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GOOD AFTERNOON, I'M JON LORSCH,

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DIRECTOR OF THE NATIONAL

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INSTITUTE OF GENERAL MEDICAL

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SCIENCES, WELCOME TO THE STETTEN

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LECTURE, HONORING THE THIRD

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DIRECTOR OF NIGMS WITH A STRONG

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COMMITMENT TO BASIC SCIENCE,

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ESPECIALLY RESEARCH AND

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GENETICS, CELLULAR, MOLECULAR

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BIOLOGY AND CHEMISTRY, SPENT

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MOST OF HIS CAREER AT NIH

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SERVING IN TWO INSTITUTES,

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OFFICE OF THE DIRECTOR, AND WAS

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PARTICULARLY WELL KNOWN AS

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CO-AUTHOR OF THE EARLY EDITION

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OF TEXT BOOK PRINCIPLES OF

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BIOCHEMISTRY.

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IN RECOGNITION OF HIS MANY

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CONTRIBUTIONS, WITHIN AND

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OUTSIDE OF NIH, HE HAS THE

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DISTINCTION OF HAVING TWO

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ENTITIES NAMED AFTER HIM AT NIH,

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THIS LECTURE AND THE DEWITT

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STETTEN JR. MUSEUM OF MEDICAL

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RESEARCH.

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SALLY JOINED THE DISTINGUISHED

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LIST OF LECTURERS, DIRECTOR OF

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WEST VIRGINIA CTSI, ASSOCIATE

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VICE PRESIDENT FOR CLINICAL AND

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TRANSLATIONAL RESEARCH,

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PROFESSOR OF MEDICINE AT WEST

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VIRGINIA UNIVERSITY.

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SALLY WORKS TO ALLEVIATE HEALTH

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DISPARITIES IN RURAL AMERICA

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ESPECIALLY REGARDING PUBLIC

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HEALTH CRISES LIKE THE COVID-19

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PANDEMIC AND OPIOID CRISIS. 

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SHE WILL HIGHLIGHT WVCTSI

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DEVELOPMENTS INCLUDING RESULTS

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FROM A STUDY USING DEEP BRAIN

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STIMULATION.

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SHE WILL DISCUSS RESEARCH

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RESULTS RELATING TO EPIDEMIOLOGY

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OF SARS-COV-2 AND TREATMENT OF

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THE DISEASE.

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SALLY RECEIVED A B.A. IN

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CHEMISTRY, AND M.D. FROM CASE

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WESTERN RESERVE SCHOOL OF

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MEDICINE, NIGMS SUPPORTED HER

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WORK THROUGH THE U54 CLINICAL

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AND TRANSLATIONAL RESEARCH

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AWARDS THROUGH THE INSTITUTIONAL

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DEVELOPMENT AWARD, IDeA

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PROGRAM, SINCE 2012.

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AS OF THIS AUGUST, SALLY WAS

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NAMED SCHOOL'S INAUGURAL

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CHANCELLOR PREEMINENT SCHOLAR

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CHAIR IN RECOGNITION OF HER

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OUTSTANDING ACHIEVEMENTS.

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SO SALLY, CONGRATULATIONS FOR

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THAT EXTREMELY WELL-DESERVED

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HONOR.

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PLEASE HELP ME WELCOME SALLY FOR

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HER TALK, BIOMEDICAL RESEARCH IN

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RURAL AMERICA, MUCH

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ACCOMPLISHED, MUCH TO DO.

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>> THANK YOU FOR THE KIND

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INTRODUCTION.

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I WOULD JUST LIKE TO THANK DR.

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LEY AND DR. LORSCH FOR INVITING

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ME, I'M PROFOUNDLY PRIVILEGED TO

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PRESENT THIS LECTURE IN HONOR OF

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DR. STETTEN, WHO PARTICULARLY

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WAS COMMITTED TO GENETICS AND

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MOLECULAR AND CELLULAR BIOLOGY,

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REALLY THE DISCIPLINES THAT HAVE

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CONTRIBUTED SO MUCH TO

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TREATMENTS AND CURES OF MANY OF

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TODAY'S ILLNESSES.

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THIS TALK IS ABOUT RESEARCH IN

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RURAL AMERICA, AND WHY IS THAT

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IMPORTANT?

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IF YOU LOOK IN THE 19th

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CENTURY, ACTUALLY MORTALITY

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RATES WERE HIGHER IN THE CITIES

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AND URBAN AREAS, AND THAT WAS

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BECAUSE OF CONTAGION AT

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POPULATED AREAS, POOR WATER

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SUPPLIES, AND A LACK OF SEWAGE

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TREATMENT.

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AS SCIENCE REALLY MADE CLEAR

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WHAT WE NEEDED TO DO, WATER WAS

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CLEAN, THERE WERE SANITATION

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PRACTICES PUT IN PLACE, AND IN

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THE 20th CENTURY A LOT MORE

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VACCINES SUCH THAT BY THE

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MID-20th CENTURY, THE

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MORTALITY RATES BETWEEN RURAL

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AND URBAN POPULATIONS WERE

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ESSENTIALLY THE SAME.

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BUT AS THIS SLIDE SHOWS ON THE

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LEFT PANEL, IN THE LATE '80s,

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THESE MORTALITY RATES BEGAN TO

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DIVERGE, WITH URBAN RATES

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SHOWING IN THE BLUE LINE

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CONTINUING TO DECREASE WHILE THE

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RURAL RATES SHOWN IN THE GOLD

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LINE REALLY FLATTENED OUT.

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YOU MIGHT SAY, WELL, THIS IS

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JUST -- THIS HAS TO DO WITH

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POVERTY, ON THE PANEL OF THE

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RIGHT YOU SEE CERTAINLY POVERTY,

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HIGH POVERTY COMMUNITIES HAVE

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HIGHER MORTALITY RATES, IN FACT

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THAT DOES NOT ANSWER THE

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DISPARITY.

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IN FACT, LOW POVERTY RATE RURAL

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COMMUNITIES HAVE SIMILAR

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MORTALITY RATES TO HIGH POVERTY

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RATE URBAN COMMUNITIES.

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NEXT SLIDE PLEASE.

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TO TAKE YOU TO WEST VIRGINIA,

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WEST VIRGINIA MORTALITY RATE WAS

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NUMBER ONE IN THE COUNTRY, A

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COUPLE YEARS AGO.

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HOWEVER, IT'S BEEN SURPASSED BY

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MISSISSIPPI, NONETHELESS AS

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SHOWN BY THE MAP OF WEST

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VIRGINIA COUNTIES, EVERY COUNTY

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IN WEST VIRGINIA HAS A 

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MORTALITY, AGE ADJUSTED, GREATER

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THAN THE U.S. RATE.

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SHOWN ON THE RIGHT ARE A NUMBER

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OF CONDITIONS AND, AGAIN, THE

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WEST VIRGINIA MORTALITY RATE IS

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HIGHER.

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COVID-19 IS NOW THE THIRD MOST

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COMMON CAUSE OF DEATH IN THE

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UNITED STATES, ACTUALLY FOR THE

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THIRD YEAR RUNNING, AND YOU CAN

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SEE HERE AGAIN WEST VIRGINIA IS

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ABOVE THE U.S. RATE.

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NEXT SLIDE.

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WHAT I'M GOING TO TALK ABOUT

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TODAY ARE TWO THINGS, NUMBER

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ONE, THE CORONAVIRUS PANDEMIC

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NATIONAL INITIATIVES ACROSS THE

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CTRs, AND SOME WEST VIRGINIA

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INITIATIVES, AND THEN THE LAST

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COUPLE MINUTES I'M GOING TO TALK

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ABOUT SOME OF THE WORK WITH

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SUBSTANCE USE DISORDERS AROUND

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EMERGENT INFECTIONS RELATED TO

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INTRAVENOUS DRUG USE AND

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INNOVATIVE TREATMENT.

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NEXT SLIDE.

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NEXT SLIDE PLEASE.

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THE NATIONAL COVID COHORT

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COLLABORATIVE IS AN ANALYTICS

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PLATFORM THAT COLLECTS

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ELECTRONIC MEDICAL RECORD DATA

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FROM PROVIDERS ACROSS THE

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NATION, HARMONIZES IT, MAKES IT

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AVAILABLE TO RESEARCHERS.

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REALLY VERY EARLY IN THE

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CORONAVIRUS PANDEMIC, THE SPRING

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OF 2020, GMS AND THE IDeA

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PROGRAM FUNDED CTRs, EIGHT

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CTRs INITIALLY INVOLVED TO BE

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PART OF N3C TO SUBMIT DATA AND

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THEN TO DEVELOP THE

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INFRASTRUCTURE FOR THE ANALYTICS

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TO ANALYZE THOSE DATA WITH

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REALLY SPECIAL FOCUS ABOUT

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POPULATIONS FOR WHICH THOSE

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CTRs SERVED.

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ON THE MAP, YOU CAN SEE THE

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INITIAL CTRs ARE IN A LIGHTER

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GREEN.

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IT WAS MAINE, RHODE ISLAND,

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DELAWARE, WEST VIRGINIA,

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MISSISSIPPI, OKLAHOMA, NEBRASKA.

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HAWAII AND PUERTO RICO AND

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VERMONT JOINED AS DID A DAKOTA,

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DATA SUBMITTED BY A COBRA IN

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SOUTH DAKOTA.

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HOWEVER, THE CTR IN NORTH DAKOTA

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IS ENGAGING INVESTIGATORS.

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IN WEST VIRGINIA WE HAD ONE OF

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OUR PARTNER SITES, CHARLESTON

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AREA MEDICAL CENTER IN THE

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SOUTHERN PART OF THE STATE,

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WHERE MORTALITY RATES ARE

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HIGHER, HIGHEST, SUBMITTING DATA

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AS WELL.

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NEXT SLIDE.

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AN EARLY PROJECT NOW PUBLISHED

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IN JOURNAL OF RURAL HEALTH

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ASSESSED MORE THAN A MILLION

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COVID-19 PATIENTS FROM ACROSS

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THE UNITED STATES, FROM JANUARY

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202020 JUNE 2021.

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REALITY WAS DETERMINED BY

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RURAL/URBAN COMMUTING AREAS

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CODES, THAT CLASS  CLASSIFY
CODES USING

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DENSITY, URBANIZATION, DAILY

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COMMUTING.

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NEXT SLIDE.

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THESE ARE KAPLAN-MEIER THAT SHOW

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SURVIVAL ESTIMATES.

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PURPLE LINE ARE URBAN RUCA

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CODES, GREEN LINE ARE RURAL RUCA

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CODES ADJACENT TO URBAN AREAS,

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AND YELLOW ARE NON-ADJACENT

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RURAL RUCA CODES.

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MORTALITY, AS YOU CAN SEE, IN

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RURAL AREAS IS GREATER THAN

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URBAN AREAS, 40% GREATER.

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WHICH IS QUITE AN AMOUNT.

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YOU CAN SAY SURE, BECAUSE PEOPLE

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IN RURAL AREAS ARE OLDER,

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FATTER, THEY HAVE MORE

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COMORBIDITIES, ALL THOSE WERE

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ADJUSTED FOR, RESULTS  WERE THE

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SAME, EVEN FOR SOCIAL

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DEPRIVATION, BEGS THE QUESTION

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WHY, WE DON'T HAVE A GOOD

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ANSWER.

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THE RIGHT PANEL INTERESTINGLY

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SHOWS OTHER HOSPITALIZED

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PATIENTS WHO DID NOT HAVE

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COVID-19, AND YOU CAN SEE THAT

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THEIR RURAL INDIVIDUALS HAD AN

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INCREASED MORTALITY, IT WAS

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ABOUT 20% GREATER AS WELL.

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NEXT SLIDE. 

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A SECOND PROJECT WITH THE NC

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3GROUP, THEY SPAN 12 INTUITIONS.

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WE LOOKED AT COMMUNITY RISK FOR

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BREAK THROUGH INFECTIONS AMONG

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FULLY VACCINATED ADULTS, LOOKED

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AT IMPACT OF DEMOGRAPHICS,

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VACCINE MANUFACTURER, ALSO

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RURALITY, AGAIN THESE WERE

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ELECTRONIC HEALTH RECORDS

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BETWEEN JANUARY 1 AND DECEMBER

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OF 2021.

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NEXT SLIDE.

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THIS IS BASELINE CHARACTERISTICS

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TO GIVE YOU AN IDEA OF WHAT THE

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POPULATIONS WERE IN EACH OF THE

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BUCKETS.

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AGAIN, IT WAS URBAN, RURAL THAT

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ARE URBAN ADJACENT, NON-URBAN

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ADJACENT.

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YOU CAN SEE AS YOU MIGHT, YOU

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KNOW, HAVE GUESSED THAT THE

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RURAL POPULATIONS ARE OLDER.

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THAT THE VACCINATION RATES ARE

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LOWER, AND THE LAST ROW REALLY

261
00:10:37,640 --> 00:10:39,840
SHOWS THE, YOU KNOW, COMPOSITION

262
00:10:39,840 --> 00:10:41,480
IN EACH OF THOSE ACROSS THE FOUR

263
00:10:41,480 --> 00:10:45,120
REGIONS OF THE U.S.

264
00:10:45,120 --> 00:10:45,800
NEXT SLIDE.

265
00:10:45,800 --> 00:10:48,840
THIS I SHOW BECAUSE I THOUGHT IT

266
00:10:48,840 --> 00:10:52,920
WAS INTERESTING, IF YOU LOOK AT

267
00:10:52,920 --> 00:10:54,840
THE VACCINE MANUFACTURER,

268
00:10:54,840 --> 00:10:57,080
ACTUALLY THE MODERNA VACCINE,

269
00:10:57,080 --> 00:11:01,160
mRNA VACCINE, HAD A LOWER,

270
00:11:01,160 --> 00:11:02,480
SIGNIFICANTLY LOWER BREAKTHROUGH

271
00:11:02,480 --> 00:11:03,240
RATE THAN PFIZER.

272
00:11:03,240 --> 00:11:05,400
THERE HAVE BEEN OTHER STUDIES

273
00:11:05,400 --> 00:11:08,520
THAT LOOKED AT THIS OTHER WAYS,

274
00:11:08,520 --> 00:11:09,600
SUGGESTING PERHAPS THE MODERNA

275
00:11:09,600 --> 00:11:12,200
VACCINE MIGHT BE A BIT BETTER.

276
00:11:12,200 --> 00:11:13,320
THERE HAVE BEEN HYPOTHESIS WHY

277
00:11:13,320 --> 00:11:16,040
THAT MAY OR MAY NOT BE TRUE.

278
00:11:16,040 --> 00:11:18,400
THE OTHER THING THAT IS NOT

279
00:11:18,400 --> 00:11:21,040
SURPRISING, HOWEVER, IS IF YOU

280
00:11:21,040 --> 00:11:22,520
HAD A PREVIOUS HISTORY OF

281
00:11:22,520 --> 00:11:23,880
SARS-COV-2 INFECTION, YOU WERE

282
00:11:23,880 --> 00:11:28,200
LESS LIKELY TO HAVE

283
00:11:28,200 --> 00:11:30,120
BREAKTHROUGH.

284
00:11:30,120 --> 00:11:33,040
AND THAT, YOU KNOW, IN THE

285
00:11:33,040 --> 00:11:34,440
OMICRON PERIOD, YOU WERE MORE

286
00:11:34,440 --> 00:11:35,360
LIKELY TO HAVE BREAKTHROUGH

287
00:11:35,360 --> 00:11:37,240
CONSISTENT WITH WHAT WE KNOW

288
00:11:37,240 --> 00:11:41,040
ABOUT THE INCREASED

289
00:11:41,040 --> 00:11:41,760
TRANSMISSIBILITY.

290
00:11:41,760 --> 00:11:42,800
NEXT SLIDE.

291
00:11:42,800 --> 00:11:45,120
THIS WAS REALLY THE

292
00:11:45,120 --> 00:11:46,080
MULTI-VARIABLE HAZARD RATIOS,

293
00:11:46,080 --> 00:11:51,360
AND AGAIN YOU SEE THAT URBAN

294
00:11:51,360 --> 00:11:53,560
ADJACENT RURAL AND NON-ADJACENT

295
00:11:53,560 --> 00:11:55,200
RURAL COMMUNITIES HAD

296
00:11:55,200 --> 00:11:55,640
SIGNIFICANTLY -- WERE

297
00:11:55,640 --> 00:11:58,240
SIGNIFICANTLY MORE LIKELY TO

298
00:11:58,240 --> 00:12:00,240
HAVE BREAKTHROUGH INFECTIONS.

299
00:12:00,240 --> 00:12:03,640
ALSO, IF YOU LOOK AT VACCINATION

300
00:12:03,640 --> 00:12:05,480
RATES STRATIFIED BY LOW, MEDIUM,

301
00:12:05,480 --> 00:12:07,560
HIGH, AS DEFINED ON THE SLIDE,

302
00:12:07,560 --> 00:12:10,400
YOU CAN SEE SLOW VACCINATION

303
00:12:10,400 --> 00:12:14,040
RATES AREAS WERE MORE LIKELY TO

304
00:12:14,040 --> 00:12:15,960
HAVE BREAKTHROUGH INFECTIONS.

305
00:12:15,960 --> 00:12:18,600
AND I THINK THIS IS REALLY

306
00:12:18,600 --> 00:12:20,880
IMPORTANT BECAUSE, YOU KNOW,

307
00:12:20,880 --> 00:12:22,640
THERE ARE PARTS OF SOUTHERN WEST

308
00:12:22,640 --> 00:12:25,040
VIRGINIA WHERE THE RATE IS 35%,

309
00:12:25,040 --> 00:12:29,000
AND I THINK THIS MIGHT BE REALLY

310
00:12:29,000 --> 00:12:30,320
IMPORTANT TO DISCUSS WITH

311
00:12:30,320 --> 00:12:32,320
COMMUNITIES THE IMPLICATIONS OF

312
00:12:32,320 --> 00:12:34,080
THIS STUDY BECAUSE EVEN THOUGH

313
00:12:34,080 --> 00:12:35,240
YOU'RE VACCINATED, IF YOU'RE IN

314
00:12:35,240 --> 00:12:39,160
A COMMUNITY WITH A LOW

315
00:12:39,160 --> 00:12:40,120
VACCINATION RATE, YOU ARE MUCH

316
00:12:40,120 --> 00:12:42,000
MORE LIKELY TO GET A

317
00:12:42,000 --> 00:12:42,680
BREAKTHROUGH INFECTION THAN IF

318
00:12:42,680 --> 00:12:45,920
YOU WERE IN A COMMUNITY WITH

319
00:12:45,920 --> 00:12:49,320
HIGHER VACCINATION RATE.

320
00:12:49,320 --> 00:12:50,840
NEXT SLIDE.

321
00:12:50,840 --> 00:12:54,640
THIS JUST IS INTERESTING.

322
00:12:54,640 --> 00:12:57,040
IT'S REALLY THE CUMULATIVE

323
00:12:57,040 --> 00:13:00,240
INCIDENCE, AGAIN, YOU KNOW,

324
00:13:00,240 --> 00:13:01,760
RURAL IS THE PURPLE AND RED,

325
00:13:01,760 --> 00:13:02,640
BLUE IS URBAN.

326
00:13:02,640 --> 00:13:05,040
YOU CAN SEE EARLY ON RIGHT AFTER

327
00:13:05,040 --> 00:13:06,920
VACCINATION THERE'S NOT MUCH OF

328
00:13:06,920 --> 00:13:07,440
A DIFFERENCE.

329
00:13:07,440 --> 00:13:09,640
BUT OF COURSE WE KNOW THAT AS

330
00:13:09,640 --> 00:13:12,400
YOU PROCEED OUT OVER TIME FROM

331
00:13:12,400 --> 00:13:13,840
VACCINATION, OVER, YOU KNOW,

332
00:13:13,840 --> 00:13:17,240
MONTHS, FOUR OR FIVE, SIX

333
00:13:17,240 --> 00:13:18,840
MONTHS, ANTIBODY WANES, THAT'S

334
00:13:18,840 --> 00:13:21,040
WHEN YOU START TO GET REALLY AN

335
00:13:21,040 --> 00:13:24,640
INCREASE IN THE INFECTION,

336
00:13:24,640 --> 00:13:26,440
SUGGESTING THAT, YOU KNOW, EVEN

337
00:13:26,440 --> 00:13:29,440
IF YOU GOT VACCINATED, AS YOUR

338
00:13:29,440 --> 00:13:30,600
ANTIBODY LEVELS WANE, YOU'RE IN

339
00:13:30,600 --> 00:13:31,600
COMMUNITIES THAT PEOPLE AREN'T

340
00:13:31,600 --> 00:13:35,000
VACCINATED WITH A LOT OF

341
00:13:35,000 --> 00:13:36,200
TRANSMISSION, YOUR CHANCES OF

342
00:13:36,200 --> 00:13:40,760
GETTING INFECTED ARE GREATER AS

343
00:13:40,760 --> 00:13:40,960
WELL.

344
00:13:40,960 --> 00:13:43,000
NEXT SLIDE.

345
00:13:43,000 --> 00:13:47,200
ANOTHER PROJECT THAT THE CTRs

346
00:13:47,200 --> 00:13:51,040
UNDERTOOK WITH THE N3C PLATFORM

347
00:13:51,040 --> 00:13:56,680
WAS TO DEVELOP AN ORDINAL SCALE

348
00:13:56,680 --> 00:13:58,720
FOR COVID DISEASE SEVERITY.

349
00:13:58,720 --> 00:14:02,840
THE W.H.O. DEVELOPED AN ORDINAL

350
00:14:02,840 --> 00:14:04,240
SCALE TO USE WITH CLINICAL

351
00:14:04,240 --> 00:14:04,880
TRIALS, MOST CLINICAL TRIALS

352
00:14:04,880 --> 00:14:06,840
WITH COVID USED THAT SCALE.

353
00:14:06,840 --> 00:14:09,720
THERE'S LESS GRANULARITY OF DATA

354
00:14:09,720 --> 00:14:11,880
WITH EHRs, AND SO THE W.H.O.

355
00:14:11,880 --> 00:14:16,120
SCALE DIDN'T WORK VERY WELL.

356
00:14:16,120 --> 00:14:16,840
USING ALMOST ACROSS 3 MILLION

357
00:14:16,840 --> 00:14:20,600
PATIENTS, IF YOU GO TO THE NEXT

358
00:14:20,600 --> 00:14:22,160
SLIDE, YOU'LL SEE THE ORDINAL

359
00:14:22,160 --> 00:14:27,920
SCALE FOR EHR USE IS SHOWN ON

360
00:14:27,920 --> 00:14:30,280
THE LEFT, AND REALLY STRATIFIED

361
00:14:30,280 --> 00:14:32,040
PATIENTS BY OUTPATIENT,

362
00:14:32,040 --> 00:14:33,240
HOSPITALIZED, ANY OXYGEN.

363
00:14:33,240 --> 00:14:36,440
WE COULDN'T -- THE W.H.O. REALLY

364
00:14:36,440 --> 00:14:39,400
LOOKED AT, YOU KNOW, OXYGEN BY

365
00:14:39,400 --> 00:14:41,480
MASK OR HIGH SWELL OXYGEN.

366
00:14:41,480 --> 00:14:44,720
IT WAS VERY DIFFICULT IN THE EHR

367
00:14:44,720 --> 00:14:47,680
TO REALLY SORT OF PARSE THAT

368
00:14:47,680 --> 00:14:48,240
OUT.

369
00:14:48,240 --> 00:14:50,520
ECMO WITH A LEVEL OF 9 AND DEATH

370
00:14:50,520 --> 00:14:52,640
WAS 11.

371
00:14:52,640 --> 00:14:53,920
NEXT SLIDE.

372
00:14:53,920 --> 00:14:58,280
AS YOU SEE OVER 28 DAYS AFTER

373
00:14:58,280 --> 00:14:59,400
DIAGNOSIS OF SARS-COV-2

374
00:14:59,400 --> 00:15:01,120
INFECTION, THAT MOST OF THE

375
00:15:01,120 --> 00:15:02,120
PEOPLE DO WELL.

376
00:15:02,120 --> 00:15:05,000
YOU MIGHT SAY, WELL IF THESE ARE

377
00:15:05,000 --> 00:15:06,480
HOSPITALIZED PATIENTS, HOW COME

378
00:15:06,480 --> 00:15:09,920
ON DAY 1 YOU HAVE SOME OF THEM

379
00:15:09,920 --> 00:15:13,800
IN THE PEACH COLOR WHICH IS

380
00:15:13,800 --> 00:15:16,600
OUTPATIENT BUT SOME DID NOT GET

381
00:15:16,600 --> 00:15:19,560
ADMITTED UNTIL LATER, SOME WERE

382
00:15:19,560 --> 00:15:20,280
ADMITTED EARLIER, GOT DISCHARGED

383
00:15:20,280 --> 00:15:21,440
VERY QUICKLY.

384
00:15:21,440 --> 00:15:23,640
THIS IS A COMPOSITE ACROSS THOSE

385
00:15:23,640 --> 00:15:24,120
PATIENTS.

386
00:15:24,120 --> 00:15:26,200
IF YOU LOOK AT THE PANEL ON THE

387
00:15:26,200 --> 00:15:28,840
LEFT YOU SEE THE MORTALITY AS

388
00:15:28,840 --> 00:15:33,480
YOU MIGHT EXPECT GOES UP AS THE

389
00:15:33,480 --> 00:15:34,920
SEVERITY INDEX INCREASES, THE

390
00:15:34,920 --> 00:15:37,040
EXCEPTION IS THAT THE ECMO

391
00:15:37,040 --> 00:15:40,680
PATIENTS STILL HAD A HIGH

392
00:15:40,680 --> 00:15:43,000
MORTALITY OF 25%, BUT THE

393
00:15:43,000 --> 00:15:44,520
MECHANICALLY VENTILATED PATIENTS

394
00:15:44,520 --> 00:15:46,800
WERE ALMOST AT 30%.

395
00:15:46,800 --> 00:15:51,920
I THINK THAT ACTUALLY THIS MAKES

396
00:15:51,920 --> 00:15:52,120
SENSE.

397
00:15:52,120 --> 00:15:53,320
INDIVIDUALS WHO WERE FELT TO

398
00:15:53,320 --> 00:15:56,240
HAVE A VERY POOR PROGNOSIS WERE

399
00:15:56,240 --> 00:15:59,640
NOT PUT ON ECMO, AND DURING THE

400
00:15:59,640 --> 00:16:00,640
DELTA WAVE THERE WAS REALLY

401
00:16:00,640 --> 00:16:03,360
RATIONING OF THE ECMO.

402
00:16:03,360 --> 00:16:05,800
IN FACT, SOME PLACES, YOU KNOW,

403
00:16:05,800 --> 00:16:08,200
PATIENTS OVER 40 OR HIGH BMI

404
00:16:08,200 --> 00:16:11,760
WERE NOT PUT ON ECMO.

405
00:16:11,760 --> 00:16:14,520
IT'S NOT SURPRISING THOSE FOLKS

406
00:16:14,520 --> 00:16:15,840
WITH POOREST PROGNOSIS COLLECTED

407
00:16:15,840 --> 00:16:17,120
IN THE MECHANICAL VENTILATION

408
00:16:17,120 --> 00:16:20,520
GROUP WITH A SLIGHTLY HIGHER

409
00:16:20,520 --> 00:16:22,840
MORTALITY. 

410
00:16:22,840 --> 00:16:25,320
NEXT SLIDE.

411
00:16:25,320 --> 00:16:27,560
NOW, THAT ORDINAL SCALE THEN

412
00:16:27,560 --> 00:16:32,040
PERMITTED US TO REALLY LOOK AT

413
00:16:32,040 --> 00:16:34,040
WHAT'S THE BEST THERAPY FOR

414
00:16:34,040 --> 00:16:37,520
TREATMENT OF COVID.

415
00:16:37,520 --> 00:16:40,160
YOU KNOW, THAT WAS A QUESTION

416
00:16:40,160 --> 00:16:44,280
PARTICULARLY EARLY ON.

417
00:16:44,280 --> 00:16:47,440
THIS STUDY REALLY USED MACHINE

418
00:16:47,440 --> 00:16:50,760
LEARNING, NEURAL NETWORK,

419
00:16:50,760 --> 00:16:52,160
MACHINE LEARNING CLASSIFIERS.

420
00:16:52,160 --> 00:16:53,680
AND IT'S INTERESTING BECAUSE

421
00:16:53,680 --> 00:16:56,000
MACHINE LEARNING MODELS ARE

422
00:16:56,000 --> 00:16:58,920
USUALLY CONSIDERED BLACK BOX

423
00:16:58,920 --> 00:16:59,240
PROCEDURES.

424
00:16:59,240 --> 00:17:00,800
YOU HAVE LIMITED INSIGHT, OTHER

425
00:17:00,800 --> 00:17:05,840
THAN SORT OF OUTCOME PREDICTION.

426
00:17:05,840 --> 00:17:11,680
BUT MORE RECENTLY, USE OF

427
00:17:11,680 --> 00:17:13,840
SHEPLEY ADDITIVE EXPLANATION

428
00:17:13,840 --> 00:17:16,040
VALUES, SHAP VALUES AS WE CALL

429
00:17:16,040 --> 00:17:18,880
THEM, CAN PROVIDE INSIGHT INTO

430
00:17:18,880 --> 00:17:20,520
INTERPRETATIONS OF COMPLEX

431
00:17:20,520 --> 00:17:26,400
MACHINE LEARNING MODELS, WITH

432
00:17:26,400 --> 00:17:29,040
HIGH ACCURACY AND ROBUSTNESS.

433
00:17:29,040 --> 00:17:30,320
SHAP VALUES WERE USED.

434
00:17:30,320 --> 00:17:34,280
WHAT THIS STUDY LOOKED AT IS

435
00:17:34,280 --> 00:17:38,440
WHAT IS PROTECTIVE OF HOSPITAL

436
00:17:38,440 --> 00:17:38,800
DISCHARGE?

437
00:17:38,800 --> 00:17:42,920
SO WOULD THERAPY HAVE SORT OF

438
00:17:42,920 --> 00:17:45,080
PREDICT OUTCOME OF DISCHARGE,

439
00:17:45,080 --> 00:17:47,840
AND WHAT FACTORS PREDICT DEATH?

440
00:17:47,840 --> 00:17:51,120
I'LL START WITH THE BAR GRAPH ON

441
00:17:51,120 --> 00:17:53,080
THE RIGHT, THOSE WERE NEGATIVE

442
00:17:53,080 --> 00:17:53,320
IMPACTS.

443
00:17:53,320 --> 00:17:56,440
IF YOU LOOK DOWN THE LIST, MANY

444
00:17:56,440 --> 00:18:00,000
OF THEM ARE PATIENT FACTORS SUCH

445
00:18:00,000 --> 00:18:01,840
AS AGE AND COMORBIDITIES.

446
00:18:01,840 --> 00:18:06,000
THE ONE TREATMENT THAT APPEARS

447
00:18:06,000 --> 00:18:07,160
THERE IS ANTI-COAGULATION

448
00:18:07,160 --> 00:18:07,520
THERAPY.

449
00:18:07,520 --> 00:18:09,880
AND I THINK THAT'S AN

450
00:18:09,880 --> 00:18:12,120
INTERESTING FINDING, AND THE

451
00:18:12,120 --> 00:18:14,720
QUESTION IS WHY ONE MIGHT

452
00:18:14,720 --> 00:18:17,600
HYPOTHESIZE THAT INDIVIDUALS WHO

453
00:18:17,600 --> 00:18:21,640
ONLY GOT ANTI-COAGULATION

454
00:18:21,640 --> 00:18:23,040
PERHAPS HAD A SEVERE

455
00:18:23,040 --> 00:18:24,040
THROMBOEMBOLIC COMPLICATION THAT

456
00:18:24,040 --> 00:18:25,440
REQUIRED THAT TREATMENT.

457
00:18:25,440 --> 00:18:26,760
WE KNOW COVID IS ASSOCIATED WITH

458
00:18:26,760 --> 00:18:27,080
THAT.

459
00:18:27,080 --> 00:18:28,840
THE OTHER MIGHT BE THAT

460
00:18:28,840 --> 00:18:32,120
INDIVIDUALS WHO HAD

461
00:18:32,120 --> 00:18:34,520
COMORBIDITIES SUCH AS DIABETES

462
00:18:34,520 --> 00:18:37,240
PERHAPS PHYSICIANS WERE NOT

463
00:18:37,240 --> 00:18:39,200
GIVING THOSE PATIENTS STEROIDS.

464
00:18:39,200 --> 00:18:41,920
IF WE NOW LOOK AT THE POSITIVE

465
00:18:41,920 --> 00:18:44,240
IMPACTS, WHAT WAS PREDICTIVE OF

466
00:18:44,240 --> 00:18:45,160
HOSPITAL DISCHARGE, YOU CAN SEE

467
00:18:45,160 --> 00:18:46,840
THERE ARE A LOT OF TREATMENTS

468
00:18:46,840 --> 00:18:49,480
THERE, BUT MOST OF THEM ARE

469
00:18:49,480 --> 00:18:49,840
COMBINATIONS.

470
00:18:49,840 --> 00:18:54,040
THE ONLY ONE THAT APPEARS ALONE

471
00:18:54,040 --> 00:18:55,400
ARE STEROIDS.

472
00:18:55,400 --> 00:19:00,280
YOU HAVE ANTICOAGULANTS WITH

473
00:19:00,280 --> 00:19:02,400
STEROIDS.

474
00:19:02,400 --> 00:19:03,440
ANTICOAGULANTS WITH TARGETED

475
00:19:03,440 --> 00:19:04,440
ANTI-VIRALS.

476
00:19:04,440 --> 00:19:04,960
SUGGESTING THAT REALLY

477
00:19:04,960 --> 00:19:06,800
COMBINATION THERAPY AND COVID

478
00:19:06,800 --> 00:19:08,200
MIGHT BE VERY IMPORTANT.

479
00:19:08,200 --> 00:19:09,720
AS YOU KNOW, OUR CLINICAL TRIALS

480
00:19:09,720 --> 00:19:13,760
EARLY ON WERE JUST LOOKING AT

481
00:19:13,760 --> 00:19:16,600
ONE FACTOR.

482
00:19:16,600 --> 00:19:20,040
AS THE PANDEMIC PROGRESSED,

483
00:19:20,040 --> 00:19:21,280
STEROIDS, ANTI-COAGULATION, WERE

484
00:19:21,280 --> 00:19:23,600
NOT EXCLUSIONARY FACTORS.

485
00:19:23,600 --> 00:19:28,760
I THINK THAT THIS IS REALLY

486
00:19:28,760 --> 00:19:29,320
INTERESTING AND MAY INFORM

487
00:19:29,320 --> 00:19:31,040
CLINICAL TRIALS AND HOW WE LOOK

488
00:19:31,040 --> 00:19:31,440
AT THEM.

489
00:19:31,440 --> 00:19:33,640
THE OTHER THING I WOULD SAY

490
00:19:33,640 --> 00:19:35,400
ABOUT THE VERY LARGE DATABASE,

491
00:19:35,400 --> 00:19:39,640
NO CLINICAL TRIAL, YOU KNOW, HAS

492
00:19:39,640 --> 00:19:40,720
INDIVIDUALS IN EVERY

493
00:19:40,720 --> 00:19:42,040
SUBPOPULATION, BUT WHEN YOU HAVE

494
00:19:42,040 --> 00:19:43,320
MILLIONS AND MILLIONS OF FOLKS

495
00:19:43,320 --> 00:19:46,480
YOU CAN BEGIN TO LOOK AT

496
00:19:46,480 --> 00:19:48,440
OUTCOMES IN SPECIFIC

497
00:19:48,440 --> 00:19:50,640
SUBPOPULATIONS OF INDIVIDUALS

498
00:19:50,640 --> 00:19:53,000
WITH PARTICULAR COMORBIDITIES.

499
00:19:53,000 --> 00:19:55,680
NEXT SLIDE.

500
00:19:55,680 --> 00:20:01,280
A SECOND MACHINE LEARNING

501
00:20:01,280 --> 00:20:03,560
PROJECT IN THE CTR N3C GROUP,

502
00:20:03,560 --> 00:20:07,760
WHAT WAS THE  POSSIBILITY OF

503
00:20:07,760 --> 00:20:10,240
DISCHARGE WITH TREATMENTS AND

504
00:20:10,240 --> 00:20:11,880
TREATMENT COMBINATIONS, AGAIN

505
00:20:11,880 --> 00:20:14,960
MACHINE LEARNING TECHNIQUES WERE

506
00:20:14,960 --> 00:20:15,160
USED.

507
00:20:15,160 --> 00:20:16,800
AND THE STUDY POPULATION AS YOU

508
00:20:16,800 --> 00:20:22,240
SEE THERE WAS NORTH OF 248,000

509
00:20:22,240 --> 00:20:22,800
FOLKS.

510
00:20:22,800 --> 00:20:28,040
AND THE TOP ONE RESULTS, SOME

511
00:20:28,040 --> 00:20:31,040
ARE NOT SURPRISING, AS THE

512
00:20:31,040 --> 00:20:32,320
CHARLESTON COMORBIDITY INDEX

513
00:20:32,320 --> 00:20:34,760
INCREASED, LOOKING AT COMPOSITE

514
00:20:34,760 --> 00:20:51,400
SCORE OF VARIOUS COMORBIDITIES.

515
00:20:51,400 --> 00:20:52,440
INTERESTINGLY, MECHANICALLY

516
00:20:52,440 --> 00:20:54,440
VENTILATED PATIENTS HAD OUTCOMES

517
00:20:54,440 --> 00:20:56,720
DURING THE OMICRON WAVE THAT

518
00:20:56,720 --> 00:20:58,680
WERE BETTER, REGARDLESS OF THE

519
00:20:58,680 --> 00:21:01,640
THERAPEUTIC REGIMEN THAN WITH

520
00:21:01,640 --> 00:21:04,400
OTHER WAVES.

521
00:21:04,400 --> 00:21:05,480
THIS PERMITTED US, AND I'LL SHOW

522
00:21:05,480 --> 00:21:10,440
A SLIDE IN A MINUTE, LOOKING AT

523
00:21:10,440 --> 00:21:12,600
PRE-DELTA WAVE, DELTA VARIANT

524
00:21:12,600 --> 00:21:15,120
WAVE, AND THEN OMICRON.

525
00:21:15,120 --> 00:21:23,840
OVERALL THE BEST THERAPY WAS

526
00:21:23,840 --> 00:21:25,960
SPIKE PROTEIN MONOCLONAL

527
00:21:25,960 --> 00:21:28,360
THERAPIES WITH ANTICOAGULANTS.

528
00:21:28,360 --> 00:21:31,240
THESE ARE REALLY PANELS

529
00:21:31,240 --> 00:21:33,240
REGENERATED THEM FOR EVERY

530
00:21:33,240 --> 00:21:35,840
ORDINAL SEVERITY LEVEL ACROSS

531
00:21:35,840 --> 00:21:37,720
ALL THE WAVES.

532
00:21:37,720 --> 00:21:43,520
I JUST SELECTED FOR BREVITY

533
00:21:43,520 --> 00:21:45,680
THOSE PANELS OF OS 3,

534
00:21:45,680 --> 00:21:46,600
HOSPITALIZED PATIENTS WITHOUT

535
00:21:46,600 --> 00:21:48,240
OXYGEN REQUIREMENT.

536
00:21:48,240 --> 00:21:50,800
YOU CAN SEE YOU HAVE THE KEY OF

537
00:21:50,800 --> 00:21:53,040
THE VARIOUS TREATMENTS ON THE

538
00:21:53,040 --> 00:21:56,960
SIDE, GOING ACROSS THE X-AXIS

539
00:21:56,960 --> 00:21:58,720
ARE INCREASING CHARLESTON

540
00:21:58,720 --> 00:22:00,640
COMORBIDITY INDEX, SO CLEARLY

541
00:22:00,640 --> 00:22:03,200
CHANCES OF DISCHARGE DECREASED

542
00:22:03,200 --> 00:22:04,720
AS NUMBER OF COMORBIDITIES

543
00:22:04,720 --> 00:22:05,600
INCREASED.

544
00:22:05,600 --> 00:22:09,040
YOU CAN SEE THAT FOR MOST OF

545
00:22:09,040 --> 00:22:10,960
THESE MONOCLONALS ACTUALLY HAD

546
00:22:10,960 --> 00:22:12,520
THE HIGHEST PROBABILITY OF

547
00:22:12,520 --> 00:22:17,440
DISCHARGE, THOUGH IF YOU LOOK

548
00:22:17,440 --> 00:22:26,440
PRE-DELTA AND  DELTA PINK IS

549
00:22:26,440 --> 00:22:30,560
TARGETED ANTI-VIRALS, MOST WAS

550
00:22:30,560 --> 00:22:31,320
WITH REMDESAVIR, PRE-PAXLOVID,

551
00:22:31,320 --> 00:22:34,480
WE WANT TO EXTEND TO LOOK AT

552
00:22:34,480 --> 00:22:36,240
TARGETED ANTI-VIRALS WHICH MOST

553
00:22:36,240 --> 00:22:38,840
WOULD FEEL ARE BETTER.

554
00:22:38,840 --> 00:22:39,480
NEXT SLIDE.

555
00:22:39,480 --> 00:22:45,240
I WANT TO JUST BEFORE I LEAVE

556
00:22:45,240 --> 00:22:47,560
THE NATIONAL INITIATIVES REALLY

557
00:22:47,560 --> 00:22:49,520
JUST SAY HOW IMPORTANT THE N3C

558
00:22:49,520 --> 00:22:55,120
INITIATIVE WAS BECAUSE WHAT IT

559
00:22:55,120 --> 00:22:58,400
DID, IT REALLY FACILITATED

560
00:22:58,400 --> 00:22:59,600
PRODUCTIVE COLLABORATION ACROSS

561
00:22:59,600 --> 00:23:00,120
CTRs.

562
00:23:00,120 --> 00:23:01,480
WE REALLY LIKED WORKING WITH

563
00:23:01,480 --> 00:23:05,840
EACH OTHER, IT WAS ONE OF THE

564
00:23:05,840 --> 00:23:06,800
MOST INTELLECTUALLY STIMULATING

565
00:23:06,800 --> 00:23:09,160
THINGS PERSONALLY THAT I WAS

566
00:23:09,160 --> 00:23:11,480
DOING. 

567
00:23:11,480 --> 00:23:14,920
AND SO WE ACTUALLY KENTUCKY HAD

568
00:23:14,920 --> 00:23:22,440
FOLKS CTSA WORKING WITH US ON 

569
00:23:22,440 --> 00:23:22,680
N3C.

570
00:23:22,680 --> 00:23:24,400
WHEN THE OPPORTUNITY CAME FOR

571
00:23:24,400 --> 00:23:26,840
THE RECOVER STUDY, THE

572
00:23:26,840 --> 00:23:28,440
OBSERVATIONAL COHORT OF LONG

573
00:23:28,440 --> 00:23:30,600
COVID, WE APPLIED SAYING IT WAS

574
00:23:30,600 --> 00:23:34,520
IMPORTANT FOR CENTERS THAT WERE

575
00:23:34,520 --> 00:23:36,200
SERVING UNDERSERVED POPULATIONS

576
00:23:36,200 --> 00:23:38,120
TO REALLY MAKE AVAILABLE STUDIES

577
00:23:38,120 --> 00:23:39,640
IN THOSE POPULATIONS AS WELL.

578
00:23:39,640 --> 00:23:44,480
MANY OF WHICH HAD BEEN HARD HIT

579
00:23:44,480 --> 00:23:51,480
BY COVID. 

580
00:23:51,480 --> 00:23:55,320
WE WERE FUNDED.

581
00:23:55,320 --> 00:24:02,320
TWO CTSA, KANSAS AND KENTUCKY,

582
00:24:02,320 --> 00:24:05,480
PARTS PATED IN THE ISCORE

583
00:24:05,480 --> 00:24:06,040
RESEARCH.

584
00:24:06,040 --> 00:24:08,040
LIGHTER GREEN AREAS, TENNESSEE,

585
00:24:08,040 --> 00:24:10,160
OHIO, PENNSYLVANIA, ARE REALLY

586
00:24:10,160 --> 00:24:11,600
CATCHMENT AREAS, JUST SHOWING

587
00:24:11,600 --> 00:24:13,360
THAT REALLY A LARGE PORTION OF

588
00:24:13,360 --> 00:24:15,680
THE UNITED STATES IS REALLY

589
00:24:15,680 --> 00:24:18,880
COVERED BY THIS NETWORK.

590
00:24:18,880 --> 00:24:24,160
WE'VE BEEN A TOP ENROLLER,

591
00:24:24,160 --> 00:24:25,360
OVERENROLLED ADDITIONAL TARGETS,

592
00:24:25,360 --> 00:24:29,840
ADDITIONAL FUNDED STUDIES ARE

593
00:24:29,840 --> 00:24:33,000
NOW BEING IMPLEMENTED.

594
00:24:33,000 --> 00:24:38,880
IMMULINA IS AN IMMUNE MODULATOR,

595
00:24:38,880 --> 00:24:39,840
UNIVERSITY OF MISSISSIPPI

596
00:24:39,840 --> 00:24:41,200
PROCURED FUNDING FOR A PILOT

597
00:24:41,200 --> 00:24:43,680
STUDY ACROSS 12 OF OUR SITES.

598
00:24:43,680 --> 00:24:46,640
AND DR. ROSEN AT MAINE MEDICAL

599
00:24:46,640 --> 00:24:50,400
CENTER, CO-P.I. OF THE ISCORE

600
00:24:50,400 --> 00:24:51,600
NETWORK IS BEING FUNDED.

601
00:24:51,600 --> 00:24:54,280
WE DON'T HAVE A GRANT NUMBER YET

602
00:24:54,280 --> 00:24:58,640
BUT TO LOOK AT THE PATHOBIOLOGY,

603
00:24:58,640 --> 00:25:01,280
ASSESS VIRAL PERSISTENT IN FAT

604
00:25:01,280 --> 00:25:02,440
TISSUE, THERE'S SOME PRELIMINARY

605
00:25:02,440 --> 00:25:04,240
DATA TO SUGGEST, NUMBER ONE,

606
00:25:04,240 --> 00:25:07,560
THAT OCCURS AND, NUMBER TWO, IT

607
00:25:07,560 --> 00:25:11,040
ALTERS THE BIOENERGETICS OF THE

608
00:25:11,040 --> 00:25:12,440
MITOCHONDRIA.

609
00:25:12,440 --> 00:25:12,760
NEXT SLIDE.

610
00:25:12,760 --> 00:25:16,040
IF WE NOW FOCUS ON WEST

611
00:25:16,040 --> 00:25:17,720
VIRGINIA, NEXT SLIDE, I JUST

612
00:25:17,720 --> 00:25:20,000
WANTED TO POINT OUT THAT THE

613
00:25:20,000 --> 00:25:21,640
PARTNERS ACROSS WEST VIRGINIA

614
00:25:21,640 --> 00:25:24,680
SHOWN IN THE LEFT PANEL HAVE

615
00:25:24,680 --> 00:25:26,120
BEEN CRITICALLY IMPORTANT TO

616
00:25:26,120 --> 00:25:29,320
BEING ABLE TO ADDRESS COVID,

617
00:25:29,320 --> 00:25:30,240
PARTICULARLY THE DEPARTMENT OF

618
00:25:30,240 --> 00:25:31,840
HEALTH AND HUMAN RESOURCES WHICH

619
00:25:31,840 --> 00:25:33,600
IS THE STATE HEALTH DEPARTMENT.

620
00:25:33,600 --> 00:25:36,440
THE PANEL ON THE RIGHT IS REALLY

621
00:25:36,440 --> 00:25:38,840
MUCH OF OUR LABORATORY, SHOWS

622
00:25:38,840 --> 00:25:40,600
OUR PRACTICE-BASED RESEARCH

623
00:25:40,600 --> 00:25:46,720
NETWORK WHICH IS NOW UP TO 129

624
00:25:46,720 --> 00:25:46,920
SITES.

625
00:25:46,920 --> 00:25:47,960
NEXT SLIDE.

626
00:25:47,960 --> 00:25:52,760
THE RAPID ACCELERATION OF

627
00:25:52,760 --> 00:25:55,360
DIAGNOSIS FOR UNDERSERVED

628
00:25:55,360 --> 00:25:55,880
POPULATIONS, RADX-UP, WAS

629
00:25:55,880 --> 00:25:58,080
FUNDED, THE GRANT NUMBER IS

630
00:25:58,080 --> 00:25:59,960
ABOVE, TO REALLY LOOK AT

631
00:25:59,960 --> 00:26:02,480
STRATEGIES TO INCREASE TESTING

632
00:26:02,480 --> 00:26:03,920
AMONG UNDERSERVED AND VULNERABLE

633
00:26:03,920 --> 00:26:05,080
POPULATIONS IN WEST VIRGINIA.

634
00:26:05,080 --> 00:26:07,640
IT HAD A COUPLE OF PARTS.

635
00:26:07,640 --> 00:26:10,280
THE MOST IMPORTANT WAS THAT WE

636
00:26:10,280 --> 00:26:11,400
EMPLOYED MOBILE VANS, ONE OF

637
00:26:11,400 --> 00:26:15,160
WHICH IS SHOWN AT THE RIGHT, TO

638
00:26:15,160 --> 00:26:16,160
DO TESTING.

639
00:26:16,160 --> 00:26:19,520
THESE MOBILE VANS WE WORKED WITH

640
00:26:19,520 --> 00:26:21,400
THE COUNTY HEALTH DEPARTMENTS,

641
00:26:21,400 --> 00:26:23,240
AND WE WOULD FIND AREAS THAT

642
00:26:23,240 --> 00:26:27,440
WERE VERY ACCESSIBLE TO FOLKS IN

643
00:26:27,440 --> 00:26:28,600
THE COUNTY, THESE WERE REALLY IN

644
00:26:28,600 --> 00:26:29,160
RURAL AREAS.

645
00:26:29,160 --> 00:26:34,240
ONE OF  OUR SITES WAS A FUNERAL

646
00:26:34,240 --> 00:26:35,880
HOME, I DIDN'T THINK THAT WAS

647
00:26:35,880 --> 00:26:37,280
THE RIGHT MESSAGE, BUT IT WAS

648
00:26:37,280 --> 00:26:38,240
VERY EFFECTIVE.

649
00:26:38,240 --> 00:26:40,360
WE ALSO WORKED WITH OUR PBRN

650
00:26:40,360 --> 00:26:40,840
CLINICIAN.

651
00:26:40,840 --> 00:26:42,840
BACK AT THE BEGINNING OF THE

652
00:26:42,840 --> 00:26:44,320
PANDEMIC, YOU COULDN'T GET

653
00:26:44,320 --> 00:26:44,760
SWABBED.

654
00:26:44,760 --> 00:26:47,600
YOU COULDN'T GET SPECIAL

655
00:26:47,600 --> 00:26:48,680
PROTECTIVE EQUIPMENT.

656
00:26:48,680 --> 00:26:51,600
THE THIRD PARTY PAYERS WERE ONLY

657
00:26:51,600 --> 00:26:52,840
PAYING FOR PCR TESTS FOR

658
00:26:52,840 --> 00:26:53,920
INDIVIDUALS WITH SYMPTOMS SO IF

659
00:26:53,920 --> 00:26:55,920
YOU WERE EXPOSED OR YOU NEEDED A

660
00:26:55,920 --> 00:26:59,000
TEST FOR WORK, YOU WERE OUT OF

661
00:26:59,000 --> 00:26:59,200
LUCK.

662
00:26:59,200 --> 00:27:02,160
AND SO WE REALLY WORKED WITH OUR

663
00:27:02,160 --> 00:27:05,880
PBRN SITES AS WELL TO PROVIDE

664
00:27:05,880 --> 00:27:06,760
TESTING, PROVIDE THEM WITH

665
00:27:06,760 --> 00:27:08,480
TENTS, ONE OF THE MOST IMPORTANT

666
00:27:08,480 --> 00:27:10,640
POINTS THERE WAS WE ACTUALLY HAD

667
00:27:10,640 --> 00:27:13,520
FLEX STAFF THAT WOULD GO AND

668
00:27:13,520 --> 00:27:16,360
TEST AT THOSE SITES.

669
00:27:16,360 --> 00:27:18,080
AND IMPORTANTLY, WE HAD A

670
00:27:18,080 --> 00:27:18,760
COMMUNITIES OF COLOR INITIATIVE,

671
00:27:18,760 --> 00:27:22,960
IT WAS A VAN THAT WORKED WITH

672
00:27:22,960 --> 00:27:25,440
COMMUNITIES OF COLOR, WITH

673
00:27:25,440 --> 00:27:27,160
CHURCHES AND SO FORTH,

674
00:27:27,160 --> 00:27:28,280
CULTURALLY COMPETENT STAFF TO

675
00:27:28,280 --> 00:27:30,040
TEST IN THOSE COMMUNITIES.

676
00:27:30,040 --> 00:27:31,920
IT WAS A POPULATION-BASED STUDY.

677
00:27:31,920 --> 00:27:33,920
WE WANTED TO INTENSIFY TESTING

678
00:27:33,920 --> 00:27:36,480
IN THOSE COUNTIES, WITH A

679
00:27:36,480 --> 00:27:39,800
PREDICTED NEAR TERM INCREASE IN

680
00:27:39,800 --> 00:27:41,760
SARS-COV-2 INCIDENCE, AS

681
00:27:41,760 --> 00:27:43,840
PREDICTED USING THE

682
00:27:43,840 --> 00:27:46,120
INSTANTANEOUS REPRODUCTIVE

683
00:27:46,120 --> 00:27:48,760
NUMBER, AND WE ACTUALLY -- THE

684
00:27:48,760 --> 00:27:53,320
TEAM HAS REALLY REFINED THAT

685
00:27:53,320 --> 00:27:55,640
MODEL, AND HAS BROUGHT IN

686
00:27:55,640 --> 00:27:57,200
VACCINATION RATES AND VARIANTS,

687
00:27:57,200 --> 00:27:58,160
ONE PAPER PUBLISHED, REVISED

688
00:27:58,160 --> 00:28:04,320
AGAIN, HAVE ANOTHER ONE UNDER

689
00:28:04,320 --> 00:28:04,560
REVIEW.

690
00:28:04,560 --> 00:28:05,840
NEARLY 143,000 PCR SARS-COV-2

691
00:28:05,840 --> 00:28:07,160
TESTS WERE CONDUCTED, YOU CAN

692
00:28:07,160 --> 00:28:09,480
SEE THE POSITIVITY RATE THERE, 1

693
00:28:09,480 --> 00:28:14,840
IN 5 OF THE CLINIC SAMPLES, AND

694
00:28:14,840 --> 00:28:17,440
MOBILE VAN SAMPLES, NOT QUITE

695
00:28:17,440 --> 00:28:19,240
20% WAS POSITIVE SO THIS WAS --

696
00:28:19,240 --> 00:28:20,920
I WAS SURPRISED AT THE

697
00:28:20,920 --> 00:28:23,240
POSITIVITY RATE AND THE MAP ON

698
00:28:23,240 --> 00:28:26,960
THE RIGHT, WE TESTED IN EVERY

699
00:28:26,960 --> 00:28:28,800
ONE OF WEST VIRGINIA'S 55

700
00:28:28,800 --> 00:28:30,200
COUNTIES EXCEPT TWO.

701
00:28:30,200 --> 00:28:33,520
THE TWO ARE SHOWN IN WHITE.

702
00:28:33,520 --> 00:28:36,040
THIS WAS REALLY ALL OVER THE

703
00:28:36,040 --> 00:28:36,600
STATE.

704
00:28:36,600 --> 00:28:40,240
WE'VE HAD A PAPER PUBLISHED IN

705
00:28:40,240 --> 00:28:42,440
AGPH, AMERICAN JOURNAL OF PUBLIC

706
00:28:42,440 --> 00:28:51,440
HEALTH, SEVERAL OTHERS BEING

707
00:28:51,440 --> 00:28:51,920
SUBMITTED.

708
00:28:51,920 --> 00:28:56,640
TESTING DATA, THE STATE HEALTH

709
00:28:56,640 --> 00:28:58,560
DEPARTMENT WAS A GREAT

710
00:28:58,560 --> 00:28:59,120
COLLABORATOR.

711
00:28:59,120 --> 00:29:01,760
AND AGREED TO PROVIDE US TESTING

712
00:29:01,760 --> 00:29:04,160
DATA NOT ONLY, YOU KNOW, WE HAD

713
00:29:04,160 --> 00:29:05,720
OUR RADx RESULTS, BUT ALL OF

714
00:29:05,720 --> 00:29:07,440
THE TESTING DATA THAT CAME TO

715
00:29:07,440 --> 00:29:09,680
THE STATE.

716
00:29:09,680 --> 00:29:11,480
AND WE LOOKED AT THE

717
00:29:11,480 --> 00:29:14,400
RELATIONSHIP BETWEEN TEST SITE

718
00:29:14,400 --> 00:29:15,840
AVAILABILITY AND, YOU KNOW,

719
00:29:15,840 --> 00:29:20,240
LOOKED AT THAT IN THE CONTEXT OF

720
00:29:20,240 --> 00:29:21,040
SOCIAL DEPRIVATION, AND SOCIAL

721
00:29:21,040 --> 00:29:22,280
DETERMINANTS OF HEALTH.

722
00:29:22,280 --> 00:29:25,360
WHAT WE FOUND WHICH WAS NO BIG

723
00:29:25,360 --> 00:29:27,800
SURPRISE, RIGHT, THE MORE SITES,

724
00:29:27,800 --> 00:29:31,560
THE MORE TESTING YOU'LL HAVE.

725
00:29:31,560 --> 00:29:34,760
BUT THAT WAS REALLY AMPLIFIED IN

726
00:29:34,760 --> 00:29:36,640
COMMUNITIES THAT HAD GREATER

727
00:29:36,640 --> 00:29:38,080
ECONOMIC DEPRIVATION.

728
00:29:38,080 --> 00:29:44,800
SUCH THAT IN FUTURE PANDEMICS,

729
00:29:44,800 --> 00:29:45,440
IN FUTURE PANDEMICS THOSE AREAS

730
00:29:45,440 --> 00:29:48,080
WOULD BE, YOU KNOW, THE PLACE TO

731
00:29:48,080 --> 00:29:50,400
PUT TESTING SITES BECAUSE THEY

732
00:29:50,400 --> 00:29:52,040
WOULD INCREASE, YOU KNOW, THE

733
00:29:52,040 --> 00:29:53,840
NUMBER OF TESTS, MORE SO THAN IN

734
00:29:53,840 --> 00:29:57,600
AN AREA THAT HAD A HIGHER

735
00:29:57,600 --> 00:29:59,360
SOCIOECONOMIC LEVEL.

736
00:29:59,360 --> 00:30:01,080
NEXT SLIDE.

737
00:30:01,080 --> 00:30:03,240
I THINK JUST BEFORE I SAY, I'LL

738
00:30:03,240 --> 00:30:05,040
JUST COMMENT, I THINK IT'S

739
00:30:05,040 --> 00:30:07,240
IMPORTANT IF YOU HAVE

740
00:30:07,240 --> 00:30:08,640
AVAILABILITY, PEOPLE DO AVAIL

741
00:30:08,640 --> 00:30:10,160
THEMSELVES OF THE TESTS.

742
00:30:10,160 --> 00:30:12,040
I MEAN, MANY WERE IN VERY, VERY

743
00:30:12,040 --> 00:30:12,680
RURAL SITES.

744
00:30:12,680 --> 00:30:14,880
SO JUST TO SAY, OH, PEOPLE DON'T

745
00:30:14,880 --> 00:30:16,200
BELIEVE IN SCIENCE, DON'T BOTHER

746
00:30:16,200 --> 00:30:18,160
TO TEST THERE, IS NOT THE CASE.

747
00:30:18,160 --> 00:30:22,440
THAT'S NOT WHAT WE FOUND.

748
00:30:22,440 --> 00:30:24,960
ANOTHER INITIATIVE FUNDED BY GMS

749
00:30:24,960 --> 00:30:27,120
SUPPLEMENT SHOWN THERE WAS VIRAL

750
00:30:27,120 --> 00:30:28,360
SEQUENCING.

751
00:30:28,360 --> 00:30:29,840
TO DATE WE'VE SEQUENCED MORE

752
00:30:29,840 --> 00:30:32,840
THAN 17,000 SAMPLES.

753
00:30:32,840 --> 00:30:34,560
THE DISTRIBUTION OF VARIANTS ON

754
00:30:34,560 --> 00:30:35,960
THE LEFT SHOWS FROM WHEN WE

755
00:30:35,960 --> 00:30:39,600
STARTED DOING THIS IN JANUARY OF

756
00:30:39,600 --> 00:30:41,040
2021 THROUGH CURRENT, BUT I

757
00:30:41,040 --> 00:30:41,960
THINK MORE INTERESTING IS THE

758
00:30:41,960 --> 00:30:44,480
PANEL ON THE RIGHT WHICH JUST

759
00:30:44,480 --> 00:30:46,920
LOOKS AT 2022, AND THE OMICRON

760
00:30:46,920 --> 00:30:47,360
VARIANTS.

761
00:30:47,360 --> 00:30:51,760
AND YOU CAN SEE BA 1 IN RED WAS

762
00:30:51,760 --> 00:30:55,560
SUPPLANTED BY BA 2 IN BLUE,

763
00:30:55,560 --> 00:30:56,440
INTERESTINGLY MORE RECENTLY MOST

764
00:30:56,440 --> 00:30:58,640
OF THE VARIANTS HAVE BEEN BA.5

765
00:30:58,640 --> 00:31:00,920
BUT YOU SEE THE ORANGE WHICH IS

766
00:31:00,920 --> 00:31:02,560
BQ, JUST STARTING IN.

767
00:31:02,560 --> 00:31:04,040
IT WILL BE INTERESTING TO SEE

768
00:31:04,040 --> 00:31:09,040
WHAT HAPPENS THERE.

769
00:31:09,040 --> 00:31:10,640
I SHOULD SAY AGAIN THIS IS NOT

770
00:31:10,640 --> 00:31:16,080
ONLY OUR 17,000 SAMPLES FROM

771
00:31:16,080 --> 00:31:17,960
SEQUENCING INITIATIVE, BUT THE

772
00:31:17,960 --> 00:31:22,120
STATE, CDC WAS SEQUENCING,

773
00:31:22,120 --> 00:31:23,000
LABCORP WAS SEQUENCING.

774
00:31:23,000 --> 00:31:25,360
THE STATE, WE WORKED WITH THEM.

775
00:31:25,360 --> 00:31:26,600
THIS ANALYSIS INCLUDES ALL THE

776
00:31:26,600 --> 00:31:31,680
SEQUENCING ACROSS THE STATE OF

777
00:31:31,680 --> 00:31:34,800
WEST VIRGINIA AND ENABLED US TO

778
00:31:34,800 --> 00:31:37,280
MATCH VARIANT SEQUENCES WITH

779
00:31:37,280 --> 00:31:40,760
ELECTRONIC MEDICAL RECORDS IN

780
00:31:40,760 --> 00:31:43,560
THE WVU MEDICAL SYSTEM THAT WE

781
00:31:43,560 --> 00:31:46,800
SUBMITTED TO N3C.

782
00:31:46,800 --> 00:31:47,080
NEXT SLIDE.

783
00:31:47,080 --> 00:31:49,800
ANOTHER WAS LOOKING AT PATTERNS

784
00:31:49,800 --> 00:31:51,080
OF VARIANT EMERGENCE AND THE

785
00:31:51,080 --> 00:31:54,560
QUESTION HERE IS, IS THERE A

786
00:31:54,560 --> 00:31:57,000
CONSISTENT PATTERN BY WHICH NEW

787
00:31:57,000 --> 00:31:58,000
VARIANTS ARE DISSEMINATED?

788
00:31:58,000 --> 00:32:01,120
AND, YOU KNOW, IS THAT A

789
00:32:01,120 --> 00:32:02,480
SUGGESTION WHERE SURVEILLANCE

790
00:32:02,480 --> 00:32:05,280
FOR FUTURE EPIDEMICS SHOULD BE

791
00:32:05,280 --> 00:32:05,720
DONE?

792
00:32:05,720 --> 00:32:08,480
WE LOOKED AT SARS-COV-2 POSITIVE

793
00:32:08,480 --> 00:32:10,520
SAMPLES FROM SEPTEMBER 2020 TO

794
00:32:10,520 --> 00:32:13,920
MARCH 2022 THAT WERE SEQUENCED,

795
00:32:13,920 --> 00:32:16,840
AND WHAT WE USED, WE HAVE A VERY

796
00:32:16,840 --> 00:32:20,600
GOOD GEOSPATIAL GROUP, BUT THEY

797
00:32:20,600 --> 00:32:22,320
ACTUALLY USED AS THE COORDINATES

798
00:32:22,320 --> 00:32:24,320
THE CENTROID OF THE PATIENT'S

799
00:32:24,320 --> 00:32:26,720
ZIP CODE, WE HAD PATIENT

800
00:32:26,720 --> 00:32:29,440
ADDRESSES, AND INTERESTINGLY THE

801
00:32:29,440 --> 00:32:32,040
VARIANTS OF CONCERN WERE USUALLY

802
00:32:32,040 --> 00:32:34,360
INTRODUCED IN THE NORTH AND

803
00:32:34,360 --> 00:32:35,440
TRAVELED DOWN THE INTERSTATES.

804
00:32:35,440 --> 00:32:38,040
I WAS GOING TO SHOW A VIDEO WE

805
00:32:38,040 --> 00:32:40,640
HAVE, BUT I THOUGHT IT WOULD BE

806
00:32:40,640 --> 00:32:41,440
A GLITCH, PROBABLY WOULD HAVE

807
00:32:41,440 --> 00:32:42,520
BEEN.

808
00:32:42,520 --> 00:32:44,080
I HAVE A NUMBER OF JUST THREE

809
00:32:44,080 --> 00:32:45,280
STILLS WITH EACH OF THE

810
00:32:45,280 --> 00:32:45,640
VARIANTS.

811
00:32:45,640 --> 00:32:48,440
GO TO THE NEXT SLIDE.

812
00:32:48,440 --> 00:32:50,240
THIS IS THE ALPHA INTRODUCTION.

813
00:32:50,240 --> 00:32:53,040
AND YOU CAN SEE IT'S HARD TO

814
00:32:53,040 --> 00:32:57,480
SEE, BUT IN THE MORGANTON, THE

815
00:32:57,480 --> 00:32:59,880
NORTH PART, A COUPLE ORANGE

816
00:32:59,880 --> 00:33:00,600
DOTS.

817
00:33:00,600 --> 00:33:01,720
THAT'S WHERE THAT WAS

818
00:33:01,720 --> 00:33:02,040
INTRODUCED.

819
00:33:02,040 --> 00:33:05,080
AND THEN IF YOU LOOK, THAT'S

820
00:33:05,080 --> 00:33:07,480
JANUARY TO APRIL, IT'S NICER ON

821
00:33:07,480 --> 00:33:09,560
THE VIDEO BUT THIS SPREAD DOWN

822
00:33:09,560 --> 00:33:11,640
THE INTERSTATE, SHOWN IN THE

823
00:33:11,640 --> 00:33:14,480
DARK LINES, AND THEN OUT TO THE

824
00:33:14,480 --> 00:33:15,880
RURAL POPULATIONS.

825
00:33:15,880 --> 00:33:16,800
THE OTHER CONCENTRATION THAT

826
00:33:16,800 --> 00:33:21,600
CAME IN THAT WASN'T RELATED TO

827
00:33:21,600 --> 00:33:25,440
THE REST OF WEST VIRGINIA WAS

828
00:33:25,440 --> 00:33:26,440
EASTERN PANHANDLE, A BEDROOM

829
00:33:26,440 --> 00:33:28,400
COMMUNITY OF D.C.

830
00:33:28,400 --> 00:33:30,480
THAT TRANSMISSION PATTERN WAS

831
00:33:30,480 --> 00:33:31,960
REALLY OVER THERE AND DIDN'T

832
00:33:31,960 --> 00:33:33,360
IMPACT RURAL WEST VIRGINIA.

833
00:33:33,360 --> 00:33:35,920
NOW, NEXT SLIDE, IF WE GO TO THE

834
00:33:35,920 --> 00:33:38,160
DELTA VARIANT, WE SEE A SLIGHTLY

835
00:33:38,160 --> 00:33:39,080
DIFFERENT PATTERN, THOUGH THE

836
00:33:39,080 --> 00:33:43,240
INITIAL ONE ON THE LEFT IN APRIL

837
00:33:43,240 --> 00:33:44,760
WAS IN THE NORTH BUT

838
00:33:44,760 --> 00:33:46,480
SUBSEQUENTLY, YOU KNOW, WE

839
00:33:46,480 --> 00:33:49,000
DIDN'T SEE JUST SPREAD DOWN THE

840
00:33:49,000 --> 00:33:49,280
INTERSTATES.

841
00:33:49,280 --> 00:33:51,520
IT WAS SORT OF ALL OVER.

842
00:33:51,520 --> 00:33:53,640
WE SAID, WHAT'S GOING ON HERE?

843
00:33:53,640 --> 00:33:55,600
WHAT HAPPENED WITH DELTA, IF YOU

844
00:33:55,600 --> 00:33:57,040
REMEMBER, IS DELTA REALLY GOT

845
00:33:57,040 --> 00:33:59,520
GOING IN THE SUMMER OF 2021.

846
00:33:59,520 --> 00:34:01,840
I DIDN'T KNOW THIS BUT A LOT OF

847
00:34:01,840 --> 00:34:05,080
WEST VIRGINIA GOES TO MYRTLE

848
00:34:05,080 --> 00:34:07,040
BEACH AND THERE WERE MULTIPLE

849
00:34:07,040 --> 00:34:11,680
CHURCH GROUPS,  RURAL AREAS,

850
00:34:11,680 --> 00:34:14,040
GOING AS A GROUP AND CAME BACK

851
00:34:14,040 --> 00:34:15,320
AND HAD MULTIPLE OUTBREAKS OF

852
00:34:15,320 --> 00:34:16,640
DELTA, DIFFERENT THAN WHAT WE

853
00:34:16,640 --> 00:34:17,680
HAD SEEN WITH ALPHA.

854
00:34:17,680 --> 00:34:22,240
IF WE GO TO THE NEXT SLIDE,

855
00:34:22,240 --> 00:34:24,560
OMICRON, YOU CAN SEE THAT,

856
00:34:24,560 --> 00:34:26,640
AGAIN, IT STARTED IN THE NORTH

857
00:34:26,640 --> 00:34:30,520
BUT, YOU KNOW, VERY QUICKLY

858
00:34:30,520 --> 00:34:34,880
CHARLESTON, WHICH IS SORT OF THE

859
00:34:34,880 --> 00:34:35,880
LEFT LOWER AREA, QUICKLY BECAME

860
00:34:35,880 --> 00:34:36,160
INVOLVED.

861
00:34:36,160 --> 00:34:38,080
AT THE SAME TIME THE NORTH

862
00:34:38,080 --> 00:34:39,920
BECAME INVOLVED, THAT EASTERN

863
00:34:39,920 --> 00:34:41,680
PANHANDLE WAS AS WELL.

864
00:34:41,680 --> 00:34:43,800
NOW, IT'S ONLY A MONTH, DECEMBER

865
00:34:43,800 --> 00:34:47,680
TO JANUARY, YOU CAN SEE JUST HOW

866
00:34:47,680 --> 00:34:49,560
QUICKLY OMICRON SPREAD.

867
00:34:49,560 --> 00:34:52,280
SO WE'RE DOING FURTHER ANALYSIS,

868
00:34:52,280 --> 00:34:53,680
PREPARING A PUBLICATION, BUT,

869
00:34:53,680 --> 00:34:57,000
YOU KNOW, OUR SORT OF CONCLUSION

870
00:34:57,000 --> 00:34:59,840
WITH SOME EXCEPTIONS IS BY AND

871
00:34:59,840 --> 00:35:06,600
LARGE YOU COME IN AT MORGANTOWN,

872
00:35:06,600 --> 00:35:07,600
EASTERN PANHANDLE, IT SPREADS

873
00:35:07,600 --> 00:35:10,080
ALONG THE MAJOR ROUTES AND OUT

874
00:35:10,080 --> 00:35:14,120
TO THE RURAL POPULATIONS.

875
00:35:14,120 --> 00:35:16,040
NEXT SLIDE.

876
00:35:16,040 --> 00:35:18,560
JUST THE LAST PROJECT THAT WE

877
00:35:18,560 --> 00:35:20,960
HAD FOR COVID IN WEST VIRGINIA

878
00:35:20,960 --> 00:35:25,640
WAS ANTIBODY STUDY THAT LOOKED

879
00:35:25,640 --> 00:35:28,440
AT ANTIBODY LEVELS FOR COVID-19

880
00:35:28,440 --> 00:35:30,080
IN NURSING HOME STAFF AND

881
00:35:30,080 --> 00:35:30,440
RESIDENTS.

882
00:35:30,440 --> 00:35:33,480
YOU CAN SEE WE HAD MORE THAN

883
00:35:33,480 --> 00:35:33,960
2100.

884
00:35:33,960 --> 00:35:35,560
NEXT SLIDE.

885
00:35:35,560 --> 00:35:37,120
I SHOULD SAY THAT WEST VIRGINIA

886
00:35:37,120 --> 00:35:40,400
DID A GREAT JOB VERY EARLY ON

887
00:35:40,400 --> 00:35:42,480
VACCINATING A WIDE MAJORITY OF

888
00:35:42,480 --> 00:35:43,920
NURSING HOME RESIDENTS.

889
00:35:43,920 --> 00:35:45,200
MANY OF THE STAFF, NOT SO MANY

890
00:35:45,200 --> 00:35:47,000
OF THE STAFF, WHO REFUSED, BUT

891
00:35:47,000 --> 00:35:51,720
IF YOU LOOK AT THOSE THAT WERE

892
00:35:51,720 --> 00:35:52,960
VACCINATED DURING THE DELTA

893
00:35:52,960 --> 00:35:55,680
SURGE, NOT VERY MANY HAD HAD

894
00:35:55,680 --> 00:35:58,440
BOOSTERS, BUT DURING THE OMICRON

895
00:35:58,440 --> 00:35:59,400
SURGE OVER HALF HAD.

896
00:35:59,400 --> 00:36:04,040
IF WE GO TO THE NEXT SLIDE, YOU

897
00:36:04,040 --> 00:36:07,040
CAN SEE THAT IN THE DELTA ERA

898
00:36:07,040 --> 00:36:09,560
INFECTIONS A LOWER ANTIBODY

899
00:36:09,560 --> 00:36:10,520
LEVEL WAS STATISTICALLY

900
00:36:10,520 --> 00:36:11,440
SIGNIFICANTLY DIFFERENT THAN

901
00:36:11,440 --> 00:36:14,920
THOSE THAT DIDN'T GET INFECTED,

902
00:36:14,920 --> 00:36:17,240
SO, YOU KNOW, YOUR -- IF YOU HAD

903
00:36:17,240 --> 00:36:20,600
LOWER ANTIBODY LEVEL YOU WERE

904
00:36:20,600 --> 00:36:21,240
MORE LIKELY TO GET BREAKTHROUGH

905
00:36:21,240 --> 00:36:23,440
BUT NOT THE CASE WITH OMICRON.

906
00:36:23,440 --> 00:36:25,400
CAN YOU SEE THERE'S NO

907
00:36:25,400 --> 00:36:26,040
DIFFERENCE.

908
00:36:26,040 --> 00:36:28,040
THAT'S CONFIRMING THE FACT THERE

909
00:36:28,040 --> 00:36:30,280
IS SIGNIFICANT IMMUNE EVASION

910
00:36:30,280 --> 00:36:32,440
WITH THE OMICRON VARIANT.

911
00:36:32,440 --> 00:36:33,240
NEXT SLIDE.

912
00:36:33,240 --> 00:36:37,840
I JUST WANT TO FINISH UP THE

913
00:36:37,840 --> 00:36:40,320
NEXT FIVE MINUTES OR SO WITH A

914
00:36:40,320 --> 00:36:42,440
DISCUSSION OF SUBSTANCE USE

915
00:36:42,440 --> 00:36:44,720
DISORDER IN WEST VIRGINIA.

916
00:36:44,720 --> 00:36:46,120
NEXT SLIDE.

917
00:36:46,120 --> 00:36:47,440
THIS SHOWS DRUG OVERDOSE

918
00:36:47,440 --> 00:36:48,360
MORTALITY RATES IN THE UNITED

919
00:36:48,360 --> 00:36:50,240
STATES OVER THE PAST TWO

920
00:36:50,240 --> 00:36:50,840
DECADES.

921
00:36:50,840 --> 00:36:52,800
AND YOU CAN SEE THAT THERE'S

922
00:36:52,800 --> 00:36:55,040
BEEN AN EXPLOSION ALL OVER.

923
00:36:55,040 --> 00:36:57,920
AND THERE'S CERTAIN HOT SPOTS IN

924
00:36:57,920 --> 00:37:00,880
CENTRAL APPALACHIA AS WELL AS

925
00:37:00,880 --> 00:37:03,720
AREAS OF THE WEST.

926
00:37:03,720 --> 00:37:05,560
NEXT SLIDE.

927
00:37:05,560 --> 00:37:09,400
IF WE FOCUS ON WEST VIRGINIA,

928
00:37:09,400 --> 00:37:12,120
2020, WEST VIRGINIA HAS BY FAR

929
00:37:12,120 --> 00:37:15,800
THE HIGHEST DRUG OVERDOSE

930
00:37:15,800 --> 00:37:16,440
MORTALITY RATE.

931
00:37:16,440 --> 00:37:17,480
81.4 PER 100,000.

932
00:37:17,480 --> 00:37:19,120
THERE'S NO OTHER STATE THAT IS

933
00:37:19,120 --> 00:37:22,760
EVEN IN THE GREEN WHICH GOES

934
00:37:22,760 --> 00:37:24,640
FROM 67 TO 81.4.

935
00:37:24,640 --> 00:37:26,920
IF WE LOOK BY APPALACHIAN COUNTY

936
00:37:26,920 --> 00:37:30,000
AGAIN YOU SEE THE SOUTHERN PART

937
00:37:30,000 --> 00:37:32,520
OF WEST VIRGINIA AS WELL AS A

938
00:37:32,520 --> 00:37:34,720
BIT OF OHIO, ALONG THE OHIO

939
00:37:34,720 --> 00:37:37,880
RIVER THERE, HAVE THE VERY

940
00:37:37,880 --> 00:37:41,240
HIGHEST OVERDOSE MORTALITY

941
00:37:41,240 --> 00:37:41,840
RATES.

942
00:37:41,840 --> 00:37:44,760
NEXT SLIDE.

943
00:37:44,760 --> 00:37:45,640
NOT SURPRISINGLY, EMERGENT

944
00:37:45,640 --> 00:37:47,120
INFECTIOUS DISEASES RELATED TO

945
00:37:47,120 --> 00:37:50,560
INJECTION DRUG USE HAS BEEN

946
00:37:50,560 --> 00:37:51,200
INCREASING.

947
00:37:51,200 --> 00:37:52,440
NEXT SLIDE.

948
00:37:52,440 --> 00:37:54,480
HEPATITIS C IS ONE OF THEM.

949
00:37:54,480 --> 00:38:01,000
IF YOU LOOK AT THE SLIDE AT THE

950
00:38:01,000 --> 00:38:05,400
LEFT, THIS IS 2013 TO 2015, THE

951
00:38:05,400 --> 00:38:07,920
MOST RECENT THAT THEY HAVE.

952
00:38:07,920 --> 00:38:09,800
YOU CAN SEE THAT FOUR OF THE SIX

953
00:38:09,800 --> 00:38:12,280
STATES WITH THE HIGHEST

954
00:38:12,280 --> 00:38:14,960
PREVALENCE OF CHRONIC HEPATITIS

955
00:38:14,960 --> 00:38:17,440
C ARE IDeA STATES.

956
00:38:17,440 --> 00:38:21,520
HEPATITIS C, YOU KNOW, BY AND

957
00:38:21,520 --> 00:38:23,920
LARGE YOU HAVE ACUTE INFECTION

958
00:38:23,920 --> 00:38:25,240
BUT UNLIKE HEPATITIS B THE

959
00:38:25,240 --> 00:38:28,800
MAJORITY OF INDIVIDUALS WITH

960
00:38:28,800 --> 00:38:30,760
HEPATITIS C WILL DEVELOP CHRONIC

961
00:38:30,760 --> 00:38:31,280
INFECTION.

962
00:38:31,280 --> 00:38:35,040
OF THOSE, ABOUT 10 TO 20% WILL

963
00:38:35,040 --> 00:38:38,520
GO ON TO DEVELOP CIRRHOSIS,

964
00:38:38,520 --> 00:38:40,040
LIVER FAILURE, AND CIRRHOSIS IS

965
00:38:40,040 --> 00:38:43,960
ASSOCIATED WITH HIGHER INCIDENCE

966
00:38:43,960 --> 00:38:46,040
OF HEPATOCELLULAR CARCINOMA.

967
00:38:46,040 --> 00:38:47,360
EIGHT, NINE YEARS AGO, WHAT

968
00:38:47,360 --> 00:38:49,840
HAPPENED, WE STARTED HAVING

969
00:38:49,840 --> 00:38:50,600
VERY, VERY GOOD DRUGS, AND

970
00:38:50,600 --> 00:38:52,960
BEFORE I GO TO THE NEXT SLIDE

971
00:38:52,960 --> 00:38:56,840
I'LL JUST POINT OUT THAT CHRONIC

972
00:38:56,840 --> 00:38:58,280
HCV IN WEST VIRGINIA, AGAIN, IS

973
00:38:58,280 --> 00:39:01,240
IN THE SOUTHERN PART OF THE

974
00:39:01,240 --> 00:39:03,040
STATE.

975
00:39:03,040 --> 00:39:03,880
NEXT SLIDE.

976
00:39:03,880 --> 00:39:08,400
SO, WE HAD DRUGS THAT COULD CURE

977
00:39:08,400 --> 00:39:11,440
CHRONIC HEPATITIS C IN 8 TO 12

978
00:39:11,440 --> 00:39:11,640
WEEKS.

979
00:39:11,640 --> 00:39:15,720
I MEAN, IT WAS REALLY AN

980
00:39:15,720 --> 00:39:16,360
UNBELIEVABLE ADVANCE,

981
00:39:16,360 --> 00:39:19,360
THERAPEUTIC ADVANCE.

982
00:39:19,360 --> 00:39:23,240
THE PROBLEM WAS, THERE WERE TWO

983
00:39:23,240 --> 00:39:23,520
PROBLEMS.

984
00:39:23,520 --> 00:39:24,400
NUMBER ONE, PBN PRACTITIONERS

985
00:39:24,400 --> 00:39:26,200
SAID YOU GOT TO HELP US WITH

986
00:39:26,200 --> 00:39:31,840
THIS, WE'RE BEING  INUNDATED
WITH

987
00:39:31,840 --> 00:39:32,840
HEPATITISC, THERE ARE DRUGS, WE

988
00:39:32,840 --> 00:39:39,320
DON'T KNOW HOW TO USE THEM.

989
00:39:39,320 --> 00:39:40,520
CRAIG ROBINSON AND AMBER CRIST

990
00:39:40,520 --> 00:39:41,960
SAID YOU'RE FREE NEXT WEEK,

991
00:39:41,960 --> 00:39:43,840
WE'RE GOING TO ALBUQUERQUE, YOU

992
00:39:43,840 --> 00:39:45,960
GOT A PLANE TICKET TO LOOK IT

993
00:39:45,960 --> 00:39:48,640
THE NEW MEXICO, UNIVERSITY OF

994
00:39:48,640 --> 00:39:49,840
NEW MEXICO ECHO PROGRAM

995
00:39:49,840 --> 00:39:51,240
EXTENSION FOR HEALTH CARE

996
00:39:51,240 --> 00:39:52,240
OUTCOMES.

997
00:39:52,240 --> 00:39:54,600
WHICH HAD A SUCCESSFUL PROGRAM

998
00:39:54,600 --> 00:39:55,680
TREATING HEPATITIS C, LONG

999
00:39:55,680 --> 00:39:58,040
BEFORE REALLY THERE WERE GOOD

1000
00:39:58,040 --> 00:39:59,240
DIRECTLY ACTING AGENTS.

1001
00:39:59,240 --> 00:40:00,960
WE WENT.

1002
00:40:00,960 --> 00:40:02,480
WE IMPLEMENTED THE ECHO PROGRAM

1003
00:40:02,480 --> 00:40:04,000
WHICH OCCURS EVERY COUPLE OF

1004
00:40:04,000 --> 00:40:04,480
WEEKS.

1005
00:40:04,480 --> 00:40:06,240
THERE ARE TWO CASE

1006
00:40:06,240 --> 00:40:06,560
PRESENTATIONS.

1007
00:40:06,560 --> 00:40:14,080
AND THEN THERE'S ABOUT A

1008
00:40:14,080 --> 00:40:17,360
15-MINUTE DIDACTIC.

1009
00:40:17,360 --> 00:40:20,520
THE STATE OF WEST VIRGINIA HAD A

1010
00:40:20,520 --> 00:40:21,640
REQUIREMENT WV MEDICAID WITH

1011
00:40:21,640 --> 00:40:23,040
ONLY COVER INDIVIDUALS WITH

1012
00:40:23,040 --> 00:40:24,720
DIRECTLY ACTING AGENTS SO

1013
00:40:24,720 --> 00:40:27,680
EFFECTIVE IF THEY SAW AN I.D. OR

1014
00:40:27,680 --> 00:40:28,520
G.I. SPECIALIST.

1015
00:40:28,520 --> 00:40:30,600
OFTEN THE WAIT WAS 6 TO 9

1016
00:40:30,600 --> 00:40:32,000
MONTHS, IT WAS HOURS OF TRAVEL

1017
00:40:32,000 --> 00:40:33,760
FOR SOME FOLKS.

1018
00:40:33,760 --> 00:40:35,920
WE WENT TO WEST VIRGINIA

1019
00:40:35,920 --> 00:40:38,120
MEDICAID AND SAID, LISTEN, COULD

1020
00:40:38,120 --> 00:40:41,000
YOU COUNT PRESENTATION AT ECHO

1021
00:40:41,000 --> 00:40:43,480
AS THAT SUBSPECIALTY

1022
00:40:43,480 --> 00:40:43,920
CONSULTATION?

1023
00:40:43,920 --> 00:40:45,240
PRIMARY CARE PHYSICIANS WERE

1024
00:40:45,240 --> 00:40:45,640
CLEAR.

1025
00:40:45,640 --> 00:40:48,240
I MEAN, THEY HAD NEW OF KNEW HOW

1026
00:40:48,240 --> 00:40:58,640
TO TREAT AND USE THOSE AND WV

1027
00:40:58,640 --> 00:41:00,240
MEDICAID, GOT RID OF ADVANCED

1028
00:41:00,240 --> 00:41:01,280
FIBROSIS TREATMENT, LOOKING AT

1029
00:41:01,280 --> 00:41:02,400
ECONOMIC ANALYSIS, NUMBER OF

1030
00:41:02,400 --> 00:41:04,760
PEOPLE TREATED.

1031
00:41:04,760 --> 00:41:05,040
NEXT SLIDE.

1032
00:41:05,040 --> 00:41:07,240
THAT WASN'T THE END OF THE ECHO

1033
00:41:07,240 --> 00:41:07,480
PROGRAM.

1034
00:41:07,480 --> 00:41:12,440
TODAY WE HAVE ALL OF THESE

1035
00:41:12,440 --> 00:41:15,760
PROJECTS THAT WERE -- A LOT OF

1036
00:41:15,760 --> 00:41:17,440
PBRN AND OTHERS SAID WE NEED

1037
00:41:17,440 --> 00:41:17,640
THIS.

1038
00:41:17,640 --> 00:41:20,040
WE'RE IN MOST OF THE WEST

1039
00:41:20,040 --> 00:41:23,760
VIRGINIA COUNTIES SHOWN IN BLUE.

1040
00:41:23,760 --> 00:41:27,160
WE ALSO -- WEST VIRGINIA ECHO IS

1041
00:41:27,160 --> 00:41:30,480
IN 20 ADDITIONAL STATES.

1042
00:41:30,480 --> 00:41:32,160
THERE ARE CURRENTLY NEGOTIATIONS

1043
00:41:32,160 --> 00:41:35,040
WITH WV MEDICAID TO SUPPORT THE

1044
00:41:35,040 --> 00:41:39,400
ECHO PROGRAM.

1045
00:41:39,400 --> 00:41:39,680
NEXT SLIDE.

1046
00:41:39,680 --> 00:41:42,320
THERE ARE TWO CURRENT HIV

1047
00:41:42,320 --> 00:41:44,360
OUTBREAKS, ONE IN THE COUNTY

1048
00:41:44,360 --> 00:41:47,160
WITH THE BLUE PIN, ONE IN THE

1049
00:41:47,160 --> 00:41:49,960
COUNTY WITH THE RED PIN.

1050
00:41:49,960 --> 00:41:52,240
YOU'LL SEE A GRAY PIN BY

1051
00:41:52,240 --> 00:41:53,440
WHEELING, IT HASN'T BEEN

1052
00:41:53,440 --> 00:41:55,640
OFFICIALLY CALLED.

1053
00:41:55,640 --> 00:41:58,400
THESE OUTBREAKS ARE 95% FOLKS

1054
00:41:58,400 --> 00:42:00,040
THAT USE INTRAVENOUS DRUGS.

1055
00:42:00,040 --> 00:42:02,240
A THIRD OF THE HIV IS DIAGNOSED

1056
00:42:02,240 --> 00:42:03,440
IN THE HOSPITAL, THIS WASN'T

1057
00:42:03,440 --> 00:42:04,560
SOMETHING THAT GOT HIV

1058
00:42:04,560 --> 00:42:05,120
YESTERDAY.

1059
00:42:05,120 --> 00:42:07,600
THESE ARE INDIVIDUALS WHO ARE

1060
00:42:07,600 --> 00:42:09,920
NOW PRESENTING AFTER HAVING HIV

1061
00:42:09,920 --> 00:42:11,760
FOR YEARS WITH COMPLICATIONS.

1062
00:42:11,760 --> 00:42:16,640
MORE THAN 40% ARE WOMEN.

1063
00:42:16,640 --> 00:42:17,640
AND RECENTLY, THE LEGISLATURE IN

1064
00:42:17,640 --> 00:42:23,800
THE STATE OF  WEST VIRGINIA MADE

1065
00:42:23,800 --> 00:42:24,640
IT DIVERSITY RESULT,

1066
00:42:24,640 --> 00:42:26,320
REQUIREMENTS FOR SYRINGE SERVICE

1067
00:42:26,320 --> 00:42:28,640
PROGRAMS, MANY HAVE CLOSED, A

1068
00:42:28,640 --> 00:42:32,960
GOOD SYRINGE SERVICE PROGRAM IN

1069
00:42:32,960 --> 00:42:33,880
CABELL COUNTY HEALTH DEPARTMENT,

1070
00:42:33,880 --> 00:42:35,240
IT'S IN THE NEWS THEY MAY HAVE

1071
00:42:35,240 --> 00:42:36,560
TO CLOSE.

1072
00:42:36,560 --> 00:42:39,920
DO REMEMBER THE OUTBREAK OF HIV

1073
00:42:39,920 --> 00:42:42,160
IN SOUTHERN INDIANA, SCOTT

1074
00:42:42,160 --> 00:42:46,040
COUNTY, THAT EPIDEMIC WAS ONLY

1075
00:42:46,040 --> 00:42:47,200
BROUGHT UNDER CONTROL WHEN THE

1076
00:42:47,200 --> 00:42:50,520
GOVERNOR PENCE AT THAT TIME

1077
00:42:50,520 --> 00:42:52,400
AGREED TO HAVE SYRINGE EXCHANGE.

1078
00:42:52,400 --> 00:42:55,920
AND THERE HAD BEEN MODELING, IF

1079
00:42:55,920 --> 00:42:57,040
THEY HAD EFFECTIVE SYRINGE

1080
00:42:57,040 --> 00:42:58,040
EXCHANGE THERE WHO HAVE BEEN

1081
00:42:58,040 --> 00:42:59,040
MANY FEWER CASES.

1082
00:42:59,040 --> 00:43:01,720
THE OTHER THING I WOULD SAY

1083
00:43:01,720 --> 00:43:04,160
GOING BACK TO CLINICAL TRIALS,

1084
00:43:04,160 --> 00:43:05,600
EXACTLY ZERO, ZERO CLINICAL

1085
00:43:05,600 --> 00:43:10,440
TRIALS IN WEST VIRGINIA ON HIV

1086
00:43:10,440 --> 00:43:10,880
PREVENTION.

1087
00:43:10,880 --> 00:43:13,800
WHEN WE LOOK AT WHAT'S NEEDED,

1088
00:43:13,800 --> 00:43:15,640
YOU HAVE TO PUT CLINICAL TRIALS

1089
00:43:15,640 --> 00:43:16,840
WHERE YOU'RE HAVING OUTBREAKS.

1090
00:43:16,840 --> 00:43:18,640
YOU'RE NOT GOING TO ELIMINATE

1091
00:43:18,640 --> 00:43:21,200
HIV BY DOING ALL YOUR STUDIES IN

1092
00:43:21,200 --> 00:43:26,160
NEW YORK CITY AND SAN FRANCISCO.

1093
00:43:26,160 --> 00:43:28,000
NEXT SLIDE.

1094
00:43:28,000 --> 00:43:30,360
THIS IS NO SURPRISE, OF COURSE.

1095
00:43:30,360 --> 00:43:33,040
WEST VIRGINIA USED TO HAVE A

1096
00:43:33,040 --> 00:43:35,160
VERY LOW HIV DIAGNOSIS RATE IS

1097
00:43:35,160 --> 00:43:35,440
INCREASED.

1098
00:43:35,440 --> 00:43:38,120
YOU'LL SEE IT TAILS OFF AT 2019.

1099
00:43:38,120 --> 00:43:39,320
THAT ISN'T TAILED OFF.

1100
00:43:39,320 --> 00:43:40,840
IT'S BECAUSE WITH COVID THERE'S

1101
00:43:40,840 --> 00:43:42,440
NOT BEEN MUCH TESTING.

1102
00:43:42,440 --> 00:43:45,120
I AM SURE THAT WE'RE NOW ABOVE

1103
00:43:45,120 --> 00:43:50,720
THE U.S. AVERAGE.

1104
00:43:50,720 --> 00:43:51,240
NEXT SLIDE.

1105
00:43:51,240 --> 00:43:53,440
ANOTHER STUDY THAT WAS FUNDED A

1106
00:43:53,440 --> 00:43:56,400
COUPLE YEARS AGO BY GMS LOOKED

1107
00:43:56,400 --> 00:43:59,320
AT PERCEPTIONS OF RISK AMONG

1108
00:43:59,320 --> 00:44:00,280
WOMEN.

1109
00:44:00,280 --> 00:44:00,960
REMEMBER, WOMEN CONSTITUTED MORE

1110
00:44:00,960 --> 00:44:03,640
THAN 40% OF THE NEW HIV CASES.

1111
00:44:03,640 --> 00:44:08,440
IT WAS MIXED METHODS.

1112
00:44:08,440 --> 00:44:09,640
ACTUALLY, MY HBTN STUDY, NIAID

1113
00:44:09,640 --> 00:44:13,160
STUDY THAT I WAS PROTOCOL CHAIR,

1114
00:44:13,160 --> 00:44:15,080
IT LOOKED AT 2,000 URBAN WOMEN,

1115
00:44:15,080 --> 00:44:22,480
A DECADE AGO, LOOKING AT HIV

1116
00:44:22,480 --> 00:44:25,720
RISK WITH AUDIO ASSISTED

1117
00:44:25,720 --> 00:44:26,600
COMPUTER SELF-INTERVIEW, FOLKS

1118
00:44:26,600 --> 00:44:27,760
HAD HEADPHONES, YOU DIDN'T HAVE

1119
00:44:27,760 --> 00:44:29,200
TO BE LITERATE TO ANSWER

1120
00:44:29,200 --> 00:44:32,560
QUESTIONS, WE DID SEMI

1121
00:44:32,560 --> 00:44:34,840
STRUCTURED INTERVIEWS, ENROLLED,

1122
00:44:34,840 --> 00:44:36,880
NEXT SLIDE, 88 WOMEN.

1123
00:44:36,880 --> 00:44:39,480
I DID 10 INTERVIEWS MYSELF.

1124
00:44:39,480 --> 00:44:42,280
THEY WERE JUST HEART WRENCHING.

1125
00:44:42,280 --> 00:44:44,720
THOUGH MOST OF THE INDIVIDUALS,

1126
00:44:44,720 --> 00:44:46,160
YOU CAN SEE DEMOGRAPHIC SHOWN

1127
00:44:46,160 --> 00:44:49,080
THERE, MOST HAD BEEN TESTED AT

1128
00:44:49,080 --> 00:44:50,960
LEAST ONCE.

1129
00:44:50,960 --> 00:44:54,080
WHAT EMERGED IN THE QUALITATIVE

1130
00:44:54,080 --> 00:44:56,120
WERE THEMES, THREE OF THE FOUR

1131
00:44:56,120 --> 00:44:59,720
THEMES WE HAD SEEN IN THE 064

1132
00:44:59,720 --> 00:45:02,880
STUDY OF URBAN WOMEN, ISOLATION,

1133
00:45:02,880 --> 00:45:04,560
VIOLENCE AGAINST WOMEN, REALLY

1134
00:45:04,560 --> 00:45:05,440
COMMUNITY STIGMA.

1135
00:45:05,440 --> 00:45:08,240
I WOULD SAY THE VIOLENCE AGAINST

1136
00:45:08,240 --> 00:45:09,760
WOMEN, IT WAS HARD TO FIT AND

1137
00:45:09,760 --> 00:45:12,640
HEAR SOME OF THESE WOMEN'S

1138
00:45:12,640 --> 00:45:12,840
STORIES.

1139
00:45:12,840 --> 00:45:15,120
IT WAS UNBELIEVABLE.

1140
00:45:15,120 --> 00:45:17,320
MY VIEW WAS I THINK SOME

1141
00:45:17,320 --> 00:45:19,440
VIOLENCE IN RURAL AREAS MAY BE

1142
00:45:19,440 --> 00:45:21,920
MORE INTENSE FOR A NUMBER OF

1143
00:45:21,920 --> 00:45:22,440
REASONS.

1144
00:45:22,440 --> 00:45:25,440
WHAT I NEVER HEARD IN NEWARK,

1145
00:45:25,440 --> 00:45:26,440
AND NEWARK'S HIV EPIDEMIC, FOR

1146
00:45:26,440 --> 00:45:28,480
THOSE THAT DON'T I RAN AN HIV

1147
00:45:28,480 --> 00:45:33,040
PROGRAM, BIG HIV PROGRAM IN

1148
00:45:33,040 --> 00:45:35,240
NEWARK FOR TEN YEARS, THAT --

1149
00:45:35,240 --> 00:45:41,800
AND THAT EPIDEMIC WAS PREDICATED

1150
00:45:41,800 --> 00:45:46,680
ON INTRAVENOUS DRUG USE, HIGHEST

1151
00:45:46,680 --> 00:45:48,240
PROPORTION OF WOMEN BECAUSE THEY

1152
00:45:48,240 --> 00:45:49,520
DIDN'T KNOW THEIR PARTNERS WERE

1153
00:45:49,520 --> 00:45:52,920
SHOOTING DRUGS AND WERE

1154
00:45:52,920 --> 00:45:53,800
INFECTED.

1155
00:45:53,800 --> 00:45:56,040
I NEVER HEARD INTERGENERATIONAL

1156
00:45:56,040 --> 00:45:56,840
DRUG USE.

1157
00:45:56,840 --> 00:45:59,120
MULTIPLE WOMEN SAID I WAS FIRST

1158
00:45:59,120 --> 00:46:00,840
SHOT UP FOR MY 7th BIRTHDAY,

1159
00:46:00,840 --> 00:46:02,120
SHOT UP AT 9 BECAUSE THEY WANTED

1160
00:46:02,120 --> 00:46:04,240
ME TO SHUT UP.

1161
00:46:04,240 --> 00:46:06,640
I MEAN, THIS IS SOMETHING THAT I

1162
00:46:06,640 --> 00:46:09,480
THINK HAS NOT BEEN WRITTEN

1163
00:46:09,480 --> 00:46:11,280
ABOUT, AND IS REALLY SOMETHING

1164
00:46:11,280 --> 00:46:12,640
THAT NEEDS ATTENTION.

1165
00:46:12,640 --> 00:46:16,600
JUST GOING TO THE RIGHT SIDE OF

1166
00:46:16,600 --> 00:46:19,280
THE SLIDE HERE YOU SEE THAT 80%

1167
00:46:19,280 --> 00:46:22,040
OF WOMEN REPORTED CURRENT OR

1168
00:46:22,040 --> 00:46:24,000
PAST INTRAVENOUS DRUG USE, A

1169
00:46:24,000 --> 00:46:27,040
QUARTER HAD A SEXUAL PARTNER WHO

1170
00:46:27,040 --> 00:46:29,800
ENGAGED IN DRUG USE, 40% HAD A

1171
00:46:29,800 --> 00:46:32,120
PARTNER WHO HAD BEEN IN PRISON,

1172
00:46:32,120 --> 00:46:34,000
YET, YOU KNOW, 85% OF THE WOMEN

1173
00:46:34,000 --> 00:46:36,080
DID NOT THINK THEY WERE AT HIV

1174
00:46:36,080 --> 00:46:36,520
RISK.

1175
00:46:36,520 --> 00:46:41,880
SO I THINK THAT THIS REALLY IS

1176
00:46:41,880 --> 00:46:44,760
CRITICAL EVIDENCE THAT WE REALLY

1177
00:46:44,760 --> 00:46:46,720
NEED EDUCATION PREVENTION

1178
00:46:46,720 --> 00:46:54,600
PROGRAMS OR THIS THING IS IN

1179
00:46:54,600 --> 00:47:00,240
WEST VIRGINIA IS GOING TO BE

1180
00:47:00,240 --> 00:47:01,400
EXPLOSIVE.

1181
00:47:01,400 --> 00:47:04,320
I'LL FINISH WITH INNOVATIVE

1182
00:47:04,320 --> 00:47:05,120
TREATMENT.

1183
00:47:05,120 --> 00:47:07,200
THE PROBLEM CURRENTLY WITH

1184
00:47:07,200 --> 00:47:09,720
TREATMENT OF OUD, OPIOID USE

1185
00:47:09,720 --> 00:47:12,240
DISORDER, SUBSTANCE USE

1186
00:47:12,240 --> 00:47:13,440
DISORDER, CLICK ONCE MORE, IS

1187
00:47:13,440 --> 00:47:15,760
THAT THE RATE OF SUCCESS FOR

1188
00:47:15,760 --> 00:47:19,880
THESE TREATMENTS IS LESS THAN

1189
00:47:19,880 --> 00:47:21,080
50%.

1190
00:47:21,080 --> 00:47:25,360
POLY SUBSTANCE USE IS COMMON.

1191
00:47:25,360 --> 00:47:26,120
AND MOST NON-OPIOID SUBSTANCES

1192
00:47:26,120 --> 00:47:28,080
DO NOT HAVE A MEDICATION

1193
00:47:28,080 --> 00:47:29,160
TREATMENT AVAILABLE.

1194
00:47:29,160 --> 00:47:31,120
THEY RELY MOSTLY ON BEHAVIORAL

1195
00:47:31,120 --> 00:47:32,840
TREATMENTS, THE EXCEPTION OF

1196
00:47:32,840 --> 00:47:36,720
COURSE IS OPIOID USE DISORDER

1197
00:47:36,720 --> 00:47:41,000
WHICH REALLY HAS MEDICATION

1198
00:47:41,000 --> 00:47:43,040
TREATMENT METHADONE, SUBOXONE

1199
00:47:43,040 --> 00:47:45,520
AND SO FORTH BUT CLEARLY THIS IS

1200
00:47:45,520 --> 00:47:46,880
AN UNMET NEED.

1201
00:47:46,880 --> 00:47:48,480
CLICK THROUGH TILL YOU GET

1202
00:47:48,480 --> 00:47:49,000
THROUGH.

1203
00:47:49,000 --> 00:47:51,320
SO, YOU HAVE TO UNDERSTAND WHY

1204
00:47:51,320 --> 00:47:54,080
WE DID THIS.

1205
00:47:54,080 --> 00:47:55,400
ADDICTION'S A BRAIN DISORDER

1206
00:47:55,400 --> 00:47:57,960
WITH MULTIPLE AREAS INVOLVED.

1207
00:47:57,960 --> 00:47:59,800
ACUTE OPIOID USE INCREASES

1208
00:47:59,800 --> 00:48:00,880
DOPAMINE IN THE NUCLEUS

1209
00:48:00,880 --> 00:48:03,720
ACCUMBENS, AT THE CENTER OF THE

1210
00:48:03,720 --> 00:48:05,840
REWARD CIRCUITRY.

1211
00:48:05,840 --> 00:48:07,560
YOU FEEL GOOD WHEN YOU HAVE A

1212
00:48:07,560 --> 00:48:08,640
LOT OF DOPAMINE.

1213
00:48:08,640 --> 00:48:11,040
YOU REALLY WANT MORE.

1214
00:48:11,040 --> 00:48:13,080
OVER TIME, THE DOPAMINE

1215
00:48:13,080 --> 00:48:17,920
DECREASES, IN THE  NUCLEUS

1216
00:48:17,920 --> 00:48:20,040
ACCUMBENS LEADING TO INCREASE

1217
00:48:20,040 --> 00:48:21,520
THE CRAVING IN EFFORT TO

1218
00:48:21,520 --> 00:48:27,240
INCREASE THE DOPAMINE.

1219
00:48:27,240 --> 00:48:28,560
DECREASED DOPAMINE REDUCES

1220
00:48:28,560 --> 00:48:29,560
PREFRONTAL CORTEX ACTIVITY

1221
00:48:29,560 --> 00:48:34,720
LEADING TO POOR EXECUTIVE

1222
00:48:34,720 --> 00:48:36,480
FUNCTION AND DECISION MAKING AND

1223
00:48:36,480 --> 00:48:41,080
THIS IMBALANCE WORSENS OVER

1224
00:48:41,080 --> 00:48:45,720
TIME. 

1225
00:48:45,720 --> 00:48:46,320
NEXT SLIDE.

1226
00:48:46,320 --> 00:48:47,360
DEEP BRAIN STIMULATION HAS BEEN

1227
00:48:47,360 --> 00:48:51,120
DONE FOR A NUMBER OF THINGS.

1228
00:48:51,120 --> 00:48:54,840
HE SAID WE SHOULD WRITE THIS

1229
00:48:54,840 --> 00:48:55,040
GRANT.

1230
00:48:55,040 --> 00:48:56,520
CTR, SOMEBODY HAS A GREAT IDEA,

1231
00:48:56,520 --> 00:48:58,240
WE WERE IN THE WAR ROOM, WROTE

1232
00:48:58,240 --> 00:48:59,560
THIS GRANT.

1233
00:48:59,560 --> 00:49:05,440
WE WERE FUNDED BY NIDA FOR

1234
00:49:05,440 --> 00:49:06,640
FOR-PATIENT FEASIBILITY STUDY,

1235
00:49:06,640 --> 00:49:07,960
INCLUSION CRITERIA SHOWN THERE,

1236
00:49:07,960 --> 00:49:11,040
MOST IMPORTANTLY YOU HAD TO HAVE

1237
00:49:11,040 --> 00:49:12,240
FAILED MULTIPLE TREATMENT

1238
00:49:12,240 --> 00:49:15,280
ATTEMPTS FOR OPIOID USE

1239
00:49:15,280 --> 00:49:16,840
DISORDER, AND YOU ALSO, YOU

1240
00:49:16,840 --> 00:49:19,320
KNOW, HAD TO HAVE MULTIPLE

1241
00:49:19,320 --> 00:49:20,440
DOCUMENTED OVERDOSE.

1242
00:49:20,440 --> 00:49:22,880
THESE WERE NOT FOLKS THAT JUST

1243
00:49:22,880 --> 00:49:24,240
HAD ONE TREATMENT ROUND AND HAD

1244
00:49:24,240 --> 00:49:26,560
FAILED IT.

1245
00:49:26,560 --> 00:49:27,760
NEXT SLIDE.

1246
00:49:27,760 --> 00:49:29,280
THESE ARE OUR BASELINE

1247
00:49:29,280 --> 00:49:30,240
CHARACTERISTICS, JUST TO SAY

1248
00:49:30,240 --> 00:49:34,040
THAT LOOK AT THE NUMBER OF

1249
00:49:34,040 --> 00:49:37,240
OVERDOSES, 5 TO 11, AND THESE

1250
00:49:37,240 --> 00:49:39,280
WERE NOT FOLKS IN TREATMENT, ALL

1251
00:49:39,280 --> 00:49:41,680
OF THESE FOLKS HAD USED WITHIN

1252
00:49:41,680 --> 00:49:45,040
THE LAST WEEK BEFORE ENTERING

1253
00:49:45,040 --> 00:49:45,400
THE TRIAL.

1254
00:49:45,400 --> 00:49:46,440
NEXT SLIDE.

1255
00:49:46,440 --> 00:49:48,600
THIS IS THE PROCEDURE JUST TO

1256
00:49:48,600 --> 00:49:50,240
SHOW YOU IF THE NEUROSURGEON

1257
00:49:50,240 --> 00:49:51,840
WERE HERE HE WOULD GO ON FOR

1258
00:49:51,840 --> 00:49:54,920
HALF AN HOUR, BUT THE NUCLEUS

1259
00:49:54,920 --> 00:49:56,240
ACCUMBENS IS DEEP.

1260
00:49:56,240 --> 00:49:58,640
THEY PUT STIMULATORS IN.

1261
00:49:58,640 --> 00:50:00,000
NEXT SLIDE.

1262
00:50:00,000 --> 00:50:02,200
AND THEN THERE IS A POWER PACK

1263
00:50:02,200 --> 00:50:06,640
IN THE CHEST.

1264
00:50:06,640 --> 00:50:06,840
NEXT.

1265
00:50:06,840 --> 00:50:08,720
AND JUST YOU CAN CLICK THROUGH,

1266
00:50:08,720 --> 00:50:10,240
ARROWS WILL COME UP.

1267
00:50:10,240 --> 00:50:13,280
THERE IS A CRAVING SCALE WHERE

1268
00:50:13,280 --> 00:50:15,400
THEY SHOW VARIOUS SORT OF

1269
00:50:15,400 --> 00:50:16,840
PICTURES AND THEN THE PATIENT

1270
00:50:16,840 --> 00:50:18,800
WILL SHOW ON THE SCALE WHERE

1271
00:50:18,800 --> 00:50:19,640
THEY FIT.

1272
00:50:19,640 --> 00:50:23,280
AND YOU CAN SEEP GOING.

1273
00:50:23,280 --> 00:50:26,240
NEXT SLIDE.

1274
00:50:26,240 --> 00:50:27,680
AND ACTUALLY, INTRAOPERATIVELY,

1275
00:50:27,680 --> 00:50:32,640
CLICK ONCE MORE, THE PATIENT IS

1276
00:50:32,640 --> 00:50:34,600
AWAKE, AND RESPONDS TO THESE

1277
00:50:34,600 --> 00:50:36,360
TRIGGERS, SUCH THAT THEY CAN

1278
00:50:36,360 --> 00:50:39,840
SEE, YOU KNOW, THAT THEY HAVE

1279
00:50:39,840 --> 00:50:41,920
NOT ONLY BY RADIOGRAPHY BUT THEY

1280
00:50:41,920 --> 00:50:43,240
HAVE THE STIMULATOR IN THE

1281
00:50:43,240 --> 00:50:44,040
CORRECT PLACE.

1282
00:50:44,040 --> 00:50:48,080
AND YOU CAN SEE BASELINE VERSUS

1283
00:50:48,080 --> 00:50:50,240
INTRAOPERATIVE IT COMES DOWN.

1284
00:50:50,240 --> 00:50:51,680
NEXT SLIDE.

1285
00:50:51,680 --> 00:50:54,120
THESE ARE THE RESULTS.

1286
00:50:54,120 --> 00:50:56,600
PATIENT NUMBER 1 HAD HAD

1287
00:50:56,600 --> 00:50:57,480
MULTIPLE TREATMENT FAILURES,

1288
00:50:57,480 --> 00:51:01,120
OPIOID USE DISORDER FOR DECADES,

1289
00:51:01,120 --> 00:51:11,040
AND HAS NOW BEEN ABSTINATE.

1290
00:51:11,040 --> 00:51:13,040
WE DO LIQUID CHROMATOGRAPHY TO

1291
00:51:13,040 --> 00:51:13,800
GET THE SUBSTANCES.

1292
00:51:13,800 --> 00:51:17,360
NUMBER 2 WAS IN AND OUT OF

1293
00:51:17,360 --> 00:51:18,920
PRISON, KEPT USING, A MUTUAL

1294
00:51:18,920 --> 00:51:21,440
AGREEMENT WITH PARTICIPANT AND

1295
00:51:21,440 --> 00:51:24,200
TEAM THAT HIS STIMULATOR WAS

1296
00:51:24,200 --> 00:51:25,640
ACTUALLY REMOVED.

1297
00:51:25,640 --> 00:51:27,240
PATIENT NUMBER 3 AGAIN DID

1298
00:51:27,240 --> 00:51:27,680
GREAT.

1299
00:51:27,680 --> 00:51:30,840
REMEMBER, THESE ARE FOLKS THAT

1300
00:51:30,840 --> 00:51:37,400
HAD MULTIPLE OVERDOSES, MULTIPLE

1301
00:51:37,400 --> 00:51:38,160
TREATMENT FAILURES, NOW

1302
00:51:38,160 --> 00:51:40,120
ABSTINATE NOW OUT TO MORE THAN

1303
00:51:40,120 --> 00:51:43,040
500 DAYS, PATIENT 1 AND

1304
00:51:43,040 --> 00:51:47,240
PARTICIPANT 3 ARE EMPLOYED,

1305
00:51:47,240 --> 00:51:49,440
INTERESTINGLY PARTICIPANT 4

1306
00:51:49,440 --> 00:51:50,640
INITIALLY HAD ISOLATED RELAPSES,

1307
00:51:50,640 --> 00:51:54,240
BUT AS TIME HAS GONE ON HE IS

1308
00:51:54,240 --> 00:51:57,840
NOW MONTHS WITHOUT ANY RELAPSES,

1309
00:51:57,840 --> 00:51:59,280
AND CURRENTLY HAS FOUND

1310
00:51:59,280 --> 00:52:01,800
EMPLOYMENT SUGGESTING PERHAPS AS

1311
00:52:01,800 --> 00:52:03,920
THE CIRCUITRY IS NORMALIZED, YOU

1312
00:52:03,920 --> 00:52:06,640
HAVE MORE DOPAMINE TO THE

1313
00:52:06,640 --> 00:52:07,840
PREFRONTAL CORTEX, BETTER

1314
00:52:07,840 --> 00:52:09,600
EXECUTIVE CONTROL.

1315
00:52:09,600 --> 00:52:12,800
ACTUALLY, WE HAVE PET SCANS THAT

1316
00:52:12,800 --> 00:52:14,640
ACTUALLY LABEL THE DOPAMINE AND

1317
00:52:14,640 --> 00:52:18,680
YOU CAN SEE INCREASE IN THE

1318
00:52:18,680 --> 00:52:20,640
PREFRONTAL.

1319
00:52:20,640 --> 00:52:21,760
NEXT SLIDE.

1320
00:52:21,760 --> 00:52:24,440
SO, IN CONCLUSION, YOU KNOW,

1321
00:52:24,440 --> 00:52:26,800
IDeA CTRs ARE CATALYST FOR

1322
00:52:26,800 --> 00:52:31,040
RESEARCH FOCUSING ON RURAL

1323
00:52:31,040 --> 00:52:34,320
HEALTH AND UNDERSERVED ISSUES.

1324
00:52:34,320 --> 00:52:37,040
WEST VIRGINIA IS THE CATALYST.

1325
00:52:37,040 --> 00:52:39,240
IDEA CTRs HAVE WORKED IN

1326
00:52:39,240 --> 00:52:40,200
EXEMPLARY FASHION TOGETHER ON

1327
00:52:40,200 --> 00:52:42,480
BIG DATA AND NOW CLINICAL

1328
00:52:42,480 --> 00:52:43,040
TRIALS.

1329
00:52:43,040 --> 00:52:47,440
AND THAT IS I THINK FERTILE

1330
00:52:47,440 --> 00:52:49,720
GROUND FOR FUTURE INCREASES.

1331
00:52:49,720 --> 00:52:51,240
AND I THINK ENGAGEMENT, FINALLY

1332
00:52:51,240 --> 00:52:53,320
THIS IS MOST IMPORTANT, RURAL

1333
00:52:53,320 --> 00:52:55,720
POPULATION IN RESEARCH IS

1334
00:52:55,720 --> 00:52:56,600
CRITICALLY IMPORTANT TO

1335
00:52:56,600 --> 00:52:58,360
FACILITATING BELIEF AND TRUST IN

1336
00:52:58,360 --> 00:52:58,800
SCIENCE.

1337
00:52:58,800 --> 00:53:01,280
I GREW UP AT AN APPALACHIAN

1338
00:53:01,280 --> 00:53:02,680
RIVER TOWN, DIFFERENT TIME.

1339
00:53:02,680 --> 00:53:05,120
YOU HAD, YOU KNOW, LIFE MAGAZINE

1340
00:53:05,120 --> 00:53:06,440
WITH ALL THE PICTURES, YOU CAN

1341
00:53:06,440 --> 00:53:07,440
SEE THE WORLD TODAY.

1342
00:53:07,440 --> 00:53:08,840
NONE OF THAT EXISTS.

1343
00:53:08,840 --> 00:53:11,120
THERE'S JUST THE INTERNET WITH A

1344
00:53:11,120 --> 00:53:12,560
LOT OF MISINFORMATION, AND

1345
00:53:12,560 --> 00:53:14,520
EVERYBODY IN THEIR OWN ECHO

1346
00:53:14,520 --> 00:53:15,040
CHAMBER.

1347
00:53:15,040 --> 00:53:17,840
I THINK UNLESS, YOU KNOW, WE

1348
00:53:17,840 --> 00:53:20,520
ACTIVELY ENGAGE AND MAKE TRIALS

1349
00:53:20,520 --> 00:53:22,160
AVAILABLE, WHY WOULD FOLKS

1350
00:53:22,160 --> 00:53:24,080
BELIEVE, YOU KNOW, SOMETHING

1351
00:53:24,080 --> 00:53:25,800
FROM MORGANTOWN OR WASHINGTON,

1352
00:53:25,800 --> 00:53:26,040
D.C.?

1353
00:53:26,040 --> 00:53:28,880
I MEAN, IT'S REALLY IMPORTANT TO

1354
00:53:28,880 --> 00:53:31,080
HAVE SUBSTANTIVE INPUT BY THESE

1355
00:53:31,080 --> 00:53:32,760
COMMUNITIES AND THE CTRs CAN

1356
00:53:32,760 --> 00:53:34,160
REALLY PROVIDE FOR THAT.

1357
00:53:34,160 --> 00:53:38,280
THEN I WANT TO CONCLUDE WITH

1358
00:53:38,280 --> 00:53:39,200
ACKNOWLEDGMENTS, NEXT SLIDE

1359
00:53:39,200 --> 00:53:41,600
SHOWS THE TEAM WITH THE DEEP

1360
00:53:41,600 --> 00:53:43,680
BRAIN RESEARCH, DEEP BRAIN

1361
00:53:43,680 --> 00:53:44,120
STIMULATION.

1362
00:53:44,120 --> 00:53:47,840
IT'S A CAST OF A LOT OF PEOPLE.

1363
00:53:47,840 --> 00:53:51,000
FINALLY, OUR NEXT SLIDE, OUR

1364
00:53:51,000 --> 00:53:52,200
CTSI, IT'S ABOUT A THIRD OF THE

1365
00:53:52,200 --> 00:53:53,960
GROUP NOW.

1366
00:53:53,960 --> 00:53:55,600
WE HAVE 65 FOLKS.

1367
00:53:55,600 --> 00:53:59,080
A LOT OF FOLKS INVOLVED IN ALL

1368
00:53:59,080 --> 00:53:59,840
THESE PROJECTS.

1369
00:53:59,840 --> 00:54:03,840
PARTICULARLY I'D LIKE TO THANK

1370
00:54:03,840 --> 00:54:10,120
DR. LEY, BRUNE L AND  MORELL.

1371
00:54:10,120 --> 00:54:12,120
NONE OF THIS WOULD HAVE HAPPENED

1372
00:54:12,120 --> 00:54:19,440
WITHOUT THEM.

1373
00:54:19,440 --> 00:54:24,480
WE HAVE A NUMBER OF QUESTIONS

1374
00:54:24,480 --> 00:54:26,440
STARTING WITH ONE, THE PERSON IS

1375
00:54:26,440 --> 00:54:29,560
CURIOUS ABOUT THE MAP SHOWING

1376
00:54:29,560 --> 00:54:31,840
SARS-COV-2 VARIANT SPREAD.

1377
00:54:31,840 --> 00:54:34,720
YOU NOTED MANY STARTED NEAR

1378
00:54:34,720 --> 00:54:35,040
MORGANTOWN.

1379
00:54:35,040 --> 00:54:37,760
DO YOU HAVE A HYPOTHESIS ABOUT

1380
00:54:37,760 --> 00:54:38,840
THIS BEING RELATED TO THE

1381
00:54:38,840 --> 00:54:40,400
UNIVERSITY OR MOBILE POPULATION

1382
00:54:40,400 --> 00:54:42,360
ASSOCIATED WITH UNIVERSITY AND

1383
00:54:42,360 --> 00:54:44,440
SPECULATE A CAUSAL LINK WITH

1384
00:54:44,440 --> 00:54:45,560
SPREAD THROUGHOUT THE STATE?

1385
00:54:45,560 --> 00:54:46,840
>> SO, WE'RE LOOKING AT THIS,

1386
00:54:46,840 --> 00:54:49,880
BUT MORGANTOWN IS AN HOUR DUE

1387
00:54:49,880 --> 00:54:50,840
SOUTH OF PITTSBURGH AND

1388
00:54:50,840 --> 00:54:51,920
UNIVERSITIES, WE'VE ALL BEEN

1389
00:54:51,920 --> 00:54:52,120
THERE.

1390
00:54:52,120 --> 00:54:53,840
HAVE YOU PEOPLE IN AND OUT FROM

1391
00:54:53,840 --> 00:54:56,240
ALL OVER THE WORLD.

1392
00:54:56,240 --> 00:54:57,320
SO, YES, THAT'S TRUE.

1393
00:54:57,320 --> 00:54:59,440
BUT THE OTHER THING THAT I THINK

1394
00:54:59,440 --> 00:55:00,600
IS REALLY IMPORTANT IS WHAT

1395
00:55:00,600 --> 00:55:02,800
APPEARS TO BE THE SPREAD DOWN

1396
00:55:02,800 --> 00:55:04,120
THE MAJOR HIGHWAYS.

1397
00:55:04,120 --> 00:55:06,720
AND, YOU KNOW, THE SARS-COV-2

1398
00:55:06,720 --> 00:55:08,880
IS, YOU KNOW, AEROSOL AND

1399
00:55:08,880 --> 00:55:10,040
RESPIRATORY DROPLETS.

1400
00:55:10,040 --> 00:55:15,000
EARLY ON IN THE AIDS EPIDEMIC,

1401
00:55:15,000 --> 00:55:16,720
ABE BERGAZI WROTE ABOUT THE

1402
00:55:16,720 --> 00:55:18,240
SPREAD ALONG THE INTERSTATE WITH

1403
00:55:18,240 --> 00:55:20,640
TRUCKERS, NOT A NEW IDEA.

1404
00:55:20,640 --> 00:55:22,480
BUT I THINK, YOU KNOW, YOU CAN'T

1405
00:55:22,480 --> 00:55:23,840
JUST SAY IT'S ONLY THIS WAY.

1406
00:55:23,840 --> 00:55:26,120
OF COURSE IT ISN'T.

1407
00:55:26,120 --> 00:55:28,160
YOU'VE GOT THE EASTERN PANHANDLE

1408
00:55:28,160 --> 00:55:29,760
THAT DIDN'T APPEAR TO AFFECT

1409
00:55:29,760 --> 00:55:31,360
MUCH OF -- THEY GOT IT FROM YOU

1410
00:55:31,360 --> 00:55:35,000
GUYS IN D.C. AND WERE GIVING IT

1411
00:55:35,000 --> 00:55:36,000
BACK OVER THERE.

1412
00:55:36,000 --> 00:55:38,920
AND, YOU KNOW, YOU REALLY HAD

1413
00:55:38,920 --> 00:55:40,520
THIS DELTA THAT REALLY CAME IN

1414
00:55:40,520 --> 00:55:43,920
WITH THE  INFLUX OF TRAVEL.

1415
00:55:43,920 --> 00:55:46,120
CLEARLY IT'S TRAVEL.

1416
00:55:46,120 --> 00:55:47,240
IT'S PEOPLE GOING FROM OUTSIDE.

1417
00:55:47,240 --> 00:55:49,720
I THINK YOU HAVE MORE OF THAT IN

1418
00:55:49,720 --> 00:55:52,480
MORGANTOWN THAN ANYPLACE ELSE.

1419
00:55:52,480 --> 00:55:52,840
>> RIGHT.

1420
00:55:52,840 --> 00:55:53,600
MAKES SENSE.

1421
00:55:53,600 --> 00:55:57,080
A QUESTION ALSO ABOUT THE

1422
00:55:57,080 --> 00:55:58,200
ANTICOAGULANT TREATMENT YOU

1423
00:55:58,200 --> 00:56:02,360
SHOWED, OR THE EFFECTS. 

1424
00:56:02,360 --> 00:56:03,720
WHY WAS THE ANTICOAGULANT

1425
00:56:03,720 --> 00:56:05,840
TREATMENT -- HAD A HIGH NEGATIVE

1426
00:56:05,840 --> 00:56:07,160
EFFECT ALONE BUT POSITIVE EFFECT

1427
00:56:07,160 --> 00:56:10,040
IN ALMOST ALL THE COMBINATION

1428
00:56:10,040 --> 00:56:10,680
TREATMENTS WITH DIFFERENT

1429
00:56:10,680 --> 00:56:11,320
THERAPEUTICS?

1430
00:56:11,320 --> 00:56:12,520
>> YEAH, THAT'S A GREAT

1431
00:56:12,520 --> 00:56:12,800
QUESTION.

1432
00:56:12,800 --> 00:56:15,400
I THINK THAT, YOU KNOW, AGAIN AS

1433
00:56:15,400 --> 00:56:17,760
I SAID, IT'S INTRIGUING WHY

1434
00:56:17,760 --> 00:56:18,600
ANTICOAGULANTS ALONE WERE

1435
00:56:18,600 --> 00:56:18,960
NEGATIVE IMPACT.

1436
00:56:18,960 --> 00:56:23,240
I THINK THAT REALLY HAD TO DO

1437
00:56:23,240 --> 00:56:28,920
WITH PEOPLE WHO HAD SEVERE 

1438
00:56:28,920 --> 00:56:29,560
THROMBOEMBOLIC COMPLICATIONS.

1439
00:56:29,560 --> 00:56:31,760
I THINK THAT WAS A GROUP, OR A

1440
00:56:31,760 --> 00:56:33,480
GROUP WHERE PEOPLE DIDN'T WANT

1441
00:56:33,480 --> 00:56:34,680
TO GIVE THEM STEROIDS.

1442
00:56:34,680 --> 00:56:37,760
THE ISSUE WITH THE COMBINATIONS,

1443
00:56:37,760 --> 00:56:39,440
THAT'S THE INTERESTING THING

1444
00:56:39,440 --> 00:56:41,240
ABOUT THIS PAPER, COMBINATIONS

1445
00:56:41,240 --> 00:56:47,480
APPEAR TO DO BETTER E  -- AND

1446
00:56:47,480 --> 00:56:49,040
STEROIDS WAS THE ONLY SINGLE ONE

1447
00:56:49,040 --> 00:56:52,280
YOU HAVE, THE ONLY THING FROM

1448
00:56:52,280 --> 00:56:53,840
SHAP VALUES, WHICH FEATURES WERE

1449
00:56:53,840 --> 00:56:57,320
MOST IMPACTFUL, MUCH DATA COMES

1450
00:56:57,320 --> 00:56:59,840
EARLY ON IN THE PANDEMIC BEFORE

1451
00:56:59,840 --> 00:57:02,640
WE HAD BETTER SORTS OF

1452
00:57:02,640 --> 00:57:02,960
ANTI-VIRALS.

1453
00:57:02,960 --> 00:57:04,960
AND I THINK THAT IT'S GOING TO

1454
00:57:04,960 --> 00:57:06,400
BE INTERESTING TO RELAPSE REPEAT

1455
00:57:06,400 --> 00:57:06,840
IT.

1456
00:57:06,840 --> 00:57:11,000
THE OTHER THING I SHOULD SAY IS

1457
00:57:11,000 --> 00:57:15,120
WE REALLY TRIED IN OUR, YOU

1458
00:57:15,120 --> 00:57:17,960
KNOW, SORT OF DATASETS TO

1459
00:57:17,960 --> 00:57:18,840
EXCLUDE THE ANTI-COAGULATION.

1460
00:57:18,840 --> 00:57:22,640
EVERYBODY IN THE HOSPITAL IS ON

1461
00:57:22,640 --> 00:57:24,720
PREVENTIVE DVT THERAPY, THAT WAS

1462
00:57:24,720 --> 00:57:25,240
EXCLUDED.

1463
00:57:25,240 --> 00:57:28,320
WE WERE LOOKING FOR PEOPLE ON

1464
00:57:28,320 --> 00:57:29,000
THERAPEUTIC ANTI-COAGULATION,

1465
00:57:29,000 --> 00:57:30,240
SUGGESTING, YOU KNOW, AT LEAST

1466
00:57:30,240 --> 00:57:32,120
EARLY ON THOSE WERE PROBABLY

1467
00:57:32,120 --> 00:57:33,840
PEOPLE WHO WERE MORE SICK.

1468
00:57:33,840 --> 00:57:35,680
>> BEFORE WE GO TO THE LAST

1469
00:57:35,680 --> 00:57:36,920
QUESTION I'VE BEEN ASKED TO SAY

1470
00:57:36,920 --> 00:57:38,000
THE CME NUMBER AGAIN.

1471
00:57:38,000 --> 00:57:44,680
IF YOU WANT THE CME NUMBER,

1472
00:57:44,680 --> 00:57:46,200
44433.

1473
00:57:46,200 --> 00:57:46,560
44433.

1474
00:57:46,560 --> 00:57:48,920
SO, LAST QUESTION FOR YOU,

1475
00:57:48,920 --> 00:57:49,520
SALLY.

1476
00:57:49,520 --> 00:57:51,120
MUCH MORE GENERAL ONE.

1477
00:57:51,120 --> 00:57:54,080
WHAT'S THE BIGGEST BARRIER TO

1478
00:57:54,080 --> 00:57:56,240
GETTING RURAL PATIENTS ENGAGED

1479
00:57:56,240 --> 00:57:57,880
IN CLINICAL TRIALS, IN YOUR

1480
00:57:57,880 --> 00:57:58,440
EXPERIENCE?

1481
00:57:58,440 --> 00:58:00,200
>> WELL, THAT'S A GREAT

1482
00:58:00,200 --> 00:58:00,440
QUESTION.

1483
00:58:00,440 --> 00:58:01,480
I WOULDN'T, YOU KNOW, SORT OF

1484
00:58:01,480 --> 00:58:03,480
PRESUME TO HAVE THE ANSWER BUT I

1485
00:58:03,480 --> 00:58:05,440
WILL SAY THAT WE DID FOCUS

1486
00:58:05,440 --> 00:58:08,760
GROUPS, AND THIS WAS RIGHT

1487
00:58:08,760 --> 00:58:10,280
BEFORE COVID, AROUND THAT ISSUE.

1488
00:58:10,280 --> 00:58:11,480
WE REALLY WANTED TO EXPAND

1489
00:58:11,480 --> 00:58:12,600
CLINICAL TRIALS.

1490
00:58:12,600 --> 00:58:14,960
AND THE NUMBER ONE REASON THAT

1491
00:58:14,960 --> 00:58:16,680
RURAL FOLKS IN THOSE FOCUS

1492
00:58:16,680 --> 00:58:18,760
GROUPS SAID THEY HAD NOT BEEN IN

1493
00:58:18,760 --> 00:58:19,760
CLINICAL TRIALS, NOBODY ASKED

1494
00:58:19,760 --> 00:58:21,680
THEM, THEY DIDN'T KNOW IT WAS

1495
00:58:21,680 --> 00:58:22,640
AVAILABLE.

1496
00:58:22,640 --> 00:58:25,040
AND SO I THINK THE MOST

1497
00:58:25,040 --> 00:58:28,040
IMPORTANT BARRIER IS TO MAKE

1498
00:58:28,040 --> 00:58:29,760
THESE TRIALS AVAILABLE TO FOLKS.

1499
00:58:29,760 --> 00:58:32,080
AND, YOU KNOW, YOU'RE NOT GOING

1500
00:58:32,080 --> 00:58:34,240
TO TAKE A FIRST-IN-HUMAN AND

1501
00:58:34,240 --> 00:58:44,360
ENROLL SOMEBODY DOWN IN McDOW

1502
00:58:44,360 --> 00:58:47,840
COUNTY, SOUTHERNWEST VIRGINIA. 

1503
00:58:47,840 --> 00:58:51,120
MANY ARE BECOMING COMMON, PBRN

1504
00:58:51,120 --> 00:58:53,280
PARTICIPATED IN AN ACTIV TRIAL

1505
00:58:53,280 --> 00:58:54,080
WITH COAGULATION, ENROLLED AT

1506
00:58:54,080 --> 00:58:55,640
THE SITE AND THEN ACTUALLY

1507
00:58:55,640 --> 00:58:57,160
EVERYTHING ELSE WAS REMOTE.

1508
00:58:57,160 --> 00:58:58,440
THEY WERE AUTOMATICALLY SENT THE

1509
00:58:58,440 --> 00:59:00,200
DRUG AND SO FORTH.

1510
00:59:00,200 --> 00:59:02,160
I THINK WE'RE GETTING, YOU KNOW,

1511
00:59:02,160 --> 00:59:04,680
MUCH MORE CREATIVE ABOUT HOW TO

1512
00:59:04,680 --> 00:59:05,440
INCLUDE THESE PEOPLE.

1513
00:59:05,440 --> 00:59:07,640
I THINK, YOU KNOW, WHAT I SAID

1514
00:59:07,640 --> 00:59:09,920
AT THE END IS WHAT'S MOST

1515
00:59:09,920 --> 00:59:10,200
IMPORTANT.

1516
00:59:10,200 --> 00:59:12,240
ALL THE MOST ELEGANT SCIENCE IN

1517
00:59:12,240 --> 00:59:14,080
THE WORLD IS FAR LESS VALUABLE

1518
00:59:14,080 --> 00:59:15,960
IF PEOPLE DON'T BELIEVE IT.

1519
00:59:15,960 --> 00:59:18,120
I THINK UNLESS WE ENGAGE PEOPLE

1520
00:59:18,120 --> 00:59:20,200
AND BRING CLINICAL TRIALS AND

1521
00:59:20,200 --> 00:59:22,800
REALLY TAKE THEIR INPUT TO

1522
00:59:22,800 --> 00:59:24,440
HEART, I THINK THAT OUR SCIENCE

1523
00:59:24,440 --> 00:59:26,240
IS GOING TO BE MUCH LESS

1524
00:59:26,240 --> 00:59:27,680
IMPACTFUL THAN IT OTHERWISE

1525
00:59:27,680 --> 00:59:28,120
WOULD.

1526
00:59:28,120 --> 00:59:29,840
>> I THINK THAT'S AN EXTREMELY

1527
00:59:29,840 --> 00:59:31,200
GOOD MESSAGE AND A GOOD WAY TO

1528
00:59:31,200 --> 00:59:32,600
END THIS GREAT TALK.

1529
00:59:32,600 --> 00:59:34,160
THANK YOU SO MUCH, SALLY.

1530
00:59:34,160 --> 00:59:35,760
WE APPRECIATE ALL THE WORK YOU

1531
00:59:35,760 --> 00:59:37,280
AND YOUR COLLEAGUES HAVE DONE.

1532
00:59:37,280 --> 00:59:38,840
AND APPRECIATE YOU FOR GIVING

1533
00:59:38,840 --> 00:59:40,160
THIS TALK FOR US.

1534
00:59:40,160 --> 00:59:41,000
THANK YOU VERY MUCH.

1535
00:59:41,000 --> 00:00:00,000
>> THANK YOU.