This podcast is brought to you by the Albany Public Library main branch and the generosity of listeners like you. What is a podcast? God daddy these people talk as much as you do! Razib Khan's unsupervised learning.
Hey, everybody. I'm here today with my friend, Dr. Emily Dean's. I talked with Emily, I think a little over a year ago about her, her psychiatry practice and psychiatric genetics. And we touched upon COVID a little bit. But this time, I want to talk about COVID I guess a year and a half a year in two thirds, really, a year and two thirds or a year more than a year and a half into it. Because Emily's been keeping an eye on it, as I have pretty closely, as we all have, to some extent. But she was pretty early, I was pretty early. And I want to do I'm not necessary post mortem, obviously, but just kind of a status update how she feels and how I feel. Emily, could you introduce yourself? Sure,
I'm a psychiatrist, obviously not an infectious disease doctor of any kind. But I have my undergraduate degree in molecular biology, and I've had tons of immunology classes, and I'm just really interested in it part of my genetics and psychiatric illness. studies are is about infectious disease. So it's just always been pandemics have always been a great interest of mine. So it's sort of my hobby, and I've been studying a lot and reading a lot of papers. So you know, probably not the worst person to be kind to kind of translate the experts into lay person, for people. So that's how I got, you know, and of course, you know, I've been dealing with the COVID one on one with family and with patients, not intubating them in the ICU, of course, but just talking to them at home, you know, when they're sick as a dog, and it's been a rough year.
Yeah, I mean, you know, I look forward to actually listening to this podcast in the future, because that's gonna be weird. I don't know, sometimes I go back and listen to my, my podcast with Spencer W ells. With Spencer, my old boss, I think it was February of 2020. And it was before COVID really hit, I think you could always tell already tells kind of freaked out my voice. But anyway, you know, we've been through this now I, as I said, it's almost a year and a half, I think it's more than a year and a half. We, you know, we've gone through a lot now, I made a back of the envelope estimate, which I thought was kind of crazy, at the time going over, going over the case fatality rates and other things. And how many people are gonna get infected in February of 2020. privately, I shared with some friends that like 500 to 500,000 Americans could could die of COVID Well, the numbers are in We're at 624,000. At the time that I said 500,000 I actually thought I was being kind of crazy. And I had a hard time believing it. And other people were saying, you know, could be a million and, you know, the 624 is almost certainly an underestimate due to delays and, and other things. I probably pad it by 100 we're probably above 700k right now of excess deaths in a year and a half or so. So it's, uh, you know, I've got my expectations, which is, which is not a good thing. With COVID. I think the biggest takeaway that I will say is, I feel like we have all this technology and I want to get to the vaccines - I get to the vaccines - yeah, with all this technology, but um, there's something really deeply lacking in our society in terms of mobilization, and shall we say, getting our shit together? Because once we have once we have the vaccines, I felt like, okay, like, if I had one, when I did talk to you, if I had told you, if we had known, we would for sure have vaccines in the fall, which is true. Because of Operation Warp Speed. And all the push that Trump Trump administration put behind it, I probably would have been like, okay, we're good to go. We're gonna deploy the vaccines, and you know, either go COVID, zero or endemic, do something, push it away. And, you know, we're in the middle of a cultural war. You know, we can't keep track of who's got the vaccine, who doesn't, it's all decentralized, even if it's subsidized. There's there's a lot a lot less information than I thought there would be for us to make proactive decisions into the future. I have to keep track of the UK data, because there's so much better about that. Yeah, no, I do too. Yeah. Okay. So so you're pretty much on the same page. I mean, what else has surprised you? I mean, how are you? How are you feeling in terms of like, Yeah, we did well on this we didn't do well on that. I mean, like what like what's your big takeaways?
So I think the major... if I were king of the United States, right, what would I have done differently? I certainly - they totally bungled. That. Testing at the very beginning of the pandemic. So it was widespread through several states, including my state of Massachusetts, by March, right by the end of February, it was spreading widely and we didn't have, you know, nobody could get a test, you could only get a test there, if you were hospitalized, it was sort of a special deal. And that was a six weeks or eight week delay between the FDA and the CDC trying to figure out they wanted a three, a test that tested at three different spots in the virus instead of the WHO test. So that delay was just disastrous, because we could have shut down earlier and I think saved a lot of those lives in New York City. And in Massachusetts at the beginning. They did a good job, though, with the vaccines, I think that was fantastic Operation Warp Speed all due, you know, to the Trump administration pushing that through. And, you know, these mRNA vaccines, particularly - the AstraZeneca, and the Johnson and Johnson, particularly being so effective, you know, we were hoping for like a 50% effective vaccine, and you got 95% for at least preventing serious illness or infection, not infection. Sorry, That was just fantastic. I know, it was a miracle. It was like we were granted, we were stepped on by God and being taken down by this terrible disease. And then all of a sudden, we you know, through science, we have this amazing vaccine. And the rollout was a little bit slow. So I was kind of glad. I thought the new administration rolled it out a little bit better. But then since then, you know, we just sort of gave up on everything, but vaccines, yeah, they're still playing, you know, masks on the plane, etc, etc. But what I would have added, and what they did, and all these serious high dollar industries, like I have friends who work in the movies and friends who work in colleges, you know, where they have money, and they have means, and they test everybody like crazy, just like in sports. And when they test everybody all the time, you Do you still get outbreaks, but they're tiny, right? You stop at it a few people, you know, maybe a few 100 people, if it was a big party or something, but then everybody is tested, and they're all you know, sent home to quarantine or, or do whatever it is, and you stop the outbreaks, it doesn't spread to 500,000 people. So if I were, I think we've really, really failed at there, we should all be getting rapid antigen tests, mailed to our house, so that we can take one before we go to the movie theater, or, you know, I think that, that they're never they're not even thinking about that now. And it's been, you know, 21 months, really, that? I think we've really I they know, they're doing that more in Germany, Germany everywhere. There's rapid tests everywhere, they're free. And they're if you look at their Delta wave, it's pretty anemic.
Okay, so, so, um, you know, to unpack a little bit what's going on here. So the Delta wave is, it's probably like two times more infectious, I guess, than the original wave and 1.5 times, so 50% more than the alpha wave, the British variant. And, you know, you're talking about testing and, and also, like, you know, we could do tracing, if we had testing. There's all of these technologies, information technologies, basically, being deployed by the government of Singapore or Singapore, does it? I think South Korea, definitely. And Taiwan does it pretty intensely, you know, these East Asian nations in particular, but you're saying in Germany, they have all this testing going on? In Sweden? Like they never really locked down, but it seems like, you know, they did enforce a lot of social distancing, just without any explicit rules.
So there's more mitigation after the first part. Yeah.
Yeah. And so, um, you know, there have been all these different strategies, I guess, you know, United States. We have Facebook, we have Google, we have all this high tech. And you know, in the first couple of months, there was some talk about like Google, working with the Trump administration and blah, blah, blah, but um, we didn't do anything did we, like we're like, there's no testing and tracing, there's no inflammation, technology. Everything is ad hoc. It's kind of just hoping people do the right thing.
Yeah, and part of that, of course, is federalism at state by state. I know there's more because cases are low here in Massachusetts, and they do a lot of contact tracing over the school year through the school nurses. So they did have kind of people on the ground. You know, I thought that went well. The hybrid school to the full opening here in Massachusetts went quite well. We really didn't have any outbreaks associated with the schools. It was more you people partying on the weekends and stuff in high school. So you get you can make it work. It's it's inconvenient. It's kind of a pain, but you can have a pretty normal life here in COVID. Um, but you do have to, there's a little bit of you know, I flew to LA this week for a conference. I wore an M-95 on the plane. I have a relative who's visiting Next week, who is immunocompromised, so I'm testing myself a couple times before she comes. Again, because I just don't, you know, it's a little bit of an inconvenience the test, I grabbed the Binax Now it cost 22 bucks. But I'm happy to have that little bit of inconvenience, do you know to protect my relative who's going to be wearing an N-95 on the plane as well, you know, if we had these higher quality masks to the mask that are not only source protection, so if somebody around you and you're breathing on them, you're, you're filtered by the mask, but the N-95. And the KN- 95 is also protect yourself. You know, they're pretty good at filtering it out. And I think the other thing that I see people arguing they keep falling into this fallacy of all or nothing. And, you know, we shouldn't do it. But if it doesn't work perfectly, so I think that's sort of what people think about with these fast antigen tests that they're not as sensitive as the PCR they're not they could miss some things, but you know what, they're not going to miss all of them, there's going to be some false positives, they're going to be some false negatives, but it's better than nothing. And same with the masks. Even if it's a cloth mask, it's not as good I honestly, personally, I was sort of push past those cloth masks or have you know, they're more high quality, nicer masks that are like N-95, that you can buy, I think or, or the procedure masks, at least as source control that are now changed out every day, I think that we should be focusing more on things like that. And then, and that's in a way, if people want to have freedom, or whatever it is, and they have more power to protect themselves protect their families, when they're in public, we're sending them off to school with higher quality masks. So you can have you can address this kind of tension between, you know, freedom and my response, you know, versus people who are scared and want to protect themselves. You can address that with some of this more empowerment and the person but I really not hearing that messaging at all. It's all it's vaccines are nothing. That is 100% vaccines, that's all they're doing. Mm hmm.
Yeah. And sometimes it's nothing because people are against vaccines, which we'll talk about a little bit, I want to like talk about, like, I've been really, you know, I'll give the United States a C minus like, and mostly because the vaccines, like we were really driving a lot of that. So that was great. But all the other stuff, the social controls the individual behavior change, a lot of that is just not where it needs to be. But I want to give, I want to give some respect props here to the United Kingdom. Um, you know, they had a really horrible winter wave. They really did botch it last year, it was kind of a joke, let's be honest. But I feel like they've done pretty well all things considered. I was reading articles in the New York Times that made the British seem pretty crazy. And experts like are very worried that they're doing these gaps and they're mixing and matching. But um, you know, we talked about how the United States bureaucrat.. bureaucracy is a bit a bit risk averse and sclerotic, they took some risks, and I think it paid off. You know, right now, they're still like, at a plateau of deaths. They're not decreasing or increasing, but it's manageable. They're their primary Delta wave is over. And there's nothing that's it's not like rising intensely, so I gotta, I gotta respect the British. They're not perfect, but I think in the last six months, they've really, really pushed forward with vaccination and other things, including some lockdowns periodically, that have helped keep things under control for now.
Yeah, they did an antibody study there, maybe a month or two ago and 90% of adults have the antibody. So that means they were either infected or they had the vaccine. So that's a big, you know, you need 90% plus 90%. For this Delta variant - it's so transmissible. And that's, I think that's kind of what slowed them down at least kept him out of the hospital, even if it's passing among some best vaccinated people with breakthrough.
Yeah, yeah. And, you know, we do need to emphasize with breakthrough, if you're vaccinated, your risk of death, and your risk of hospitalization is pretty low. So, you know, that's one reason why even with the case spike, they really, really decreased the, the rates of hospitalization there, which are much more under control than in parts of this country, unfortunately, over the summer, but you know, that's a different question. I want to talk about real quickly about authority, and trust and all those things. You know, I'm gonna be frank, I've lost a lot of trust. And not that I was the most trusting person in general. But I've lost a lot of trust in a lot of different groups and different people. I'll be frank, I don't really care. A lot of times what public health people say, because it just seemed like they were saying things in the beginning to keep us calm, which we shouldn't have been calm. And then now sometimes they seem to go out of control with hygiene, you know, like, like just theater, like all the theater that that you know. So let's... I'm gonna get concrete. We all know about the great we all we all know about the great mask flip, right? We all know we all know about that that undermine a lot of authority. Then there's the other issue was the aerosol air civilization and, you know, washing things. Okay, that was just performance. We kind of knew that by last. I by the time I had talked to you last spring, I think that was pretty obvious to everybody.
But, you know, I do have to give the reason the health care people kind of called that wrong is because they were thinking more like flu and Coronavirus are just different than flu.
Yeah, yeah. But I mean, you know, health care people in the United States, like in, you know, East Asia, they just assumed, right, yes, yeah. Then the Japanese were saying it very early on.
It was totally obvious, honestly, from the Diamond Princess. I mean, if you look at the RO from the Diamond Princess, it was like, 17 you can't have a 17 without airborne. Yeah. Unless they're, you know, all in an orgy in the back kissing. I don't know. Yeah, it was clear from it was it was
It was because of ventilation in the cruise ship that really, really amplified everything up. Right. And, and we saw cases like a South Korean call center. It was all about like the airflow. There was a restaurant and I think Wuhan. And there was a bus. I mean, there are multiple, yeah, multiple cases where we were seeing this. So I feel like that really depressed me in terms of just like, okay, what's going on here? And then the other thing, there's, I mean, there's a bunch of things, but like, another thing is, I feel public health. People are very ideological. I'm not like super happy with the anti vaccination stuff. On the right. In the United States that's happening. It's insane. It's killing their own voters to some extent. But um, you know, there's another group in the United States that's pretty recalcitrant. And that's black Americans. And I'm seeing these weird arguments that are just really pathetic comment on our country about who you should be targeting and who you should be excoriating? Well, why aren't you? Why aren't you know? Like, I'm being conservative? And why aren't you criticizing black people in New York City? Like you're criticizing, like, overweight, you know, MAGA people? And, you know, my thought is, why are you criticizing people anyway? I mean, you know, I mean, you should criticize them for not vaccinating. But this is not the way that you what you have people trust you and believe you, you know, by verbally abusing them.
Right. So this is a really important discussion, because it's actually very pertinent to psychiatry. Because we're talking about the difference between someone being frustrated and ranting, or trying to persuade right there. Those are two different kinds of communication. So if I'm frustrated and ranting, I'm talking to my people right under where people who have the same agree with me, and we all feel good about that. But I'm not going to persuade anybody by doing that. But there's still there's a reasons for doing that. And there's goals of doing that makes me feel better to rant, right. But if I'm, if I'm sitting with a patient who is unvaccinated, I'm not going to rant at them and point my finger, you know, that's not going to get them convinced to vaccinated I have to talk to them about why they're not getting vaccinated. And what scares them, some of them have very legitimate concerns that are particular - you know, I can't, it's too personal, I can't really discuss it. But some of them, you know, had scary reactions to past vaccinations or, you know, other reasons, in psychological profile, where it might be a risky thing to do. So, you know, you have to get down, you have to do motivational interviewing, and get down and talk. So really an overall public health message that hasn't picked it hasn't picked up all the people, there not too many remaining people that that's going to pick up they need their pastors, their individual doctors, their relatives, people they know and trust to talk to them about that. But you know, what's interesting, though, about the like, the black versus white issue is that when I've traveled around the country, you know, this summer on some of our vacations and to conferences and things, the people that I saw in, like, I went down to Virginia, and the people that I saw who were wearing masks still, it was African American families. So it's interesting, because, you know, they do have the lower Vax rates, but they're also doing more of the MPI's. And the masking that I saw, certainly, to sort of, you know, they're not necessarily trusting of the government, the vaccine, but they're protecting themselves a little bit better, you know, in a personal kind of level, but not with the technology of the vaccine.
Mm hmm. Well, I mean, my understanding from the from social sciences, you know, Um, let's let's braket out Latino's because it looks like with Latinos, there was a very specific issue with a lot of them are in professional service professions where it's inconvenient for them. And so that's why they delayed. It wasn't like a big ideological reason. I mean, some of them it is, but then you have black Americans who have the issue with the Tuskegee syphilis. I mean, that's, that's what everyone goes to. But that's, you know, that's the anchor, right? There's other things related to the distrust of healthcare. And then you have a group of white Americans, mostly Republican, conservative, more lower middle class, I would say, concentrated in South who have strong ideological, suppose that ideological opposition to, to, you know, mask mandates to vaccination to all sorts of things. And so there's a bunch of things going on there. Um, well,
they're actually more anti government. You know, when I really talk, I talk to those people as well. And their ideology is just a distrust of government. And you hear a lot that government's trying to control me with this vaccine. It's a lot of them are actually independents. Not necessarily they've, they were kind of Trumpy because they like the populism. But they're they're not really they're not what I would call necessarily the like, red Republican, they're more kind of independent slash distrust of government.
Yeah. Yeah. I mean, you know, there's a lot of Republican, right wing intellectuals who are pro mask, and, you know, it's scramble some ideological affinities. I mean, I do have to say, you know, you were talking about ranting versus communicating. I mean, I, you know, I will rant to you privitly about how I... - Yeah, yeah. No, I mean, like, I I'm obviously, like, pretty frustrated about this, you know? Yeah. I mean, like, the crazy things that people, it's basically like, I will, I'll tweet out, I'll tweet out, you know, this is the effectiveness against infection. And this is what it protects you against in terms of severity and depth, and then somebody will tweet back at me "FREEDOM". Yeah, no, I'm really confused. You know, and I, I'm with them politically a lot, you know, so I'm not, you know... and so I tried to be - but when I talked to them, I talked to them differently. Because ultimately, the goal is not to validate me, the goal is to get them vaccinated, so that everybody is safer, including them. And so that's the kind of thing that I have, like been, like, you know, my friends in academia, they just don't, they're just they don't hear it, because they don't know any conservatives, but but I've seen like, like, public health people with hundreds of 1000s of Twitter followers, on one day rant about conservatives, and like white supremacist conservative, like people in red areas in extremely angry way, which they had reasons, I'm not denying that. But then the next day, they're trying to explain why people should get vaccinated in those areas in a very calm way. And I'm just trying to say, you understand, people just saw what you did the previous day, like 24 hours early, you know,
yeah, the, you know, they do have to control their their message...
If they're public, if they're public facing - yeah. And so I mean, that's, I think that's caused a lot of issues. In terms of... in the other countries. It's not as bad. It's not like this. It's not ideologically polarized, right. I mean, there's like people on the right and the left and all these countries. Yeah.
Like Canada, or the UK. Yeah,
yeah. And so it's like, this is a discussion we're having in this country. And why are we and you know, there was a little bit of this that happened in the fall. Remember, Kamala Harris and other people that were like they didn't trust the vaccine? Because they don't trust the Trump administration?
Yeah, I mean, I think they were worried that he was going to try to pressure the FDA to push it through too fast, which is what's interesting now is that people are trying to pressure the FDA to approve it a little bit faster -Yes- So is this exact same pressure that I would rather actually no political group have pressure on the FDA that they need to be making their decisions sort of in a very cold scientific way? So, so I do find there, there's definitely a double standard there.
Yeah. And, you know, I mean, I'm not gonna say it's fine, but it is what it is. I still think, you know, like, what I tell people is like, yes, these people hate you. But they also don't want you to die. But that's like, that's like a different. That's a difficult message. No, that's a difficult message to sell to people. You know, they're suspicious, but they I mean, I'm being entirely Frank. They hate you, they do like, it's not a lie. You know,
I do you know, if you if you look at doctors, so most surgeons are Republican, right? And psychiatrists are actually - I'm, I'm pretty much a centrist. But psychiatrists tend to be much more left wing and the most left wing physicians, there are the infectious disease doctors, yes. And that's because they work in really underserved populations, helping with parasites and STDs and all this kind of stuff. So they tend to really want you know, like more government health care, because it's the only way that they can help their patients. And then, you know, see people who come up, you know, immigrants who come up, you know, with TV and all that kind of stuff. And then TB is endemic in places like Texas, and So that's why they're so left wing in public health in general, because you're kind of dealing with sort of forgotten populations that don't have a lot of money.
Yeah. And so now that but now that this is like throughout the whole population, you know, it's a different it, maybe it's a different dynamic, where it's like, yeah, they've been having to deal with, you know, issues related to small to narrower groups that they could, like, you know, and it's not just public health. So I read the - I'm a subscriber to the New York Times. So every time I read a poor, Manda Vilee's, she has been covering the COVID beat. Yeah, I remember her moronic tweet, that the true story of the lab leak is going to be white supremacy or something, you know, yeah, I'm just like, remember that? Yeah. Yeah. But I mean, it was like a big thing for for a couple of days where it was like, that was her like, that was her opinion. And I'm just like, that's fine that you have the opinion, but you've just like blown. Like your credibility, okay. Cuz I think that every single time I'm like, I know how stupid this person is. That's honestly what I think, you know. And that's what people were saying at the time. They're like, you should never have tweeted something like that out. Because you're not a political beat reporter. You're actually you're talking about public health, which is already very ideologically fraud. And I understand that, you know, they're like, Oh, well, only liberals read the New York Times anyways, but you know, it's actually a little bit more diverse. Yeah, I mean, the New York Times has, like, it has a lot of pull. So I mean, there's things like this where I mean, what is your goal? Is your goal to just be like a pundit? Or is your goal to actually make a difference in terms of public health and that's fine if you just want to be a pundant if you want to be I don't know like some like right wing shock jock that's like, against, like, okay, these right wing people that are against vaccination. Why are they doing this? A lot of them I don't know, if they're super sincere. They just know that they hate liberals, and liberals want them to get vaccinated. Okay, this is like the most stupid. I mean, I'm not even gonna like say what I...
Yeah its like oppositional defience disorder. Todlers...
Yeah, yeah. I mean, it's, yeah, yeah, it'd be like, it'd be like, I don't know if like some guys like, you know, I'm straight. But the liberals said that I should like, date a woman. So I dated a guy. Yeah, there.
I mean, there is there's actually a sort of a psychological principle that ties all these things together, like the popularity of the lab leak theory and the the government control thing. And that's that people, you know, I'm just, you know, what I was just look at this scientifically, I recognize it's us against the virus that physics and science are about how these things spread. And then there's also human behavior. overlaid on that. But people - it's like, they can't accept that it's not somebody doing this to them that it wasn't some nefarious plot by the Chinese to create us a super bio weapon that got loose, you know, that that's such a more satisfying psychologically for people than just, you know, a virus mutated and, and I'm not trying to debate the merits of the lab leak versus not the lab leak. But people prefer they like that conspiratorial theory, because it feels like that's human control. And yeah, this virus devastating us that doesn't care. Whether you ike Trump or Biden.
Yeah. Yeah. I mean, I feel like on the right, there is a tendency to, to, you know, want to believe that this is a liberal conspiracy. And we're gonna stick into the liberals. And I'm like, bro, and it's not about the liberals, this is a virus, it doesn't care about your ideology, your raised your age, blah, blah, blah. There's just, it's just like, we need to beat it. We need to put aside all of this crap. And like, I think for the first kind of month or two, we kind of did, but now we've just like, reverted back to the mean. And it's really disappointing. It's really disappointing.
A month was all we had, we're not an island. Six weeks, we got six weeks. And you know, what's funny, I do think of we' have know that the vaccines were going to come out so soon, I think there would have been that push for just a little bit longer. Yeah. But you know, what, we don't have that law and you can't use it. And you don't need lockdown. Right? You know, it makes sense in Australia right now and trying to suppress that, because they have almost zero spread, and there's really slow with their vaccines. But we can't - we can live with the virus with testing with masks and MPIs when cases are high, and with, you know, getting every human meatbag that is susceptible to the virus vaccinated as soon as possible.
Yeah, I mean, that's what they're doing in places like South Korea, you know, and so this is another interesting thing where I feel like, you know, just reading the media, like, I don't I don't know, I understand people are biased, but I feel like, you know, there's a little bit of America, you know, I read the New York Times, Washington Post Wall Street Journal, I'll just put that out there. I tend to see this honestly, mostly in the New York Times, which is weird, because you figure that's most cosmopolitan. But you know, when other countries do certain things that are against what we're doing. There's almost, there's almost a sense that I get that they're like, Well, you know, they're doing this, but just you watch. So when South Korea when South Korea had an outbreak because they didn't do full lockdown or whatever, you know, they're doing tests and trays, the total of the coverage was almost Well, you know, they didn't do a full lockdown. So this is what's going to happen to them. And you know, South Korea has been touching go especially with COVID - or with the Delta, but they've done it their own way. And it's not been horrible, you know, so
Yeah, they're all walking around with cell phones to tell them when they've been exposed, and then they can get I'm sure free tests. You know, it's - it's a very sensible way of dealing with a very pragmatic and practical way -And I don't know, you know, I was just listening to one of the podcasts about viruses and they were comparing the study of actually, someone exposure plus quarantine versus exposure plus serial antigen testing. And, you know, people It's been too long, it's been 21 months, people don't quarantine. Like, I'm not staying in my house for 14 or 10 days, or whatever it supposed to be. So they actually found that the there was less spread in the group that didn't quarantine but they had cereal testing. So, you know, we, we make assumptions about human behavior. And, you know, you got to kind of, you got to kind of, you know, public health has to be fluid and how they talk about these things.
Well, yeah, let's point out South Korea's got a population of 51,000,000. They've had 2200 deaths cumulatively. Okay. So, I mean, what are we? I mean, there were all sorts of ideas that were mooted initially. Like, for example, like to crush it, you do like local quarantine, we never did that did that in this country. We never executed test and trace . You know, whatever information? I mean, in terms of the vaccination rollout. You know, it hasn't been the worst, it's been okay. But I thought some of the arguments about who should get vaccinated. In hindsight, the British had it right, like, up there, like focused on health care workers, and age, and it was just really, so I'll tell you a story. I was on a business call with a British colleague. And I asked him, I was like, oh, have you gotten vaccinated? This was last winter. And he looked at me, he's like, Where are you trying to say, I'm old? And I'm like, Well, no, no, I just What do you mean? And he's like, he was like, Well, I mean, they're only vaccinating old people. And then I realized, we're here in the United States. I know a lot of young people who are just lying and getting vaccinated.
Yeah, you know, Brittan-,
I was one of the later healthcare workers that I knew they got vaccinated partly just because Massachusetts had such high uptake, it was impossible to get a to get an appointment. Um, and yeah, so we had a delay here compared all my friends in other states, who are my age got vaccinated way before I did. Interesting. Cuz, yeah, there's a high demand here. Yeah.
Yeah. I mean, so I mean, they're just like, there's a lot of like policy, sociology, execution issues that I would say right now. That's, that's, I mean, that's my takeaway, and the United States and a lot of other countries too. But, I mean, like Brazil, I think Bolsonaro - I think, frankly, he's probably they're gonna do analyses, econometric analyses that he was responsible for deaths, because of the social signaling of his behavior and what he did, right. I think they're gonna
You know I was looking at Brazil's curve. And it's just been horrendous the entire time. I feel like they're the only nation that hasn't had sinusoidal waves. It's just been there been a few little waves, but they've just had high transmission and people dying like crazy. For the entire pandemic. It's aweful
I think, I think Peru is a little bit like that. Peru is something like point 6% or something approved populations died. I don't know.
Yeah. Well, you know, the two sets is point .26%. Okay, yeah, that's the total population. Now we again, we ours is mostly loaded toward that first couple months and the nursing homes. So you know, it's a little bit not the same comparison as people who had their first waves like in the in the summer when we had testing and kind of knew what we're doing. But yeah, so anybody who says, oh, the unit, the IFR is .1%. I'm like, our total population. death rate is point .26. Yeah. It's not gonna be lower than that in most places, you know?
Yeah. Yeah. So, um, so like, you know, going to, to just like kind of a little bit evolution of virology. I haven't kept track of this. I mean, what do you think about these concerns? So initially, I was like, I remember reading in the fall or hearing in the fall of 2020. Oh, they're not like super worried about mutations. And I remember when the Canterbury and when the British I think they call it Alpha variant now. -. Yeah, they showed up. There was there were a fair number of evolutionary geneticist who were just like, they did not think that it was actually going to be turned out to be more infectious. Like it could be like some confound, blah, blah, blah. Well, it turns out, it's clearly more infectious, right? Um, but it's not more virulent. Right. And so we've had the Delta variant now, which is more infectious than the than the Kent variant. Again, it's not more virulent.
You know, I've seen some data that it may be more virulent.
Like, what, what what what's the percentage virulence increase? What What would you
Ah, well, so David Fishman, I think in Canada done a study comparing, I think it was Alpha and Delta in kids and kids were 2.5 times more likely to end up in the hospital with Delta. Now that's confounded because we protected our kids last year. Yeah. So, you know, that's hard to say. But there's higher viral loads and a higher viral load is going to make, you know, more of an infectious response and people sicker or just kind of, you know, biology.
Yeah. Um,
so I personally do tend to think that Delta is a little is more deadly than the original, more virulent. I, but I can say, I could be wrong about that. There's some cross signal about that.
Yeah. Okay. Fair enough. But
what we're talking about, you know, am I worried about more variants, which, what's very interesting is we had a bunch of them kind of develop, and they tend, several of them seem to have come from maybe an immunocompromised patient, that they banged around in the same patient for several months and learned, you know - had a little close in session of evolution to to make the most immune innovating version of the virus within one person and then spread out from there. So that's kind of just an interesting observation. Because they had too many mutations in the change to account to to be that gradual, where they just didn't track any of the central ones. So they think that's maybe how some of these evolved. But you start to run into, you know, the more transmissible sometimes it's luck and founder effect, things like that. But then more virulent in the... because how do you get more transmissible, right, more virus particles quicker virus particles sending up virus particles earlier? Or immune evasion, right? So the people who've already been immune can be spreading it, and there's more vulnerable human meatbags right. Yeah. So all these processes right now and the evolution would kind of I think combined and it's the nasty or strain that wins. That's the scary part is we have billions of humans walking around and and white tailed deer and all these animal reservoirs. Yeah, walking around as as little incubators to make the nastiest variant and the nastiest variants gonna win. Now, you know, I follow some people on Twitter who think you know, there's going to be Lambda and then they're starting to going to name them after we have Lambda, but you know, e]Epsilon and a million more and they're going to start naming them after constellations and you know, and 2025 Capricorn is going to come around or so they think that you know, we're just going to be nastier and nastier variants but I've talked about or talked to other people who you know say we're also coming against the limitations of physics like they don't really think that that a Coronavirus you know how they are now and then and the limitations of just the Coronavirus structure and how strong it is and the lipid membrane outside of it and how it can survive. That kind of delta is limitations of physics of how transmissible It can be as an aerosol, right? It's like it's transmissible as a as an Coronavirus, could be, you know, I don't know, the physics of that. But they've said you know, this is kind of it. And I haven't seen this is what I've not seen in the last few months is any variance outcompete Delta you can see Delta out competing Alpha and Lambda and P1 and all those other ones. Yeah, delta seems to be the supreme and you know, Delta plus, but Delta Plus didn't even beat out delta in India. Yeah. So, um, you know, so I, we may be coming up against wow, you know, delta is definitely going to plow through and take all the anybody's on vaccinate is going to get it. It's going to keep sign sign waving around the world. Yes. Until we vaccinate enough people or enough people get it. Yeah. And, you know, here's the problem, though, is that you know, Coronavirus is people tend to get multiple times throughout their lives. It's not smallpox or measles where you, if you get the infection, you get a sterilizing immunity. And so, you know, we need a sterilizing vaccine and you how I think this is going to end is a sterilizing vaccine, like an IGA nasal vaccine, that just snaps that bugger right away. Yeah, affect you. Or the other thing will be really good like, or really good, cheap, oral antivirals, like HIV. You know, there are a lot of parallels with the HIV epidemic I just watched, and the band played on I don't know if you saw that. And I remember you know, I remember I was in medical school before it was right when kind of anti virus came out and people were dying. Right and left. Yeah, if you had it was 100% that was it. Yeah, you know, it was a death sentence. And now you know, I have patients with HIV who you know, have totally undetectable viral loads. They have their their husbands or their wives are taking prep so they don't get I mean, yeah, it's it's such a different world. We're gonna win - if you're trying to make this you know, podcast, so people in the future kind of come back and listen, it it'll be like me watching in the band played on How we were in this desperate situation right now.
Yeah, yeah, no, I yeah, I think I agree with a lot of that. I mean, I think people were a little too sanguine about the mutation issue. On the other hand, it's not like there aren't viruses out there in the whole world, you know, I mean, if like, if like super virulent, lethal viruses would regularly occur, like flus around every year. I mean, there's nothing, there's nothing that doesn't make a flu, you know what I'm saying? I mean, there's ways that that can happen. That's kind of a random variable. But I'm not necessarily sure if we should, again, like prepare for the worst hope for the best. I think we need to be a little bit more more a little moderate about our expectations here. In light of, you know, the priors that we have, it's obviously kind of a mutable virus, but as you said, Delta seems to outcompete things. So, in terms of like an endemic future, zero, COVID, those sorts of things. What do you think? Do you think just were endemic, right, zero COVID- Zero COVID - Kind of over? Like, what do you think?
Yeah, I don't think that's possible now.
Well, actually, let me Why don't you tell tell the listener was zero COVID is because I just kind of threw that out there, you know.
So zero COVID is the idea of sort of shutting down everything for let's say, a month. And that would, especially with Delta, which is actually a little bit faster transmission. You shut down everything. You locked down everything you test and trace and you completely squashed the virus, right. And that, you know, we eventually took decades, but we eradicated smallpox, we've nearly eradicated polio. But SARS COVID 2 has a couple of things that are very different than those other and we could eradicate measles if we really put ourselves to it. Because every person who gets polio, every person who gets measles, every person who gets smallpox is symptomatic, they're are also human only diseases. So there are no animal reservoirs. You know, you can't eradicate malaria without addressing the mosquito issue. Right. We can go vaccinating mosquitoes just SARS COVID 2. They don't spread them, just you know. So. So SARS COVID 2 has many animal reservoirs, rodents, minks, white tailed deer, or cats, dogs less successfully. Now, there is things about viral evolution is that a SARS COVID 2 that's ideal for the human host is not going to be as virulent or spreadable to an animal, as much maybe like a primate like a gorilla. Sure. But, you know, if it starts to perfect itself, in the white tailed deer, it's going to be less. It's, it's going to be less successful in humans, we're just different enough. But zero COVID is not ... zero COVID is gonna exist in New Zealand and parts of Australia and parts of Canada for a little while, until everybody gets vaccinated, and then it's going to be, it's going to be bouncing around the world. It's endemic.
Yeah. And so I think, you know, I think we'll have a waiver to hear, you know, as we're recording, but um, I mean, you know, like in India, most people aren't vaccinated, but it looks like it's infected so many people that it's that that's why it crashed. And probably, you know, people develop some immunity, some reservoir, and their T cells have some recognition here. And so, I think, you know, we're going to move through this, but it's going to be around, there's going to be pockets of COVID, around indefinitely until we get on it. Well, I mean, I, you know, as you said, there's animal reservoirs. So just like bird flu, it's around. It's around. Yeah, no, yeah. It might not be an outbreak, we might not have to vaccinate intensely. But I think this is where we are. This was a prediction by a lot of people. You know, there's some countries like if the whole world was like China, I think it could have we could have had zero COVID It seems like the Chinese with their, shall we say efficient government systems of control are able to even crush Delta. I mean, they could be lying. But the it looks like they have been able to crush the Delta, mostly through what you were talking about, by the way, testing. They will they they will test whole cities. Yeah. like 9 million people all at once. Yeah, yeah. Which like, we could not like imagine doing anything like that. But um, and they're about 50% vaccinated now. And I know that their vaccines are less effective than our vaccines, especially one of them. But I think the way that people need to think about it is there's no silver bullet. So vaccinees vaccines are imperfect. But then if you do tested trays, you know, if you do lock downs or social distancing, if you do masking all of these things, they cumulative - cumulatively can add up where the R0 can go below zero and we haven't talked about are not I feel like in our culture a lot since last year. I don't know why I think it's because a vaccine was going to be a miracle that ended everything. But once the R0 goes below zero, then it's going to stop being a pandemic. Yeah, it's gonna be around at low frequencies. But as long as it's bouncing down at low frequencies, we can manage it. What do you think about that?
Yeah, I think that's pretty accurate. I mean, the real issue here is everyone talks about, you know, IFR, and all those kinds of things. And the real problem is, especially with child infections, and all those kinds of infections right now, and the level is, you know, if we have 50% of the population of the US unvaccinated, that's... and let's say, generously, 40% of us are either vaccine, you know, had COVID, maybe that overlaps with the vaccinated, so let's say additional 20%. So 70%, either had COVID, or were vaccinated, there's still a huge number of vulnerable people. And that's enough to overwhelm the hospital system, as we see right now in the south us 17,000 people in the hospital in Florida, right now. Yeah, yeah. And, and it's even going to be a problem with the children's hospitals, because they're fighting with Delta, in some of these areas, or depends on the socio economics of the area. But one and 100 kids are ending up in the hospital with Delta. Yeah, and they're just not that many pediatric ICU, there's just not prepared for all these kids to get sick. At the same time, you know, you have 20,000 kids get sick in the same state, you can overwhelmed a lot of the capacity for the for the hospitals there. So we still have to be thinking about the numerator now. But in the few in the endemic future, the numerator is going to be different, but it's still going to take a you know, there's going to be a butcher's bill for a long time.
Yeah, yeah. Um, you know, I want to say like, this hospitalization thing is very, very interesting to me. You know, we're having like, so much more hospitalization here. than in, in the UK. And I don't know what that is like. So for example, in England, delta peaked at like, 700. And, like, seven 785, adding Scotland, Northern Ireland, it's like, above 800. And it's been like, between seven like 730 and 800. Since then, but the previous peak was like, was like at 3600. Was it was almost 4000. So, um, you know, I don't know what's going on. I think part of it is like, the vaccination, we probably have some more comorbidities. I mean, you know, right now, as we're recording, there's a lot of talk about the deep south, and its massive wave. The Deep South is also the most obese part of the country. It is also the least insured part of the country. You know, there's just all sorts of things bundled up in there.
Yeah, lots of comorbidities. And, you know, the deep south, too, this is their air conditioning time. This is when they had the wave last year in Texas, and Florida was in July, August. Yeah. And whereas, you know, the Northeast where we have all our windows open. We, we can eat outside, and it's really nice. You know, our wave crash last summer.
I'm recording. I'm recording from Austin right now. And I can tell you, we're all inside. Yeah.
So when we come around to the fall again, and kids start going to school up here, you know, we may see, we may see ours going up again, though. I compare Massachusetts, more to the UK and yeah, are you even as we're having our delta wave right now in Massachusetts, our hospitals, our peak hospital was 4000. We have a population of about 7 million. So it's like 1/3 of Florida, about 1/3 of the UK. So our peak hospitalization was 4000. We barely squeaked by we had PT pediatricians rounding as hospitalist we had like three extra floors, and our big hospitals were filled with ice us with travel events. I mean, it was we had field hospitals that had hundreds and hundreds of people in them. So we barely squeaked by with 4000. And now we're at like, 375.
Okay, okay, yeah, delta is kind of coming through. Want me This is one this is one thing that I will say the United States is 330 million some people now. It's like a bunch of United Kingdom's it's like a bunch of countries. I think some of those countries will actually come through this okay now at this point, you know, you're let's talk about New England with its vaccination rates and social distancing, and all these other things, lower comorbidities, perhaps the place like Colorado where people tend to be thinner. And then, you know, think about like, the Ozarks, you know, rural antivax, a lot of co-morbidities, I think that's gonna be a flare up. And that's just how it is. That's just a structural fact of this country that were diverse, and sometimes that's good. And sometimes as well, you know, that presents opportunities for a pandemic and pathogen. So I think that's just the reality and you can't do an apples to oranges comparison between the United States and the some of these European, some of these European countries, right. So I guess like as, as we're closing this out, Emily, what do you think is going to change in the future? Like, what are you anticipating so for example, concretely, I'm probably gonna wear a mask on a plane indefinitely. I've always had a problem with getting sick on planes my whole life and I just kind of took it for granted. I'm gonna get the flu I'm gonna get the cold on the plane. That's just what happens when I travel. And now I'm saying you know what, I'm gonna wear a mask I'm gonna take some precautions here just because I think it's socially more acceptable to do stuff like that. Whereas before it's America you don't do stuff like that. So I mean, what are you thinking?
I think so I think on public transportation and on planes I you know, again I flew last week and normally on a plane I've got the hoodie I got the long pants I don't like my skin exposed or so I don't know I feel dirty coming off a plane so the more of my skin that's you know covered up the sort of the better I feel it was really I felt nice having had the mask I felt the you know my hoodie over my head I felt even more I don't know cleaner when I got off the plane. It's sounds a little bit weird, but I certainly did not mind I didn't get a cold or anything. When I was in LA or when I was on the plane like like you I've had many a cold coming off of travel. So I do think that just kind of like Southeast Asia and Asia after SARS, I think we're going to be looking at more of the population walking around in public transport... You know, I we didn't learn a lot. We need preparation for pandemics we need we need to be more prepared for the - Here's the other big opportunities that we have is better ventilation better heppa filters, more UVC cleaning maybe of the air when it as it goes through the through the filters, because I think I known a doctor for a long time who'd caught was pretty sensitive to flus and kept catching them. And he was convinced you know that flu was airborne and not just droplets spread, which you know, that was heresy. But now it's clear that probably all of them are kind of a mix, right? It was this? Yeah. It was actually this... It was a word difference that for us aerosol meant something in particular, but for you know, airborne mechanics scientists, it means a different thing. And that communication kind of broke down with just again, a stupid kind of word kind of difference that if it's droplet, oh, it can't You can't you breathe it in if it's nearby, but it can't go far. But clearly, you know, little droplets can ride the ride the winds go far. So I think if we could upgrade or ventilation or heppa in our buildings, more mask wearing and public , I think we could cut down a lot of things, you know, we didn't have when there was a serious lockdown. Places like Finland. And again, I'm not suggesting we do this every winter, by no means but it taught us something right places like Finland and parts of the US. There NICU was totally emptied out. It turns out that respiratory diseases a cause preterm labor. Yeah, maybe your last trimester of pregnancy wear a mask when you're going out. Yeah, I mean, all these little things, I think we could actually reduce a lot of morbidity, disease and a lot of cost. You know, compared to an ICU visit, upgrading a HEPA of system in a doctor's office is not that expensive?
No, no, I agree. I agree. I mean, I think I guess like as we're closing out, I just want to say like, you know, this, let's take it as a learning experience. This has been harrowing, stressful, depressing. I mean, some people a lot of people have died. A lot of people have known people who died.
I have to say that my biggest beef with the anti-vax side is not just the death and horrible things that happened to these poor families, but my healthcare worker friends are now intubating, you know, 39 year old mothers of three, who could have been vaccinated, but they didn't. And it's and they've been working so hard, you know, in the ICU and in the emergency rooms, and they're just, they're just done, they're more it's a moral injury to them to be watching these people die when it's totally preventable, or almost totally preventable. And that's that, that this is the personal pain part to me. Yeah.
Yeah. Now, I've been saying those stories. I don't even know what to say like, it's like, it's it numbs me right now, and I hope we come out of this learning about, I mean, you know, the science. You know, we're scientists, like science has been great. It's been interesting. Obviously, it's fascinating to us. But you know, I've learned some unfortunate things about sociology and politics of this country, and I hope we learn, learn more positively in the future. And, you know, we're going to compare ourselves to other countries like research. I mean, there's got to be like, a decade of economic sociology, political science studies of the COVID pandemic . I mean, yes, we're gonna study the science. You know, the biologists are gonna be studying the science epidemiologist, but there's gonna be a lot of studies have like the the social, cultural, economic responses and consequences. And I think that's one of the takeaways where I think, you know, I hope we can learn because i think i think what the mRNA technology and vaccine, I think we know, we can do better when it comes to the biotechnology. But, you know, what about the social technology? I don't know that it's kind of a mystery to me at this point. I'm hopeful, but I'm not gonna, you know, bank on it. Yeah, it's,
I don't even know necessarily what to say about that. Because it's didn't have to be this way. Yep. You know, I feel like have certain winds had gone different directions. And there have been different messages at different times. Or if, you know, it didn't become it didn't become so split. And this is I talk to people all the time on the right on the left, you and our values are actually shared. And it's us again, we didn't kind of settle down, it's a it's us against the virus not us against the government or us against, you know, this, this guy who wants me to wear a mask, or whatever it is. And we also have to just keep in mind, again, those psychological biases, we want to hear the skeptics, the flu bros who are telling us what we want to hear that it's not that serious, or we want to, we want to believe, again, that it's a human failing that's causing all this, which, to some extent it is, rather than this virus that does not care about us, it's just doing its thing.
Yep. Yeah, it's a force of nature. And so, um, you know, I think I got really mad props out to healthcare workers, like you, yourself, Emily, you know, who've been going through this the whole time, and hopefully, hopefully, I'm not going to be talking to you next year. Let's just put it that way, at least about this. Maybe we'll talk about psychiatric, psychiatric genetics or something like that. But next year, you know, come next year, you know, we will be in Jerusalem or something, you know, I mean, let's, let's be optimistic that um, you know, travel and life will go back to normal with some improvements and modifications, right.
Yeah. Yeah. Little mask and a little heppa filters people get in there. boosters, were there.
Yeah. All right. Thank you, Emily, and I will see you around.
Alright, thanks for the invite Razib I enjoy being on your podcast.
