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

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72 Comments

  1. I was hoping for a summary in the show notes of Dr Makary’s out patient regimen suggestions with links to the studies.

  2. I liked this podcast but to be honest I feel like it missed something pretty important.

    The US is killing about 1500-2000 people per day. Overall the US has killed a lot more people relative to its population and esp. relative to its development than comparable nations. The gist of the panel, however, is we must do….LESS. We are killing 2,000 people a day, but we have TOO MUCH immunity from people getting boosted vaccinations. We are killing 2,000 people a day but TOO MANY people are wearing masks.

    If you want to use an analogy to wokeness, consider the argument to defund police in areas that have high rates of crime. OK you’re saying there’s a lot of crime here but we should have fewer police.

    Now that can work IF you couple it to an argument that addresses both things. For example, Chicago solves only about 20% of its murders. I could see how it could be plausible if Chicago doubled its murder solve rate, it could at the same time have fewer police and get a smaller rate of crime (most cops are not doing murder investigations and many murderers commit other crimes as well). Of course there’s a lot of IFs there. Some murders are harder to solve than others. Sometimes you need a lot of manpower to canvas the neighborhood….but in theory a person could argue that is the way forward.

    But the panel is basically under the impression we’ve done too much against Covid…despite nearly a million dead, despite the CEO of a major life insurance company saying he is seeing 40% more deaths among 18-64 customers.

    I heard a lot of talk about therapies that should be employed if a person gets Covid and starts getting very sick. I’m great with that and to be honest as a layperson that’s what I expect hospitals, ER’s and ICU’s to know from a lot of hard won practice. Likewise I expect the regional trama center to really know how to deal with gunshots well. But as a layperson probably the best thing I can do is avoid getting shot so the trama center doesn’t have to take their time on me and likewise avoid getting Covid if possible.

    But when during this podcast did we hear anything about that? We heard a lot about how maybe we vaccinated too many people, despite that even a skeptical take still says vaccination probably reduces transmission by 1/3-2/3 (from the podcast). How would the US have experienced fewer deaths if schools didn’t close in 2020? If some schools weren’t using masks today? If fewer people were vaccinated or boosted?

    For example, for all the talk about natural immunity, I am underwhelmed. Not a single doctor on the panel was willing to embrace the ‘chicken pox party’ idea (namely trying to purposefully get infected). OK so that means those who have natural immunity have it and those who don’t, don’t. Does vaccination reduce immunity for someone with it? Not that I have ever seen evidence of, in fact the opposite such people are likely more immune than those who are simply vaccinated. Again 800,000+ dead is our problem really we have TOO MUCH immunity going around? Hmmm

    Now at this point it may all be moot. Omicone and Delta might be the two ‘Darwin Vaccines’, the second nasty and the first nicer but both sweeping through the population so fast that at the end it becomes moot. Those left standing will quickly get some type of immunity with unvaxxed not being among those left standing more often than the vaxxed. That may in fact happen but that is not really in our control (unless you want to go down the ‘chicken pox party’ route which I clearly heard all the doctors reject!)

    Often there’s a real desire to respond to these things but few places where you can do so effectivelly. Twitter is like peeing into the ocean because it is filled with so many bad actors that any creator who spends too much time there will likely go crazy from the toxic troll contact* (although it is nice sometiems to get feedback from a creator when I challenge them). Still I think for all the talk about groupthink there was a lot in this discussion.

    * Living in NJ, I can tell you indoor masking has gone up and down, maybe was 10% at a low in the summer but rose to 40% and now maybe 60%. Clearly people are following cases and increasing masking when they suspect the virus is going up in their area. The image that got Dt. Attia mad, the supposed pediatrian who has her kids masked and face shielded, is something I have never seen in any store I’ve been in. I suspect this is an example of shitposting, purposefully taking an extreme position just to get a rise out of people or possibly to discredit a side you disagree with. 20-40% of Twitter accounts are bots, trolls, ‘amplifiers’ and other discourse parasites.

    • Greetings from Finland. Check David Martin THE No.1 patent investigator in the world. He has a message to share.

      “CEO of a major life insurance company saying he is seeing 40% more deaths among 18-64 customers. ”

      This is the relative risk increase-trick used over and over. A CEO of an Insurance company would want people take more insurance thinking they are in high relative risk when in fact they are not when truly calculated by the absolute survival rate. Very different picture with a same data set. People are not educated. Peter has in fact on this very site a series of how to detect flaws in such statistical bending. Highly recommended to anyone. Good post anyway 🙂

    • You’ve missed the point. These guys think in terms of risk management and how to optimize health across the population. Every “action” taken by public health has unintended negative consequences. For example, by closing schools you may have reduced some infections temporarily, but at a tremendous cost that could last generations and reduce life and health more than the virus ever would have among the school age population.

  3. I wonder if any of the studies will be cited at some point here so I can pass them on to others?

  4. Editorializing, weak analogies, where, given the pedigrees of the guests, I expected more studies/data review. Here’s a fact: hospitals are overwhelmed with COVID related admissions, mostly of unvaccinated patients. Disruption/crowding out of other care, staff burnout. And, do you really think that the unvaccinated are masking up and otherwise taking more precautions than the vaccinated?

  5. Peter, you are to be commended for this Podcast.
    As a physician, I know that it unfortunately takes thick skin and a degree of bravery in order to espouse anything other than what the NIH and CDC dictate. I thought this was nuanced and timely. It is indeed sad that the world today is divided between “Covidians” and “Covidiots”. I am not sure why the divisions we have in our politics have spilled over into our healthcare so easily, but such is the world in which we live. Thanks again for hosting this Podcast. I have recommended you to many other critical thinkers, and this Podcast in particular to my colleagues.

  6. Physician here. I, my patients, and my colleagues would definitely characterize me as the opposite of a “groupthink” medical professional. I feel like I have to preface my comments by saying this because half of this episode seems to be a prophylactic rant against anyone who offers a counter-argument in defense of public health.

    What a horrific episode! I came here for some good analysis on the best and most recent data, and all I got was 3 doctor-influencers offering essentially 3 tiresome, editorialized, caustic arguments:
    1. That the CDC, public health officials, and medical professionals in favor of widespread vaccination are fatally political and shouldn’t be trusted,
    2. That disabled, chronically ill or “paranoid” persons can just “avoid large crowds” and stop ruining it for the rest of us.
    3. That this is just a cold.

    In regards to number 3, it’s pretty insulting to have spent 2 years working on the frontlines dealing with endless COVID patients, deaths, long-COVID, just to have 3 fellow physicians whine for over an hour about masks and boosters and fear-monger about totalitarianism. A little reminder for you boys: We may be getting used to it, but the COVID-19 pandemic is the 5th deadliest pandemic in human history, and it is still happening. Yes, it will eventually become endemic and fade into the background, but we ain’t there yet. It’s premature, privileged and myopic to pretend we are.

    • James. To be fair, they didn’t say “COVID” in general is a cold. Specifically, they jokingly referred to the omicron variant as a cold, in a qualified fashion. The tone of your comment here sounds like you have a dog in this fight.

    • I couldn’t agree more with this comment. I was very disheartened to hear this podcast coming from Peter Attia, someone I had previously respected. I’m sick to my stomach thinking about how much MORE divide, arrogance, and judgement he’s created here. In particular when he recounts his emotions towards the mother/physician with her masked children in the store… calling her an “idiot.” I truly think Peter should be ashamed of his words and I will no longer be a subscriber after listening to this truly horrific podcast episode.

  7. Please have the wife of Zubin Damania – she sounds balanced. Thank you for your time

  8. Really enjoyed this episode – although a lot more “editorializing” than what I’ve come to expect from this podcast. Agreed with parts, disagreed with others, but overall I think this has been a conversation missing in the decision making throughout this pandemic. I am hopeful that you will post references to studies mentioned (for us avid listeners but lowly non-members) so we can feel more comfortable sharing this episode or talking about the statements made, given the importance having sound science available to point to in continuing these kinds of discussions with our own (understandably doubtful) friends and family…Thanks for yet another great episode Peter and co.!

  9. Hello Peter and all your cast of experts. Thank you for all you do, to help inform with great information! These podcasts to me, are very informative and likely, life changing, when it comes to health and wellness. I look forward to these every week, my challenge is finding the time to get to them all. Fortunately I am middle aged and should have enough weeks left in life to catch up on the previous podcasts.
    Thanks Again
    Steve

  10. Yeah, hearing you vs what I hear from the Romanian authorities is a very different reality. I am from Romania and I am trying to make sense of all of this covid thing, and for example I see you viewpoint regarding masks, and we have a 2022 new policy for indoor masks for FFP2 use only. As long as I read …different viewpoints, from US, Fimland,Germany , Netherlands, Australia…etc….the more confused I become…

  11. My personal focus is primarily on helping people reverse Type 2 diabetes; I mostly leave analysis of other areas to you and several others I follow. I’ve been following you for several years, and respect your analysis of health issues tremendously, so was very interested in your thoughts here.

    Given your rant against tribalism, there’s an awful lot of it in this podcast. Asking people to have an open mind wrt to actual data while mocking them as you present that data is not exactly a good method of persuasion. As someone “fully vaccinated and boosted,” though I wanted to hear your thoughts, you really made it hard to do so.

    I am inclined to read the show notes and find out if I agree with your analysis, or where I disagree, and I hope I do agree as I want this crap OVER with as badly as anyone does.

    But your superior attitude actually makes it difficult to hear. Though I am apparently in a group you seem to disrespect, I’m not inclined to disrespect the anti-vaxxers particularly, and certainly not when trying to persuade them. But then, I am not on Twitter arguing with them constantly, so perhaps have much more patience than you do.

    You’ve previously said things I disagree with, such as your approval of SGLT2 inhibitors, and it’s never bugged me so much when I don’t agree with you as during this podcast, when I felt *attacked* for not knowing what you know and not having come to the same conclusions yet.

    This is not your finest teaching moment.

  12. As a fellow Canadian – Peter may be interested to know how some of his views are shared by more Libertarian inclined Canucks

    https://financialpost.com/opinion/terence-corcoran-the-covid-and-carbon-rights-killers

    I beg to differ on some (not all) crucial points floated in the podcast.

    Reality Check: In Canada’s case, how does one convince 37 million people to take something seriously and act (ahem) “responsibly” as speciously suggested by the Australian prime minister?

    Fast answer: YOU DON’T

    Leaders are supposed to lead! When governments govern – they often need to make hard decisions in timely fashion without consensus seeking!

    That’s what former prime minister Pierre Eliot Trudeau did in response to the FLQ while his perma-pubescent successor (the Papineau Princling aka le Dauphin) still smarts by unflattering comparisons to his father!

    Reality Check: Around the world, early testing and social distancing measures diminished the ferocity of the Coronavirus epidemic (as in Singapore where the obtuse unvaccinated are now obliged to pay their own Covid-hospital costs) whereas tardy responses proved catastrophic (as in Italy). While Canada continued allowing inbound flights from China, Taiwan (China’s closest neighbour) sealed its borders to ANY arrivals from the mainland. Casualty counts reflect policy differences.

    I took great exception to the brief compliment tossed Sweden’s way. Sweden today boasts Scandinavia’s lowest transmission rate (and high vaccination rate BTW) but at what cost?

    Numbers don’t lie, Sweden’s combined death toll compared to its neighbors is staggering

    https://tinyurl.com/yckzjmuc

    Canada offers an excellent observational study for Pandemics moving forward:

    The Maritime provinces took unilateral action, including the closure of provincial borders, while Ottawa dithered. As a result, the Maritimes became the envy of Canada as life quickly resumed a semblance of normalcy impeded by only a minimum of social distancing measures as defined by a “code orange” circuit breaker.

    New Brunswick then unilaterally took it upon itself to go “code green” despite objections of other Maritime provinces. New Brunswick’s justifications aligned perfectly with “editorializing” expressed on this podcast. The results were disastrous. New Brunswick went green just as Delta struck – lives were lost and NB’s economy took a hit, while more prudent neighbors continued as before. Lesson to be learned – Much of the podcast’s editorializing surrounding Omicron was contingently true – as opposed to necessarily true.

    ITMT Omicron’s arrival combined with some unfortunate “super-spreader” events in Nova Scotia have washed out disparities, but once burnt – twice wise. Canada’s Maritimes (NB included) are again imposing strict measures including school closures and vaccine passports, measures which would shock Americans.

    Why? Because urgent care is being denied while beds are freed for the anticipated tsunami of post-holiday-celebration Omicron casualties. Such is also true stateside! A wealthy friend in New Hampshire (one of America’s most vaccinated states) cannot get surgery for her Ovarian cancer.

    So puhleez! Mathematics does not always provide insight for real-life problems. It is true that vaccines and therapeutics alone can diminish “the area under the curve” – but “flattening the curve” remains no less worthy a goal. ITMT Social distancing can be effective, as proven in countries whose citizens are more trusting (obedient?) of authority (such as South Korea for example).

    Canada lies somewhere in between – but compared to the US – Canada may not have dodged a bullet, but at least it was struck by a smaller caliber.

    https://tinyurl.com/95vsw2d6

    Otherwise, the podcast was bang on target, especially suggestions regarding a “pyric victory”. Our self-perceived moral and intellectual superiors have no right to regard themselves as guardians of the truth against impertinent heresy which needs to be taken down. Such belongs to the domain of theological debate and not to an honest exchange of scientific ideas.

  13. Great podcast. Laughed out loud during the last 12 minutes. Let me know when the device is on the market. 😆

  14. I was VERY disappointed with this episode. I wonder why Peter would put out a Covid podcast with ‘limited show notes’ and no video in the middle of a surge? Why not wait a few weeks and provide some more in depth conversation? This is not a criticism of the content or the positions taken. It just felt like 3 guys complaining and somewhat tone deaf towards an audience that is just trying to get past the next month or so.

  15. I’m a paid member, and I was deeply disappointed by this episode because it didn’t clarify the current state of COVID. I would have much rather had a discussion among Drs. Attia, Makary, and Zdogg with epidemiologists like Marc Lipsitch and a previous guests like Drs. Peter Hotez or Paul Offit where they could lay out areas of agreement and where they disagree and why. I would have preferred to see a diversity of opinion so that the strongest “iron man” arguments could be made for X vs Y, or X and Y, etc.

    Instead we heard straw man arguments and a small group of elites making “out of touch” decisions for the public health of the US (and indirectly the world).

    For example, 2 hours and 4 minutes, Zdogg talks about inefficient focus on giving boosters to 18 year olds while the rest of the world goes without vaccines. I’ll grant him the first part – maybe 18 year olds don’t need a booster. However, other countries have told the US to stop sending vaccines because of vaccine hesitancy: they are unable to get them into people’s arms before they go to waste. So given this, I’d rather give boosters to those who want them here in the US.

  16. As a practicing pulmonary, critical care physician on the “front lines” with this – I found the podcast episode intriguing, thought provoking but somewhat misleading and unfair. I may have fallen for “group think,” I’ll admit, but flovoxamine, to my knowledge, has not been well supported by an RCT or other high quality evidence as a frontline treatment for Covid. Stating over and over that this is a highly recommended treatment option is not responsible. At the very least, please provide citations about this.

    And, great, you’re in Texas where there’s an anti-government sentiment — but vaccines have been unquestionably shown to reduce severe disease. As anyone practicing in the ICU since the vaccines were rolled out can tell you, almost all patients with severe disease are not vaccinated. This may or may not be true with Omicron. To call Omicron the “Omicold” at this point seems also not responsible – we simply do not know if it will cause severe disease in some fraction of people, vaxxed or not.. Hopefully, it will be just a matter of another “cold” but it’s too soon to know.

    In general, I enjoy your podcast — but I agree with others here — too much editorializing and not enough (supported) facts.

  17. I would have liked a risk comparison on myocarditis vs long-covid.

    Re long covid, as soon as there is enough data to start constructing the lower end of the distribution curve of # days for all omicron symptoms to (practically) disappear, please present it.

    I suggest (Australian) politicians are not a reliable source of wisdom, other than how to spout platitudes that increase their chances of being re-elected. (The Australian Prime Minister’s previous profession was in advertising.) Personally I enjoy the heavy hand of government mandating sober driving, and I would be annoyed if much of my taxes are spent repairing those who exercise Princess Diana’s right to not wear a seatbelt. You expect individuals to exercise responsible judgement re jabbing their infants with MMR??! Sigh. Maybe I too need some joules to my jewels.

    Coming up is an interesting social experiment / looming horrible disaster in Tweed Heads Hospital’s capacity to cope with its catchment notorious for low vax rates.

    Peter, imho this podcast has many useful comments that you should consider – too much holiday spirit with mates? (Tut tut!) I suggest that next time you SEPARATE the discussion into:
    * what is optimum policy re various jabs / timings / ages / isolations
    * what methods of persuasion / coercion are most effective at achieving those optimum policies.

    +1 for keeping an open mind – thanks.

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<div class='gf_browser_unknown gform_wrapper form--inline_wrapper gtm--newsletter-form-popup_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_5' ><form method='post' enctype='multipart/form-data' id='gform_5' class='form--inline gtm--newsletter-form-popup gform_legacy_markup' action='/covid-19-current-state-omicron/comment-page-2/?utm_source=podcast-feed&#038;utm_medium=referral&#038;utm_campaign=220124-pod-covid2&#038;utm_content=220124-pod-covid2-podfeed' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below'><li id="field_5_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_1"><label class='gfield_label' for='input_5_1' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_1' id='input_5_1' type='email' value='' class='large' placeholder='Your email address' aria-required="true" aria-invalid="false" /> </div></li><li id="field_5_10" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_10"><label class='gfield_label' for='input_5_10' >CAPTCHA</label><div id='input_5_10' class='ginput_container ginput_recaptcha' data-sitekey='6LeuYQ0dAAAAAHQqB_Z3xNQAwCRlN5ykarrLsrZw' data-theme='light' data-tabindex='-1' data-size='invisible' data-badge='bottomright'></div></li><li id="field_5_2" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_2"><div class='ginput_container ginput_container_text'><input name='input_2' id='input_5_2' type='hidden' class='gform_hidden' aria-invalid="false" value='#189 - COVID Part 1: Current state of affairs, Omicron, and a search for the end game' /></div></li><li id="field_5_3" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_3"><div class='ginput_container ginput_container_text'><input name='input_3' id='input_5_3' type='hidden' class='gform_hidden' aria-invalid="false" value='https://peterattiamd.com/covid-19-current-state-omicron/comment-page-2/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=220124-pod-covid2&amp;utm_content=220124-pod-covid2-podfeed' /></div></li><li id="field_5_4" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_4"><div class='ginput_container ginput_container_text'><input name='input_4' id='input_5_4' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_5_5" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_5"><div class='ginput_container ginput_container_text'><input name='input_5' id='input_5_5' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_5_9" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_9"><div class='ginput_container ginput_container_text'><input name='input_9' id='input_5_9' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_5_8" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_8"><div class='ginput_container ginput_container_text'><input name='input_8' id='input_5_8' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_5_7" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_7"><div class='ginput_container ginput_container_text'><input name='input_7' id='input_5_7' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_5_6" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_5_6"><div class='ginput_container ginput_container_text'><input name='input_6' id='input_5_6' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_5' class='gform_button button' value='Sign up' onclick='if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} jQuery("#gform_5").trigger("submit",[true]); 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[gravityform id="1" title="false" description="false"]
<div class='gf_browser_unknown gform_wrapper form--inline_wrapper gtm--newsletter-form_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_1' ><form method='post' enctype='multipart/form-data' id='gform_1' class='form--inline gtm--newsletter-form gform_legacy_markup' action='/covid-19-current-state-omicron/comment-page-2/?utm_source=podcast-feed&#038;utm_medium=referral&#038;utm_campaign=220124-pod-covid2&#038;utm_content=220124-pod-covid2-podfeed' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><li id="field_1_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_1"><label class='gfield_label' for='input_1_1' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_1' id='input_1_1' type='email' value='' class='large' placeholder='Your email address' aria-required="true" aria-invalid="false" /> </div></li><li id="field_1_11" class="gfield gfield--width-full ohnohoney field_sublabel_below field_description_below gfield_visibility_hidden" data-js-reload="field_1_11"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'></i><span>Hidden</span></div><label class='gfield_label' for='input_1_11' >H-o-n-e-y-p-o-t</label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_1_11' type='text' value='' class='large' aria-invalid="false" /> </div></li><li id="field_1_10" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_10"><label class='gfield_label' for='input_1_10' >CAPTCHA</label><div id='input_1_10' class='ginput_container ginput_recaptcha' data-sitekey='6LeuYQ0dAAAAAHQqB_Z3xNQAwCRlN5ykarrLsrZw' data-theme='dark' data-tabindex='-1' data-size='invisible' data-badge='bottomleft'></div></li><li id="field_1_2" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_2"><div class='ginput_container ginput_container_text'><input name='input_2' id='input_1_2' type='hidden' class='gform_hidden' aria-invalid="false" value='#189 - COVID Part 1: Current state of affairs, Omicron, and a search for the end game' /></div></li><li id="field_1_3" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_3"><div class='ginput_container ginput_container_text'><input name='input_3' id='input_1_3' type='hidden' class='gform_hidden' aria-invalid="false" value='https://peterattiamd.com/covid-19-current-state-omicron/comment-page-2/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=220124-pod-covid2&amp;utm_content=220124-pod-covid2-podfeed' /></div></li><li id="field_1_4" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_4"><div class='ginput_container ginput_container_text'><input name='input_4' id='input_1_4' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_1_5" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_5"><div class='ginput_container ginput_container_text'><input name='input_5' id='input_1_5' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_1_9" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_9"><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_1_8" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_8"><div class='ginput_container ginput_container_text'><input name='input_8' id='input_1_8' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_1_7" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_7"><div class='ginput_container ginput_container_text'><input name='input_7' id='input_1_7' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_1_6" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_6"><div class='ginput_container ginput_container_text'><input name='input_6' id='input_1_6' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_1_12" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_12"><label class='gfield_label' for='input_1_12' >Name</label><div class='ginput_container'><input name='input_12' id='input_1_12' type='text' value='' autocomplete='new-password'/></div><div class='gfield_description' id='gfield_description_1_12'>This field is for validation purposes and should be left unchanged.</div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' value='Sign up' onclick='if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} jQuery("#gform_1").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='1' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_1' value='WyJbXSIsIjU1MGM3MDVmNDUwOTYxNmQyYTU0NTkwMjUzZjU2NGI1Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> <p style="display: none !important;"><label>&#916;<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_4" name="ak_js" value="125"/><script>document.getElementById( "ak_js_4" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form> </div>
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