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Omicron came and flipped everything we thought we knew about how to act during COVID up in the air. It also made another edition of Safe or Not Safe necessary. This time around, Andy brings in two new contestants, epidemiologist Katelyn Jetelina and former guest host Dr. Bob Wachter, to answer your questions about indoor dining, outdoor transmission, and how to keep kids under five and those who are immunocompromised as safe as possible. After you finish listening, head over to Twitter and tell Andy who you think won: #TeamKatelyn or #TeamBob.

Description

Omicron came and flipped everything we thought we knew about how to act during COVID up in the air. It also made another edition of Safe or Not Safe necessary. This time around, Andy brings in two new contestants, epidemiologist Katelyn Jetelina and former guest host Dr. Bob Wachter, to answer your questions about indoor dining, outdoor transmission, and how to keep kids under five and those who are immunocompromised as safe as possible. After you finish listening, head over to Twitter and tell Andy who you think won: #TeamKatelyn or #TeamBob.

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

Follow Katelyn @dr_kkjetelina and Bob @Bob_Wachter on Twitter.

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• Throughout the pandemic, CVS Health has been there, bringing quality, affordable health care closer to home—so it’s never out of reach for anyone. Because at CVS Health, healthier happens together. Learn more at cvshealth.com.

Check out these resources from today’s episode: 

• Check out all the organizations that In the Bubble’s host profits have gone to: World Central Kitchen, Navajo & Hopi Relief Fund, Central Valley Community Foundation, Safer Foundation, Sakina Halal Grill, YWCA Minneapolis, Get Us PPE, Still Kickin, Community Foundation of Northwest Mississippi, Survivor Corps, International Rescue Committee, Black Doctors COVID-19 Consortium, and Invisible Hands Deliver
• Check out all of Katelyn’s posts on her Your Local Epidemiologist Substack: https://yourlocalepidemiologist.substack.com/
• Read more on the likelihood of getting long COVID if you’re vaccinated, using data out of Israel: https://www.nature.com/articles/d41586-022-00177-5
• Here’s more on what Israel is learning about a 4th dose of the mRNA vaccines: https://www.nytimes.com/2022/01/25/world/europe/israel-fourth-covid-dose.html
• Find a COVID-19 vaccine site near you: https://www.vaccines.gov/
• Order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response: https://us.macmillan.com/books/9781250770165

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/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Dr. Bob Wachter, Kim, Katelyn Jetelina

Andy Slavitt  00:18

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. We have an exciting show for you, one you’ve been waiting for your entire life. Which is if that is you knew what Omicron was. And if your entire life you wanted to hear a silly game show about how to stay safe during Omicron. It’s actually our Safe or Not Safe episode around Omicron. What makes the world safe and what doesn’t it is tons of your questions, tons of your questions that I run by, two great people. Katelyn Jetelina, Lena, who I just think is marvelous. She goes by your local epidemiologist. She’s at the University of Texas. He’s an assistant professor, she’s great. And Bob Wachter, who many of you know and love, for good reason, he is at UCSF, He is the chair of the Department of Medicine. And let me just say that Katelyn gives him run for his money, you know, the way this thing works, you’ll hear, but you’re gonna have to decide pretty quickly whether you are team Katelyn, or team Bob, team Katelyn or team Bob, just you’re going to be making your decision. Feel free to light up Twitter, with your choice throughout this. But really, I think it just been our creative way of bringing you the information that you need to stay safe during Omicron.

Andy Slavitt  01:35

Let me expand the dialogue before we get going to talk a little bit about overall response, policy response to where we’re going next. Because there’s been a lot of noise about back to normal, this thing’s over. Let’s take off the masks. There’s been a lot of people saying, well, gee, that’s a little concerning. Don’t things turn around quickly, there’s been some noises from the WHO in Europe about letting go guidelines even in San Francisco, as things seem strapped, so let me tell you how I look at that. And think about that. First of all, individually, there really are very few wrong answers. You know, if you feel comfortable dining indoors, if you feel not comfortable dining indoors, if you’re really worried about getting COVID If you’re not so worried about getting COVID. There’s things in your life that you’ve been missing, that you wanted to take more advantage of, understanding, particularly if you’re vaccinated, that you can do those things, you’re not going to put your life in danger, that there are those things that are worth doing. And if you feel a little more reluctant, that’s okay, too. And try, it’s hard not to criticize people for having different points of view.

Andy Slavitt  02:48

The only rub in that the only difference in that is I think I just think it’s most of you listening and probably agree with this. It’s just irresponsible to put other people at risk. So if you find the average person who says I don’t mind getting COVID That’s their business. But if they do things that are reckless to put so that other people might get sick, well, that’s where we should step in with some form of modest and reasonable protections. That’s why recording vaccinations in certain venues and requiring masks and other venues during key times is important. But we should be judicious. And I think the more that this becomes less life threatening, and I’m not saying that we’re there, and then certainly is the life threatening to people who are unvaccinated and to other people that are frail. But the more that it becomes into that category, if it does move into that category, and the more people have choices, i,e. can I get vaccinated? can I protect myself, you know, the less you probably will need to end up worrying about these restrictions. Coming out a pandemic is challenging when we’re at that point, because you don’t really know you’re out of it until you’re long out of it. And so, you know, taking down steps is as hard as putting steps up. And so my view is if we do start to see cases drop significantly as we will, two things that I have to say about that.

Andy Slavitt  04:13

The first is that when cases go up, we are always more doom and gloom than we probably should be. And when cases are dropping, we’re always more optimistic than we probably should be. So the talk tends to bounce a little more to the extreme reaction because this is just a roller coaster. And that’s what you do in these roller coasters. But also say that, as things come down, we absolutely should be comfortable taking down some of these barriers societally, again, doesn’t mean their individual choices can’t reflect our own individual needs. But that’s certainly the case. I also just would continue to point out that everything good we have is worth working for. So we value in person learning in school, which we all do, then in the right moments when you need them, masks are a way to do that, they’re a small price to pay, no one loves them. No one wants to wear them forever. But in order to be able to do things that don’t put other people at risk, like teachers, or other students and their families, that’s why that’s appropriate. Now, there’s a lot of people that would say, but that impedes on my rights and rights of my child. And, you know, why should I carry the obligation of society based upon my kid, my decision. You know what, there’s room for disagreement, there’s room for hopefully, respectful disagreement on some of these things. But that’s how I think about it.

Andy Slavitt  05:48

And I think, you know, it is psychologically sometimes difficult to get used to reduced restrictions. But you know, we all want to be there. And we will be there eventually, they say, can’t say when can say what will bounce up and down, I did put a tweet thread out about how we will know a little bit you can look forward, it’s about Florida, I think what we see in our historic Florida bump in the summer in cases, that’ll be a good tell for us as to whether or not the kind of immunity offered is the kind that will really protect us and protect us more going into the fall weather will protect us from, okay, I need your help with one other thing, we have a very weird problem. We have $40,000, we have to give away to COVID relief causes. For those of you who don’t know, IN THE BUBBLE gives away my share of the money that comes in from the show. Because you listen to it to people who are doing great things to help people cope with relief. And at the end of the year, a lot of people listen to thank you very much. And now we’ve got to give out $40,000 to organizations that are doing something to help people in need COVID relief, we have a great list of organizations we’ve given money to you can see that list, if you look at the show notes, but please leave a tweet after this episode. Go in and just enter your favorite organization, one that you think we should be donating this $40,000 to, thank you for your help. And thank you for listening. So now we’re gonna get to our show, and it is going to be fun. I want to see who does a better job answering your questions. Team Katelyn, or Team Bob?

Andy Slavitt  07:48

Well, it’s so good to have you both, I think, safe to say, a massive upgrade from prior Safe or Not Safe episodes.

Dr. Bob Wachter  07:59

Yeah that goes without saying.

Andy Slavitt  08:03

I think people have had enough of Farzad Mostashari. And it’s a great pleasure to bring actually two of the people that are most beloved by in the bubble listeners, Bob Wachter, who tried to impersonate me for a few months from UCSF, who I think is known to everybody who’s been following the pandemic. And I welcome, Bob, you’re contestant number one.

Dr. Bob Wachter  08:26

Thank you, Andy. It’s great to be here. I remember when you came back in May and I asked you what was going to become at this podcast as Covid went away. So we see how good I am at prognostication, but let’s try it again.

Andy Slavitt  08:38

What is it Yogi Berra said, predictions are hard, especially about the future. And now  I’m going to introduce the winner of today’s show. I guess I shouldn’t give that away. And it is your local epidemiologist. Maybe your favorite epidemiologist too, Katelyn Jetelina.

Katelyn Jetelina  08:54

Yeah. Thanks for having me. I’m excited to be back.

Andy Slavitt  08:56

So for those who haven’t listened to safe or unsafe before, it is our game show where we ask your questions that you have sent us directly to our two contestants. They give their answers and then I come up with some on the fly scoring system to tell you why Katelyn won. I mean, who would have won. So let’s dig in. And some of these are going to come directly from me somewhere from voicemail. Okay, first question. First question for both of you comes from Dana Dean. She asks, previously, we were advised that a vaccinated person being with a group of people who are also vaccinated was pretty safe. What are the risks of transmission between fully vaccinated and boosted people with Omicron? So let’s start with you, Dr. Wachter. And by the way, that’s the last time I’m gonna call you doctor on the show just for simplicity.

Dr. Bob Wachter  09:46

That’s fine. So early in the vaccine era of the pandemic, there were proclamations that vaccinated people could not spread the virus and those were very heady days. There, it’s no longer true. So we’ve seen by the number of breakthrough cases by the fact that we all know people who’ve been vaccinated and gotten infected, that vaccinated people are fully capable of getting infected, that the amount of virus they carry and their ability to infect is somewhat lower, probably by virtue of two things. One is, they are somewhat less likely to become infected, although clearly not zero. And they transmit a little bit less. But I don’t think the ground rules we used a year ago where a vaccinated person is perfectly safe to be with, we can’t use any more particularly at a time like this where Omicron is so incredibly, it’s really raining Omicron almost everywhere, getting a little bit better. But still, there’s a lot of Omicron around. So the bottom line is, if the only way you’re deciding that someone is safe is that they’re fully vaccinated. That’s no longer good enough. They’re capable of having the virus and infecting others.

Dr. Bob Wachter  10:03

So I’m going to ask this to Katelyn, and I’m going to put a little extra spin on it, given how much more capable you are the Bob, which is, does the implication that this spreads among vaccinated people also mean that whether you’re vaccinated or not as more and more your business, then other people’s business? In other words, why should we care if other people are vaccinated if their vaccination status doesn’t have that big an impact on us compared to our own vaccination status?

Dr. Bob Wachter  11:25

I love the fact that you throw the political part into her. Thank you, Andy, I appreciate that.

Andy Slavitt  11:29

You’re not off the hook.

Katelyn Jetelina  11:30

I think it’s a really good question. You know, I actually still have hope that our boosters do reduce transmission to some point, whether it’s reducing infection altogether. Or even if you get a breakthrough infection, you clear the virus much quicker than in vaccinated. And so I do hold out that, you know, vaccines will reduce transmission to some point, but it certainly isn’t going to be what we saw in the beginning. I think the other really important thing is that, yeah, you know, a vaccinated person is safe, and they have a very nice bubble around. But on a population level, that’s not necessarily the case. And so, it really depends how we look on an individual level or as the community level?

Andy Slavitt  12:21

Well, let me ask you to individual level Katelyn, if you’re vaccinated, if you’re around other vaccinated people, indoors, people, you are positive are vaccinated. Do you still feel the need to wear a mask?

Katelyn Jetelina  12:31

I don’t wear a mask with a vaccinated people that I trust, who I know are boosted.

Andy Slavitt  12:38

And what about you, Bob?

Dr. Bob Wachter  12:40

It all depends on the context. It really, let’s take San Francisco, for example. Last week, about 1 in 10 asymptomatic people were testing positive. So these are people who feel perfectly fine. When we parse that at UCSF and looked at vaccinated versus unvaccinated. It wasn’t that different, maybe about. Maybe about one in 15 vaccinated people were testing positive. So they feel perfectly well, they’re nice people, they don’t want to infect anybody, but they are still carrying the virus. So I am less confident in an environment where there’s a ton of COVID around, I’m less confident that if the only measure I have of safety is that the fact that is the fact they’ve gotten three shots, I’m just less confident that that’s a perfectly safe environment. I still do it without masks with very small bubbles of family members, basically. But if it’s any larger bubble than that, if we’re getting together with five or six or eight people indoors, that is where I think the role of testing comes in this will all change if the prevalence of the virus goes down tremendously as it’s likely to do in the next few weeks.

Andy Slavitt  13:51

Got it. Well, so I love it. We have slightly different answers for both you which reflects, I think, slightly different risk profiles. I don’t think it reflects a difference in understanding of the facts. I think it’s important that people who are listening understand that their own assessment. It requires some of that judgment. Let me ask the next question. And I’ll start with you, Katelyn, because you’ve written about this recently. It’s from Wendy […] She asks, how concerning is the new mutant, the stealth Omicron that has been raising its menacing head in various countries? I think she’s actually hinting at her own answer by saying menacing.

Katelyn Jetelina  14:29

Yeah, menacing. You know, I’m not that concerned about it. You know, we have preliminary evidence that shows that yeah, this is a sub variant. It’s a sister lineage we need to pay attention to particularly because it looks like it’s more transmissible than BA.1. But we do have preliminary evidence from Denmark that this very doesn’t look to be any different than the original Omicron variant and we think that the vaccines will still largely work. And so to me, that’s really good news. To me, it tells me that we’re probably may have our waves kind of strung out a little longer than we expected. But in the end, this is still Omicron, we’re still going to be falling in our descent. I’m much more concerned about another variant popping out of nowhere, like Omicron did after Delta.

Andy Slavitt  15:28

So your concern level sounds relatively low. Bob, what about you?

Dr. Bob Wachter  15:31

Yeah. A low-ish. I mean, it’s gonna be very confusing to people, because they’re gonna hear from all of us, it looks like Omicron in the way it’s acting in terms of severity and an immune escape. And yet, if it’s winning the race against Omicron version one that it must be somewhat more transmissible. So I’d say that’s a little bit worrisome. It also, you know, for those of us that have been saying, it’s sort of hard to believe that something could come out and be even better than Omicron was at its job of infecting people that the answer is okay. There is something already, that may be a little bit better than Omicron at infecting people. So I’m more worried, as Katelyn says about what it means about the future and will there be other variants that do their jobs better than Omicron, then specifically about this one, it’s probably just going to be a slightly better version of Omicron. But as long as the vaccines work and the immune escape isn’t very large, and the severity remains lower, no indication that any of those things are not true, then not very worried about it.

Andy Slavitt  16:32

Okay. So the next question is from Robin […]. I hope I pronounced it right, Robin, she asked, is there any evidence of Omicron behaving differently outdoors? Can we assume that small, unmasked outdoor gatherings are still safe? Bob, why don’t we start with you?

Dr. Bob Wachter  16:52

Yeah, I don’t think there’s good evidence of a lot of outdoor transmission epidemiologic evidence, but I guess I approach this as this virus is better at infecting people than what it replaced. So the general rule that outdoors is completely safe, I have tempered my thinking about that a little bit. There’s really nothing about outdoors that makes it completely safe other than a larger volume of air, and the fact that it’s usually a little bit windy. So if I am in a space outdoors, where there’s a lot of room around me, and I’m walking the dog, I don’t wear a mask, for example, when I’m walking the dog, but if I was at an outdoor cocktail party face to face with people, I would now have a little tiny concern about getting infected with Omicron in a way I would not have had with prior viruses just because it’s better at infecting people, either because it’s better at latching on to cells or it’s better at evading your immunity. We’re still not exactly sure what the overall mechanism for being better at infecting people. But I think it makes outdoor situations a little less safe than they were before. So safe outdoor situations I’m not worried about but ones with in very close quarters. I now I’m a little more careful than I used to be.

Katelyn Jetelina  18:04

Yeah, you know, I very much agree with Bob, I think these questions are really difficult too, because it depends when we are in this wave. And when we’re not, you know, once we make it down Omicron in transmission is really low, outdoors are going to be super safe. And I don’t think we need masks. But right now we’re at the top of the Omicron wave. Yeah, if you’re shoulder to shoulder with someone outside, you need to be wearing a mask period. If you’re walking your dog, I don’t think that’s necessary

Andy Slavitt  18:35

I went on a hike on Saturday, I’m going to tell tale on someone who listens to the show friend of mine, let’s say his name is Steven, it actually is Steven. Sorry, Steven calling you out more making funny. But he had allergies, or so he claims. And so we were going on a hike with Steven and his wife and Lana and I and he kept sneezing and we were walking next to each other and he just kept close to me. And I was like I kept slowing down or speeding up or doing everything I could to come in that. And because like I’m much more conscious of somebody sneezing on or near me, even if it’s an allergy that I ever was in the past. And it just it had this weird sensation of almost like the affiliate, when you see someone run a red light. You’re like, oh, it’s something your brain tells you something’s wrong here or someone sneezing near me and if you’re outdoors, like that has me going okay, I’m uncomfortable.

Dr. Bob Wachter  19:30

Yeah, I think we should bring Steven on to see how he felt about the hike with you because it probably wasn’t all that much fun having you run off the trail all the time. I think that you know, there’s a part of our brain that has just been PTSD over the last couple of years and that little fight or flight reflex is now very finely tuned to see a threat and be scared of it. Which is why getting back to normal is really hard for people because you’re still processing all of the trauma over the last couple years. That is not completely irrational. And the reason is not that Steven sneeze was necessarily a symptom of COVID. But as Katelyn said, when the prevalence is so high in our community, there may be at the peak of the Omicron surge, there was probably about a one in 10 chance in many cities, that someone who feels perfectly fine has COVID. And if that person is sneezing, whether it’s from their allergies or from their COVID, that is a that increases the level of transmission in the same way that you know, you could be near someone if everybody’s sitting silently the risk is substantially lower than if everybody’s singing or shouting. And so it’s not completely irrational for you to have taken that head dive into the rosebush. Every time Steven sneeze.

Andy Slavitt  20:50

If you knew Steven, you may have done the same thing.

Andy Slavitt  21:26

Ruthie Smith asks, and I’ll put this one to you, Katelyn, first, should we be holding back on travel while Omicron is spreading? Or is it still safe? It’s still a safe travels before? What precautions should we taking if we do travel? Katelyn, what are your thoughts on travel during Omicron?

Katelyn Jetelina  21:43

Yeah, you know, it’s another good question. It’s not as safe as before, because if you’re going to the airport, there’s lots of transmission, you’ll be walking through SARS-CoV-2 clouds basically. Now, the risk that someone wants to take is really up to their risk tolerance. You know, I’m a moderate risk taker, I will say, and I traveled at the peak on an airplane of Omicron.

Andy Slavitt  22:13

Did you feel differently than the peak of Delta? Did it feel more scary, less scary? About the same?

Katelyn Jetelina  22:20

I don’t know if it was more scary to me, but I was definitely like, this risk is high, I felt like the risk was high risk is higher. Yeah, risk was higher. And you know, I’m not I’m actually not very concerned about on the plane travel, like in the air, I’m a lot more concerned going to and from an airplane. And because, you know, a lot of people are taking off their masks, they’re talking, they’re eating blah, blah, blah. And if you don’t have the best filtration in a terminal or an Uber, then you do compare it to on the plane. So yeah, I mean, there’s moderate risk to it. And you have to balance that risk with the quality of life that travel brings you. If you are dreading to go see grandma, then just cancel the flight and blame it on Omicron, right? But if you really need that travel to go see grandma that’s dying on the other hand, you know, it’s an it’s a different resets that people are willing to take.

Andy Slavitt  23:17

I wouldn’t fly to see Steven, my life depended on it. Okay, Bob, just enter maybe just this way, the one element of the question, do you feel it’s riskier relatively speaking to travel during the peak of Omicron versus Delta?

Dr. Bob Wachter  23:33

Riskier if you look at the chance of getting infected, and then less risky, if you do get infected, that something terrible will happen to you? And I think those two things sort of cancel each other out. In a way?

Andy Slavitt  23:46

I guess it depends on what matters more, what you’re more concerned about.

Dr. Bob Wachter  23:49

Yeah. Yeah.

Katelyn Jetelina  23:50

Well, if you’re healthy, and boosted right now, it’s different than if you’re unhealthy.

Dr. Bob Wachter  23:56

Yeah, I think it’s, you know, someone who’s gotten three shots. think the other twist on with Omicron is once we saw the curve in South Africa, Andy, and you know, saw, I’d go up and come down super-fast. It felt like, okay, this is a two-month period of badness. And therefore, travel that is truly elective. I’m going to put that off. Why risk it because as we talk about the risks during the surge, and not during the surge, people get very confused. And they think somehow, the virus is going to change or your immunity is going to change, none of those things will change. The thing that changes is the chances the person sitting next to be in the airplane is infected. And so in some ways, my feeling has been why do it for things that are elective when you can delay it if you can, if you have to travel, I think if you’re wearing an Nl95, or the equivalent, you’ve put yourself in a situation where you’re very safe and on an airplane. Recognize there’s that period where it turns into a flying restaurant where it’s really going to be important to have your mask on. If you do that I don’t see travel as being you know, unduly risky, but again, why do it, why put yourself at elevated risk while the prevalence is so high if it’s going to go down in a month?

Andy Slavitt  25:05

Got it. Okay, here’s a question from Carla. And what she’s basically asking is, is indoor dining safe, but she has a twist she puts at the end, she adds, my husband is tested regularly for work, and would lose income and projects with a positive test. So, quote, unquote, not dying is not the only goal. Really interesting twist that I think reflects a lot of people’s personal situations now, where being out is costly. So given that, is there a threshold that we can look at, and I assume she means a prevalence or something for us to let loose a bit? In other words, she may not live in the warm climes of California, like you, Bob or Texas, like you, Katelyn, and she wants to go out and have a dinner once in a while. But she’s got this concern that even if her husband gets infected, that’s a really bad thing for them. I love this puzzle. What do you think, Katelyn?

Katelyn Jetelina  26:05

I wouldn’t risk it right now, with the high wave. Yeah, it’s very possible to get Omicron inside while you’re eating at a restaurant, especially if those tables are close, especially if ventilations are not good. Order out order Uber and Uber Eats, or go sit on the patio? I think there’s other options. And this goes back to what Bob was saying, is that is it truly needed? Because you could get infected. And that could then impact your livelihood.

Andy Slavitt  26:36

Is there a threshold under which you change your answer? Like, what does that look like?

Katelyn Jetelina  26:40

Yeah, there is a threshold. So when I say transmission is low, that is, you know, less than 10 cases per 100,000 in a location or low TPR, test positivity rate. I will say, though, going forward, we’re really going to need to recalibrate our surveillance system because that testing rates and those case numbers are not going to be as accurate anymore.

Andy Slavitt  27:04

Given that home tests, etc. But what do you think? Do you agree to agree with Katelyn or is she dead wrong?

Dr. Bob Wachter  27:09

Well, let me start with where you’re dead wrong. Andy, I live in the Bay Area. So it’s not as warm as you folks who are who are luxuriating in Southern California, it’s freezing here. But freezing, I mean, it’s 50. I ate out last night on the outdoor patio with heaters of a restaurant that we really like. And I will not eat indoors until the case has come down to a level similar to the one that Katelyn stated again, you know, do I need to do it this month? The answer is no, I’m happy to put it off until the cases are lower. The issue of how reliable the case rates are, is a real one. So 10 cases per 100,000 people per day has a very different meaning in the world of a lot of home testing, where you might be missing two out of three cases. But still, the curves are going to be reliable. You know, when you see cases, down to a 10th of what they were at the peak, if that’s 10 cases per 100,000 per day. And you know, in your heart of hearts, actually, it’s really 15 because we’re missing some or even 20, it’s still low enough level, that the chances that the waiter or my dinner companion has COVID has gone down by orders of magnitude and makes indoor dining much safer. It’s just not safe now, if you don’t want to get COVID and I still do not want to get COVID if I can avoid it.

Andy Slavitt  28:30

The dilemma here of course is he may be where you live, Carla, that it’s safer to eat indoors when it’s warmer outside. And when it’s easier to eat outdoors. That’s unfortunate. Hopefully, you won’t have to wait that long, hopefully in the spring, a combination of the weather and lower prevalence, somewhere around 10 cases per 100,000. Will I eat indoors? Cindy Johnson asked questions on so many people’s minds. I hear it so much. And maybe I’ll start with you, Katelyn. And she wants to know whether or not there’s data now to support whether or not people who are vaccinated and boosted are getting long COVID to the same degree as people who are not. Cynthia has heard that there’s one study from Israel, showing a very low risk of long COVID among people who are vaccinated and boosted. Is that true? And do we have any additional data yet from South Africa?

Katelyn Jetelina  29:32

That is true. Vaccines reduce the chances of long COVID And that’s because, one, you can’t get long COVID If you’re never infected in the first place, and then two if you get a breakthrough case, we think this is what the hypothesized pathway is that you have less infectious virus you have a less infectious load, viral load, which helps not infiltrate your org So you don’t get long COVID I haven’t seen and maybe Bob has the latest data on boosters and the difference between being boosted and not boosted in long COVID. But I would assume that the more antibodies you have, the more protection you have the even less likely as long COVID as a more of a dose response relationship. But I’d love to hear what Bob has to say.

Dr. Bob Wachter  30:23

Yeah, that’s my, there have been a few studies in the last couple days on this issue. And I believe they certainly have exactly confirmed what Katelyn says about the value of vaccination in decreasing the risk of long COVID. And I believe I saw one that said that looked at boosters versus two shots and saw additional value, I’d have to go back and take a look at that. You know, I go into this feeling that vaccination for both of the reasons Katelyn said less likely to get infected, and also less likely to get long COVID If you do get infected lowers the probability of long COVID a lot, not to zero. So the number I float around in my brain, which is really a commission of a lot of different studies, is 5%. That there’s maybe a for a fully vaccinated person, there’s probably a one in 20-ish chance that you’ll still feel crummy in one way or another a month or two from now. And in fact, making all of your risk benefit decisions, I think you have to say it’s not a zero chance, it’s not super high. But there’s some small chance that you could still get a case that lingers. And it is one of the reasons why when we had all this discussion a couple of weeks ago, is it inevitable you’re going to get Omicron? I’d say first of all, I don’t think it is the best data says that maybe 40% of people will get Omicron at least during this wave. And it’s possible to avoid it. And if you can, you’re better off in part because this small but not zero chance of getting long. COVID.

Katelyn Jetelina  31:53

Andy, I’m just gonna add, I think the other really fascinating thing that we’re seeing in the data is that vaccines are helping, if you had long COVID, and then you get a vaccine, it looks like about 30% to 40% of people symptoms are alleviated, which I think is fascinating, maybe that the vaccine is kind of re-amping the body. And now that’s not everyone. And so that tells us that long COVID is being caused by multiple different pathways. But I still think that’s kind of a cool addition, if you have long COVID.

Andy Slavitt  32:29

Okay, good. Got about a dozen or so more questions here. Maybe a few more. So the right out of square, by the way is tight 18 to 18. For those of you been tracking, it’s an incredibly close. And now we’re gonna give extra points for helping me get through more of these questions. So you’re gonna get more points for hitting it a little bit quicker. It’s a new rule change. It’ll be tough on Bob because he’s a doctor. He likes to talk. That’s not gonna work for me. I’ll talk faster. You just lost a point just for interrupting there. Okay. 18 to 17. Okay, Sally Noel. Bob knows I love him. He can have a point back anytime he wants. Just anytime you want. You can get that point back. Okay, Sally, she is a small business owner. She has a really interesting question. She’s been asking for proof of vaccination. For people who come in house, he teaches yoga studio, which is question about whether or not she should also be willing to accept people who have natural immunity from prior Omicron infection, equally. She knows a lot of local people who haven’t received the shots and weren’t affected. And so that’s part one question. And then I think she also has some other questions around how testing might factor into that. She hates excluding people. But of course, safety is number one. But I think there’s this broader justification question of people with natural immunity. Okay, tough question to answer in a short time, but this is your challenge. We’ll start with you, Bob.

Dr. Bob Wachter  34:06

No. That was a long question, Andy. So I should have a little bit longer more time for the answer. Is your infection the equivalent of three shots? No. It gives you some protection. We don’t know exactly how much a lot of it depends on how severe the infection was and when you had it. And because of that lack of predictability. If you’re going to check people’s vaccination status, it’s safer to be sure they got vaccinated. If you did have an infection, you should also get vaccinated. So one of the rationales for checking is to try to encourage people to get vaccinated even someone who had an infection should get vaccinated.

Andy Slavitt  34:46

And where would you put testing in that, if someone was previously affected, and showed a positive, showed a negative test? Would that change your answer?

Dr. Bob Wachter  34:55

Let me try to understand the question. Previously infected, right?

Andy Slavitt  34:59

Previously infected, they’re not vaccinated. They don’t have a card at least. But they can show up, they can show a negative test.

Dr. Bob Wachter  35:06

I don’t think the I don’t think the fact of their prior infection is all that relevant. I think the essence of the question for some of the prior infection or with vaccination is a negative test, a reliable measure that you are not infectious at that moment. And the answer is, if you did a rapid test within a few hours of coming into the space, it markedly lowers the probability that you were infected, but does not bring it down to zero. And we’ve seen that with Omicron.

Andy Slavitt  35:34

I think this question will make an excellent SAT question. With a logical reasoning a little bit of a story problem. Okay. Katelyn, do you have an answer?

Katelyn Jetelina  35:43

Yeah, I would, I would actually accept an antigen test within the last I don’t know two hours before the yoga class, if they weren’t vaccinated. And I think the more interesting, or I guess I’ll stop there. So I get a point.

Andy Slavitt  35:57

Oh, man.

Dr. Bob Wachter  35:58

Oh, I didn’t realize we were playing hardball. This is different. All right. Throw down the gauntlet.

Andy Slavitt  36:38

Melissa Wolf, how do you stay safe in a work environment where there’s no mask requirement, and no limit on the amount of people in a conference room. My work has been removed from us two years, and now they’re ready to go back to the way things were pre-pandemic. I’m concerned that my N95 mask will not keep me safe enough around the unmasked. What about eating lunch? Okay, Melissa Wolf’s question. Okay. What do you think, Katelyn?

Katelyn Jetelina  37:02

Yeah, the N 95 is gonna work great to protect yourself. And it’ll also help protect those around her, period.

Andy Slavitt  37:08

What would you do for lunch?

Katelyn Jetelina  37:09

I wait, what I do at my own work and be a loner and eat in my office. But that’s what I would do.

Andy Slavitt  37:17

Interesting. Bob, note the tight answer, Bob.

Dr. Bob Wachter  37:21

Yes, for lunch, I think I’d have a ham and swiss sandwich. In terms of the actual question, I think it all depends on the prevalence. So we may find ourselves a month from now with case rates that are low enough that it’s perfectly fine to and safe to be inside with colleagues not wearing masks much, much safer if everybody’s had three shots. So there’s an argument there for vaccine requirements, which will make an indoor maskless gathering much safer than it would be otherwise. But if the case rates get down really low, and we can’t count on this forever, but I think we probably will be in the situation at least next month, then we may be in a situation where taking the mass off and acting in an indoor space, like it’s 2019 is a reasonable thing to do.

Andy Slavitt  38:09

Okay, good. Well, you’re actually both doing so well, that I’m going to throw another proposed rule that game to make it that much harder. From now on, you could no longer say it depends on the prevalence, there’ll be a five-point loss, if you say depends of the prevalence.

Dr. Bob Wachter  38:26

If we say depends on the number of cases or something, can we just use a different word?

Andy Slavitt  38:30

So you can try that? Okay, thanks. Christy asked my booster’s five months old. Will there be another booster for Omicron? And when? What do we know about this, Katelyn?

Katelyn Jetelina  38:42

So we know that clinical trials started with Omicron vaccine. And I am not convinced at all that we need an emoticon specific variant booster. Once we have the available those vaccines that will be passed Omicron I think the much more important conversation and scientific debate we need is how do we predict when we need that next booster and what that booster formula is. And that is something I don’t have an answer to.

Andy Slavitt  39:13

Okay. Fair enough. Fair enough. Bob?

Dr. Bob Wachter  39:17

Yeah, we may have a little bit of data to answer that question just in the last day.

Andy Slavitt  39:30

Yeah, go ahead.

Dr. Bob Wachter  39:31

So Israel, which is testing the fourth shot that the second booster in people over age 60 reported last week, that they weren’t seeing much of a benefit. They were seeing a benefit in antibodies but not a benefit in terms of preventing cases or preventing severe cases. On Sunday, the Ministry of Health announced that they were seeing a benefit that’s the only data that we have got it hasn’t been published anywhere but the better benefit that they cited was a twofold reduction in symptomatic cases and a threefold reduction in severe cases. If that turns out to be true, and it’s not ready for primetime yet, we have to wait to see the data. But if that turns out to be true, then it’s a reasonable thing to be thinking about a fourth shot, the challenge is going to be I’m losing points up the yin yang here, because this is actually complicated, but I’ll give it a try and you can cut, the challenge is going to be something we call in medicine number needed to treat. Meaning if you’ve had three shots, the chances of a severe outcome may be so low, the chances of dying are infinitesimal, the chances of needing go to the hospital very low, that even a threefold reduction may not be clinically that meaningful. So if my chance to go to the hospital is 1 in 1000. Is it worth me getting another booster to lower that to 1 in 3000? The boosters are perfectly safe. The answer may be yes. But that’s very different than if the chance was one in 10. And I’ve lowered it to 1 in 30. That’s the issue.

Andy Slavitt  41:03

I don’t know, what you think, Katelyn. And I thought that was pretty useful use of time. What do you think?

Katelyn Jetelina  41:07

I think so. No points docked.

Andy Slavitt  41:10

No points. I completely agree.

Dr. Bob Wachter  41:12

But no, no, plus points. Just no points docked.

Andy Slavitt  41:15

Too much. All right. Okay, Kim from California, she has so many questions. And the big one is about kids, and how to keep kids safe in the next few years.

Kim  41:25

We have two kids six and three. And they’ve been in virtual school, they’ve missed indoor activities. For two years, we’ve tried to shield them from what’s going on. We went to an outdoor playdate. At the end of December. And afterwards, my vaccinated six-year-old tested positive for Omicron. We didn’t step foot inside. And I guess I’m just wondering, you know, we want to be part of the world. We want to send them to school. And we just want to know, how do we move forward? And what’s the new name of the game as far as letting kids live their life, but also keeping them safe? Thank you so much, bye.

Andy Slavitt  42:03

Both of you have kids, I believe, and one of you has a well-chronicled case of COVID among your kids, although your kids are little bit older, Bob? And Katelyn, yours are undoubtedly younger.

Katelyn Jetelina  42:16

Yeah, two under two and a half.

Andy Slavitt  42:19

So maybe we’ll start with you, Katelyn.

Katelyn Jetelina  42:23

That’s a really tough question. You know, what I’m holding out for as a parent, is their vaccine, we’re hearing mumbles that a vaccine data should be coming out in February. I’m kind of not holding my breath until summer, though. And so what I’m doing is keeping them a little bubble around them as much as possible, that meant going to finding a daycare that does masks and make sure everyone’s vaccinated and you know, that they’re going to have to go to child care, but we can make it as safe as possible. That means not going to the trampoline park, but going outdoors to the park at you know, the regular park all the time. So, you know, the name of the game, for me at least is waiting for their vaccine and keeping them as safe as possible until that gets to that point, or we reach an endemic state. And it continues to be an impossible landscape for us parents to navigate, especially those with us, you know, under five.

Dr. Bob Wachter  43:25

Andy, I want to point out the skill there, the skill there is when she says until we reach an endemic state. That means a low prevalence, but she’s managed to avoid the point loss by saying low prevalence. Very, very, very impressive.

Andy Slavitt  43:38

I think so. Very artful. Is it reasonable, Katelyn? I think there are parents out there who say, You know what, my kids are two and five, putting a mask on them is ridiculous. The chances of them being sick, or say but very opposite attitude. Is that also reasonable? Or would you say that that’s a problematic perspective?

Katelyn Jetelina  44:01

It is, no, I don’t think it’s problematic. It is a reasonable perspective. I think that you know, some people have a numerator perspective and some people have a denominator perspective. But it is reasonable and there is questions you know, my two-and-a-half-year-old doesn’t wear a mask well at all so that it’s not going to really be helping anyone but we can help in other ways. I think the other important point again goes back to yeah, their individual level of risk is low if they’re healthy, but they are very good vectors for this disease and this virus and they are a part of our community and can reach unbought in vaccinated and unprotected pockets.

Andy Slavitt  44:44

I thought it was strange that you named your daughter Vector but whatever. Okay, Bob?

Dr. Bob Wachter  44:50

I think it was a good if it was a boy it would have been Victor. And so yeah, yeah, I’m first of all, I’m glad I don’t have little kids now. This has just been brutal and all of this complex decision making, you know, you can look at that, as you pose the question, Andy, I think, you know, the risk to an individual kid, even if they get COVID is exceedingly low, we know that there is this lingering uncertainty about long COVID. And in this case, I don’t really mean the long COVID As in you feel fatigued a month or two from now it’s what is the impact of an infection on vital organs years later. We don’t know the answer to that it can’t be very high, but it may not be zero. And if I was a parent of a young kid, I would also be trying to avoid infection to the degree feasible. And then that the question is, how feasible is that? And what is the cost? We’ve clearly learned that virtual school take carries a very, very large mental health cost on the kids, and learning costs, too. So it’s almost an impossible question. And then it’s gotten so politicized, that it’s very difficult to have kind of a rational conversation about it.

Andy Slavitt  46:00

Elizabeth has a very specific question. It’s a good follow up. And she happens to have a seven-year-old is in first grade and is vaccinated in the four-year-old in preschool who obviously isn’t yet. Her question is actually really, I think, a great one. And I’ve been asked this by school boards, different parts of the country. It says she says, for each of them, she wants to know when we can start to discuss benchmarks for de masking in school settings. And what should those benchmarks be? If you were advising a school board? What would you say? Is the right moment to change their mind if they’ve been masking to say that they no longer need to mask? The same prevalence question as before? 10 per 100,000.

Katelyn Jetelina  46:43

I think it’s low transmission. I think we’re also going to get to a point where everyone’s kind of had an option to go get the vaccine too. And we’re going to get to a point where they’ve had that opportunity to be protected or not. And so yeah, I don’t know.

Dr. Bob Wachter  47:07

Yeah, no, I think that’s right. I think yeah, I don’t think the case numbers differ in terms of everybody’s sort of willingness to take their masks off and congregate indoors, I think the kids are the same as adults, the kids in some ways, the cost of masking is higher, their risk of a bad outcome is lower. And so you might argue that the threshold can be even a little bit higher than it is for adult D masking. But probably a similar order of magnitude, the cases have to be lower than they are now. And the issue that Katelyn raised is really a fundamental issue. At some point. It is rational to say anyone who is unvaccinated and obviously the kids didn’t make the choice themselves, their parents made it for them. But anyone who was unvaccinated it has not been for lack of the ability to the availability of vaccines. And the risk is largely to those people that people who are fully vaccinated are really extraordinarily safe because of the magic of the vaccines.

Andy Slavitt  48:09

Okay, questions that have an explanation mark in them carry five points. And we have one from Cassandra Whitman. And these are really the how the hell does this make any sense type of question. So the five points, Sacramento County Public Health in California is allowing vaccinated children to attend school, even if family members have tested positive, no negative tests required as long as they don’t have symptoms they must attend. How does this make any sense as a policy to slow the spread? Question mark exclamation mark, Katelyn?

Katelyn Jetelina  48:40

I mean, technically, that’s right, though. I mean, according to the CDC, if you’re fully vaccinated, it sounds like that those kids are and they were exposed. They don’t need to isolate. So I actually agree.

Andy Slavitt  48:56

But does it pass your logic test, that if they’ve got people at home, they’ve not tested? They’ve been vaccinated? We know it can spread within families?

Katelyn Jetelina  49:05

Does it pass my logic test?

Andy Slavitt  49:07

I’ve seen you disagree with the CDC do it very politely.

Katelyn Jetelina  49:12

Everyone should be testing, we have antigen test, they tell you if you’re infectious or not take an antigen test, and then go back to school.

Andy Slavitt  49:19

So your answer is this does not their policy does that make any sense? You’re telling the capital of the largest state in the country? Okay, avoiding the controversy is a huge opportunity for Bob. Huge opportunity for Bob, because Katelyn is avoiding the controversy. Bob, what say you?

Dr. Bob Wachter  49:39

Yeah, it’s a tough question. I think. I agree with Katelyn that the more sensible policy is with close family exposures the kid does an antigen test before that day in school to be sure that they’re safe. It’s all very probabilistic. The household attack rate with Omicron is about 30%. So it’s not a done deal that you’re you know that mom is infected the kid is automatically infected, it’s maybe a one in three chance that kid will become infected, that seems to be to be high enough that allowing the kid to go into school without the additional safety of a 15-minute test. It seems like it would be safer overall to just add an antigen test on top of that, as opposed to willy nilly just they’re fine to attend as long as they’re asymptomatic.

Andy Slavitt  50:24

Both of you seem to be in the pocket of Sacramento because you’re unwilling to say, we’ll get you five points, which is very simply say this makes no sense. You’re almost saying it, are you taking it Bob or not quite?

Dr. Bob Wachter  50:34

Not quite.

Andy Slavitt  50:35

Okay. Neither of you get the five points. Okay. […] asks, What are your thoughts on the Harvard University and Columbia University isolation policies? I’ll explain what they are. Currently COVID Positive students are to isolate in their dormitories with non-infected roommates with non-infected roommates for five days. While breathing on each other in a small space. In fact, it’s required that they breathe until they’re supposed to be. Non-infected roommates can go about business as usual without daily testing. Infected students can go out to pick up meals and use communal bathroom facilities. Does this isolation policy even make sense? If so? Is this the direction we’re headed as a country? It’s another five-point question. By the way, it should tell you that right now, Zach is at school and has COVID and is in an isolation dorm.

Dr. Bob Wachter  51:27

I’m sorry to hear that.

Andy Slavitt  51:31

Oh, Katelyn grabs.

Dr. Bob Wachter  51:33

She just came right in there with that. Wait a second on Jeopardy. If you buzz in before the question is over. You cannot answer. That was an early buzzer.

Andy Slavitt  51:44

Katelyn, press the buzzer.

Katelyn Jetelina  51:49

No, I know, I don’t think it makes sense. I mean, in that sense. I mean, in that case, why aren’t we using tests?

Andy Slavitt  51:56

But this is Harvard and Columbia? Aren’t they smart people?

Dr. Bob Wachter  51:59

I’ve taken a look at the Harvard and Columbia endowments they can afford a hotel room nearby for the kids to isolate for a few days. Yeah, I mean, to throw these kids again, the household attack rate is not 100%. But it’s significant. And for you know, for a roommate to be exposed to the air filled with virus of an infected roommate, and not to have an option of going some other place while the person is isolating. That just seems like it’s asking for trouble. And these institutions have enough resources they could pull this one off if they wanted to. So, wait.

Andy Slavitt  52:40

That’s why I don’t think they should call Harvard.

Katelyn Jetelina  52:42

So that roommate that’s not symptomatic. Can still like go to class and stuff? Yeah, no. I don’t know. I don’t agree with that.

Andy Slavitt  52:52

I like how from your that someone who wants, has a question about people who are immunocompromised.

Kim  52:58

My question is, Will older people, high risk people with comorbidities and the immunocompromised. Will we ever get to leave our houses? Or do we get to spend the rest of our lives inside as hermits and only scurry out with a mask for one or two places? It’s mighty damn discouraging right now. And now that Omicron is here, it’s not looking good. I’d really like to hear what they have to think. Thank you.

Andy Slavitt  53:29

Bob, let’s start with you.

Dr. Bob Wachter  53:32

Yes, I think they will. First of all, you have to have tremendous empathy for people in this situation who are seeing everybody around them vaccinated and going back to life of some form closer to normal and they can’t. So what makes a difference here, I think therapeutics will make a significant difference is already a monoclonal antibody cocktail named Evusheld, that a single infusion of that seems to offer some protection for a number of months. So it’s worth exploring that. The Pfizer anti-viral pill Paxlovid lowers the risk of a severe outcome by 90% in people who take it and for now, that supply is quite limited, but we are giving it to immunosuppressed people. It doesn’t work through your immune system, and so it should work fine on immunosuppressed people. And it’s important to recognize that immunosuppressed people, their risk of a very bad outcome is not that much higher by virtue of their immunosuppression their immunosuppression makes it far more likely they will get COVID. So because their immunity is not going to fight the virus in the same way, so the combination of the monoclonal antibody and or the Paxlovid, I think it’s going to put them in a situation where it is substantially safer than it is now for them to go out and about they probably have to be a little bit careful, but I don’t think they’re gonna have to be hiding under the table as they’ve had to do for the last couple of years.

Andy Slavitt  54:57

Katelyn, all you have to do is say agree or disagree.

Katelyn Jetelina  54:59

Agree.

Andy Slavitt  54:59

All right, all the points go to Katelyn. Bob, you did a lot of the work but Katelyn I think she brought it home. Couple more questions, immunocompromised and then I think we’re at the end of our questions. People are having a really difficult time getting answers from physicians, their own physicians here and what seemed to be very complex situations and it’s hard to go through all of them. But more […] maybe put a few of these together, talks about how he has his wife has lupus. She was supposed to get another booster within six weeks, trying to find out for the rheumatologist what level of risk to assume during Omicron and how to navigate it. Ellie Martel asks. She has a question for those of us who are diabetic and are considered obese, will risk factors continue to be high, even being vaccinated and boosted and what can people with these kinds of health conditions do to reenter life a bit and stay safe. And because she’s often hears messages that say if you’re vaccinated and boosted do blank and she doesn’t know she should be listening to those. Someone else’s. Joseph Block has an immunocompromised adult son, who’s had a J&J and a half dose of Moderna and wants to know if that’s enough with Omicron.

Andy Slavitt  56:23

And Janice Cooper, husband’s taking immunosuppressants after a stem cell transplant for AML. And she’s nine weeks out after open heart surgery, God bless you both, the both vaccinated and boosted in the world of COVID. They still feel that it’s safest if they act as though they weren’t boosted or that they stay away from crowds that are masked, etc. They wonder what their best strategy is. They’re in their mid-70s. And they want to know if they’re being too scared or too cautious. I think to sum up this question which we can answer kind of all at once, really difficult situations for people who are feeling very isolated. I don’t think any of them are asking too much. I don’t think you need them are trying to kiss caution to the wind. But all them are trying to figure out how to get bits of their life back in some of these situations. And so I realized that you can’t address everybody’s specific needs. Bob in this amalgam of questions, but I’m wondering if you have overall advice for people in this type of situation?

Dr. Bob Wachter  57:26

Yeah, first of all, yeah, I think we have to have a lot of empathy for people in these situations trying to navigate this and do the risk calculations. It’s extraordinarily difficult, I guess is I heard all of those questions, I parse them into two big buckets. And one is the person just at elevated risk by virtue of age, or obesity or diabetes. And the answer is that the person who is a 75-year-old with risk factors, who has had three shots, has a lower risk of death than a healthy 30-year-old who is unvaccinated. The shots, now the recent data from the CDC says, says you are 100 times safer in terms of the risk of death if you’ve gotten three shots, compared to an unvaccinated person. So I think the 75-year-old, obese person with diabetes who’s gotten three shots. First of all, better get three shots. And second of all, should go back to living life as if they have essentially normal risk, they do have an elevated risk over someone younger or who doesn’t have comorbidities. But the risk has been you’ve done everything you can to lower the risk. And I don’t think there’s any way to live your life. And this is going to be you know, once we get out of the surge, this is a version of life going forward. And so I think you accept a very, very tiny risk and go and try and live life as normally as possible for the immunocompromised people, you gave three or four different situations, it’s really important to look at how immunocompromised you are. So just having lupus and let’s say being on a low dose of corticosteroids doesn’t make you all that immunocompromised, you probably did fine with your three shots. The person who’s gotten a stem cell transplant and is on massive immunosuppression. That’s the person who’s as I said before, you’re going to look to the therapies, look to the possibility of taking the monoclonal as prophylactic and the possibility of having access to the Pfizer drug if you do get infected, because I think the bottom line is hunkering down for the rest of your life is not a not a tenable solution.

Andy Slavitt  59:23

So I have to I have to, I have to give you five points for that answer, because you actually managed to hit everybody’s situation. And you’ve managed to provide somewhat of a solution and not just that outlook, but a solution for everybody. So you just started yourself back into the running.

Dr. Bob Wachter  59:39

Thank you.

Andy Slavitt  59:40

You re-tied the game with Katelyn. Caitlin, did you have anything you wanted to add to that before I go to the final bonus question?

Katelyn Jetelina  59:47

No, I don’t think so. I think it’s what basically what Bob said is that we have the tools now to make our lives very safe through boosters through antigen testing through ventilation through masks, and so we need to leverage those so we can get out back into the public and continue to protect those around us including immunocompromised.

Andy Slavitt  1:00:09

Okay. Final question. And it was our final question in our last Safe or Unsafe and a different version of that same question. And the question is how many more Safe or Unsafe episodes will we need to do? I will tell you that the last time we played this game, Farzad Mostashari, in November before Omicron, said, zero, where we’ve just done our last one, we will no longer need to do these anymore. We’re going to be in a steady state. So the answer you have to choose from is obviously zero. You could say one to two, you could say three to four, you could say five plus. So this is the final question. And Bob since you just caught up, you’ve got the most familiarity with the show for anybody. You understand what makes a good episode? You have a little bit of vantage point; we’ll start with you. How many more safe or unsafe episodes will there need to be?

Dr. Bob Wachter  1:01:02

Well, again, a lot of this depends on how risk averse you are. Farzad said zero, and he got exiled from the show. So you know, it makes me not want to say zero. I will say zero though, I will be gutsy. And say we will still have many searches going forward. But that Omicron will be the last game changing variant and the availability, increasing availability of therapeutics will make life substantially safer. I recognize that’s optimistic, and I recognize that that can easily be proven wrong, but that is the bet I’m willing to make at this point.

Andy Slavitt  1:01:39

Love the guts. Love it. Katelyn.?

Katelyn Jetelina  1:01:41

I was gonna say three to four until Bob said zero. So I’m going to say one to two. No, you know, I agree with Bob, we’re gonna have more waves. And I think we’re gonna have more tools to figure out how to have a safe environment and make our life safer. And I think it’s worse coming on the air when those more tools come or when the next wave comes to discuss it. And then we’re kind of beyond our own.

Andy Slavitt  1:02:10

Well, I hope if we do have more episodes of this topic, did you guys will come back because you are both fantastic. We’re gonna let the listeners vote. Team Katelyn, Team Bob. Get your social media forces out your sub stack, your papers, your office hours, all your tools out to try to sway the victors the voters because I’m finding it very hard to choose. I think you both are amazing. You’re both amazing contributors to people’s understanding this pandemic. Thank you for playing Safe or Unsafe.

Dr. Bob Wachter  1:02:43

I was just waiting for the double jeopardy question, that never came. Thanks for having us.

Andy Slavitt  1:03:00

What do you think? Team Bob? Maybe? Team Katelyn? Promising. I hope that you have a choice. But I think they both did a good job answering your questions. I like the fact that they come from slightly different perspectives. But man, they’re both super smart. Wow. Our episode Wednesday is about what kind of protection Omicron infection is offered us and what that will mean for what comes next in the pandemic. Bill Hanage, Harvard School of Public Health is our guest. Warning he’s English, Warning, he is very charming. So bring your defenses to that English charm if you’re the kind of person to get taken in by it. I unfortunately am a sucker for an English accent and literary references. He’s really interesting guy, is great guy, but important topic is he’s willing to look ahead and say what’s going to happen here in the US and writing. He’s writing about what’s gonna happen here in the US based upon the fact that we have now most people in this country are either vaccinated or have a prior infection. So he’s got some points of view on that. I think it will be a great episode. Then the following week, we have more great episodes to come. Thank you for tuning in. We’ll talk on Wednesday.

Andy Slavitt  1:04:30

Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev and Veronica Rodriguez. Jessica Cordova Kramer and Stephanie Wittels Wachs are the executive producers of the show, we love them dearly. 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 @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, please tell your friends and please stay safe, share some joy and we will definitely get through this together.