Video URL: https://www.youtube.com/watch?v=wyr3WHXMy5k
[Music] dr osterholm welcome back thank you very much very good to see you again good to see you it's been basically two years uh 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 [ __ ] out of a lot of people well you know my job is not to scare anyone out of their wits to scare them into their wits 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 going to be a pandemic and so yeah there was a lot of denial about how it was going to 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 on 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 where we're going in particular right now um 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 has 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 caked 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 uh 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 politician 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 variance these variants are really challenging we don't know what they're going to do they kind of like 10 110 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's 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 comments 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 100 only 10 people get serious illness or hospitalize you say this is a much milder disease the problem was you have 20 times as many cases 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 uh 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 uh 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 uh 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 had actually paralleled the exact experience in humans so as the numbers and 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 kappa captive servant industry well i don't think it's there i think it's uh something because it's a statewide even where you don't have captive servants they were seeing the same increase and decrease in cases so i think what it's really pointing out though is that if you look at all the other animal species that get infected and then you look at the potential for humans to continue to get infected i don't know what the next variant's 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 mature 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 too 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 um maybe you know what whatever numbers are you used that it's uh 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 uh 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 who 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 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 co-morbidities no minimum 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 uh a hit on kids that's interesting because i in my kid's 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 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 covid thirteen hundred and thirty four kids yep and out of these kids how many had comorbidities how many were some some did but but a comorbidity is just just obesity yes in fact let me come back and say somebody who has diabetes is considered having a cold
if you look at somebody who has uh uh asthma which you know about seven percent of all the asthma in the countries and 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 was really it absolutely it was is that shocking to you because it seems like for adults it the the effect that it has on the general population it seems that the consensus is that it's more mild yeah i think that's one of the challenges we have if you've known the covid19 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 those 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 covet 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 on what it did and how it did it with kids and the variants uh as they like so 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 what we call the ancestral variant the one that originated in wuhan all the subsequent variants we've seen have actually all gone back and their
roots are in that ancestral variant it doesn't mean that if you had alpha it turns into a 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 are 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 takes you back to the original variant so the question on omicron's initially when right now in the united states virtually 100 percent of the uh variants we see are omicron 100 100 in the us and virtually around the world it's beating out delta completely uh if you look in the united states there are three sublineages of that variant what we call ba1 ba2 and ba3 and we're watching a battle go on right now between 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 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 uh 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 this is one of those questions where clearly i'm not the world's expert on the overall genetics of those 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 uh 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 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 that 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 we don't necessarily see us go giving it back to the animals they give it back to us we give it to the analyst they give it back to us with looking at sarsko v2 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 kovi ii 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 uh game animals mink and so forth in europe they saw that but it became clear because we started seeing zoo animals infected right just this past week we've heard about lowlands gorilla 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 spill back moment into humans with a 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 if sometimes an animal may get an infection from us and it's terminal it is 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 kovac in this case and this came what we're talking about are primarily furbearing animals for pelts okay 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 um 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 was 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 viral blizzard because it 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 others it 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 uh likely in china we're not hearing enough about it korea et cetera but most of the rest of the world has 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 kovi ii 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 the number one this was a man-made virus absolutely none zero no evidence that would support
that it is a man-made violence 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 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 are back to animals it's not surprising that it might have emerged there and so i'm 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 of course i shouldn't say anybody yeah some people believe the world's flat right that's absolutely true that's absolutely true too so i think no that but i think that it is fair to say that uh 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 might be a mosquito born something okay where do you think they might find that virus first atlanta why atlanta because it's the indus 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 it's 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 is 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 at 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 born now you're 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 stonewallers 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 they just open their lab up i just wish they would and let us let 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 of 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 it continues to be a major distraction wasn't there recently a version of the virus that was discovered a very early version of covid19 in one of the labs there's been a number of sars cov2 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 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 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 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 okay i sat for a number of years on what was the newly established uh 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 gin 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 can 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 no there is some anecdotal evidence right there was uh some i believe there was three researchers at the wuhan lab who did get ill with a very similar disease to covid19 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 well it's it's it's it's not storytelling but you know i see some of these things yeah and you know i've never seen any of those data collaborated by any responsible group it's kind of one-off you know it's kind of that whole idea you know president kennedy's secretary was named lincoln president lincoln's 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 so as a scientist you're just not willing to make that leap i'm not willing to make the leap but i'm willing 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 again 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 uh 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 et cetera 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 cooperate 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 would i don't know you don't know i don't know um if there was proof that a lot of files were deleted would 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 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 uh 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 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 are 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 those viruses want 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 right 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 center 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 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
ace2 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 a function first of all means that you're adding something to the virus like i talked about with influenza it was again a function where you're trying to see if you could make it transmissible between in this case an animal species in 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 uh coronaviruses i've not seen any evidence of again gain a function because this virus is pretty damn functional on its own is 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 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 that it could exist i just don't know i i'm not trying to answer they're 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 uh equal alliance the group that was doing the work digital health alliance yeah equal health alliances actually yeah i just agreed with that so that's not what was 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 gaining 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 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 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 h2 receptors that this would somehow or another make a virus more so more transmissible to people yeah that's the idea behind 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 a 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 so 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 yeah is like 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 functional research of how you actually were going to go about doing it and showing the safety steps you had in place to make sure that it couldn't be a release 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 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 um that this kind of research is important to understand how these viruses evolve how they become more virulent how they can infect people and jump species that it has to be done safely 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 to wuhan because i don't know of course well you're a scientist and you look at the evidence you look at it it has 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 of that i didn't i you know i didn't really you know if something substantive come out what i you know uh you know i already spend way too many hours a day working on code right the last thing i have time for is basically getting into these politics you know it's you know and as you know i mean it 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 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 a point so therefore now the assumption is 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 uh 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 i 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 why did that happen 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 was going to do to kill people and 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 when 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
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 often times with my colleagues we do know that it's not likely tied to dose originally you know i was co-op you mean by viral load yeah by viral load how much virus is there didn't dictate how seriously illiad it 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 it's absolutely true we've seen people 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 is 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'd get very yellow and jaundiced and we go back and test the child and sure if 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 percent 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 uh one of those questions again that kind of begs the very issue of what is this ours cov2 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 to delta to omicron just in a matter of two years right i mean it's amazing how 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 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 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 very 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 chronic viruses meaning common coronavirus that somehow or another that may have imparted some at least some kind of either immunity or some kind of protection from sarsko v2 and that is currently being studied and in fact if you look at the issue of just take immunity from sarskovi to if you look at the data for delta you could actually show that basically those people who had previous infection did better than those who hadn't had previous infection and were vaccinated 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 you think about delta more than once 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 had previously been infected with the ancestral variant now actually with alpha were 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 uh 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 it's only four point four 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 four 4.4 yep right so uh a lot of people thought it was a lot higher than that like there was an impression that when you got infected by sars ko v2 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 cov2 at all these are important things that you should be considering okay do you think that that was reinforced by the government oh i think particularly around body mass index a lot really oh yes i think so but i mean i i gave many talks where i was talking you might have given many talks but 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 disease autoimmune diseases etc so you know i i fully support the fact that we should be emphasizing this issue around body mass index uh meaning i.e should lose weight etc and and i i agree with that it's really obesity it's body mass index is a weird one because like i'm technically obese yeah by the body mass index yeah and in that sense you're right you're right it's really about weight um the weird thing about uh coven 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 a 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 i.e 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 stars kovi v2 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 about today is long covet and with long cove it is clear that that is not evidence there's not evidence at this point of an ongoing infection it's not that the virus is still proliferating and we just haven't gotten rid of it so can you explain what long cove it is technically you know i can't and other reasons i can't it's not because i'm not even an expert because most people can't it's a whole a
series of different conditions the brain fog the fatigue uh 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 covet 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 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 coveted there are these new centers starting right now to try to address this you know overall we estimate that there may be anywhere from three to ten percent some say as high as eighteen to twenty percent of people without regard to whether it was serious uh covert they had or milder covet go on and develop this long covet there's an interesting parallel with fighting i can talk to you about this okay the mma fighters yeah that um some mma fighters who have had kovid um particularly ones that didn't i don't know i don't want to speak that they i don't want to say that it 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 covet 19 tended to suffer long-term consequences from it there's several examples of this and after those bouts of covid19 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 covet 19 then competing and not looking as good 8 year 8 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 covet because clearly they're in shape clear they look great but when they're competing they're not 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've 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 you can actually find that that your body's ongoing activity and we've seen this with people against 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 dysregulation 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 is is 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 it's a
series of different issues but i think the most important message is is if anybody listening to this uh 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 covet 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 coveted 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 as they were before the virus they never have recovered fully is that a fair way i think it's it's really 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 along covered 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 covet who then in the second or third week thinking they're getting better all of a sudden start feeling tired they feel like they 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 the their physical response like they're yeah
i've actually know of people who had mild or coveted and they'll tell you that their long coat was much more severe than when they had the acute infection but what did they mean by that like meaning when i had coveted 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 that they have a higher resting heart rate all of those things artists 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 covet that just says if you have this symptom this symptom and this symptom you have lung 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 emphasis 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 covet 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 right and then once we do that what can you do about it what what kind of treatments could be effective and giving people hope because i've seen people who at 12 months after their covet infection who are feeling like they've kind of lost their life they 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 nope
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 uh you know why might you have uh some evidence of some heart involvement or your lung involvement so part of it is right now just taking very seriously that long covert 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 to develop long cove but we don't know that yet it's such a strange term long cove i know yeah because it's like you don't really have covid your covet is done but you have the deterioration of your your physical abilities yes yeah very strange right yeah well you know we saw it again as i said with chronic fatigue syndrome you know that's a term that many people have uh 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 kobut now is drawing the resources towards and hopefully you know people who have that condition also can be helped by learning what what did kova do why did covid cause this um are there any i know there's some new uh treatments that are on the horizon that merck has and that pfizer has there's a bunch of different 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 in 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 etc 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 ivermecton you know there are five big trials going on right now they're going to be announced the results in the next weeks to months that really have looked carefully at ivermectin including high dose iverbectin and you know i've again as a scientist reserve judgment you know i didn't close my mind and say no yes whatever i want the data and we've got to have these double-blind placebo-controlled trials you know studies where neither the investigator or the patient know which they got you know and then objectively find out what's happening 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 paxlovid while it has some contraindications with underlying health conditions that might already exist on a whole it is really a very very fantastic drug but the problem we have right now with that is that we have many many places in this country where during the surge of omicron i couldn't get tested for three four or five days why is that because we just didn't have the testing capacity but doesn't that seem that seems like something that would be much more easily that's what i'm going to okay that's exactly you you you've hit my line for me thank you okay
um 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 is 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 indian 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 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 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 my covenant 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 um 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 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 kept 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 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 but 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 these 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 impacts 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 where we need as a globe a 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 um press conference where uh ron desantis was uh 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 covet tests expired so they have a shelf life 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 also it's not just surplus but we do a thing called vendor management control so you know you basically rotate it on your shelf so you have a place that says okay i will help vendor managers product so i'll make sure that 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 basic 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 search 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 with the 911 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's is the last of the variants you believe that the 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 hope's not a strategy right yeah gotta be prepared what if another variant shows up the challenge is again we're gonna have the same needs we're gonna have the same issues ahead so we're gonna have to plan for that what kind of shelf life do those tests have it varies i can't tell you a test by test but it it uh it's it's months but it's it's not years it's not years yeah um let's go back to vitamin d sure so when you're talking about how a disproportionate amount of hispanics and black folks and and native americans essentially people with more melanin in their skin people with more melon 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 cold infections 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 at one point in time and people in the icu had insufficient levels of vitamin d yeah and i can't comment the question we have 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 supplements 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 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 don't they supplement vitamin d and milk as well uh to some degree yeah well my milk has 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 one 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 front-line workers who are the people who left largely unprotected who did the critical service for us even in healthcare 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 conf 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 and their chairs and who trust people more than your barber and they talk about all issues of health and it's a program it started out at 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 it actually is and then they actually look at the outcome and their clients and they've been able to demonstrate major increases and 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 there's seminars like how are they educating these people it's a major program uh dr stephen thomas who heads us up who is just a very creative innovative guy and is 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 they where do they hear it you know i heard it in the barber chair well who do you trust me i trust my barber i don't know well i don't have a barber clearly i i i kind of was making that in first you know i was talking about this when i started but when i did i had 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 told good stories but you know um so when you're talking about front front line health care workers um one of the things that um is a real point of contention is folks that were front line 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 a dose of vaccine for certain so why didn't that happen with those still working out folks still working still working on them i know but in the middle of a pandemic when you desperately need these people that risk their lives in the early days of the pandemic when there were no vaccines and 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 no it's not and again 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 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 infected and then got vaccinated and then that got vaccinated added one more dose on and it really did boost them up and they if you how do 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 100 000 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 the booster it was point zero one zero much lower even yet and this is death yeah this is death and you're talking about death from delta uh in this case this is even omicro is omicron but the point i'm trying to get at is if you looked at the whole ray of these those who were had facts who had previous infection and were one dose like a boost actually did very well so i'm willing count to 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 not as high as doctors but we're 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 healthcare workers bringing the virus in and transmitting and where we looked at that we saw data 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 three right when it comes yeah well it's the outside insight 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 healthcare workers had to play a role there so our point in getting healthcare workers vaccinated is not just to help protect themselves but it's also to help protect the patients right but isn't it hasn'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 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 do that previous infection right and i'm saying they should so you think that the healthcare 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 moderners a stiffer version of the virus correct or excuse me vaccine and then johnson johnson is different as well right right it is and
right now clearly the evidence points to the fact that modernity gives us a bit of a better take than we see with pfizer because it's stronger stronger now where j 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 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 wayne and immunity it doesn't mean that's the people that have the difference in the j j worth because it isn't an mrina 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 than 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 we very well be 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 sidrap center for infectious research and policy at the university of minnesota is actually going to be leading and be 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 correlated protection today there's different kinds of antibodies there's neutralized natural there's total antibody okay all these different kinds of antibodies 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 correlated protection so for example i can tell you if you get a measles vaccine and i do a blood sample and i can tell you likely if you have the immune response is 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 correlation 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 it do you anticipate in the future that we can figure out how to boost overall 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 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 a 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 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 the 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 that 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 how does that how would was it an mrna well that's you know how mrnas 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 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 um 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 uh 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 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 itself is causing
this immune response to attack part of your heart muscle that would cause that 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 the 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 coveted 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 modernity vaccine is more problematic than the fires are working absolutely it has been yep it has been absolutely and isn't isn't it shown that with the modern 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're looking at the you know it's it's it may be close to a trade-off there but you don't take into account pericarditis you don't take into account arrhythmias all the other things that the virus does to the heart which we never talk about 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 seen 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 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 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 two instances where well studying in the sense that we know about when i say studying they haven't even yet confirmed that that really is caused by the vaccine it's being looked at right now we're more clear on the thrombosis from the j 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 perspective the risk of a bad outcome with to your heart or to your basically the thrombosis is still greater overall from getting the disease now at this point the jj 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 jnj vaccine is a real advantage vaccine because of the lower dosage the more stability of it and the fact that overall the health benefit's 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 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 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 they will continue to make it it's not their down and it's uh and they continue to distribute 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 so why do they call it a boost i mean well i hate i don't like the turtle 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 seemed 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 at that time they called it the booster dose i think cdc should change the definition of fully vaccinated for the mrna 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 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 uh big uptick in cases they had it was almost all in unvaccinated people i don't that's not what i read i realized it was the thing about vaccinated people in israel like that there was a giant surge of vaccinations now 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 uh the real burden the the major thrust in this surge uh 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 we 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 and i actually had the numbers in front of me and actually went through what percentage were unvaccinated what percentage of vaccine clearly the unvaccinate the vaccinated did see increased numbers of cases but the surge was really covered by the unvaccination so there's an enormous surge but it's because of unvaccinated people yes we can look it up see that is so confusing to me because i was almost positive that i'd read that an enormous percentage a very high percentage of the people that were new cases that were infected with covid 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 going to find it see whatever you can find jamie you got anything sorta sort of i mean i could think it gets here's the first thing i found which i don't know like the efficacy of the analysis of cova vaccine breakthrough infections in highly vaccinated israel okay a recent study published in uh what does that say med rxiv preprint server research has evaluated model age structured cases of severe acute respiratory syndrome chronovirus ii um vaccination coverage and breakthrough infections to do this the researchers data ministry of health pop up i don't know if this is this is an older piece yeah this doesn't give it to you this is january 13th yeah but i mean it's in terms of the omicron surge 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 unfortunately my research assistant's outside the door he actually has the papers in hand so well let's um see 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 right that's an old one that's an old one that's an old one okay yeah yeah you got to have what's the nature january let's go to that january one and see what it says though yeah like it is an analysis we only looked at the top about the study yeah the following data sources received okay march 21st to november 6 2021 the 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 are 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 we had breakthroughs right okay so maybe we can google what percentage of people that have coveted in israel are vaccinated covert omicron okay so omicron which is uh the how much more infectious is
omicron than than the the alpha variant or 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 i had heard it was way more infectious than that yeah that's roughly so 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 and look look at households and direct 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 yep that's it it's a real experience of 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 it was blocked but it said the before block said that forty percent of the population israel is un is unvaccinated yep forty percent yep again why did i see like i read that it was eighty percent 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 going to disappear real quick see it said it but yeah sorry you've got you have the right stuff you've got to find that that is the right piece yeah archive thing so but anyway i think that's messy i think that materials 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 uncovered 40 percent of israelis have no protection against covid but isn't that it's omicron varian it says 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 process but it's a 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 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 while just a hundred and ten thousand out of one point two million young kids got the that's a lot of language there yeah i originally found something when i was looking that said that uh this is back in the end of the summer that ninety nine enough doses had been administered in israel to get 99.3 percent of the population vaccinated yeah that's enough to but it doesn't mean that they were no 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 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 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 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 it 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 uh with this is during omicron if you look at deaths again the point i made earlier if you're unvaccinated your rate is about nine point seven four per hundred thousand population nine point seven four if you're fully vaccinated it's point seven one but if you're fully enacted with a booster it's point zero one per hundred thousand 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 production 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 so how is it not protecting you from the vet then how is it evading the the vaccine well the evasion is not complete it's it just limited it 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 that's a term that is not very artful to say the main evision immune evasion doesn't mean that it's 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 talk about biweening immunity
so the booster helps something from omicron it helps you avoid severe illness yes that's what i just gave you just now were deaths but if you look at hospitalizations the same thing okay 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 were 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 100 000 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 do 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 and previous infection again also gives you more protection like a dose of vaccine but it's not yes or no yes 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 life 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 is 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 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 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 the 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 sid rap news this week and i covered it my podcast was very weak the one that was uh 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 they were down to one monoclonal as you know the other two basically uh 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 and omicron basically canceled out their effectiveness because the mutations were where those two monoclonals really attacked the virus was it um a reduction of protection or elimination of protection well in the laboratory setting it was largely almost elimination of protection and 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 them off the market right there are 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 in particular 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 or 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 an 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 the trovamab is the name of it most people wouldn't recognize the name but it's one that uh basically uh it attacks the virus in 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 yes it is so yeah it is too yeah interesting yep so that would be like almost universal monoclonal anybody 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 uh 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 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 10 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've 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 say if covet was to die off you don't think so we're in what's worse 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 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 mayo clinic that's right 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 et cetera so you think that's a false narrative i think it's absolutely a false narrative absolutely vaccinated health care workers very few 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 covet since the beginning of the pandemic and so they want to be vaccinated largely and as i said 99 of doctors got vaccinated quickly i think the challenge is we don't understand yet is how fragile our healthcare system is so when you ask me are we better prepared right now the department of labor has just surveyed healthcare workers and think that we're going to see a number of them quitting in the next three to six months just out of their burnt out 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 advance we have to be better prepared to handle surge capacity we just weren't we missed this is the term is this hospital beds is this no staffing is 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 from medical school we've had more applications of 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 right effect casca 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 at add 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 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 surge 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 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 difference between night and day how well they work you know shortly i was after on 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 did 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 declaration than they are anything about really working and so when you ask me do n95s and kn 95s 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 yes 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 drawers in your submarine you know it doesn't matter you know what good does it do so explain to me how uh n95 masks work if you can breathe out of them yup 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 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 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 so what a milk blowing it's like a foam that hardens okay and it has you're saying milk milk yeah that's what they call it yup 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 mass no it's it 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 oh okay so when you see i'm sure you're probably seeing 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 otherwise that's right yeah yeah i jokingly said 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 you said it's a milk what is it milk blowing 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 in 95 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 healthcare 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 we do with math and schools so kids go to class all day they wear their whatever they're supposed to be wearing 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 in 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 what other option i mean in an indoor setting can you really space people out to the point where you can have sick people in the same room and not can't affect it 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 biologists specialists who devise these are basically taking a regular old fan and putting in a merv filter a high level furnace like filter on one side of it and basically attaching it to the fan and then letting the air blow through the filter put one of those or two in the 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 the time and it was a surgical mass 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 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 it should you be doing you think everybody should be not eating on a plane and just keep you know i think phase 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 serious 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 and so i continue to come home and say you know please wear high quality respiratory protection then i could support more mandates for a limited period of time when you have that search 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 health care 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 ten causes of death for all age groups when you have three thousand kids that are threatening three hundred thousand kids in this country three hundred thousand 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 so i'm actually acknowledging what i'm saying though is trying to understand that isn't it self-important for going forward because we as i shared earlier in this uh 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 of their 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 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 is the long-term nature of what's happening and and i'm not saying that that excuses any 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 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 change quickly that we we're not credible you know like what for example you know a year ago right now yeah 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 how how could they affect things well and look what happened but we had many of the talking heads out there i wish 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 hot 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 ulster osterhome 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 sessions 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 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 vaccinated right yeah what yeah what the definition of that word becomes so when we walk out of here my researcher assistant is going to tell you exactly the answer okay he's going to 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 hospitalization deaths it's vaccine vaccine vaccine good example but is it true is it 90 percent of the population of israel have at least two doses of the vaccine yes the data we have shows that but that was what we know but i'm talking about the fact if you look at the surge it's being contributed by those people who are unvaccinated completely unvaccinated and well we have a number of that have one shot which is not nearly enough adequate protection unless it's the jnj no that's even
people who have gotten mrna but just got one shot we still see that in here in the united states right but i'm saying is the j and j count as like a one shot because one shot is fully vaccinated with the j and j until i get a second one i don't know in israel how much jnj 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 it'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 that search 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 right 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 coveted 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 yes 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 were 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 death well first of all we have to be really cautious about saying how many cases they've had because 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 surely it's not the same as the u.s 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 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 under reporting 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 i 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 to 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 tale 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 covet 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 australia and 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 covert 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 i 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 covet 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 icu's 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 uh 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 going to 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 uh the data coming out on these five trials with ivermectis can be very interesting i am eyes wide open you know i'm ready to see them these double-blind placebo controls have you looked at any of the randomized controlled trials that have been done previously you know they 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 autoflunked them so i think we need really much more comprehensive data and we should be collecting data on these kinds of treatments so i 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 learned from this is some of these things have to be done much sooner and a grade 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 control trials on masking and how to 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 n95 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 10 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 of it in a dose of humility say what do i know and don't know i mean you know what this interview will probably be remembered for how many times i told you today i don't know well that and i mean i think he gave a great analysis of things that went wrong and things that we could have done better and also the burden on the healthcare providers i think that's something that people need to be really reminded of thank you um okay uh your podcast is the old strom 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 um 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 so much
bye everybody [Music] [Applause] [Music]