Fr. Tom Soroka: This is Fr. Tom Soroka, and I’m so glad that you’re with us this evening. We’ll be taking your calls in a bit at 1-855-AF-RADIO; that’s 1-855-237-2346. John will be answering your calls tonight, so please make sure to turn the show volume off before you come on air. You can also join us in the chatroom, which is now open, by going to ancientfaith.com/live. Another way to connect with us is to go to facebook.com/ancientfaithtoday, and place your question in the thread for tonight’s show. You can also send us an email at aft@ancientfaith.com, and remember also that our show is being simulcast live weekly on both the AF Facebook and YouTube pages. So let’s get started.

It’s been almost three months since the coronavirus outbreak has been designated as a pandemic, though we know now that it’s been wreaking havoc on various parts of the world for quite a much longer time. Over these months, which for many of us have seemed excessively lengthy, we’ve tried to carry on with our lives through the restrictions of social distancing; closed businesses, schools, and churches; mask-wearing; repeated hand-washing; unprecedented unemployment for many; and sheltering in our homes.

When this pandemic began, we hosted a special Saturday pop-up edition of Ancient Faith Today with Dr. Peter Pappas, and we’re extremely fortunate to have him here again with us this evening as we begin the slow movement toward reopening our communities, our businesses, and our churches amidst still many unknown factors.

Dr. Peter Pappas is Professor of Medicine in the Division of Infectious Diseases and Tinsley-Harrison clinical scholar, the Department of Medicine, at the University of Alabama at Birmingham. After graduating Phi Beta Kappa from UAB, he completed his internship and residency training at the University of Washington in Seattle, Washington, where he also completed a fellowship in infectious diseases. Dr. Pappas is the co-author and author of numerous abstracts presented at national and international congresses, and he’s a fellow of the American College of Physicians. That’s actually I think about one-tenth of his amazing Vita and biography. So, Dr. Peter Pappas, welcome back to Ancient Faith Today. Christ is risen!

Dr. Peter Pappas: Truly he is risen. Thank you, Fr. Tom, for having me back.

Fr. Tom: Obviously, you had a big impact on our show when you agreed to come on, and a lot has happened since then. I can’t think of anybody better to guide us through this conversation, because there are so many questions that we still have. The first question is really about you. Tell us how you’re doing and how your family’s doing. How has it been for you these last three months?

Dr. Pappas: Well, thank you for asking. When we spoke, it was as we were leaving Montana. If you remember, we were in the airport coming back from a vacation with one of our boys. Rather than going back to West Point, he had to fly home with us, because West Point closed at that time. So the world, for us, in terms of the kids and other respects, really just kind of turned upside-down.

Really, when I came back to Birmingham that Monday morning and we just hit the ground running, the hospital and our division had already started working on a COVID emergency plan. The hospital was very forward-thinking. We became very quickly the center for COVID care in the state and then the region. Of course, a lot of research studies sprung out of that and are still going on, because even with all the warnings and all the publicity, our numbers have continued to climb. It’s really just a reflection of the seriousness or, as the prayer says, the indifference of people who just choose not to pay any attention to the warnings, even just simple types of things.

For me personally, it was a difficult first month, from the middle of April—really from Holy Week forward. I have not been involved as much with patients as I was the first month. We’re basically catching up on research, and starting in June again I’ll be back on servicing patients every day. But we’re doing well. We’re doing well. Thank you.

Fr. Tom: I see. Thank God. May I ask: Have you treated patients with COVID-19?

Dr. Pappas: Yes. It’s kind of hard to avoid. Of course, we see everybody in the hospital. When you’re talking about our medical center; it’s 1200 beds, and about 100 of those are devoted to COVID patients. But there’s still 900 or 1000 or 1100 other patients. Even when a hospital was emptying out, the lowest we ever got was about 50%, which is still about 5-600 patients, so still a lot of need. The transplant patients continue to get sick, we still have patients with HIV, and so forth. So, yes, taking care of COVID patients really is largely the domain of the intensivists, the pulmonologists, the respiratory specialists, and so forth. We get involved directly in the care when these patients develop complications. I think since that time I think I’ve seen 50 patients with COVID in various stages.

Fr. Tom: Wow. Are you seeing any similarities between them in terms of… We’ve been reading a lot, and obviously speaking from a lay point of view, there’s a lot of reporting about these blood clots and inflammation filling the lungs. Does that seem to be the main culprit here, the main result of the virus?

Dr. Pappas: Yes, it’s one of the things that leads to death, mortality and morbidity. So it’s really… The host inflammation, that is, what the individual, how they respond, oftentimes that really dictates how well or how poorly they do. It’s been kind of interesting that some of the patients who have done the best have been individuals like, let’s say, a transplant patient, who’ve become sick with COVID, but then doesn’t really go into respiratory failure and so forth, and the only explanation is: they’re already on a lot of these medications that inhibit inflammation. I don’t think we’ve had a single transplant patient die in this COVID epidemic, and part of it of course is that they’re sequestered and are staying at home, but the other part is, when they do become ill, they seem to have done pretty well.

I think that people who are normal hosts, I think a lot of us walk around feeling like we’re invulnerable to this, that this is only going to affect and really kill the super-vulnerable, but that hasn’t been our experience at all. We’ve seen young and old die from this alike.

Fr. Tom: But haven’t these statistics shown that the great majority of the— and I’m not disagreeing with you, I’m just asking for clarification here. The statistics seem to show overall that the greatest number of deaths are happening in the over-65 category. So, for instance, in Pennsylvania, the vast majority of the deaths have been—I don’t think we have any deaths under 30 at all. That’s not to say it’s not serious, but it seems that those who are older, because they maybe have more co-morbidities, succumb to this faster. Is that what’s happening?

Dr. Pappas: Oh, no, that’s true. There’s no question that that’s true in terms of mortality. But if you look at the individuals who are hospitalized or in the intensive care unit requiring ventilation, there are plenty of 30-year-olds. They just survive, whereas for an older person, especially someone in their 70s and 80s, that’s just a very difficult thing to tolerate: to be on a ventilator, to be on your back or on your stomach all the time. It’s just a really, really tough road to hoe. The younger person can endure organ failure far, far better than the older person. So when you start developing organ failure as a result of inflammation, either the lungs or the kidneys or both, and you’re an older person, you really have the odds stacked up against you for sure.

Fr. Tom: 1-855-AF-RADIO; that’s 1-855-237-2346. We’d love to hear your phone calls this evening, and we have Dr. Peter Pappas on with us. He’s an infectious disease specialist. Dr. Peter, we have a question in the chatroom from Ross. This is also… I doubt that you have much time or stomach to watch the news lately, but there are certain threads that happen a lot and come up a lot. So there’s this issue of the cause of death, and the idea that someone died from COVID. However, we know that with co-morbidities there are all kinds of factors there. So Ross was asking: How do medical examiners discern dying with COVID or dying from COVID?

Dr. Pappas: That’s a great question. Assigning the cause of mortality is really, really a tough thing under any circumstances, independent of COVID. The types of studies that we do, we often look at people with certain types of infections, and they die, let’s say, within 48 hours of developing that infection, and we commonly say that they died from that staph infection or that they die actually from their renal failure or their respiratory failure. In a sense, we all die sort of with these complications.

When a person dies with COVID, technically they’re dying really as a result of renal failure or sepsis or maybe a clotting disorder, maybe renal failure. It’s really a combination of things; it’s really multiple systems shutting down simultaneously that ultimately leads to death. The infection, it maybe the direct cause, the proximate cause, but it might have been the triggering event. At some point, it’s kind of splitting hairs. As far as a medical examiner, they will, if you read the reports, they’re going to say things like, “The patient had severe lung injury, severe kidney injury, and we also found particles of COVID in their bloodstream or in their lungs,” so that was the triggering event. And you just kind of to draw one’s own definitions of how do you determine causality. I’m giving a vague answer because it’s a vague science; it’s a really vague science.

Fr. Tom: Yeah, and I think that the problem is that a lot of us are watching the news, and you see this ticker on the news that says, “Okay, we have 30,000 deaths, and then it’s 40,000; 50,000; 60,000—97,000 deaths now.” From the lay person’s point of view, it basically is sending a message: If I get COVID, I’m going to be a statistic; I’m going to die. So the ticker doesn’t discern whether, like you said, these are… There’s splitting hairs here, but the ticker is just saying they got COVID and they died. But the answer is not that simple, right?

Dr. Pappas: No, it’s not, but again I think if you look at COVID, and among those people that have died, COVID was the trigger. For the other 95% or 96% who survived, they either had no symptoms, they endured it, were able to fight it off, or their system failure didn’t lead them to death. I think it’s interpreting it way too liberally to say that if you get a COVID infection you’re going to die. The vast, vast majority of people survive with this infection.

Fr. Tom: Right. Okay, good. 1-855-AF-RADIO; that’s 1-855-237-2346. Obviously, you’re involved in both sides of this, as you said at the beginning. You’re involved in the research side; you are involved in the patient care side. And I assume you’re reading up on the latest work that’s being done about COVID and how it’s treated and how it progresses. So can you summarize for us, now that it is May 26, three months later, what has the medical community actually learned about COVID-19? How is this disease particularly unique? How is it different from just getting the flu or from a typical coronavirus cold or something like that? What are we learning at this particular point?

Dr. Pappas: Some of these points we talked about before, and while I’m not a virologist and I’m certainly not a genius, some of what I’ve said is still true. The main thing here is transmissibility and impact on mortality. The transmissibility is unlike flu in that it seems to be far more easily transmissible than flu. Let me give you an example, the best example that I’ve seen recently. CDC described an outbreak in Skagit County, Washington, which is north of Seattle, I believe. One evening, 61 people in a church choir got together to practice. There was one person— This is in early March, so there’s no coordinated approach; everybody knew it was happening…

Fr. Tom: No social distancing or anything?

Dr. Pappas: Yeah, so they all convened. There’s one person who is symptomatic, who the next day goes and gets tested and has COVID. Out of that 61 people, 54 became infected. 54. Can you imagine a person with influenza showing up at a meeting and infecting more than just a handful of people around them? That’s kind of what you expect, and you’d say, “Oh, yeah, I stood next to Mary last night, and she was coughing, and we touched,” and blah blah blah, “and now three days later I’m sick.” 54 people, 86% became ill. 33 of them, I think, tested positive; the other three had an illness that was clinically compatible with it. Three died. They don’t give any details about the deaths, but you assume older, perhaps older choir members. But that’s just how transmissible this is. When you hear those types of stories and see the number of family members that we’ve seen who have had to come in and be hospitalized… Sometimes we’ve had husbands and wives in the same ICU, in adjacent beds: one doesn’t make it; the other does.

We don’t see that with influenza. It’s much more transmissible, and it really seems to be quite a bit more lethal. Again, the popular media would liken this unto flu, but flu doesn’t kill one, two, or three percent of the population that it infects; maybe one in a thousand, two in a thousand. But every day, each and every day since we last talked, we have new deaths from COVID. We’ve never seen that with influenza, never.

Fr. Tom: Is it more transmissible because we have no antibodies to it, and it’s an entirely new disease? Is that the point, or is it…? Because transmission… Again, I’m speaking as a lay person, so help me understand this. When I think of transmission, for instance, I watched the video yesterday on the news that showed there was an experiment about how far air droplets flow, when somebody coughs.

Dr. Pappas: What was it, ten feet?

Fr. Tom: Yeah, it was pretty far. It was like 12 feet, 15 feet. It takes 30 seconds to get there or something. But the point is a germ is a germ, and a virus is a virus, so when you say it’s highly transmissible, isn’t the case that when somebody has the flu and they’re at that choir rehearsal, the reason that people don’t get sick is because they have built up more of an immunity to it, or is that not correct?

Dr. Pappas: Well, it’s hard to discern which, but certainly there is no immunity, so everybody is vulnerable. That much is certainly true. How much of that impacts the fact that for every person with COVID, the R-factor, the number of people they infect, unchecked is about three or four, whereas with flu it’s one or one and a half. That’s why flu epidemics generally go away. But the fact that we’ve never seen this before certainly means that we’re all vulnerable at some point, unless we’ve been silently infected.

The other thing that makes this really sneaky—and I think we know this more now than when you and I last spoke—is that the viral carriage, that is, the amount of virus that you have in your throat and your nasopharynx, the upper part of your throat, is very, very high the day or two or three before you become ill. That’s why the asymptomatic person is so important. They’re carrying loads of virus in their nasopharynx and pharynx before they even develop fever. Maybe they have a little bit of a scratchy cough, and they start becoming sick. When they start becoming ill with fever and respiratory symptoms, it becomes increasingly difficult to isolate virus from their nasopharynx, and now you almost have to go down into the lungs to find it. That’s when all the coughing and all the aerosolization become important. You’ve got a lot of transmission that’s happening among people who are shedding millions of viruses unknowingly. That’s why the mask is important. That’s why the mask is so important.

Fr. Tom: Can I just ask you a question? You were talking about the nasal cavity. [Laughter] This might sound like a little bit of inside baseball, and I’m asking forgiveness of the listeners at this point. As I am a professionally trained singer and I have a degree in singing and voice and so forth, so I have learned the importance of keeping that cavity clean. I actually use—again, not to be too gross or too much information here—but I’ve used neti pots, I use this Naväge system, which I think is terrific. Do you think that would help people, if they did that every day, if they felt that they were around somebody and they could clean out their nasal passages? Would that be… at least provide some kind of effective prophylactic toward trying to get that out of your nasal cavity?

Dr. Pappas: No, I don’t think so, not unless you were flushing it with an anti-viral or something.

Fr. Tom: You’re bursting my bubble here.

Dr. Pappas: [Laughter] I’m so sorry. I’m a singer as well, and I’m going to have to try this neti pot business.

Fr. Tom: Oh, the neti pot is great, but get the Naväge. We’ll talk about it after the show. 1-855-AF-RADIO; that’s 1-855-237-2346. We’d love to hear from you. We have Dr. Peter Pappas.

Okay, Dr. Peter, there’s this fierce debate in the media about effective treatments, and we know that the president came out and said one thing, and then the news media came out and said, “No, that’s not it,” and then another news media said, “Yes, that’s it,” and now we’re hearing about a vaccine. Before we get to the vaccine part, let’s talk a little bit about treatments, because, again, as lay people, we don’t really know what’s going on in the hospital. There’s a sense that when you go into the hospital and you have COVID, nobody knows what to do. I assume that that is changing and that there would be some kind of treatments that are being tried and are maybe having more or less success. Even though it’s going to be over our heads a little bit, can you tell us a little bit about some of the treatments that are being used, especially those that are being successful?

Dr. Pappas: Sure. It’s not over your head at all. First things first, the hydroxychloroquine that the president was taking despite everybody calling for him to not take it or to quit taking it. The evidence supporting that is just really thin. The evidence against it is building. Honestly, I think at the very beginning people were mostly just hoping on hope that somehow that this agent, which is pretty plentiful and pretty cheap, was going to prevent the virus from entering the cell. But they didn’t take into account that it does have cardiac toxicity. So the most recent trial has been stopped because of cardiac toxicity. So the hydroxychloroquine, while it’s not been scientifically proven to be of no value, I think most people in the business don’t see it as a very important part of the armamentarium. Let’s put that aside.

The remdesivir, the trial that… That’s the drug that’s an anti-viral; it’s made by Gilead. I think that remdesivir has to be given IV. We participated in that trial; we enrolled lots of patients in that trial. I would say that remdesivir showed benefit: a slight improvement in overall mortality and a significant improvement in getting out of the hospital. But it’s wasn’t like penicillin treating meningitis. It was a step, and so I think what became clear and what has become clear is that maybe an anti-viral alone is not the answer. Maybe we can’t look at this as: “I’ve got a herpes or a shingles infection, and I need acyclovir,” which works. This is something where you not only have to inhibit the virus but also mitigate and slow down the inflammatory process.

The trial that we’re currently involved in and a number of centers—I’m sure University of Pittsburgh is involved in this; I have colleagues up there who are actively involved in the same types of studies we’re doing—the current design is remdesivir versus a biologic agent that inhibits inflammation, or just in a very focal sort of manner inhibits inflammation, and that’s compared to placebos. So you’ve got everybody getting remdesivir, and in a blinded fashion, half the patients getting an anti-inflammatory, the other half not getting it but they’re getting a placebo. That study really just started. I think they’re going to enroll about a thousand patients. I think enrollment right now in the first week, they’ve probably enrolled a hundred people. So I think enrollment right now should be over a hundred. That study will probably be complete enrolled in the next six or eight weeks, and we’ll have the answer to that study—

Fr. Tom: Is that what they call a double-blind study? Is that what that means?

Dr. Pappas: Yeah, it’s a double-blinded study. It’s a study where you sign onto that, you know you’re going to get remdesivir as the only proven effective agent, but you don’t know whether you’re going to get an anti-inflammatory or a placebo; neither you nor the investigator know that. So that’s what’s going on now in a large, multi-center double-blinded study that’s going to enroll, again, around a thousand patients. Numbers should not be a problem. It’s not going to be based on 20 or 50 patients; it’s going to be based on a huge end, a huge number of patients. And randomized and all with COVID. It should be the first step towards understanding if combination therapy, or dual therapy, like this is really important.

I’m not aware of any other anti-virals specifically right now that is right on the brink of being rolled out into a clinical trial. I’m sure there is one, but I’m just unaware of it right now. Right now, most of the science seems to be chasing how to abrogate the inflammatory response, which seems to be really, really what’s killing people.

Fr. Tom: Okay, very good.

Dr. Pappas: So that’s where we are.

Fr. Tom: In a way, it surprises me, but it must point to the mysteriousness of this disease, that so many doctors and researchers around the world are befuddled by this and are having difficulty trying to figure out what the best treatment is.

Also there was a question in the room asking if you have heard of sirolimus? I don’t know if that’s pronounced…

Dr. Pappas: Yeah, sirolimus. Si-ro-lee-mus, si-ro-lie-mus.

Fr. Tom: As a treatment for COVID.

Dr. Pappas: Yeah, it’s another. It’s a drug that we use primarily for organ rejection: prevention of organ rejection. It’s a drug that’s used largely in transplant recipients, liver, lung, heart, and kidney. It’s a very potent anti-rejection medication. That’s one of the many that people are touting that should be looked at. The problem is, there’s so many of those drugs, there’s so many of them compared to the anti-virals—there’s just a handful of anti-virals, and there are scores of these biologic agents, and then agents like sirolimus that need to be studied. But at that point, you don’t run out of patients so much as you run out of qualified investigators and qualified sites and centers that can actually do the study.

There certainly is interest in doing that. There is interest in doing just a simple remdesivir-plus-prednisone, which is a commonly used steroid, or dexamethasone.

Fr. Tom: For inflammation?

Dr. Pappas: Yeah, if you argue that inflammation is the problem, then why not prednisone? The really hot scientists would say you’re not being specific enough; you really need to retard information at this particular point, and so forth. But we won’t get into that.

Fr. Tom: One quick follow-up, because we want to go for our break here. And the follow-up is: What about the problem of cytokine storm with COVID?

Dr. Pappas: Cytokine storm, yeah. Cytokines, that is precisely… That is the cause of the inflammation. So the cytokine storm is what you’re trying to treat, what you’re trying to prevent by giving these biologic agents. One of the chief ones is something called IL-6, that’s Interleukin-6—we’re getting pretty technical here. These are small molecules that control inflammation, and if you control these cytokines, these small molecules, you control inflammation. Some of the agents that are being used are targeting molecules, like IL-6, and trying to inhibit it, trying to keep it from doing its thing, so that inflammation calms down.

Fr. Tom: We have the smartest listeners in the world; that’s why they’re asking you this.

Dr. Pappas: You must! [Laughter] You must!

Fr. Tom: All right. Let’s take a break. We’re talking to Dr. Peter Pappas about the coronavirus, three months later, where are we at. We’re going to take a 90-second break. We will be right back.

Fr. Tom: We’re back with Dr. Peter Pappas, and we’re talking about the coronavirus three months later. We’re getting updated on the latest research and the treatments and where we go from here. Dr. Peter, you presented a pretty bleak picture here in the first half of our program, and I want to make sure that I’m reading that correctly or that I’m maybe even reading between the lines of what you’re saying, because you said something to the effect of: This is highly infectious, we don’t have an immunity to it—and where does that go in terms of our regular life? There has been an economic catastrophe in our country from the shutting-down of businesses. It’s devastated many families. It’s really unprecedented.

Now, there seems to be a kind of a slowing down of the number of cases—we assume due to good care, we assume due to the social distancing—but even without a vaccine, states and communities are starting to slowly open up again, with certain measures. Is it inevitable that a second wave is coming?

Dr. Pappas: I really hate to be a pessimist about this, but I can only share with you what we’ve seen here in Alabama. I won’t mention names, but our governor has been very thoughtful. She was very open to listening to our state health officer, and much of her policy was driven by the advice she was getting from our institution, and it was very forward-thinking. But at some point, like in every state and every community, you reach a breaking point, where it’s like you have to open up. And that makes plenty of sense to me, but when you open up, people still have to follow the rules, and by that you mean maintain the social distancing, continue to wash your hands, wear a mask, do the things that are just common sense that’ll really slow down transmission, because we have no idea whether this is… I mean, it’s clearly going to go through the summer; the question is: Are we going to have a second peak, or does this ever really go away, until… We’re talking about it like it’s going to go away in the summer.

Fr. Tom: That’s the real question.

Dr. Pappas: Is it going to go away in the summer? If you live here…

Fr. Tom: Or is it going to go away at all?

Dr. Pappas: Yeah, I mean, if you lived here, and in many states in the union right now… I was looking at one of the news channels that 18 states have increases since opening up, and we’re one of them. Is it ever going to really burn out until everyone or the majority of people have seen it? I don’t know, but I think that economics being what they are… I was telling my wife, this is the great ethical dilemma of our time. What are we… Do we value economics over lives and health?

Fr. Tom: Right.

Dr. Pappas: It kind of has come down to that, but you realize also that it’s not just a callousness. There’s a need for people to get back to work, to go to places of worship. The way we’ve been living is unnatural. But there are ways forward, provided that individuals are willing to abide by certain restrictions, and that is staying out of packed crowds. Again, handwashing, the masking, that sort of thing. Those are still really, really important, and probably the most important things that we can do.

Sadly, we’re getting a very dual image of this. I don’t want to get too political, but if you’re on one side of the aisle, you wear a mask; if you’re on the other, you don’t, because “this is all a hoax” or whatever, and we really need to be of one mind about this, because until we [are], it’s going to be really difficult. We’re going to be fighting against each other as to whether this is real and whether transmission is important, or do we just say, “The heck with it!” go great guns ahead, and let the chips fall as they may. Personally, I really don’t like that idea. I don’t care for that option.

Fr. Tom: Yeah. But it’s like you said, there is this ethical dilemma, because the other part of it is economic collapse and all of the result of that, so you have poverty, you have people that are unemployed, you have people that are worried about their jobs, suicides… We are hearing about spousal abuse, the rise in spousal abuse and child abuse. So it’s a tough thing. I agree with you. I don’t think, honestly, that there are that many people that are saying, at this point this is a media-controlled hoax or the New World Order or whatever it is. There’s always going to be that fringe out there, but I think even from—and I’ll just say it—kind of the conservative point of view, there’s more of a leaning toward the economic result of this as opposed to purely “everybody needs to shelter in place indefinitely,” which seems to be the other side of the aisle of that.

Dr. Pappas: And there obviously needs to be a balance. There absolutely has to be a balance, but that’s the key, is balance. Balance becomes really the key. It’s quite possible to go on about your business, to go on about doing the things that we ordinarily do, in an altered manner, so that we can, in some semblance, move on about our lives, and gradually returning to normalcy. I don’t know when that normal will be. I’m a college football fan. It’s going to kill me that we can’t go to Tuscaloosa and sit with 100,000 people yelling, “Roll Tide!” But that would be really foolish. That becomes a game of Russian roulette, and it’s one that I’m not willing to play with anybody.

Fr. Tom: Sure. Well, that brings us to the most important thing for Orthodox Christians to consider, and that is bishops are slowly and very cautiously beginning to open their churches. Many of the jurisdictions had entirely closed or had only been having services with the priest and the cantor. So now churches are starting to open up, I would say almost all of them are asking that people wear masks and people socially distance. There is the issue of singing that has been a hot topic lately. So let’s talk a little bit about that, because—and I don’t want to mention her name; I’ll just say H—in the chatroom, and the reason why is she’s saying something a little sensitive here. It says:

My parish in Pennsylvania is resuming services in the coming weeks without masks, without distancing, and with an 8-10 person choir in a small church. In our region, the COVID cases are low. I want to be obedient to our bishop and attend the services, but I’m feeling concerned, especially in singing in the choir. Can you offer any reassurances from a medical perspective to help me overcome my concerns?

Before you answer that, Dr. Peter, I want to say, H, that I am surprised, because I don’t know of any bishops that are permitting no masks, no social distancing. I really am not aware of that. But go ahead, Dr. Peter, and let’s address that first, and just be honest about it.

Dr. Pappas: I will.

Fr. Tom: And let’s talk about the general idea of re-opening our churches and what we need to look at.

Dr. Pappas: Sure. Well, first of all, I am in favor of opening churches in a sensible manner. What’s being described by the caller or by the questioner doesn’t sound real reasonable to me.

Fr. Tom: To me either.

Dr. Pappas: And I’m not… It’s really not trying to criticize anybody, but I don’t think we want to make going to church or taking communion a test of faith. We want everybody to be as comfortable as they can be. There’s going to be a similar issue in the Greek Orthodox Church about the common cup and the common spoon, and how comfortable are you using the common spoon in a congregation where maybe a hundred people are in the congregation, and statistically two or three of those people are carrying COVID in the backs of their throats? So is that something that makes you comfortable? It raises a lot of theological, but also a lot of scientific, questions.

Fr. Tom: Sure.

Dr. Pappas: So I think that the concerns that H brings up are legitimate. I think that… Again, I hate to see us placed in a position where going to church alone, the simple act of going to church, or taking communion becomes in and of itself a test of your faith—not an act of faith, but just kind of a test of your faith.

Fr. Tom: Oh, I agree with you. From a theological standpoint, I agree with you 100%, and I’ve said all along—and I don’t really care who criticizes me—I’m not going to use the spoon as a test of someone’s faith. You hit the nail right on the head. To frame the question in that way is really a sign of immaturity, to say that you have to take from the spoon. That makes us no better than snake-handlers, who say, “You’ve got to pick up the snake because you have to trust God that you’re not going to get bit.” That’s absurd, and that is not our Orthodox teaching at all. So our bishops have been, I think… Some have taken one approach, for instance, with the spoon, some are having them clean the spoon so that you still have this idea of the single spoon. Others are having you use a separate spoon, which, again, is causing a stir. To me, it’s six of one, half a dozen or the other. Whether you’re cleaning the spoon each time or whether you’re using a separate spoon each time, there’s no difference here. It’s really kind of the same thing, and from a priest standpoint, to be cleaning the spoon all the time is just… It’s awkward, and you could spill something or knock the chalice over or whatever. So I am in favor of doing whatever is going to calm the weakest among us.

But let’s go back to H’s description here, and she says they’re doing it without masks, without social distancing, singing in a choir. And she’s saying that in their small location in Pennsylvania—let’s say the county, because the county is actually doing these things—the county has maybe ten cases. It’s out in the middle of nowhere and there’s not a lot of people, and they’re all spread out anyway because maybe they’re all farmers or something. She’s saying that’s what they’re going to do; is that wise? Because nobody has it here anyway.

Dr. Pappas: Right, well, I suppose that if you can prove that, if you can… Here again, I think one of the things that we’re doing here which makes sense because we have much more of it than this parishioner is seeing or experiencing, we’re going to be starting on Sunday. We’re going to be taking temperatures electronically. We’re limiting individuals to sitting in their family groups, and individuals will sit along certain areas. Of course, we have pews in our church, so the seating is in every other pew. Using those types of measures: masks, separation into family groups, screening individuals as they come in. Obviously, we’re not doing COVID testing as people walk in the door. Who can do that?

But even in a rural area, I would want to know: Do you really not have any? Do you really know that? Are these individuals going elsewhere to get their care? Is it just really not there? COVID’s making it into every little nook and cranny in the country, so it’s really kind of a matter of time before it reaches into that particular county or town. So it really makes sense to take these precautions. That’s how you remain safe. That’s how you remain a location where there is a low incidence of the disease: by taking the precautions and not ignoring the really common-sense type of precautions. That’s really my answer to that. I feel like that’s really going too far, in my opinion.

Fr. Tom: Yeah, I know it’s a sensitive issue, and people need to listen to their priests, but they also need to listen to their bishops. [Laughter] And the bishops have been pretty darn clear about this.

That brings up another issue; there’s actually two issues here. Number one, the idea of asymptomatic carriers of this virus: Do we have any idea, are there any statistics that are happening that are reliable to say: Do we know how many people who have had this virus? For instance, I will… for a total transparency here, I actually had a COVID test done; I had the antibody test done, excuse me. I had the antibody test done, and I didn’t have it. I know that’s not maybe 100% accurate, but I was going back to church, and I went to my doctor, and I said I want to see if I had this. I have many preexisting conditions: I have asthma; I have an immunity deficiency. I am very high likelihood, if I got it, I would really struggle. So how many people do we think, in terms of a percentage, in any given area, have it that are asymptomatic?

Dr. Pappas: Okay. We did a study. Again, this is going to be completely related to your location, but I will share with you the information that we have. People coming into the emergency room at the University of Alabama hospital who did not have COVID—they came in with trauma, they came in for gallbladder, you name it—if you subtract all the individuals who came out because they were concerned about COVID, and you take everybody else, because we’re doing COVID tests on everybody who walks in the hospital, so we have that data now. One percent. One percent in Birmingham, or Birmingham and the surrounding counties, are carrying COVID and they have no symptoms. So in a church of 300, there are three people…

Fr. Tom: That’s all?

Dr. Pappas: Well, in New York City, it’s sufficiently… I mean, three people are plenty, and in a crowded area, as I told you before, one person at choir practice infected 54 out of 61. So three people… Go ahead.

Fr. Tom: But I’m asking how many people had it. In other words, through the antibody testing…

Dr. Pappas: Oh, okay. So how many people… Right. So the asymptomatics are the people who are actually carrying the virus. The other piece of it—

Fr. Tom: So you’re saying that at any given moment, three percent of the people have it and they don’t know it. Statistically speaking, that’s what you found out.

Dr. Pappas: One. One percent.

Fr. Tom: Oh, one percent, excuse me. One percent of people.

Dr. Pappas: If you go to antibodies, there is much less data on that, but there was a small study out of New York City suggesting that somewhere around 15%—15%—of New Yorkers, New York City, had antibodies, which shows an enormous prevalence of the disease. I’m sure it’s not—it can’t be much higher anywhere else. But it’s unclear whether the antibody protects, so that’s really a big question. So you have antibodies. If it’s not protecting you from reinfection, or it’s not mitigating the effects of reinfection, then it may not be of much value. So nobody knows what to do with the antibody right now. There are a lot of false negatives, and that is people who were truly infected who don’t have antibodies or it’s just not measuring it. And no one knows whether it’s really protective or not. So right now the general feeling is that antibody testing is not ready for prime time. Virus testing is prime time., but the antibody testing itself is not ready for prime time.

Fr. Tom: Is there a relationship there between the antibody testing and the kind of not-being-ready-for-prime-time and the idea of a vaccine, because aren’t those two kind of related, that you’re taking that antibody and then developing that to create a vaccine?

Dr. Pappas: You’re not taking the antibody to develop the vaccine, but they’re related in a sense, because vaccine is a function of immunogenic, that is, how much immunity can a replica of this virus stimulate, and can it be protective. That’s really what a viral vaccine has to do. You have to take… either kill the virus or a virus that’s biologically manufactured to look like the virus, be modified in some way so that it’s not virulent, that it stimulates a really good, just really exuberant host response so that it’s protective. It’s not clear right now that natural infection necessarily does that. You would think that it would, or you would think that, like flu, it helps you to control it next time around so that if you get infected next year with a similar strain you have partial immunity.

Fr. Tom: Right. And those are always kind of hit and miss in terms of their protection.

Dr. Pappas: Yeah, they are, absolutely.

Fr. Tom: Do we have a… Are you familiar with the timeline for that vaccine? I know we’re seeing things on the news, and again it becomes a political football, but what’s a realistic time-frame do you think for that vaccine?

Dr. Pappas: If they’re lucky, if they’re really lucky, and vaccinologists—vaccine science is very tricky—but if they’re very lucky, maybe they’ll have one by the first of next year. Realistically, most people are thinking two to three years.

Fr. Tom: Wow.

Dr. Pappas: So, yeah, if they happen to go to the plate and hit a home run the first time out, or even a triple, or maybe even a single, so that you get some kind of partial protection… But these trials take time. The vaccine has to be not only effective, but first and foremost it has to be safe, and then you have to demonstrate effectiveness. The trials themselves just take months. So I am hopeful, and I would love to see something available in January, but the realistic part of me, the sane part of me, says, enh, two or three years probably.

Fr. Tom: Wow.

Dr. Pappas: I think that’s what most people are saying. I think that’s what most people are saying in the back rooms, that this is not going to be an easy solution.

Fr. Tom: Well, then, that… You’re answering my question, the next one. [Laughter] And there is some talk about a new normal, essentially saying that our way of life has been permanently or not temporarily altered by COVID-19. So while it is speculative, what are your views on the future regarding COVID and our lifestyles? Does history inform us at all about this, or is this just so unknown that for the foreseeable future in years, we’re looking at masks and social distancing?

Dr. Pappas: It’s hard to say. I think history informs us a bit, but this is not influenza. I’m not sure that we’re seeing the seasonality that we have expected to see with influenza. We might have seen that already, and here we are getting into summer and we’re still seeing thousands of cases every day. The only places that it’s going away are places where there has been really stringent adherence to social distancing and wearing masks and that kind of stuff, and that’s why it’s so important. I guess we just have to look at recent history to see what works.

As far as how far this goes, I don’t know, but I fully anticipate we’re going to see cases through the summer, and then in the wintertime, I don’t know that there’s anything specific about the wintertime other than people tend to congregate more in the winter, and that facilitates transmission. But I kind of expect that we’re going to see cases throughout the summer. I think we’re going to see the death toll rise. There doesn’t appear to be any slowing down in the death toll. We’re going to be at 100,000 in the next day or two. We can only hope and pray that this will take a turn-down, and we learn that if we want, if we really want to do without this virus, we will have to change our lifestyles for at least the foreseeable future until a vaccine is available. Until we learn that antibodies is really protective and so many people have been infected that we no longer have to worry about it because we all have this herd immunity.

I think we have the power to influence this. We really do; we really have the power to influence this. One way or another, we can do it.

Fr. Tom: So as we wrap this up, let’s go back to you personally. We started that way, and I want to go back to that. You’ve obviously been deeply involved in this. Are you learning any lessons about yourself in terms of the social distancing and the being apart from other people, in terms of your life in the Church—you are a devout Orthodox Christian—how has that been for you? I’ve had some medical professionals reach out to me and say, “I’m really struggling with this because I need the Church right now,” and that the Church is, obviously because of caution, saying, “You can’t come” or “You can’t have the sacraments, especially if you’ve been around COVID patients.” So tell us what’s on your heart these days and how you’re dealing with all this. What are you learning about yourself?

Dr. Pappas: I think that we’ve all learned how much human beings need one another. I think it’s a rare person who can live in a solitary type of environment. It really gives you great respect for the Fathers and the Mothers of the Church who, centuries ago or even now, choose to live these solitary lives. I think most humans are not meant to live that way. So thank God for our families. Our family has become closer, we’ve spent so much time together. I think we’ve found, like everyone, how much you need contact with other individuals. I’m not probably the right person to talk about this, because I’ve gone to work every day. I go to the hospital every day, so the only thing that’s different is that when I get home, we don’t… We haven’t been to a restaurant in months. We don’t hang out with our friends, and when we do we stand six feet from them.

Not only being Greek but being Southern, we touch each other. We hug; we hug people we don’t even know! We hug. We’re not like you northerners; we don’t keep people at arm’s length. [Laughter] We come up to total strangers and hug them and tell them that we love them. So personally, it’s been challenging.

The other thing that’s really not fair, especially for my wife who works at the church, is that I’m one of the psaltes. I’ve hardly missed a lenten service—I hardly missed an evening lenten service, let me clarify that. Until this last Sunday, I haven’t missed a Sunday. We just went out of town to visit our children and grandchildren.

Fr. Tom: Good for you.

Dr. Pappas: So I’ve been lucky. I’ve been able to go to church most every Sunday.

Fr. Tom: You’re actually going to the church physically?

Dr. Pappas: Well, as one of the psaltes. We’re allowed three psaltes, so I’m one of those. We are also blessed with several priests. So there are ten of us that are allowed in the church. There are three psaltes, usually three priests, someone in the altar, someone working the camera. We’ve got a great filming ability.

Fr. Tom: That’s great.

Dr. Pappas: We’ve just got tremendous videography. Then we’ve got a couple of PC members, and that’s ten, and that’s all the city or the state will allow us. But that’s going to change on Sunday, and we’re going to enact these new changes with allowing family groups. I don’t know that we’ve put a numerical limit, but it’s going to be somewhere… We’re going to have two services, and we’re going to allow 80 to 100 in each service.

Fr. Tom: Oh, wow. Yeah, we’re still at 25 here.

Dr. Pappas: Ours is a big community, but you know the state will allow us to do that, and I think that, provided that we have distancing and people wearing masks and we check their temperature and they’re not kissing icons and congregating with one another… We don’t have any coffee hour, which, again, is a huge problem with Southern Greeks.

Fr. Tom: Of course, for all of us.

Dr. Pappas: We just have to do without our coffee hour.

Fr. Tom: Yeah, all of us.

Dr. Pappas: But it’s been challenging. I’m really fortunate enough to be married to a wonderful woman who is just very, very devoted to the Church, and it just kind of kills her to see me going to church every Sunday and she has to stay behind.

Fr. Tom: Yeah, that’s hard.

Dr. Pappas: She watches our service, and then she watches another service… [Laughter] I think it’s pretty hard for her.

Fr. Tom: That’s what we’re getting. People are service-surfing now. They’re saying, “I like the singing at this church, I like the sermon at that church…”

Dr. Pappas: Yeah! [Laughter] It’s actually been funny. It’s three o’clock in the afternoon, I’m saying, “Okay, come on. Haven’t we had enough church already?” But anyway, she: “I really like this one!”

Fr. Tom: That’s great.

Dr. Pappas: It’s been challenging, but we’ve made the best of it. Like I say, I’ve been particularly blessed.

Fr. Tom: Well, stay safe.

Dr. Pappas: Thank you so much, Fr. Tom.

Fr. Tom: Thank you very much for all of your information. Honestly, you hit just the right tone, and it was very encouraging, although obviously we want to stay safe, but we also want God to just knock this virus out and get us back to normal.

Dr. Pappas: Absolutely.

Fr. Tom: I think everybody’s hungering for that. Dr. Pappas, thank you very, very much. I appreciate it very much.

Dr. Pappas: Thank you for having me again. God bless you.

Fr. Tom: God bless you. Thanks for everything you do.

Our many thanks to Dr. Peter Pappas for sharing his knowledge and his experience and his outlook with us. Thanks to John for engineering the program; for everybody in the chatroom; and for those who are listening online.

So we’re not completely out of danger yet, as Dr. Peter affirmed, but many leaders of our society, including the Church, are encouraging us to slowly and cautiously begin to return to our places of work, our worship, study, and socializing, but still with appropriate safety measures, like social distancing and wearing masks. We don’t know what the future holds, but history does show us that eventually this will end; we just don’t know when. Until then, just keep praying that God would be merciful to us, that he would send his angels to guard us, especially the elderly among us; that he would heal the sick and grant repose to the dead; that he would strengthen the medical community to serve those who are healing with patience, endurance, and clarity.

Also before we close tonight, we want to offer our condolences to the family of Fr. John Winfrey, a brother priest who did work with Ancient Faith Radio but also was in the Antiochian Archdiocese, who died suddenly of a heart attack today. So we want to express our deepest condolences to his family and to his parish.

That’s our show for tonight. Remember to like us on Facebook at facebook.com/ancientfaithtoday; share our program after it’s posted; give us your feedback and contact us with any ideas or topics that you might want to hear about. Join us next Tuesday for our next edition of Ancient Faith Today as we talk to the composers and performers of a musical work combining the Orthodox vespers service with the sounds of black gospel music. You won’t want to miss it. Good night, everybody.