 Hello, everyone. I am here with an expert. This is Dr. Katelyn Jadalina, who is an epidemiologist and a biostatistician, and she is here today to answer all of our burning questions about COVID-19, the Delta variant vaccinations, and more. Dr. Jadalina, thank you so much for coming on. Yeah, thanks for having me. So for anyone who's unfamiliar with Dr. Jadalina's work, I just want to share it with you because it's excellent. So she has a sub-stack. It's called Your Local Epidemiologist, and basically everything that I have questions about, she answers it. The blog does a really great job at explaining the complexities of science and how it's constantly changing. Like, science is not static. It's dynamic, and that's the beauty of it. So you're kind of giving up the up-to-date news, and so I really appreciate that. So the first question that I wanted to ask is about the new booster shots that we're hearing quite a bit about. I know that the White House just has announced that as of September 3rd, Americans will be able to receive a booster shot after eight months of getting vaccinated, pending FDA and CDC approval. What do you know about the booster shots? Yeah, it's been a really confusing ride. I'll say that in the past two months. So what do we know about the booster shots? Well, first of all, what do we know about the vaccines right now with Delta? One, vaccines continue to work really well against hospitalization and death. I think we're actually really lucky that it is. The real question what's really up for debate right now is how well do the vaccines work against mild and moderate disease? And we unfortunately in the United States don't have real-time data. We actually don't have a great surveillance system in the United States because of a chronically underfunded public health system that's decentralized. I mean, I could go on for hours about that, but so we don't have the data in the United States. So what we look at is the UK and Israel. And what they're showing us is that after time, about six months, our vaccines start to wane a little like the efficacy, the effectiveness of those vaccines aren't as good. For example, if you got vaccinated in January compared to if you got vaccinated in April or May or June or July. And that is really what drove the White House COVID task force yesterday to really push the need for a booster shot. And so it was very clear that this is a proactive approach, which I actually applaud them for. We've been playing a very reactive game in this pandemic in the United States. So I like the proactive approach. I think it's stirred up a lot of debate, though, among scientists. If we do even need a booster shot, you know, antibodies isn't the only protection we have in our human body. We also have an adaptive system like T cells and memory B cells that are a lot harder to measure. So we don't even know if those are working. We assume that they are. So why would he even need a booster shot? There's also the whole global equity. You know, why are we taking three booster shots if only 30% of the world has a vaccine? You know, if a variant pops up in Peru, it's going to affect us directly anyways. And so it's stirred up a lot of debate. But what it looks like is we'll be getting booster shots starting September 20th, but only if or especially if you have the mRNA series, so Pfizer or Moderna shot. We don't know yet what's happening with Johnson and Johnson. We're waiting on that data. I'm glad that you brought up the global vaccine efficacy because that's something that I've been talking about quite a bit on this program. And there's a lot of countries that haven't been able to vaccinate large portions of their population. So this does definitely raise some questions about whether or not those of us in, you know, the developed world should be doing this. Having said that though, you know, when the public health officials say get your booster shot, I'm going to be the first in line to make sure I do everything I can. Honestly, that's right. You know, I rather my vaccine go to someone else, but the reality is it's way beyond my control. And the reality also is we're throwing away millions of shots a day in the United States just because no one's getting even their first dose. And so, yeah, I mean, it eventually helps also stop transmission with this third booster. So it's necessary in the long run. Is it necessary now? That's up for debate, but it is a proactive approach. So I wanted to ask about the necessity of boosters and this might not necessarily be something that you can answer at this point in time. Are the boosters needed because just in general the mRNA, the efficacy of those vaccines decrease over time? Or do you think that the Delta variant is what is decreasing the efficacy? So we actually don't know that answer yet. We don't know if it's because of Delta or it's because of the waning immunity or more likely, which I think it's going to be a combination of the both. We are still trying to sort through the data. And again, we just can't sort through the data in the United States because we're not collecting it, which continues to baffle me. And so we don't know. What we do know is that the coronavirus is mutating every two weeks, really high transmission in the globe. We are worried that the next variant or the next two variants or three variants will eventually escape our vaccines altogether. And so what our goal right now is, which the booster shot will help is to decrease transmission as much as possible. Right. That is really important. From my understanding, every single time the virus spreads, that's another opportunity for it to mutate. And so if it's mutating at this rate of every two weeks, I know that you don't have a crystal ball. But how long do you think it would take for a new variant of concern to emerge that actually does bypass the vaccines? I know that the Lambda variant that emerges out of Peru is a variant of concern and there's not much information yet. But I mean, do you think it would be unreasonable to predict that in a year, a new variant could go straight through to the vaccines? It's a really good question and one that's actually really complex to answer. I'll kind of give you like a higher level. So we know the coronavirus isn't mutating as quickly as the flu. So that's why we need a new vaccine every year, just because the flu changes so quickly. On the other spectrum, coronavirus is mutating faster than, for example, the measles, which hasn't changed since the 60s. So coronavirus is somewhere in between. We think that our hypothesis is that we'll need a shot every couple of years. The reason we need lots of shots right now is because this thing is mutating so fast. Transmission is so high. Once we get transmission down and keep it down, the rate in which this thing changes will also decrease over time. It'll decelerate. So we don't know. Honestly, it could be tomorrow that this thing mutates. It could be never that it mutates to escape our vaccines. It's just not a game that we're wanting to play. You mentioned Lambda. There's actually really good news that came out this week that Lambda is actually fizzling out. So it may have been more dangerous, but it's not more transmissible than Delta. So it can't push Delta out of the way, which is fantastic news. The other thing we're paying attention to right now is Delta Plus, which is the Delta variant with another mutation on the spike protein. We're keeping a close eye on that. Very low rates in the United States right now. So the threat right now is Delta. That's good news about Lambda actually. I was trying to follow that as much as I could, but that's really encouraging to hear. Getting a little bit more doomer, however, is I've noticed that there is a correlation between increased COVID-19 cases among children and the prevalence of the Delta variant. Now, from what I understand, there's not necessarily proof that there is a causal relationship, but what do you know about the Delta variant's effect on kids? Because I know that there's a lot of anecdotal evidence that hospitals are filling up. PICUs are reaching full capacity in some places and it's really, really concerning. So what do you know about the Delta variant as it relates to children? Yeah, it is. The numbers are concerning. In the South, when it's really concerning right now, our PICUs are full. We don't know whether Delta is more severe than previous variants. We have a little bit of evidence from Scotland and Canada that Delta is more severe for adults. And so we're kind of making the assumption that it's maybe a little more severe for kids as well compared to past variants. The good news is though, honestly, we're very lucky because the rate of severe disease among kids compared to adults is so low. And this is really weird. Typically in viruses like H1N1, kids are the most vulnerable and elderly are the most vulnerable because of their weak immune systems. And that's just not the case with coronavirus. And I think we got really lucky. With that said, though, if hospitalization is around one to two percent with COVID, we have 50 million kids in the United States that are unvaccinated. One to two percent of 50 million is a lot of people. And so on an individual level, right, the risk is low. The problem is you start looking at a population level and then we start talking about needing to flatten the curve again. We are going to overwhelm our health care systems. We're already seeing that in the South. And that is what truly the concern is for epidemiologists or public health officials. The other thing that's really important, which I actually think gets kind of pushed to the side a lot, is the risk of severe disease is lower among kids. The problem is that it is clear that kids have a very important role in the transmission chain. They are able to spread the virus very efficiently and effectively and sometimes even better than adults. And so that's why it's even important when we start talking about schools, right? Yes, we're very concerned about the kids health, the teachers health, but also their role in keeping transmission down won't work because they keep spreading it too. And so that is a really important key into ending this thing, is ending transmission among kids as well. Yeah, and you talk about the proactive versus the reactive response when it comes to policy. And we're seeing some kids resume schooling and they're having to go into quarantine because there's hundreds of cases in some instance. What do you think is the good policy prescription as an expert in this field? I mean, should distance learning be resumed? I know that there's a lot of COVID fatigue and people are just kind of over it. But having said that, though, it's still really serious. And as you said, kids are transmitting it. So what do you think would be the best thing for parents to do as they make their decisions in the Pacific Northwest? School is resuming in a couple of weeks. What do you think is the best decision if you had like a magic wand and you can institute the correct policy like that? Yeah, so I've always been a big proponent that we need schools open. There's a lot of value of instruction learning. There's a lot of value, especially with when we start talking about equity. People, kids rely on schools for food, for safety, for, I mean, there's so many reasons beyond just school. And so I've always been a big proponent of that. But there's a big if though. And that's if and when we implement public health mitigation measures. We can open schools safely in the middle of the pandemic. We saw this study after study after study last year that a lot of schools opened up and with masks with this layered approach of testing of distancing of good ventilation and schools and classrooms. Transmission was really low and even low among a community with the background of community transmissions very high. So we have the tools to do it. And the problem is, and I think this is what you kind of hinted at is the ability, at least in the South to implement those without getting clients without going to jail. And so that that's the challenge right now is convincing people to follow the science to open school safely. And, you know, there's there's been certain states such as Florida where mask mandates at the school level have been banned by the governor. And this is something that doesn't really make any sense from a scientific standpoint and part of it is misinformation. But we're seeing increasingly more anti mask rhetoric disproportionately from conservative news outlets. This is one of the most popular box news Tucker Carlson, one of the most prominent news hosts in the world or in the country, I should say. Why, why are people suddenly against masks in your opinion? You know, I've seen countless videos about the way that they are very effective. It's a very simple thing that you can do to stop the spread of the disease. What is, do you think it's just fatigue? Like, how is this misinformation spreading again after I feel like we kind of put a cap on it? Yeah, I think it has to do with with multiple things. I think one, there was a huge mistake that CDC dropped the mask mandate in May. I mean, I can talk for hours about that. It was a really big mistake. And so you lose the social you lose the the the social pressure to wear masks, right? Even from vaccinated to there's always been never maskers. I mean, that's who I get all of my death threats from honestly is never maskers. Wow. And so there's always been that rhetoric. I think the other thing that has Delta's changed the game. And we are having we as in who have public health officials are having a really hard time telling that story that this isn't last fall. But this is actually a whole nother ball game we're playing with. And I think people look at last fall and schools were open, maybe half capacity, kids did fine. You know, the hospitals didn't over whatever surge, but this is a different landscape. And people have a hard time one following the science and then to understanding why it's a different landscape and things just won't work the same as it did last year. Yeah. Can you talk through the the threats that you receive from anti maskers? That's really interesting because you have a very popular Facebook page. And I think that what you're doing is so incredibly valuable. It's nice that you have a big following because what I've seen from my personal experience is that Facebook is one of the biggest sources of for the spread of misinformation. And I, you know, I don't use Facebook that frequently, but just logging on. After not being there for a while, I see like my past coworkers, some family members spreading anti mask anti vaccine misinformation. And to me, it really feels real when it reaches like the normie community and my personal life. What is the response on Facebook because that's where you see so much of this. So how has it been for you as an individual? I mean, you talked about the death threats. Do you feel comfortable kind of elaborating on that? Yeah. I mean, I think it's the reality of any public facing figure. And it is what it is. I mean, it's online and social media and you get you get death threats all the time. They come in waves. They come from different groups. Like I said, and Nevermaskers was last summer. Now it's the anti-vaxxers, especially when the kids stuff starts coming out with vaccines. And so it's it's the reality of the game. And honestly, I've gotten very jaded about it. I guess online it feels a little more distanced two months or three months ago. Now I was actually doxxed. So my work information was published on a pretty brutal site. And so people started calling my work phone and leaving harassing messages. And so to me, that wondered me closer is a lot more scary than what someone says online to me. And and so, you know, I it's and why is it happening? I think it's happening for a lot of reasons and a lot of really big reasons, right? Beyond the pandemic of politics of anti science aggression of people are very stressed and confused. And there's an overload of information and frustrated and whatever. And and so you just kind of get the brunt of that. But yeah, it's it's the reality. And I'm not the only public health official that's gone through this or is going through it. And many have received threats at their homes. I have a girlfriend in scientific communication. She had to move her house because they started showing up at her house. And so it's it's so there's some crazy people out there. And it's a weird time for scientists to be targeted. Yeah, it's just it's so sad to hear this because hearing your story. I've also seen interviews with a lot of nurses who are talking about compassion fatigue because they treat COVID-19 patients. And many people actually believe, depending on the area in more vaccine hesitant areas, like Little Rock Arkansas, for example, that like they're part of some conspiracy and that the nurses and doctors are lying. And it's real like it's really like it's got to be draining on public health officials on experts. And for you, like you go out of your way to try to make really complex information about this virus easily digestible. And, you know, it's it's so sad to hear that. But unfortunately, we're at the point of the pandemic where nothing really surprises me. But it still is. I'm not numb to it yet, even if I'm not necessarily surprised on another note. So I wanted to share a video with you. Give me one second here because while you're sharing it while you're sharing it, I wanted to highlight, you know, it's important to also recognize it's a very small minority of people. And, you know, I have 300,000 followers, whatever. But the majority of them are amazing and find it super useful and send me wine and, you know, whatever. And so that it's important to keep that perspective as well. That's true. That's true. Some folks who are the most vocal and the most like outrageous, they're always the loudest, but that is that is a good thing to keep in mind. So this is Dowd Winslow tweets this out. So this is anti mask, anti vax protesters protesting in a COVID testing clinic. So I have not watched this yet, but I just wanted to get your reaction after seeing some of this. So I mean, you pretty much you get the point. It's it's a COVID testing facility. There are people who are very anti vax as it relates to children and I understand the sensitivity for children and being concerned about their health. But with increased COVID cases, pediatric hospitals getting filled up. It's I don't know how you reach this people. So as an expert, what would you say? Like if you if you have a family member who's very conspiratorial anti vaccine anti mask, what do you think is the best approach in your experience? Yeah, it's a great question. I think first people need to recognize that we're not going to build boards in the ivory towers aren't going to change these people's minds. It's going to be family and friends. And so when you approach someone like that, one, you have to know the landscape, right? You have to know where they're coming from, which means you have to listen and it's really hard to do. You have to listen and you have to be a bidirectional relationship communication. Two, once you listen, you start understanding what their concerns are, then you can start combating that misinformation. You know, a lot of misinformation is budded from a kernel of truth. There's some small little piece of truth in there. So you need to find that and then start redirecting them of that's a better way of thinking of it. And then, you know, third, it's the way you talk to them to you can't use the word dumb or, you know, stupid or whatever, because then all you're doing is challenging their worldviews and people double down. And that's not an effective way to do it. And it's really, really hard to do. I'm not going to lie. I'm very guilty of the dumb work. Yeah, because, you know, to us, it's a no duh. But we have to recognize that and have to come with empathy that there are legitimate concerns out there. There's a ton of confusion out there. And yeah, you know, some people are just never going to change their minds. But I do do you still think there's a movable middle in there somewhere that we can start approaching this. And if you they don't if you don't know the answer, say you don't know the answer. Don't, you know, BS them, but then what you need to do is then drive them or show them the way to find that answer. Because if you don't fill that void, they will fill that void with misinformation. And then, and then you can do the best you can do and you move on honestly. But I think we all have a role to play in this and having those tough conversations and swallowing your pride and trying to be patient is is really the only way we're going to change minds. Yeah, that's really important. On that same note of combating misinformation and disinformation, you did a really great write up of a doctor. I believe his name was Dr. Stock, who is spreading both miss and disinformation. And one thing that I wanted to ask you about just as individuals who who don't have expertise in this field. So I've come into contact with people online who they're, you know, share anti vaccine misinformation. And, you know, looking at some of these websites, they look very professional if you read them, the language that they used. I mean, if I don't know any better, it seems medically competent. It's very technical. How do we look out for misinformation? Because somebody who isn't necessarily prone to conspiratorial thinking after seeing it myself. I think people can easily be misled because a lot of the misinformation, it isn't just like this foaming at the mouth screaming like a lot of it sounds really legitimate. So what do we look out for? It does sound legitimate and it's, it's weaved into very technical jargon that some people are like, oh, yeah, that sounds, that sounds right. And then even more dangerously, like with Dr. Stock, it's a physician, right? We're trained to be trusting these people. There's a lot of other misinformation coming from a physician from Pfizer. He used to work at Pfizer. And so you, you, you come at it like, oh, they sound, they, they sound good. They have the credentials. And so the, you know, the thing I tell everyone is stick to solid news sources. Don't go down a lot of YouTube channels. Don't go down opinion pieces and Washington Post. Stick to like five news sources, right? And yeah, they're going to be boring. It's going to be NPR, New York Times, whatever Washington Post. But, and they'll tell you when there's actually something serious going on that we need to worry about, like the myokite artists, right? Or like the blood clots after vaccines, those are very serious safety signals that they talked about. And so that's what I, I try and tell people it's very difficult to tell misinformation from true information. If you don't have the training. And that's why I think it's really important for us scientists. And that's why I put so much frickin time into these types of misinformation posts because there's nowhere else people can go. And, you know, that Dr. Stock video got watched what five million times in the first hour. I don't even know what the stats are, but it's, it, it sounds correct. And it is confusing. Yeah, you know, I try to teach media literacy to a small extent on my YouTube channel because, you know, YouTube has been a huge problem in the spread of misinformation. But as someone who's on the platform, what I try to teach people is listen, question the resources that people present to you. Question me, understand where we're getting our information from what our motivations may be. And one thing that really is difficult to overcome is this veil of legitimacy, like with Dr. Stock, people who are doctors who don't necessarily have expertise as it relates to epidemiology or COVID-19. But they know enough to do a lot of people. So it's, it's a really tricky thing to try to teach people what to look out for. And when it comes to, you know, medical jargon, it's tough because I don't know. So I get all of my information from resources such as yourself, people who I know are doing very, very hard work to try to get us the accurate information. But the problem with public health messaging, and I see this from a policy side as well, is this is all so complex and you can't distill something that complex into a really easily digestible message from the governmental level. But also, the issue is that things change so rapidly with science. So that is in and of itself somewhat worrying for people who don't know any better. And, you know, they see a message and then they question, well, you just said this. So it's so hard to keep up. So I really appreciate folks like you who put in so much time and effort to like prepare graphs and explain things to people and explain that the change is part of the process. You know, it's this is what we expect as scientists, and we try to equip ourselves with the capability of adapting, speaking of adapting. I wanted to move on to the future of COVID-19 impossible to predict at the moment. But a lot of epidemiologists that I've heard say that they believe COVID-19 will ultimately be endemic. It'll kind of be like this annual phenomenon. And on top of that, one epidemiologist, I'm blinking on his name. He says that he thinks after this latest Delta surge, that's when he thinks it's going to reach the endemic status. Talk through what that's going to look like for normal people who might not necessarily know what that means. Yeah. So I think there's a general consensus among epidemiologists that if when and if we get out of the fall and winter, we should be pretty good to go in this spring. And that's what that said, without a variant that's, you know, escaping our vaccines. But what does that look like? It'll probably look very seasonal, like the flu, right? It popping up at different time, you know, in the winter. What it'll also look like is we're going to have pockets of outbreaks. So, for example, we're going to have an outbreak at a nursing facility or a school. These outbreaks aren't going to be statewide, like they are right now. They're not going to be nationwide, but they will be pockets. And that's what it's going to look like. And we are going to be living with this thing. Hopefully we don't need a booster shot every year, maybe every couple of years, maybe just this third one and we're done. But it will be part of our lives. We've only eradicated one of their disease in our lifetime or in the human race and that's smallpox. And so this is going to be with us. We just need to figure out how to live with it and not have 650,000 people die in one year. And, you know, with that, we are creating treatments, too. So, you know, like we have Tama Flu for the flu. They're working on a lot of treatments for like COVID viral treatments. And so this will get better. It's just we're in the weeds. We're in the thick of it right now. And it's hard to imagine life just with living with coronavirus. Yeah, yeah. And that's the thing. It's, you know, it seemed like for a while in spring, once vaccinations became available, when I got vaccinated, it kind of felt like the light was right there at the end of the tunnel. And then Delta variant, you know, came along and then it's like, OK, how long are we going to be living with this? And I think the way that you described that makes sense. It's just a matter of like how intrusive it is in our lives. And that's what I think, you know, the trying to visualize what it's going to look like when it becomes endemic is something that, you know, I try to keep in mind that, you know, it's going to be here. You know, we were not going to eradicate it in my lifetime, in your lifetime, possibly. But it's not going to be a thing that's constantly on our minds. It's not going to be as big of a threat. I keep that, you know, at the back of my mind, because, you know, it's really frustrating. I felt like I've been one of those people who tried to flatten the curve. I didn't go anywhere. It helps that, you know, I'm relatively agoraphobic as it is. But, you know, it'd be nice to not have this like fear in the back of your mind, not necessarily for myself because I'm vaccinated, but for my nieces and nephews who, you know, are under the age of 12. And I think, wow, this is something that I want to get rid of so they can have a normal future. So one last thing I wanted to ask you. Now, this is a seemingly really straightforward question, but I've heard so many different explanations. And so for viewers, when they hear, you know, this vaccine is 95% effective or efficacy is decreased to 85%. What exactly does that mean? Like, does this mean that if I encounter someone with COVID-19, I have an 85% statistical likelihood of not getting it? What does that actually mean in practice? Because we hear this all the time and I think that mainstream media isn't doing a great job at informing people about what these numbers are. Yeah, efficacy is not that. It's not like how effective is the vaccine if you come in contact with someone and you're right. Everyone's getting this wrong. What efficacy is is risk reduction. And so if there's 100 people that got COVID, right, if the vaccine is 90% efficacious, 90 of those people could have been prevented. And so it's a risk reduction. And what we currently, we constantly figure out trying to find is that the vaccines continue to reduce our risk of COVID compared to the unvaccinated. When the vaccinated or if the risk of COVID among vaccinated equals the same as the risk among the unvaccinated, that just means the vaccines aren't working anymore and it's not efficacious at all. So we just need to make sure that really the efficacy is about over 50%. Once it starts getting under 50%, like we've started seeing in Israel, we start getting nervous and that's what's really informed the booster. Right. I don't know if that helps at all. Probably not. No, it's complicated, but it's nice to just have you here to set the record straight because I've heard a lot. And people, I think that we were a society where we read headlines and we don't necessarily look at the articles. So the headline is going to be usually sensationalist to grab the most eyeballs. And that's not great at informing people if we don't actually dig a little bit deeper. So just to have you clarify, that is very helpful. So I appreciate that. So before we go, can you please tell everyone what you do where we can find you and how we can support your great work? Yeah, of course. So I write a blog called Your Local Epidemiologist. I do it. I have a day job as an epidemiologist. I have little kids, so I actually do it at night. And I also have a face. So the blog is on Substack and you can subscribe to it for free. Science should always be free, but you can also donate. And then I also have a Facebook page where I literally just copy and paste my Substack to the Facebook page because there's so much information on Facebook. And I'm also on Instagram, sometimes on Twitter. So yeah, you can really just Google me. You'll find me. Well, Doctor, thank you so much. It's been an absolute pleasure. This has been really illuminating. Hopefully we can touch bases in a couple of months because by then things might look completely different, hopefully for the better. But yeah, it was really great talking to you. Thank you so much, Doctor. Yeah, thanks for having me. This was fun.