's just encoding a teeny, teeny, teeny fragment, 1000000th of a fragment of that entire virus. What it does is once it encodes and makes the tiny protein, our body doesn't know it comes from a virus, it just sees it as something that it hates. And so it makes the immune system go nuts. 

[00:12:24] Joel Berg: So it sounds like there are some pretty big discoveries, even though the MRNA idea has been around for 40 years.  I'm going to pause now for a word from our sponsor. We are back with Dr. Purnima Kumar. And she's talking about some of the recent discoveries that have allowed us to use the MRN idea. It has been around for 40 years. You mentioned the case of trying to get insulin production in the case of diabetes. And please continue to talk to us about these little fragments you were describing of  and protecting them with lipids and in getting them to work, to make the antigens that our body then fights against. Is that correct? 

[00:13:06] Purnima Kumar:  Exactly. And we also, you know, bulk up the response to what an owner's Agilent's. These albumins are completely inert particles. If you ate them, if you swallowed it, it'll, it won't do anything to you. The reason is when you inject it, that the site of injection starts this. That's why people have redness. People have this, this giant red patch. So as people start getting vaccination and vaccinated, our healthcare frontline workers, most of us dentists are getting vaccinated.

[00:13:32] Or many of us are noticing these angry red patches at the site of infection. It simply means that your body's reacting to the agent, not to the marinade itself. So that's not, should not be a cause for worry. The second dose of the vaccine. It seems to elicit a more, um, aggressive response. People are getting fevers, chills, almost a mini, you know, COVID kind of a disease a day or two, and that is also to be expected. It just speaks to a very robust immune response. So yes, we are seeing all of those. And that just says the vaccine is doing exactly what you wanted it to do. 

[00:14:11] Joel Berg:  Exciting. Yeah. So what about the difference with the, or we're about to get Johnson and Johnson going? What's the difference with that one? 

[00:14:20] Purnima Kumar: So there are four kinds of vaccines, right? This is the genetic vaccine as the first, the first two have been genetic vaccines, and then we're getting what are known as viral vector vaccines. So what a viral vector does is basically takes the smallest virus known to man, which is an ID Novartis, which gives you a common cold and sometimes just lifts happen in your body.

[00:14:40] And it loads a protein into this adeno virus and sends the virus into your bloodstream. Well, what does a virus do? It can multiply by itself. So the virus can literally act like a photocopy machine and make million copies of this protein, which then your body can respond to. Or you can take this protein and put it in, on other vehicles, right? So [00:15:00] the next Zandra vaccines, the next group of vaccines that are coming out, we have the Johnson and Johnson. We have, uh, other, other things that are coming out, these vaccines or all of them, um, protein based vaccines. And that's how they work, right? So they have some different carriers and there's going to be a whole slew of them.

[00:15:19] Canada is going to make its own vaccine by 2021. That's also a protein based vaccine. So all of these are protein based vaccines and their efficacy depends. On more factors than your own body making the protein, right? It's like buying a cloth and making a dress versus buying a dress. Right? The dress can be baggy at the knees and you know, maybe tight on the chest. Just exactly that this protein is comes pre-made. It cuts the job. Your body has to do it in half, but also fits a little less. That a custom made suit. 

[00:15:53] Joel Berg: Does that mean implication wise in terms of efficacy? And I I'm reading that, you know, the Johnson Johnson is a hundred percent effective, 50 something days out it's only one injection. Uh, is that it? How does that relate to what you just said is, you know, that it's a protein versus a, an instruction to make a peptide or you in the case of the . 

[00:16:13] Purnima Kumar: Right. So yes, and protein based vaccines have been used in the past for many others and they're immensely successful. So obviously the choice to make what protein has been has. I know that the workup to finding the exact protein that will elicit the best immune response has already been worked out. And that's why they're getting this beautiful a hundred percent response. So I'm very happy to see the same that the news that you're, you know, that Johnson Johnson is shared with all of us.

[00:16:43] Especially that it actually reduces severe disease. Right. So that's brilliant because it's now faster acting it. Doesn't wait for your body. Doesn't need a highly immunocompetent host. So it's going to be great for those kinds of populations to know we have almost like a vaccine boutique, right? If you're highly mental competent, your body is ready and ready to go. Take the genetic vaccine. If you're less than immunocompetent, then go for a protein vaccine. If you've had the disease or in the middle of a disease experience, a protein vaccine might be right for you. So we're developing this vaccine boutique and we can actually do a la cart, which is fantastic for us.

[00:17:21] Joel Berg: So we're learning a lot about, you know, COVID is actually teaching us a lot about things that will be useful beyond COVID not only for influenza or for bad seasons of influenza, but just about virology in general. And I want to shift gears and the last portion of our conversation today. And I also want to get in that. I want you back, Dr. Kumar, you have so much to offer us and you know, you're a scientist and a clinician who can explain things to us in a way that's important to us. So that's much appreciated. So regarding virology the subject, and you gave us that course mini course in virology 101 in the midst of COVID, you're doing that again today by your descriptions, as it relates to the vaccines.

[00:18:03] You know, I remember in dental school, way back in microbiology class, we learned a lot about bacteria and fungi. That was kind of in a different world. So today, do you think this is having implications on curricula? Are we going to be teaching more about virology. And I I'm assuming also if you could comment on more research in virology, that as it relates to preparedness for pandemics and other difficult things.

[00:18:34] Purnima Kumar: Wow. That's a tall order. Dr. Berg. Yes. So the first thing I think, I think one thing we have learned, is how self-sufficient dentists are and how much we have to offer to the medical community at large. So, so many. Schools are now incorporating vaccinations as part of the training of dental students. And the first dentist to offer  vaccination was, you know, you've seen that newscast is Dennis from Oregon health sciences. So, so we are doing that. I actually took the course and I'm on standby to offer vaccine in the state.  

[00:19:11] Joel Berg: As of today, February 4th, we're recording this. There are 20 States that allow dentists to give vaccines and growing by the day.

[00:19:19] Purnima Kumar: Exactly. Exactly. So it's not a difficult task, so we can integrate with our medical colleagues and step up and do what's needed in, in times of, you know, when they're looking for qualified healthcare personnel and we are it. So it teaches us how much more we have to offer them in previously thought possible. And it teaches us about the importance that we should place. On learning how our immune systems functions and how they can betray us if we don't take the greatest care of them. Right. So I, if nothing else, I hope if nothing else at the minimum, I hope it brought into focus. The big picture of, you know, factors like obesity factors like, CLPD or, you know, behavioral issues like smoking and vaping and how they can contribute long-term. You know, set the, set you up for failure. You know what I mean? When, when a pandemic hits, you cannot suddenly say, Oh, I quit smoking today. And so I'm done and I should be fine tomorrow. What you're going to be fighting is the cumulative effects that, that kind of, you know, um, cut you off at the knees when you're trying to find fight this, this new disease, this new pandemic.

[00:20:34] Right? So important health perspectives, focus on more holistic kind of treatment. Yes, of course learning virology and learning how it impacts the immune system and how the immune system fights. And finally, just an appreciation of this amazing mammalian immune system and the myriad ways in which we can destroy it through our behavior and lifestyle [00:21:00] choices.

[00:21:01] Joel Berg: [00:21:01] Yeah, I think you're right. Dr. Kumar. You've given us so much insight on immunology. That's what really we're talking about here. And I suggested that virology needs to be an advance. It advancing as a subject, but really you're right. It's immunology comprehensively. And that we've learned. So much about that and the awareness of individuals for the health literacy. That's another subject, by the way, that's going to be core in the agenda. You know, vitamin D comes up, that's, it's all related to immunology. So boy, we really appreciate you being with us today. And I have so many reasons why I want to get you back if you're willing, because I want to talk about vaping. I want to talk more about immunology, latest trends and Periodontology for kids.

[00:21:41] And I hope you'll stay friends with our community because you have a lot to offer us. I have one last question for you as we close and just to go out on a limb, we’re at the beginning of February now, and you as an expert, what's your take given everything, you know, and I know you're concerned about people getting vaccines to make sure they do. When are we going to have herd immunity? 

[00:22:03] Purnima Kumar:  Oh, wow. So, so. You know, this in $2 would buy you coffee anywhere, right? That much, I guarantee you. But when the first vaccine rollout, they were talking about rollouts, right? When, when Pfizer and, Pfizer actually came out with the efficacy rate, the trials clinical trials, and we were all celebrating. They said, you need to read for, to achieve herd immunity. You're going to need 42 to 57% of people vaccinated, but that was before everyone decided to travel for Thanksgiving and Christmas and then party over new year's. So now that all of that data is coming out, I believe Dr. Fauci upped the numbers two days ago and today's February 4th. So I'm going to say the first of day in February, he told us we're going to need a 90 plus percent immunization to achieve herd immunity. And I think the reason for upping that number is also an increasing awareness of the number of people with co-morbidities it doesn't, isn't an amazing, the most developed country in the world. We don't have a good, um, sense of how many individuals have co-morbidities any kind of comorbidities were fun. Finally, getting up, getting a number on them. And you're finding out that, Whoa, this number is far more than we thought originally, right? It's not that one in eight Americans are obese. It's now one in five Americans are obese, right?

[00:23:29] Joel Berg: We're learning a lot as time progresses. Well, you're going to be our teacher. I really appreciate it. Our audience appreciates it. So thank you so much for being with us today on our podcast. And, uh, I want to get you back as soon as possible, as I said, you're much appreciated.

[00:23:48] Purnima Kumar: Thank you. This is wonderful. I'd love to be back. And you know, I have to say, I am a little bit of a pediatric dentist myself. You know, my PhD advisors, one half of them is a pediatric dentist. Dr. Ann Griffin, right? The 

[00:24:05] Joel Berg:. Yes. I know Anne, yes. 

[00:24:09] Purnima Kumar: And my husband has been part of the nationwide children's hospital. He is part of the dental trauma team. He's an endodontist. So I will say Columbus, he was probably the only, must be one of the programs, few programs that actually has an endodontist on staff. So he's been innovating on, you know, MTA and atypical regenerations and stuff like that. But you guys for 15 years, so I am part pediatric dentist.

[00:24:34] Joel Berg: I can feel that. And I'm going to take you up on your offer. So thank you.