January 24, 2022

COVID-19

#192 – COVID Part 2: Masks, long COVID, boosters, mandates, treatments, and more

“I think people are starving out there for honesty on this topic that's not tribal” - Marty Makary

Read Time 54 minutes

This episode is a follow-up to our recent COVID-19 podcast with Drs. Marty Makary and Zubin Damania (aka ZDoggMD). Here, we address many of the listener questions we received about our original discussion. In addition to Marty and ZDoggMD, we are also joined by Dr. Monica Gandhi, an infectious disease specialist and Professor of Medicine at the University of California, San Francisco. In this episode, we talk about new data on Omicron, long COVID, masks, kids and schools, vaccine mandates, policy questions, and treatments. We also discuss some of the most prevalent misinformation and spend time talking about claims made by Robert Malone. We end with a conversation about our exit strategy.

*Please note: we recorded this episode on January 17, 2022, and in an effort to get it out as soon as possible, this won’t have full show notes or a video. Additionally, Monica was only able to join us for the first section of the podcast, so you’ll hear her drop off partway through.

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We discuss:

  • Severity of infection from Omicron—reviewing the data [5:15];
  • Factors contributing to the relative mildness of Omicron infections [8:30];
  • Is SARS-CoV-2 evolving to cause less severe disease? [13:00];
  • Potential of Covaxin—an inactivated virus-based COVID-19 vaccine [17:45];
  • How B cells and T cells work together to defend against viruses [22:00];
  • Comparing the COVID-19 vaccines, and the rationale for the time between doses  [25:30];
  • Reviewing the purpose and effectiveness of boosters for reducing severity and transmission [32:30];
  • Debating vaccine mandates, and putting COVID’s mortality risk in perspective [41:00];
  • Why the topic of COVID has become so polarized [1:03:15];
  • Reviewing the data on masks for protecting oneself and protecting others [1:06:30];
  • The inconsistent logic used for mask mandates [1:16:00];
  • Long COVID and the potential for vaccines to reduce risk [1:21:45];
  • Risks for children and policies for schools [1:27:30]; 
  • Reviewing the outcomes from Sweden, where the government didn’t impose lockdowns [1:31:00];
  • Draconian measures implemented in Canada [1:38:15];
  • Antiviral treatments for COVID and a common-sense approach [1:42:15];
  • Importance of ending tribalism and having rational discussions with humility [1:47:30];
  • Treating infection with monoclonal antibodies and convalescent sera [2:01:45];
  • Reviewing claims made by the controversial Dr. Robert Malone [2:11:15];
  • A potential exit strategy from the current situation [2:30:30];
  • Change needed at the NIH [2:40:00];
  • More.

§

Pre-show notes:

  • A couple of weeks ago Peter, Dr. Marty Makary, and Dr. Zubin Damania (aka ZDoggMD) sat down and had a relatively informal discussion of the COVID-19
    • Podcast #189 – COVID-19: Current state of affairs, Omicron, and a search for the end game (January 3, 2022)
    • Different from our usual podcasts, this is a discussion among a group of us
    • We have tried to call out what is fact and what is opinion
      • We have a healthy mix of both
    • The format seemed to resonate a lot with people, and the follow- up was surprising
    • Peter thought it would be a one-and-done episode as they put to rest as many of the misconceptions as they could
    • It may be helpful to go back and listen to the earlier episode linked above if you didn’t hear it
  • We are back with Marty and ZDoggMD, and this time Dr. Monica Gandhi joins us
  • We will get into the newest data on Omicron
  • We’ll talk about how viruses evolve over time
  • Monica gives a great explanation of what B cells and T cells do, and how antibodies work
    • She explains the implications for different types of immunity: vaccine-induced and natural immunity
  • We’ll talk about the ideal timing for vaccines and number of doses
    • We’ll talk about how natural immunity plays into this and if a booster is needed
  • We’ll discuss some side effects of current vaccines
  • We’ll get into the controversial topics of: vaccine mandates, masking, the lock-down in Canada, kids in school, Sweden’s approach to COVID, Joe Rogan’s podcast with Robert Malone
    • Podcast, December 2021 – #1757 – Dr. Robert Malone, MD 
    • ZDoggMD does a pretty good point-by-point analysis of where he thinks Malone is off the mark and where he is saying something valid
  • We spend a lot of time discussing the fact versus fear approach to COVID
    • We’re still very much in a fear approach and it’s not clear why this is
  • We end this conversation again talking about the future and what the exit strategy is 
    • We are in an endemic; this is no longer a pandemic
    • We should have strategies geared toward an endemic now

Severity of infection from Omicron—reviewing the data [5:15]

  • Preprint in medRxiv Jan. 11, 2022 – Clinical outcomes among patients infected with Omicron (B.1.1.529) SARS-CoV-2 variant in southern California
  • They found 52,000 cases of Omicron, none required mechanical ventilation
    • And remember, 52,000 documented means there are 4-5 cases out there in the community for every 1 that is picked-up with testing
    • Roughly half of infections are asymptomatic and a lot of people have a tough time getting access to testing
    • So we’re really looking at a population of, say, a quarter million people with Omicron and nobody required a ventilator
  • There was 1 death in this group (not in the ICU or intubated)
  • Infection with the Omicron variant was determined using PCR diagnosis where S gene dropout was observed
  • There was a net total of 154 people who were hospitalized out of, say, a quarter million infected with Omicron
  • Of those hospitalized, 83% were there in the hospital for less than 48 hours
    • Remember way back about 2 months ago, this is exactly what the South African doctors observed early on
    • They noticed people were in the hospital about two days instead of eight days, and they proclaimed to the world this is a mild infection 
  • According to the most recent CDC numbers, 98.3% of new cases of COVID in the United States are Omicron 
    • On December 10th, it hit 73%
    • Now, we’re at 98.3%
    • So we’re dealing with a different virus
  • People who are still in the hospital are those who came in with Delta
    • Unvaccinated people who got Delta
    • And remember, people stay in the hospital a long time especially right now and it’s very difficult to discharge a COVID positive patient to a skilled facility or rehab so that’s inflating the numbers a little bit
    • Hospitals are truly strained, but it’s really those who had Delta
  • If we look at the future, Omicron promises to be a mild virus based on all of this data

 

Factors contributing to the relative mildness of Omicron infections [8:30]

Current numbers of people in the hospital with Omicron

  • Marty just looked this up, NYU, for example, reported 53% are not there for COVID, but they are COVID positive
    • These are incidental COVID admissions
  • In Jackson Memorial in Florida, 65% are incidental COVID positive cases
  • Perhaps 50% to 60% of the COVID hospitalizations are incidental
  • This depends on how highly vaccinated the region is
  • The numbers are even higher out in California for people with COVID in their noses because so many people are tested
    • So LA County reported 67%
    • This was closest to what we saw in South Africa during the Omicron surge which was 63%. 
    • And it wasn’t that South Africa was a highly vaccinated region; it was about a 25% vaccinated region
      • Instead, a seroprevalence study in SARS-CoV-2 in South Africa that showed 79% of adults had SARS-CoV-2 antibody
      • So think of South Africa, between natural immunity and vaccines, as likely having the same degree of immunity as California
    • So the higher the vaccinated region, the higher the incidental rate is

Study in South Africa just released aims to dissect the contribution of immunity to outcomes with Omicron versus the contribution a milder variant 

The contribution of immunity, both natural immunity and vaccine induced, estimated vaccination probably led to a 0.24 hazards ratio of a severe outcome” – Monica Gandhi

  • A hazard ratio compares the risk in 2 groups
    • A hazard ratio of 1 means there is not difference between the 2 groups
    • A hazard ratio of more than 1 or less than 1 means outcomes were better in 1 of the groups
  • Here this study is looking at the risk of severe outcomes from COVID infection in people who have some form of immunity (from vaccination or recovery from infection) compared to people without immunity
    • They conclude that immunity provided protection from severe COVID outcomes with a hazard ratio of 0.24
    • The hazard ratio here divides the occurrence of severe COVID outcomes in people with immunity by the occurrence of severe COVID outcomes in people without immunity 
  • As doctors in South Africa kept saying the Omicron variant is more mild, the fundamental question became, “Okay, is Omicron more mild because we have so much immunity in the population at this point, January 2022 now, that our T cells and B cells are attacking that SARS-CoV-2 variant?
  • It takes a while for the B cells to make antibodies; one may not have antibodies right away
  • Maybe if one just got boosted, they may have antibodies right away if they’re older
  • But say someone has been vaccinated or has natural infection
    • They now have T cells; and their B cells produce antibodies
    • This attacks that virus; it brings down the viral load quickly
    • This will make it less infectious and it helps the person do well with the virus
  • And so, immunity, of course, will help one do well
  • This is what probably what happened in 1918 when the world was transitioning from pandemic to endemic
    • There was a lot of immunity to influenza in the world
  • The next question is also, is Omicron less virulent inherently than the other strains that we’ve had so far, the other variants we’ve had so far? 
    • Yes, it seems to be not just based on the 6 laboratory studies, including 2 in ex vivo lung transplants
      • So this is human lung tissue
    • And then also animal studies that show it can’t infect lung cells very well
    • 6  studies now
  • What the South Africa study showed us was very good analysis distinguishing between immunity making it more mild and also having fewer less virulent,

They estimated it’s 25% less virulent than Delta above and beyond immunity” – Monica Gandhi

  • So it’s not just our increasing immunity in the population that’s making Omicron more mild, but it’s something to do with the virus itself likely, that it can’t infect lung cells well

 

Is SARS-CoV-2 evolving to cause less severe disease? [13:00]

Do viruses cause milder disease as they become endemic?

{end of show notes preview}

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MARTY MAKARY M.D., M.P.H. - ZUBIN DAMANIA, M.D. - MONICA GANDHI, M.D., M.P.H.

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

Monica Gandhi, M.D., M.P.H.

Monica Gandhi earned her M.D. from Harvard Medical School and did her internal medicine residency and ID fellowship at UCSF. After her residency, Dr. Gandhi completed a fellowship in Infectious Diseases and a postdoctoral fellowship at the Center for AIDS Prevention Studies, both at UCSF. She also obtained a Masters in Public Health from Berkeley in 2001 with a focus on Epidemiology and Biostatistics.

Dr. Gandhi’s current research program is on identifying low-cost solutions to measuring antiretroviral levels in resource-poor settings, such as determining drug levels in hair samples. Dr. Gandhi also works on pre-exposure prophylaxis and treatment strategies for HIV infection in women. .

Dr. Gandhi also has an interest at UCSF in HIV education and mentorship. Dr. Gandhi co-directed the “Communicable Diseases of Global Health Importance” course in the Global Health Sciences Masters program from 2008-2015, and serves as the overall Education Director of the HIV, ID and Global Medicine Division. She also served as the principal investigator of an R24 mentoring grant from the NIH focused on nurturing early career investigators of diversity in HIV research, is the co-Director for the Center for AIDS Research (CFAR) Mentoring Program, and is the Chair of the Advisory Board for the UCSF Building Interdisciplinary Research Careers in Women’s Health (BIRCWH). She directs the HIV/ID Consult Service at San Francisco General Hospital (SFGH) and attends on the inpatient Infectious Diseases consult service. [UCSF Department of Medicine]

Twitter: @MonicaGandhi9

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.

57 Comments

  1. I agree with Chris above re: 1. Natural immunity is effective 2. Children are at essentially no risk (and even weren’t under delta) 3.Omicron is very mild…so what’s the point of vaccinating for it?

    In the same vein as you say, some of these drugs that are being used to treat covid should be prescribed based on individual risk, if the seriousness of the current variant (Omicron) is letting up, why are you advocating vaccines for healthy people? Why not say–if you’re vulnerable get vaccinated, if not don’t worry about it? Regarding vaccines, you are not differientiating clearly between people with different risk factors.

  2. I also want to thank you for your enlightening presentation. I have one more question: Why not speak about the monetary influence and pressure of the pharmaceutical companies on media and the CDC and NIH, because of advertising and funding, etc. Which influences their push for vaccines and censure of information?

  3. COVID Deaths per 1 mil population(Statistic.com/Our World in Data.com)

    USA: 2633/2609
    Sweden: 1524/1543
    Canada: 862/851

    Every country has muddled this pandemic to some extent. I think that Canadian national and provincial health authorities have done a fairly consistent job of reflecting the health data as it became available, and the population generally trusts their authority. Provincial politicians have variably acted on this data; for the most part the restrictions have been targeted, limited and done begrudgingly – politicians have had to walk the tightrope between those saying not enough and those saying too much. Re schools the mantra has been “last to close and first to open”. My observation is that the critical factor for the introduction of restrictions has been either the actual or anticipated overwhelming of hospitals, and they have cut it very close in this regard with ERs and ICUs overflowing at times. We have had better vaccination rates than the US, even though we were delayed out of the gate by a couple of months – and vaccine mandates have likely helped this. There is a subpopulation that needs a nudge, and passports for travel and entertainment can do the trick. The stats above indicate that we did a very much better job than the US or Sweden on this critical data point. Admittedly, the extraneous costs of the pandemic, ie masking and school shutdown effects on children, are yet to be determined, but relative to almost any other country, so far so good. I hope this adds some balance to the opinion you expressed on this podcast.

    • Good nuanced response to the ‘nuanced’ participants in this conversation, with regard to the Canadian situation. I agree with your assessment. I also think Peter et al have flagged important questions about how we get ‘OUT’ of this pandemic. I’m reminded of Einstein’s view that the same thinking that gets one ‘in’ to a problem will not get one ‘out’ of the same problem. While I disagree with several of the comments from this group of like-minded thinkers, I think they are directionally correct in asking the right questions about how to get out of this pandemic in a sensible and data-based approach.

    • Hi Dean,

      As a fellow academic in Canada (Ontario) I will strongly push back on that. I completely disagree that the public trust is high (I mean at look at the protests going on right now). And whether one agrees or disagrees with these protests, one can’t ignore the fact that our public health has essentially ignored every single basic logical fact discussed in this episode (ie. the weight of natural immunity, the limit of masks etc.). We cannot simply look at total deaths and say “oh yah we’ve done better.” Which was also very nicely laid out here. This ignores the immense collateral damage. Lastly let’s consider the following example : our healthcare system was no doubt at risk of over burden. As a result we fired health care workers including those with natural immunity!! And then asked existing employees who we Covid positive to work, knowing the vaccine does not prevent transmission. Respectfully, this does not garner trust in public health!

  4. Thank you for another great bit of ‘all-things-covid part 2’. I appreciate your humility, common sense, humor and desire to get to the truth. Regarding Robert Malone, I wonder if you’d consider interviewing him? There is always nuance to all perspectives. I’d be very curious to hear how Robert would respond to your conclusions of some of his statements being factually incorrect. You all seem to be respectful, smart, truth seekers. Why not invite a conversation and call out the truth?

    • I support this 100%. Simply dismissing his points as incorrect, which ZDog did several times in the podcast for many of Malone’s points, is not convincing at all and frankly, comes off as unscientific.

  5. Thanks guys so much for providing a sensible discussion on where we are, and what works, I’ve learned a lot.
    However, your assessment of Canadian policy regarding restrictions to the unvaccinated was rather disturbing. Citizens are free to move about the country and leave and return, they simply must be vaccinated to do so. And getting vaccinated n Canada is free, and readily available. I’m genuinely puzzled that the three of you cannot see the benefit of these types of policies.It’s simple, it’s a policy designed to get the maximum vaccine uptake through incentive. I totally agree that Legault’s proposed tax on the unvaccinated is ridiculous, he’s just mouthing off, trying to get more Quebecors vaccinated. I’m really tired of the “my rights” crowd whining about how the state is cramping their style. Boo hoo, you don’t get to drive 100 mph on the public highway either, get over it. My T-shirt would state “what if everyone behaves that way” Your arguments for making the personal choice not to get vaccinated seem quite reasonable, but it is also agreed amongst the four of you that a high vaccination uptake is the most important way through this pandemic. In this case the public good outweighs personal choice, at least it does in Canada, and I’m totally ok with that. And on another point, while masking may no longer be beneficial (I had no idea) how do you tell that to the population without eroding public confidence even more? Especially in one of the most poorly educated populations in the western world? We were first told masks didn’t work, then they did, and now you want to tell people they don’t.

  6. a very informative podcast which slew several shibboleths. Thank you!

    I am reminded of Peter’s great line: “Strong convictions – loosely held” while listening and remembering concern expressed in an earlier podcast when Covid19 first broke fearing its toll could exceed all other causes of death combined.

    The point how B Cell memory is not synonymous to neutralizing titers was right on target – and the discussion of the politics behind convalescent plasma therapy was much appreciated.

    However – some caveats:

    Israeli data is unequivocal that booster shots save lives and rescue health in older adults

    https://www.nejm.org/doi/full/10.1056/NEJMoa2114255

    A comparison of Myocarditis/pericarditis in Vaccinated vs Unvaccinated cohorts is misleading

    A better comparison would have been Myocarditis/pericarditis in vaccinated who catch Covid vs unvaccinated who catch Covid

    … while remembering that a small subset of those vaccinated are GUARANTEED to be have been just infected while being vaccinated, making it therefore impossible to parse effects of vaccination from infection when looking at such small numbers

    It would also appear the Covid kinetics may be reported differently in Canada than in the US. In 2020 alone, 15,606 people died from COVID-19 in Canada. When compared to death rates reported for 2019, that would make COVID-19 the third leading cause of death in Canada – surpassed only by heart disease and cancer.

    The province of Alberta is different! Calgary has often been referred to as the northernmost suburb of Dallas and the province marches to a different Libertarian (Texan if you will) drummer than the rest of Canada. Here’s the kicker as quoted from the credible Calgary Herald

    https://calgaryherald.com/news/local-news/covid-19-on-track-to-be-among-albertas-leading-causes-of-death-in-2021

    “The province has recorded 2,061 deaths in 2021 where COVID-19 was a contributing factor through Dec. 12, meaning the novel coronavirus would rank second on Alberta’s most recent list of leading causes of death…”

    I also have issues with the appraisal of Sweden while mentioning a “dry tinder” effect

    Comparison with America is disingenuous! Comparisons with Sweden’s immediate Scandinavian neighbors are pertinent

    https://ourworldindata.org/grapher/covid-deaths-per-million-exemplars?country=SWE~NOR~FIN~DNK

    Ditto excess mortality. Sweden’s eventually converged to the same rate as neighbors’ due to vaccination AND “natural immunity” achieved by Sweden’s higher infection rates

    https://ourworldindata.org/grapher/excess-mortality-p-scores-projected-baseline?country=SWE~DNK~FIN~NOR

    One other issue skirted in discussion was how Sweden is ONLY NOW a success story compared to other non-Scandinavian countries because

    1- the most vulnerable succumbed before vaccines arrived
    2- Sweden has now one of the world’s highest “natural immunity” rates – achieved at great cost

    FTR: Sweden’s top epidemiologist has admitted his strategy to fight Covid-19 resulted in too many deaths

    https://www.bloomberg.com/news/articles/2020-06-03/man-behind-sweden-s-virus-strategy-says-he-got-some-things-wrong

    As for “excess mortality” as “dry tinder” – such considerations are small comfort for those denied urgent care including cancer operations because hospitals are still overwhelmed.

    Moving on

    Private Health Insurance in America does indeed demand higher premiums for preexisting health issues including symptoms of prediabetes. (Not sure about Hba1c)

    It gets better. Here is an interesting take on vaccine mandates in America which mirrors Singapore’s “draconian” mandate policy:

    https://www.forbes.com/sites/roberthart/2021/08/19/the-cost-of-being-unvaccinated-just-went-up—most-insurers-are-passing-costs-back-to-patients-as-covid-hospitalizations-soar/

    Credible authority counter dismissive claims about boosters’ efficacy

    https://jamanetwork.com/journals/jama/fullarticle/2788485

    and

    https://www.bmj.com/content/375/bmj.n3079

    Final Point – Math nerds will love this link with an exquisite analysis incorporating wave functions – much of which is frankly beyond me

    Salient quote: “Omicron is not mild. Viruses do not need to evolve to be less deadly. And endemicity has nothing to do with mildness.” Amen!

    https://dglassman.medium.com/omicron-was-never-mild-2b130568d7fa

    In other words – strongly held convictions are contingent on how the covid-cards fell. The world didn’t dodge a bullet but merely struck by a smaller caliber. Next time we may not be so lucky.

    • Great response on this podcast. I can offer another tidbit from the Alberta (‘Texas-North’) perspective in the Canadian context. I always gag at comparisons between ‘the flu’ (whatever that is) and the COVID19 virus. I took a look at this based on government-reported Alberta statistics for pre-Pandemic (2019) vs late 2020 (when I looked at it, around October, I think…). In 2019, there had been 19 deaths from ‘flu’ for the entire year. By the time I looked in Oct 2020, deaths attributed to the corona virus exceed 1,800… and it wasn’t even a full year yet. If you are a public health official in the midst of that, damn right you’re going to be deploying more vigorous measures than you’d use for the flu.
      It’s easy for talking heads, with the benefit of hindsight, to pontificate about how omicron is ‘less than the flu’. That certainly wasn’t always the case with earlier variants. That said, omicron is different and the response needs to be different… and a helluva lot more nuanced and effective. From this perspective, I’m really happy that Peter et al have raised some uncomfortable questions, and spoken some hard truths, about what we should be thinking about as we formulate a way out of this mess. This discussion was way more useful than anything else I’m seeing in public discussions. This tribalism we’ve seen emerge, where data is disparaged unless it aligns with your political leaning, will cause a world of hurt for us all… and I use those words advisedly.

  7. Hi there…before listening to this podcast I was very pro mask pro mandates etc. At one point while listening I was even thinking of unsubscribing but kept listening and I’m glad I did. I live in a part of California right in the middle of anti mask anti vaccines etc and my 77 year old father with COPD, asthma, diabetes, high blood pressure lives with us but only got the first Moderna vaccine and now refused to get any more because he buys into all of the microchip and crazy nonsense that getting the vaccine supposedly entails. After listening I have decided to be more open minded to not being pro mask pro vaccine mandates which I’m thankful for as there’s too much division right now. Our 10 y/o daughter has her first vaccine and we’re awaiting her second. My question is related to protection in my father with just the 1 Moderna vaccine. We’ve been on the fence about whether to let our daughter go maskless in certain settings once she’s fully vaccinated because of my father and the worry about bringing the virus home to him and hearing the data on which masks etc to use was helpful but I’m curious where I can find data on how much protection he may have against severe disease with only one vaccine in him.
    Hope someone can point me in the direction of an answer.

  8. These two covid pdocasts are incredibly good! Sane, rational, calm, informed. . . .and lots more good adjectives. Just these two were worth being a subscriber. Thanks so much for the good work! Now if we could shout this from the rooftops to everyone, maybe we would get to a better place faster.

  9. You have misrepresented and misinformed about Dr. Malone thus bashing him without seeing the JR interview. He has put his neck( integrity) out there fighting for kids like Maddie de Garay.

    Please tell me the absolute/ relative risk to that Pfizier trial where she was terribly injured, and that was misreported…

    Furthermore, he was removed, censored by Twitter for posting a video from The Canadian Care Alliance: The Pfizer Inoculations Do More Harm Than Good.

    Censorship kills. Controlling the narrative kills—not permitting a free flow of information.

    You have presented one side of the discussion from the very beginning of Covid?

    • For a thorough debunk of Dr Malone, the (not) inventor of mRNA technology, see https://www.youtube.com/watch?v=wkz1ln5AJ5Q, wonderful interview with the a real vaccine expert, Dr Paul Offit.
      The problem with Joe Rogans interviews, is the failure to filter out the crap, from the useful information and insights. The number of people who refuse to hear good information and nuanced arguments who quote Malone and parts of Rogan that reinforce their (often) absurd, ill-informed, outrageous, extreme views shows that Rogan in the minds of many other wise reasonable people, needs to be quarantined.

  10. You asked if the Pfizer and or the Moderna vaccines were no longer on the Emergency Use Authorization list and your guest stated that the Moderna vaccine was still EUA but the Pfizer vaccine was no longer under the EUA because it was now approved by the FDA.

    While the FDA did approve a Pfizer vaccine on 8-23-21, the FDA approved a vaccine from Pfizer named “Comirnaty” which to this day is not in production and as such, none of that vaccine is available anywhere in the world. Pfizer is still making and distributing the vaccine that was EUA approved on 12-22-20.

  11. This podcast was excellent, though the snark may turn some listeners off.

    I noticed the religiosity in myself today. Went maskless to Costco and definitely had pangs of embarrassment. And I still have some leftover fears that aren’t founded in data — I drive my car without fear but still somewhat fear contracting Covid. (I’m vaccinated and relatively young)

    Interesting to see these patterns in myself.

  12. I am a physician, subscriber, and fan. This is my first time commenting though I’ve intended to many times as you light my brain on fire in a very welcome way. I truly appreciate your earnestness and the deep and thorough work you put into this in order to uphold the value of the scientific process. I listened to both recent podcasts on Covid. Dr. Attia, at the end of the first one, you mention that you are not optimistic. I just want to let you know that while I agree the overall situation and tribalism it evokes is grim, YOU ALL have given ME optimism. THANK YOU from the bottom of my heart for doing those podcasts. I found it brilliant and such a breath of fresh air from the Alt Middle. The second comment I would have is related to fluvoxamine and ivermectin. Honestly my opinion based on the research on both is that neither excites me very much, though I am willing to prescribing either potentially and I certainly agree we need to be more open minded about therapeutics. For fluvoxamine, the JAMA article is small and the LANCET is relatively small. I also suspect (opinion not fact) that the adverse events in the fluvoxamine group are underestimated. In my early and inexperienced days as a doc, I have unfortunately caused patients to end up in the ER with panic attacks for prescribing even starting doses of an SSRI, instead of starting low and ramping up gradually. I can only imagine what happened to some of those patients getting 2-3 times the maximum dose of fluvoxamine. Whereas I have never (knock on wood) seen a side effect prescribing ivermectin. The basic science also seems stronger to me with ivermectin in terms of possible mechanisms of action (again opinion not fact). I do have a problem with the fact that only studies done in the US or England seem to be acknowledged (i.e. the fluvoxamine studies). Many studies done elsewhere on ivermectin, to be fair, may be of lower quality, but there does seem to be a there there. How can we say ivermectin doesn’t work when we haven’t studied it here, and don’t acknowledge foreign studies? (i.e. how can we prove a negative if we haven’t done the research?). As far as I can tell on clinicaltrials.gov, two years into this pandemic and they have barely finished RECRUITING patients for a study on Ivermectin in Covid-19, and they have chosen to use a dose (12 mg) on the very low end of what many suggest. (Versus the fluvoxamine study which uses 2-3 times the MAXIMUM dose of that drug). So to me something doesn’t add up and though I agree it’s completely crazy to take ivermectin “bid” as you joked about, I am not ready to dismiss it yet.

  13. First time listener and I really found this informative. I especially appreciate your frustration with illogical thinking. THAT is what has been SO upsetting to me in all this. But as a first time listener I have to say that your associates sure gave Dr Fauci a pass – something about how it’s hard to criticize him because he’s such a nice gentleman – and in the next sentences talked about how this whole public messaging has been fear not facts and the terrible distribution of NIH research. No logic there – that is directly attributable to DR Fauci. I find his short comings understandable – maybe – but that sure isn’t the orientation that Dr Malone received. The tone was a bit condescending (tribalism??) and though they attributed wee bits of truth to his comments there was quite a lot of undertones of ridiculousness about him too. For those of us who don’t have any authority in public health or medicine – well, I will speak just for myself – I’m sick of this takedown mentality. Everybody has a little truth in them, let the voices be heard and let people decide for themselves.

  14. Monica is great, truly a thoughtful, level-headed super star, Marty and Zubin come across as very opinionated and arrogant. I’ve listened to all 5 hours of the two part podcast along with Michael Osterholm’s weekly podcast as a contrast of opinion. He brings in the full global context as opposed to just highlighting Sweden to back up Marty and Zubin’s opinions. I’m definitely open to learning and evolving as we all learn more. I find the disparaging of Tony Fauci a real turnoff-where’s the respect for a long term public servant who lived through Trump!? I think its really funny (and concerning) that you call Texas a ‘free’ state. Ask a woman who wants to get an abortion how ‘free’ Texas is or the doctor who would like to perform it. You couldn’t pay me a lot of money to live there even though both my brother and sister live there. I’ll take the cold and snow of MN and our liberal policies ANY day!

    Also, keep in mind that every generation has things that shape it, 9/11, WWII, Covid, HIV, etc. etc. and somehow we all come out neurotic in our own ways but successful in others. Kids are resilient and as a grade school teacher (who is VERY smart) just told me this Covid thing is a shared experience with the current generation of kids, that social media is just as responsible for shaping our kids (probably more responsible) than Covid, school closings, etc. Your guests are taking one thing and blaming all the troubles with kids right now on just that. When is your podcast coming on the harm to kids of Twitter, Instagram, etc. (how about the Tourets phase?). I greatly appreciate the knowledge you share and also your focus on data vs opinion but on these two podcasts with Zubin and Marty, it seems your own opinion has gotten in the way of separating the two.
    Thanks for listening.
    One thought, keep in mind that the people who listen to your podcast are your fans, so of course they will respond positively. It takes more work to write something that critiques than applauds.

  15. Hi Peter: I am Canadian ER Physician 25 years into my career. I am also the Chief of Staff and ER department head for the hospital I serve. I have subscribed and listen to your podcasts. This podcast was once again medically informative and current.

    I would like to say in Canada you can travel, we are not enforcing vaccines (although not being vaccinated places personal and social disadvantages). Vaccinations are an option but not being vaccinated has potential impacts individually and socially.

    Also you made an analogy of vaccinations and pancreatic cancer. I truly think this was in the heat of conversation but I will say not an accurate analogy and in slightly in bad taste. Pancreatic cancer is not an infectious disease and comparing a Whipples procedure to Covid vaccination does not enlighten people as to why we should be or shouldn’t get vaccinated.

    Canada’s medical system is under threat. We have one of the lowest ICU beds per capita in the developed world. Over 90% of Covid patients currently in the ICU are unvaccinated. This has a significant impact on the rest of our system. We are redeploying nurses and physicians to needed areas (ICU, Covid wards, ER) without adequate training. We are cancelling needed surgeries and medical screening. We are close to collapse in our so called socialize medical system. Omincron still presents a challenge to us despite the lower pathogenicity due to shear numbers of infected population.

    For this reason we need to have tighter lockdown measures in Canada.

  16. I enjoyed your perspectives for the most part but I must say that your repeated comparisons of an infectious disease like COVID to things like cancer, suicide, MV deaths, and opioid death doesn’t make sense in this context. If a child/teen contracts COVID, she may very well readily infect her parents, siblings, grandparents, etc. Not all persons in any household carry the same risk level. Everyone in a household is unlikely to all get cancer or become opioid addicted when one member does.
    Some mitigation strategies need to be instituted (even if temporarily) to relieve the burden on hospitals during surges. To do otherwise puts the rest of the community at risk of missing out on necessary medical care.

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