A Bestie gets COVID, Delta breakthrough, Billionaire Space Race & more

The episode opens with a mock game show called "Guess who's got COVID". The hosts establish that all four are vaccinated with Pfizer, so whoever caught it had a breakthrough infection. A few quick clues follow: the case came from an outdoor restaurant, from someone who was also vaccinated, and the person does not fly commercial. The clues point to Sacks.

Sacks says it is not funny to be comedy fodder, and the others tease him about weight loss and read out the jokey text messages they sent when they learned. The jokes are dark and aimed at the idea of recruiting a replacement or borrowing his plane. They then say they are glad he is safe, and he promises he is going to live.

Sacks says he had dinner on a Tuesday with a few friends at Matsuhisa in Los Angeles, in a covered outdoor area that he says traps air and is effectively indoors. The next day a friend woke up with a fever and sore throat and tested positive; the friend is also double vaccinated with Pfizer. Sacks tested negative on Wednesday and Friday, then woke on Sunday with a fever, a dry cough and sinus congestion.

His fever topped out around 99.9, which he calls barely a fever, and Tylenol brought it down. A test on Monday was positive; the lab could not confirm the Delta variant, but he says it is thought to be Delta because it is surging in Los Angeles. By the following Thursday, he says, he feels about 99% recovered. Another person from the dinner now has symptoms, and two of the four other diners besides the infected friend got it, all vaccinated, which he takes as a sign of how virulent Delta is. These are his own accounts.

Asked about a pulse oximeter, he says his reading has been around 95%, slightly down, and another host notes the usual advice is to go to the emergency room at 92 or 93. Sacks says he isolated from his family, but his eleven-year-old still caught it. He had tested negative on Wednesday and Friday and thought he was through it, so the household was lulled into a false sense of safety.

A host says he has read that Delta is 60% more transmissible than the UK (alpha) variant, which was itself 60% more transmissible than original COVID. Multiplying, he gets roughly two and a half times the original, and applying that to an R naught of 2 to 3, he says Delta's is about 5 to 8, possibly around 8. He compares that to smallpox territory. Asked to explain, he defines R naught as how many people an average infected person infects before they know and can isolate. These are his own figures, drawn from things he says he has read.

He points to Israeli data discussed the previous week, saying Pfizer's effectiveness at preventing infection fell from about 95% to 64%. So perhaps a third of vaccinated people can catch and pass it on unknowingly, and he concludes that unvaccinated people are going to get Delta. He cites a 500% jump in the five-day average of cases in Los Angeles County within a month and says a tweet by a cartoonist put it as: either today is Wednesday for the vaccinated, or it is the day the unvaccinated get the virus. These numbers were not checked on air.

The good news Sacks offers is that on the Wednesday his friend tested positive, he told his wife, who had one shot, and they decided about their thirteen-year-old; all got vaccinated that day. With about three or four days for the vaccine to prompt an immune response, he says they did not get sick. This is his anecdote, not evidence that post-exposure vaccination protects.

Asked about treatment, he says he took only Tylenol for fever and Flonase for congestion, and that his doctor judged the prednisone his friend was prescribed to be unnecessary or a bad idea for him. He stresses that it was a very mild cold for him and that this is why everyone should get vaccinated. The other hosts quip about wine pairings at the restaurant. A host then recalls considering Moderna as a boost, which another host had called crazy, and asks whether that view has changed.

Friedberg says the earlier data did not justify extra action but new data now does. He relays, from memory and from a pharmaceutical executive he says he spoke with, a breakdown of vaccinated people newly infected in Israel: nearly two thirds had been vaccinated in January, about 30% in February and under 10% in March. The implication he draws is that more recent vaccination means fewer breakthrough infections. He stresses that he is approximating what he remembers.

He also cites a well-known virologist he says he met. Antibody levels in the blood decline over time, but another study found memory B cells persisting in lymph nodes, which suggests lasting immune memory. Taken together, he says, these point to a booster, a third shot, being needed soon, with efficacy dropping to roughly the two-thirds level after about six months. He adds that the more pressing point is vaccine durability rather than any particular variant. These are secondhand accounts that were not verified on the show.