 The radical, fundamental principles of freedom, rational self-interest, and individual lives. This is the Iran Book Show. All right, everybody. Welcome to Iran Book Show on this Saturday evening. Hope everybody's doing well and having a great weekend. I'm excited. We've got Amish back with us today. He's been with us since really, I don't know if this is fourth, fifth, sixth show since February of last year. He's my go-to guy when it comes to issues related to COVID. He's been a lot of help both personally and just on how to think about this, but also personally in terms of just medical advice for people that I care a lot about and that's all being spot on. And he's been right from the beginning. That's the other amazing thing. So some of the numbers you projected in February, some of the sad numbers you projected in February have actually turned out to be all true. All right, we're going to get to Amish in a minute. Just quickly remind everybody, just a few things. Tomorrow we will have a show at 2 p.m. No, sorry, 1 p.m. East Coast time. 1 p.m. East Coast time will be tomorrow. We are going to, I've got a small session with whoever signs up. It'll be, I think, 14 people, something like that on socialism and that'll be on December 18th. You can get information about that on the website if you want to sign up for that. And it should be a lot of fun. The last one we did on capitalism was a lot of fun. You can use the Super Chat today to ask questions of Amish. We're going to stick to the topic at least for the first hour while he's here with us. Let's just make sure that the questions are all related to COVID, policy around COVID, new variant things going on in the world related to COVID. But let's stick to that. All the infectious diseases more broadly. So the things that Amish is an expert on. And then we'll see. I might stay on after Amish has to run, and then you can ask general questions about anything. We'll see how the show goes. So first, Amish, thanks for coming on. I'm not going to go through your whole bio. You've been here enough that I think everybody knows who you are. So thanks for being on. Sure. Thanks for having me. Sure. So almost two years in. I mean, really two years in since the first cases in Wuhan. We now know probably a little bit more than two years starting sometime in November or certainly in December. They were reporting first two cases. Any kind of, you know, it's a big question, but kind of assessment of where we are. You said it last time you wanted to show you said it was going to be endemic. Is that still your sense? And how does that play out? How do you think that plays out from here? I've always thought that this is going to be an endemic virus because it's not something that can be eliminated. It's not something that can be eradicated because it has an animal host. It transmits efficiently through the respiratory route. It's not something that even meets the criteria. So what we know is that this will eventually become something that we deal with every every year. This is not going to be. There's always going to be some time when there's always going to be a baseline number of COVID cases, hospitalizations and even deaths. It's going to be one of our seasonal respiratory viruses. And the goal was to remove its ability to kill, remove its ability to crush hospitals by immunity in the population, primarily through vaccination, getting tools like antivirals, rapid tests, all of that to kind of defang it and make it much more manageable. And we're getting there, but it's very variable depending upon where you live. So certain parts of the United States, they probably have reached that because they've got such high levels of vaccination. With other parts, for example, West Virginia, 41% of the population is fully vaccinated. They're not near that level yet. And the same is true around the world. So many European countries have very high vaccination rates. Canada certainly does as well. But there are other parts of Asia, Africa, where it's very, very low. So they're going to continue to have issues with COVID until they get that immunity level higher. But that's the trajectory. It's just not something that happens all of a sudden. It's gradual. And it also has to do with how people think about it, their ability to risk calculate and understand that there is no zero COVID, that everything is going to have some level of COVID risk. But you've learned a lot about it. You've got vaccinations, you've got antivirals. So this is a manageable risk. That's sort of how something goes from the pandemic phase to an endemic phase. And it's going to be rocky for people to get used to that because they haven't had to risk calculate because the way the government set this up was a false alternative. Either you want no COVID risk is acceptable or COVID doesn't exist. And the truth is actually in the middle. And I think that's what's happened. And when we say it's going to be endemic and it's going to be with us forever. Does the science suggests that it gets weaker? I mean, does it put aside our immunity, but does it start getting weaker? Does it become a common cold? Because we know that some coronaviruses, I guess four common colds are coronaviruses. Is that the long-term trajectory of a virus like this to get weaker over time? It's sort of the general principle in virology that you often see respiratory viruses that spread efficiently start to mutate or start to be selected by evolution to become more efficient at transmitting and not causing as severe disease. Because if you're a virus, you want to infect more people if it actually has once. That's basically what's happening. So if you're making people really sick and they're not able to go out, they're stuck at home in their bed where they're in a hospital, that's not very good from the virus's perspective because they're not going to be able to infect people at the hospital or taking care of them with masks and gowns and gloves. The virus needs people to be out there going to the grocery store or going to school or going to work. So the milder it gets, the easier it is for it to transmit. And that's what many of our respiratory viruses do. So that's the hypothesis that this will eventually happen. And we think maybe one of those four common cold-causing coronaviruses was responsible for a pandemic in the late 19th century, around in the late 1800s. And now we deal with it all the time. But it just takes some time for that to happen. And clearly it's not at that phase if it's still killing a thousand people a day in the United States. And there are hospitals, like the one I worked at just now, where 30% of the population in the hospital are COVID patients, all on vaccinated. So we're not quite there yet, but that's probably where this is going. And we can talk about Omicron and maybe the hypotheses about it being one of the first signs of that. So before we get to Omicron, let's talk about the issues around vaccines. So there's a lot of stories out there about vaccines because people are confused, right? So on the one hand, you've got countries like Israel where you had very high vaccination rates, very early vaccination rates. And then you saw this massive spike in cases. I was in Israel when that happened. They immediately went to boosters. They were the first country, I think they went to boosters and boosted everything. But then now we're seeing massive spikes in Germany, which is not as well vaccinated as Israel, but still it's in the 60%, 70%, maybe what people talked about way back as the range for natural immunity. And of course, UK, we saw the same thing in the UK. So I think people are confused about this because they thought that once 60%, 70% of the population was vaccinated, this would go away. And then the other aspect of that is that a lot of the people, and maybe you can clarify how many, because it is confusing, a lot of the people who are getting COVID are vaccinated. That is, there seem to be at least, I don't know, superficially, there seem to be more people with breakout cases than one would have expected based on the kind of Pfizer and Moderna numbers initially. I don't know if that's true or not, but that's just kind of the impression. I think it's part of why people, I think, are confused about the vaccinations. So can you clarify kind of all of that? So there's a whole bunch of points to try to explain. So first of all, let's think about, so we saw these Moderna, Pfizer, J&J had these high efficacy numbers from the clinical trials. And it's important to remember that when those clinical trials were done, especially Moderna and Pfizer, many parts of the world were under lockdown. There was little chance to get exposed. People were all wearing masks. So that's going to bias your result in favor of the vaccine. So before we go on. So tell us how these tests actually done. So they take a population of people, and they let them live their lives in half GAD and half NOT, and some will get the, so it really does depend on the conditions under when the test is done. Exactly. Because at the time, if your daily life is nothing is open, you can't go do anything, you're obviously going to have less exposure to COVID than if you do it, if you do a trial right now. So first of all, there's that level, there's that issue is that those efficacies in the trials were not real world conditions and because the real world changed. Number one is that at the time of Moderna and Pfizer vaccines, we were dealing with the ancestral strain, the Wuhan strain of the virus. Soon after that, the Alpha strain emerged, then the Delta strain. Those Alpha and Delta, even though the vaccines did a really good job, there was a decrease in the amount of protection. And at the same time, people were getting pandemic fatigue saying, I'm sick of this. Many of the mask mandates went away. Things started opening back up, people started to learn to risk calculate. So their activities also gave them a higher chance of coming into contact with COVID-19. And when they got in contact with it, they weren't getting contacted by the ancestral strain that the vaccines were designed against, but the Alpha and the Delta and Beta and Gamma as well. So there's going to be a diminution as well because it's not quite as matched. And then the other point is, yes, there is some waning, but these first generation vaccines, their primary goal wasn't to block every infection. They're not force fields. They're not bug zappers. They're meant to make any breakthrough infection mild. That's what their goal is. So the fact is, yes, breakthrough infections are happening, but the fact that they're mild and most people don't have to call their doctor when they get them is a sign none of the vaccine failing are not working as well as it once did, but it's actually a success. There may be second generation vaccines that are better and maybe more like the measles vaccine. Maybe there'll be nasal spray vaccines because these vaccines don't give you a lot of antibodies and you're a special type of antibody that gets produced in your nose, which is how you get infected. These ones are not the best at doing that. So that's the issue. So breakthrough infections were always expected. I think people just misunderstood what a vaccine was doing. And I think they got spoiled by seeing those numbers from the clinical trials. But yes, breakthrough infections occur. And I think the other point is that because they're not severe, that's something that we have to kind of cheer about, but that's being used against the vaccines. And those breakthrough infections are less contagious than someone who doesn't have a vaccine because you're contagious for a shorter period of time when you get a breakthrough. So I have no problem with the vaccines. I think they're the solution to COVID and Omicron. I don't think that there's any issue that we can actually blame on the vaccines. I think it's very, very almost unjust to the vaccines. I think it comes from a misunderstanding and the anti-vaccine movement, kind of taking data and presenting it in a certain way to confuse people who don't really have all the expertise or the knowledge of what this vaccine was meant to do or how those clinical trials are going on or the context of different variants and people's activities having an impact. So there was a story out there that for a while that the first shot of the vaccine hurt your immunity somehow and you were more susceptible to COVID after the first shot. And until you got the second shot in two weeks after, you were actually, there was increased susceptibility to COVID. Is there anything to that? Have you seen anything in the numbers suggesting any of that? No, I've seen actually the opposite. About a week after your first dose, you started to see cases drop. So if you look at the original Pfizer-Moderna trials, after their first dose, a week later, cases, that's where there's lots of separation between the placebo and the vaccine group. So that's the exact opposite. One dose is definitely better than zero doses. And then you mentioned that, so the breakthrough cases are milder. Is that, is there now solid, I mean, are the numbers solid in terms of the number of breakthrough cases that go to hospital, the number of breakthrough cases that ultimately die? Some people are going to hospital still and some people are dying, but are the numbers significantly lower than unvaccinated? Yes, it's like around 14 times less likely to die if you're vaccinated, 11 times less likely to be hospitalized if you're fully vaccinated. And I think when you look at breakthrough infections that are severe, that's where there actually is a role for boosters in people who are above the age of 65, people who have high risk conditions, people who may have gotten the J&J because it seems to top off that immunity. That's where boosters make sense. And that's why they were authorized initially for those groups, because that's where we saw erosion of protection against severe disease, which is what the vaccines were meant to do. So you would suggest boosters for people with either over certain age or people with existing conditions or comorbidities? Yeah, I do. I think so where it comes down to for me is above the age of 65, any medical condition that puts you at higher risk, including being overweight or obese. And then also people who got the J&J vaccine because that probably should be a two-dose vaccine. The J&J vaccine didn't actually drop, it just stays around that 70% efficacy. And if you get an mRNA boost, it goes up higher. So I think those people can benefit from that. Let me see. So we've got a bunch of questions already. Let me pull out at least the ones about vaccines. So Brian asks, there's some personal advice here. So Brian asks, it looks like the risk from COVID for someone like me under 30 and healthy is very low. I understand that the vaccines lower that risk even further. But at what point is the risk so small that it's not worth lowering? Well, it depends on what you mean by risk. I mean, yes, you're at very low risk for being hospitalized. But if you get infected, you could go infect somebody else. That's something that why would you want to be in that situation if you can prevent it with the vaccine? And you're going to have to take 10 days off from work. You're going to have to tell your contacts that you're positive and they need to quarantine and get tested. Why disrupt everything when you can take a safe and effective vaccine and minimize that whole disruption that COVID-19 poses to you? It's not just about severe disease. It's about why have that illness when you can prevent it. And we take vaccines for lots of things that are even almost like nuisance to many people. They give children vaccines for chickenpox, which was a nuisance disease. So I still think that those are valuable even if you're not at high risk. But particularly, it's important about transmission. I think that's the most important thing. Why put yourself in a situation where you could accidentally infect somebody and it doesn't take it down to zero, but it lowers it significantly. So do we have a number and how much, if I'm vaccinated in particular situation or not vaccinated in particular situation, how much, how less likely is it for me to get the virus if I'm vaccinated? Do we have any kind of numbers? So that number has changed over time, but in the immediate months after getting a vaccine, it's probably 60-70% at least with the Delta variant out there right now and then it will drop off. But if you're investigating an outbreak, you're not going to be looking at the vaccinated people first as the spreader. It's likely to be an unvaccinated person. Even though, because people take anecdotal stories and that's what they blow them out of proportion. And people can't think statistically and probabilistically. So they look at anecdotes. Say even though you might find they might be a vaccinated super spreader, it's super unusual and super rare. Yes, it is. And there were some evidence. There was this thing that happened in Provincetown in Rhode Island where there was this huge festival and people got infected there. But that wasn't normal behavior of vaccinated people. It was bear week there. It was a big party, lots of alcohol. It was bad weather. Everybody was indoors and lots of singing and yelling. That's not normal. And they did have cases there. But all those cases were mild. But in the average life of a vaccinated person, yes, you might have some risk of transmitting to somebody else, especially if you're symptomatic. That's why if you get sick when you're even if you're fully vaccinated, you should get tested and make sure you don't expose anybody. But you're contagious for a shorter period of time and it's not likely that you're going to be the one that spreads it. It's hard to figure out the magnitude because it all depends on activities and what you're doing and what the situation is. But in general, it's not vaccinated people driving transmission. Yes, they can get infected. Yes, they're increasingly more breakthroughs and there's going to be more breakthroughs with Omicron. But they're not the issue in terms of the overall spread. The proportion is much smaller than the unvaccinated groups. So John asks, Amish, would you recommend a healthy pregnant woman get a booster dose if they're ready fully vaccinated? Yes, I would. I think pregnant women are at high risk for severe disease. I consider that a high risk condition. Pregnant women are more likely to be hospitalized, more likely to get in the ICU, more likely to get a C-section, preterm labor, stillbirth, all of that. So pregnant women should be boosted. And what is the research looking at the effect of the vaccines on the fetuses? It's good actually because you get trans placental transmission of the antibody. So you can protect your newborn by getting vaccinated when you're pregnant. There was no untoward effects to the fetus, no higher rates of miscarriages. It's actually good for the fetus if its mother gets vaccinated. And what are the latest numbers on this, on the what was it, the heart inflammation? And there was something in the American Heart Association yesterday, I think. It turned out there was an abstract that said that there increased the heart disease for five years after that they are now questioning that there's a whole, the whole, I was just reading it today, there's a whole thing at the American Heart Association about this. But in terms of the heart inflammation for young people taking the vaccine. So put it this way, are there downsides to the vaccines? Is there any risk analysis to taking a vaccine in terms of downsides to taking them? Every medicine you take has a risk-benefit ratio. No, nothing is 100% safe, not Tylenol, not ibuprofen and not any vaccine. So when you look at the risk of myocarditis, I think it's important to remember a few things. Number one, myocarditis is more common with COVID-19 than it is with the vaccines. I just today, I rounded at the hospital, I have an 18 year old kid not vaccinated myocarditis from COVID, which is an interesting thing to see. But he's not vaccinated, it's more common in that situation. The risk for myocarditis is not in everyone. The risk is very limited into certain populations. So it's late teens to like 20s, males, because it might be testosterone driven. And that's where it occurs. The myocarditis that occurs is very different than other myocarditis. It's transient, it's mild, no one dies from it. They obviously get hospitalized because people get scared when their hearts are inflamed, but it's very manageable. It doesn't occur with all the vaccines. It seems to be more common with the mRNAs, specifically Moderna. Moderna is a higher dose vaccine. And it's not after the first dose. It tends to be more after the second dose. And there's evidence that if you space those doses more than three to four weeks, if you space them eight to 12 weeks, they'll actually work better. And you mitigate that myocarditis risk. So I think this is something very manageable. And I tell people, if you're really worried about it and you're above 18, you can get the Johnson and Johnson vaccine and not worry about it. But if you're a small child, if you're worrying about your child, and they're not a teenager, they're maybe less than pre-periodal, I don't think there's a major risk there. And if you're really worried, just space the vaccines eight to 12 weeks of the mRNAs, which are available for children. So I don't think that this is as big of a deal as possible as people have made it out to be. But yes, there is a myocarditis risk there. But I think it's something that can be managed and it's mitigatable. And I think it's still outweighed by the benefit of the vaccine, not because this child is going to get severe disease, but because it's disruptive, they have to go home from school. All of this kind of cascading impact. So I think this is something that is definitely not as big a deal as some people have made it out to be. But it is something that's real. You have to counsel patients about it. And I think it's important for parents to have questions about it, to ask those questions. And I think if you've got somebody that's knowledgeable, there's ways to work through this so that you can make an informed decision about the vaccine. So again, anecdotes, people are posting all over the place anecdotes of people they know who got vaccinated and then died. What is the research show about these cases? I mean, how many of them have shown causal links? Are there any scientific studies looking at deaths caused by the vaccines? It's very, very, very rare. There's just, I think, almost a handful related to the Johnson and Johnson blood clotting issue, the AstraZeneca blood clotting issue that we saw and a few rare immune side effects that have occurred. So it's not that big. And I think it's because people misinterpret the vaccine adverse events reporting system that the CDC has set up. They misinterpret it because, sorry, they misinterpret it because it's something that's meant to be a catch-all where anybody can put something in. You could put something in. I could put something in. And it's meant to just be this big data repository where trained scientists look through that and sift through it and say, do I see a signal? Is there a signal here? Is this something we need to investigate? So, but people are looking at that raw data without any training and then reporting from it. And I think that's how this idea that there's deaths or all of this stuff gets, and I get asked this question a lot, that all of these deaths and all these horrible things are in there, but anybody can report everything. And just because something happens after a vaccination doesn't mean it was caused by the vaccine. If you're vaccinating a bunch of nursing home patients, some of them are going to die the next day. So that's not because of the vaccine. And there's lightning strikes in there. If you read in the VAERS database, they'll say, someone got the vaccine, they got struck by a lightning, got by lightning. There's some people who say that magnets now stick to them. That's in the VAERS database. There's a lot of things in there that you have to interpret it very, very carefully. It's not meant. That chip from metal that Bill Gates is injecting into all of us through the vaccines. So Ryan asks, what is the risk of a vaccinated individual getting a severe case of long COVID? Some of the outcomes you hear about a long-term and life altering such as chronic fatigue? So this is still an open question. It's definitely much less if you are fully vaccinated that and the problem is that we don't have good definitions of long COVID. We don't quite know what it is. And I think we have to get a lot better at defining it because lots of things get put into long COVID. So someone could have a chronic cough like six weeks later and that gets called long COVID, but most viruses will give you a chronic. There's a certain percentage of people with any viral infection that have a chronic cough. So we've got to separate what's actually disabling or interferes with your activities of daily living versus what's a nuisance type of thing. So some people's taste and smell may be a little bit off for a while. I don't consider that long COVID unless maybe you're a chef or you work in a perfume factory or something like that. It's not the same type of thing. But there are people that have difficulties concentrating. There's like accountants that can't add anymore that those are real issues. And I don't know what the I think the percentage is going to be much smaller when you actually drill into what actually disables someone. But it seems to be much less with people that are fully vaccinated. We don't know. Like I said, it's a little bit of a mystery. It seems to be more common in women, more common in older people and more common with people with other medical problems. But it's still we're only only on the infancy, maybe this than the infancy of understanding what this is or how it occurs. And it may be something that happens with lots of infectious diseases. Just a lot of attention to it right now because there's a lot of people that got sick. So I would say that the best way to prevent yourself from getting long COVID is to be vaccinated. The chance you get it is very is lower. There's some people will say 50% lower. I think it's probably lower than that. But the data is around 50 at least from some of the studies around 50%. But again, those are poor definitions of what long COVID actually is. Do we know that long COVID is real versus kind of a psychosomatic kind of thing? I do think it's real. But I think the percentage that you're seeing, you might see a paper will say 30%. I think that's much too high. It's probably less than 5%. I have one patient that I've been dealing with that clearly has had a major functional decline. And some of it can be exacerbated by the fact that you get COVID and you can't do it. There's lockdown. All of these issues probably play a role and they all coincide. There may be higher levels of psychiatric illness in those people, meaning that they had preexisting depression. They may have had preexisting anxiety disorder. And it might be that there is, I think with many illnesses, there is some psychosomatic component to it. But I think that still makes it, it's still real because the patient's still not able to get back to their baseline. And they're still looking for help. And I think we will get to the bottom of this eventually, lots of big centers are setting up long haul COVID clinics to try and understand what's going on here. But it's going to take some time. And it's frustrating for the patients and it's frustrating for the doctors because everything comes back normal, except for their function. So we've got a lot of questions and all our good questions. So this is good. But I'm trying to clear all the vaccine questions all at once. And then we'll get to some of your other questions. So thank you guys. Some of you are putting a lot of dollars on these questions and that's great. Quint asks, do you recommend vaccination at 5 to 11 year olds? In general, I do recommend it because I think it's a safe and effective vaccine. Why get the illness if you can avoid it? I don't think it's absolutely mandatory. But I think it's something that avoids your child getting something that's disruptive. It keeps them in school because right now the threshold to shut a school down or go to virtual is still very low. So I think that if this wasn't a safe and effective vaccine, there's a different calculation. But I'm very confident in the data in children. So I do recommend that parents get their children vaccinated. I don't think that it's as it's not the most important vaccine in a child. I think I would rather have them all get flu vaccines. But I think this is an easy vaccine for them to get. And it's not a major, I think it's like, it's like me recommending everybody get an iPhone. I think everybody should have an iPhone. Why not have an iPhone? That's what I think of the vaccines. I think of them as iPhones. I want the newest one as soon as it's out that day. So what do you think of schools that are still, I know universities where they're acquiring vaccines and then they all sit in class with masks on? There has to be off-ramps. If you have a fully vaccinated student body, like Yale had a fully vaccinated student body, it makes no sense to continue this to act as if those people are not vaccinated because we're always going to have some COVID risks. There's always going to be cases. But if you've got a fully vaccinated, if you've had a fully vaccinated student body, the worst that's going to happen is you get some cases. It's much easier to handle. I understand in the pre-vaccine era that they were very worried about outbreaks and disruption. But now, what's the point of getting vaccinated if nothing changes? So I think that they should have off-ramps. I wrote a piece in the New York Daily News a couple of weeks ago in our bed about this that people can look up where I talked about off-ramps. And I think that we have to start moving towards off-ramps in organizations like universities and as a country, as a state, as a city, as a county. All of that has to be in the discussion as we move to this endemic phase that we've got to get people to learn to risk calculate and get this idea that the post-pandemic world is going to be 2019. It's not. The post-pandemic world is a world with COVID. And you were never supportive of schools closing for the whole school year in 2020 and 2021? I think this could have been managed very easy. Maybe we might have needed it for a minute just to figure out what's going on. But it needed to come back right away. And it's interesting because in Europe, schools were the last thing to close and the first thing to open. But here it was the exact opposite. So I didn't think schools should have closed to begin with. And then what was going on was really a travesty, damaging children really badly because at-home learning was not working. And I think there was a lot of politics that played a role here because the teachers' unions got involved and it became very, very politicized in a way that made it impossible to open the schools because they have such a political force. And in the end, this is an area where, for example, President Biden campaigned on this, getting schools open. And most of them are open now. He's sort of delivered on that. But early on, it was taking some time for them to get open. And the CDC director was saying, you know, we don't have to vaccinate teachers. We know how to do this. We've seen this work. And then President Biden's, his press secretary said, oh, she was just speaking on her personal behalf, not on the Biden administration. Because the teachers' unions were so involved in this. So I think, yes, this was one of the hugest mistakes with the pandemic was the school closures. Daniel asks, any risks from taking the vaccine for nosing mothers? No, it's good to take it for nursing mothers because then the antibodies get passed to the newborn through breast milk. So those are people that absolutely should be getting vaccinated to protect the newborn. Adam is asking, he's 75. He's on, I guess, a trial for prostate cancer. He's had three Moderna shots. He's asking how long before he should get a fourth? I think we don't really know that answer yet. Probably at least six months. There may be, since I'm assuming because you've got prostate cancer, you're going to be getting immunosuppressants. There may be better solutions for immunocompromised people. We may give them long-acting monoclonal antibodies. AstraZeneca has a long-acting monoclonal antibody that's about to get an emergency use authorization. That will probably be used in immunosuppressed populations and maybe give them extra immunity for a year on top of the vaccine. That's likely what will happen in your case. Okay, let me see. All right, let's talk about Omicron. The new variant. I'm always bad at names. What's your estimate? I know there's still limited data coming out, but what's your estimate from what we've heard out of South Africa and what scientists around the world are figuring out about this? There's a couple of things. First of all, the Omicron variant was something that got discovered in South Africa around early November. It got people's attention because it has a lot of mutations in the spike protein. The spike protein is what the virus uses to attach to cells. It's what our antibodies attack. People were really worried about it because some of the mutations they saw were seen in other variants like the beta and gamma variant, which you don't hear that much about, but would have the ability to get around immunity. It also had certain mutations that made it likely to be able to transmit more rapidly. Then they saw this uptick in cases in South Africa. They were having a lull and then cases started going up in that one province, which I probably can't pronounce. It went up in that province. This is all happening at the same time. They're worried about a more dangerous variant. Right now, I think there's still a lot more questions that need to be answered, but a couple of things, a couple of points. This is something that didn't descend from Delta. It's a new whole branch of the virus family tree. It's something that probably descends from a virus that hadn't been seen since mid-2020. It might have evolved in an immunocompromised host and just developed all these mutations. Some people hypothesized that it might have jumped into an animal and then came back into humans because we are seeing deer and mink and all kinds of cats and dogs get infected. We don't know that yet, but what's also important is the fact that it occurred in South Africa, likely in the Southern African countries, makes sense because that's a low vaccination area. 25% of the population is fully vaccinated in South Africa, and that is the most vaccinated African country. What we know so far is that we're seeing cases there. The anecdotal reports in some of the early case series seem to be that this is mild, that it's not something that is really sickening people to the point that we're seeing hospitals worried. I just tweeted a bunch of things from South Africa saying that many of the people that are getting picked up are incidental hospital screenings. This is all good news. It seems that the vaccines, even if this variant can get around some of the immunity that vaccines provide, the vaccines are still doing what they're meant to do, prevent serious illness, hospitalization, and death, that the hospitalized people tend to be unvaccinated. The cases that we've seen all around the world, which is not surprising, these were already spreading into Netherlands before South Africa even discovered them. No one has died. I think in the United States, only one person went to an ER. That's all really good. There is a hypothesis that this might be something that is evolving towards what a common cold causing COVID would be like, that it's able to get around immunity just like other coronaviruses can, but it's losing its ability to cause severe disease. That would be something we would all take. It would be great. Obviously, there's a lot of panic that's occurred because that's just what politicians and political people do, even though all of us, everyone in my field was saying no travel bans, no travel bans. We were you not unanimous, but it still happened. It happened for countries that didn't and only pick seven, eight countries for the US, some of which, and there were countries that had community spread like the Netherlands, which were not included. It's just a lot of badness that happened in South Africa. We want all these answers about this variant in South Africa saying we can't get reagents to do these experiments because you've travel banned us, so how are we going to do these experiments? If you want people to be transparent and talk about the variants, talk about what they've discovered, you can't punish them like this. It's really backwards. Now we've got community spread in New York and all kinds of places all around the world, but the travel bans are still in place. It really makes no sense. President Biden said he feels bad, but that's not enough. He campaigned on the fact that he wouldn't do this. He called it, he rightly criticized the Trump administration for doing this, but now when he's in power, he did the exact same thing, which to me is disappointing, but I guess that's what happens when you deal with politicians. And it's not just travel bans. I mean, all these countries are increasing. I mean, Israel shut down completely. A lot of these countries are increasing testing. They're increasing requirements. They're increasing isolation. When you land this, UK was easy to go into, and now it's become almost impossible. And of course, yeah, I mean, you'd think they'd learn, but they seem to panic and knew every single time. Yeah, it's as if the last two years didn't happen. It's not like we're January of 2020. We know so much about this virus. We've got tests. We've got vaccines that are protecting against serious illness. We've got monoclonal antibodies, at least one of which is going to work against this. We have antivirals like Remdesivir. In the UK, the mercury antiviral is actually approved. So this is baffling to me that they basically turned the clock all the way back and went back into panic mode and then panicked the entire world because of the way they acted. So it's just very frustrating to see these mistakes keep getting made over and over again. Yeah, I mean, I'm constantly shocked by how aggressive Israel is in just shutting everything down. There was a really good at rolling out vaccines, but on everything else, they'd be terrible. This comes back to not understanding the goals. Some people continue to chase cases. We're always going to have a baseline number of cases. You have to think about severe disease. That's our goal. So cases are going to come and go. You can't make actions. You can't make your public health actions based on cases, especially in the post vaccine era. And I think these politicians continue to get very nervous about cases. And yes, cases are disruptive, but they're not of the same caliber as they were two years ago. So you told me about politicians. You told me you had to run in with the Prime Minister of New Zealand. And so this is a funny story. And I will probably, this will now the New Zealand people will continue to attack me after this, but I had to do their morning show, their version of Good Morning America. And if you remember, New Zealand was the zero COVID policy. They'd been shut down, very aggressive. They at that time had just shut down Auckland for one case. And I said, this is a non-sustainable approach. You're not teaching your population how to risk calculate. This is not going to work. This is the wrong approach. And I basically said something like that on their Good Morning America. And then I just got started getting a lot of attacks on Twitter, on everywhere. And then the next day, the Prime Minister went on that same show and rebutted me. But then she also had her people call my employer and chew them out for this and then continue to have an onslaught of people just spamming all of my social media, not just Twitter, but LinkedIn and everything. Then they asked me to do a debate with their chief epidemiologist on their version of NPR, which I did. And I would not back down. I said, I continue to because will you admit that we did the right thing? I said, no, I will not admit because I disagree with that policy. You can't tell people they can't, you can't treat indoor activities the same as outdoor activities. You can't do all of this. And it just became a major, major, major divisive thing where I actually had to tell the FBI that I was getting death threats and the threats from New Zealand that I didn't because I had opposed their lockdown policy. So those people who think that I'm in favour of lockdown, that is the furthest thing from it. And eventually, just a couple of maybe about two months ago, she basically said, yes, this was the wrong policy that we need to move on. We're not in the same situation. But it's just interesting how much, you know, how that COVID-zero, how people want to stick to it. And they had, you know, New Zealand did have a very low number of deaths, but at what cost? They had low, less COVID deaths than they actually had flu. So I said, what are you going to do? What have you taught? What's going to happen now? Because you had more flu deaths than you had COVID deaths. How are you going to have a sustainable approach if this is your approach to any infectious disease? It was just a crazy episode. And it looks like maybe New Zealand has changed its approach, but things in Australia are nuts. I mean, they're still putting people, you know, dragging people out of their homes, putting them into isolation. And everybody's vast parts of Australia are still locked down. Yeah, I have no understanding of where this is coming from. And it's mind boggling to me. And the kind of surveillance state tactics they're using, just calling your phone and telling you to turn your camera on, using drones, all of that doesn't really bode well for the level of freedom in Australia. This is, you know, one of the worst approaches probably, you know, on the way of like in Wuhan, they were nailing people in their houses. This is very similar to that. So let's move to therapeutics and then we'll go to some of these questions. So let's start with the kind of the existing drugs that people would be trying and playing around with. Ivermectin is an example. There's been talk over the last year of doing a big study in Ivermectin. There was an Oxford who was going to do something and then other places I think in the U.S. What if it happened with those trials? Because all you get are the second, third, fourth rate studies that came out primarily out of the Third World that have very, you know, some of them are really dubious and some of them are just so-so. But where's the state of the art kind of study to show us one way, one way or the other? So the only, there is a trial, I think it's called the principal trial that Oxford is doing. I think that's still ongoing. I haven't seen any interim results. That's the one that everybody's waiting for to be able to kind of stop these trials and say we have enough information. All of trials, as you said, are very mixed. Many of them had fraud. People had to withdraw them. Someone had made up things inside them, which is very strange. And there was one negative trial that showed that it wasn't a benefit that was published in JAMA, which is one of our premier medical journals. So very few of these get published in high-level journals. I think in my mind, Ivermectin, there's no evidence that it's going to work. It may work to treat worm infections, but we've always said that if you immunosuppress someone, and that's what steroids are, dexamethasone is an immunosuppressant, that if you have untreated infection with certain worms, that can come out and it can be disastrous. So that may be an interesting variable that may play a role in why you might have seen some benefit, but not probably for COVID, but for actually treating an undiagnosed worm infection. But I think this is another issue that I think has completely gotten politicized, where I get the most threats of anything when I talk about Ivermectin, more so than even hydroxychloroquine, which is strange to me. And it's interesting, the Ivermectin people haven't gone on to fluvoxamine, where there actually is some good data that was published in two major journals, JAMA and the Lancet. They haven't glommed on to that. So I think this is very puzzling to me, people's attachment to Ivermectin. It would be awesome if it worked. None of us didn't want it to work, but it doesn't. And we've got better things out there. And the thing is, we have doctors that will not just prescribe Ivermectin, but they'll say, don't take the vaccine. You've got Ivermectin in your medicine closet. That's dangerous to do, to substitute the vaccine for Ivermectin, or don't get a monoclonal antibody, because I'm just going to give you this Ivermectin. And then taking the veterinary horse paste, that to me is mind-boggling. And the fact that now veterinarians are worried that they're running out of Ivermectin, because so many people are buying veterinary Ivermectin. But there's people drinking hydrogen peroxide. I just read something about people eating dirt now, because they think that that will help them with COVID. So there's a lot of things. I think it's the voice of the dark ages, again, and it's scary. And you mentioned the one drug that seems to have positive responses, an anti-depressant, I think it's a mild anti-depressant. Are doctors prescribing that? Is that something that's being used out there? Not that much, but I think that there's interest in it. I think that we've got two good trials. The trials show some decreased ER visits. They're not hard endpoints. We like to see decreased mortality. That's what we're looking for, or decreased ICU use. So people are wanting a bigger trial just to be able to say this for short. But there clearly is a signal there. And I wouldn't fault any doctor that prescribed fluoxamine in a responsible manner, not as a substitute for the vaccine, not as a substitute for monoclonal antibodies, but something that's a relatively safe drug. Half the population is on an SSRI anyway. This is another SSRI. But it's an interesting thing. I want to see a little bit more data, but I'm not negative on it at all. So Gail is asking, is there science to show the nasal spray Alkalol could be preventive as an extra measure? Nasal spray. What's the word? What's it? Can you spell it? Alkalol, A-L-K-L-K-A-L-O-L. A-L-K-A-L-O-L. I don't know any evidence of that. I think there are nasal spray vaccines that are in trials. I haven't seen anything specific on that, but I may not be, I may not, that's not, nothing I'm aware of. Okay. And what is going on with the other vaccines that we talked about? There were a number of other companies working in vaccines. So they still... Yeah, they're percolating. They're anticipating. Yeah, so Novavax will likely have a successful candidate. Novavax has filed for approval in Canada, and I believe Australia, maybe Indonesia as well. This is another innovative vaccine that uses recombinant technology. It uses insect cells to produce the spike protein. This is one that was part of Operation Warp Speed. I suspect it will be around. I hope it actually gets approved in the U.S. because some people who don't want to use Moderna J&J and Pfizer, maybe they'll get this one because we still have about 60 million Americans that are eligible to be vaccinated that are not. So this will likely happen. There are other second-generation vaccines, nasal spray vaccines like we talked about earlier, maybe universal coronavirus vaccines that will take out those other four coronaviruses that caused the common cold. That would be awesome too. So I think there'll be a lot of innovation with coronavirus vaccines. We're just at the dawn of these first-generation vaccines. That's cool. So the FDA, I guess the panel, I don't know if the FDA has actually given emergency authorization just to prove the MOOC drug. Pfizer I think is up next and it looks pretty favorable to Pfizer. The MOOC studies look fairly mixed. What do you think of that and then what's your assessment of the Pfizer drug? So the Mark drug, it's a little bit of a disappointment that it only prevents hospitalization by 30% and the absolute risk is not very big between people who got this and didn't get it about 3 percentage points. So that's why if you look at the FDA advisory committee vote it was mixed because some people said is this really worth it especially because we have monoclonal antibodies and especially because Pfizer has a drug in the wings. So I think this has a role. It's not going to be a knockout punch but I think it's a good sign that we're getting oral antivirals because that's part of the taming of this virus, making it much more manageable. There may be some issues and there's going to be issues with pregnant women because the way this antiviral works is it makes the virus mutate a lot. So people are worried that it may make other things mutate. So it's not going to be approved for pregnant women. It's probably going to be something that has a limited role. I probably would favor the monoclonal antibodies over it based on the data and I think the Pfizer drug looks like it's got much higher efficacy. It uses a different type of mechanism and the Merck drug was sort of repurposed. They were using it for respiratory viruses. The Pfizer drug is specifically designed for SARS-CoV-2 so it's not surprising that it has very high efficacy and for those people who think that my 100 shares of Merck bias me, I'm telling you this is not a knockout drug and the 100 shares don't make it that much of a difference to me to say that I'm somehow owned by Merck. That's a strange thing. I have done work on gram-negative bacteria for Merck but I don't have any horse in this race when it comes to the antivirals and I'm probably predisposed towards the Pfizer drug and the monoclonal antibodies being superior to Merck but I think it will have a role and I think it will be good to have just another tool in the toolkit and it's already approved in the UK so I think this will come in the US pretty soon. And do you think the Pfizer drug is a knockout punch? If the data hold 90% protection against hospitalization and death with an oral drug you have a five-day window to get it. I think that would be really a major blow to the virus and its ability to crush hospitals if you can get people oral drugs because monoclonal antibodies they work but they need to be infused or injected. There's a lot of paperwork I had to fill about so many times. It's such bureaucracy at the hospitals to fill this out that it's not easy to do and then you've got to get an appointment and because it's injected or infused you've got to make sure they have room to do it there. I know we talked about a patient that needed this earlier on how difficult it can be to do that and that's made them very hard to use and they were underutilized so if you could just call someone and they tell you you're positive you send them a prescription it shows up at the door that's a much better prospect. The thing that we have to make sure that people can be tested we need to be testing a lot more for these drugs to be used optimally both Merck and the Pfizer drug because you need to you get the sniffles you should get tested and then get the drug quickly because you've got this window of opportunity for it to work but these are big exciting. The Pfizer drug is very exciting. I think the Merck drug has a role but a little bit of a smaller role than what people hope for. In any sense when the Pfizer drug is approved I know the CO's Pfizer complaining about holdups at the FDA. I think sometime in December they're going to have to have an advisory committee meeting and all of that stuff. There is just a lot of bureaucracy and steps and what's happening in this pandemic is every step is going very deliberate because there's so many people saying this is being rushed and they're not going to take it or they don't like it so everything is very transparent and slow for the most part. So I think probably my for the Pfizer drug I suspect maybe by the by the new year in the best case scenario the Merck drug probably in the next couple of it's imminent. The FDA acting director is probably going to issue an approval any any day now. All right we've got let's go through some of these questions they're kind of bigger bigger questions. Same as being authority in the field in your field of expertise what are your thoughts about how your scientific assessment should be considered in relation to other scientists such as economics. I guess I don't understand the question. I don't know if you do. Well I'm just I'm a doctor that specializes in this that's been working on this since I was a medical student and I think you should think you should judge for what I say if it's actually true if it holds up if it integrates with everything else you say everything else I say or everything that you know about just judge me like you would judge anybody else giving you expert advice. I think it's not I don't claim to be omniscient I don't claim to not make mistakes. I try my best to analyze it and give you my analysis of it and hopefully that that's correct and it holds up but I don't I don't think I'm a sage or anything like this on this or or claim to me. Maybe he's asking is is is the field is your field do you sense more accurate in terms of in terms of the science and economics right the the then something like economics which is there's a pretty pretty bleak history of predicting anything. I think well so I think modeling is different because most of our infectious disease modeling work comes from economics that they've actually borrowed it so so but when it comes to the science in facts of this is what's happening COVID attaches to the SARS-CoV-2 virus attaches to this receptor this is how this drug works that's very accurate the harder the harder sciences are the the more you're closer to the life sciences I think the more accurate you are I think actually I ran had a quote about biology not being as corruptible but so in that sense yes but I think when we get to the modeling that's always going to have a lot of uncertainty because there is assumptions built into that and those assumptions might not necessarily be true and people's behavior changes you make a you make an epidemic curve that's based on people acting the same way but then people's behavior changes because now they get scared and they don't get scared that's why we we sometimes use what are called agent-based models to to stimulate what people do but yes those models are not always going to be accurate they have to be interpreted with a context and sometimes policymakers look at our look at a model and then make a decision without actually understanding that there's certain assumptions in those I think that's probably would happen in economics that the whole perfect competition model got taken out of context that happens a lot in infectious disease because a policymaker sees this graph they see their whole country turning red and then they freak out not knowing that there's all these assumptions built in that so I've always you know you have to look at models with with a critical eye and try to figure out what the assumptions are there were models of Ebola causing four million deaths during 2014 I remember I used to say that's completely crazy that's just not going to happen that's just a thought experiment and you have to look at that you have to look at the models that way they can help you they're decision-making tools but they're not reality they're an attempt to model reality and they can be wrong if you don't get it all right Charles Bud asks what role do you think the internet plays in our response to COVID would our first response to influenza I guess in 1918 have been similar if we had internet back then it's interesting um so I think the internet is a force for good and for bad because we learned so much about this this virus people were remember that first heroic doctor that ophthalmologist in china who ended up dying he put it on a little bulletin board that this is what's going on so the internet does get lots of information out that's how people that's how scientists communicate that's how I do zoom calls with people in I gave lectures in Wuhan during that and get information so the internet is a really great tool for spreading information quickly in a way that we couldn't do before waiting for a journal article to get published and getting it into mail that's not going to be good when you're responding to a pandemic but then I think there's you know the the voices of the dark ages again can use the tools of the 21st century to spread their misinformation so I think that's been a really hard thing to deal with because there is a lot of misinformation out there and it spreads very quickly and people can look things up without you know a lot of guidance and they may believe something that's not true so there there is pluses and nine inches on the whole though I think the internet has made it much much better in terms of response because we learn about things much much faster in 1918 that it was interesting because you talk about information there was actually censorship in almost every country because of world war one including in the US and that's how poor Spain got blamed for this whole thing because they were neutral in the world war one so their press was free whereas you couldn't write anything in the united states that would undermine the war effort during the wilson administration he put this law in effect that you couldn't that talking about 1918 flu which likely probably started in the united states in in Kansas that you couldn't actually write about it because it would undermine the war effort so it was illegal to talk about it so um there was information problems even back there were information problems the other way in 1918 um so michael asks emissary you said during your talk at okon there is a high likelihood of a real pandemic with a 60 mortality rate could you elaborate on why you think that and what would that look like would lockdowns be justified in that lifeboat scenario so I talked about the fact that COVID-19 is something with a mortality rate of 0.5 0.6 something that's not a severe pandemic on that scale 1918 is probably one to two percent mortality rate so this is not a severe pandemic in the sense of it's intrinsic what made it so bad was policymakers they're human factors but I do worry about certain bird flu viruses that have 60 percent 30 percent 40 percent mortality rates they may get lower if they actually if they adapt to humans just based on that that hypothesis about how things um evolve but I think it would be if we handle it any way that we handled COVID-19 it would be disastrous I couldn't even predict what politicians would do if something like that happened I think it would be apocalyptic and cataclysmic I think what we the only thing that we could do is hope that because so many people know the importance of pandemic preparedness and thinking about this now after their lives got destroyed by COVID-19 either how many deaths occurred plus all the disruption to the world that they're actually trying to get this right with flu we do do a lot more preparation we do a lot more surveillance and understanding of those viruses so that we're likely to have a vaccine quicker we've got antivirals we've got some tools but I think if there was something like that spreading it would be um I don't know I just imagine it would be almost like the black death in terms of how people would respond based on what they're doing now with omicron or what they did with the beginning of COVID-19 so it's it's unfathomable about well to me but I think what we would have to do and that's sort of what you're working for now is to try to fortify ourselves so that that doesn't happen when one of those viruses inevitably jumps into humans so that we don't get this response but I just have no confidence in the political our policymakers to be able to act rationally in the face of something like that and in terms of your profession are you seeing people as worried as you are and as you know as motivated to try to get once COVID let's say subsides to try to get better policy in place we're all doing that right now I have I'm scheduled to testify in front of congress next week so this is all happening that they're listening finally because they now think this will get them keep them in office probably but um yes I think everybody knows that there's a window of opportunity to fix some of this the public health community and the infectious disease community is a little bit split some people where the whole pandemic split all of us just the way it split the country but so that's going to be interesting to see how that plays out but all of us recognize that there's major improvements that could happen um in terms of policy in terms of public health laws to get it all in a better on a better footing hopefully that happens there's a lot of talk in congress we'll see what actually happens in the end but at least they're interested in their listening in a way that they haven't for a long long time well you said that going into COVID there was a plan much better than what was actually done it was just never executed right we had the the CDC had done all kinds of plans on how to do all of this and all and when they talk about lockdowns and school closures it was all voluntary stuff it was never forced but that basically went out the window immediately um yes i think it's not as if this was something that came out of nowhere we have been worrying about coronaviruses for some time i actually wrote a whole report on characteristics of pandemic pathogens in 2016 if you want to google that where i talk about coronaviruses as a high high consequence type of thing to happen and what what what it will look like but many of our recommendations never actually got put into place what happens is congress has a very short attention span it's boom and bust panic and neglect so after the anthrax attack yes there's a lot of interest in getting all of this stuff fixed but then nothing else happened for a little bit and then the same thing happened with the bird flu scare and then the same thing with with zika and ebola and h1n1 it just goes up and down up and down if it's out of the headlines the politicians stop caring about it and then nothing ever happens that's why after h1n1 they didn't replete the n95s and the strategic national stockpile even though we were telling them for year after year you have to do this it's like a simple thing just put them in there it's just just just buy some more and put them there and they just didn't do it it's just inexcusable and it's just it again it's a nature of dealing with politicians that this is they have they're very short-ranged and if it's not in the headlines they don't think of it as a priority yeah let's see michael asks if you've got some more time there are a few more questions here yeah amish do you think social justice and affirmative action policies have diminished quality of doctors and medical staff over the decade should people be worried about getting surgeries because their doctors might be social justice appointees no i don't i wouldn't worry about that i still think it's a rigorous training program and we don't have if you can get through residency training board certification that's still pretty objective and i think you know if you're looking you know you you're on you just did a big show on the AMA yeah and i think the whole field is very into that so it's it's not even even the most competent doctors most of them are in in that camp so no i wouldn't worry about it i think it's not as i think medicine has a self-correcting mechanism pretty quickly and the malpractice lawyers are part of that self correcting mechanism so i don't think it's anything i would worry about at this at this point i don't think it's devolved to that that stage yet is your sense of medical schools that they're keeping up the high standards or is there some erosion going on and maybe we shouldn't be worried today but we should be worried in 20 years well they have moved away from being heavily reliant on the MCAT which is the entrance examination they've moved a lot of classes to pass fail instead of giving people a grade that's i think something that's difficult to that could eventually have some issue overall but the subject matter hasn't changed it doesn't get easier you still have to memorize all of that stuff and you still have to understand and you still have to take care of patients and that's staring you right in the face if you if you either get that right or you don't get that right so i think there's a little bit it's a little bit harder for that to erode completely maybe someday it will but i think it's there's i think there's a lot of forces that kind of push objectivity in medicine that are hard to that are kind of almost inherent in it yeah because it's a life or death kind of a profession okay bogdan asks so politicians are overreacting or in panic mode because of omnicon but why are scientists worried about it since besides being more contagious not much is known about it well scientists are worried about it because it has a whole bunch of mutations that give our vaccines problems that give our monoclonal antibodies problems that give give not you know quote-unquote natural immunity problems and it seems to be more transmissible and you have a world that is mostly not vaccinated so anything that allows this virus to spread more rapidly is going to be a problem maybe not in you know in a country where we have a lot of people vaccinated but most of the world is not vaccinated so yes this this could be disastrous for many places if it's going to displace delta and transmit more efficiently than delta and get around pre-existing immunity the way it's doing in in south africa it's clearly infecting people that had been infected with the delta variant or the beta variant before so that's why people are worried about it and it increased it wasn't just an oddity that they found they found at the same time cases were going up percent positivity was going up on their tests so that's why they were worried about it but i think scientists when they express uncertainty or interest in something like this it gets interpreted as panic and i don't think the scientists are panicked about it they say we've got questions to answer and this is a small problem right now delta is still killing everybody all around the world delta is a bigger problem than omicron is but we have to track this down and run it down but then the politicians took that and turned it into let's stop travel let's do this let's do that which is a totally different approach and i i have a piece in the hill about that i wrote not that i wrote about how we didn't know enough to actually panic but that's what policymakers do yeah jeff ask a friend is hesitating vaccination over components of the vaccines that can cross the blood brain barrier and cause strokes or is found in stroke patients any truth to this none that none that i've seen no and and i would want to know exactly what they were they read that because there's so much misinformation out there i've not seen any evidence of that with any of the vaccines there's just so much out there that's not true so ian writes after 911 we got the tsa patriot act etc after covid it doesn't seem like there's even a political push to reform the fda cdc do you think there's any chance of real reform happening at that level it's going to be difficult i think that people have been i think that the fda has worked at the best that it can with in its constraints in terms of emergency use authorizations being pretty forthcoming with them i think there is an effort to just kind of overall the cdc and make it much more independent at least lots of us are advocating for that but it's very hard to do because even in the biden administration we thought we all feel that the cdc director is being sidelined again and i think that that's it's very hard because of the way these these organizations i think the cdc should be more if it's going to exist it should be more like the fed where there's a little bit of independence because right now you you're at the behest of the secretary of hhs or the or the president uh if you're the cdc director and they control who you talk to in a way that probably the fed chief doesn't have to get his his comments approved by the white house i think that's that's something i would i would really advocate is just make it like the fed get it down to its core function of communicable disease and i think we'd be in a lot better shape yeah um somebody's asking if the debate with new zealand is available online anyway um they didn't release the audio they released the they released a transcript of it okay so what do people search is your name new zealand something i can probably read all kinds of nasty stuff about me if you about the from the new zealanders but yes um his name i've now i've forgotten his name um but yes if you write radio debate covet new zealand my name you should be able to find it okay so steven asks is dr gelger familiar with dr peter mccullough i think i'm pronouncing that right in dalis and the success with early treatment of covet and yes i've emected in but also recipe of other drugs i understand he's widely read i i mean that anti-depressant is in some of these recipes that i think i think joe rogan took like 30 30 things one of them was that drug that there's some positive studies on and vitamin d and all kinds of stuff so i don't know if you're familiar with this particular doctor no i'm not not not particularly no but i would i would caution against taking cocktails of things where you don't know what's in them you don't know what's working you don't know how those things interact with each other it's just a little bit dangerous uh now that covet 19 has brought mRNA technology into widespread use what kind of positive innovations can you imagine in the near future so many that i couldn't even listen it could be a whole show i think we had all been advocating for mRNA vaccine technology for a long time i wrote a report on this as a way to really change the way we do the emerging infectious disease response before the pandemic so we were all wanting this to happen i used to have meetings and i would invite maderna and then i have to we have all this like seating priority where you put companies and i have to put maderna like in this little small seat because nobody from like sanofi or murk or any of those people wanted to sit near the minute because they thought it was a small company so it's really really exciting so i think we're going to get new new vaccines maybe for influenza maybe for malaria they're working on hiv vaccines but it's also not just infectious disease maderna was started as a cancer cancer yeah because they were trying to make tumor vaccines to make a vaccine against your specific tumor so i think this is going to be a revolution in medicine that mRNA vaccine technology really had the chance to shine and it really showed and now these companies like maderna biotech have they've been they're flooded with cash now so they've got the ability to to actually do these experiments and make all these drugs so i think we will see kind of a renaissance in vaccine technologies because of what mRNA did and it's really bright the future yeah i'm super excited about these things i think it really does look amazing all right let's try to get these four questions quickly jeff says if an unvaccinated child under 12 contracts covered how long would you recommend waiting to get the child vaccinated after recovery i think you could probably wait you could get that you can get the vaccine any time you want after they're not contagious so i'm waiting at least 10 days but you're probably not going to get a benefit for probably 90 days plus so i i think you can wait three months if you want to just don't bring the kid to the place to get vaccinated sick people do show up when they're they're just positive and then they feel they feel bad that they tested positive like i want the vaccine today but you're contagious get out get out of here basically so yeah i think anytime but 90 days or so you this child is going to be pretty good for 90 days unless less omicron changes that factor but all right scott is asking some of your comments seem to apply that folks you wouldn't have asked for lockdowns if we've done more contact tracing earlier is that how you see it i do i think that if you look at his comments early on he said we're not going to have this wuhan type of thing because most of us thought we would do better that we would be able to keep up with cases that we wouldn't foul up testing so badly i don't think he would have if you listen to his early interviews um they're very different than what happens eventually and again this is the i talked about this in my ocon talk and when you put a scientist if you tell a scientist so i could tell you how do you get rid of covet 19 i would just say and no one leave their house ever um that that's that's just an answer and but what but that's not necessarily what you want to do and i think when you put when you have this abdication by the federal government the cdc sideline and you're giving someone you're trying to figure out what to do that's kind of how it all how it all went about and it wasn't just found she was also deba berks and it was even president trump because he was saying you know why did deblasio keep new york open he should have shut it down there was a lot of people saying that um but the reason that you do lockdown to the who says this all the time is if there's policy it's a sign of policy failure if you're going to the lockdown that means you've failed and that's basically what happened in january february march you did nothing and then you and then you have new york almost collapsed their hospital system and other governors panic and that became the only solution because it was too late then because we had no way to know who was infected who wasn't infected because we couldn't test anyone and that's all they did and then they couldn't they couldn't get it together uh so i don't think anybody ever advocated that and even now you read the who's their main lead their coaches like not lockdowns will say we need to do a lot better but not lockdowns they that's not something that public health people that actually know what they're talking about actually want it's it's it's a sign of failure so looking back do you think that if the if the cdc and the trump administration everybody had got their act together in january got the tests organized and do you think uh contact you know a test trace isolate could have worked in the united states not eradicated we're not covered zero but it but significantly reducing deaths in cases i definitely i think that we could have we could have met cases as they came we could have had the ability to test we already knew that nursing homes were going to be highly susceptible because old people were really really uh likely to have high risk we could have fortified nursing homes we could have made sure that hospitals had personal protective equipment told them make sure you've got we could get ventilators in place we could have come up with a plan to move patients around the country around a state if hospitals gotten trouble we could have told the public this is what we need this is coming you need to think about this we could have given people recommendations all of that could have been done and we didn't do anything in january february march even just say even just putting the n95s in the stopping the n95 shortage would have helped none of that was done it was just you know as as president trump said i i always wanted to play it down that's a direct quote i mean that's basically what happened our hands were tied and they screwed up the testing so badly i think that is the original sin of this pandemic and it's still a problem we still can't test like they can test in europe or in asia all right uh my uni requires daily rapid testing and offers them free for those with exemptions from vaccination i'm vax but i'm concerned about outbreaks is it worth convincing them to offer rapid test to all including the vaccinated it depends on your risk tolerance i think if you're fully vaccinated you you know that you're if you get a breakthrough it's going to be mild you're not going to even have to call your doctor so i think it's up to your own risk tolerance in general i don't i'm not a big fan of testing asymptomatic people who are fully vaccinated because i think that breakthroughs are inevitable and that they're mild is a good thing and it's not going to be something that we that we can continue to chase these mild cases because you're going to have covid cases on your university campus five years from now i think that we really want to stop spread amongst the unvaccinated and out major outbreaks are occurring and usually that's not going to involve the vaccinated so i i'm not a big proponent of testing uh of just asymptomatic screening of vaccinated people because i think it it's i don't see where this ends there's no off ramp if we're doing that right i think uh okay how does covid measure up in mortality rates and the way it was contained in contrast to the spanish flu were the methods of lockdowns with spanish flu more effective than what politicians are doing today the 1918 flu killed more people it you know killed 50 to 100 million people around the world we're in the single digit millions which is still too many but but we and the the sheer number of americans killed was was more but obviously it's a totally different thing um that that's happening they they're they used masks there was anti mask people out there back then schools some schools closed some schools moved outdoors i i don't know that it was more effective or it's very hard to know because it's not all well studied or at least it's it's not you can't compare them pound for pound the excess mortality in new york city is probably was higher for covid 19 than it was for 1918 at least that data is out there but also people couldn't travel that far and that fast people weren't as mobile in 1918 there were no airplanes people kind of stayed around in their own town so they went on a train or whatever they did at that time it wasn't the same connectedness which i think makes it hard to know how effective restriction of movement was at that time and you actually had the end of world war one which was the opposite of restriction of movement which actually facilitated it so it's a little bit hard to compare all of that uh completely together but i think that covid is not like it's it's much better than than the 1918 flu it's just uh it's just a different type of different type of thing hard to make strong comparisons um all right do you still two more questions yeah keep holding it uh aspiration is necessary for vaccination that's a question mark okay so there's some people that think that you should when you so aspiration means you draw back on the syringe a little bit before you inject just to get it make sure you're not in a vein there's some people who think that there's a hypothesis that people got myocarditis because maybe they're in a vein and some of that the material gets leaked into that i don't know if that's true or not in general you're taught to aspirate a little bit when you inject just to make sure you're not in a vein um it's not always necessary it's just a it's just a practice that lots of people do all right a faulty question faulty said he doesn't care about individual rights and then he is science itself a few weeks ago um were they taken out of context those comments i think the question about individual rights i think he basically said i'm not here to talk about rights i'm here to talk about how to stop covid that's basically what he said this is exactly what i'm saying he's he's focused on one thing that's the task he was given he's not thinking about it's not his it's not his job to think about individual rights and what the law should be or what they're not they've given him a tool to say they've given him this task to figure out what tools can we use to stop covid-19 whatever that's it he's not asking about individual he's not he's not being asked within the confines of this that's probably what he meant by that obviously he cares about individual rights because i i think most people do at least at least some learning of some some sense of that yeah and then the i am science i think what's happening is he's getting attacked a lot and i think i probably wouldn't have said it that way because it kind of i think it got i don't know if it got taken out of context but it's being used in a way that probably he didn't mean he meant to say that what he's trying to do is you know save the world using scientific principles and he's getting attacked and it's not just about him because i don't think i think that some of those people would still attack him even if it were attacked whoever if it wasn't about you they would attack whoever was saying that vaccines are good because they're or whatever it might be i think i think it's gotten a very political i think some of the the exchanges he gets into with senator paul and senator cruz probably aren't productive for anybody but you know i do understand what he means when he when he's saying that they're attacking science because i do think they're attacking science if they're passing laws to to force hospitals to give iver mekton they're passing laws to say a private company can't have vaccine requirements they're passing laws that if you get fired because your employer says you need to be vaccinated you'll get unemployment now i mean that that i think that there is a real problem we have with anti-science rhetoric that i've never seen before in the last 20 years or so well i mean i think we agree that one of the big challenges is like in every field in the world in which we live today that because government has its hands in everything including medicine that everything becomes politicized and and it's inevitable that once you get government money and once the government the government is controlling all these aspects of health care that things get politicized and and it becomes it it people are not going to pay attention to science they're going to pay attention to politics starting with politicians on down yeah all right thanks amish this was great uh really appreciate it we went well over the hour so i really appreciate that but i think we covered a lot and uh everybody seems uh um seems really thankful for that uh so thank you feel free to jump off whenever and i'm sure we'll have you on again as things develop all right sadly this is not a going away of the story thanks for having me and hope that was useful to your audience absolutely thanks amish thanks guys i really appreciate it um a lot of questions a lot of good questions respectful questions i appreciate that uh and uh uh wow i mean some of the comments on the comment section are not very respectful are very nice but uh but so be it uh wow all right we are going to let's see we've got a show tomorrow at uh at 2 p.m we are i think like 44 dollars short of our goal of 600 dollars if somebody wants to jump in and just uh and top it off that'd be great um as i said we're gonna have a series of guests coming on the show this month and going into the months um uh into into 2022 i hope you appreciate that and you value that if so uh please become a monthly contributor to the i mean to the to the i mean to to the uran book show uh at uran book show dot com slash support patreon subscribe star don't forget to like the show if you like it it's interesting youtube now has suppressed the dislike so while you guys can press this dislike button i can't see how many of you have actually disliked the show i can see how many of you like the show but not how many dislike the show and i'm sure there's a bunch of you who have oppressed the dislike based on the comments in the comment section but i find that interesting that youtube is trying to spare my feelings by um by not uh by not allowing me to actually see the uh the number of dislikes all right tomorrow at two then we'll probably do a show on monday and then i'm gone for the rest of the week for the debate those of you in texas and austin uh hopefully you can make the debate with your arm chasoni on wednesday individualism versus conservatism uh thanks everybody it was uh it was great to have you on thanks for the support thanks for the questions i appreciate it talk to you um thank you john really appreciate that i'll talk to you all tomorrow