In this episode, infectious disease expert Dr. Hans Osterholm joins me to talk about the 2019 H1N1 Pandemic and the lessons learned from the first year of the crisis. We talk about what mistakes were made, what was done right, and what we can do to prevent future pandemics like this from happening in the future. We also talk about how important it is to have a sense of humility in the face of so much information, and how important is it to understand what we know and don't know about a pandemic like the one we've had so far. This episode is a must-listen for anyone with an interest in infectious disease, public health, or public policy related to the pandemic. I hope you enjoy listening to this episode and that it inspires you to keep fighting the fight against the next pandemic! Thank you so much for listening and supporting this podcast. I appreciate your support and your continued support of infectious disease research, education, and public policy efforts. I can't wait to do more of this in the coming years. -Dr. Hans talks about the challenges we face, and why it's so important to have humility in our response to a crisis like this. Thanks again for listening, Hans, for being on the podcast, and thank you for being a good friend of the podcast. XOXOXO. Dr. Osterholser, Dr. John Hopkins and Dr. Bill McKinnon, for working so hard to make a difference in our lives and in our health care. . , and for all the work we do to make this podcast a better place for people everywhere. and for the people we can have a better day to live their best day to day, not just in the next day, and in their lives, and they deserve a better life . . . and we're all of us have a chance to be a part of the next one. , not just a better one, and we don't have to wait for the next episode, but a day to do it, and the day to remember the day, so we can be a day like that, and a day that's coming, so they can do it thank you all of their day to be there, and so on, and more of them thanks you, thank you, Thank you for listening to us, and thanks for being here, and
00:00:16.000It's been basically two years from the day.
00:00:19.000And I think when you were on the podcast, for a lot of my friends, that was the first real fear that they felt about the pandemic.
00:00:28.000You scared the shit out of a lot of people.
00:00:30.000Well, you know, my job is not to scare anyone out of their wits.
00:00:33.000It's to scare them into their wits and to do what they can to deal with the situation.
00:00:38.000As you know, at that time, March 10th of 2020, no one wanted to believe this was going to be a pandemic.
00:00:44.000Yeah, there was a lot of denial about how it was going to play out, and people were thinking that it was inflated or it was not that big of a deal.
00:00:53.000And then, like I said, when you came on the podcast, I got a bunch of calls from friends going, Jesus.
00:01:01.000Yeah, I think the understanding of where we've been, where we're at, and where we're going still I think isn't really completely clear.
00:01:07.000Where we're going in particular, right?
00:01:09.000Now, as an infectious disease expert, it's very rare that you have an opportunity during your lifetime, during your career, to examine a pandemic and to be through it and examine the responses to the pandemic.
00:01:27.000When you look back at it, what mistakes do you think were made and what do you think was done correctly?
00:01:37.000Well, first of all, let me just say that one of the things I think that's been missing from a lot of the response that we've had so far is an incredible sense of humility.
00:01:48.000Every day when I get up, the first thing I do is I look over at my nightstand and I see this crystal wall that has five inches of caked mud on it.
00:01:57.000And I try to scrape it off and then decide, what do I know for the rest of the day?
00:02:01.000And I think that we've had far too many answers before we really had the answers.
00:02:06.000And while we always want to use that term, quote, follow the science, I think we didn't do a good job sharing with the public and even within ourselves, what did we really know and not know?
00:02:16.000And what did we have to do to learn more?
00:02:24.000Is there a reason why they didn't do a good job sharing the information with the public?
00:02:29.000And do you think that some of that might be just the fact that being involved in something that has such a massive footprint, something that literally overwhelmed the entire planet Earth, that there's so many variables,
00:02:44.000there's so many things to deal with, there's so many things to manage, that that became part of the problem?
00:02:51.000Well, you know, Joe, I think that if I had to look at it, there were days that I felt like I was trying to plant my petunias in a Category 5 hurricane.
00:02:59.000I mean, it was just one of those situations where there was so much going on.
00:03:08.000They often weren't really about the substantive issues of what was happening.
00:03:12.000And so we had a lot of these counter-current issues, and the question was, what do we really know or not know about this virus?
00:03:19.000I mean, I'm sure there are people after I'm on here today that are not going to be happy at all with what I have to say, because I don't think we're done yet.
00:03:26.000And as I said a year ago, right now, a year ago right now, when the world was basically seeing the curve come down from that early January peak, And the vaccines were flowing that we were done.
00:03:37.000Everyone wanted to declare independence from COVID. And I said, no, I think the darkest days of the pandemic could still be ahead of us because of variants.
00:03:45.000These variants are really challenging.
00:03:48.000We don't know what they're going to do.
00:03:49.000They're kind of like 10-mile-an-hour curveballs.
00:03:53.000And so I think that even going forward, we surely are at a better place right now.
00:03:57.000And we're going to be this for a while.
00:04:00.000But I don't know what the next variant is going to bring.
00:04:04.000Will it mean that the antibody, the immune response we've had so far, the vaccine protection we've had so far, what will it be like with the next variant?
00:04:16.000Maybe we're going to see it become a regular old flu-like illness every year, but maybe not.
00:04:21.000And I think that that's the challenge we have is that kind of humility to say we don't know.
00:04:27.000And that's what's been a real problem, trying to help the public understand it, because we've had far too many answers when we really didn't.
00:04:33.000There's an inclination to think that because Omicron is so much more mild than Delta, that this is where the direction of the virus is going.
00:04:43.000That is the sense, but there's a couple of assumptions there that I think really deserve comment.
00:04:48.000Number one, The term, it's a milder disease, was really unfortunate in the sense that it gave everybody the sense that across the population, it's a milder disease.
00:04:59.000If you actually look at what happened, let's say you had a thousand cases of Delta, and a hundred of them would show up in the hospitals, have severe illness, and die.
00:05:46.000But, you know, we're in a very amazing place right now with a virus where when you look at its original source from a human to another human early on in Wuhan, but, you know, it had to come from an animal at some point.
00:06:02.000Well, now we're seeing all kinds of animal species infected with this virus.
00:06:06.000Look at what's doing with white-tailed deer.
00:06:07.000I mean, in my 46 years in the business, I've never seen data like I've watched the emergence of this new variant in wild deer.
00:06:20.000Well, in fact, even if you look at studies like in Iowa, where they followed it and actually looked roadkill deer, so that it was really random across the state, they actually found looking for the actual virus, which was a Delta-like virus, that it actually paralleled the exact experience in humans.
00:06:35.000So as the numbers in humans went way up, the number in deer went way up.
00:06:45.000I think it's something because it's statewide.
00:06:48.000Even where you don't have captive cervids, they were seeing the same increase and decrease in cases.
00:06:52.000So I think what it's really pointing out though is that if you look at all the other animal species that get infected, and then you look at the potential for humans to continue to get infected, I don't know what the next variant is going to bring.
00:07:17.000On the other hand, it may re-assort, meaning that it swaps out its genetic material like a flu virus does with other coronaviruses, and we could see a new punch.
00:07:26.000It could actually evade immune protection.
00:08:11.000Now, when you say that, maybe, you know, whatever numbers that you used, that it's less likely to cause hospitalization, but because it's infecting so many people, you actually get more hospitalizations.
00:08:34.000We do know a couple of things about protection.
00:08:37.000Number one is if you've been vaccinated, particularly if you've had the third dose, if you've previously been infected, which also does add to your immunity, clearly, Those obviously work in your favor.
00:08:50.000If you have some of these underlying health issues that we've talked about, which, you know, it's not just about being in shape or not.
00:08:56.000You know, people with diabetes, people with asthma, people who are immunosuppressed.
00:09:00.000There are 7.5 million Americans right now that are immunosuppressed either because of the disease they have, they're being treated for cancer, All those people are at much higher risk of having severe illness.
00:09:11.000And even what we saw with kids, we had never seen this level of activity as we see all with Omicron with kids.
00:09:19.000And so I think the challenge we have today is...
00:09:51.000If you look at it right now, just through this up till this past month, with most of this activity having been primarily in the last six weeks, 1,334 kids between the ages of 0 and 17 have died from COVID. 1,334 kids.
00:10:08.000And out of these kids, how many had comorbidities?
00:10:46.000Because it seems like for adults, the effect that it has on the general population, it seems that the consensus is that it's more mild.
00:10:55.000Yeah, I think that's one of the challenges we have.
00:10:58.000If you've known the COVID-19 pandemic in 2020, and you knew it in 2021, doesn't mean how well you know it today, because things have changed.
00:11:10.000For example, if you look at the infectiousness in kids, the early data we had on how well this virus transmits in kids was before we ever had the Alpha variant, which showed up in roughly December of 2020 into January 2021. And we found limited transmission in kids,
00:11:37.000Then Delta came and added even more transmission with kids than we'd seen before, and Omicron was the king.
00:11:43.000And so I think if you knew COVID-19 back in 2020, you didn't necessarily know it today in terms of the infectiousness and what we saw happen.
00:11:53.000So I think that's one of the challenges we have, is just keeping up to date on what it did and how it did it with kids.
00:11:59.000And the variants as they, like, so there's the original version and the alpha version is the first variant that was discovered?
00:12:18.000Well, what's really interesting with this virus is the fact that if you look at what we call the ancestral variant, the one that originated in Wuhan, All the subsequent variants we've seen have actually all gone back in their roots or in that ancestral variant.
00:12:33.000It doesn't mean that if you had Alpha, it turns into Delta.
00:12:36.000With a little bit more changes, it turns into Omicron.
00:12:39.000Every one of them have a distinct line back to the original variant.
00:12:43.000And that's one of the challenges we have because that's going to continue to happen, where we're going to continue to see these new variants show up.
00:12:50.000And as far as the variants that are in play right now, like what percentage of the infections right now are Omicron?
00:14:02.000So we don't know what that's going to mean in terms of seeing more of the BA2 variant emerge.
00:14:11.000How do they make the distinction between Delta, Omicron, and then BA1, BA2? Why do they decide that this isn't another variant?
00:14:19.000Why do they just keep calling it Omicron?
00:14:22.000Yeah, and this is one of those questions where clearly I'm not the world's expert on the overall genetics of this virus, but I'll tell you that The mutations that occur surely can accumulate.
00:14:35.000If you look right now, for example, there's more difference genetically between BA1 and BA2 than there is between the ancestral virus and alpha.
00:14:44.000So it has to do pretty much how it evolved out of that ancestral virus tree, and is it different enough?
00:14:50.000And so, you know, there's been discussion that there may actually be some effort made to consider BA2 as a new variant of concern by itself.
00:14:59.000But this is, I think, the message here is this is what we have to continue to be mindful of.
00:15:04.000I know everybody wants me to say today we're done, and I hope we're done.
00:15:09.000But as I said just a moment ago, hope's not a strategy.
00:15:12.000I think that we could still see the emergence of new variants that could challenge the immunity that we have already, which is what makes this virus so difficult and so different than we've had before.
00:15:23.000When you see influenza, Pandemic influence occurs because a bird virus finally evolves out of the bird, gets into particularly a pig because a pig has a lung that has receptor cells for both human viruses and bird viruses.
00:15:36.000And when they get into a pig cell in particular, they combine, they mix up.
00:15:41.000The flu viruses are very promiscuous and they come up with this brand new strain that causes the next pandemic.
00:15:46.000Well, when that spillover occurs into humans, that's kind of the seminal event.
00:15:51.000The rest of it emerges pretty much in humans.
00:15:53.000We don't necessarily see us giving it back to the animals.
00:16:47.000I think there's a whole number of animal species where, ultimately, they could be infected with this virus.
00:16:52.000And the trillion-dollar question, we don't know.
00:16:55.000Will that, in any way, shape, or form, contribute to a spillback moment into humans with a new virus that, again, will challenge our immune systems, challenge our protection, and what does that mean?
00:17:22.000It doesn't keep going in the animal population.
00:17:24.000But as we just talked about the white-tailed deer, clearly there the virus is ongoing with transmission in the deer population itself.
00:17:31.000Are there any examples of an animal being infected and then like from a human, like a human giving it to their cat, for instance, and then the cat giving it to another human?
00:17:44.000And when I say unclear, there was surely some data looking at the game farms where it was thought that some of the transmission was from human to animal, animal back to human.
00:17:52.000When you say game farms, are you talking about like captive COVID? In this case, what we're talking about are primarily fur-bearing animals for pelts.
00:18:01.000The mink, ferrets, that type of animal species.
00:18:05.000So that's where they first started to see the transmission?
00:18:25.000So I don't think we have any good examples of a human to an animal and an animal back to a human.
00:18:31.000There was a recent outbreak in Hong Kong.
00:18:33.000It's now emerged into a large outbreak where they thought that hamsters were potentially being sold and pet stores were involved with Being infected and transmitting.
00:18:42.000But I think the data still are out on, did the hamsters really transmit back to people?
00:18:46.000They were definitely infected, but I don't know if they transmitted back to people.
00:18:50.000Now, this virus, are there parallels to other viruses that we could look to and see this kind of similar pattern emerging, particularly with, like, transmitting it into these other animals and then the potential of these animals transmitting it into the people?
00:19:06.000It seems like there's so many different species that have it.
00:19:10.000You know, we really don't have one like this, particularly, that can cause such widespread disease.
00:19:16.000I mean, when you think about Omicron, for example, you know, when this first emerged in November, I coined the term a viral blizzard, because to me, that's what it looked like it was going to be.
00:19:27.000If you look at Alpha and Delta and all these others, it took weeks, in some cases months, Before it spread around the world.
00:19:34.000This one spread around the world literally overnight.
00:19:37.000And, you know, we're now seeing major activity in the Western Pacific region, you know, in Hong Kong, likely in China, we're not hearing enough about it, Korea, etc.
00:19:47.000But most of the rest of the world's already been hit hard and over it.
00:19:51.000Well, that is like a blizzard, what it did.
00:19:53.000We've not seen that with any other animal-related virus in humans.
00:19:57.000Even influenza hasn't done what Omicron's done in that way.
00:20:02.000Now, in the beginning of the pandemic, you were of the opinion that this was from a natural spillover, from the origin of SARS-CoV-2 was most likely from an animal that it spilled over into human beings.
00:20:24.000Well, again, let me clarify what I said and have maintained all along because I, too, have concerns about the potential for what we call gain-of-function or clearly biosecurity of laboratories leaking out of labs.
00:20:39.000I have not seen any evidence at all that would support that, number one, this was a man-made virus.
00:20:50.000And I, again, with my limited expertise in viral genetics, I believe the people who I work with.
00:20:55.000Now, the question is, could it, however, been in that lab and spilled out because somebody got infected, there was a lab accident, which surely can happen.
00:21:04.000And again, we don't have any conclusive evidence that that happened.
00:21:09.000I think even anecdotal evidence we've had has been very short.
00:21:12.000But I'm the first one to say, I wish we'd had a much more exhaustive investigation into what happened at that laboratory, which much more transparency.
00:21:22.000I don't think we've had that kind of a transparent investigation yet.
00:21:26.000To see, were there sick people at that time?
00:21:28.000Because if it was going to spread out into the population, there would be sick people.
00:21:32.000On the other hand, I'm not surprised that it might have emerged in Wuhan, because here's an area of over 40 million people living in that whole area, for which their food sources come from hundreds to up to a thousand miles away, of which the open markets there are ripe with the kind of animals that very well could have brought the virus there.
00:21:51.000And when you look now at the ease at which this virus goes between animals and humans, at least initially, or humans or back to animals, it's not surprising that it might have emerged there.
00:22:02.000And so I am still open to the fact that was it a laboratory accident?
00:22:07.000I don't have any reason to believe it was an intentional one.
00:22:10.000I know it was based on everything we have.
00:23:26.000And so if that were the case, imagine the Russians and the Chinese saying, wait a minute, this was a lab leak out of CDC. We want to come and investigate.
00:23:37.000Do you think the U.S. would just willy-nilly open up the lab at the CDC to the Russians and the Chinese?
00:23:42.000So in some ways, I'm not being sympathetic at all to the Chinese because I think they are continuing to make the problem worse by not providing more transparency.
00:23:51.000But at the same time, if the same thing happened in the United States, I could see where we wouldn't just open up the CDC to everybody in the world to say, okay, come on in and look.
00:23:59.000Right, but is the CDC doing gain-of-function research on coronaviruses?
00:24:04.000Well, so if something emerged from there that wasn't something they were working on, that would probably not arouse the suspicion of the world.
00:24:13.000I think part of the problem with what's going on in Wuhan was that lab is a level four lab that was working on No, you're absolutely right about that.
00:24:23.000But at the same time, CDC might be working on a lot of the viruses that would emerge in the Caribbean.
00:24:28.000And they would have labs that were working on that because some of their best expertise is on, for example, mosquito-borne viruses in there.
00:24:35.000So I'm merely pointing out that it's not just the fact that the Chinese have basically stonewalled us.
00:25:05.000You know, the viruses they have, what they've self-reported, were not any that were...
00:25:11.000Close to this one in terms of actually, yeah, that actual virus was in the lab that was suddenly found in Wuhan.
00:25:17.000So I think it continues to be a major distraction.
00:25:20.000Wasn't there recently a version of the virus that was discovered, a very early version of COVID-19 in one of the labs?
00:25:29.000There's been a number of SARS-CoV-2-like viruses there, but again, this is out of my area of expertise, but the viral genesis I know would say there surely is not the direct link yet that that virus came from that virus in the lab.
00:25:45.000And so I think that, but that's the kind of thing we need to have the transparency on, and I wish we'd move on.
00:26:03.000And I do see a virus that right now sure is very effective at moving between people to animals.
00:26:09.000So it doesn't surprise me that it could move from animals to humans.
00:26:13.000Now, the people that are suspicious that this did come from some gain-of-function research, they point to that as an indicator that this is a virus that was at least cultivated in a laboratory, right?
00:26:29.000And let me just come back and add a context to this.
00:26:31.000I sat for a number of years on what was the newly established virus.
00:26:36.000This basic group inside of the federal government to look at biosafety and biosecurity work, okay, the national science group that did that.
00:26:45.000And, you know, for all the years from 2005 to 2012 that I was on that, I was one of the really outspoken people about my concern about doing influenza work in labs where they were trying to understand We're good to
00:27:55.000There is some anecdotal evidence, right?
00:27:58.000I believe there was three researchers at the Wuhan lab who did get ill with a very similar disease to COVID-19 and one of their spouses wound up dying and there was some indication that that could have been the initial source.
00:28:56.000In the early days, there was some evidence that Was deleted.
00:29:02.000There was a lot of files that were deleted from the Wuhan lab, and a lot of people pointed to that as being an indicator that they were not just not being transparent, but withholding some data.
00:29:14.000Yeah, at this point, I can't comment on that to say I know exactly what happened.
00:29:20.000There surely was some evidence that there had been some files moved or deleted.
00:29:25.000Also, there's been evidence that some of those files have been replaced, etc.
00:29:32.000The people that I most respect in this business who have concerns like I have have not pointed to that as being any evidence necessarily that that's what happened was that there was data that they wanted to get rid of so people wouldn't see it.
00:30:33.000You know, we delete files all the time on research things after things are completed.
00:30:37.000Now, on the other hand, laboratories typically keep everything forever because they may have to go back to it at a later date.
00:30:45.000So, you know, I can't comment on that other than to say that should be pieces of evidence or pieces of investigation that would address that.
00:30:53.000Now, one of the things I think that you said early on in the pandemic was you didn't think that it had emerged from a lab.
00:31:02.000You thought it was a natural spillover just simply because of the design of the virus itself, that we wouldn't design something like that.
00:31:09.000Yeah, and I still say that's the case.
00:31:12.000I mean, this thing is so effective at infecting humans, and it only got better over time.
00:31:17.000Think what it did in Mother Nature since the first variant occurred up to Omicron.
00:31:23.000And you can see it just got better and better at infecting humans without any hand of a man-made event.
00:31:29.000And so this thing was an evolving virus right from the start that was basically capable of infecting humans and got better at infecting humans as time went on.
00:31:38.000So the accusations or the people that think that it was made in a lab, how do they think that something like that would be created?
00:31:47.000And why do you think that that's not the case?
00:31:50.000Well, again, this is out of my sphere of expertise.
00:31:52.000I am not the person who can tell you from a genetic standpoint how to manipulate this virus and what to do.
00:31:57.000As an epidemiologist, I can tell you, you know, I've seen these other spillover events.
00:32:01.000I've been very involved with investigating SARS back in 2003 when it first emerged in China and spread around the world.
00:32:08.000I've been very involved with the work with MERS, the Middle Eastern Respiratory Syndrome, another coronavirus.
00:32:14.000And in each one of those, you can show clearly the spillover event from animals to humans.
00:32:20.000In fact, with the camels being the main reservoir for MERS in the Arabian Peninsula, we keep having MERS cases because nobody's going to put down all these camels.
00:32:29.000You know, we're not going to get rid of them.
00:32:30.000And so we watch those spillovers occur from time to time into humans.
00:32:34.000So coronaviruses emerging out of an animal reservoir in and of themselves are not unusual.
00:32:40.000It's not somehow like A plus B plus C plus miracle ended up with the answer.
00:32:45.000So I haven't seen anything that would tell me that that was any different than that.
00:32:50.000But again, I'm wide open to whatever new data can come forward and I hope we do exhaustively look at this.
00:32:56.000Now, when they perform gain-of-function research, can you explain how that's done?
00:33:03.000They're using different coronaviruses and various viruses and infecting human respiratory tissue, and they're also doing experiments on ferrets because they have very similar ACE2 receptors to human beings,
00:33:50.000And those are all considered parts of gain of function.
00:33:53.000In other words, trying to make it do something else.
00:33:55.000So in terms of the coronaviruses, I've not seen any evidence of, again, gain of function because this virus is pretty functional on its own.
00:34:06.000And it's teaching us, by just watching it, how it's changing to become almost a sense of a gain of function of Mother Nature.
00:34:14.000The way that these experiments are done, when they're infecting human respiratory tissue, when they're infecting ferrets, and they're doing it purposefully for these experiments, aren't they allowing selection and evolution to do the work for them?
00:34:30.000I mean, I don't necessarily think they're manipulating the virus.
00:34:33.000Aren't they allowing the virus to go through its normal processes, but they're doing it purposely, right?
00:35:21.000Right, because this was like the arguments between Rand Paul and Dr. Fauci, and, you know, it was very contentious about the definition of gain-of-function.
00:35:30.000Do you think it's just splitting hairs, or do you think this is...
00:35:33.000Well, I think anytime you consider gain of function for any virus, it's an important issue because of the potential for it to do more harm, particularly if it's accidentally released, which can happen.
00:35:43.000Again, I don't have any first-hand or second-hand knowledge that that was what was being done in Wuhan.
00:35:48.000But if they were doing gain of function, that's how they would do it.
00:35:52.000They would infect human respiratory tissue, they would infect various animals, and they would study how this virus progresses and how it evolves and selects.
00:36:02.000Well, that's one way to do gain of function, but because I'm not a coronavirus virologist, I can't tell you if that's what they're doing with this or not, or if they have done that.
00:36:12.000And do you know if someone or a laboratory had done something like that and they had gone through these steps to use evolution in terms of like infecting this human respiratory tissue, infecting ferrets who have the similar ACE2 receptors,
00:36:27.000that this would somehow or another make a virus more susceptible?
00:37:01.000During the Obama administration, didn't Obama put the kibosh on gain-of-function research?
00:37:06.000It was limited in the sense that it was for all gain-of-function research of how you actually were going to go about doing it and showing the safety steps you had in place to make sure that it couldn't be a release.
00:37:17.000A good example is we do want to know if flu viruses leave a mark that says we're about to become a human-to-human transmitted virus so we can plan for that.
00:37:27.000So we do want to do some of this, but we want to do it safely.
00:37:30.000And what I'm suggesting here is I don't know what happened in this lab or how it did it.
00:37:36.000I'd love to see that transparent information come out.
00:37:40.000Is it safe to say that this kind of research is important to understand how these viruses evolve, how they become more virulent, how they can infect people and jump species that it has to be done safely,
00:38:01.000And this is all about the risk-benefit equation.
00:38:03.000And I think that's what the whole purpose of what the NIH evaluation was, of when can we declare that there's a benefit here and this is the risk and we can actually address the risk and therefore the benefit is worth doing.
00:38:17.000And, you know, you can't unring a bell.
00:38:19.000So I'm one of those people that am very concerned.
00:38:39.000And I'm open to any new information, as I said before, that comes forward.
00:38:43.000Did you read any of those emails where there was discussions that were about the narrative of whether or not it had come from a lab leak and deterring that narrative?
00:39:11.000As you know, I mean, it's oftentimes the kind of almost entertainment debate about, wait, he did this, he did that, who did this, what did that, and trying to trace it all back.
00:39:22.000And so for me, you know, if there's substantive information, I want to read it.
00:39:28.000If I can't understand it, I want to ask people who do know, because there's a lot of the parts of this, as I said, With humility, I don't understand.
00:39:35.000As an epidemiologist, I think I have a pretty good handle on what the virus is doing in terms of how it acts in people.
00:39:41.000But this particular area really does require a really level of scientific excellence in this area for which we have people who have continued to pursue this.
00:39:51.000And so we'll go for it, and I would like to see what they come up with.
00:39:55.000So as an epidemiologist, you are just trying to follow the facts of the disease and avoid the weeds.
00:40:11.000What we can't do is more, you know, it's like the Kennedy-Lincoln analogy I just used, and now it proves the point, so therefore now the assumption is, well, they are linked.
00:40:19.000I can tell you, the CIA of, you know, Of the 1860s, we're still active back then and they're still active in the Kennedy era.
00:41:04.000I did not get involved with that discussion because I felt like it was in the weeds in a way that I was trying to figure out what this virus was going to do to kill people and how I could stop it from happening.
00:41:14.000So to me, again, I will let the experts who have that kind of expertise deal with it.
00:41:19.000And rather than he said, she said, I stay out of it.
00:41:24.000That's why when I tell you what I know, you better count on it as true.
00:41:28.000When I tell you that I don't know something, then you can take that to the bank too and say he just didn't know.
00:42:14.000What it does indicate is clearly having these comorbidities adds to the likelihood that once you get infected, you're going to have severe illness.
00:42:23.000But as you just pointed out, and it's absolutely true, we've seen people who have comorbidities who've had mild disease.
00:42:28.000We've had people for unexplained reasons, we don't know why, have had serious disease, younger, healthy, no underlying comorbidities, you know, physically fit.
00:42:38.000And so, generally speaking, though, you can say that, no, in fact, if you have these comorbidities, you are much more likely to have severe illness.
00:42:51.000And as I just mentioned, these kids, you know, a number of these kids did have comorbidities, but some didn't.
00:42:57.000And why they got infected and died, I don't know.
00:43:02.000Is there a parallel to any other disease that you've ever studied before or that scientists have studied?
00:43:07.000Like, is there any disease that behaves this way?
00:43:10.000Well, clearly there are a number of viruses where the seriousness of the illness can vary a great deal by age, for example.
00:43:17.000Let me just take one that is not a respiratory transmitted agent, but the virus that causes hepatitis A or infectious hepatitis.
00:43:25.000In young kids, this is often a very mild, totally asymptomatic infection, and it's transmitted from fecal-oral.
00:43:32.000You know, if you have diaper changing, etc., hygiene's not there.
00:43:36.000We would often pick up outbreaks of hepatitis A Because parents would come down with it, and they'd get really sick.
00:43:43.000Their livers would be in trouble, you know, they'd get very yellow and jaundiced.
00:43:47.000And we'd go back and test the child, ensure that the child had been infected already, and brought it home to mom and dad.
00:43:53.000And so, in a disease like that, the percentage of people who have serious illness, who get infected and have illness in general, is much higher than the older population than it is in the younger population, where it's almost a mild disease.
00:44:06.000So we have examples like that that do happen.
00:44:09.000It's not as if it's an unusual situation.
00:44:12.000And for some diseases, the vast majority of illnesses are mild, asymptomatic.
00:44:16.000You only pick them up by doing blood studies in populations.
00:44:19.000For other diseases, well, rabies is, of course, the classic example.
00:44:25.000And so it varies across all the viruses we have.
00:44:29.000So is the percentage unusual of people that are asymptomatic with this disease?
00:44:36.000Well, you know, I think, Joe, that's one of those questions, again, that kind of begs the very issue of what is this SARS-CoV-2 virus all about?
00:44:45.000Because if you go from the beginning of the COVID pandemic to now, look at how different the ancestral variant illness was to alpha.
00:44:59.000And the question you asked me earlier about the issue with Omicron, you know, why do we see so many infections out there?
00:45:05.000Well, because it's much more infectious.
00:45:08.000And I think that what we're watching here is a really real-time evolution of a virus that, you know, we could never, you know, suggest for a moment that the measles virus is going to change a whole lot in two years.
00:45:20.000It hasn't changed Basically in decades and decades and decades.
00:45:24.000So I think this is one of the challenges we have.
00:45:27.000And when I answered your question earlier about what is the future of this pandemic, it's because this virus keeps throwing 210-mile-an-hour curveballs at us.
00:45:34.000I don't know what the future is going to bring yet.
00:45:36.000Maybe one of these variants is going to spin out of this that is going to, again, cause a large number of cases, some of it severe, and is going to evade the immune protection that we have already.
00:45:50.000I've read some articles that seem to indicate that there may be some immunity that certain people have because of previous infection for other coronaviruses, other coronaviruses meaning common coronaviruses, that somehow or another that may have imparted at least some kind of either immunity or some kind of protection from SARS-CoV-2.
00:46:19.000And in fact, if you look at the issue of just take immunity from SARS-CoV-2, if you look at the data for Delta, you could actually show that basically those people who had previous infection did better than those who hadn't had previous infection and were vaccinated.
00:46:41.000I mean, actually they had more protection.
00:46:43.000But if you go back to Alpha, People who had previously been infected were more likely to get reinfected than people who were vaccinated.
00:46:53.000So people who caught the Alpha variant could catch it again?
00:48:35.000So a lot of people thought it was a lot higher than that.
00:48:38.000Like, there was an impression that when you got infected by SARS-CoV-2, there was whichever variant, that you had a high likelihood of being hospitalized.
00:48:56.000But for those that did, yeah, they were seriously ill and the number of deaths were elevated.
00:49:01.000Do you think that there was a wasted opportunity to discuss metabolic health, metabolic health in terms of weight loss, in terms of taking care of yourself and eating correctly and vitamin supplementation and exercise?
00:49:17.000All these things were kind of ignored during the pandemic.
00:49:21.000Well, you know, I don't know if I agree with that because, I mean, I surely have heard it over and over again that this was important.
00:49:46.000I mean, I gave many talks where I was talking about— You might have given many talks, but this is not something that was echoed by the White House where they were talking about it openly in public.
00:49:55.000Hey, folks, you've got to lose weight.
00:49:57.000Well, I think that if you look at just even the recent weeks in terms of the discussions about comorbidities and what they are, you have to separate out those ones which you can control, such as, as you said, exercise,
00:50:13.000Those which are unfortunately just a part of your health profile, diabetes, asthma, autoimmune diseases, etc., So, you know, I fully support the fact that we should be emphasizing this issue around body mass index, meaning IE should lose weight,
00:51:01.000I mean, how much of a factor is obesity in terms of just a general immune system?
00:51:07.000Well, I can't say, again, I'm not the expert in metabolic disease issues, but we know for a number of conditions that if you have increased weight, i.e., body mass index-like measures, that you are at a higher risk of having The additional problems because there is,
00:51:27.000from an immunologic standpoint, some activity with fat cells that can surely enhance an over-vigorous immune response.
00:51:34.000And remember with SARS-CoV-2, it's a combination of directly what the virus does to impact you, but also what does your immune system do?
00:51:41.000One of the examples we're all very concerned about today is long COVID. And with long COVID, it's clear that that is not evidence at this point of its ongoing infection.
00:51:53.000It's not that the virus is still proliferating and we just haven't gotten rid of it.
00:51:56.000So can you explain what long COVID is technically?
00:52:01.000And the reasons I can't, it's not because I'm not even an expert because most people can't.
00:52:04.000It's a whole series of different conditions, the brain fog, the fatigue, the cardiac involvement, the heart, you know, as we see the heart, the lungs.
00:52:15.000And it's not really clear what is going on.
00:52:19.000If you just take a step back, remember before COVID ever existed, we had chronic fatigue syndrome, a real condition and people were really suffering.
00:52:26.000And when you say chronic fatigue syndrome, is that something you can have a test for?
00:52:31.000No, that's the whole point, is that it was kind of a general term, a catch-all, that basically covered people.
00:52:38.000And most often, it was associated with people who had had an infectious disease of some kind, which may have triggered this ongoing immune response.
00:52:47.000Is there like a specific infectious disease?
00:52:50.000Well, you know, Epstein-Barr virus has been often implicated as being a part of this picture.
00:52:55.000But what it's really pointing out is it's really about this ongoing immune response that we don't yet understand.
00:53:01.000And I think if there is any area right now that we need tremendous efforts put into, it's long COVID. You know, there are these new centers starting right now to try to address this.
00:53:13.000You know, overall we estimate that there may be anywhere from 3 to 10 percent, some say as high as 18 to 20 percent of people, Without regard to whether it was serious COVID they had or milder COVID, go on and develop this long COVID. There's an interesting parallel with fighting,
00:53:29.000and I can talk to you about this, with MMA fighters.
00:54:01.000And after those bouts of COVID-19, there's a thing that happens with fighters.
00:54:06.000At the very highest level, and one of the things that I study with the UFC is I'm studying the elite of the elite athletes, like championship-level fighters, and just a small drop-off of performance is noticeable when they face other elite athletes.
00:54:25.000And you're starting to see some of these folks that have had COVID-19 then competing and not looking as good.
00:54:34.000Eight months later, a year later, post-infection.
00:54:37.000And I'm wondering, like, what is this long COVID? Is this like a milder form of long COVID? Because clearly they're in shape.
00:54:47.000But when they're competing, they're not, maybe some of them are not quite at the level that they used to be.
00:54:55.000Well, I think you raised two very important points.
00:54:57.000When you asked me earlier about risk of going on and developing COVID and what the long-term impact may be, here you got some of the finest fit people in the world.
00:55:08.000I think the issue around the immune response in the host and things like inflammation, you know, the fact that you can actually find that That your body's ongoing activity, and we've seen this with people who, again, chronic fatigue, chronic Lyme disease,
00:55:24.000people have talked about this kind of same concept.
00:55:26.000And we really, I think, are at the opening of what I think will be a huge, huge effort to really look more at the long-term impact of immune response on something once it gets triggered.
00:55:40.000Remember, our immune system is like skating on a razor blade.
00:55:43.000You want to make sure anything that shouldn't be there shouldn't be there.
00:55:47.000But you want to protect everything you can that's yours, and you don't want anything to happen to it bad.
00:55:53.000And where that really gets interesting is, for example, in pregnancy, where, you know, that fetus is not totally all that mother, but at the same time, the body is working to protect that more than it's done anything ever to make sure nothing bad happens to it.
00:56:06.000And when that dysregulation occurs, where the immune system tips a little bit more on one side or the other, you can see ongoing problems.
00:56:14.000And I think that's what this virus is doing.
00:56:16.000It's creating this environment where this ongoing immune response is occurring.
00:56:26.000But I think the most important message is if anybody listening to this effort here is that there are people right now working on this and that this is not something you have to live with hopefully forever.
00:56:40.000Looking at drugs, treatments, what can we do to deal with long COVID? But right now it's a daunting challenge and I think the example you just gave very well could possibly be a part of a long COVID picture.
00:56:52.000Now, long COVID, as described, the way we're talking about it, is essentially people that feel like they're not the same now as they were before the virus.
00:57:08.000Yeah, it's really important to distinguish.
00:57:10.000If you've spent The last three and a half to five weeks in an intensive care unit, I don't care whether it was for an automobile accident or it was for COVID, you have a long-term recovery at hand.
00:57:23.000And it's going to take a while before you begin to feel like yourself again, you know, what will happen.
00:57:29.000So you have to distinguish that, which is not necessarily, you can't get long COVID that way, but you also would just have that no matter what.
00:57:38.000Where it really becomes very clear is people who've had milder COVID, who then, in the second or third week, thinking they're getting better, all of a sudden start feeling tired.
00:57:52.000And that's where it's really most noticeable because these were people whose bodies were not, quote-unquote, insulted in such a way with COVID to have been bedridden for days and weeks and, you know, trying to recover from that.
00:58:06.000And I think that's the one example where you can say it's clear that there is a aftermath of this COVID for which some people experience and some don't.
00:58:16.000I mean, I know many people who have fully recovered from COVID and, you know, they are doing perfectly fine.
00:58:23.000Now, so you're saying some people with mild COVID still show some sort of a decrease in their physical response?
00:58:33.000I actually know of people who had milder COVID and they'll tell you that their long COVID was much more severe than when they had the acute infection.
00:58:43.000Meaning when I had COVID itself, I was test positive, I was tired, you know, but I was kind of around the house and, you know, not feeling that bad.
00:58:53.000Now here I am eight to ten weeks out, and I some days feel like I can't get out of bed.
00:59:14.000And that's what these new centers that have been set up are actually studying.
00:59:17.000Is there a mechanism that can explain this, or is it a series of mechanisms?
00:59:23.000Why do some people have more cardiac and lung involvement?
00:59:26.000Other people have more brain fog, you know, where clearly neurologically something is happening.
00:59:31.000You know, why do some people feel such severe fatigue and others don't?
00:59:35.000So one of the things is there's not a hallmark of long COVID that just says, if you have this symptom, this symptom, and this symptom, you have long COVID. It's a combination of different conditions that are happening to people.
00:59:47.000And are there any methods that they're utilizing that seem to be effective in treating people that have this?
00:59:53.000At this point, we're just in the infancy of that.
00:59:56.000And that's, as I said just a moment ago, this is going to be a critical part of our ongoing efforts with COVID, is just the study of and trying to understand what's happening.
01:00:06.000First of all, as you pointed out, we have to know why you're having these findings.
01:00:11.000And then once we do that, what can you do about it?
01:00:14.000What kind of treatments could be effective?
01:00:16.000And giving people hope because I've seen people who at 12 months after their COVID infection who are feeling like they've kind of lost their life.
01:00:25.000They don't have the energy to go to work.
01:00:27.000They don't have the energy to be with family.
01:00:42.000Have you read anything about, is there anything else that stands out, like stem cells or anything that they seem to think would be effective?
01:00:49.000I think right now it's in that stage of just trying to define what it is, you know, before they can even know necessarily the interventions that they can look at.
01:01:01.000Do you have evidence of certain immune markers that are elevated?
01:01:04.000You know, why might you have some evidence of some heart involvement or your lung involvement?
01:01:10.000So part of it is right now just taking very seriously that lung COVID really exists and that we're trying to figure out first and foremost what might be the mechanisms that are causing it.
01:01:21.000And then I think you're going to see a large number of efforts trying to address treatment itself.
01:01:30.000And, you know, one of the things that's going to be a challenge is to find out how many of the people who had Omicron, even in their mildest stages, that go on to develop long COVID. We don't know that yet.
01:01:39.000It's such a strange term, long COVID. I know, yeah.
01:01:42.000Because it's like you don't really have COVID. Your COVID is done, but you have the deterioration of your physical abilities.
01:02:37.000Isn't there an attenuated vaccine, an attenuated form of the virus?
01:02:42.000Yeah, well, first of all, let me just say, I think the treatment area right now is a very exciting time in development.
01:02:51.000You know, I look back to my work in the early 1980s in HIV-AIDS, and at that time, a diagnosis of HIV was a death sentence, simply a death sentence.
01:03:02.000And with the emergence of drug therapies, even in the absence of a vaccine, we've taken HIV for many people to a managed chronic disease.
01:03:11.000And I think that as we look at the vaccines, it's clear we have challenges with waning immunity.
01:03:23.000And so vaccines remain really the foundational response for dealing with COVID. But I think the drug therapies are going to become really, really critical.
01:03:34.000I mean, for example, I know a topic that you have been of interest about and the show that ivermectin.
01:03:41.000You know, there are five big trials going on right now.
01:03:43.000They're going to be announced results in the next weeks to months that really have looked carefully at ivermectin, including high dose ivermectin.
01:03:51.000And, you know, I've, again, as a scientist, reserved judgment.
01:03:55.000You know, I didn't close my mind and say, no, yes, whatever.
01:03:59.000And we've got to have these double-blind placebo-controlled trials, you know, studies where neither the investigator or the patient know which they got, you know, and then objectively find out what's happening.
01:04:08.000I think there's a whole series of drugs coming down from several companies that surely have that potential if given very early.
01:04:17.000And the one you mentioned from Pfizer, for example, Paxlovid, while it has some contraindications with underlying health conditions that might already exist, on a whole, it is really a very, very fantastic drug.
01:04:29.000But the problem we have right now with that is that we have many, many places in this country where during the surge of Omicron, I couldn't get tested for three, four, or five days.
01:04:52.000Is the fact that we need a comprehensive system with surges.
01:04:57.000Where, in fact, when a surge occurs, you can scale up quickly.
01:05:02.000So if I need to get a test done, I can get it done the same day and get a result back the same day, and then I can get into a system automatically that makes sure I get these drugs.
01:05:12.000You know, if you're someone in the community, and, you know, one of the things that I have been so challenged by is what this has done by race.
01:05:38.000Hasn't there been correlations drawn between vitamin D deficiency?
01:05:42.000There has been some, and again, this is another area of study that needs to be done.
01:05:46.000But I mean, if you look at these issues here, getting the drugs to those populations, okay, what can we do, whatever their risk is, so that if you have a community where I don't have a doc, I don't have one.
01:05:59.000I don't have access to healthcare in general.
01:06:03.000So what I think this whole issue around drugs, the point you just raised, is really highlighting Is now's the time to address this issue of health disparities and just generally our health care system.
01:06:14.000You know, we have a disease care system.
01:06:16.000A disease care system, not a health care system.
01:06:19.000And by the way, it has been under attack for two years.
01:06:52.000And try to reduce the hospitalizations of serious illness and deaths and make this more of a treatable type disease, like I talked about with HIV. And the impact in the communities of color, for example, you know, will be huge if we could do that.
01:07:10.000And it would improve healthcare in general.
01:07:11.000So to me, that's one of the things I'm working on right now, is trying to understand surge capacity for testing.
01:07:17.000Let me give you one last example, I think, that helps illustrate this.
01:07:21.000If you look at the fire departments in the state of Minnesota, one of the best well-funded fire departments in the entire state is the Minneapolis-St.
01:07:29.000Paul International Airport Fire Department.
01:08:26.000Just testing and then the drug availability, the drugs you just talked about.
01:08:29.000I mean, I think we're going to see more and more drugs become available that I think are going to have real positive impacts.
01:08:36.000So I see this as kind of the silver lining of this pandemic is that people are now beginning to do that, and we can do that around the world.
01:08:43.000If you're knowing about HIV drug distribution, you know some of the most remarkable improvements in health have been in Africa, where we've been able to distribute these drugs for HIV day in and day out.
01:08:54.000So we surely can do this for a COVID-like situation.
01:08:57.000So that's what we need to focus on, and that's what we need as a globe The global community understand how can we improve testing so that we make sure we get people on there and then how can we make certain that they get their drugs?
01:09:09.000Now you covered a whole bunch of things, so let's start from the beginning.
01:09:12.000First of all, you talked about testing.
01:09:14.000Now one of the things that I thought was shocking, I was watching this press conference where Ron DeSantis was addressing the claim that they had let a bunch of COVID tests expire.
01:09:58.000But we do a thing called vendor management control.
01:10:01.000So, you know, you basically rotate it on your shelf.
01:10:04.000So you have a place that says, okay, I will help vendor manage your product.
01:10:08.000So I'll make sure that of all the locations out there, somebody's not sitting on some stuff and others are using more, I'll make sure that the one closest to outdating gets out there.
01:10:20.000And the ones that are farthest back, basically, I'll hold so that we don't lose.
01:10:25.000And with vendor manage, you can do a lot to actually reduce that problem.
01:10:28.000So that was the accusation from the Florida administration that they hadn't distributed those things.
01:10:34.000They could have done that and got them out there before they expired and it seemed like they were hoarding them.
01:10:39.000Yeah, and clearly this, again, is part of that whole testing issue is some of it's going to be surge capacity because there's only so much you can actually put in surplus stock with the fact that some of it basically will, in fact, expire.
01:10:53.000And so then it's a matter of, okay, so what's your surge capacity?
01:10:56.000How do you then say, I can bring on board, and you can't make it at the last minute.
01:11:01.000It's kind of like a fire department that goes out and tries to buy their fire truck when the 911 alarm comes in.
01:11:06.000And so you've got to have people ready to go.
01:11:08.000You have to have manufacturing capacity to go.
01:11:10.000So when you have a surge, you can do that.
01:11:49.000So when you're talking about how a disproportionate amount of Hispanics and black folks and Native Americans, essentially people with more melanin in their skin, People with more melanin in their skin have traditionally had lower levels of vitamin D that live in urban areas, especially in cold climates where they're covered up.
01:12:08.000How much of a correlation do you think there is between low levels of vitamin D and more severe COVID infections?
01:12:17.000Well, I can say that there clearly have been studies done that demonstrate reduced vitamin D levels in cases coming in into the hospital.
01:12:26.000It was like 84% at one point in time of people in the ICU had insufficient levels of vitamin D. Yeah, and I can't comment it.
01:12:33.000The question we have With vitamin D, is it a marker for something else?
01:12:38.000Meaning people who have adequate vitamin D, is it because of their behavior, what they eat?
01:12:43.000Is it because they have access to certain foods, etc.?
01:12:49.000And so we still have to figure that out.
01:12:51.000But vitamin D isn't really like effectively supplemented through food, is it?
01:12:55.000Well, sunlight and some degree food, meaning I take a supplement.
01:12:59.000I'm talking about taking a supplement.
01:13:00.000You know, if you're basically living from paycheck to paycheck and you're having a hard time just feeding your kids, are you as likely to go buy vitamin D to supplement?
01:13:11.000But I think the point that you're raising here is, again, this is another example of what the kind of studies we need to say could that help improve.
01:13:20.000You know, much like we did with niacin and milk and so forth, you know, where we basically were able to show that we can get health benefits in some cases by supplementing food.
01:13:28.000Don't they supplement vitamin D in milk as well?
01:13:34.000But I think the point being is exactly what you're raising is this is another example of can we have an indirect benefit to the public by learning this and actually helping people have adequate levels of vitamin D. I think that's critical.
01:13:47.000But I do want to make one comment on this, because I think this has been sometimes misunderstood about race and the issue of risk for COVID and for serious illness.
01:13:59.000If you look, the real correlation, which again is not cause and effect, but is who are the frontline workers?
01:14:04.000Who are the people that are left largely unprotected?
01:14:07.000Who did the critical service for us, even in healthcare?
01:14:10.000During the course of this pandemic, it was often, you know, our communities of color.
01:14:15.000And people from that community, I could stay home and work in my computer in my office at home.
01:14:22.000I didn't have to sit there and, you know, have close contact with the public.
01:14:28.000And so one of the challenges also is, of course, how do we protect these people from a work standpoint?
01:14:33.000And that's why getting vaccines to them is really, really important and supporting the issues.
01:14:39.000And we've seen some really novel ideas.
01:14:41.000Probably the most, in fact, you would find this interesting, is the fact that one of the most novel programs I've seen has been a new movement among black barbers and black stylists who basically work to talk to their clients in their chairs and who trusts people more than your barber.
01:14:58.000And they talk about all issues of health.
01:15:00.000And it's a program that was started out of the University of Maryland.
01:15:03.000And it's been fascinating of how it's actually having a really positive impact in health.
01:15:08.000But they do kind of like what you do, talk about all the health issues.
01:16:20.000So, when you're talking about frontline healthcare workers, one of the things that is a real point of contention is folks that were frontline healthcare workers that were infected, that recovered, and then they were facing vaccine mandates.
01:16:54.000I know, but in the middle of a pandemic when you desperately need these people that risked their lives in the early days of the pandemic when there were no vaccines.
01:17:04.000And many of them were infected with COVID, recovered, and had robust immunity, but yet they were fired because they refused to get vaccinated.
01:17:12.000Well, let me add a little more detail to the story.
01:18:07.000And the data are actually out there right now looking at that.
01:18:10.000And in fact, if you look for deaths, for example, if you were unvaccinated, your deaths during this most recent was about 974 per 100,000 among people infected, okay?
01:18:22.000But if you were fully vaccinated only and you got 0.71 cases per 100,000, big drop, and then fully vaccinated with a booster, it was 0.010.
01:18:44.000But the point I'm trying to get at is if you looked at the array of these, those who had previous infection and were One dose, like a boost, actually did very well.
01:19:24.000Because we were able to demonstrate, particularly with Omicron, a number of outbreaks or ongoing transmission of cases in healthcare settings, where it was the healthcare workers bringing the virus in.
01:19:37.000And where we looked at that, we saw data, and there are several studies coming out very shortly, looking at people who were hospitalized, negative upon admission, not there for COVID, who were there at least 10 days, and then got infected and got seriously ill.
01:19:52.000Well, they had to pick it up in the hospital.
01:20:27.000But isn't it been proven that people that are vaccinated also catch COVID and also spread COVID? They can, absolutely.
01:20:35.000But I'll tell you right now that if you were previously infected and you had that dose, you're going to be much less likely to actually get infected yourself and spread the virus.
01:22:16.000Yeah, it's what we call an adenovirus platform.
01:22:19.000It uses that to basically get into the cell to have the cell make basically the spike protein that you then get your immune response for.
01:22:28.000But it looks like the J&J vaccine may have more positive impact on the thing we call T cells, a type of immune cell, than we see with the mRNA vaccines.
01:22:39.000Again, all emerging new science we're learning about.
01:22:43.000I think if I had to make a prediction in the near term, meaning, you know, 6 to 12 months from now, we very well would be likely talking about the preferred heterologous vaccine approach.
01:22:56.000Of using one dose, for example, something like a J&J, and then a dose of mRNA.
01:23:01.000I think that's really a possibility because...
01:23:06.000This is based on more and more data we're seeing accumulate that that may really be a possibility.
01:23:11.000And in fact, it's also in this issue that I happen to have an intense personal issue because our center, the CIDRAP, Center for Infectious Research and Policy at the University of Minnesota, It's actually going to be leading, and it'll be announced very shortly, what we call a pan-coronavirus vaccine roadmap process.
01:23:30.000We just completed a two-year effort to come up with a detailed roadmap for how to get new and better flu vaccines, all the way from research and development to marketing, licensure, etc.
01:23:42.000And we're trying to get new and better flu vaccines, and we're working on that.
01:23:46.000I think you're going to see version 2.0, 3.0, and 4.0 of the vaccines in the next few years.
01:23:52.000The vaccines we have now are remarkable tools, but they're not perfect.
01:23:57.000And I think you're going to see an evolution, just like with drug treatment, better and better vaccines coming out over the long term.
01:24:05.000One of the things that I read was that one of the problems with accepting natural immunity due to previous infection is that different people had different levels of the disease and that some of those very mild infections did not impart enough of an antibody response and that these people were not as protected as maybe they thought they were.
01:24:31.000Because even though they tested positive for COVID, they really didn't have that much of an impact on their immune system.
01:24:39.000That's an important point, but let me just add a qualifier to that.
01:24:43.000When we talk about measuring antibody, I don't know what we're doing.
01:24:47.000And what I mean by that is that we don't really have a correlative protection today.
01:24:52.000There's different kinds of antibodies.
01:24:55.000Okay, all these different kinds of antibodies.
01:24:57.000There's the different kinds of T cells.
01:24:59.000And what we're doing is taking one test and saying, how high is this here?
01:25:03.000Well, does it really correlate with protection?
01:25:06.000And this is what we call a correlative protection.
01:25:08.000So, for example, I can tell you if you get a measles vaccine and I do a blood sample, I can tell you likely if you have The immune response is going to protect you against measles.
01:25:18.000I don't know what a protective level is here.
01:25:21.000So when I talk about it, I know that that work is going on, and I think you're going to hear a lot more about correlates of protection in the months ahead.
01:25:29.000But I'm looking at it just from practical experience.
01:25:31.000If you've had COVID before, are you protected or not when you are exposed again?
01:25:37.000And compare those who were vaccinated after having had one episode, those who only had an episode, and those who had nothing.
01:25:52.000And that's where we're showing right now that I can't distinguish people who've had a really severe case of COVID versus those who have had milder cases of COVID. Maybe over time that will emerge.
01:26:02.000Clearly the antibody levels are different, as you pointed out.
01:26:17.000What we can say is it's likely you have more, but it's a combination of all the parts of the immune system, you know, the B cells and the T cells.
01:26:26.000And this is where, I mean, I always jokingly say, you know, if you really want to talk about something complicated, Hell, rocket science is easy.
01:26:36.000You want to know science, it's immunology, okay?
01:26:39.000Because this whole immune system we have is so complicated.
01:26:42.000And so, to me, the science you're going to see coming out of the immunity related to COVID is going to, I think, bring us some really exciting developments.
01:26:55.000We learned a lot about the human immune system.
01:26:57.000I think this is the next best opportunity here.
01:27:00.000We're going to learn so much about human immunity from just trying to understand how to protect against COVID and how to respond to long COVID. So immunity as a whole is a very comprehensive and wide-ranging thing, right?
01:27:15.000Because it's immunity to all sorts of different diseases and viruses.
01:27:20.000Do you anticipate in the future that we can figure out how to boost overall immunity?
01:27:27.000So it wouldn't just be immunity to COVID, but immunity to flu, immunity to all these different things, common cold, like that sometime we could get a grasp of the immune system to the point where we could elevate their levels of immunity For all infectious diseases.
01:27:45.000Well, let me just add that that's a really plus-minus situation.
01:27:51.000And what I mean by that is that there really isn't a term natural immunity.
01:27:55.000Everybody uses it, so you're in good company, okay?
01:28:05.000It doesn't matter whether you get it from actually being exposed to the virus, Or you get it exposed to the vaccine.
01:28:11.000How your immune response happens, it happens.
01:28:14.000But there is another kind of immunity called innate immunity.
01:28:18.000And that's where, if today I get a sliver in my finger, okay, if there's bacteria all over that sliver and I'm starting to get an infection, there are cells in my body that don't recognize that anything other than this shouldn't be there.
01:28:40.000So, you know, if I get an infection with something, the immune response is, I'm going after that specific part of that virus because I've been trained to do that.
01:28:51.000So when you say about boosting the whole immunity, you've got to be very careful because, again, what we don't want to do is cause an immune-related disease, like the trigger that might be happening with COVID, to up all the immune system in a way that causes you to have this over-vigorous immune response.
01:29:07.000So I think you're going to always come back to the specific Antigen or the specific piece of a virus or a bacteria that you're going to want to go after.
01:29:17.000And you're not going to have one kind of monolithic vaccine because that will elevate everything, which could trigger these bad things, and it won't necessarily give you the specific lock and key with that fun virus.
01:29:31.000And so I can't say I see the overall boost.
01:29:34.000What I do see, though, is more work on how do you handle so many different infectious agents.
01:29:40.000Or for that matter, I think one of the areas you're going to see a lot of work coming out in the near term is on cancer.
01:29:46.000Cancer vaccines, I think, have a huge future because you can detect those cells that are just starting to emerge that are cancerous.
01:29:54.000Let your immune system clear them out.
01:29:56.000So what kind of work is being done right now on cancer vaccines?
01:30:03.000Well, that's, you know, how mRNAs got all their initial research effort was for cancer vaccines.
01:30:08.000That's how the first real efforts were put into place by the NIH on these vaccines.
01:30:13.000And I think that one of the things, particularly for people who have specific risk factors, you know, genetically, they're predisposed to breast cancer, they're predisposed to these things, if you could pick up certain changes in the cells That indicate this is a pre-cancerous cell or an early cancerous cell.
01:30:30.000Imagine if you had a specific, you know, kind of police officer in your body that could help identify that and take it out.
01:30:38.000So a general immune system response is not enough.
01:30:41.000It has to be a specific immune system response for something that you're looking for.
01:31:08.000Stress has been shown to challenge your immune system.
01:31:12.000And so I think it's general things like that.
01:31:14.000Again, I'm not an immunologist, but I'm curious for my own self, if nothing else, you know, what you can do that way.
01:31:20.000So I think those are the issues that right now there's not one thing.
01:31:26.000When you look at these cancer vaccines, how far off are they from being deployed?
01:31:35.000Well, it's not somebody in the cancer area, but only familiar with the work is going on.
01:31:39.000You know, from my colleagues in the cancer side of the house, they seem, you know, it's still early, but it surely has a potential future.
01:31:47.000Now, when it comes to side effects and adverse effects from vaccines, what is causing that?
01:31:56.000Well, again, we don't completely know, but for example, the myocarditis piece has come up over and over again as likely an immune response that's occurring, okay, that in itself is causing this immune response to attack part of your heart muscle.
01:32:11.000And what part of the vaccine is causing that immune response?
01:32:15.000Well, that's what's not clear yet, because when I say it's not clear, you know, it's not just a spike protein, obviously, because that, in fact, is, you know, a lot of people have that response to that.
01:32:26.000And so I can't say, again, not being a clinician immunologist, I can say, though, that, you know, when you look at the seriousness right now of myocarditis, my job is to try to figure out, well, is this really a deterrent to getting vaccinated?
01:32:40.000And, you know, we can show time and time again right now from study after study that, in fact, the risk of myocarditis is greater in getting COVID by far than it is to getting the vaccine.
01:33:08.000And isn't it shown that with the Moderna in particular that there's more of a chance of myocarditis from the vaccine than it is from the virus?
01:33:17.000Actually, at this point, that's where we are looking at the, you know, it may be close to a trade-off there, but you don't take into account pericarditis, you don't take into account arrhythmias, all the other things that the virus does to the heart, which we never talk about.
01:33:31.000And those are actually very substantial and are as much of a burden in many cases as myocarditis.
01:33:37.000So you have to factor in, what does COVID do to your heart?
01:33:41.000What does the vaccine do to your heart?
01:33:43.000Does the vaccine cause any pericarditis?
01:34:30.000I mean, this is ongoing studies right now looking carefully at that.
01:34:35.000And it's surely a major area of study right now, but I don't know.
01:34:39.000Is there any understanding of what could be done to prevent it?
01:34:44.000Is there anything that like when someone is infected that it shows that certain nutrients or certain medications have been known to impart some protection from that?
01:34:56.000You know, I'm not aware of any nutrient issues, but I want to point out, just so people are aware, if you look at the serious outcomes of particularly vaccines, there are only two cases of myocarditis that are currently under investigation that caused fatal outcomes.
01:35:13.000Out of all the millions of doses of vaccine, 193 million doses they've looked at in these age groups.
01:35:50.000But I can tell you that even there, if you look at those, it's still, from the J&J perspective, the risk of a bad outcome with your heart or basically the thrombosis is still greater overall from getting the disease.
01:36:06.000Now, at this point, the J&J vaccine has had a warning put on it, a black label warning about the fact of thrombosis Which I think is important.
01:36:14.000But as we have shown over and over again data-wise, particularly in many parts of the world, the J&J vaccine is a real advantaged vaccine because of the lower dosage, the more stability of it, and the fact that overall the health benefit is going to be much greater than not having the vaccine.
01:36:30.000Didn't I read something that was pointing to the potential ceasing of the production of the J&J vaccine?
01:37:15.000I've been really opposed to that from the get-go.
01:37:17.000You know, in August of last year, I was one of several people who came forward and said, look at the waning immunity data.
01:37:24.000It's clear that at five to six months out, we're seeing an increasing number of people who previously before were being protected, who are now getting infected, who are getting seriously ill and hospitalized.
01:37:34.000And it's because it tends to wane at four to six months.
01:38:53.000I read this whole thing about vaccinated people in Israel.
01:38:57.000Like that there was a giant surge of vaccinated people catching COVID. The surge is primarily, and I don't have the numbers in front of me, but the surge is primarily in unvaccinated people.
01:39:07.000There surely was an increase in cases in vaccinated people who had had three doses.
01:39:13.000That's why they went to four doses for older populations, etc.
01:39:16.000But the real burden, the major thrust in this surge in Israel was, in fact, unvaccinated people.
01:39:23.000That's confusing to me because I'm almost positive that I read something that was talking about the confusion that they're having because the amount of vaccinated people that have been infected with COVID and that it's a giant percentage of the cases.
01:39:37.000I didn't read anything about it being primarily unvaccinated people.
01:39:42.000Can we see if we can find something on that?
01:39:44.000I just did that in my own podcast, by the way, okay?
01:39:46.000I covered that about two weeks ago, and I actually had the numbers in front of me, and I actually went through what percentage were unvaccinated, what percentage were vaccinated.
01:39:55.000Clearly, the vaccinated did see increased numbers of cases, but the surge was really covered by the unvaccinated.
01:40:03.000So there's an enormous surge, but it's because of unvaccinated people.
01:40:11.000See, that is so confusing to me because I was almost positive that I read that an enormous percentage, a very high percentage of the people that were new cases that were infected with COVID were vaccinated.
01:41:53.000The following data sources received, okay, March 21st to November 6th, 2021. Proportions of the various types of variants and concerns were also confirmed throughout the course of the study.
01:42:04.000The vaccinated class divided into five stages to mimic the diminishing of immunity.
01:42:32.000So Omicron, which is the—how much more infectious is Omicron than the Alpha variant or the Delta variant?
01:42:42.000Well, it's estimated to be at least two to three times more infectious than Delta, and Delta was two to three times more infectious than Alpha.
01:42:49.000I had heard it was way more infectious than that.
01:44:21.000I mean, is that because Omicron evades the protection of the original vaccine?
01:44:26.000It does, and it also evades the protection of previous infection.
01:44:29.000But is that like, put that article up again?
01:44:33.000The way they're phrasing that, is that a manipulation of language?
01:44:37.000Because it's saying 40% of Israelis have no protection against COVID Omicron variant, but are they vaccinated from the original variant?
01:44:46.000Because if they're saying that they don't have any protection, are they saying that because they don't have protection because they don't have antibodies for it?
01:44:56.000Or are they saying they haven't been vaccinated?
01:44:58.000I can't tell you what that headline is saying there.
01:45:03.000All I'm telling you is that if you look at the proportion that had no vaccine, those that had full vaccination but no booster, that's what they were trying to compare.
01:45:21.000Yeah, I recently found something when I was looking that said that, this is back in the end of the summer, that enough doses had been administered in Israel to get 99.3% of the population vaccinated.
01:46:24.000So part of the thing, the reason why that article was phrased that way is because Omicron evades the protection of the vaccine.
01:46:32.000It does evade protection of vaccine and it evades the protection from previous infection at a level that the other variants hasn't done.
01:46:41.000If that's the case, then what is the benefit of getting vaccinated now?
01:46:45.000Well, there's still very substantial protection.
01:46:48.000But if it's evading the protection of the vaccine, what is the protection it gives you?
01:46:53.000Well, again, let me point out, these are numbers I said before, if you just look in this country for the issue of, this is during Omicron, If you look at deaths, again, the point I made earlier, if you're unvaccinated, your rate is about 9.74 per 100,000 population.
01:47:40.000So for example, with the booster, you can boost it back up.
01:47:43.000If you look at, for example, fully vaccinated, two doses, or you look at it versus two doses plus what some would call the booster, you had eight times as much protection with full vaccine And that booster than you did just full vaccine.
01:49:03.000I just gave you just now we're deaths, but if you look at hospitalizations, the same thing, okay?
01:49:08.000If you look at, these are data from December 25th for the United States, for hospitalizations.
01:49:14.000And this is gauging, like, how many people who were admitted were boosted versus how many people only had two shots versus how many people were unvaccinated.
01:50:25.000And in fact, I think many of the vaccine researchers are thinking, what can we get to really cause the upper respiratory protection, localized protection in your upper respiratory tract?
01:50:35.000Because if you can stop the virus there, you can stop it from going deep into your lungs and then going into the rest of your body.
01:50:43.000Clearly, people are looking at what vaccines would work, and our previous experience would suggest that live attenuated, as you called it, which is something that actually grows, causes an immune response, but doesn't cause illness, could be one way to go.
01:50:57.000Can't say that it's going to be the way, but it surely is something that everybody's looking at right now.
01:51:03.000Well, I can't say it's in development in the sense there are several labs working on it, research-wise, but development might stay a little further along.
01:51:12.000But I think it's going to be the future.
01:51:13.000I think it surely could be a big part of the future.
01:51:16.000And when these labs that are working on it, have you seen promising data?
01:51:23.000I mean, I think part of the challenge we had was in January and February of last year, We kind of jumped on the mRNA bandwagon to the extent of saying this was going to be the answer.
01:51:38.000And some people will say, well, you know, we didn't say it would protect against infection, but there was a sense it was going to really protect against infection at 95%.
01:51:47.000I think it was only really by the summer that people began to realize that they're still very, very important and remarkable tools, but they're not perfect.
01:51:57.000You know, these aren't going to necessarily be the final vaccines we need.
01:52:01.000And so it's really only this summer that you started to see more interest in, well, what other vaccines can we look at?
01:52:41.000And I actually covered the issue that our big challenge right now is we're seeing it not being used.
01:52:47.000You know, even though we're down to one, monoclonal as you know, the other two basically because of Omicron and the mutations challenging how well they worked.
01:52:56.000But we're sitting in a number of states right now where we have pexlovid and monoclonal antibodies not being used.
01:53:08.000It's because people can't get tested in time?
01:53:11.000And so, therefore, you have to have it within that five-day period.
01:53:15.000People actually get sick enough that they move into the hospital quickly, and then, therefore, they're not eligible for it.
01:53:21.000Is it because they don't have access in their communities?
01:53:24.000I mean, if you don't have a health care provider, how the hell do you get tested and get the result back and take it to somebody that will issue a prescription for that drug?
01:53:32.000It seems like if you're trying to reduce deaths and severe illness, that monoclonal antibodies would be an important part of that strategy.
01:53:43.000Now, why did they eliminate the first versions of monoclonal antibodies?
01:53:48.000Well, the first two actually, which were quite effective, it turned out that actually the mutations in Omicron basically It canceled out their effectiveness because the mutations were where those two monoclonals really attacked the virus.
01:54:02.000Was it a reduction of protection or elimination of protection?
01:54:07.000Well, in the laboratory setting, it was largely almost an elimination of protection.
01:54:12.000And the challenge we have is we went through a period where Omicron wasn't everywhere all at once.
01:54:19.000And some people were concerned about the fact that, well, you know, we should have taken them off the market right away.
01:54:51.000Even if you can't get it for a patient, can you have a running average of what's happening in your community?
01:54:58.000So if you suddenly see that only, you know, 4% are, you know, Omicron and 96% are Delta, you're probably going to err on going with the monoclonal, but it's for Delta.
01:55:10.000If you see the reverse, you're going to say, well, it doesn't matter to use those other two.
01:56:33.000And, you know, I looked to our colleagues in Italy, to New York, a number of places, that the kind of care that they provided, whether it was ventilators, how they approached it, what they did in terms of oxygen...
01:56:47.000How they helped basically try to regulate what the immune response was or wasn't.
01:56:54.000And frankly, the survivorship of patients with similar conditions between those early surges in 2020 and even six to ten months later was substantially better.
01:57:05.000The intensive care community did so much, so much, to try to understand what should be the best methods.
01:57:13.000You know, what should be our standards of care, our best practices?
01:57:17.000And so we have seen a substantial increase in outcomes for patients just based on the early research.
01:57:24.000Do you think that because of our having gone through this pandemic that we are better prepared for another pandemic?
01:57:33.000Like say if COVID was to die off, you don't think so?
01:57:38.000500,000 healthcare workers have quit their jobs in the last two years.
01:57:43.000I have seen battle-fatigued soldiers who are friends of mine come back from war with less post-traumatic stress syndrome than you see in the healthcare workers.
01:57:56.000We don't really have a good sense of just how fragile our healthcare system is right now.
01:58:01.000If that's the case, why would they fire so many unvaccinated workers?
01:58:05.000Well, you know, they didn't fire so many.
01:58:32.000Very few of the doctors and nurses who work in intensive care are unvaccinated.
01:58:35.000They want to be vaccinated to protect themselves.
01:58:37.000I mean, we've lost 300 health, or excuse me, 3,000 healthcare workers have died of COVID since the beginning of the pandemic.
01:58:45.000And so they want to be vaccinated largely.
01:58:48.000And as I said, 99% of doctors got vaccinated quickly.
01:58:53.000I think the challenge is we don't understand yet is how fragile our health care system is.
01:58:58.000So when you ask me, are we better prepared right now?
01:59:01.000The Department of Labor has just surveyed health care workers and think that we're going to see a number of them quitting in the next three to six months just out of their burnt out.
01:59:10.000What could be done to strengthen and enlarge the healthcare system to make it better prepared for some new pandemic?
01:59:21.000And what could be done in terms of having treatment protocols prepared in advance?
01:59:27.000We have to be better prepared to handle surge capacity.
01:59:37.000And the problem is, Joe, that we've lost so many senior doctors and nurses who are just burnt out.
01:59:44.000That even though we have the pipeline coming in for medical school, we've had more applications in medical school in the last year than we've had in many years.
01:59:52.000But the problem is it takes time to educate them, to get them to be in a more senior status, learned status.
01:59:58.000And so for this period of time right now, we're going to have real troubles if we have another big surge.
02:00:08.000The more people that were infected meant more cases in the hospitals, the more care needed.
02:00:14.000The more care needed, the more people were stretched.
02:00:16.000The more people got stretched working, the more quit.
02:00:19.000The more that quit meant that the fewer people had that much more work to do again, again and again.
02:00:25.000And, you know, I thought I'd never see this in my lifetime, but all eight of the major health care systems in the state of Minnesota, including the Mayo Clinic, We took a full page ad out in papers around Minnesota, back during the Omicron surge,
02:00:41.000begging people, please don't get infected.
02:01:11.000And so I think that that's one of the things we have to really invest in right now if we're going to be prepared for any future surge.
02:01:18.000And what we have to understand is how many healthcare workers now, not just the stress of what they did, But how many times that they're vilified in the community because people say, you know, you didn't do what you should have done to save my loved one's life, etc.
02:01:34.000And they're doing everything they can.
02:01:58.000And so whether you had the N95 on, that thing that I wore into the studio, Which is a high-level protection, or you wear a face cloth covering, totally different between night and day, how well they work.
02:02:09.000You know, shortly after, when I was on here in 2020, I wrote a piece in April of 2020 saying this is aerosol transmitted.
02:02:57.000A lot of people are wearing those surgical masks, which are to stop droplets when you're doing surgery, right?
02:03:03.000And not only that, but, you know, just on my trip down here, which this is only my second trip in two years, some of you used to fly 150,000 air miles a year.
02:03:13.000I can't tell you how many people We're not wearing masks at all, even though it was mandated.
02:03:23.000You know, we've been doing a study where we freeze frame news media reports and just look at the people in the frame, whether indoors or outdoors.
02:03:32.000We have consistently seen, since the beginning of the pandemic, a quarter of the people wear it under their nose.
02:03:37.000That's like fixing three of the five screen doors in your submarine.
02:04:16.000You know, if they don't seal completely, they leak, okay?
02:04:19.000So you've got to have something that's a very tight fit.
02:04:21.000That means also, by the way, you can't wear a beard.
02:04:24.000If you wear a beard, you invalidate anything you put in front of your face because it all leaks right through, okay?
02:04:30.000One of the problems we have with kids is we don't have good sizes because N95s, as basically the oversight regulation of those, comes from the occupational world.
02:04:41.000It's largely for professional use, and we've never really looked at for personal use.
02:04:46.000So I will have to say fit is a challenge, okay?
02:05:29.000The virus clings to the outside of the mask?
02:05:31.000No, actually as it comes in, it's outside, but it's on the inside too.
02:05:35.000As the mask, that's why it's like it is.
02:05:38.000And so this special material is what gives you both the breathability, but also the protection.
02:05:44.000So when you wear a cloth, even if you can breathe, you have no protection.
02:05:48.000The virus will come right through in and out.
02:05:50.000Okay, so when you see, I'm sure you've probably seen these, there's a doctor who uses a vape pen, and he blows through various masks to show you the porous nature of them, and he uses a surgical mask and a cloth mask, but he also uses an N95. So you think that that is disingenuous because he's not taking into account the electrical charge of this mask?
02:06:20.000I jokingly say I could stop all transmission if you let me put cellophane over people's faces, but that wouldn't last very long.
02:06:25.000And so that's what makes these so really important.
02:06:29.000And so what we need, though, is we need a major initiative to basically develop a personal N95-like material that's comfortable, that people can wear with good fit, And that people can actually breathe through in a way that they'll use them.
02:06:46.000So the N95 material, and you said it's a milk, what is it?
02:08:33.000And what we can do, for example, in fact, you can actually develop and build and put into schools things called Corsi boxes.
02:08:42.000Corsi boxes, named after the aerobiologist specialists who devise these, are basically taking a regular old fan And putting in a MERV filter, a high-level furnace-like filter on one side of it,
02:08:58.000and basically attaching it to the fan and then letting the air blow through the filter.
02:09:03.000Put one of those or two in a room, you can do a great deal of lemonade virus.
02:09:07.000Things like that that we haven't thought about.
02:09:24.000But, you know, I sat next to a guy yesterday in the plane that took his mask off most of the time, and it was a surgical mask to begin with, okay?
02:09:31.000And so, I mean, if you have enough infected people on a plane, I do believe you get transmission on planes.
02:09:36.000I don't think you can say that they are absolutely perfectly safe.
02:09:39.000They are safer, clearly by the air filtration, how it goes through the filters that they have and move it around.
02:09:45.000But isn't it kind of nonsense if you're sitting right next to a person and they're allowed to take their mask off to eat?
02:09:50.000And what is the point of a mask mandate?
02:09:55.000You think everybody should be not eating on a plane and just keep up in 95, tighten your face?
02:10:00.000Well, first of all, I wrote a piece, again, not long after I was on here, where I didn't support general lockdowns.
02:10:07.000I said, you know what, when you have a surge, Apply the brakes.
02:10:12.000And what you're applying the brakes for is trying to keep people from overwhelming the healthcare system.
02:10:17.000And of course, you want people not to become seriously ill and die.
02:10:20.000But that if you maintain lockdowns, as they call them, When you don't have high activity, and we had many parts of Minnesota that didn't know of anybody that got infected in greater Minnesota, and yet they went into that.
02:10:44.000One, there's a time and a place if you want to try to stop or eliminate transmission as much as you can, but then also don't make a mandate around somebody wearing a face cloth covering.
02:10:58.000And so that is what you see, though, when you have a mask mandate.
02:11:01.000You see people wearing what you think are very ineffective masks.
02:11:05.000And so I continue to come home and say, you know, please wear high quality respiratory protection.
02:11:10.000Then I could support more mandates for a limited period of time when you have that surge capacity.
02:11:15.000I mean, what we just went through for the last 10 weeks was an example where the more we could do to slow down transmission like that, add in the papers in Minnesota from the healthcare systems we're asking people to do, just give us a break.
02:11:30.000I think you're going to see a period coming up in the next weeks where, you know, whether the public health thinks you should be wearing a mask or not, the governors have already read the tea leaves and said, no, we're not.
02:11:39.000And I don't think that's a wrong thing.
02:11:42.000When you saw the residual effects of lockdowns, like particularly high suicide rate, depression, drug addiction, there's a lot of businesses went under, a lot of restaurants went under.
02:11:56.000What do you think could have been done to manage that differently?
02:11:59.000And do you think that that residual effect is just a function of not being prepared and not anticipating anything like this ever happening and not having the steps in place to handle it?
02:12:13.000You know, I don't think it's a straightforward issue.
02:12:16.000What I mean by that is I just saw a recent research effort that just showed that the number one reason for depression during the pandemic was not about losing a job or work.
02:12:29.000And you know, when you have 900,000 people die, and it's among the top 10 causes of death for all age groups, when you have 300,000 kids in this country, 300,000 kids who have lost a parent or a guardian who took care of them,
02:13:11.000What I'm saying, though, is trying to understand that isn't self-important for going forward because, as I shared earlier in this session, we could see another surge again.
02:13:59.000I mean, if I get asked to run a marathon once, that's tough.
02:14:03.000But if I get asked to do it day after day after day for months and months, you know, I give up.
02:14:08.000And so I think that part of the challenge we have with this virus, which has made it so difficult, It's the long-term nature of what's happening.
02:14:17.000And I'm not saying that that excuses any of the mistakes that have been made about how to approach it, but it's just human nature.
02:14:59.000Well, a year ago, right now, and I'm not taking any great credit, but I made public statements that I thought the darkest days of the pandemic were still ahead of us.
02:15:16.000But we had many of the talking heads out there, of which I include myself as a talking head, who were saying to the public, You know, it's over with now.
02:15:34.000Why do you think that they made those declarations?
02:15:41.000There was a situation where we lacked humility in saying what we know and don't know.
02:15:46.000I mean, when I leave here today, I hope everyone says, Osterholm says, maybe it'll be okay, but maybe it could be another bad one, and we've got to be prepared for it.
02:17:04.000Okay, so to wrap it up, what's your assessment of what we just looked at in terms of like the Israeli data?
02:17:12.000I think the really important message here, if you look at the countries, what happens to them in terms of cases, severe illnesses, hospitalizations, deaths, it's vaccine, vaccine, vaccine.
02:18:11.000So your thought is the reason why everything's going sideways in Israel is not the failing of the protection of the vaccine, but rather the fact that there is a substantial portion of the population that's unvaccinated?
02:18:27.000But what I'm saying is what really brought that surge on was in terms of hospitalizations, severe illness and deaths, was largely that surge piece was among unvaccinated or one with one dose.
02:19:42.000And, I mean, if you look, for example, at South Africa, where we have better testing, we have better follow-up, you did see increased number of cases.
02:19:51.000If you look at Zimbabwe, You look at countries like that.
02:19:55.000And so part of it is that surely it's not the same as the U.S. We're not seeing the hospitalizations the same way.
02:20:03.000But then we have a much younger age population.
02:20:06.000You know, any of those conditions that could predispose, if, you know, your median age is 20 or 30 years younger than it is in A high-income country, right there you have an advantage in terms of likelihood of having severe illness.
02:20:19.000But I think at the same time, we're trying to study that to understand how many cases did we miss?
02:20:26.000And it's been particularly important in Africa for a separate reason, is because public health services have been so disrupted there because of COVID. Levels of vaccination, malaria control, maternal and child health, all these other issues are taking a huge toll right now.
02:20:42.000And, I mean, we're really going to have to reinvest back into that area just because we've lost a lot of footing in our control from a public health standpoint of many infectious diseases.
02:20:53.000Is there any other factors that could be a consideration in terms of like the low rates of infection?
02:21:00.000Do you think that it's just a lack of reporting and testing or is it possible that there's other medications that they've been taking that could have contributed to their low numbers of infections?
02:21:11.000Well, again, I come back and say that it's not just the fact of underreporting.
02:21:16.000As I pointed out, you know, if you have a much younger age population, you can see big differences in the rate of serious illness, hospitalizations, etc., just by that alone.
02:21:27.000In terms of any of the factors, such as has been suggested, could certain drugs that they may take or how often do they take those drugs could play a role?
02:21:34.000You know, I'm at this point, again, open to the data.
02:21:37.000You know, we just have seen so little come out of Africa and we need more.
02:21:41.000We need much more information to understand that.
02:21:43.000I think the South African experience was helpful in allowing us to see what Omicron was going to do.
02:21:50.000Now, however, we're in a place where, even looking at South Africa, that big burst of cases has come down, but it's not going away.
02:21:58.000There's a tale here that's pretty substantial.
02:22:03.000So I think the African continent has been largely neglected relative to many other parts of the world to better understanding what COVID has done, both directly and indirectly, to the society.
02:22:17.000Were there any countries, do you think, that were a model of how to handle the pandemic correctly?
02:22:26.000You know, I think trying to make the very best out of a horrible situation, I think Australia and New Zealand have probably done as well as any two countries.
02:22:34.000And you can say, well, they're islands.
02:22:36.000But, you know, they pursued this zero-COVID policy to the extent that they could.
02:22:41.000And when it became impossible with Omicron, they graduated their response in a way, you know, that I think is really helpful.
02:22:49.000I mean, just take, for example, New Zealand.
02:22:52.000Here's a country that with, you know, 5.2 million people.
02:22:56.000Here's Minnesota, the state I'm from, you know, with 5.6, 5.7 million.
02:23:01.000You know, when you look at our deaths, you know, we've had, you know, 12,000 almost.
02:23:12.000Well, I think in part it's because they did try early on to really have major control and then allow things to be relaxed when the numbers didn't appear to be increasing or the follow-up.
02:23:24.000And so I think there's lessons here for us to learn across the board.
02:23:28.000All countries need to go back and look carefully at it.
02:23:31.000A very interesting piece in the Financial Times a couple of weeks ago, David Byrne Murdoch, who I think is one of the most wonderful journalists today in this topical area, did an analysis looking at what would have happened during the Omicron surge in the United States if,
02:23:48.000in fact, we had the same immunization rates for COVID as Denmark.
02:23:53.000And he estimated that about half of all the hospitalizations would have been eliminated.
02:24:00.000That's why if you see now, you see lots of cases in Denmark occurring as they've opened up everything, but the number of hospitalizations and people in ICUs have gone down.
02:24:09.000Because again, they're actually providing protection against serious illness, hospitalizations, and deaths with their immunization programs.
02:24:16.000And I think that's a lesson for us going forward.
02:24:18.000How do we make that work so that we can do more of the same?
02:24:21.000Now, what is your take on doctors like the FLCC that had this early treatment protocol for COVID? That has been widely disparaged by other people, like, you know, the ivermectin,
02:24:38.000hydroxychloroquine, azithromycin, all that stuff together.
02:24:43.000Like, what do you think about these doctors that had put out these protocols for early treatment?
02:24:49.000Well, I don't have an opinion on the doctors.
02:24:51.000Do you have an opinion on the protocols?
02:24:54.000I think, again, it has to be science-driven.
02:24:57.000And as I just said earlier in our discussion, I think the data coming out on these five trials with ivermectin is going to be very interesting.
02:25:07.000I'm ready to see them, these double-blind placebo-controlled trials.
02:25:10.000Have you looked at any of the randomized controlled trials that have been done previously?
02:25:14.000You know, there were none that were really randomized controlled trials, I can tell you.
02:25:18.000Looking at the studies carefully, there were so many problems.
02:25:21.000The one in Brazil was really a challenge.
02:25:24.000I mean, again, going back to my previous statement, if one of my graduate students had done that kind of a study, I would have flunked them.
02:25:30.000So I think we need really much more comprehensive data, and we should be collecting data on these kinds of treatments.
02:25:37.000So I hope everyone can agree, if you do a double-blind placebo-controlled trial, that means that neither the patient nor the investigator knows who got the drug and who didn't.
02:26:42.000You know, you understand this, but, you know, people really respond to when you tell them a story.
02:26:50.000You know, I learned a long time ago as a kid growing up in rural Iowa that if I wanted to try to make a point or to try to put forward a position, if I couldn't get it to sell at the Tennecock Coffee Group at the S&D Cafe in my little hometown in Iowa,
02:27:07.000you know, I needed to go back home and rethink it.
02:27:29.000I mean, you know what this interview will probably be remembered for?
02:27:32.000How many times I told you that I don't know?
02:27:35.000Well, that and, I mean, I think you gave a great analysis of things that went wrong and things that we could have done better, and also the burden on the healthcare providers.
02:27:45.000I think that's something that people need to be really reminded of.