0:01

Many young people in our communities feel alone

0:03

and need support. Carillon Behavioral

0:06

Health can help. Carillon Behavioral

0:08

Health provides access to mental health services.

0:11

Their Child, Young Adult, and

0:13

Family Services program helps

0:15

connect young people and their families

0:18

to expert care that's compassionate

0:20

and appropriate. Take the first

0:22

step to feeling stronger and better. Visit

0:25

carillonbehavioralhealth.com

0:28

That's C-A-R-E-L-L-O-N

0:32

behavioralhealth.com

0:35

It's now the law in Ohio. Schools

0:38

must fulfill the SAVE Students Act to

0:40

help prevent suicide and promote healthy

0:43

student life. But there's no single plan to

0:45

providing a safe learning environment in any

0:47

one school. Which is why many schools have turned

0:49

to Sources of Strength Ohio to train

0:51

students and teachers. Yes, it's

0:53

the law. And it might make the difference in

0:55

the life of a young person in your community.

0:58

To get on board the SAVE Students Act visit

1:00

SourcesofStrengthOhio.org That's

1:03

SourcesofStrengthOhio.org

1:07

Lemonada

1:23

This is In The Bubble with Andy Slavitt. Hi everybody.

1:26

Email me, andy at lemonadamedia.com

1:31

Go ahead and write a review in Apple because

1:33

I know you're looking for an assignment from me. And

1:36

tell your friends about the show. A

1:38

lot of you have questions about COVID. A lot of questions

1:40

have come in about COVID. And

1:43

I think people are

1:45

I think people are I

1:48

think people are I

1:50

think people are wanting

1:53

to remember that at

1:56

times like this when cases are going up the danger

1:58

has not cleared. feel

2:00

personally at risk there

2:02

are a number of people who do and

2:05

so I wanted to take stock

2:08

a la the in the bubble

2:10

episodes of the first couple years of exactly

2:12

what was going on with

2:14

the variants that are emerging

2:17

cases and

2:18

how are

2:22

our vaccines,

2:24

our tests,

2:25

our drugs that

2:27

we have available going to be ready

2:30

and then what will ultimately the fall look like. So of

2:32

course I invited Caitlin Gentilina your

2:35

local epidemiologist on the

2:38

show and that's going

2:40

to be as always with Caitlin

2:43

a great dialogue. She's

2:46

done a lot of work we got a lot of analysis she's

2:48

explained it incredibly well and

2:51

the reality is she is getting

2:54

her hands around this

2:56

new quite mysterious variant

2:59

that we've all been

3:02

kind of scratching our heads around and she's going to

3:04

share that news with

3:06

us as we dig into this that's

3:09

BA 286 which

3:12

is not to make a model of

3:14

an automobile it's

3:17

actually a variant

3:20

of COVID-19 with a whole bunch

3:22

of mutations and

3:24

I think she's going to tell us whether or

3:26

not that's going to be a beast or

3:29

whether it's going to be just a tiny little mouse as

3:32

well as talking about the

3:36

things that are going to happen in the fall. Now

3:39

you should know that Monday the FDA approved

3:42

these new boosters that are going to be coming to

3:44

you very very soon and we're going

3:46

to talk about that as well and

3:49

enjoy this look

3:52

at where we are and where

3:54

we might be with COVID-19.

3:57

Here's Caitlin Gentilina.

4:06

There she is, your local

4:08

epidemiologist. Hi, Andy. How

4:12

are you? I'm so good. How are you?

4:14

I'm good. Welcome back to the bubble

4:16

for your umpteenth time. Thanks for having me.

4:20

You know, I think the overlap on

4:22

Caitlyn Jettilina fans and the bubble listeners

4:25

is probably pretty good.

4:26

It is. Do you know how many emails

4:29

I received after you mentioned I was coming

4:31

on in the bubble maybe a week or two ago

4:33

and I didn't know I was

4:35

coming on in the bubble?

4:36

Oh wow. So I was being presumptuous.

4:39

Well, thank you for letting me presume you're

4:41

present. I get a lot of feedback from

4:44

people who are saying, your shows with Caitlyn

4:46

are among the best. They had

4:48

one today which said, I don't love when

4:50

you have government officials

4:52

on because they're always in the talking points. And

4:56

I'm like, my job is to get them, you

4:59

know, whether it's a sheesh or science

5:01

or Mandy to, you know, go

5:03

deeper and be honest. And if I'm doing my

5:06

job, they're doing that. But I think there's nothing like

5:08

hearing from a truth

5:10

teller and a great communicator like you.

5:12

Yeah, you know, I think that the reality is

5:14

that there's pressures

5:16

in a lot of those government jobs and

5:19

they're not impermeable to them. And that's

5:21

one benefit that I have

5:23

of being independent. Honestly, I can

5:26

be organic

5:26

and I kind of kind of say what

5:28

I want for better. Yeah,

5:32

no, it's good. And look, it's for better because

5:34

you help people with understanding. Maybe

5:36

you just paint a picture of where we are. We

5:38

know 2020 felt like, we know 2021 felt like, we know a 22 felt like. 2023, we're

5:44

kind of allowed ourselves to kind of

5:47

go like this. I'm making a hand motion

5:51

where I'm wiping them back up and down to think,

5:53

aha, we're done. I don't know if I'm thinking about this

5:55

again. And in a lot of respects,

5:58

I think that's extraordinarily healthy. getting

6:00

back to priority to life, school, work, friends,

6:02

family. But

6:06

really where are we? We're going into another winter,

6:08

where are we?

6:09

Yeah, so I think you're right, Andy,

6:11

that there's been a significant mind

6:13

shift from last winter

6:15

and I think we're also in that

6:18

same sort of mind shift this winter as

6:20

a population and like you said, I think it's

6:22

fair. We are in a very different place in March

6:24

of 2020. The challenge

6:27

is we don't really know what this winter

6:29

is going to look like. And there's

6:32

a couple reasons for that is when

6:34

SARS-CoV-2 continues to mutate

6:36

and that's no surprise. We

6:39

just hope we don't

6:39

get some massive mutations out

6:41

of nowhere. And also

6:44

there's pretty good scientific

6:46

agreement that COVID-19 is not

6:48

seasonal yet, that we continue to see

6:51

this ebb and flow of waves that

6:53

are pretty unpredictable. And

6:55

to a lot of epidemiologists, that means that

6:57

we're not necessarily in this endemic stage

7:00

yet. And it's going to take time

7:02

for that virus to find a good

7:05

cadence in our population

7:08

with the amount of immunity we have.

7:09

So a lot of epidemiologists

7:12

are very curious of how things are going to

7:14

unfold this winter, particularly

7:17

also around healthcare capacity,

7:19

given that we haven't really built

7:23

or expanded our healthcare capacity,

7:25

although we've gained a new virus and

7:27

a repertoire

7:27

of threats.

7:30

So

7:32

in 2020, there were some people

7:34

that were basically trying to classify

7:36

COVID as, oh, it's just the flu. And

7:40

because it was a novel virus that

7:42

was killing people, there

7:45

was no immunity. It felt like that was

7:47

a really bad comparison. Today

7:50

though, in 2023, I do

7:53

hear people start, now that

7:55

there are layers of immunity, to talk about COVID. it

8:00

in the same breath as other respiratory

8:03

viruses as a similar

8:05

kind of feeling threat.

8:08

Is that the right way

8:10

for people to think about it or is the

8:13

relative newness and the potential for

8:15

variance still so high that

8:18

people should be more anxious about COVID than

8:21

that would let on?

8:22

Yeah, I don't know if

8:25

people need to be more anxious about

8:27

COVID, but I think that, you

8:29

know, I'm looping in COVID

8:32

with RSV and flu as well in my newsletter. I'm

8:34

looping it in as a respiratory virus,

8:37

but that doesn't necessarily mean they're all

8:39

the same and they should be all treated the

8:41

same. For example, we

8:44

know COVID

8:46

kills four times more than the flu.

8:47

So four times, is

8:50

it four times the death rate or is it four

8:52

times when you account for the spread

8:55

times the death rate?

8:56

Oh, that's a good question. When

8:59

you account for the spread, so

9:01

the burden

9:02

is four times the death

9:04

of the flu. Okay, so what that doesn't

9:06

mean if you get the flu and you get COVID, you're

9:08

four times more likely to die, right? It

9:11

just said what it is saying is

9:13

that four times more, four times as many

9:15

people are likely to die because

9:17

a combination of factors

9:19

including how fast it spreads.

9:21

Yeah, that's right. So that's on a population

9:24

level rather than the individual base.

9:25

Okay.

9:26

But yeah, and again, it's more contagious.

9:29

So we're going to get more people infected

9:31

every year. For example, the flu infects about 10%

9:34

of our population a year. And in just

9:36

one wave, COVID will infect 15 to 20% of Americans.

9:41

The other important aspect that

9:43

I think is

9:45

kind of in the background, but again, important

9:48

to keep in mind with COVID is that

9:51

people usually get the flu when they're young.

9:54

And so they have a lot of memory

9:56

about what a flu looks like and can adjust to

9:59

it. The challenge

9:59

with COVID, especially among our

10:02

older population, is they saw

10:03

COVID or were exposed to

10:05

COVID when they were over 40 or 50 or

10:08

over 60. And the challenge

10:10

with that is that our, I mean, memories

10:13

are just not the same as if they were exposed

10:15

at a younger age. And so it's getting

10:17

harder and harder to mount

10:21

a

10:21

long protection among

10:23

those people as well. And so, again,

10:26

I think, I don't know if you have to be more anxious,

10:28

but there are certainly different approaches.

10:31

For example, flu, you go home

10:34

after 20 or you can go to school 24 hours after

10:36

a fever because your 83% of

10:41

people are not contagious after 24 hours

10:44

of fever. With COVID, that's

10:46

very different. And so I want us to be careful

10:48

about applying flu things

10:50

we do on an individual level

10:53

to things we do on with

10:54

COVID. That makes a lot of sense. There's

10:57

two other things that people point to, which

11:00

make them more nervous about

11:02

COVID. They're worth paying attention

11:04

to. I'm not sure whether or not you would think they're both exactly

11:06

right. One of them is long

11:08

COVID. And the

11:11

reason I'm not sure that that's exactly right is because there's

11:13

certainly also long influenza,

11:16

but it's certainly something that

11:18

importantly worries people. A

11:20

second thing would be, you know,

11:23

COVID's impact that people are immunocompromised,

11:25

is that different than the flu? Is

11:27

it more worrisome? And then the third, of

11:30

course, is that, you

11:32

know, we kind of understand flu variants.

11:35

They come and go. They come every year and some are,

11:37

you know, we don't always have a vaccine that works just as well against

11:40

others, but the flu tends

11:42

to mutate in a predictable way. And

11:44

as we'll talk about, BAA.2.86

11:48

shortly, so you don't have to go there yet. But

11:50

the fact that there can still be surprises

11:53

in mutations more

11:55

so than with flu, because it's also not impossible

11:58

with flu. those three

12:00

areas, long the

12:02

impact on particularly people who immunocompromised

12:06

and the more unpredictable nature of variants, are those three

12:08

things that are also, you

12:11

know, things that

12:12

are

12:13

appropriate to be more nervous about or

12:16

not so much?

12:17

Yeah, you know, long COVID is an interesting

12:19

one and that

12:20

personally is a reason I

12:23

still, for example, wear a mask at the height

12:25

of a wave. And

12:27

you're right, there is such

12:29

thing as a long flu. However, long

12:31

COVID is more likely. There

12:34

was a few studies done a year or two ago

12:37

that shows that long COVID is about six times

12:39

more likely than long flu. So I think

12:45

long COVID is a legitimate concern.

12:48

But over time, the risk

12:50

has decreased and of long COVID

12:52

because of vaccines, because of antivirals.

12:56

And I think that we need to keep

12:58

that in mind as well. The second thing

13:01

is immunocompromised. Immunocompromised,

13:04

there's a very, very

13:06

small bucket of immunocompromised

13:09

that the vaccine does not work

13:11

on. In the beginning, yeah, the

13:14

primary series wasn't working for immunocompromised,

13:17

even the third shot wasn't working. But once

13:19

we got

13:19

to that fourth shot, immunocompromised

13:22

people started mounting our stats.

13:25

Now there's two groups

13:27

that don't.

13:28

One is, for example, active organ transplants

13:31

and they do still have to be very careful

13:33

because they just can't.

13:34

And then the third,

13:36

you said, is predictability. And I completely

13:39

agree with that. We've had omicron for

13:43

the past almost two years, which

13:46

is a good thing that we've seen omicron

13:48

change in incremental steps. And that's

13:50

good because we can predict where it's going. And we use

13:52

that prediction to our benefit to mount a proactive

13:55

response like XBB vaccines as

13:57

well. However, it's

13:59

only

13:59

been four years since

14:02

SARS-CoV-2

14:02

has been around. And one of our big concerns

14:05

is, again, a variant of concern coming

14:07

out of the woodworks out of nowhere.

14:09

And not necessarily starting

14:12

over with our response. We

14:14

won't be going back to March of 2020, but we will

14:16

be less prepared. Our vaccines

14:21

will probably be less, match

14:24

it less. Hopefully our path's sloven

14:26

would still work, our antivirals, hopefully

14:28

our antigen tests would still work. But

14:30

there's a lot of unknowns.

14:32

And so, yeah, that unpredictability

14:34

is certainly

14:35

something on the forefront of us epidemiologists.

14:39

Okay. Well, let's take a quick break and I want to come back.

14:41

We're going to talk about B.A.286. Is

14:44

it bad? Is it the big bad new thing? Is it not?

14:47

But before I do, I just want to make one point on long COVID.

14:49

I'm such a baby, Caitlin, that for me, two

14:52

hours would be long COVID. Like,

14:54

if I feel lousy for two hours, like

14:57

I'm making everybody around me miserable.

15:00

And I'm like, that's too long for me to be

15:02

sick.

15:03

So I don't know if there's

15:05

any preachers, maybe some like me out

15:08

there, but if so, the idea of

15:10

long is

15:11

that's where I go. Okay.

15:13

We'll be right back.

15:25

Falls almost here and

15:27

we all know how busy it can get. In fact,

15:30

it can be so busy that finding time to enjoy

15:32

a healthy meal can be tricky. But

15:34

with Factor, you can enjoy a delicious,

15:36

nutritious meal with no

15:38

extra work. I got to test to that. Factor's

15:41

fresh, never frozen meals are

15:43

ready in just two minutes. Two

15:46

minutes. And so you can skip the extra

15:48

trip to the grocery store, the chopping, the

15:50

prepping, the cleaning up while getting

15:52

all the flavor and nutritional quality that

15:54

you're looking for. All you have to do is

15:56

heat it up and enjoy. I

15:59

have tried the... pulled pork carnitas,

16:02

rice and beans, and the broccoli

16:04

rice, which is actually rice made out of broccoli,

16:06

but it's really amazing. It's

16:08

actually really, really good. And so

16:10

I'm adding some new things to my

16:12

order list next week. And

16:15

with over 34 weekly flavored packed

16:17

meals to choose from, I'll never run out of

16:19

things to try. And not only is Factor

16:22

healthy for me, healthy for the planet.

16:25

They offset 100% of their delivery emissions,

16:27

source 100% renewable electricity

16:30

for their production sites and offices and feature

16:32

sustainably sourced seafood in their meals. So

16:35

head to factormeals.com slash

16:38

inthebubble50 and use

16:40

the code inthebubble50 to get this 50%

16:42

off. That's

16:45

code inthebubble50 at factormeals.com

16:49

slash inthebubble50 to get 50% off.

16:55

With everything happening in the world today, climate

16:57

change, economic injustice, attacks

17:00

on women's rights, is easy

17:02

to feel overwhelmed and like the choices

17:04

we make don't matter. But they do

17:07

matter and that's what motivated the folks

17:09

over at Credo Mobile to start

17:11

America's only progressive phone company. Every

17:15

month, Credo Mobile donates

17:17

a portion of their proceeds to progressive nonprofit

17:19

groups. That means that just

17:21

by using your phone, you can

17:23

support Credo Mobile's mission and

17:26

make a difference every day at no cost

17:28

to you. You'll also get

17:30

the nation's top-rated, most reliable

17:33

network with coverage nationwide. Learn

17:36

more about the nonprofits Credo supports

17:38

and shop online at credomobile.com

17:41

slash inthebubble50. And when you go

17:43

to credomobile.com slash inthebubble50,

17:46

use the code bubble300 and get $300 off a new smartphone.

17:50

Or

17:51

bring your own phone to Credo and

17:53

get $300 in credits using

17:56

code bubblebyo. That's

17:59

Credo! code

18:02

bubble 300 for $300 off a new smartphone or

18:04

code bubble byo for $300 in

18:06

credits. Make

18:16

the switch enjoying the only mobile phone

18:18

company that fights every day to make a difference in

18:20

our world.

18:34

Okay, we are back.

18:37

Caitlin, it's interesting. You

18:39

reacted very negatively

18:43

to when I said the word, should people have anxiety,

18:45

but you were

18:47

not disputing the

18:49

fact that there are things to be nervous about or cautious. And

18:52

I just, I feel like I noticed before that the word

18:54

anxiety itself triggered something

18:56

in you, which is like, no, don't be anxious. And

18:59

I want to just get to that for a second before

19:01

we get to BA.2.86, which is that, if

19:07

you let yourself worry

19:09

about unknown, unpertical things that could happen

19:12

in the future, it's a recipe for misery

19:15

and disaster because there's always

19:17

unknown things that can happen. And as we talk about BA.2.86,

19:22

no one ranks the probability of a variant

19:25

against the probability of being hit by a car or

19:28

hurricane quake data like we just had in

19:31

California. I mean, there's all kinds

19:33

of that stuff, but we don't live

19:36

our lives in constant fear and anxiety.

19:38

So I don't know if that's what you were reacting

19:40

to or what I observed is right, but

19:43

I do think this idea,

19:45

and I know there's a lot of people that are still worried about

19:48

COVID and still know that we're living with COVID,

19:50

but this idea that I

19:53

think I tried to promote this, knowledge

19:55

should relieve anxiety not the

19:58

other way around.

19:59

I think you can relieve anxiety

20:03

through just having smarter tools. And

20:08

if we're always in an emergency, we're never

20:10

in an emergency. And having

20:12

constantly in this fight or flight mode

20:15

is not sustainable. And

20:17

I think that after

20:20

year one or probably year two

20:22

of the pandemic, I recognize that

20:24

we are in a marathon and we're

20:26

not in a sprint. And my

20:30

personal approach and my family's approach

20:32

shifted a little because

20:34

of that. And so I

20:37

hope that people are not living in

20:39

fear

20:40

of the unknown. There is a lot of

20:42

unknown. And I think we can alleviate a lot

20:44

of that fear from conversations like this, as

20:47

well as communicating on what we're seeing

20:49

in real time.

20:50

Yeah, I once got a fair amount of Twitter

20:53

hate. And by the way, what other kind of Twitter is there besides

20:55

Twitter hate? By saying,

20:58

if you've gotten vaccinated,

21:00

pick up parts of your life that have value

21:03

to you. And meaning and purpose,

21:05

obviously had whatever number of characters

21:08

to say it. So I'm sure I didn't say it very eloquently. But

21:10

I do think there's a constant balance

21:13

here. And we have to make

21:15

those decisions for ourselves. And

21:19

what I always try to tell people is like the

21:21

thing that I don't think is healthy is judging

21:23

how other people make their choices. If somebody

21:25

wants to wear masks all the

21:27

time, if someone wants to wear masks part of the time,

21:30

if someone doesn't want to wear masks, as

21:32

long as they're not endangering other people, then

21:36

I think we ought to not be so

21:39

judgey. But that's just more of a personal thing.

21:42

And I think be informed. Like

21:46

read your local epidemiologist's

21:49

newsletter. Let's talk about BA.2.86.

21:55

And the reason we're talking about it is because interestingly

21:58

enough, got

22:00

a lot of mutations. It's

22:02

different now

22:08

that it's the kind of thing that

22:11

if we were going to see like the next

22:14

new thing that was very different

22:16

and caused a lot of cases we didn't have it, it

22:18

would have a lot of mutations. So when

22:20

it first came out you kind of said, hey

22:23

guys let's pay attention to this. Tell

22:25

us what we've since learned about

22:27

BA2B. Well

22:30

you know what I'm gonna say BA286. What do you think?

22:33

Yeah so you're right.

22:36

The 35 mutations on the spike protein

22:38

got a lot of attention among even

22:40

the cool-headed scientists.

22:44

And the reason for that is we just want

22:46

to know when the virus is becoming smarter

22:49

and entering into ourselves. But

22:53

the challenge is we needed to wait to see

22:55

the puzzle pieces. The puzzle pieces in the lab

22:57

data, the puzzle pieces in epidemiological

22:59

data to see the real-world implications.

23:02

And all of us gave a pretty big sigh of relief

23:04

earlier this week when we saw lab data

23:07

trickling in showing that

23:09

you know these 35 mutations didn't

23:13

completely translate into

23:15

disaster. That yeah

23:17

it escapes our immunity a little more

23:20

incrementally. It's surprisingly

23:22

less infectious than other currently

23:25

circulating variants. And

23:28

so the implications of that are

23:30

not like another Omicron-like event.

23:32

We don't think. Now that what happens

23:35

in the lab is very different than what happens

23:37

in real life. And so we also are looking

23:39

very closely at epidemiological data

23:43

in real time. And we are

23:45

seeing that this is spreading.

23:47

It has enough oms to be

23:49

spreading. We don't know necessarily how

23:51

quickly it's spreading. But initial

23:54

estimates show that it's not necessarily a

23:56

tsunami like if

23:58

we were to see a wave. It would be...

23:59

more of our seasonal

24:02

waves that

24:03

we're seeing. But we

24:05

still have a lot of puzzle pieces to put

24:07

together. For example, this morning

24:09

the UK

24:11

gave a risk assessment showing

24:14

that there was an attack rate of

24:16

BA2.86 and a nursing home of 86%,

24:19

which is really

24:21

high. What does that mean, an attack

24:24

rate of 86%?

24:26

That means that out of all

24:28

the nursing home residents, 86% of them

24:30

were infected

24:31

with BA2.86. Over 90% of them were

24:34

vaccinated, a few of them were hospitalized.

24:40

So we still

24:42

have some unanswered questions about what are the

24:44

implications of this. Is it because

24:46

they're in a long-term care

24:49

home with very close contact?

24:52

Is it because there's high viral load? Is it

24:54

because we

24:56

have a lot of unanswered questions still. So we're

24:59

still trying to put together this picture,

25:01

but so far

25:03

it does not look like it's going

25:05

to be a tsunami, but that doesn't mean there

25:07

won't be sickness or

25:10

suffering. Okay, so there's a useful

25:12

framework here you've written about

25:15

and I'll butcher it up a little bit, but you

25:17

look at kind of I think the

25:20

four questions you ask when there's a new variant or so.

25:23

Number one, does it escape

25:26

immunity? In other words, in

25:28

the worst case, wow all that built

25:30

up immunity and whether for vaccines or prior

25:32

infection doesn't do anything. That's

25:35

one question. Second is, is

25:37

there something about it that makes it grow faster?

25:40

In other words, will it become the dominant

25:42

virus? Because if not, then

25:45

it'll get crowded out by things

25:47

that are more powerful. The third is, does

25:49

it cause people to become sicker? And the fourth

25:52

is, do our tools work? Do our

25:54

rapid antigen tests, our antigen tests and

25:57

most importantly our vaccine? scenes,

26:00

impact flow vid, work

26:02

just as well or are they knocked over?

26:05

Yeah, I like that framework. It's way more cleaner.

26:07

So one is immune escape

26:10

that BA2.86

26:13

has about a two to three fold increase

26:15

in immune escape compared to XBB. That's

26:19

not that much. We actually expected about

26:21

a ten fold increase and so

26:23

that means that it can escape our

26:25

immunity a little but not as bad as we

26:27

expected. By escaping immunity,

26:30

does that include memory

26:32

B cells and T cells or does that just include a

26:35

kind of frontline immunity? That's

26:37

a good question. It's just the first line of defense

26:40

which is neutralizing antibodies which protects

26:43

against infection. SARS-CoV-2

26:45

isn't really evolving to escape

26:48

our T cells which protects us against

26:50

severe disease and death.

26:51

So that sounds like great news. It is great

26:53

news. That sounds

26:54

like great news. Yes, it is.

26:55

Don't bury the lead here, Caitlin.

26:58

It is great news

26:59

for those of us that can keep a

27:01

memory response. Those

27:04

over 65 have a really challenging time doing

27:06

that because of their thymus

27:09

and all these other reasons. Anyway, okay.

27:12

So the second is transmissibility is

27:14

how contagious is this and that's

27:17

what we're trying to get with, well,

27:19

one, the lab data shows it's less contagious

27:21

in the lab meaning the

27:24

ability for it to latch

27:26

onto a cell, attach to a

27:28

cell and insert viral DNA.

27:32

It's not very great at doing that.

27:33

Well, and let's just pause there for a second

27:35

because there's a reason why none of us

27:38

really remember alpha, beta, gamma

27:41

particularly well because

27:43

there were in fact mutations. They

27:46

just never really went anywhere because

27:49

they didn't have the ability to reproduce

27:51

as fast as something else that was out there. So in

27:53

other words, there have been variants with

27:55

lots of mutations but they

27:58

never really affected a whole lot of people. And

28:00

so I think that's part of what's important

28:03

in what you're telling us is

28:05

that this one isn't, seemed

28:07

to be spreading like wildfire.

28:09

Yeah. I mean, and alpha did

28:11

cause some waves, particularly in Michigan,

28:14

which was weird, but other examples

28:16

is like IODA or MEW. I

28:19

mean, I guarantee you people don't even know what

28:21

those were.

28:22

I loved the MEW period. I

28:24

loved that period.

28:25

But they did sizzle out.

28:28

They looked scary, but they weren't fit

28:30

enough for the current environment. So they fizzled

28:33

out. And we're hoping that

28:34

that's kind of what BA2.86 does too.

28:37

The third question was severity. That

28:41

same nursing home data we saw

28:43

from the UK today showed

28:45

us that it does not look

28:48

like BA2.86 causes more

28:50

severe disease, which is fantastic news.

28:53

And then the fourth and probably the most important

28:55

is how well our tools work against BA2.86.

28:58

Papillovid

29:00

works, antigen tests work,

29:02

monoclonal antibodies do not work,

29:05

but they also don't work currently

29:07

against XBB.

29:09

And our vaccines, oh, we're getting

29:11

great data from Moderna

29:14

showing how these updated follow

29:16

vaccine, COVID vaccines

29:19

work pretty darn well against BA2.86.

29:21

So

29:22

in general, it's looking very

29:24

good. And like I said, a lot of us gave us

29:26

sigh of relief this week.

29:28

Let's take one more break and

29:31

we're going to come back and address a lot of questions

29:33

that you, the audience have sent

29:35

me about the

29:38

NextGen Project, nasal vaccines, about

29:41

COVID apathy and fatigue, about

29:43

what's happening if the kids go back to school. We'll

29:45

be right back. And we'll of course end with a prediction

29:48

on exactly how many COVID cases we'll see in this

29:50

coming wave.

31:47

You

32:00

know, we are seeing, you know, over

32:02

the course of August and September, an increase

32:06

in hospitalizations. A

32:08

lot of that was driven by kind of weather

32:11

which kept people indoors. Now

32:13

we have kids in

32:15

school and indoors. And

32:19

you know, I think for people

32:22

who are like,

32:24

I'm still focused on COVID, they're

32:27

probably feeling like very much

32:29

in the minority. They're

32:31

probably feeling like why

32:34

is there so much apathy and

32:36

why is there so much fatigue and

32:39

how do I deal with this? I

32:41

think it would be great to start with

32:44

who are the kinds of people that are most

32:47

likely to be hospitalized if

32:50

they are to catch COVID right now?

32:52

Yeah, I think that's a really important

32:54

point. When we look at these hospitalization

32:57

rates going up, it's not your average

33:00

general population. These

33:02

people in the hospital right now are vastly

33:06

unvaccinated still and then

33:08

too much older.

33:12

So around 60 years old plus

33:14

ending up at the hospital. And again,

33:16

that's just because of their weaker immune systems.

33:19

We're also seeing a very different type

33:22

of illness right now than

33:24

we were in the beginning of the pandemic. We're

33:26

not seeing this COVID pneumonia

33:29

with ventilators

33:29

headed into the ICU.

33:33

We're mainly seeing

33:34

comorbidities really flaring up

33:37

because of COVID-19 infection. The body's

33:39

just overwhelmed by trying to fight

33:41

all of these things at once that they end up in the hospital.

33:44

I don't think one's better than the other, but

33:47

there is a different type of sickness

33:49

and I think that's important

33:52

to recognize when we are

33:55

calibrating our risk tolerance.

33:57

Right. Like we still have

33:59

a little PTSD.

35:48

because

36:01

this vaccine is privatized.

36:03

So to be determined

36:05

but if I'm

36:08

eligible I'm certainly getting it.

36:11

So let's talk

36:14

about what the booster actually does. I mean

36:16

it's assumed that everyone has

36:18

some degree of protection

36:21

from prior infection

36:25

or a

36:26

prior vaccine or

36:29

both because I think that

36:31

is I've

36:31

been met anybody that hasn't had one or

36:34

the other and plenty people have had both.

36:37

What's the benefit? What's the additional

36:39

benefit

36:41

to getting a booster

36:44

now? Is it that it makes

36:47

it less likely that you'll contract COVID but it really

36:49

doesn't do much for severe

36:52

disease protection because you sort of already have that.

36:54

What is the rationale?

36:56

So there's three main things

36:59

that an updated booster will do. The first

37:02

is particularly among

37:04

older adults is that it'll better

37:07

protect you against severe disease

37:09

and death. Last fall vaccines

37:12

I had about 60% additional

37:15

benefit over those that didn't

37:17

get the vaccine but were previously infected

37:20

and I think a lot of us older adults would like that

37:22

additional benefit.

37:23

Are you calling yourself an older adult? I

37:26

did it well. You said a lot of us older

37:28

adults I just want to be sure. Well I just I

37:30

didn't know who the audience was

37:32

in the bubble. Okay all

37:36

right as long as you're not saying you're an older adult

37:38

I think we can all give that a pass or

37:41

as long as you're not saying I'm an older adult that would

37:43

be even worse. I'm not saying you're an older adult

37:46

now. Very vigorous.

37:48

The second benefit

37:51

is a lot shorter term. It's neutralizing

37:54

antibodies which will prevent us against infection

37:56

and transmission. This lasts

37:59

unfortunately

37:59

Unfortunately, very short timing, maybe

38:02

three months, maybe four months. And

38:05

so if you're looking for the booster to help

38:07

protect against infection, you'll want to try

38:10

and time the fall

38:12

vaccine with a wave,

38:14

which is

38:15

challenging to do. Okay. Let's

38:17

take a look. Can we stick on that for one second? Sure. Okay.

38:22

So kind of like this

38:24

next week or so,

38:27

most likely. So three to four months,

38:30

October, November, December,

38:33

January. And

38:35

you've written about how we think

38:37

COVID will peak kind of late December, although

38:40

that could obviously slip a few weeks since it happened

38:42

in January before as well. Does

38:45

that imply that

38:48

the smartest time to get it is

38:51

in October? What's, I know

38:55

you said we shouldn't time it, but I also think we

38:57

don't want... People to take

38:59

it too early to the point that it wears off.

39:02

So what

39:04

I am telling my family and friends and what I'll

39:06

be doing myself is I'll be waiting. Probably

39:10

the role I'm giving everyone is get all three

39:12

of our vaccines, right? RSV flu and

39:14

COVID if you're eligible before Halloween.

39:17

And I think that's a pretty good bet

39:20

with timing. Again, we don't know when any

39:22

of this is going to really peak, but

39:25

that's my advice. You're going

39:27

to leave it. Yeah. No, what I think is

39:30

important about that advice is if you're

39:32

getting together with your family over Thanksgiving,

39:34

getting it before Halloween

39:37

gives you enough time to have the vaccine

39:40

fully firing and working. So

39:43

for that reason, no reason to go later than

39:45

Halloween. Obviously if

39:48

you've got some major risky activity

39:52

earlier than that, then maybe that causes you

39:54

to change, but also very justified

39:57

in getting closer to Halloween. you

40:00

have nothing that you're kind of too

40:02

worried about in the next few weeks?

40:04

The only reason I would

40:07

wait until after Halloween, I

40:09

could see this scenario is if someone just

40:11

got infected with SARS-CoV-2 in

40:13

September.

40:14

Good point. Because

40:16

you want,

40:17

yeah, you want enough time between

40:19

your infection and your next vaccine

40:22

where it'll be beneficial. And what we

40:24

see is within the first two, three,

40:26

four months of an infection, there's really no

40:29

huge additional benefit. There's

40:31

no risk, but there's really no reason

40:34

either. That's great. That's

40:36

great. Okay. And you mentioned, and

40:38

I cut you off, you're about to mention the third benefit of a vaccine.

40:41

Third benefit is it updates our

40:43

B

40:43

cells. And so B cells

40:45

are antibodies factories, just like

40:48

we have factories for cars,

40:50

it will update our factory. And

40:53

when it updates our factory, it'll

40:55

show us that we

40:58

need to be well

41:00

prepared against currently circulating

41:02

variants, which is XBB. So severe

41:05

disease, protection against

41:07

infection, transmission, at least in the

41:09

short term, and our antibody factories.

41:12

I can just say, the

41:14

more I've learned, I think

41:16

the coolest invention that's ever

41:18

been made is the human body. Like I

41:20

am amazed at

41:23

all of these crazy cool

41:25

things our bodies do to

41:28

protect itself and

41:31

adjust

41:32

and

41:33

make us better and heal.

41:36

Like I

41:37

can't think of anything

41:39

that's as cool. Yeah. Our

41:41

immune system in particular is so

41:44

complex, but I think it's

41:47

a good... It shows why as humans

41:50

are dominant species.

41:51

I mean, it's really quite

41:54

incredible evolution.

41:55

Yeah. I brag about our immune

41:57

systems and our opposable thumbs to my dog.

41:59

the time. He doesn't

42:02

have them. Okay, a couple

42:04

more things. Back to school, parents

42:07

sending the kids back to school. What

42:10

should they be thinking about, talking

42:12

about, and of course fighting with other parents about because

42:14

that seems to be not that don't fight with

42:17

other parents. The biggest challenge

42:19

that us parents have because I am a parent,

42:21

so I can say us now, is isolation.

42:23

It's how long

42:26

do we keep our kids at home

42:28

because there's a benefit for them going back

42:30

to school. But

42:31

again, we don't want them going back to school infectious.

42:33

And currently CDC, and I

42:36

agree with this for kids, is

42:38

isolate for five days and then go back

42:41

to school if they're still testing positive on

42:43

an antigen test with a mask until

42:45

they're not testing positive. And

42:47

I think that's the best thing you can do for

42:49

fellow students and

42:52

as a good community member.

42:54

Next Gen vaccines, we want nasal vaccines

42:57

or universal vaccines. Are we making

42:59

enough progress? Just going fast enough?

43:02

Well, we now have $5 billion

43:03

for next gen

43:05

vaccines, which is fantastic. I think

43:08

that people don't realize

43:10

how challenging it is to make a

43:12

good nasal vaccine. And are

43:15

we going fast enough?

43:17

I mean, I guess we're never going fast enough. It would

43:19

be great to have a vaccine today that

43:21

stops transmission, but I think we're going

43:24

as fast as we can in the current political

43:27

landscape that we are in. If not

43:29

faster, I was pretty impressed

43:31

of getting that money for next gen vaccines

43:34

and treatments. Yeah, hats off to Ashish Jha

43:36

for getting that, but there should be no... A good

43:38

nasal vaccine. And are

43:41

we going fast enough? Well, I mean, I guess we're

43:43

never going fast enough. It would be great to have a vaccine

43:45

today that stops transmission,

43:47

but I think we're going as fast

43:49

as we can in the current

43:51

political landscape that we are in. If not

43:54

faster, I was pretty impressed

43:56

of getting that money for next gen vaccines

43:58

and treatments.

43:59

off to a sheath job for getting that but because

44:19

you don't know whether or not to

44:23

have a feel

45:05

seeing

45:23

is do we think this is a another

45:27

if we call the last winter kind of on the

45:29

low side and we call before that on the

45:31

high side. Do we predict low, medium

45:34

or high kind of winter ahead?

45:37

And maybe more importantly than that, like

45:39

when will we really know?

45:42

We won't know until it's passed.

45:44

I think that we'll

45:47

have a good idea and seeing how

45:49

this virus continues to mutate seeing how

45:51

the A2.86 works in this

45:53

landscape. But we won't, I mean, we

45:55

won't

45:55

really know. I think

45:58

that if we look at the Southern Hemet atmosphere,

46:00

they had a pretty middle of the road

46:02

respiratory season with COVID,

46:05

RSC and flu.

46:05

So I hope that we kind

46:08

of have a repeat of last year and I think you

46:10

categorize that as low but

46:14

low to medium, I sure

46:16

hope but we'll see

46:18

what happens.

46:19

Okay. Well, thank

46:22

you so much for

46:25

being in our bubble

46:27

with us. And for all your

46:29

fantastic work, I'll tell you again,

46:31

if you don't get to your local epidemiologist

46:34

newsletter, you're missing like the most

46:38

human understandable report

46:41

on what's going on out there,

46:43

not just on COVID, but other like interesting

46:45

and important topics.

46:47

Thank you, Caitlin.

46:48

Yeah, thanks for having me.

47:03

Thank you, Caitlin. I

47:05

have a very special episode next

47:08

week. Franklin Fore, who

47:11

is a great writer for

47:13

The Atlantic has

47:16

written a book on the first two years of

47:18

the Biden presidency. I

47:20

really enjoyed the read. I enjoyed

47:22

talking to Frank. I was part

47:25

of the source material and then

47:28

featured a couple of pages in the book. That's not why I'm having

47:30

him on. As we move towards

47:32

the election, I really,

47:35

really important to get insights into the

47:37

first two years of Joe

47:39

Biden, some of the mythology

47:42

that's out there about him, some of the BS that's out

47:44

there, some of the reality. And

47:46

I think Frank took a incredible

47:49

up close look. So we'll have him on

47:51

next week. In the meantime,

47:54

I hope everyone is getting back to school and work

47:57

and enjoying the remaining days

47:59

of warm weather.

48:00

and we'll talk to you next week.

48:09

Thank you for listening to In The Bubble. If

48:11

you like what you heard, rate and review,

48:14

and most importantly, tell a friend

48:16

about the show. Tell anyone about the show. We're

48:18

a production of Lemonada Media. Cal

48:21

Shealy is the senior producer of our show. He's

48:23

the main guy, and he rocks it with

48:25

me every week. The mix is by

48:27

Noah Smith, and he's a wizard. He

48:29

does all the technical stuff, and he's a cool guy. Steve

48:32

Nelson is the vice president of weekly content. He's

48:34

well above average. And of course, the

48:37

ultimate big bosses are Jessica

48:39

Cordova-Kramer and Stephanie Wittleswax.

48:42

They are wonderful, inspiring, and

48:45

they put the sugar in the lemonade. The

48:47

executive produced the show along with me. Our

48:49

theme was composed by Dan Mallott and Oliver

48:51

Hill, and additional music is

48:54

by Ivan Kariev. You can find out

48:56

more about our show on social media, at

48:58

Lemonada Media, where you can also get

49:00

a transcript of the show and buy

49:03

some In The Bubble gear. Email me directly

49:05

at andyatlemonadamedia.com. You

49:08

can find my Twitter feed at

49:11

a Slavet, and you can download

49:13

In The Bubble wherever you get your podcasts, or

49:15

listen to ad free on Amazon Music

49:17

with your Prime membership. Thank you for listening.

49:28

What's up, everyone? I'm Delaney Fisher,

49:30

comedian and serial entrepreneur. And I'm

49:32

Kelsey Cook, comedian and, I swear

49:34

this is real, a world champion foosball

49:36

player. On our podcast, Self Helpless,

49:39

we dig into everything from heartbreak to

49:41

career burnout to the wild stories

49:43

from our

49:44

20s and the many anxieties

49:45

we've experienced along the way. We're

49:48

often joined by guests who range from celebrities

49:50

to renowned health experts. And together,

49:53

we'll unpack big topics like deciding

49:55

whether or not we want kids, building your dream

49:57

career, strengthening self-trust, and much,

49:59

much more. So join us every Monday

50:01

for an unsiltered, entertaining and honest

50:04

conversation with friends where you don't even have

50:06

to leave your house. If you're not wearing pants, we

50:08

will never know. That's

50:09

right. So listen to Self Helpless wherever

50:11

you get your podcasts.

50:15

This message is brought to you by MakersMark.

50:17

Hey, everyone. I'm Sam Bee. You might know

50:19

me from The Daily Show, from

50:21

Full Frontal with Samantha Bee, or maybe

50:24

from my new podcast, Choice Words, which

50:26

is another Lemonada Media Show as

50:28

well. Each week on Choice Words,

50:30

I interview people I admire about the biggest

50:32

decisions they've made in their lives and what they've learned

50:35

from those experiences. That's why I'm

50:37

so excited to partner with MakersMark

50:40

on Choice Words, because just like our

50:42

show, Makers celebrates those who live

50:44

life with a curious mindset. And

50:46

now, thanks to the MakersMark personalized

50:49

label program, you can create

50:51

a custom label for the people in your life

50:53

who you admire. And best of all, the

50:55

label program is

50:57

free. Go to MakersMarkPersonalized.com

51:00

to order your personalized label today.

51:02

Must be 21 or older. Labels currently

51:04

available for 750 milliliter bottles only. Bottle

51:08

must be purchased separately. MakersMark

51:10

makes their bourbon carefully, so please enjoy it

51:12

that way. MakersMark Kentucky Straight Bourbon

51:14

Whiskey, 45% alcohol by volume.

51:17

Copyright 2023. MakersMark

51:19

Distillery Incorporated, Loretto, Kentucky.

51:22

Oh, and listen to Choice Words wherever

51:24

you get your podcasts.