Michael Osterholm
Guests: Michael Osterholm
Full transcript · Read the full conversation in order, with its original context.
Contents29 chapters
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The Joe Rogan experience
Dr. Osterholm welcome back. Thank you very much very good to see you again.
Good to see
It's been basically two years from the day and 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 you scared the shit out of a lot of people
Well, you know my job is not to scare anyone out of their wits
It's to scare them into their wits ah and to do what they can to
Deal with the situation as you know at that time March 10th of 2020 no one
wanted to believe this was gonna be a pandemic
And so yeah, there was a lot of denial about how it was gonna play out and
people were thinking that it was
Inflated or is not that big of a deal and then like I said when you came on the
podcast that like I got a bunch of calls from
friends like oh and Jesus
Yeah, 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
You where we're going in particular right now
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, you
know
How when you look back at it what mistakes do you think were made and what do
you think was done correctly?
Well, 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 humility every day
When I get up the first thing I do is I look over at my nightstand and I see
this crystal ball
It has five inches of cake mud on it and I try to scrape it off and then decide
what do I know for the rest of the day
And I think that we've had far too many answers before we really had the
answers
And 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 and what did we have to do to learn more?
So I'd say it's humility
Do you think that it's overwhelming like the the reason is there a reason?
Why they didn't do a good job sharing the information with the public?
And do you think that some of that might be just the fact that
being involved in something with that has such a
massive footprint something that literally overwhelmed the entire planet earth
That there's so many variables there's so many things to deal with there's so
many things to manage that that became part of the problem
Well, 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
I mean, it was just one of those situations where there was so much going on
look at the politicization
Look at the misinformation disinformation
I mean look at the debates they often weren't really about the substantive
issues of what was happening
And 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?
I mean, I'm sure there are people after I'm on here today
They're not going to be happy at all with what I have to say because I don't
think we're done yet
And 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. Everyone wanted to declare
independence from covet
And I said no, I think the darkest days of the pandemic could still be ahead of
us because of variants these variants are really challenging
We don't know what they're going to do. They kind of like 10 hundred 10 mile an
hour curveballs
And so I think that even going forward we surely are at a better place right
now and we're going to be this for a while
But I don't know what the next variant is going to bring and will it evade
immune protection?
Will 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?
I don't know that maybe it's going to be fine
Maybe we're going to see it become a regular old flu-like illness every year,
but maybe not
And I think that that's the challenge we have is that kind of humility to say
we don't know
And 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
There'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 is that correct?
That is the sense
But there's a couple of assumptions there that I think really deserve comment
number 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
If 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 someone would die
Well, then along comes omicron instead of a hundred only ten people get serious
illness or hospitalized you say
This is a much milder disease the problem was you have 20 times as many cases
§02Transcript · 05:18–10:28
occur
So actually your health care systems are much more overwhelmed
I mean, it wasn't just the total number of cases
It was the severe cases and the last 12 weeks have been among the most severest
weeks of the pandemic
And it's just because the sheer number
And so I think that that's one thing first of all
This was a mild disease for a lot of people but for a whole lot more it wasn't
I think number two is the fact that
You know, we don't know what these variants are going to do they could be milder
again
But 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 of at some point
Well, now we're seeing all kinds of animal species infected with this virus
Look at what's doing with white-tailed deer
I mean in my 46 years in the business
I've never seen data like I've watched the emergence of this new variant
In in wild deer yeah, it's very strange, right?
I mean, that's some in some places as many as 50 percent of the deer of
antibodies
Yeah, well, in fact, even if you look at studies like in iowa where they
followed it and actually looked rogue kill deer
So that 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
So as the numbers in humans went way up the number and deer went way up where
are they getting it?
Yeah, that's the question, right?
Are they getting it from the capid captive cervid industry?
Well, I don't think it's there. I think it's
Something because it's a statewide even where you don't have captive cervids
They were seeing the same increase and decrease in cases
So I think what it's really pointing out though is 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 and no one can tell you
that and if they do be careful
Because they probably have a bridge to sell you. Yeah
So you could have one it gets milder and we surely have four coronaviruses
right now that typically cause milder disease cold-like symptoms
Maybe it'll go that way on the other hand
It may reassort meaning that it swaps out its genetic material like a flu virus
does with other
Coronaviruses and we could see a new punch it could actually evade immune
protection
We don't know that so I think the challenge we have is just being honest with
everybody. This is the guardrail
One side is it could go back to another omicron like experience or that may be
the last one
I hope for the last one being the mild one, but hope's not a strategy
So you got to look at what do we need to do to be prepared and right now
everybody in this country wants to back away back off and say
We're done which I want to to I feel that but at the same time
I have to say I don't know that we're done just like I said a year ago
I thought the darkest days were still ahead of us now when you say that
So omicron is far more contagious than delta and far far more contagious than
the original variant. Yes, right now when you say that
Maybe you know, whatever numbers are used that it's less likely to cause
hospitalization
But because it's infecting so many people you actually get more hospitalizations.
That's exactly right
So what are what's the cause like why are some people getting badly hit by it?
Whereas other people it's just a runny nose
Well, and we don't know
We do know a couple of things about protection number 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 if 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, you know people with
diabetes people with asthma people are immunosuppressed
There 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 and even what
we saw with kids
We had never seen this level of activity as we see all with omicron with kids
And so I think the challenge we have today is for hospitalizations. Yes, even
for hospitalization
Now the kids that were hospitalized did all of them have comorbidities?
No, none of them did not so many some of them were not even obese. Yep, and
they were hospitalized. Yes, absolutely really, yep
omicron clearly really took a
a hit on kids that's interesting because
I in my kids school a few kids got omicron and it was uh essentially like
Me or my friends who got it was very mild if you look at right now
uh, just
Through this up till this past month with most of this activity having been
primarily in the last six weeks
1334 kids between the ages of zero and 17 have died from covet
1334 kids. Yep, and out of these kids how many had comorbidities? How many were
obese?
Some did but but a comorbidity is just obesity. Yes, in fact, let me come back
and say
Somebody who has diabetes is considered having a comorbidity if you look at
somebody who has
uh, asthma which you know about seven percent of all the asthma in the country
§03Transcript · 10:28–15:53
is in kids all sorts of autoimmune diseases
Exactly, so all of those add to it. Right, and and so that's been part of the
real challenge we've had with this
But for normal healthy kids is this something that's more dangerous than delta?
Absolutely, it was it's really absolutely
It was that is that is that shocking to you because it seems like for adults
The the effect that it has on the general population
It seems that the the consensus is that it's more mild
Yeah, I think that's one of the challenges we have if you've known
The covet 19 pandemic
In 2020 and you knew it in 2021 doesn't mean how well you know it today
Because things have changed right for 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 to january 2021?
And we found limited transmission in kids limited severe illness
Then alpha came along and we saw much more transmission
We had places in this country that had large outbreaks school-based outbreaks
Then that kind of went away then delta came and added even more transmission
with kids than we'd seen before and omicron was the king
And 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, so I think that's one of the challenges
We have is just keeping up to date and what it did and how it did it with kids
And the variants uh as they like so the there's the original version and the
alpha version is the first variant that was discovered
Well, yeah, that's they what they've labeled them by is the greek alphabet
So alpha was kind of the first one there and then we've had
Not not a not the original virus, but the first variant of the virus. Yeah
Well, what's really interesting with this virus is the fact that if you look at
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
It doesn't mean that if you had elf it turns into delta with a little bit more
changes
It turns into omicron every one of them have a distinct line back to the
original variant
And 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
And as far as
The variants that are in play right now like what percentage of the the
infections right now or omicron what percentage or delta?
Is there any of the original variant left?
The original variant surely is out there because we keep seeing these new
variants come from it
So it has to be somewhere. I can't tell you where it's at the variants don't
come from like delta creating a new variant
So it's it's actually takes take you back to the original variant
So the question on omicron's industry when right now in the united states
virtually 100 percent of the variants we see are omicron
They've taken a hundred percent
100 percent in the u.s and virtually around the world it's beaten out delta
completely
If you look in the united states there are three sub-lineages of that variant
what we call ba1 ba2 and ba3
And we're watching a battle go on right now between the those sub-variants and
it turned out ba1 was the original one
We first saw kind of the original omicron
But ba2 which appears to be more infectious now is beating out omicron in some
countries in the world
It's become the dominant variant in the united states is still a a small
percentage, but it's growing last week
It was four percent the previous week was one percent. So we don't know what
that's going to mean in terms of seeing more
of the
ba2 variant emerge
How do they make the distinction between omicron delta omicron and then ba1 ba2?
Why do they decide that this isn't another variant? Why do they just keep
calling it omicron?
Yeah
And and and this is one of those questions where I 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 if you look right now for
example, there's more difference
Genetically between ba1 and ba2 than there is between the ancestral virus and
alpha really?
Yes, so it has to do pretty much how it evolved out of that ancestral virus
tree and is it different enough and 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
So but but this is I think the message here is this is what we have to continue
to be mindful of
I know everybody wants me to say today we're done and I hope we're done
But as I said just a moment ago hope's not a strategy
Right
I 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 when you see influenza
Pandemic influenza occurs because a bird virus finally evolves out of the bird
gets into particularly a pig because a pig has a lung
So it has receptor cells for both human viruses and bird viruses
And when they get into a pig cell in particular they combine they mix up
The flu viruses are very promiscuous and they come up with this brand new
strain that causes the next pandemic
Well when that spillover occurs into humans, that's kind of the
Seminal event the rest of it emerges pretty much in humans
§04Transcript · 15:53–21:03
We don't necessarily see us giving it back to the animals they give it back to
us we give it to the animals
They give it back to us with
Looking at SARS-CoV-2 in the and this particular coronavirus
We don't know what it's going to do is it going to go back and forth between
animals
I mean, I could line list an entire
Set of all the animals that are now infected with this virus
And we don't know what that means the first ones that we found that trans
Transmit from humans to animals or back to in in terms of SARS-CoV-2
Was it ferrets like what was the first animal that they discovered that uh
humans can infect and they can infect us with us?
Well, there was
Game animals mink and so forth in europe that we saw that
But it became clear because we started seeing zoo animals infected right just
this past week
We've heard about lowland gorillas and stuff cats we've seen dogs and cats in
people's homes where there were cases
And they got the white-tailed deer. I think there's a whole number of animal
species where ultimately they could be infected with this virus
And the trillion dollar question
We don't know will that in any way shape or form contribute to a
Spillback moment into humans with the new virus that again will challenge
Our immune systems challenge our protection and what does that mean?
And we just don't know is that the term they use by a lot or animal reservoir.
Yes, absolutely. That's it
So that's um any other animal that can catch it now is that
We'll catch it and keep it going
Inside them. So sometimes an animal may get an infection from us and it's
terminal it ends
It doesn't keep going in the animal population
But as we just talked about the white-tailed deer
Clearly there the virus is ongoing with transmission in the deer population
itself
Are 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
You know, it's
Unclear and 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
When you say game farms, are you talking about like captive coven?
Captive survey rather in this game what we're talking about are primarily fur-bearing
animals for pelts, you know, the mink
Ferrets that type of animals. So that's where they first started to see the
transmission?
Well, it's suspected. It's never been confirmed, but it's been suspected there
There's been some discussion and follow-up on people's homes where somebody got
infected
The animal was infected the dog or the cat and somebody else got infected in
the home
Well, it could just easily been person to person the animal is incidental
So I don't think we have any good examples of a human to an animal and an
animal back to a human
There was a recent outbreak in hong kong
It's now emerged into a large outbreak where they thought that hamsters were
potentially being sold in pet stores were involved with
Being infected and transmitting, but I think the data still are out on did the
hamsters really transmit back to people
They were definitely infected, but I don't know if they transmitted back to
people
Now this virus are there parallels to other viruses that we could look to and
and see this kind of similar pattern emerging
particularly with like
transmitting it into these other animals and then the potential of those these
animals transmitting into the people
It seems like there's so many different species that have it. Yeah
You know, we really don't have one like this particularly that can cause such
A widespread disease. I 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 was
going to be
It was just going to flood the world if you look at alpha and delta and all
these other took weeks in some cases months
Before it spread around the world
This one spread around the world literally overnight and you know
We're now seeing major activity in the western pacific region, you know in in hong
kong
Likely in china's we're not hearing enough about it korea, etc
But most of the rest of the world's already been hit hard and over it. Well,
that is like a blizzard what it did
We've not seen that with any other animal related virus in humans even
influenza hasn't done what omicron's done
In that way
Now in the beginning of the pandemic you were of the opinion that this was
from a natural spillover
from the the origin of
SARS-CoV-2 was most likely from an animal that it spilled over into human
beings. Do you still have that opinion?
Well, again, let me clarify what I said and and have maintained all along
because I too have concerns about
The potential for what we call gain of function or or clearly biosecurity of
laboratories leaking out of of labs
I hadn't have not seen any evidence at all that would support that number one
This was a man-made virus absolutely none zero no evidence that would support
that it is a man-made virus
None whatsoever and I again with my limited expertise in viral genetics
I believe the people who I work with now the question is could it however been
in that lab
And spilled out because somebody got infected there was a lab accident which
§05Transcript · 21:03–26:00
surely can happen
and again, we don't have
Any conclusive evidence that that happened. I think even anecdotal evidence we've
had has been very short, but 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
I don't think we've had that kind of a transparent investigation yet
To see were there sick people at that time because if it was going to spread
out into the population there would be sick people
On the other hand
I'm not surprised that it might have emerged in wuhan because here's a you know
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
And 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
And so I am still open to the fact that was it a laboratory accident
I don't have any reason to believe it was an intentional one
I know it was based on everything we have it was man-made
But I don't think anybody thinks it's an intentional release do they?
No, well some people have no some people think
Well of course I shouldn't say anybody
Yeah, yeah
Some people believe the world's flat
Right, that's absolutely true too
That's absolutely true too
So I think no that but I think that it is fair to say
That there still remains this question could have leaked out of that lab and I
continue to say
I wish we would have
An exhaustive comprehensive investigation which the chinese government would
agree to
Is that part of the problem a lack of transparency?
I think it is but let me let me paint a picture here that also helps explain
the situation
Imagine a brand new virus emerged in the caribbean
Okay, I mean it came from nowhere. It might be a mosquito born something. Okay
Where do you think they might find that virus first?
Atlanta
Why Atlanta? Because it's the industry it's a transportation hub for the caribbean
And they have the sophisticated laboratories there not even at the cdc. I'm
just talking about universities, etc clinicals
Imagine if that virus was found in atlanta a brand new virus the assumption we
made immediately it came from the cdc
Because it's there geographically there. It's in atlanta. That has to be the
source. I see what you're saying
And 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
We're going to come in and see
Do you think the us would just willy-nilly open up the lab at the cdc to the russians
and the chinese right so in some ways?
I i'm not being sympathetic at all the chinese because I think they are
continuing to make the problem worse by not providing more transparency
But 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
Right, but is the cdc doing gain-of-function research on coronaviruses?
They're not they're not well, so if something emerged from there
That wasn't something they were working on that would probably not arouse the
suspicion of the world
I think part of the problem with what's going on in wuhan was
That lab is a level four lab that was working on
Bat-borne
Absolutely right about that, but at the same time cdc might be working on a lot
of the viruses that would emerge in the caribbean
And they would have labs that were working in that because some of their best
expertise is on for example mosquito board viruses in there
So i'm merely pointing out that
It's not just the fact that the chinese have basically stonewall this they have
And unfortunately, I think that that can be interpreted as you know, there's
definitely guilt there, right?
I think some of it has to do with this issue where they just opened their lab
up
I just wish they would and let us let that an independent group from around the
world go in
Examine all the records was there any evidence of illness around that time was
there any unusual activity?
You know the viruses they have what they've self-reported were not any that
were
Close to this one in terms of actually yeah that actual virus was in the lab
that was suddenly found in wuhan
So I think it's a continues to be a major distraction
Wasn't there recently a version of the virus that was discovered a very early
version of covid 19 in one of the labs?
There's been a number of 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
And so I think that but but that's the kind of thing we need to have the
transparency on and and I wish we'd move on
I wish we'd move on then so the part of the issue is that there's just not
enough data from them to make an accurate
honest
§06Transcript · 26:00–31:11
Clear determination that's what I see and I do see a virus that right now
Sure is very effective at moving between people to animals right so it doesn't
surprise me that it could move from animals to humans
Now the people that are suspicious that this did come from some game of 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?
Yeah, and I see no evidence of that and let me just come back and add a context
to this
I sat for a number of years on what was the newly established
Basic group inside of the federal government to look at biosafety and biosecurity
work
Okay, the national science
Group that did that and 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
Virus h5n1 a bird virus that occasionally infects humans
But could it one day become the next pandemic virus and a group of researchers
wanted to try to gen up that virus
By passing it multiple times in ferrets and looking to see can we predict when
it might become readily transmissible between mammals?
I.e could it affect humans and my concern was all along wait a minute. What
happens if this gets out?
What's the challenge you could start the next flu pandemic?
So I have always considered myself kind of the champion in a way as amongst
others of looking at biosecurity as a really critical issue
So I I come into this with the wuhan experience feeling the same way. I think
this is an important issue
I think it needs further discussion
But again, I don't see any evidence at this point that anyone has provided that
shares that this is what happened
But I think we just need that transparency. We don't have yet
So there's not enough evidence to draw a clear conclusion in your opinion
None and I there is some anecdotal evidence, right? There was uh, some I
believe there was three
Researchers at the wuhan lab who did get ill
Uh with a very similar disease to covet 19 and one of their spouses wound up
dying
And there was some indication that that could have been the initial source
Yeah, you know
Let me first of all just say in my world anecdotal evidence is not really
evidence, you know
It's it's it's it's it's that storytelling, but you know, I see some of these
things
Yeah, and you know, I've never seen any of those data corroborated by any
Responsible group. It's kind of one off, you know, it's kind of that old idea
You know, president kennedy's secretary was named lincoln president lincoln
secretary is named kennedy
So there must be a tie between the two assassinations, you know, it's that kind
of thing. Yeah
I've seen nothing that supports that activity
Okay, so as a scientist, you're just not willing to make that leap
I'm not willing to make the leap, but i'm unwilling to make the leap if we get
the evidence that it's there
So i'm not sitting here saying write it off right. I get it. I get it. Yeah
Um in the the early days there there was some evidence that
Was deleted there was a lot of files that were deleted from the wuhan lab
And that a lot of people pointed to that as being an indicator that they were
not not just not being transparent
But withholding some data
Yeah, I at this point I can't comment on that to say I know exactly what
happened
There surely was some evidence that there had been some files moved or deleted
Also, there's been evidence that some of those files have been replaced, etc
So I I can't comment beyond that
But again, the 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
Right, it's just again not enough, right? Is that what you're saying?
Yeah, in fact, I wouldn't even say not enough
I would say I'm still waiting for
Even a limited smoking gun to come forward and say that I just haven't seen
anything like that
I'm open to it. I'm willing to it. I've said time and time again
I wish that their Chinese would allow for an exhaustive
outside review of what happened there to corroborate all these pieces of
information or basically
Show that they're not true
And I think that would put us all in a better place of trying to move forward.
Is there proof that they deleted evidence?
I don't have any proof of that. I don't know. You don't know. I don't know
If there was proof that a lot of files were deleted would you would that give
you pause?
Well, I'd want to know why you know
We delete files all the time on research things after things are completed now
on the other hand laboratories
typically are
Keep everything forever because they may have to go back to it at a later date
So, 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 now
One of the things I think that you said early on in the pandemic was you didn't
think that it would
That it had emerged from a lab
You thought it was a natural spillover just simply because of the design of the
virus itself that we wouldn't design something like that
Yeah, and I still say that that's the case
§07Transcript · 31:11–36:12
I mean this thing is so effective at
Infecting humans and it only got better over time think what it did in mother
nature since the first omicron or since the first variant occurred
Up to omicron and you can see it just got better and better at infecting humans
without any hand of a man-made event
And 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
So 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 and why do you think that that's not the
case?
Well, again, this is out of my sphere of expertise
I am not the person who can tell you from a genetic standpoint how to
manipulate this virus and what to do it as an epidemiologist
I can tell you, you know, I've seen these other spillover events
I've been very involved with investigating SARS
Back in 2003 when it first emerged in China spread around the world
I've been very involved with the work with MERS the Middle Eastern respiratory
syndrome another coronavirus
And in each one of those you can show clearly the spillover event from animals
to humans
In fact with the camels being the Bain Reservoir for MERS in the Arabian
Peninsula
We keep having MERS cases because nobody's going to put down all these camels,
you know, we're not going to get rid of them
And so we watch those spillovers occur from time to time into humans
So coronavirus is emerging out of an animal reservoir
In and of themselves are not unusual
It's not somehow like A plus B plus C plus miracle ended up with the answer
So I I haven't seen anything that would tell me that that was any different
than that
But again, I'm wide open to whatever new data can come forward and I hope we do
exhaustively look at this
Now when they perform gain-of-function research, can you can you explain how
that's done?
They're they're using
Different coronaviruses and and various viruses and infecting human respiratory
tissue
And they're also doing experiments on ferrets because they have very similar
ace-2 receptors to human beings
Right is that the case?
I can't comment on what research they're doing. I don't know. You don't know. I
don't know that
But you do know how gain-of-function is done, right?
Well gain-of-function first of all means that you're adding something to the
virus like I talked about with influenza
It was a gain-of-function
We were trying to see if you could make it transmissible between in this case
an animal species and a human
Or you're trying to make it so that it is actually more infectious or you're
trying to make it so that it kills it
It does more damage
And those are all considered parts of gain-of-function in other words trying to
make it do something else
So in terms of the
coronaviruses, I've not seen any evidence of again gain-of-function because
This virus is pretty damn functional on its own it's doing very well and 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
Right, but the way that these experiments are done are 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?
I mean I don't necessarily think they're manipulating the virus aren't they
allowing the virus to go through
Its normal processes, but they're doing it purposely, right? Is that the case?
In the principle what you laid out that's the case, what I'm saying is I don't
know that they're doing that
I have not seen any evidence. It could exist. I just don't know. I'm not trying
not to answer
Doing any of those studies where they're trying to make it more transmissible
or that they did do that. I just don't know
I thought that was the entire argument that that even the NIH had laid out that
they had done
Well, that had come up and as you know
Equal Alliance the group that was doing the work
EcoHealth Alliance
Yeah, EcoHealth Alliance
Actually, yeah, I disagreed with that so that's not what's being done
They said they disagreed with it. Yeah, and I saw I can't comment. I don't know
Right because this was like the arguments between Rand Paul and Dr.
Fauci and you know was get very contentious about the definition of gain of
function. Right, right
Do you think it's just splitting hairs or do you think this is?
Well, 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
Again, I don't have any first-hand or second-hand knowledge that that was what
was being done in Wuhan
But if they were doing gain of function, that's how they would do it
They would infect human respiratory tissue and they would infect various
animals
And they would study how this virus progresses and how it evolves and selects.
Is that the case?
Well, 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. I just don't know
Right
§08Transcript · 36:12–41:12
And 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
That this would somehow or another make a virus more
Transmissible to people. Yeah, that's the idea behind it. You know, yeah, and
again, I just come back to the fact that
You know, you don't need to set up a research study today to do gain of
function with this virus watch it in people
Watch what it's doing on its own right?
But that's once it's been released correct once it's been released
If we're looking at the origins of it, I mean, this is what's concerning to
people, right?
They're wondering like was this
avoidable
During the obama administration didn't obama put the kibosh on gain of function
research
It was limited in the sense that it was for all gain of function or research or
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 a 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. So we do want to do some of this, but we want to do it
safely
And what i'm suggesting here is I don't know and yeah, what happened in this
lab or how it did it
I'd love to see that transparent information come out. I just can't comment. Is
it safe to say that?
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 it has to be done safely,
but it's
There's benefit there surely can be benefit and there's risk and this is all
about the risk benefit equation
And 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
And you know you can't unring a bell
So i'm one of those people that am very concerned. I don't want to find out
later. I wish we had taken more caution
Right, okay, my problem is I for this discussion
I just can't comment on what happened at wuhan because I don't right of course
Well, you're a scientist and you look at the evidence you look at it
How's and there's just not enough of it, right? Is that safe to say?
Yeah, and and i'm open to any new information as I said before that comes
forward
Did you read any of those emails where there was discussions that was were
about
The narrative of whether or not it had come from a lab leak and deterring that
narrative
I didn't read any of that. I didn't I you know, I didn't really you know if
something substantive come out, but I you know
Uh, you know, I already spend way too many hours a day working on code
The last thing I have time for is basically getting into these politics, you
know
You know, and as 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 and so for me
You know, if there's substantive information, I want to read it
I want to know about it if 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 as an epidemiologist
I think I have a pretty good handle on what the virus is doing in terms of how
it acts in people
But 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 and so
We'll go for it and I would like to see what they come up with
So as an epidemiologist you are just trying to follow the facts of the disease
and avoid the weeds
Exactly okay
And and and and be really clear about this is that I think that
We have to have these discussions with how we have them they have to be based
on data
What 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 as well, they are linked let's I can tell you
the cia of you know
Of the 1860s were still active back then and they're still active in the kennedy
era, you know
That does not help and to me that's where a lot of people find they spend time
I don't
I don't know if that's a good analogy like see what you're saying
But we actually have the the actual people that were trying to say that it
seems like this is coming from a lab
And then and these were credible people from
Legitimate universities and then you had some other people that were trying to
say we need to disparage these people
And we need to look at them as if they're fringe conspiracy theorists
Yeah, I think in the early days that happened in a way that that happened
Um, you know, I can't comment. I wasn't part of that discussion
I did not get involved with that discussion because I felt like it was
You know, it was in the weeds in a way that you know
I was trying to figure out what this virus is going to do to kill people and
§09Transcript · 41:12–46:29
how I could stop it from happening
So to me again, I will let the experts who have that kind of expertise deal
with it
And rather than he said she said I just I stay out of it got it. That's why
when I tell you what I know
You better count on it's true
I but 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
I appreciate that
Um, what about what one of the weird things is of this virus in the early days
was how many people were asymptomatic?
And you know, and it didn't matter by age
It seemed like there was quite a few older people that were asymptomatic that
got it
And do you think what do you think the reason for that is?
I don't know
And I can tell you right now that is a point of discussion i've had oftentimes
with my colleagues
We do know that it's not likely tied to dose
Originally, you know, I was a co-author
You mean by viral load?
Yeah, by viral load how much virus is there didn't dictate how seriously ill
you did
It doesn't mean you didn't get infected or not and we're still looking at that
what it does indicate is
Clearly having these comorbidities adds to the likelihood that once you get
infected you're going to have severe illness
Right, but as you just pointed out and is absolutely true. We've seen people
who have comorbidities who've had mild disease
We've had people for unexplained reasons. We don't know why have had serious
disease
Younger healthy no underlying comorbidities, you know physically fit and 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
But it's not totally the rule. There are those exceptions we see and as I just
mentioned these kids
You know a number of these kids did have comorbidities
But some didn't and why they got infected and died. I don't know
Is it a is there a parallel to any other disease that you've ever studied
before or that scientists have studied like is there any disease that behaves
this way?
Well, clearly there are a number of viruses where
The seriousness of the illness can vary a great deal by age for example
Let me just take one that is not a respiratory transmitted agent, but
The virus that causes hepatitis a or infectious hepatitis
In young kids. This is often a very mild totally asymptomatic infection
And it's transmitted from fecal oral, you know if you have diaper changing etc.
It's not hygiene is not there
We would often pick up outbreaks of hepatitis a
Because parents would come down with it and they'd get really sick their livers
would be in trouble
You know, they get very yellow and jaundiced and we go back and test the child
and sure not the child had been infected already
And brought it home to mom and dad
And 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 that is the younger population where
it's almost a mild disease
So we have examples like that that do happen. It's not as if it's an unusual
situation
And for some diseases the vast majority of illnesses are mild asymptomatic
You only pick them up by doing blood studies and populations for other diseases
Well rabies is of course the classic example. It's virtually 100% fatal
And so it it varies across all the viruses we have
So is the high the percentage
Unusual of people that are asymptomatic with this disease
Well, 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 because if you go from the beginning of the covet
pandemic to now
Look at how different the ancestral variant illness was to alpha
The delta to omicron it's just in a matter of two years, right?
I mean, it's amazing how change how much and and the question you asked me
earlier about the issue with omicron
You know, why do we see so many infections out there because it's much more
infectious
And 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
It hasn't changed basically in decades and decades and decades
So I think this is one of the challenges we have is that and when I answered
your question earlier about what is the future of this pandemic?
It's because this virus keeps throwing 10 210 mile-an-hour curveballs at us
And I don't know what the future is going to bring yet
Maybe one of these variants is going to spin out of this that is going to again
cause various
A large number of cases some of it's severe and is going to evade the immune
protection that we have already
I've read some articles that seem to indicate that there
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 some
At least some kind of either immunity or some kind of protection
from SARS-CoV-2
And that is currently being studied and in fact if you look at
The issue of just take immunity from SARS-CoV-2
If you look at the data for delta
§10Transcript · 46:29–51:44
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
I mean actually they had more protection
But if you go back to alpha
People who had previously been infected
Were more likely to get reinfected than people who were vaccinated
So people who caught the alpha variant could catch it again?
Yes, well everybody look at delta delta the same way people
We have delta more than once
Oh, it's not. I'm sorry. I'm talking about when they actually have the next
variant
So people have who had had alpha did get delta people who had delta got omicron
And it's really too early for us to say
What happens with ba1 ba2 can you get omicron a second time? We don't know yet
But so when I was talking about for the alpha issue
We were talking about people who had previously been infected with the
ancestral variant now actually with alpha
We're basically more likely to be protected by vaccine than previous infection
For delta if you had delta basically
You were less likely to be protected from vaccine and more so from previous
infection
And so what it's pointing out is this is a fluid situation and and
We're still trying to learn with omicron. We had a lot of breakthrough
infections with omicron, you know
What was it that protected you or didn't protect you?
With omicron and and we're still really looking at that issue
And that is with people that have been previously infected as well as people
who have been vaccinated with omicron, correct?
Right, right
So if you if you look at just hospitalization alone
If you were unvaccinated you had about a 79.6 per hundred thousand people were
hospitalized
If you were fully vaccinated only 4.4 percent, okay?
So 79 people out of a hundred thousand were hospitalized if you're unvaccinated
And it was 4.4 if you were in fact previously vaccinated
Four people 4.4 people versus 79 people?
Yep, yep, right
So a lot of people thought it was a lot higher than that
Like 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
Yeah, and this is for omicron remember we just talked about the fact that for
many people who are infected
You know, you didn't even get seriously ill
Right
But for those that did, yeah, they were seriously ill the number of deaths were
elevated
Do 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 all these things were kind of ignored during the pandemic
Well, you know, I
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
But it's important for everyday life. I mean, basically whether you have
Omicron or delta or SARS-CoV-2 at all, these are important things that you
should be considering
Okay, I think that that was reinforced by the government
Oh, I think particularly around body mass index a lot. Really? Oh, yes, I think
so. I mean, I
gave many talks where I was talking about
You might have given many talks
But I mean, this is not something that was like echoed by the white house where
they were talking about it openly in public
Hey folks, you got to lose weight
Well, 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, you know the exercise that type of thing those which are
unfortunately just a part of your health profile
diabetes
Asthma
Autoimmune disorders
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, etc. And and I I agree with that
It's really obesity. It's a body mass index is a weird one because like i'm
technically obese
Yeah by the body mass index. Yeah, you and in that sense, you're right. You're
right. It's really about weight
um
the weird thing about
COVID-19 also is the the way it attacks fat cells correct
It can and that can be part of the amplification of this immune response issue
that we work on. Yes, absolutely
That is that really unusual or I mean how much of the factor is obesity?
In terms of just a general uh immune system
Well, I can't say
Again, I i'm not the expert in metabolic disease issues
But we know for a number of conditions that if you have increased weight
Ie body mass index like measures that you are at a higher risk of having
The additional problems because there is from an immunologic standpoint some
activity with fat cells that can surely enhance
An over vigorous immune response and 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? One of the examples? We're all very concerned
§11Transcript · 51:44–57:00
about today is long COVID
And with long COVID it's clear that that is not evidence. It was not evidence
at this point of its ongoing infection
It's not that the virus is still proliferating and you we just haven't gotten
rid of it
So can you explain what long COVID is technically?
You know, I can't and the reasons I can't it's not because I'm not even an
expert because most people can't it'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
And it's not really clear what is going on if you just take a step back
remember before COVID ever existed
We had chronic fatigue syndrome a real condition and people were really
suffering
And when you say chronic fatigue syndrome, is that something you have a test
for?
No, that's the whole point right is that it was kind of a general term a catch-all
That basically covered people and most often it was associated with people who
had had an infectious disease of some kind
Which may have triggered this ongoing immune response
Is there a like a specific infectious disease?
Well, you know epstein-barr virus has been often implicated as being a part of
this picture
But what it's really pointing out is it's really about this ongoing immune
response that we don't yet understand
And 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
Uh, you 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 and I can talk to you about this
with the mma fighters. Yeah that um
Some mma fighters who have had COVID
Particularly ones that didn't I don't know. I don't know. I don't want to speak
that they
I don't want to say that they didn't take it seriously
Maybe they didn't recognize
That they needed to rest more and allow themselves to recover and they trained
through it
And guys that trained through
COVID-19 tended to suffer
Long-term consequences from it there's several examples of this and
After those bouts of COVID-19, there's a thing that happens with fighters
At the very highest level and one of the things that I study with the UFC is
I'm studying like the elite of the elite athletes like championship level
fighters and just a small drop off of performance
Is is is noticeable when they face other elite
Athletes and you're starting to see some of these folks that have had
COVID-19
Then competing and not looking as good
Eight year eight months later a year later post infection and i'm wondering
like what
Is this long cove is this like a milder form of long COVID because clearly they're
in shape clearly?
They look great, but when they're competing
They're not. Yeah, maybe some of them are not quite at the level that they used
to be
Well, I think you raised two very important points when 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
So there that's why I brought it up. Yeah, I know I think the issue around the
immune response in the host and things like
Inflammation, you know the fact that the you can actually find that
That your body's ongoing activity and we've seen this with people who again
this chronic fatigue with chronic lyme disease
People have talked about this kind of same concept
And 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
Remember our immune system is like skating on a razor blade
You want to make sure anything that shouldn't be there shouldn't be there
But you want to protect everything you can that's yours and you don't want
anything to happen to it bad
And 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
And when that
Disregulation occurs where the immune system tips a little bit more on one side
or the other
You can see ongoing problems and I think that's what this virus is doing
It's it's creating this environment where this ongoing immune response is
occurring
And I think you're going and it's not just one thing
It's a series of different issues
But I think the most important message is is if anybody listening to this
Effort here is that
There is people there are people right now working on this and that this is not
something you have to live with
Hopefully forever looking 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
Now long covid as described
As the way the way we're talking about it is essentially people that feel like
they're not the same now
§12Transcript · 57:00–1:02:31
As they were before the virus they never have recovered fully is that a fair
way
I think it's it's really where they were damaged. Yeah, it's really important
to distinguish if 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 in at hand and it's going to take a while before
you begin to feel like yourself again
You know what will happen so 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
Where it's 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
They feel like they can forget things they're feeling this brain fog
And 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
And 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 I mean,
I know many people who have
Fully recovered from covid and you know, they are doing perfectly fine
Now so you're saying some people with mild covid still show some sort of a
decrease in in
Their physical response like their yeah
I've actually know of people who
Had milder covid and they'll tell you that their long code was much more severe
than when they had the acute infection
But what do they mean by that like meaning meaning 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 now here. I am eight to ten weeks out and I some days feel
like I can't get out of bed
So something happened
And do we know is it measurable is this like can you get a ekg is there there's
something you can show
And do they have a higher resting heart rate all of those things all those come
to play?
And that's what these new centers that have been set up are actually studying
Is there a mechanism that can explain this or is it a series of mechanisms?
Why do some people have more cardiac and lung involvement other people have
more brain fog, you know, where clearly neurologically something is happening?
You know, why do some people feel such severe fatigue and others don't?
So 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
And are there any methods that they're utilizing that seem to be effective in
treating people that have this?
At this point, we're just in the infancy of that and 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
First of all, as you pointed out, we have to know why you're having these
findings what's going on
And then once we do that, what can you do about it?
what kind of treatments could be effective and 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. They don't have the
energy to go to work. They don't have the energy to be with family
And this this is really a challenge
And um have you read anything about hyperbaric therapy in relation to recovery
from this?
I haven't you haven't no
Have you read anything about is there anything else that stands out like stem
cells or anything that they seem to think would be effective?
I 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. You know, what are the markers?
How is your immune system operating? Do you have evidence of certain immune
markers that are elevated?
You know, why might you have
Some evidence of some heart involvement or your lung involvement so part of it
is right now
Just taking very seriously that long covid really exists
And that we're trying to figure out first and foremost
What might be the mechanisms that are causing it and then I think you're going
to see
A large number of efforts trying to address treatment itself
So it's still ongoing still ongoing absolutely and
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
and develop long covid?
We don't know that yet. It's such a strange term long covid. I know yeah
Because it's like you don't really have covid your your covid is done, but you
have the deterioration
Of your your physical abilities. Yes. Yeah, very strange, right?
Well, you know, we saw it again as I said with chronic fatigue syndrome, you
know, that's a term that many people have
Had to suffer with for years and years and years
And you know, we didn't have the major research initiatives around that that I
think
Covid now is drawing the resources towards and hopefully
You know people who have that condition also can be helped by learning. What
what did covid do? Why did covid cause this?
um are there any
I know there's some new
Treatments that are on the horizon that merck has and that pfizer has there's a
bunch of different
§13Transcript · 1:02:31–1:07:43
Antiviral medications and pills that they're putting forth. Is there anything
else that's I think there's also isn't there an attenuated
vaccine an attenuated form of the virus
Yeah, well, first of all, let me just say I think the treatment area right now
is
A very exciting time in development
You know, I look back to my work in the early 1980s and hiv/aids
And at that time a diagnosis of hiv was a death sentence simply a death
sentence
And 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
And I think that you know, as we look at the vaccines it's clear
We have challenges with waning immunity. How well will they work? How many
booster doses can you give?
Et cetera, and so vaccines remain really the foundational response for dealing
with covid
But I think the drug therapies are going to become really really critical
And we're learning more. I mean, for example
I know a topic that you have been of interest about and the show that ivermectin
You know, there are five big trials going on right now
They're going to be announced results in the next weeks to months
That really have looked carefully at ivermectin including high dose ivermectin
And you know, I've again as a scientist reserved judgment
You know, I didn't close my mind and say no, yes, whatever
I want the data and we 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
I think there's a whole series of drugs coming down from several companies that
surely have that potential if given very early
And the one you mentioned from pfizer for example
pax lovid
While it has some contraindications with underlying health conditions that
might already exist on a whole
It is really a very very fantastic drug
But the problem we have right now with that is that we have many many places in
this country
We're during the surge of omicron. I couldn't get tested for three four or five
days
Why is that because we just didn't have the testing capacity but doesn't that
see that seems like something that would be much more easily
Well, that's what i'm going to okay. That's exactly you you you you hit my line
for me. Thank you. Okay
Is the fact that we need a comprehensive system with surges
Where in fact when a surge occurs
You can scale up quickly so 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, you know
If you're someone in the community and you know, and and you know one of the
things that I have been so challenged by
Is what this has done by race?
I mean this disease has been cruel
If you look at the number of deaths, you know
If you look at blacks twice as likely to die from covetous whites hispanic 2.3
times as likely to die from covet as whites
American india native american 2.4 times isn't this uh
Hasn't there been correlations drawn between vitamin d deficiency?
There has been some and again
This is another area of study that needs to be done
But I mean if you look at these issues here getting the drugs to those
populations
Okay, what can we do it whatever their risk is so that if you have a community
where I don't have a doc
I don't have one
I don't have access to health care in general, you know, I go to a community
clinic
So what I think this whole issue around drugs the point you just raised is
really highlighting
Is now is the time to address this issue of health disparities and just
generally our health care system?
You know, we have a disease care system a disease care system not a health care
system and by the way
It has been under attack for two years. It's it's it's incredible what's
happened by covet by covet
I mean what it's done to care in general and it was done to our health care
workers, okay
So we need to take a look and step back and say, okay, so what could we do to
improve on that?
We'll keep the vaccines, but we know we're hitting a wall on that
Okay, some people are just not going to get vaccinated no matter how we try to
share the information
But we should be able to get people to understand if you do get sick
These are the drugs that can be helpful. This is how you get them quickly
And 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 and it would improve health care in general
So to me that's one of the things i'm working on right now is trying to
understand surge capacity for testing
Let me give you one last example
I think that helps illustrate this
If 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. Paul international airport fire department
And thank god we have them. I support every penny we give them to cap that fire
department going
You know large number of units people well trained we've not had a plane go
down there on the airport itself
§14Transcript · 1:07:43–1:12:34
Since its inception any big plane the two that did went down in south minneapolis
in the 50s and were handled by the
Minneapolis fire department
Well, we pay for that every day because we wouldn't operate that airport
without them
We should be paying for test capacity
So if we have a lull in it, it doesn't mean that everybody gets laid off or we
don't do that
We use them for other things
But as soon as that surge occurs, we could put testing back into place
So everybody can get a test that first day and I don't care where they live
I don't care who they are they can get on those drugs and joe we could do so
much
To reduce if not eliminate the serious illnesses hospitalizations and deaths
just with that alone
Just with testing just testing and then the drug availability the drugs you
just talked about
I mean, I think we're going to see more and more drugs become available that I
think are going to have real positive impact
So 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
If 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. So
we surely can do this
For a covet like situation. So that's what we need to focus on and that's what
we need as a globe
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 now?
You covered a whole bunch of things
So let's start from the beginning first of all you talked about testing now one
of the things that I thought was
Shocking I was watching this
press conference where uh ron de santis was
Addressing the
Claim that they had let a bunch of covid tests expire
And that they were no longer useful and I was like wow, I didn't know covid
tests expired
So they have a shelf life is they do they do why is that?
Because basically the reagents in there can degrade over time and you want to
make sure you have exactly the right one
So they do have a shelf life
So they must be manufactured in accordance to the need and they're going to
have a surplus and then you have to
Abandon those but you have to keep up the supply
Well, and also it's not just surplus, but we do a thing called vendor
management control
So, you know, you basically rotate it in your shelf
So you have a place that says okay, I will help vendor managers product
So 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 most
The one closest to outdating gets out there right and the ones that are farthest
back
Basically, I'll hold so that we don't lose and with vendor manage you can do a
lot to actually reduce that problem
So that was the accusation from the florida administration that they hadn't
distributed those things
They could have done that and got them out there before they expired and they
it seemed like they were hoarding them
Yeah, and I 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 and so then it's a matter of okay. So what's your surge capacity?
How do you then say I can bring on board and you can't make it at the last
minute?
It's kind of like a fire department that goes out and tries to buy their fire
truck when the 9-1-1
Alarm comes in and so you got to have people ready to go
You have to have manufacturing capacity to go so when you have a surge you can
do that now
Here's the challenge if you believe that omicron is the last of the variants
you believe that covet is done
Why would you invest in that and that's where I come back and say well?
I hope it's the last one, but hopes not a strategy right yet got to be prepared.
What if another
Variant shows up the challenges again. We're going to have the same needs. We're
going to have the same issues ahead
So we're going to have to plan for that. What kind of shelf life do those tests
have?
It varies. I can't tell you test by test, but it
It's it's months, but it's it's not you know years. It's not years. Yeah
Let's go back to vitamin D sure. So when you're talking about how
disproportionate amount of Hispanics and black folks and and 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 like cold climates where they're covered up
How much of a correlation do you think there is between low levels of vitamin D?
and
And
more severe code infection
Well, I can say that there clearly have been studies done that demonstrate
reduced vitamin D levels in cases coming in into the hospital
It was like 84 percent at one point in time of people in the icu had
Insufficient levels of vitamin D. Yeah, and I can't comment at the question we
have
§15Transcript · 1:12:34–1:17:29
With vitamin D is it a marker for something else meaning people who have
Adequate vitamin D is it because of their behavior what they eat is it because
they have access to access to certain foods etc
What does that mean? And so we still have to figure that out
But vitamin D isn't really like effectively supplemented through food is it?
Well sunlight and some degree food meaning I take something I'm talking about
taking a supplement
You know if you're 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?
That's what i'm saying
And so it's that kind of issue there
So but 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
You 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
Don't they supplement vitamin D and milk as well?
Uh to some degree yeah
Well my milk is just a higher level but but 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
But I do want to make one comment on this so because I think this has been
sometimes
Misunderstood about race and the issue of risk for covid and for serious
illness
If you look the real correlation which again is not cause and effect
But is who are the frontline workers who are the people that left largely unprotected
who did the critical service for us?
Even in health care during the course of this pandemic. It was often
You know our communities of color
And people from that community
I could stay home and work in my computer in my office at home
I didn't have to be out and about I didn't have to sit there and confer you
know and have
Close contact with the public and so one of the challenges also is of course
How do we protect these people from a work standpoint?
And that's why getting vaccines to them is really really important and
supporting the issues
And we've seen some really novel ideas probably 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 in black stylists who basically work to talk to their clients in their
chairs and who trust people more than your barber
And they talk about all issues of health and it's a program that started out of
the university of maryland
And it's been fascinating of how it's actually having a really positive impact
in health
But they do kind of like what you do talk about all the health issues
I'm confused. So you're saying there's a program to educate barbers to talk to
their clients?
There actually is and then they actually look at the outcome in their clients
And they've been able to demonstrate major increases in people getting
vaccinated
People seeking out screening for cancer issues, etc
Because the barbers use that time when you're sitting in the chair or the
stylist to talk about health
So how are they doing this through seminars like how are they educating these
people?
It's a major program
Dr. Stephen Thomas who heads this up who is just a very creative innovative guy
and it's starting to spread around the country
It's actually one we need to duplicate replicate in other places where you can
actually
Get the message out to help people, you know, where do they where do they hear
it?
You know, well, I heard it in the barber chair. Well, who do you trust more? I
trust my barber
I don't know. Well, I don't have a barber clearly
I kind of was making that the inference when I was talking about this when I
started
But when I did I had a lady cut my hair and she was great, but I wasn't taking
medical advice from her
Yeah, well, you know if she was highly trained she may it may be a good time
for you to listen
Maybe I don't she tell good stories, but you know
So when you're talking about front front line health care workers, one of the
things that
Is a real point of contention is folks that were frontline health care workers
that were infected that recovered and then
They were facing vaccine mandates
What are your thoughts on that? Well, first of all?
I think it's critical that we add in
Previous infection as a dose of vaccine for certain
So why didn't that happen with those still working folks still working it still
working on it?
I 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
Well, many of them were infected with covet recovered and had robust immunity
But yet they were fired because they refused to get vaccinated
Well, let me add a little more detail to the story. It's not quite that simple.
It's not you know, it's not and again
I i'm already up front saying I believe that to be considered fully vaccinated
or whatever status you're going to call it
You should at least include previous infection as a dose now
§16Transcript · 1:17:29–1:22:50
I shared with you a few minutes ago that's been very interesting if you look at
either alpha delta or omicron
It mattered which variant it was as to who did better people who clearly had
had previous infection
Or people who had previous infection were vaccinated and across the board
people who were infected had vaccine
Did much better, okay, so infected and then got back and then that got
vaccinated added one more dose on and it really did boost them up
And they if you study that basically as we look at people then who during the
omicron
Surge who got infected and if we the data are actually out there right now
looking at that and in fact
If you look for deaths for example, if you were unvaccinated
Your deaths during this most recent was about 974 per hundred thousand among
people infected, okay?
But if you were fully vaccinated only
And and you got point seven one cases per hundred thousand big drop and then
fully vaccinated with a booster was point zero one zero
Much lower even yet. And this is death. Yeah, this is death. Okay, you're
talking about death from delta
In this case. This is even omicron is omicron, but the point i'm trying to get
at is if you looked at the hurray of these
those who were
Had fact who had previous infection and were
One dose like a boost actually did very well
So i'm willing to count a dose
But let me tell you why I have a problem with health care workers
Who aren't vaccinated and I support health care worker mandates
If you look across the board
99 percent of doctors got vaccinated they did I mean the data are there where
we saw the lesser levels of vaccination were in the technician group
Nurses were not as high as doctors, but were there
And why is that important because we were able to demonstrate particularly with
omicron
A number of outbreaks or ongoing transmission of cases in health care settings
Where it was the health care workers bringing the virus in
And transmitting and where we looked at that we saw data in and there's 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
Well, they had to pick it up in the hospital and there were two sources
basically
Somebody coming in from the outside i.e
Visitors who in most cases didn't exist or health care workers or they got
infected from other patients. Yeah
And that's three right when it comes yeah when it well, it's the outside inside
kind of thing
So when it comes to patients, uh, you know, we often these people were highly
segregated
They were in totally different segments of the hospital health care workers had
to play a role there
So our point in getting health care workers vaccinated is not just to help
protect themselves
But it's also to help protect the patients right but isn't
Isn't it been proven that people that are vaccinated also catch covet and also
spread covet they can absolutely and we should
But but i'll tell you right now that if you were previously infected and you
have that dose
You're going to be much less likely to actually get infected yourself and
spread the virus
That's true. Yep. So it's not just that you're less likely to die
But you're also less likely to get it and spread it. Yes, exactly. By how much
what factor?
Uh, I can't give you the exact data, but it's it's substantial. I don't have it
right in front of me
It's very substantial that you can get protected with that infection and dose
What the debate has often been for health care workers?
They feel like they didn't get credit for that previous don't that previous
infection right and i'm saying they should
So you think that the health care workers who've had a previous infection
should get one dose of a vaccine
Right and I think we should look at that carefully as considering that fully
vaccinated
And do you think that it matters whether it's pfizer or moderna moderna's a stiffer
version of the virus correct or excuse me the vaccine and then johnson and johnson
is different as well, right?
Right it is and right now
Clearly the evidence points to the fact that moderna gives us a bit of a better
Take than we see with pfizer because it's stronger stronger
Now where j and j is interesting and and complicated is the fact that if you
look at its response initially
It's not nearly as high. It's in the 80 low 80 percent level where the mrna
vaccines are in the high, you know mid to high 90s
But if you look over time
The j and j levels don't decrease they actually go up some and the
Actual level of protection for the mrna vaccines will decrease where you see
that waning immunity at
Can you explain that to people that how the difference in the j and j works
because it is an mrna?
It's not yeah
It's what we call an adenovirus platform
It 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 but it looks like
the
The j and j vaccine may have more positive impact on the thing
We call t cells a type of immune cell then we see with the mrna vaccines again
all emerging new science
We're learning about I think if I had to make a prediction
In the near term meaning, you know six to 12 months from now
§17Transcript · 1:22:50–1:28:12
We very well we're likely talking about the preferred heterologous vaccine
approach
Of using one dose for example something like a j and j and then a dose of mrna
I think that's really a possibility because this is speculative
This isn't speculative this is based on on more and more data
We're seeing accumulate that that may really be a possibility
And in fact, it's also in this issue that I happen to have an intense personal
issues because our center
The cidrep center for infectious research and policy at the university of minnesota
is actually going to be leading and we announced very shortly
What we call a pan-coronavirus vaccine roadmap process
We 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
And we're trying to get new and better flu vaccines and we're working on that
I think you're going to see version 2.0 3.0 and 4.0 of the vaccines in the next
few years
The vaccines we have now, you know are remarkable tools, but they're not
perfect
And I think you're going to see an evolution just like with drug treatment
Better and better vaccines coming out over the long term
One 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
because even though they had tested positive for covid
They they really didn't have that much of an impact on their immune system. Is
that yeah?
Yeah, no, I that's an important point
But let me just add a qualifier to that
When we talk about measuring antibody
I don't know what we're doing and what I mean by that is is that we don't
really have a corridor protection today
There's different kinds of antibody. There's neutralizing antibody. There's
total antibody. Okay, all these different kinds of antibody
There's there's the different kinds of t-cells
And what we're doing is taking one test and saying how high is this here?
Well, does it really correlate with protection and this is what we call a
correlative protection
So for example, I can tell you if you get a measles vaccine and I do a blood
sample on you
I can tell you likely if you have the immune response that's going to protect
you against measles
I don't know what a protective level is here
So 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
But i'm looking at just from practical experience if you've had covet before
are you protected or not when you are exposed again
And compare those who were vaccinated after having had one episode those who
only had an episode and those who had nothing
And then let's follow them forward and that's where the real proof in the
pudding is is that do they get clinically ill or not?
Do they get infected?
And that's where we're showing right now that I can't distinguish people who've
had a really severe case of covet versus those who have had milder cases of
covet
Maybe over time that will emerge clearly the antibody levels are different as
you pointed out
They are but I don't know how that responds to protection interesting
So just because antibody levels are high doesn't necessarily correlate with
superior protection at this point
We can't say that what 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 and this is where I mean if I always
jokingly say
You know if you really want to talk about something complicated hell rocket
science is easy it's immunology you want to know science
It's immunology, okay, because this whole immune system we have is so
complicated, right?
And so to me the science you're going to see coming out
Of the immunity related to covet is going to I think bring us some really
exciting developments
HIV aids did that in the 80s and 90s we learned a lot about the human immune
system
I think this is the next best opportunity here
We're going to learn so much about human immunity from just trying to
understand how to protect against covet and how to respond to long covet
so immunity as a whole is a very comprehensive and
Wide-ranging thing right because it's immunity to all sorts of different
diseases and viruses and
Do you anticipate in the future that we can figure out how to boost over all
immunity?
So it wouldn't just be immunity to covet 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
The earlier levels of immunity for all infectious diseases. Well
Let me just add that that's a really plus minus situation and what I mean by
that is is that
There really isn't a term natural immunity everybody uses it. So you're in good
company. Okay, sorry, but no you're in good company
But if you go to any textbook of immunology or anything in epidemiology
There's no term natural immunity immunity is immunity
It doesn't matter whether you get it from actually being exposed to the virus
or you get it exposed to the vaccine how your immune response
§18Transcript · 1:28:12–1:33:22
Happens is it happens
But there is another kind of immunity called innate immunity
And 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 and it responds
Now they're not very effective overall. What you want is the very effective
specific they recognize that bacteria
So, 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
So when you say about boosting the whole immunity you 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
So 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 and 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
And so I I can't say I see that overall boost
What I do see though is more work on how do you handle so many different
infectious agents
Or for that matter, I think the one of the areas you're going to see a lot of
work coming out in the near term is on cancer
Cancer vaccines I think have a huge future because you can detect those cells
that are just starting to emerge that are cancerous
Let your immune system clear them out
So what kind of work is being done right now on cancer vaccines?
Oh a lot a lot of work
How does that how would was it an mrna platform?
Well, that's you know how mrna's got all their initial research effort was for
cancer vaccines
Was that's how the first real efforts were put into place by the nih on these
vaccines
And 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 these things if you could pick up certain changes in the
cells
That indicate this is a pre-cancerous cell or an early cancer cell
Imagine if you had a specific
You know kind of police officer in your body that could help
Identify that and take it out
So a general immune system response is not enough it has to be a specific
immune system response for something that you're looking for
To make it most effective right it most yeah
Is there anything that's being developed that works as like a general immune
system response that enhances general immune system?
You know, I can't say other than just being healthy. I mean if you malnutrition
is a good example where
Basically, you know, you really have a major compromise on your immune system
You know, that's a real challenge, you know stress has been shown to challenge
your immune system
And so I think it's general things like that again. I'm not an immunologist
But i'm curious for my own self if nothing else, you know what you can do that
way
So I think those are the issues that that right now. There's not one thing
When you look at
These cancer
Vaccines, how far off are they from being deployed?
Well, it's not somebody in the cancer area, but only familiar with the work is
going on
You 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
Now when it comes to the side effects and and adverse effects from vaccines,
what is causing that?
Well again, uh, we don't completely know but for example
The myocarditis piece has come up over and over again is likely an immune
response that's occurring
Okay, that it in itself is causing this immune response to attack part of your
heart muscle
What part of the vaccine is causing that immune response?
Well, that's what's not clear yet because it's uh, when I say it's not clear,
you know, it it it's not just a spike protein
Obviously because that in fact is you know, a lot of people have that response
to that
And 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 is this really a deterrent to getting vaccinated?
And 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 covet by far than
it is to getting the vaccine
Much greater isn't that different though with different ages and also with
different vaccines like
Hasn't it been shown that particularly for young boys the moderna vaccine is
more problematic than the fires are one absolutely it has been
Yes, it has been absolutely
And isn't
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?
No, actually at this point that's where we were looking at the you know, it's
it's it may be close to a trade-off there
§19Transcript · 1:33:22–1:38:38
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 and those are actually very substantial and are as
much of a burden in many cases as myocarditis
So you have to factor in what does cova do to your heart?
What does the vaccine do to your heart does their vaccine?
Cause any pericarditis or none. We've done zero zero cases zero cases pericarditis
very zero cases of arrhythmias
But the virus does it zero zero
That's wild. Um, yeah
I have a friend who was a very healthy guy who wound up getting some strange
heart condition from the virus
And he was shocked and one of the reasons why he avoided the vaccine because he's
worried about a heart condition
Yeah, and then he wound up getting a heart condition
From uh, the virus itself now. What what causes?
This response in the heart tissue because myocarditis is an inflammation of the
muscle
In the heart. Like what is causing that from the virus?
I don't know really. I don't know
I mean, this is ongoing studies right now looking carefully at that
Um, and it's surely a major area of study right now, but I don't know
Is there any understanding of what could be done to prevent it?
Is 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?
You know, I 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
out of all the millions of doses of vaccine 193 million doses they've looked at
in these age groups
And so there's only two two two under currently under investigation
But does that mean that there's only two instances or two instances where
people have died or
Studying well studying in the sense that we know about when I say study they
haven't even yet confirmed that that really is caused by the
Vaccine is being looked at right now. We're more clear on the thrombosis from
the j and j the blood clot issue that clearly caused that
Again inflammation why how the inflammation occurred why it occurred?
I can't comment. We I don't know but I can tell you that even there if you look
at those it's still
From the j and j perspective the risk of a bad outcome with your heart or if
you're basically the thrombosis is still greater
overall from getting the disease
Now at this point the j and j vaccine has had a warning put on it a black label
warning about the fact of thrombosis
Which I think is important but as we have shown over and over again data wise
particularly in many parts of the world
The j and j vaccine is a real advantage vaccine because of the lower dosage the
more stability of it
And the fact that overall the health benefits going to be much greater than not
having the vaccine
Didn't I read something that was pointing to the potential?
Ceasing of the production of the j and j vaccine. Yeah, they did but uh
It was in part and I don't have primary knowledge of this that they actually
had enough inventory
That they didn't want to have outdating kinds of things happen. So my
understanding is not
Permanently shut down. Oh, it's not a holiday. They have a surplus. They have
quite a surplus and so they had more than enough
But they're putting the vaccine out and and they will continue to make it. It's
not they're down and it's uh
And they continue to distribute it is is it still a one dose or are they
thinking of it as a two dose?
One dose with the what they call a booster
Right. Yeah, why do they call it a booster? I mean if it's I hate I don't like
the term
Yeah, I've been really opposed to that from the get-go you know in august of
last year
I was one of several people who came forward and said look at the waning
immunity data
It's clear that at five to six months out
We're seeing an increasing number of people who previously before were seen
protected who are now getting infected who are getting
Seriously ill and hospitalized
And it's because it tends to wane at four to six months
So I very strongly urge that in fact everyone get that that time they called it
the booster dose
I think cdc should change the definition of fully vaccinated for the rm rna
vaccines to three doses
Skip the booster concept for the j and j two doses
And then for those who are immune compromised. They surely should get a fourth
dose. Absolutely. They should get a fourth dose
The data we have says that that does boost even better. You know it
successfully there
But I think that right now
We should be labeling
People with three doses and don't call it a booster. What do you think is going
on with israel?
Well, israel actually is
A very interesting situation in that it is both
The best of science and the worst of times and what I mean by that is they only
have a segment of their population vaccinated
They have a relatively high percentage not vaccinated
Well, I thought they were one of the most vaccinated countries in the world
§20Transcript · 1:38:38–1:43:55
Well, they are among the vaccinated
That's the whole point. They are actually where they're now doing fourth doses
among many people
But if you look at the recent big uptick in cases, they had it was almost all
in unvaccinated people
I don't that's not what I read
I read this whole thing about vaccinated people in israel
Like that there was a giant surge of vaccinated people
No, the surge is primarily in and I don't have the numbers in front of me
But the surge is primarily in unvaccinated people
There surely was an increase in cases in in vaccinated people who had had three
doses
That's why they went to four doses for older populations, etc. But the real
burden the the major thrust in this surge
in israel was in fact unvaccinated people
That'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 covet and
that it's a giant percentage
Of the cases I didn't read anything about it being primarily unvaccinated
people
I just did that see if we can find something yeah, go ahead. I just did that in
my own podcast by the way
Okay, I just did a cover. I covered that about two weeks ago
I actually had the numbers in front of me and actually went through what
percentage were unvaccinated what percentage were vaccinated
Clearly the unvaccinated the vaccinated did see increased numbers of cases, but
the surge was really covered by the unvaccinated
So there's an enormous surge, but it's because of unvaccinated people. Yes
You can look it up
See that is so confusing to me because I was almost positive that read that an
enormous percentage
Like a very high percentage of the people that were new cases that were
infected with covet were vaccinated
They were increased but again the big surge itself and particularly in hospitalizations
and deaths were unvaccinated people
We can get it here looked up here. Yeah, we're gonna find it. See whatever you
can find jamie
You got anything
Sorta sort of I mean
I think it gets
Here's the first thing I found which I don't know like the
efficacy of the analysis of covet vaccine breakthrough infections in highly
vaccinated israel
Okay, recent study published in uh, what does that say? med rx iv
Preprint server research has evaluated model age structured cases of severe
acute respiratory syndrome coronavirus 2
Um vaccination coverage and breakthrough infections to do this the researchers
data ministry of health
I don't know if this is an older piece
Yeah, this doesn't give it to you. This is january 13. Yeah, but I mean it's in
terms of the omicron surgery
There's more data that's come out on that issue, right, but this is only a
month old. Yeah, I know, but
If you look here, uh, I guess google then unfortunately my research assistant's
outside the door. He actually has the papers in hand
So well, let's see what we'll get you we'll get you the data and show you that.
Okay
Uh, and that you can take a look at that. Uh
That's highly that's an old one. That's an old one. That's an old one. Okay.
Yeah
Yeah, you got to have what's in that first let's go to that january one and see
what it says though
Yeah, like it is an analysis and we only looked at the top about the study
Yeah, the following data sources received. Okay, march 21st to november 6 2021
Proportions of the various types of variants and concerns were also confirmed
throughout the course of the study
The vaccinated class divided into five stages to mimic the diminishing of see
these are all vaccinated people
This is not the unvaccinated so you have what we're looking for data that will
actually talk about the number of unvaccinated
So what this study is doing is an important study. What it's looking at is
among the vaccinated
breakthroughs, right? Okay, so maybe we can google what percentage of people
that have covid in israel
are vaccinated covid omicron
Okay, so omicron, which is uh, the mo how much more infectious is omicron than
Then um, the the alpha variant of the delta variant. Well, 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
I had heard it was way more infectious than that. Yeah, that's roughly what we've
got. Just guesswork. Well, two to three is a lot
How do they guess that is like is it dependent on it's a scale based on say if
you're infected how many people you'll infect?
Yeah, how many it look look at households and
Drug contacts that look at that and that's really the primary way to get it
There's not a way you can like look at the actual virus itself and say oh, this
is like
Measurably more infectious. So it's basically in how many people it infects.
Yeah, that's it
It's a real experience. So what happens with it and in the same setting between
the different variants. What does it mean?
You got anything
The first thing I found what it was blocked, but it said before blocked said
that 40% of the population is rules and on and is unvaccinated
Yep, but 40% yep again
Why did I see like I read that it was 80% that were vaccinated?
Uh, is that true? No, that's right. That's exactly what that's exactly and that's
the group that really had to click on this
It's gonna disappear real quick. See, it said it. Yeah, sorry
§21Transcript · 1:43:55–1:49:08
You got you have the right stuff to find that is the right piece
Yeah, I can get it. Yeah, I have thing
So, but anyway, I think the message I think that is only got 60% of their
population vaccinated
Yeah, I thought it was way higher than that
No, so I think the message though lags behind on code 40% of israelis have no
protection against covet
Yeah, but isn't that oh, it's omicron variant. It says yeah, right
But how does that work then? I mean, right is is that because omicron evades
the protection of the original vaccine?
It does and it also evades the previous infection
But is that like put that article up again?
The way they're phrasing that is that a manipulation of language because if
saying 40% of israelis have no protection against covet omicron variant
But are they vaccinated from the original variant?
Because if they're saying that they don't have any protection are they saying
that because
They don't have protection because they've not they don't have antibodies for
it. Are they saying they haven't been vaccinated?
I can't tell you what that headline is saying there all like it's weird though,
right?
All i'm telling you is is that if you look at the proportion had no vaccine
those that had full vaccination, but no booster
That's what they were trying to compare. So this is what that is what they're
saying
So look it says 1 million refuse the booster. Yep
While just 110 000 out of 1.2 million young kids got the that's a lot of
language there
Yeah, I recently found something when I was looking that said that uh, this is
back in the end of the summer that 90
Enough doses had been administered in israel to get 99.3 percent of the
population vaccinated
Yeah, that's enough to but doesn't mean that they were
It's also because they also counted a dose to person and if you get two and
three doses you take it away from somebody else
So merely having 100 million doses and 100 million people doesn't mean you have
100 million people vaccinated
Well, they also don't count you being vaccinated if you're not boosted
Well, they do but they don't count it as fully vaccinated
Right, yeah, but you have they have a green card situation or yeah, yeah,
whatever they what is that?
What's their term that they use? I don't know what it is
So with them you have you must be boosted to be termed fully vaccinated correct,
right?
So when looking this is what pops up
For what percentage is vaccinated?
But like it's enough to have vaccinated 99% of the country's population, but it
doesn't mean that they did it exactly
Okay, so you said that
Omicron so part of the thing the reason why that article was phrased that way
is because omicron
Evades the protection of the vaccine
It does evade protection of vaccine and it evades
the
Protection from previous infection at a level that the other variants hasn't
done if that's the case
Then what is the benefit of getting vaccinated now?
Well, there's still very substantial protection
But if it's evading the protection of the vaccine, what is the protection it
gives you?
Well, 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 9.74 if you're fully vaccinated,
it's 0.71
But if you're fully vaccinated with a booster, it's 0.01 per 100,000
But how is that possible if it evades protection of the vaccine?
If you said a hundred percent of all the cases that nearly a hundred percent
are now omicron
But omicron evades the protection of the vaccine
But not for everyone. It reduces it. So what we're talking about
It reduces the protection of the vaccine?
Yeah, so for example with the booster you can boost it back up if 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 from omicron. Yep. Yep
And how is it not protecting you from the vet? Then how is it evading the the
boot the vaccine?
Well, the evasion is not complete is it is limited
So if you take something from 95% protection to 78% protection, we call that evading
immune protection
But you're still getting substantial protection for most people
So when that's a term that is not very artful to say the main of fusion
Immune evasion doesn't mean that is yes or no. It's like a real stat
And so what we're concerned about is that goes on over time
That immunity may actually continue to lower and lower and lower and that's
what we're trying to study right now
Is we can't boost our way out of this pandemic. Are we going to need vaccines
every six to seven months? We don't know
But that's when I talked about by waning immunity
so
The booster helps something
From omicron it helps you avoid severe illness
Yes
That's what I just gave you just now or deaths
But if you look at hospitalizations
The same thing, okay
§22Transcript · 1:49:08–1:54:11
If you look at these are data from december 25th for the united states for
hospitalizations
And this is gauging like how many people who are admitted were boosted versus
how many people
Only had two shots versus how many people were unvaccinated
Right, and I don't have the data on the boosters for those data here
But if you look at for unvaccinated people for hospitalization, it was about 79.6
per hundred thousand during
Omicron
If you were fully vaccinated, it was only 4.4 per hundred thousand. So 79.6
versus 4.4
If you're boosted it even takes it down lower
And does this factor in comorbidities?
Does this factor in all the things we talked about like low vitamin d obesity?
It's all of it
There's not a distinction made
I haven't seen any breakouts
The best breakouts we get are largely those with age and some of the major comorbidities
And what about previous infection?
How does that factor in with omicron?
In previous infection again also gives you more protection like a dose of
vaccine, but it's not yes or no
It's think of it like a dose of vaccine and that's what it does
Now is there a possibility of an attenuated covid vaccine?
It's possible and 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
Because 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
Clearly, people are looking at what vaccines would work and you know
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 can't
say it
It's going to be the way but it surely is something that everybody's looking at
right now. Is that in development?
Well, I can't say it's uh in
In development in the sense there are several labs working on it research wise,
but
Development might say a little further along, but I think it's going to be the
future
I think it surely could be a big part of the future and when these labs that
are working on it
Have you seen promising data? Have you seen trials?
I haven't at all. It's far too early for that yet
I 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
And some people will say well, you know, we uh, we didn't say it would protect
against
Infection, but there was a sense it was going to really protect against
infection at 95 percent
I think it was only really by this summer that people begin to realize that
they're still very very
Important and remarkable tools, but they're not perfect
You know, these aren't going to necessarily be the final vaccines we need
And so it's really only this summer that you started to see more interest in
well
What other vaccines can we look at? What is going to be 2.0? What's going to be
3.0?
And at this point, you know, that really is now people are realizing we do need
much more in the way of vaccine research
That's why I mentioned you our group is actually developing a roadmap
For how do we get these new and better vaccines?
Now, what are your thoughts on the monoclonal antibodies?
Well, I think it's a very powerful tool
I think my concern and we had an article in the sidrap news this week and I
covered it in my podcast this very week
The one that was what's the name of your podcast ostrom update?
It comes out every thursday morning and I actually covered the issue that our
big challenge right now is we're seeing it not being used
You know, even though that we're down to one
monoclonal as you know the other two basically
Because of omicron and the mutations challenging how well they worked
But we're sitting in a number of states right now where we have pexlovid
And monoclonal antibodies not being used. Why is that?
Well, that's the challenge. Is it because people aren't aware? It's because
people can't get tested in time
And so therefore, you know, you have to have it within that five-day period
People actually get sick enough that they move into the hospital quickly and
then therefore they're not eligible for it
Is it because they don't have access in their communities?
I 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?
It seems like if you're trying to
reduce deaths and severe illness
That monoclonal antibodies would be an important part of that strategy should
be absolutely I couldn't agree more now
Why did they eliminate the first versions of monoclonal antibodies?
Well, the first two actually which were quite effective
It turned out that actually the mutations in omicron basically
Cancelled out their effectiveness because the mutations were where those two
monoclonals really attacked the virus
Was it a reduction of protection or elimination of protection?
Well in the laboratory setting it was largely almost an elimination of
§23Transcript · 1:54:11–1:59:26
protection
And uh the challenge we have is is we went through a period where omicron wasn't
everywhere all at once
And some people were concerned about the fact that well, you know, we should
have taken off
The market right away still delta cases because there were still delta cases
and the problem
We had is we just didn't have an adequate way to test people to say you have
delta or you have omicron
Because either one would have made a decision easier to say oh go with this one
or go with these two yet
So that becomes a problem
Again with testing and that and and particularly testing for which variant
people are sick with yep
And and how fast could we get those even if you can't get it for a patient
Can you have a running average of what's happening in your community?
So if you suddenly see that only you know four percent are you know omicron and
96 percent are delta
You're probably going to err on going with the monoclonal that's from for delta
If you see the reverse you're going to say well, it doesn't matter to use those
other two
They're going to be in ineffective. I'm going to use this one
And we don't even have those kind of data in a timely way, which is part of
what I was talking about earlier
We need this national testing
Prioritization we need to really put this in there and that should be part of
it for purposes of treatment
And which monoclonal antibody is most effective for omicron?
Well, it's one that
Actually is made in england. It's not very common here
Trovimab is the name of it that most people wouldn't recognize the name, but it's
one that
Basically, it attacks the virus at a different location to the other two
And that still has been shown to be quite effective. Is that one effective on
delta as well?
I mean yesterday so yeah, it is too. Yeah interesting. Yep
So that would be like an almost universal monoclonal antibody at right now
But tomorrow another variant could show up and it'd be all done. And that's how
it works with this stuff, right? Yeah. Yep. What was
What was unusual about this in terms of early treatment?
This this
This disease is so unique and so different like what do you think could be
learned?
From the way the early treatment of the virus particularly before the vaccines
were administered
You know a lot was learned and 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
um
How they helped basically try to regulate what the immune response was or wasn't
and frankly the survivorship of
Patients with similar conditions between those early surges
In 2020 and even six to ten months later was substantially better
The intensive care community did so much so much to try to understand what
should be
The best methods, you know, what what should be our standards of care our our
best practices
And so we have seen a substantial increase in in outcomes for patients just
based on the early research
Do you think that because of our?
Having gone through this pandemic that we are better prepared for another
pandemic like save
COVID was to die off. You don't think so we're in westward shape. Why is that?
500,000 health care workers have quit their jobs in the last two years
I have seen
Battle
Fatigued soldiers who are friends of mine come back from war
With less post-traumatic stress syndrome that you see in the health care
workers
They are we don't have really have a good sense of just how fragile our health
care system is right now
If that's the case, why would they fire so many unvaccinated workers?
Well, you know, they didn't fire so many there was one to two percent at most
one percent a Mayo Clinic. That's really a Mayo Clinic
Fired, uh, you know 700 people out of 70 or excuse me. Yeah
700 people out of 77,000, okay? And again, you have to look at where their jobs
were
Were they in intensive care or not? Were they up front? You know, were they the
people that were at admitting, etc?
So you think that's a false narrative that I think it's absolutely a false
narrative
Unvaccinated health care workers very few of the doctors and nurses who work in
intensive care were unvaccinated
They want to be vaccinated to protect themselves. I mean we've lost 300 health
or excuse me
3,000 health care workers have died of COVID since the beginning of the
pandemic
And so they want to be vaccinated largely and as I said 99 percent of doctors
got vaccinated quickly
I think the challenge is we don't understand yet is how fragile our health care
system is
So when you ask me are we better prepared right now?
The 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 they're burnt out
what could be done to
Strengthen and enlarge the health care system to make it better prepared for
some new pandemic
And what what could be done in terms of having treatment protocols prepared in
§24Transcript · 1:59:26–2:04:35
advance?
We have to be better prepared to handle surge capacity
We just weren't
And this is a term is this hospital beds is this staffing staffing and training
and the problem is
Joe that we've lost so many senior doctors and nurses who are just burnt out
That 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
but the problem is it takes time to educate them to get them to be in a more
senior status learned status
And so for this period of time right now we're going to have real troubles if
we have another big surge because
It was it was almost like a a vicious cycle
The more people that were infected meant more cases in the hospitals the more
care needed the more care needed
The more people were stretched the more people got stretched working the more
quit the more that quit
meant that the fewer people had that much more work to do again again and again
And that's why in effect it casket and 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
took a full page out ad out in papers around minnesota back during the omicron
surge
Begging people please don't get infected we can't take care of you
We we don't have the quality of care has dropped you know when you were during
this recent omicron surge
You did not want to have a heart attack. You did not want to have an automobile
accident or a stroke
Because of the challenge we saw people literally waiting two days in emergency
rooms
Really? Oh, it's crazy
And it was just a shortage of staff. So equipment wasn't the problem beds weren't
the problem
It's people
And 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 search
And what we have to understand is how many health care workers now not just the
stress of what they did
But how many times that they're vilified in the community because they people
say you you know
You didn't do what you should have done to save my loved one's life, etc
And they're doing everything they can
Do you think masks work?
Um, i'll answer that if you can tell me what's what's what's similar between a
747 and a and a
Car
What's similar?
Yeah, they both hold people they both have tires. That's it. Well master like
tires, you know, it's it's they're different
They're totally different
And so whether you have the n95 on that thing that I wore into this studio
Which is a high level protection or you wear a face cloth covering totally
different between night and day how well they work
You know shortly I was after I when I was on here in 2020
I wrote a piece in april 2020 saying this is aerosol transmitted. It's like a
perfume. It's like smoke
And basically you have to have high level respiratory protection to really
protect yourself
And what we get is we got into people saying well anything works and some
studies were done
Which frankly if one of my graduate students had done those studies, I would
have failed them
Because they were so badly done in terms of trying to understand that face
cloth coverings work
Well, they don't they're much more of a clothing
Decoration than they are anything about really working and so when you ask me
Do n95s and kn95s work? I'd say yes
If I say a face cloth covering surgical mask no
And that's a big problem a lot of people are wearing those surgical masks which
are to stop droplets when you're doing surgery, right?
Yeah, and and 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
I can't tell you how many people
Were not wearing masks at all even though it was mandated or they wore them on
their chin. They were chin diapers. That was it
You 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
We have consistently seen since the beginning of the pandemic a quarter of the
people were under their nose
That's like fixing three of the five screen doors in your submarine. You know,
it doesn't matter. You know, what good does it do?
So explain to me how
N95 masks work if you can breathe out of them
Yeah, if you can breathe into and breathe out of them
What are they doing to protect you from infection?
And what are they doing to protect other people from being infected?
And that is the key issue right there people don't understand the difference
There are two issues that are critically important to protecting you and
protecting others from you
That is fit and filtration
Think about swim goggles. I mean, you know, it's all about fit
You know, if they don't seal completely they leak. Okay, so you got to have
something that's a very tight fit
That means also by the way you can't wear a beard if you wear a beard
You invalidate anything you put in front of your face because it all leaks
right through. Okay
One of the problems we have with kids is we don't have good sizes because n95s
§25Transcript · 2:04:35–2:09:45
as
Basically over the oversight regulation of those comes from the occupational
world
It's largely for professional use and we've never really looked at for personal
use
So I will have to say fit is a challenge. Okay, it absolutely is
But filtration is what's critical and people don't get this the material in an
n95 is a milk blowing material
It's actually it's a what a milk blowing. It's like a foam that hardens. Okay
And it has you saying milk milk. Yeah, that's what they call it. Yep. Just like
that. Yeah
And it is basically one that has large enough spaces in it
That allows air to move through it regularly. Okay, but like a good
Electronic filter you might put in a room it has an electrostatic charge in it
So as the viruses come through they get grabbed quickly
So and this works really well the virus clinics to the outside of the mask
No, it's in actually as it comes in it's outside
But it's on the inside too as the mask. That's why it's like it is
And so this special material is what gives you both the breathability
But also the protection so when you wear a cloth
Even if you can breathe you have no protection the virus will come right
through in and out
Okay, so when you see i'm sure you've probably seen these uh, there's a doctor
who uses a vape pen
And he blows through various masks to show you
The 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 mass that actually exactly
You want you want to have it breathable you want to be able to make certain you
have to
That's right. Yeah. Yeah. I jokingly say I could stop all transmission
Let me put cellophane over people's faces, but that wouldn't last very long
And so that's what makes these so really important and 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
So the n95 material and it you said it's a milk. What is it milk born blown?
It's basically
It's a type of industrial process where they basically put this material down
And it has the electrostatic charge and it has the porous nature that lets air
move in and out
Now should they be replaced on a regular basis and if so like how regular you
know
Only when they're really soiled or they're not tight fitting tight in your face
You can actually wear them for quite some time. I wear my n95 for days days.
Yeah days
But you should probably have a new one once a week or something if you can that's
great
You know, they run a little over a buck buck 50 some places
And I think the most important thing about them is right now they're readily
available early on in the pandemic
You know all of us said don't use them because health care workers need them
We had a major short supply
But by the summer of 2020 all the manufacturers had so boost production that we
have more than enough right now
So the public can use them they can be very helpful, but you got to use them
And you know wearing it under your nose or not wearing it. I mean I find for
example in schools
The great debate right now is you know, what do we do with masks in schools?
So kids go to class all day
They wear their whatever they're supposed to be wearing then they go to the
lunchroom for half an hour
They take it off while they eat with all their friends. I'm sitting there going
now the virus doesn't take a vacation just when you're at lunch
Okay, so what should they do not eat?
No, but I think you have to at that point then figure out do you need to space
people and just does that work?
Well, basically, it's one other option
I mean in an indoor setting yeah, can you really space people out to the point
where you can
Have sick people in the same room and not
Can't sick affected but then that's where ventilation comes in ventilation is
huge
And what we can do for example in fact
You can actually develop and build and put into schools things called Corsi
boxes
Corsi boxes named after the
The air aeros biologist specialist who devised these are basically taking a
regular fan
And putting in a MERV filter a high level
furnace like filter on one side of it
And basically
Attaching it to the fan and then letting the air blow through the filter
Put one of those or two in a room. You can do a great deal to eliminate virus
Things like that that we haven't thought about things that we need to we should
be investing in the in our ventilation systems in
So many buildings and we're not
Interesting. So the ventilation systems that they have on airplanes
They've been touted as being very highly effective, right?
They can be more effective
But 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
And so I mean if you have enough infected people on a plane
I do believe you get transmission on planes
I don't think you can say that they are absolutely perfectly safe
They are safer clearly by the air filtration how it goes through the filters
that they have and move it around
§26Transcript · 2:09:45–2:14:31
But 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?
Then what is the point of a mask mandate?
Thank you. I agree
So what should you be doing?
You think everybody should be not eating on a plane and just keep up?
Well, you know, I think
Well, first of all, I wrote a piece again not long after I was on here
where I didn't support general lockdowns
I said, you know what?
When you have a surge, apply the brakes
And what you're applying the brakes for is trying to keep people from
overwhelming the health care system
And of course you want people not to become seriously ill and die
But 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
That's a challenge
But when you do see the transmission
Then you want to have that limited time period
Well, I'm the same way with mask mandates
Two things
One, 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
You know
Because it doesn't work
It doesn't work
Or a surgical mask
Yeah
And so that is what you see though when you have a mask mandate
You see people wearing what you think are very ineffective masks
And so I continue to come home and say
You know, please wear high quality respiratory protection
Then I can support more mandates for a limited period of time when you have
that surge capacity
I mean what we just went through for the last 10 weeks
Was an example where if the more we could do to slow down transmission like
that
Add in the in the papers in Minnesota from the healthcare systems we're asking
people to do
Just give us a break
I think that's fair
I 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
And I don't think that's a wrong thing
When 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
What do you think could have been done to manage that differently?
And you think that that that residual effect is just a function of not being
prepared and not
Not anticipating anything like this ever happening and not having the steps in
place to handle it
You know, I don't think it's a straightforward issue
What 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. It was losing a loved one
And 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 3000 kids or excuse me 300 000 kids in this country 300 000 kids
Who have lost a parent or a guardian who took care of them?
You know, it's that adds to the challenge
So I think that we clearly had an impact by the negative things you just talked
about
But how much was actually caused by quote unquote these mandates and how much
was caused by just going through a pandemic as hell
It's not it's it's tough
Right. It was both though, right?
It was both though. I'm actually acknowledging what i'm saying though is trying
to understand that
Isn't a self-important for going forward because we as I shared earlier in this
Session we could see another surge again. So what are we going to do next time?
How are we going to be prepared for that? How are we going to communicate to
the public?
What are we going to tell them we need to do and why?
And you know right now I think they tune us out quite a bit because they feel
like we don't get it
We're not going to you know, why do you think that is?
One is they're fatigued and tired. I mean think about ebola back in
2014-15 it lasted for about four months worldwide
It was over with if you look at the 2009 h1n1 pandemic
It was really about six and a half to nine months and then it was over with we're
now into our third year
fatigue is setting in
I mean if I get asked to run a marathon once that's tough
But if I get asked to do it day after day after day for months and months, you
know, I give up
And 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 and and I'm not saying that that
Excuses any of mistakes that have been made about how to approach it, but it's
just human nature right now
We're challenged. We're tired. We want it done
And so I think that's one thing. I think the second thing though is is that
§27Transcript · 2:14:31–2:19:56
We didn't communicate clearly
What we know and don't know I started out the program by saying that
What do you think was was done incorrectly by what we
By not communicating what we know or don't know?
I think we had
We gave the public expectations that they felt like they
When things changed quickly that we were not credible
You know
Like what for example, you know, a year ago right now, you know, and I'm not
taking any great credit
But you know, I made public statements that I thought the darkest days of the
pandemic were still ahead of us
And it was because of these variants. I didn't understand. Wow. How could they
affect things?
Well, and look what happened
But we had many of the talking heads out there of which I include myself as a
talking head who are saying to the public
You know, it's over with now summer is going to be
Quiet and calm the peak has come down vaccines flowing. Maybe we'll have a
little bit of activity next winter
And then delta came along
Why do you think that they
Made those declarations?
I think
There was a situation where we lacked humility and saying what we know and don't
know
I 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 got to be prepared for it
You know, it's it's that willingness to say I don't know
I mean, I think probably the three most important words I've said to you all
this entire session is I don't know
You know, and I think that that's what we haven't done enough of and then we
have to tell people
What are we going to do to find out?
What do we need to know, you know to basically answer the question?
Well many of the questions you asked me already
And I think that message is one that we have not done a good job getting out of
just being humble and saying I don't know
But this is what might happen. This is what could happen
Speaking of I don't know did you did was there any more definitive data on israel
or was it too confusing?
I think that the confusion came with
That because I kept seeing that four doses for some people
The confusion meaning what they determine as to being vaccine right yeah, what
yeah what the definition of that word becomes so when we walk out of here
My research assistant is going to tell you exactly the answer. Okay, he's gonna
bring him in here
Go get him if you want we could take a 10 second break
Yeah, we'll take a 10 second break and go get the data. That'll help everybody.
I like that. Thank you
Okay, so to wrap it up
What's your assessment of what we just looked at in terms of like the the israeli
data?
I 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
Good example, but is it true?
Is it 90% of the population of israel have at least two doses of the vaccine?
Yes, the data we have shows that but the right of it
That was what we know
I'm talking about the fact if you look at the surge is could being contributed
by those people who are unvaccinated
Completely unvaccinated and well, we have a number of them that have one shot
Which is not nearly enough adequate protection unless it's the j and j
No, that's even people who have gotten
mRNA but just got one shot we still see that in the in here in the united
states
Right, but i'm saying it's the j and j count as like a one shot because one
shot is fully vaccinated with the j and j until
I can't I don't know in israel how much j and j was used
I don't know so 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 it's both
But what i'm saying is what really brought that surge on was in terms of
hospitalizations severe illness and deaths
Was largely of that surge piece was among unvaccinated or one with one dose
Okay, so it's one dose or zero doses. It's not two doses not two doses
So when you hear about vaccinated people catching covid in israel
It's a small percentage
Small percentage of what of their population that has covid
No, actually it well, I shouldn't say small. Yeah, it is relative
But if you look at the total numbers, we also did see infections
Among people who were fully vaccinated. Yeah, what we're talking about and I
talked about that surge
I'm talking about it in terms of severe illness hospitalizations and deaths and
that was being driven
Largely by those who are unvaccinated or who had just a single dose
And that's what those data show
What is going on in africa and why did they have such low rates of infection
and and death?
Well, first of all, we have to be really cautious about saying how many cases
they've had
Because there's a lot of surveillance surveillance and testing
And 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 if you look at zimbabwe
You look at countries like that and so part of it is that
§28Transcript · 2:19:56–2:25:34
Surely it's not the same as the us. We're not seeing the hospitalizations the
same way
But then we have a much younger age population
You 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
But I think at the same time
We're trying to study that to understand how many cases did we miss did we miss
what are the impacts
And 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
And I mean we're really going to have to reinvest back into that area just
because
You know we've lost a lot of footing in our control
From a public health standpoint of many of infectious diseases is there any
other factors that could be
A consideration in terms of like the low rates of infection do 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?
Well again, I come back and say that it's not
Just the fact of underreporting as 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
In 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
You know i'm at this point again open to the data
You know we just have seen so little come out of africa and we need more we
need much more information
Understand that I think the south african experience was helpful in allowing us
to see what omicron was going to do
Now 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. It's there's a
tail here. That's pretty substantial
Why is that what's going on in south africa? So I think the
African continent has been largely
Neglected relative to many other parts of the world to better understanding
what colbert has done both directly and indirectly to the society
Were there any countries do you think that were a model of how to handle the
pandemic correctly?
You know, I think trying to make the very best out of a horrible situation
I think australian new zealand have probably done as well as any two countries
and you can say well, they're islands
But you know, they they pursued this zero covet policy to the extent that they
could and when it became impossible with omicron
They graduated their response in a way, you know that I think is really helpful
I mean, just take for example new zealand
Here's a country that with you know 5.2 million people here's minnesota state.
I'm from you know with 5.6 5.7 million
You know when you look at our deaths, you know, we've had you know 12 000
almost
Look at their deaths. They've had 52 as of two weeks ago
What's different?
Well, 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 you know, the numbers didn't appear to be increasing
or you know the follow-up
And so I think there's lessons here for us to learn across the board all
countries need to go back and look carefully at it
A 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 had what happened during the omicron surge in
the united states
If in fact, we had the same immunization rates for covid as denmark
And he estimated that about half of all the hospitalizations would have been
eliminated half
And I think that's probably true. That'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
Because again, they're actually providing protection against serious illness
hospitalizations and deaths with their immunization programs
And I think that's a lesson for us going forward. How do we make that work so
that we can do more of the same?
Now, 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 hydroxychloroquine
azithromycin
All that stuff together like what do you what do you think about these doctors
that had put out these
Protocols for early treatment well, I don't have an opinion of the doctors. You
know, I have opinion on the protocols
Well, I'm gonna say yes. I I think again it has to be science driven
You know, and 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. I am eyes wide open
You know, I'm ready to see them these double blind placebo control
Have you looked at any of the randomized controlled trials that have been done
previously?
You know, there were none that were really
Randomized controlled trials I can tell you I look at the studies carefully
There were so many problems the one in brazil was really a challenge. I mean it
Again going back to my previous statement if one of my graduate students had
done that kind of a study out of flunked them
So I think we need really much more comprehensive data
§29Transcript · 2:25:34–2:29:06
And we should be collecting data on these kinds of treatments
So I'm 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 everybody is otherwise the same
They're equal it's only when the code is broken by the monitoring board
Does anybody know what the results were then we can feel confident that we have
a study that is objective
That is based on the data and you know if ivermectin comes out working you'll
hear me say it
If it doesn't i'll explain what I think the study said and what it meant
So i'm i'm wide open on all of these things
I just if I had to say anything that I wish
We learn from this is some of these things have to be done much sooner
And agreed I think a year ago people thought we were done
I wish we had started some of these trials. I wish we had done some randomized
controlled trials on masking
And how does it make it work? You know, what can you do?
Maybe you can't what can you do and maybe inform people about what you were
saying about n95s?
Exactly and then and then share that information as quickly as possible tell
the story
You know I you know you you understand this but you know
People really respond to when you tell them a story
You 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 ten o'clock coffee group at the s&d cafe in my little hometown in iowa
You know, I needed to go back home and rethink it
How do you get that to sell?
And you don't do it by being a salesman you do it by just being a good storyteller
Telling the truth telling what you know and don't know
And I think that's what we need to do a better job of in public health right
now
We need to be that we need to code it all all in a dose of humility say what do
I know and don't know?
I mean, you know what this interview will probably remember for how many times
I told you that I don't know
Well that and I mean, I think you gave a a great analysis of things that went
wrong and things that we could have done better
And also the burden on the healthcare providers. I think that's something that
people need to be really reminded of
Thank you
Okay, your podcast is the olstrom update podcast every thursday
Every thursday morning it drops and it's on our website. It's on apple. It's on
spotify. It's on all of the services out there and
Welcome it. I try it's again my attempt just to be
Unvarnished to be humble and just to tell you what I know and don't know
Well, thank you very much for that and I appreciate you coming back again and
hopefully we won't have to do this again in two years
Well, if we do it won't be on this topic. Yeah, hopefully. Yeah. Well,
hopefully it won't be a new one, right?
Yeah, all right. Thank you very much. Thanks a lot. Thank you. Bye everybody
You