January 3, 2022

COVID-19

#189 – COVID Part 1: Current state of affairs, Omicron, and a search for the end game

Where's the humility? People are hungry for honesty right now.” —Marty Makary

Read Time 25 minutes

In this episode, Peter sits down with Drs. Marty Makary and Zubin Damania (aka ZDoggMD), both previous guests on The Drive. Marty is a Johns Hopkins professor and public health researcher and ZDoggMD is a UCSF Stanford trained internist and the founder of Turntable Health. This episode, recorded on December 27, 2021, was in part inspired by some of the shoddy science and even worse messaging coming from top officials regarding COVID-19. In this discussion, Marty and ZDoggMD discuss what is known about the omicron variant, the risks and benefits of vaccines for all age groups, and the taboo subject of natural immunity and the protection it offers against infection and severe disease. Furthermore, they discuss at length the poor messaging coming from our public officials, the justification (and lack thereof) for certain mandates and policies in light of the current evidence, and the problems caused by the highly politicized and polarized nature of the subject. Themes throughout the conversation include the difference between science and advocacy, the messaging which is sowing mistrust in science despite major progress, and a search for what a possible “end” to this situation might look like. 

NOTE: Since this episode was recorded over the holiday and published ASAP, this is an audio-only episode with limited show notes.

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We discuss:

  • Comparing omicron to delta and other mutations [4:15]; 
  • Measuring immunity and protection from severe disease—circulating antibodies, B cells, and T cells [13:15];
  • Policy questions: what is the end game and how does the world go back to 2019? [18:45];
  • A policy-minded framework for viewing COVID and the problem of groupthink [24:00];
  • The difference between science and advocacy [39:00];
  • Natural immunity from COVID after infection [46:00];
  • The unfortunate erosion of trust in science despite impressive progress [57:15];
  • Do the current mandates and policies make sense in light of existing data? [1:02:30];
  • Risks associated with vaccines, and the risk of being labeled an anti-vaxxer when questioning them [1:18:15];
  • Data on incidence of myocarditis after vaccination with the Pfizer and Moderna vaccines [1:26:15];
  • Outstanding questions about myocarditis as a side effect of mRNA vaccination and the benefit of boosters [1:35:00];
  • The risk-reward of boosters and recommendations being ignored by policy makers in the US [1:40:30];
  • Sowing distrust: Lack of honesty and humility from top officials and policy makers [1:43:30];
  • Thoughts on testing: does it make sense to be pushing widespread testing for COVID? [1:52:15];
  • What is the end point to all of this? [1:58:45];
  • Downstream consequences of lockdowns and draconian policy measures [2:05:30];
  • The polarized nature of COVID—tribalism, skeptics, and demonization of ideas [2:10:30];
  • Looking back at past pandemics for perspective and the potential for another pandemic in the future [2:20:00];
  • What parents can do if their kids are subject to unreasonable policies [2:25:00];
  • Voices of reason in this space [2:28:45];
  • Strong convictions, loosely held: the value in questioning your own beliefs [2:32:15];
  • More.

§

Comparing Omicron to Delta and other mutations [4:15]

  • It is important to differentiate between fact and opinion
  • Omicron is a new surge so a lot of the information is in flux
  • There is some laboratory data (3 labs) that show that Omicron does not infect lung cells as well as the Delta variant
    • This is why we’re not seeing the cough and as much severe disease
    • We see more upper respiratory/ bronchus symptoms
  • Omicron is more contagious
  • Epidemiological data from South Africa
    • Their numbers are down now, over 35% off their peak
    • There is a shorter length of hospital stay- 2.5 days versus 8 days
    • Hospitals there were not over run
  • Bedside data also suggest Omicron causes a more mild illness
  • The observation of a milder clinical syndrome is complicated by the high seroprevalence in South Africa (from previous infection)
    • There is some natural immunity and vaccine immunity in this population
    • This is a more immune population and this has to be taken into consideration with the observation that this virus is a little more replicable and maybe a little less pathogenic
  • Question- with the immunity present in our population, will Omicron cause less of a problem than Delta (in terms of outcomes that we care about)? 
    • The population had less immunity when Delta began to spread
    • Delta seems to cause more severe disease than Omicron
    • Omicron begins to spread as there is more immunity in the population
    • Omicron is very transmissible but seems to cause milder disease
  • When are there enough mutations [in SARS-CoV-2] to cause new variants to be considered a different coronavirus instead of a variant?
  • Is this going to be the 5th seasonal coronavirus
  • Put this in context, there are 4 coronaviruses the circulate year to year and account for about 25% of the cases of the common cold
    • So will this (Omicron) become the 5th seasonal coronavirus? 
  • The Russian flu of 1889-1891 
    • Many postulate that this horrible pandemic may have been caused by a coronavirus that turned into 1 of the 4 seasonal coronaviruses that we live with today
    • This preceded the Spanish flu (of 1918)
  • A seasonal cold can actually kill somebody who’s medically fragile with comorbidities
    • Hospitalists see this every winter
    • Standard viruses can cause a very nasty syndrome; these viruses include: influenza (the flu), coronavirus, adenovirus, and RSV
    • People with comorbidities fill up the hospital
    • Hospitals operate at capacity
  • The question is at what point does this coronavirus become different from seasonal viral disease?
  • Thinking of this through the lens of evolution, Omicron would be the best (in terms of the virus’s best interest) because it is highly communicative and not lethal
    • The worst viruses are harder to spread and kill their hosts
  • Is there an evolutionary argument or logic to suggest that as the virus becomes  more evolutionarily fit it will kill less and spread more? 
    • This seems to make evolutionary sense
    • Compare it to SARS-1
      • It had higher fatality rate
      • It could be detected symptomatically when it was contagious
      • When people were asymptomatic, they weren’t contagious
      • This virus could be stopped by behavior restrictions
      • What is now considered hygiene theater, pointing a temperature gun at somebody’s head would have worked (to identify who is infectious) with SARS-1
      • Evolutionarily, this wasn’t avery successful virus
    • SARS-CoV-2 spreads with it’s asymptomatic and causes severe disease in vulnerable people (typically) 
      • But there are so many vulnerable people that this ended up causing a pandemic level of drama
    • Now Omicron spreads so fast that everyone gets exposed at some point
      • It causes less severe disease (we think)
      • This is a very successful virus that gets rewarded by being part of the pantheon of our seasonal biome that affects humans every year
  • Maybe Omicron is nature’s vaccine
    • For 93% of the population living in poor countries in the world, they don’t have access to a vaccine right now 
    • It may be ideal to get the vaccine over getting the infection
    • But maybe that is the silver lining of this variant, providing immunity to those not vaccinated
      • Maybe this is how the pandemic ends

 

Measuring immunity and protection from severe disease—circulating antibodies, B cells, and T cells [13:15]

  • A Johns Hopkins study in pre-print shows the importance of T-cell immunity in protection from COVID
    • This is an under recognized part of the immune system and absent from  much COVID discussion
    • T cell immunity is solid against Omicron as it is for Delta
  • Peter brings up the expression, “what gets measured, gets managed

{end of show notes preview}

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Marty Makary M.D., M.P.H. & Zubin Damania, M.D.

Marty Makary M.D., M.P.H.

Dr. Marty Makary is a Johns Hopkins professor and public health researcher. He is a member of the National Academy of Medicine, serves as Editor-in-Chief of the 2nd largest trade publication in medicine, called Medpage Today, and he writes for The Washington Post, The New York Times, and The Wall Street Journal. He is the recipient of the Business Book of the Year Award for his New York Times bestselling book The Price We Pay. He is a graduate of the Harvard School of Public Health, has served on the faculty of the Johns Hopkins School of Public Health for the past 16 years, and served in leadership at the World Health Organization.

Zubin Damania, M.D.

Zubin Damania, aka Zdogg MD, is a UCSF/Stanford trained internal medicine physician and founder of Turntable Health, an innovative primary care clinic and model for Health 3.0 that was part of an ambitious urban revitalization movement in Las Vegas spearheaded by Zappos CEO Tony Hsieh. During a decade-long career as a hospitalist at Stanford, Zubin led a shadow life performing stand-up comedy for medical audiences worldwide as a way to address his own burnout. His videos and live shows have since gone epidemically viral with nearly a half a billion views on Facebook and YouTube, educating patients and providers while mercilessly satirizing our dysfunctional healthcare system. The goal of his movement is to rapidly catalyze transformation by leveraging the awesome power of passionate and engaged healthcare professionals. [zdoggmd.com]

Facebook: ZDoggMD

Twitter: @zdoggmd

Instagram: @zdoggmd

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.

72 Comments

  1. What is effective is that omicron is more contagious, but less lethal, so it equates to other common viruses. So the pandemic is much more political than scientific

  2. I wish you guys could get on the news and have this discussion. In all the noise and all the Jargon being thrown around, this podcast puts out the real science and facts based on the knowledge we DO have. Unfortunately there is a large population of the world that doesn’t necessarily understand or have the means or background to grasp what the science is showing! Well done!

  3. Thank you for doing this podcast. Hearing the conversation about the suppression of science, scientific inquiry and “group speak” regarding COVID has been incredible apparent throughout this pandemic. Unfortunately, it is similar across many other areas of health research and is running strong, rational researchers out of academia and limiting the production of unbiased (as much as we can be) research. It has been incredibly disheartening and, in my opinion, is the result of a long-term lack of critical thinking and logic education in our schools . I keep hoping the tide will turn, but it is hard to have confidence in that when fear and feelings drive our policy and behaviors, rather than reasoning and logic.

  4. It strikes me as very odd that the new COVID-19 antiviral medication’s are essentially repurposed HIV medications. Why are we not using medications such as Kaletra at day 1 of diagnosis?

    To my knowledge, the only study published using Kaletra was on extremely ill ICU patients with an average time at beginning treatment of 14 days into the illness. This makes absolutely no sense. No antiviral medication is going to help a COVID-19 patient two weeks into the disease and who is on a ventilator!

    Should not we be doing a study administering a cheap, readily available, old HIV medication at first onset of symptoms of COVID-19? Shouldn’t this be a study someone is doing?

    Also, it would be interesting to see the incidence of COVID-19 infections in HIV positive patients currently on anti-retroviral medication. As an ER doctor I can tell you I do not remember over the last two years treating a single HIV positive patient on antiviral medication for HIV who has contracted COVID-19. (Antidotal I know).

  5. Thank you for the candid conversation and the disclosure of fact vs. opinion. I agree with “what gets measured, gets managed.” I also have observed that in regards to human behavior, “rewarded behavior is repeated”. Hence, politicians and government appointees behave in ways that increase the probability of maintaining their current jobs.

  6. I remember when vaccines were rolled-out and you were promoting them without enough data, I was so surprised and couldn’t even listen to your podcast, all until today and this interview! Now I see there were other interesting interviews I missed, and have to say : thank you! I don’t know you or much about you, except of what I have been following for years, and I respect you not because I am a tribalist, but because you use your scientific mind and have skills to explain them to us, normal people.

  7. I appreciate your taking on a difficult topic.

    Still, for the first time on your podcasts I found the dismissive tones especially by the guests off putting. I should say I almost completely agree with the positions advocated. I don’t think adequate consideration of the difficulty of actually putting in place public policy in a dynamic and politically fraught environment was well represented. I also think it is naive to think the outcome would be radically different no matter what reasonable policies were in place and this should at least be considered in evaluating policy.

    Also on science based questions, for example gain of function research were not well presented at all. This is a difficult issue, one I have considered carefully as a scientist myself, and research that can be classified as such is necessary and inevitable — this suggests better regulation. It is a nuanced issue presented as obviously without value moving forward.

    Thank you for you wonderful work. Your podcast has literally changed my life in many ways. While I think your guests did not present themselves well here it is just my opinion and their perspective is valuable nonetheless.
    Sincerely,
    Brian Space

    • I completely agree with Brian Space when he said that he found the dismissive tones of especially the guest off-putting. I was really hoping for the most up-to-date scientific evidence, but I felt too many questions were raised and not answered adequately. Many of the facts were glossed over as if they were common knowledge despite conflicting data. There were times when you posed a direct question, and the guests answered with their opinions rather than facts. In some instances, you even pointed this out, and yet I still didn’t feel the answers were given. This episode didn’t meet the standard you have set regarding the quality of research and evidence presented.

      • I agree with you and Brian Space. I’ve listened to Peter’s podcasts for years and this one seemed so out of character, so lacking in science/facts/depth.
        There is so much more to be discussed and the future is certainly not a known quantity.
        This podcast has definitely made me want to think more critically about the others.

        • I agree with Brian, Nicole and Lana. While I do think there were some thought provoking points made, the snarky tone was distracting and unhelpful. I hope you give this subject another go. I would love to hear from some epidemiologist. I really want to understand why our Covid death rate is so high in this country. We clearly need to do better.

  8. Thank you for the way in which you separated (and verbalized) fact from “editorializing”/opinion. I’ve been trying to expand my views and see these conversations from different sides and often I find it hard to get past someone to hear possible truths that might disagree with my current understanding when they speak in absolutisms and black and white. The discussion of probabilities and likelihoods (and of course facts) are much more powerful to me as that’s how I understand the world and think about it. I also loved the sprinkling in of tribalism as I think that is an important topic that drives a lot of the conversations and behavior of certain groups. It’s a messy topic for sure and really appreciate your take on it.

  9. Great discussion, Peter fumbles the ball yet again. It might be his “antidentite” frame of reference, or just his irrational fear of dentistry, but he undercut his guests with his dismissal of vitamin D, as if it’s snake oil. Peter didn’t learn about vitamin D3, (or K2) in state sponsored Canadian medical school, and probably hasn’t read Dr. Weston A Price’s groundbreaking book “Nutrition and physical Degeneration” The medical community has doomed millions of people like myself to a life of pain and shame, by omitting Prices observations from 80 years ago. Shame on you peter, have your “staff” present you with some of the thousands of studies on vitamin D, or invite a vitamin quack like Dr. Michael Hollick on your show to explain to you what you are too closed minded to investigate for yourself.

    Sun exposure produces so much more than vitamin D, so you are partly correct, sunlight is better than a pill, but its the middle of winter in the northern hemisphere, and no one north of Atlanta can naturally make vitamin D. Your ignorance in this matter is dangerous, dissuading people to supplement, without knowing the details can affect lives.

    To those whos loved ones have died of cancer, heart disease, and dementia, dig deeper into vitamin D, its a hormone big pharma cant patent. It can change your life, like it changed mine, and many of my patients.
    Even if you don’t care about yourself, you owe it to investigate this for your children.
    If your vitamin D level, (for whatever reason) is lower than 10ng/ml, and you get covid, or any flu virus, you are going to get very sick, no matter what your excuses are, you cant fool mother nature.
    A one time high dose of vitamin D can help you, almost instantly, if you want to help save lives and really care Peter, let me know I will send you the studies, and give you a long list of “real doctors” who would love to share their information with your viewers.

    • Dude, just to hold up the mirror I am going to respond to your comment in kind… Something tells me that after that comment that was dripping with arrogance and condescension, Peter is not going to contact you for your references or your info. I could be wrong. That said, I am interested to know more about Vitamin D myself and it sounds like you know a lot about it.

      Or I could have said…

      Hey Dr. Gould, I think there might have been more effective ways of getting your point across. This comes off as a little bashing and insulting. Sounds like you know a lot about Vitamin D, though and I am interested to know more.

      Do you see the difference? You might know a lot about Vitamin D, but you might consider checking out some info on psychology. Just a thought!

  10. If it’s fair to say that tribalism/atomization is at the overarching issue,self-regulation through understanding polyvagal system theory could be the antidote.

  11. Interview Dr. Peter McCullough and Dr. Robert Malone and Dr. Vladimir Zelenko and then you will have presented full spectrum unbiased science regarding all aspects of covid, but particularly, treatment. Thus far, Joe Rogan doing a better job.

  12. I haven’t been personally concerned about the short term impact of covid on me or my family. My concern all along has been with the long term impact of covid, long covid. Can someone point to the timestamp where long covid was discussed? I didn’t hear this topic discussed when I skimmed the discussion.

    • Absolutely concur. A potentially devastating impact of the virus which is rarely discussed in depth, including this podcast.

    • I had this question, too, and did not hear it discussed. From the tone of the discussion, my inference is that they are as concerned about it as they are with the virus generally. I would be curious why that is? Do any other viruses have long-term consequences (is there such a thing as “long flu”)?

  13. Didn’t Merck give a statement against Ivermectin in Feb 2021 and then in late spring 2021, got a 1.2 Billion dollar check from the government to land an antiviral “pill” And did not the head of the WHO quote Merck when it came out against Ivermectin??

  14. this thoughtful discussion is so much needed in the USA. with perhaps some return to sanity is possible. I would ask why all we spending billions of dollars of vaccines and vaccine mandates , when perhaps we need to study why US as being one of the richest countries in the world and has a high vaccination rate is still having a very high infection rate but the poorest countries , are dealing with omicron spread relatively well. Perhaps it is natural immunity . And I understand that you don’t discuss much about money , but it is more than a political can of worms; it is being driven by money . How much did Pfizer make last year ? $33 billion? It does make America look like the ” emperor with no clothes ” and the laughing stock of the world . Perhaps more transparency from Fauci is in order , or appointing someone else to lead?

    • “study why US as being one of the richest countries in the world and has a high vaccination rate is still having a very high infection rate but the poorest countries , are dealing with omicron spread relatively well. Perhaps it is natural immunity .”

      Well actually if you split the US into high vax counties and low vax counties, you see a huge difference in death rates. I don’t know what ‘natural immunity’ means in this context. If natural immunity is a solution, then lots of people get the virus then enjoy immunity from it. But wait a minute, that’s exactly what was happening before there were vaccines and a lot of people died!

      Developing nations have their own dynamics and it is not so easy to understand why one nation does better than another, in fact we’ve seen cases where one nation seemed like it was doing better but then got whacked hard. India, for example, had some people speculating maybe there was some type of natural ‘Hindu gene’ that made the population less suspectable. Once a lot of patting on the back was done, Delta hit India. For reference, India’s median age is 28, Africa’s is only 19.7, while the US is 38.1. That alone is going to drive massive differences in outcomes.

  15. I have no PHD to attach to my name. I’m a soon to be 69 year old who went to a technical school to get a 2 year degree in Journalism. I used that piece of paper to get into Marketing, Advertising and Public Relations.

    I can’t thank you gentlemen enough for keeping this discussion real while refraining from talking over my head most of the time! Thanks for helping me grow my knowledge on a highly volatile subject. It was amazing and while most of my friends will ignore my invitation to also listen to this podcast, I shared the link with them anyway!! They already think I’m a bit crazy so it won’t hurt my reputation one bit!

    • Sandra, I turn 65 tomorrow. I feel we are kindred spirits on this topic. I too shared this link widely…to crickets. And yet we will continue to learn and to share, wont we? There is no other option!

  16. How about an interview with some of the researchers that ran the last Fluvoxamine trial. It’s been approved in Ontario, Canada but not yet in the USA? People are still dying. An already fda approved drug like Fluvoxamine, that costs $4 for 10 day treatment would be a game changer. Are we waiting on more trials? Giti

  17. Peter. I’m a long term listener and fan of your work but I never normally post anything. However I have to say thank you so very much for broadcasting this podcast. I have spent the last two years feeling hemmed in – I’m not generally anti-vax but have been cautious about this one for various reasons, but the discourse where I live (London, UK) is so polarised, it is impossible to even question the wisdom of government policy publically without being shamed and agressively put down, even by friends. I’d say I am generally someone interested in the truth and accept that the knowledge available evoles over time. Your podcast is very brave as it has broached so many questions that I had and that I feel are “not up for discussion” – it has helped me answer a lot of questions that I had personally, and has made me feel there is some help that reason and real evidence based science might finally prevail. Thank you.

  18. I am hoping that the show notes for this episode will be updated to include links to some of the studies/information mentioned. There is a lot there and I would love to look at it at some point (would also like to pass it along to some of my family who is currently arguing with me about some of these topics).

  19. I was surprised by the vehemence of Peter’s reaction to masking. We in Ontario are still masking — now with N-95s — and I wonder if you can share your understanding of the science that says this is not wise?

  20. I think there are a couple of ways to look at the evolutionary argument differently. Re Delta and before, these iterations were finished their replication cycle before the lagging cytokine storm which was the fatal event. So standard Darwinian forces would no be applied to the virus.
    One Canadian analyst opined that the probable path to Omicron occurred through a single immune compromised patient is S Africa. Because of the large number of mutations it probably lived in that patient for months. And thus if the mutations had been toxic the variant never would have made it to the dissemination stage. In this case in a single patient Darwinian forces could be operating.
    All just conjecture but worth pondering.

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