Dr. Bob calls up University of Florida biostatistician Natalie Dean to ask whether or not we’ve hit the fourth wave. They discuss where cases are surging, why it’s regional as opposed to national, and what role the vaccines will play in keeping this wave smaller than the previous three. Plus, how she’s using Legos to help the masses better understand vaccine efficacy.

 

Follow Dr. Bob on Twitter @Bob_Wachter and check out In the Bubble’s new Twitter account @inthebubblepod.

 

Follow Natalie Dean on Twitter @nataliexdean.

 

Keep up with Andy in D.C. on Twitter @ASlavitt and Instagram @andyslavitt.

 

In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask questions, and get discounted merch at https://lemonadamedia.com/inthebubble/

 

Support the show by checking out our sponsors!

 

• Click this link for a list of current sponsors and discount codes for this show and all Lemonada shows: https://drive.google.com/file/d/1NEJFhcReE4ejw2Kw7ba8DVJ1xQLogPwA/view

 

Check out these resources from today’s episode: 

 

• Check out this Washington Post article debating whether or not we’re entering a fourth wave: https://www.washingtonpost.com/health/2021/04/04/covid-fourth-wave/
• Learn more about the COVID-19 situation in Michigan, and what it means for a fourth wave: https://slate.com/technology/2021/04/covid-michigan-infection-surge-fourth-wave.html
• Don’t miss Natalie’s tweet explaining vaccine efficacy with Legos: https://twitter.com/nataliexdean/status/1360701856616493060
• Read more about herd immunity, and why it’s so difficult to achieve: https://www.cnn.com/2021/03/30/health/herd-immunity-covid-shifts/index.html
• Keep up the vaccine rollout in the United States: https://covid.cdc.gov/covid-data-tracker/#vaccinations
• Learn more about Dr. Bob Wachter and the UCSF Department of Medicine here: https://medicine.ucsf.edu/

 

To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.

Transcript

SPEAKERS

Natalie Dean & Dr. Bob Wachter

Dr. Bob Wachter  00:09

Welcome to IN THE BUBBLE. I’m Dr. Bob Wachter. We’re at another interesting time so many of them over the past year with cross cutting trends and a little bit of a split screen trying to figure out where we are, I’d say, you know, the moment that we find ourselves that is this question of whether we’re entering a fourth wave and how big or bad it will be. And when you look at the data from a state like Michigan, you would say that’s not even a question, they’re surging right now. And although there’s a little bit of a disconnect between cases, and hospitalizations, and deaths, there are plenty of hospitalizations and inevitably going to be some death. So it looks like there’s an unambiguous fourth wave. And yet, here I am in California, and cases are pretty much at the lowest level they’ve been in the past year, and things are really starting to open up.

Dr. Bob Wachter

The vaccines are rolling out really quickly, 3 million doses a day, the process is going quite well. And then we hear about the variant. So it’s the it’s the vaccines versus variants narrative we’ve had for the last couple months. But now we’re entering this new stage where we may be entering a fourth wave, we may not be or we may be, depending on where you happen to live. It’s hard to make sense of all of it. And so we’ve asked one of the people who has done the best job over the past year, helping us all make sense of complicated data. And that is Natalie Dean. We’ve asked Natalie to join us and Natalie is a biostatistician specializing in infectious disease epidemiology.

Dr. Bob Wachter

She’s Assistant Professor of Biostatistics at the University of Florida. And this is what she does for a living. She does epidemiologic modeling of outbreaks in the past; she’s done that with Ebola and Zika. And now for the past year has dedicated herself to doing that with COVID. And I find really good at explaining complicated mathematical and statistical models and processes, to folks like me, who really don’t get that stuff and struggle a little bit with the math.

Dr. Bob Wachter  02:13

And so it was a pleasure speaking to her and having her help me and I think you’ll find help you understand where we are, whether we are entering a fourth wave and what that might look like I think the bottom line is, she leans toward the optimistic side that we’re going to be seeing some regional bumps, but they’re not going to be as bad as what we’ve seen before. And the vaccines really will come to the rescue. So it was a great conversation and let me ring up Natalie Dean.

Dr. Bob Wachter

Hello, Natalie, how are you?

Natalie Dean 

Hi, I’m doing well.

Dr. Bob Wachter 

I’m Bob, we’re Twitter, friends, but I don’t think we’ve ever met.

Natalie Dean 

Very nice to meet you.

Dr. Bob Wachter 

Nice to meet you as well. So let’s go ahead and get started hidden. Thanks for the […], I’ve admired your work and you explain things incredibly clearly. So thank you for that.

Natalie Dean 

Well, thank you the feeling is very much mutual. I really admire your threads.

Dr. Bob Wachter 

Thanks so much. So let’s start with maybe the top line, and then we’ll work our way into a more granular understanding. But when people say to you, is there a fourth wave? What do you say?

Natalie Dean

I say we’re seeing the start at you know, we’re seeing increases across a number of states and regions. There’s just uncertainty about how big it will get. And there’s uncertainty about how much it will impact hospitalizations and deaths, which is the real primary public health impact. So just because we have a lot of uncertainty with these variants, but then competing against these vaccines, which we know work extremely well. So, you know, we’re definitely seeing an increase. And we expect that to continue for a little bit. But we’re hoping that the impact on those real public health measures, like hospitalization and death are not as significant.

Dr. Bob Wachter  04:03

Let me give people just a warning, there’s probably gonna be a little math coming up. So but we’ll try to make it understandable. As I think about the factors that go into a wave at this moment, it feels like in my head, and I’m not good at this. I’m trying to weigh the efficacy of the vaccines and the number of people who have taken them and the people that have innate immunity from the virus and the percentage of variants and how much more infectious the variants are. Are you doing the same thing? Or how do you process this to try to come up with some understanding of what’s happening or what may soon happen?

Natalie Dean

Absolutely, yeah. When I talk to people about it, I think about this very tenuous balance between factors that are moving in one direction or the other. I mean, we have the things that are working in our favor. We have these vaccines that we know work extremely well, we’re moving into the spring, people can go outdoors, they don’t need to be cooped up, we also don’t know really the relationship with seasonality and the virus, but presumably things would get better in the spring, we also have a lot of people who have already been infected. And so there is that development of natural immunity, particularly among younger populations that are highly connected. But then we have things that are working against us.

Natalie Dean 

So very real fatigue, about being cooped up for a year, and people are so enthusiastic and excited and optimistic. And so wanting to reconnect and get together, and then the variance. So, you know, it’s this very feels like a knife’s edge. And we, and there’s uncertainty about how impactful each of those things are. And so it makes it very difficult to predict what will happen in the future, because if something swings a little bit too far, in one way, I mean, we know with infectious diseases, that they can build a little bit of momentum, and then when they start to take off, they can, you know, really increase quickly.

Natalie Dean  06:05

So, you know, we may not see the same balance happening in every area. But I think what has been, you know, I was very particularly optimistic. But then I think when I started to see things take off in Michigan, you know, it occurred to me that, okay, this is going to be challenging, may not take off everywhere, but it can take off in some places. So it requires more vigilance.

Dr. Bob Wachter 

So when you see a Michigan and the day we’re taping this, the numbers in Michigan are bad, and they’re heading north pretty quickly, sometimes reminds me of I remember, hearing, there used to be, maybe there still are stock market reports on the radio, and they say, stock market went up today. And they give the reasons. And then the next day, stock market went down today. And they gave exactly the same reasons. So I see Michigan, and you hear well, people are enacting, you know that they’re letting their guard down.

Dr. Bob Wachter 

And the vaccine isn’t rolling out as fast as we’d like. And then I look at many other states, and it’s exactly the same thing. And they’re not seeing the wave, including where you live in Florida. So what is this just random? It just happens to hit a given place? And then it takes off? Or is there some other factor? Because you know, every time you hear an explanation, that explanation is almost always true for other places that are not seeing the same thing.

Dr. Bob Wachter 

Absolutely. And I think we all need to have a lot of humility about what we understand and what we don’t, right? Because if we try and apply very simplistic explanations to these very complex local dynamics, then we’re yeah, we’re likely to have the situations where we can easily be sort of proven wrong. Yeah, things have started to increase a little bit in Florida. So I think it remains to be seen, but maybe it’s weather, maybe it’s this sort of, you know, we can talk about things like vaccination coverage at a state level, but that may not reflect what’s happening at more local levels.

Natalie Dean  08:04

There could be, you know, pockets of variation. And then, you know, infectious diseases just have these very nonlinear dynamics, it’s a little bit of math, but basically, they, you know, they can start to take off. So vaccines are very good at preventing outbreaks. But it’s a much harder thing to slow something down once it’s sort of already started to take off. So I think, you know, that’s going to be a challenge as is sort of race and the timing may have not been quite right for some places, or it’s weather or these other things, but it’s definitely complex.

Dr. Bob Wachter 

Yeah. And the reason it bad begets worse, is it that there’s a threshold effect. And once you have enough virus in a community, the chances that you’re going to encounter someone with a virus and therefore get another infection goes up is that you sort of hit some threshold, and then it goes in the wrong direction.

Dr. Bob Wachter

Yeah, I just think about epidemics is having a little bit of momentum, like a speeding train. And just once things start to take off, it kind of builds upon itself, and it’s just harder to slow down. So when we think about, you know, how quickly we’re rolling out vaccines, and that’s fantastic. And you know, doing a really great job, that’s really good at kind of keeping things from taking off, but it’s just a much bigger lift. If something’s already really started to spread, then it’s just harder for the vaccines to slow that down. It just will take more effort.

Dr. Bob Wachter 

You think there’d be a little bit of a counter force to momentum that once things start to spread in that particular area, people get religion, and maybe change their behavior more quickly than they would in a place where things are more benign, does that happen too?

Dr. Bob Wachter

Yeah, well, I think we’ve tried to understand why things have been able to turn around fairly quickly, you know, in certain locations, when things really start to take off. I mean, we saw this kind of in the summer in Florida and Texas and Arizona. I mean, there’s a mix of policy, but sometimes, but then also it can just be a behavior or something or some combination of factors. But the fact that things can kind of turn around on a dime, or we saw this in the winter, we saw this large increase, and then kind of everywhere across the world, things turned around.

Natalie Dean  10:23

And so, you know, we don’t know, it’s definitely a combination of a number of different factors, including just a buildup of, of immunity from just these how large these outbreaks have been. It may be the beginning of a bit of seasonality. But it’s, you know, I really do believe there’s something about people seeing the impacts on their communities and seeing those numbers rise and get very large and hearing about people, their neighbors or friends, family members being impacted, that does change behavior and behavior can change quite quickly.

Dr. Bob Wachter 

What are the things you’re famous for on Twitter is you showed with Legos how vaccines can do a lot of different things, sometimes decrease infection, sometimes decrease illness, sometimes both. First of all, can you explain that? Hard to do without Legos. We’ll link to it on the website. And then talk to us about what we’ve learned about these vaccines, how they actually are working.

Dr. Bob Wachter 

Yeah, well, a funny thing about being someone who studies vaccines, and I’ve been trained by some, you know, my mentors, or people have really defined a lot of how we study mathematically, you know, how we study vaccines. And so I have this under understanding that I can kind of share with people pretty easily, you know, I made this little sketch, it was after AstraZeneca, came up with some results about how the vaccines had impacted asymptomatic infection, I think there was a lot of confusion. So what does that mean for transmission? Well, you know, we know the vaccines work really well against preventing disease. But there was a question about how well they work against all infections.

Natalie Dean 

And there was some worst-case scenario that people could still be infected and not develop symptoms, but may still be able to transmit and so we’ve gotten a lot more data since then. That’s really, allayed a lot of our concerns, you know, that, in fact, these vaccines are very good at reducing infection and thus transmission. But I was able to make this little sketch with highlighters, and then someone suggested I make it with Legos. And I did and so, you know, the neat thing about Twitter has been able, there’s a lot of people are interested in learning about some of this stuff. And I can have this opportunity to explain it to them. So yeah, it’s been cool.

Dr. Bob Wachter  12:56

So take us through what have we learned particularly about this, you know, the early days of the vaccines, you know, early November, okay, they’re 95% effective in preventing a COVID was the top line and then okay, that’s all cases, but they’re 100%, against severe COVID. But we don’t know whether you can still get infected and spread it to someone. So still don’t change your behavior. And we learned a lot more in the last couple of months. So where have we landed on these vaccines?

Dr. Bob Wachter 

Yeah, well, I mean, so we had these great top line results that reflected the ability of the vaccines to prevent disease with any symptoms, because the way these trials work, if you vaccinate or don’t vaccinate some people, you follow them over time. And when they develop symptoms, you get them tested. So it’s actually harder to estimate how well the vaccines work against infection, because either you need to be testing people, weekly, bi-weekly, I mean, really, almost constantly. And there’s maybe a handful of trials, none in the US that are doing that it’s quite, at least for these large phase two trials, it’s very expensive. So you know, we haven’t had these results. Another way that with the trials have actually done, but we still don’t really have the data for most of them, is they look at your antibodies, and they can see there, you know, the vaccine gives you antibodies to the spike protein.

Natalie Dean  14:20

But that’s not the only protein that’s contained in the virus. And so you can look at someone at the beginning of the trial, and then look at them later on the trial and see if they develop antibodies to this other protein. And if that’s the case, then that signals that they’ve been infected naturally, so it actually with the virus, and so we can use that as a way to estimate how well the vaccines preventing real infection. But we still don’t have the data on that from Moderna or Pfizer. We have a little bit of data on that from J&J. And then AstraZeneca we have a little bit of data as well because they did very frequent testing in the UK. I mean, all of its signals, you know, a reduction in infection overall, you know we’re seeing is, and that’s, you know, reasonably to be expected because this big benefit that we see in terms of reduction in disease that’s going to reflect some protection against infection.

Natalie Dean 

You know, we weren’t sure kind of how much is that the vaccines preventing you from getting infected? And how much is it preventing you from developing symptoms, even if you do get infected, there’s some, you know, the vaccine helps in two ways. But we’re seeing, you know, definitely a big benefit in terms of infection. And also, we see the real-world data in Israel. And then there’s been recently some data from the CDC, that’s shown a big, you know, among healthcare workers who are tested very frequently as part of their job after they were vaccinated, there was a big reduction in infection. So that’s great because, you know, that’s what really matters for these population level benefits of vaccines with the transmission when we talk about herd immunity, that’s really about people not being able to get infected and transmit to others. So that’s great, that makes us just even more optimistic about the value.

Dr. Bob Wachter  16:08

Is a reduction in infection the same as a reduction in transmission? Or can you see situations where there’s a disconnect, you can still get infected, you can still have asymptomatic disease, but for some reason you’re not capable, or you’d have even a bigger reduction in transmission.

Dr. Bob Wachter

Yeah, absolutely. Yeah. So you can be infected, but the vaccine can make you less infectious. And it can achieve that in a few different ways. So you know, it can reduce your viral load. So if you have less virus, you know, we don’t know exactly the relationship between viral load and how infectious you are. But it’s reasonable to think that the more virus you have, the more infectious you are. It can also you know; a vaccine can also work by reducing how long you’re infectious for. So that period where you have the detectable viral load.

Natalie Dean 

For other diseases, you know, where the asymptomatic transmission is not as big of a feature, it could reduce the symptoms that, you know, like, if you were coughing, sneezing, vomiting, anything that would actually contribute to sort of shedding virus into the community. That’s another way vaccines can reduce transmission. So actually, when we see the efficacy against infection, that’s not even measuring that full benefit, because there is another source of benefit, which is that even where people do get infected, they themselves may be less infectious to others.

Dr. Bob Wachter 

Will you just take us through her to me to do 101. I think people by now have a sense of what it is, but what are you tell us what it is, and when you think we get there in terms of the percentage of the population vaccinated.

Natalie Dean 

Right, So when everyone is naive to a virus, so when everyone could can get, you know, like, say, you’re at the start of an epidemic, you know, we have this concept of the basic reproduction number which characterizes, on average, how many people get infected from a single person. And so, you know, it’s estimated to be about 2.5, to 3. But imagine if you’re in a world where some of those people have immunity. So some fraction of the people around me have immunity, either they have already been infected, or they are vaccinated. And so they themselves cannot get infected. So then say that I’m infected now.

Natalie Dean  18:22

And who am I going to go on to infect, if there are fewer people around me to infect, then you can actually get to a point where I’m infecting fewer than one person. And so when that happens, then the epidemic cannot grow, we can only get smaller. So basically, we have a lot of different things that are driving how the epidemic is sort of growing or shrinking. And that relates to policy behavior, seasonality, this, you know, acquired infection, the variance, all these things are in the vaccines, all these things are working in tension right now. And basically, you know, the way that I think about it is, the more people who are vaccinated, the more that we can relax some of the other things that allow us to return back to normal without being in a situation where the epidemic can grow again.

Natalie Dean 

So, you know, these things kind of work and attend intention, and that true herd immunity threshold, those estimates of whatever 75%-80%, you know, those relate to sort of how much immunity we would need in a population where you have no other kind of interventions in place that are reducing transmission, no other policies or things like that. So the idea is that right, the more people who are vaccinated, the more we can kind of return things back to normal without concern about things surging. You know, I will say, as we look at the dynamics right now, what’s going on with the numbers, it’s not just about how the vaccines are exerting protection on transmission.

Natalie Dean 

It’s not just about herd immunity, it’s also the vaccines protected in two big ways. I mean, the first Is that they provide this indirect protection, but they also provide this very direct protection to at risk individuals. So even in the absence of herd immunity, you know, widespread immunity, that’s really having a big exerted influence on these population level dynamics, you can still see a benefit in that we’ve vaccinated a lot of older adults, people, you know, high risk adults. And so that also changes the dynamics because there can be more infection, but you may not see the same outcomes in terms of number of people hospitalized, or dying. So that’s what I think about is the first benefit of vaccines. And then the second benefit is population level impact.

Dr. Bob Wachter  20:45

Great, it makes sense. And so we would expect to be seeing now or soon a disconnect compared to last year between the number of cases and the number of people hospitalized, the number of people dying, are we starting to see that?

Dr. Bob Wachter

Yeah, we’re starting to see a little bit, you know, so you can look at Michigan, for example. And you can see, looking across the different age groups that rise in hospital admission, and it’s just, you know, we are seeing a rise, but it’s far slower for adults over 65, where vaccination coverage is high, you know, so that’s where we start to see this disconnect between these two numbers. And because, you know, the vast majority of severe diseases in these older adults, I think it will, it will have a big impact. The challenge, though, is that with this, the some of these new variants, you know, because they can be more severe than, than we are still seeing increases in younger populations. And so that’s why it’s just, you know, important that we continue vaccinating and it’s great that so many states have been able to open up eligibility for vaccines all the way down to, you know, 18-year-old or 16-year-old, and so we can move quickly.

Dr. Bob Wachter 

When I see the estimates that we need 75% of people sometimes they say vaccinated, and sometimes they say immune, I then struggle a little bit with the difference between those two things, particularly. So let’s say if it’s vaccinated, do I have to take into account the 72% efficacy for the Johnson&Johnson? So you have to vaccinate more people to get them fully immune? Or is it if they’re vaccinated, they’re fine, they’re in that number to have to take into account the people that are immune from prior infection, where we assume that their immunity may begin to wane at some point. Is it just a matter of, you know, counting up the numbers? Or do that have to multiply by some fudge factor about efficacy and level of immunity?

Dr. Bob Wachter  22:43

Yeah, these are great. These are the real technical questions, right, that when we, when we build models, to say things about, you know, impact of vaccines, right? You have to account for all these different features. One is, how much of the population is already has some immunity? And does it wane over time? And did so. But a lot of it’s just a lot of guesswork. Because we don’t really know, this. The second feature in our models is this the impact of vaccination. And, you know, we have to separate out the impact on infection and transmission from the impact on disease, those have different impacts, because there is some difference.

Natalie Dean 

You know, we have written more evidence. So that’s not a big difference. But there is some difference, you wouldn’t plug in that 95% as sort of the fraction of people who are totally immune, somehow. And so there is some fudge factor there. I mean, the challenge with all of this, and why you hear so many different numbers, and explanations is that it’s fudge factors on top of fudge factors on top of fudge factors, right? And you can input a lot of different assumptions. You know, I think the real important thing is it all kind of gets you to the same place in terms of practical recommendations, which is that we want to vaccinate as widely as possible, we want to achieve good coverage across.

Natalie Dean  24:08

We don’t want pockets where people are unvaccinated because we can talk about like an average, you know, a national average or state average, but where there are pockets where vaccination coverage is much lower, those were made susceptible. This happens with measles, where you have, you know, areas of the country where people have taken religious exemptions for personal exemptions for measles vaccination, and, you know, they’re vulnerable. So a lot of the same policy recommendations don’t change as a function of that target estimate. We just want to try and vaccinate as many people as we can. Because we have to admit there’s a lot of uncertainty in those exact numbers.

Dr. Bob Wachter

Yeah, I think it confuses a lot of people because they hear different experts with different numbers and they kind of assume experts know the answer, in the end, you know, they do know a lot and but, but as you say there’s a lot of uncertainty and this is still is a relatively new disease and the vaccines are new. And we’re learning a lot as we go along.

Dr. Bob Wachter 

How important is vaccinating the kids?

Dr. Bob Wachter 

Yeah, that’s a great question. You know, the kids have different, there’s different dynamics in the kids, it’s a different sort of risk benefit profile, just because, you know, we do know that they’re at far lower risk of severe disease. But when we think about really getting to a very comfortable place as a population, you know, I do think it will be important to vaccinate children, you know, one of the things about sort of bridging vaccines into kids is that kids have very strong immune systems, so they can be very reactive. And so we’ll have to keep an eye on the side effect profile.

Natalie Dean 

And make sure just, you know, not like anything serious, but just that the kids may, you know, the way that adults feel lousy, kids may feel even a little bit lousy or so. So it may, you know, remains fine. Maybe it’s the J&J vaccine, or something that seems to have a lighter side effect profile, maybe better for kids. And something like that to mRNA vaccines. But ultimately, yeah, when I, when we think about sort of a real return to normal, you know, we want to make sure those the kids are protected, and also that the kids are not sort of part of a web that allows infections to continue to move through the population.

Dr. Bob Wachter  26:39

When we talk about herd immunity numbers, as you’ve said, it’s an imprecise guess. But if we say it’s going to be important to get 75% of people vaccinated, if you take the kids out of it, then you’d almost need every adults. Are we talking about 75% of adults? Are we talking about 75% of the country?

Dr. Bob Wachter

Yeah, I mean, see, this is where there’s like fudge factors on top of fudge factors. I mean, yeah, so crudely, we’re talking about 75% of everybody. And so yes, that makes it important for the kids, then to be able to contribute to this sort of broader, our population level protection and also for themselves to be protected. But, you know, kids are fed sort of had a mysterious role that we’re still, you know, within, within the spread of the virus that we’re still trying to perfectly reconstruct, I mean, some of the early studies, kids themselves may be a little bit less likely to be infected.

Natalie Dean 

Once they’re infected, they do, you know, there’s sort of competing evidence about how well that they themselves transmit, I’ve seen good estimates sort of going either way, kids may have a little bit of a different role in the overall dynamics, but then when we think about every other kind of infectious disease, kids can play a big role in the dynamics like for Influenza. So yeah, you know, it will be important for them ultimately, to get protected.

Dr. Bob Wachter  28:01

Great. Can you explain Florida to us? And I don’t mean, in general, because that’s a really hard question. But, you know, those of us outside Florida, sometimes look at Florida, and what’s going on politically and the parties and you’re at a university campus in Florida, you would think it would just be a hellish hotbed of infections? And it’s done average, in some ways. Probably adjusted for the age of the state, maybe even better than average. So what’s going on there?

Dr. Bob Wachter 

Yeah, Florida has been a big enigma. And I think there’s also been a lot of misunderstanding, you know, I think the way that people like to talk about everything is through a political lens. But they’re, you know, there’s more complexity there. So Florida has had a set of less restrictive policies, and we did see, you know, a large surge in the summer and then again, a surge in the winter. But overall, the numbers have not, has sort of been kind of average, there’s a set of people who think that Florida is sort of faked the numbers or something. And that’s also that’s not supported. You know, there’s no evidence of that, either. I mean, really just the data or the data and there. So yeah, in some ways, Florida has done fine in some ways it you know, it hasn’t done particularly well, it’s really just kind of in the middle.

Natalie Dean 

But you know, I think the reality is, is that there, if we really want to understand what’s going on, we need to dig in closer and pay deeper attention to all of the different complex factors that contribute to why some places are risky, you know, how much is weather playing a factor? How much is the fact that most older adult you know, a lot of older adults in Florida live in retirement communities that are kind of in these sort of isolated and taking precautions there. You know, how of nursing homes been handled, I think, you know, the state’s done a pretty good job with nursing homes, you know, here on campus at UF, I mean, they’ve been very aggressive with testing. I mean, I walked by the stadium every day on my way to my car. And there’s always about 30 or 40, college kids spitting into tubes getting tested, they have to get tested frequently.

Natalie Dean  30:23

And now and today, they’re doing a very aggressively vaccinating. So they’re, you know, they were able to vaccinate like 5000 people in a day, a few days ago. And so sometimes when we talk about things, at a state level, it misses some of the more local dynamics that occur, either it’s, you know, cities or counties having their own policies. So I don’t really know what’s happening with Florida, you know, I do know that the B117 variant is starting to increase a little bit in the state, and the numbers are starting to pick up in the state. And so it remains a little bit to be seen, it’s something I’m paying close attention to. But if we really want to understand how things are working, and why and what puts certain populations at risk, we just need to consider that we may not know, we may not know everything, and some things may be more complex.

Dr. Bob Wachter

Maybe last question, how are you doing personally? It strikes me that you have trained your entire career for this. And, you know, you’ve been very prominent and helping to explain a lot of it to those of us who don’t fully understand it. So I imagine this probably some mix of exhaustion and also kind of excitement and about being in the middle of something and making a big difference. How’s it feeling right now?

Dr. Bob Wachter 

Yeah, it’s been a really bizarre year. So actually, I was on maternity leave with my second child, last winter, and so January, February, March. And so that’s why I started tweeting is because I was kind of caring for a small baby. And tweeting is kind of something you can do. And I just, you know, I’ve been part of this infectious disease community research community for a while now, and particularly part of this emerging infectious disease community. So we did work on Ebola and Zika. And so just to see everyone launch into action, and I think all of us have really felt that we want to contribute in whatever way you know, we can.

Natalie Dean  32:19

And so, you know, contributing in different ways to the research has just been very active. And then also here with this sort of what I never would have expected is this public engagement piece, which is trying to explain and teach and break things down for people and, and sort of help everyone come together and exchange ideas to help people understand. It’s been bizarre. I went from having like, 200 followers on Twitter to over 100,000. And so that’s really changed just a lot of how I think about interacting. And it’s just, you know, it’s funny, because it’s all happened while I’ve sort of been home or just sort of have, you know, in my leggings and things like that.

Natalie Dean

So just behind a little a phone screen or something like that. But yeah, I mean, the real benefit has been that I’ve got to meet a lot of people in my professional community, both, you know, get to know better the people in my infectious disease community and also broaden even beyond that, and I’m so grateful that how everyone has really come together to work together so many different sectors. So it’s a huge problem. And it requires, you know, diverse input and a lot of learning and an effort.

Dr. Bob Wachter 

How are the kids doing?

Natalie Dean 

Oh, they’re great.

Dr. Bob Wachter 

Good. How old is the older one?

Natalie Dean 

I have a three-year-old and a one-year-old. So yeah, they’re little. So yeah, that’s, you know. A whole other thing is being a mom to two young kids, which has its own demands on my time.

Dr. Bob Wachter 

I would think so. Yeah.

Natalie Dean 

But they’re wonderful. They actually, they keep things feeling very normal, because they don’t really know what’s going on. So they really ground my days.

Dr. Bob Wachter  34:08

You have to explain to them over time. What you know, what mommy did in the war.

Natalie Dean 

Well, I tried to show one time, I was on Good Morning, America. And they actually asked for some photos of my kids. And so I put some photos on my kids up. And then I showed the clip to my son, my oldest, and he was like, turn it off. Turn it off. You would think it was cool, but I didn’t record it. So we’ll save it for them for later.

Dr. Bob Wachter 

Right. Exactly. Well, thank you for everything you’ve done2 and for explaining some really complicated things to a lot of people including me. It’s been very, very helpful and appreciate you being on today.

Natalie Dean 

Great. Thank you so much for having me. That was fun.

Dr. Bob Wachter 

A special thanks to Natalie Dean for helping us understand where we are in the fourth wave. And in this epic battle between vaccines and variants, it’s pretty tricky to figure out where we are in part because where we are, really depends on where you are. And things are quite benign here in California, but certainly in other parts of the country in other parts of the world. They are anything but so the next few weeks are going to be crucial. Please get yourself vaccinated, encourage your friends and family to do so.

Dr. Bob Wachter

We have a number of other interesting episodes coming up on IN THE BUBBLE. On one of them, we’ll talk history, and we’ll talk the history of two major epidemics both of which came to an end, but they ended in very different ways. One of them is “The Great Influenza”, the title of the wonderful book, By John Barry, he will be one of our guests. We also have another guest, who’s TBD right now, but who will discuss the polio epidemic and how the polio epidemic came to an end with effective vaccination. We’ll talk about that campaign and its analogies and differences to COVID. Will also do another safe or not safe episode, this one on summer plans. Lots of questions these days about summer, summer travel summer camp for kids, and more and we will bring back Caitlin Rivers and Farzad Mostashari for that.

Dr. Bob Wachter  36:29

Finally, we’ve not spoken enough really about global efforts in vaccination and in COVID, not necessarily not for the last several months. And a points that’s been made many times on the show is that we’re not safe completely until everybody is safe. So there is not only an ethical obligation to vaccinate the world, but a very practical obligation to do so. Because as places are hot around the world, that means more viral replication, more variants, and more risk to all of us. So my old friend Nikki Laurie will come on Nikki has had a number of important leadership roles in both us and worldwide vaccination and public health campaigns. So lots of great stuff coming up here on in the bubble. Please stay safe, get vaccinated, and I look forward to talking to you soon.

CREDITS

We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced our show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs executive produced the show. Our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @InTheBubblePod. Until next time, stay safe and stay sane. Thanks so much for listening.