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In the Bubble with Andy Slavitt: Our Shot
All Podcasts America’s Next Omicron Wave (with Bill Hanage)

America’s Next Omicron Wave (with Bill Hanage)

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Description

Andy brings Harvard epidemiologist Bill Hanage back to discuss what the US can expect to see with the new Omicron subvariant BA.2. How will our bump compare to what we’re seeing in Europe? And how will people navigate it with the nationwide relaxation of vaccine and mask mandates? Plus, they revisit some of their previous conversation about the original strain of Omicron from six weeks ago to see how well their predictions held up.

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

Follow Bill @BillHanage on Twitter.

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Transcript

SPEAKERS

Bill Hanage, Andy Slavitt

Andy Slavitt  00:18

Welcome IN THE BUBBLE, this is your host, Andy Slavitt. Happy Spring, March 21st. By the way, it sounds like we’re going to go through this thing there where the clocks are no longer going to change. And if you heard about this came out of this in the Senate. Anyway, we’ll talk about that another time. It’s not the topic of today’s show. If the topic of today’s show was to time change, I don’t know I would feel the hour unless I fell back and got rid of the hour, that’s a dead joke. Today, we’re going to be talking with Bill Hanage, who we talked to six weeks ago, when we very intelligently asked him what’s going to happen if another wave comes. And now we’re going to ask him again, six weeks later. And if you didn’t listen to that show, he has a really interesting perspective on what difference it makes when you’ve got some layers of protection in the public, from vaccines, and from recent infection from Omicron. The next wave that is on its path here, as you probably know, if you’re paying attention is BA2, which is another version of Omicron that just hit us. And it’s gonna have some different kind of connotations here. I won’t spoil it. Bill has some perspectives. What I like about Bill, is he’s always willing to stick himself out there and give an opinion on what’s likely to come next. A lot of people don’t do that. But he does. I would talk about one thing before I just turn this interview on because it’s great if you’ve heard Bill before, which is this notion that is a sort of very loaded idea that I talked to Bill about of when it’s something the responsibility of government and society and when is it an individual responsibility? Now, as I say this, I know that this conjures up different political philosophies, these are loaded phrases, I hear people in healthcare, use the words individual responsibility, in ways that I think are masking what is, in fact, policies that that leave a lot of people behind. So I know that those are loaded phrases. But I think it’s important to talk about this, and try to take some of the steam out of what those phrases imply, and talk about whether or not as we look at this next wave that might come, you know, we’re likely going to be doing this and under most circumstances, in a situation where governors and store owners and stores and restaurants are not going to have things like mask mandates, let alone schools. They may be in some places, but maybe not another’s. And for some people, that’s really confusing. Because it certainly is an important signal for us, when the government says hey, you need to wear a mask. People say wear a mask, it’s also just a little bit more socially acceptable to just go along. But as in a lot of things that we do in life, the government gives us the option, right? In fact, you could say it a different way, we have the option and the government hasn’t taken it away, for people who believe that we have a lot of these rights to begin with. And with anything the government does, becomes a […], I doesn’t matter which way you look at it. I’m not trying to get into the political philosophy, what I am trying to say is that we may end up in a situation and then this next time we go through this, where we have to make our own decision to put on a mask.

Andy Slavitt  03:43

If we’re going into a restaurant, going into school, going into work, when the government’s not telling us we have to now I probably could have offered policymakers the advice that they should not be saying mask requirement, masks not requirement, but actually say, masks are strongly recommended, masks are recommended. Masks are required based upon the status. So we at least communicate to the public, that when you have a lot of cases when a mask would be an appropriate thing to do to protect yourself. And we’ve got a lot of people out there who have various degrees of risk in their lives because of their health status because of their age. And also because of the risk tolerance. I’ve said that before. I’m gonna say it again. I’m a baby. I don’t like getting sick. I don’t like getting sick because I’m a grown man, baby. See, simple as that. That’s why I might wear a mask. And so if you were to stop me and say, Hey, dude, why are you wearing a mask inside this bar? Then I might just cry and say because I’m a baby, and that would understand people would understand. So we all have our own reasons. Mine is as legit as anybody else’s. That’s my way of expressing my freedom. God loves me for that, you may have your reason. And I would just say that if you’re worried because there’s not a strong policy that you agree with in your state, and you wish that state had a stronger policy, you can be strong enough to decide how to handle this. And in fact, the reality is whether you agree with it or not, you’re probably going to have to, because unless we get to a situation where hospitals are overflowing, or at risk of overflowing, I don’t think we’re going to see the country move in any clear, specific, big way, towards these kinds of restrictions again, and I’m happy to have the argument whether that’s good or bad, and we do, on the show all the time. But I don’t want to divorce that from what I think is the reality, which is that whatever comes in this next wave, we’re very likely going to have to take more of that responsibility on ourselves. And that is going to put some people at risk, perhaps is going to mean the virus spreads a little more, perhaps, but people would argue that, hey, there’s a tradeoff for that. The tradeoff for that is also real, legitimate. Okay, did that make any sense? Any sense at all? If it didn’t make any sense? If you play it again, it still won’t make sense. So just keep moving on. All right. Here’s Bill Hanage. He is the associate professor of epidemiology at the Harvard TH Chan School of Public Health. He is an evolutionary biologist. He knows a lot. And he sounds smart. He is smart.

Andy Slavitt  06:41

Man, you’re on like all of six weeks ago. And the topic we were talking about six weeks ago. What will the world look like when we get another wave? I hope you enjoyed those six weeks.

Bill Hanage 

Oh, yeah, they were great. I gotta tell you, though, give, you’ve got a bit of a crystal ball of yourself. Because I think the word that you’re using at the end was saying that we were going to have to lull and I have lost count of the number of times people have used the word lull, you’ve obviously had your finger on some pulse there.

Andy Slavitt 

I’m right with the American psyche. You want to meet with any man of America, that’s me. I’m the guy.

Bill Hanage 

But low also has to work two centers, you mean, you know there’s a lull? In the sense that things are kind of quiet for a bit. But also, somebody can be lulled into a false sense of security.

Andy Slavitt 

We’ll come back maybe to our state of lull dumb. But look, I mean, there’s people that are, I think, up in arms about, we’re not ready for another wave and people are taking off the ball. How do you contrast that with people like during these periods of time? They should be living their lives without fear, because it’s a rare commodity.

Bill Hanage  08:00

Yeah, I mean, I think that it’s reasonable to suggest in a situation where you don’t, where you’re not going to actually be expelling the virus permanently, that appoints when things are relatively chilled. There are points when it’s time to do certain things that you would like to do. And you know, you can still work to reduce the risk, and so on and so forth. But it’s worth noting that we’ve just come through a couple of months with Omicron, which is BA1, flavor of Omicron, which is an incredibly infectious virus. And yet, I’ve been wandering around and seeing the restaurants and the bars packed, and so on and so forth. It’s really, if people talk about wanting to get back to normal, then it’s been pretty normal. And, you know, there have been consequences. Don’t get me wrong, and there have been pretty serious consequences. But taken all in all, we should be recognizing that we could be in a much worse place. By the way, can I ask you a question? When was normal defined as whatever was happening in 2019? It’s very weird. We’ve come on a lot since 2019. We’ve got like an mRNA. Vaccines, I don’t want to go back to 2019 and lose them.

Andy Slavitt 

But from what I remember, 2019 was the f* up year.

Bill Hanage  

It wasn’t a great year; I have to say 2019 was not my favorite year. Yeah, there were multiple not good things about 2019. Admittedly, 2020 was pretty bad. 2021 was pretty bad. But going back to 2019. Maybe we can do better than that.

Andy Slavitt 

I bet we’d have a tough time leaving a year that we’d like to go back to because, you know, if you’d say, you know, 2008, you’re in the housing crisis. You get much before that we get away living in a much more overtly racist country than we are living in today, which is now just more covertly and actually more overtly racist now, now that I think of it. It’s not a fun game because you can’t win.

Bill Hanage 

But this is the thing you keep going forward. You keep trying to make things better.

Andy Slavitt 

Oh, I love it. I love it. I think that’s really well said in all seriousness, probably the first smart thing you’ve said, Bill.

Bill Hanage

Once it’s a little bit it’s a little like the way that I teach my class, when I teach my class, I always start off by trying to say, I’m trying to teach you how to be wrong, but wrong in a useful way. Because we’re always trust trying to be less wrong. And that and just improve.

Andy Slavitt  10:14

You want to hear somebody say the other day that you want to be wrong small, and you want to be the first one to catch it. And so if you find ways to be wrong, small, do that all day long and be the first one to catch it, you can correct it. And I think part of learning about talking to the public about the virus is, for whatever reason, if you’re wrong big, even if it’s completely defensible, because you didn’t see another variant coming. Public has a very tough time forgiving. So it actually begs you to be more cautious. Yes, that’s correct. You know, and I think people like you always have been appropriately noting your sources and separating your opinions from what seems to be more data driven. But people don’t always hear the contours around the statement. They hear, Andy said, or Bill said, and it’s very difficult.

Bill Hanage 

Yeah, that’s extremely true. I actually wrote a thing right at the start of the pandemic with my friend, Marc Lipsitch, where we were trying to, we’re trying to explain to journalists that when they’re talking to scientists, there are facts, like SARS-CoV-2 is a Coronavirus. That’s a fact. Then there’s informed opinion, which is based on the stuff that we might be talking about our colleagues with, and data that we’re beginning to see, which isn’t quite ready for primetime. And then there’s complete speculation. And we want to try and keep away from that last thing as much as we can, right, we can have some informed speculation, but you know, we want to keep it towards the first two and be very clear about which is which.

Andy Slavitt

You know, I had about five or six reporter calls over the last day, and my stock answer, which we’re now maybe we’ll do better than on this episode, but my stock answer to what’s gonna happen is I don’t know. And, , you know, I think a lot of people aren’t used to talking to the media and feel like, well, if I say, I don’t know, they may not consider me to be a reliable source in the future. And therefore, I think sometimes people feel obligated to have an opinion. And look, the reality is that I don’t think we do anybody any favors, when we try to get beyond where we are and what we what we know, what we don’t know. It is interesting, though, how many people are willing to say that Omicron was indeed the last wave, the lesser Omicron. It’s amazing how many people are willing to say that quite clearly.

Bill Hanage  12:49

Yeah, I mean, I think that anybody who’s been paying attention knows that it’s a bit dim to be doing that you should be recognizing that this virus has a habit of flipping the script, and being prepared for what you’re going to do if it does.

Andy Slavitt 

So six weeks ago, I asked you the following question. There are people in the country who are unvaccinated, let’s say they’ve had prior infection of Omicron, at least, and maybe ever kind of Delta. Does that give us enough protection? That between that and of course the vaccinated people, we’re unlikely to see much of a wave, or are you not convinced of that? Okay, let me play your response, which I don’t think you’ll be embarrassed by. Okay, so that was February Second that aired. So I think we recorded that. Probably just before that, and since then the US has seen what you and I did called a lull. We’ve seen a decline in cases. But we’ve observed different things across the globe to wastewater readings here in the US. What could you tell us today about what you can expect it when we see BA2 becoming more dominant here in the US?

Bill Hanage  15:28

Yeah, yeah, too. So I think I should start off by saying what BA2 is. So Omicron is a very peculiar variants. And it comes in multiple flavors. The one that we had before was BA1, BA2 is also Omicron. But it’s quite different from BA1, they diverged about a year ago, we don’t know where we don’t know exactly where it came from. I my own bed has been a very long-term infection, in an immunocompromised individual, maybe multiple immunocompromised individuals. But when bat was sufficiently divergent, that it is quite different from BA1. And it appears to be transmitting more successfully than BA1, we have seen it take over in places like South Africa. It has caused a pretty large outbreak in India. It has caused a large outbreak in Denmark which has had by far its worst period of the pandemic so far, albeit not as bad as any period in say, the US or the UK or some places that were hit hard. And now it’s taking over in the UK, again, and it’s turning in stand up in the United States, and it’s starting to transmit here. Now BA1 is looks like it’s more transmissible sorry, BA2 looks like it’s more transmitting than BA1. By the way, I can’t wait until they come up with another name for these things. I’ve don’t have to say BA, bla bla bla. I mean, I keep wanting to say BA […] and turn it into absolutely the 18 or something, but BA1 one was the Omicron that we knew BA2 two is a different flavor of Omicron, which is on the way. Now the question is, what is it going to do? I don’t know exactly. But I can tell you the things we want to know and the things that will matter. The first thing is that it looks as if BA1, being infected with BA1 provides good immunity, at least in the short term against BA2. That’s great. Suggests that those people who were infected with Omicron are less likely to be infected in what’s coming now. It’s not impossible. There are reports of people infected with BA1 getting infected with BA2 from Denmark and the UK. But it’s rare.

Andy Slavitt 

And about 45% of the public has been infected with BA1 is that roughly?

Bill Hanage  17:48

Roughly speaking, yeah, about 40% or so. So the remainder are capable of being infected, or at least some fraction of the remainder are capable of being infected with BA2. However, BA2 has been here for a while. It’s been cropping up in sewer sheds around the country in the first case in the United States was actually in Massachusetts, just before Christmas, but it’s not going anywhere. It’s a bit mysterious as to why not. One of the reasons could be that I apologize in advance, we’re going to go down the BA rabbit hole again. The majority of the pandemic in the United States recently has been BA1.1, which is a fraction of the BA1 family that appears to be more transmissible than the original, not as transmissible as BA2, but a little more transmissible. So basically, BA2 has come over here. And instead of competing with BA1, it’s actually finding it’s got something a bit more seriously competitive to try and be beating out. So that could explain why it hasn’t been taken over so quickly here.

Andy Slavitt 

Is that different than Europe?

Bill Hanage  19:00

Yeah, but it’s been just mostly BA1 in Europe. So that explains some of these things. The other thing, which is frankly, very different between here in Europe is that for much of the united states that haven’t really been much in the way of restrictions for quite a while. Whereas across Europe, they just opened up a whole load of stuff. And so what you’re doing there is you’re basically sort of you’re opening up the doors to the henhouse, and at the same time that Fox arrives, whereas here, we’re in a somewhat different situation. I mean, locally, yes. I think there’s a lot more contacts that are being made in Massachusetts, because it’s been pretty gun shy of the virus. But frankly, a lot of the stuff that has just been opened up in Denmark, for instance, has not been in place in say Florida for the longest time. And as a result of that, the potential marginal benefit that BA2 is going to get is less.

Andy Slavitt  20:01

So does that is that like saying there’s a mini version of what’s happening in Asia? Where they have had. Yeah, so they have so little protection because they’ve done such a good job, that when it comes, they’re actually quite a bit of a disadvantage.

Bill Hanage 

Absolutely right. We published a paper in SEL, in November, the most timely paper I’ve ever published, I think based on basically saying what you expect from different variants with different properties. And we extended the model early in December to see what we thought would happen. And the top line answer was places like China and Hong Kong, they can have a really hard time, or it’s going to be very dependent upon how many of their folks are vaccinated. And of course, as we all know, now, the older population in Hong Kong has been vaccine hesitant, and they’re seeing per capita mortality, which is really, really pretty shocking

Andy Slavitt 

vaccine hesitant with an inferior have a slightly inferior vaccine.

Bill Hanage 

That’s right, they have been had some mRNA is available there. But I mean, I think that folks were anxious about side effects. But Sinovac It’s not a completely terrible vaccine, but we have better ones here.

Andy Slavitt 

It’s like tapwater versus Springwater. So what that suggests, possibly, for those two factors, you just laid out that we’ve had a slightly more competitive version of BA one to begin with, or aggressive, I should say, and that we have had our barn doors, if you will open for quite a bit longer. So there’s less of a rush, I would suggest we, when we see BA2 to rise here, it might be a more modest bump in cases that we’re seeing in Europe.

Bill Hanage  22:15

Yeah, I think that’s right, I don’t think it’s going to be, it’s not going to be, there’s going to be a bump, and it’ll be bigger in some places and others. And I don’t think it’s going to be as dramatic as Europe, because the recent pandemic history has been really quite different. And because, you know, most of Europe has been pretty COVID averse, you know, whereas parts of the United States have been quite COVID curious. And that hasn’t really, that had, you know, as a result of the fact that Europe change, just at the point when BA2 arose, or arrived, and had a lot more to be able to, you know, a lot more material to work with, shall we say.

Andy Slavitt 

That is interesting. It has me puzzling over this morning console poll that I just saw this morning. And I’m not sure if you saw it. David Leonhard put it into his column at the New York Times. It was strictly attitude sorts of virus in the US. But rather than breaking down attitudes by just political divide, liberal versus conservative, it actually broke it out into further categories, if you consider yourself very liberal, liberal, somewhat liberal, moderate, somewhat conservative, conservative, or very conservative. It was all relatively as you would expect a little bit of a slope, people being progressively more worried as they get more liberal. But what stands out is that was a relatively speaking, you know, a few points apart until you got to very liberal. And people who are very liberal, are extremely concerned about 10% of the US adult population describes themselves as very liberal, it’s almost entirely a White upper middle-class group. And there were far, it was far more worry in that group. And I was just wondering, it’s just sort of connecting into the relative politics in Europe, which are different, but the scale is shifted over to a large degree, and how those attitudes either have been reflective, and they certainly been reflected in vaccination levels, to take one measure.

Bill Hanage  24:26

Very much so. I mean, it’s I think that I haven’t seen the poll, although it was like the first. And although it was the first thing my wife said to me this morning. Exactly this finding that ultra-liberals are those who are most worried about the virus. I think that there a degree of unfortunately talk about this has become quite performative. And you see it in people, maybe in some places, you see it with people refusing vaccines in a way that is performative and other places. You find it in the sense of people are wanting to cling to masks for, you know, in contexts where then probably not as helpful as you might think they are. And it’s quite difficult, because I think the most important thing to do always is just say to folks, well, the virus is not going away, we’re not going to eradicate it. These are the ways we’re going to help you to live your life with a level of risk that you can feel comfortable with. And the first step of that is getting a vaccine. Sorry, we’ll have you people on the right wing that the vaccines really, really do work, then it’s also making sure that those vaccines are available to poor folks, you know, because there’s a lot of folks still struggling with vaccine access, huge numbers, then there’s the question of, well, if you’re going to be going to this event, is there a way in which you might be able to do it outdoors? If not, well, maybe you can wear a mask. And you know, lots of people by this stage are already, by the way, way through the point when they are completely comfortable doing things. But the idea is that we get people to the point when they are comfortable with reduction in risk, because it’s very difficult to eliminate risk otherwise, none of us would ever get in a car. But we still live our lives. And we live with a level of risks, which we find tolerable. And there are ways that we can do that we’ve got loads of tools in our Arsenal. I said Arsenal.

Andy Slavitt  26:20

Yeah, we’re cutting that. Turns out my son likes the other soccer team that hates Arsenal.

Andy Slavitt

He’s got some really choice words about arsenal, and Arsenal, fans and so forth, which I won’t, I won’t say on the air, because we’ll get into big spat that I really don’t have to keep up the other end of the spat. And you look really, really mad. So wouldn’t do it. But there’s, there’s an element of this that I want to try to figure out how to ask intelligently, which is where I think this plays out, is the words that are often loaded, I’m trying to get them unloaded, which is this idea of collective responsibility versus individual responsibility. I want to take again, the loaded part of those words out and just talk about this, as I think it will play out, which is that I think the biggest difference coming in this next wave, big small medium, unless it’s enormous, is that the emphasis is moved from government action to individual action, meaning that you’re less likely to have your governor or your restaurant owner or even the CDC say, you should be required to wear a mask, but much more likely for you to decide, hey, I’m going into this building, it’s going to be a two hour event, it’s indoors I want to wear and N95 masks, I’m going to choose to even though it’s not required. And some people this is confusing, because they’re used to the running through the pandemic, with the government saying this is what’s required. It also takes away all of the peer pressure, right? Because I put it on a mask because it’s required in this grocery store. Not because I’m trying to make a statement. And so to a certain people, it’s going to be far less comfortable to be in this place. But scientifically, and this is a part where I also want you to weigh in, because vaccines don’t prevent spread, they are more likely to just benefit us. And because masks particularly well fitting N95, or equivalent masks do a very good job of protecting us, we have the ability to take self-protective measures now. And this would lead you to think that this individual responsibility again, trying to unload that phrase makes a certain amount of sense, if we can adjust ourselves to it. Do you agree with it?

Bill Hanage 

Tottenham?

Bill Hanage 

Up to a point. I mean, I think that if you want to put the responsibility on to individuals, you have to give them the tools that they need to do it. I mean, if you it’s like this is one of the problems with rapid tests, rapid tests are really, really useful if you want to be going to go visit your grandma. Or if you want to be visiting somebody who’s recently recovered from COVID. And yet, if they cost money, then that means that they’re not available for some people, and where they’re much more difficult to access for some people. Same with vaccine access. Same with good quality masks all of these things. I mean, one of the things in public health is you’re meant to make it easy for people to do the right thing. I mean, I heard there was an anecdote that I was told earlier today, or earlier this week, sorry, by one of the older faculty members where I work, which is a work at Harvard’s TH Chan School of Public Health, and apparently in 1987 the graduates emulated the graduates in the business school who will toss dollar bills in the air, except the public school and school of public health graduates tossed condoms in the air. And they had a Latin thing on them, which I wouldn’t be able to remember. But it basically said in Latin, you know, have safer sex. So in you know, in the same way, you know, once we start handing out condoms to folks at risk of HIV, once we start giving them prep, or pre-exposure prophylaxis, we’re doing things which make it easier for them to live their lives. And we’re doing so without stigma or judgment or anything like that. And we are also working to help public health. And I think that that’s putting, you know, that’s the individual responsibility there. But I want to circle back a little bit to where the collective responsibility, I think still lies. There are things that we can do, as a society to limit this, because those folks who are at risk yet you can wear a mask. But if you’re wearing a mask, and you’re deflecting nine out of 10 attempts that the virus might make to infect you. What happens when you get to number 10, if there’s just that much virus around, and the amount of virus that you’re going to, that’s going to be around is going to be determined by how much there is in the society as a whole, the force of infection, and stuff that we can do to reduce that at times when there’s a lot of stuff happening when there’s a surge, therefore helps all I mean, and you know about this non-pharmaceutical interventions, what people who don’t know what that means is called knockdowns. lockdowns are things which you need to prevent the worst outcomes of an oncoming surge. And there’s nothing more you can do about it. They are an expression of failure to control the virus with less severe means we should be trying to avoid them at all costs. And yet, under very limited circumstances, they may be necessary. But if we can move past them, we really should try to do so.

Andy Slavitt  32:05

Yes. So first of all, I will say that Harvard Business School has changed their approach to people now, toss a flag of the country of origin of where they come from, because that dollar bill thing was a bad luck plus inflation. They just were just really waving around 75 cents, and it was not a good thing. So I think we initiated that back in 93′ or so.

Bill Hanage 

I’m glad to hear that.

Andy Slavitt 

It really makes you proud when people are waving money around, really makes you proud.

Bill Hanage 

Loads of money. I’ve got loads of money in my ward. Exactly. Sorry that was a reference to a 1980s or 1990s British comedian.

Andy Slavitt 

You make the point that we can’t just rely on individual responsibility, particularly in all circumstances. And I guess the question is, in situations where we are not at risk of hospitals being overrun, and in situations where it is, I will say, a more manageable, predictable condition. At what point are we at the place where we’re like, you know, what, if you chose not to get vaccinated, and you’re choosing that to wear a mask, I really can’t restrict everybody’s activities because of you. It’s what people call the heckler’s veto. Do you think we’re at a point with this? And I didn’t realize I’m asking you about policy as opposed to the science, but it’s kind of fun to speculate there as well.

Bill Hanage  34:08

Well, it’s always what do you want to achieve? This is always the question. I mean, basically, you say what, you know, there’s a particular level of tolerance that you have for the amount of virus and so on, and once we figured that out, then we can start putting things in place to try and achieve it. The heckler will have there are a number of hecklers. Yep, we have to put them into the column alongside the other things which are risky, which produce risk. And because the hecklers just like the virus are not going to go away. We have to work out how to live with those individuals and the problems that they got. But we can also reasonably figure out that there are going to be times and we’re going to need more than other times, for instance. I mean, like I’ve said to a lot of people, keep an eye on Florida over the summer. See what happens there. You might get a harbinger of what the rest of the country can expect in the fall and winter. And when it comes to the fall and winter, we may be needing to think about some of these things again, because we’re going to be having a bunch of people getting COVID, we’re probably going to have a load of people getting flu. And we put those together, we have something else, which is a pretty nasty respiratory virus showdown.

Andy Slavitt 

I ran to somebody the other day, not that long ago. How was your winter? Oh, not so great. What happened? Well, my mother and my father, my brother all died. From COVID. They lived in Arizona, and like everybody else in their town, they’re unvaccinated. I bet it’s really hard for people to figure out how to grapple with the various emotions you feel when you hear a story like that. Because on the one hand, I hope we all respond first as humans, and we’re not so blinded by attitude, politics, whatever, that we don’t at first, think about how horrible that is. And yet, I think there are people out there who are also saying themselves, and maybe it’s not polite conversation, but they’re probably saying themselves, well, they they knew about vaccines, they had a chance to get vaccinated. What else should we do? What else could we do? And therefore, what other adjustments should we be making for people who are choosing to put themselves at risk? I totally get your point about when you put others at risk. But I think just decided that I feel this is what’s going on in Europe with high vaccination levels. It’s like once you’ve given people plenty of chances to get vaccinated, and they don’t, it’s really hard to run your society, with a worry about those folks. Yet, we’re all humans. And I find myself thinking about this as a tragedy, nonetheless.

Bill Hanage  36:54

it is a tragedy. It absolutely is a tragedy. I mean, it’s a story which has unfolded more times, far more times than it should. And it’s I know also of I mean, there’s an example where you’re saying folks refuse a vaccine. There are also opportunities where people didn’t realize he could get one I know of folks who have older folks who didn’t realize they could get a booster. Or were completely clueless about it until people went door to door in their retirement community saying, well, you know that your neighbor died, there was a booster which might have protected them. And you could, you could have it. So you’re constantly trying to protect people in that way. What you’re talking about there, I think, is a situation which the science and medicine writer David Gorski has occasionally called misinformed refusal. As a kind of, you know, in human subjects research, we talked about informed consent, which is an extremely well-established concept. But there’s also misinformed refusal. And I think that what we often we see with a lot of folks who are not being vaccinated is an example of this. They don’t realize the benefit of the vaccines that they’re getting. And they don’t realize the purpose. People can point to the vaccines that we have, at the moment saying correctly that while they are not, you know, the vaccines we have right now are very good at preventing against severe outcomes. They’re great at preventing hospitalization and death. If you go and talk to anybody who’s working in a hospital at the moment with treating COVID patients, the people they are treating are unvaccinated. It’s not necessarily perfect at preventing transmission. But that doesn’t mean it’s useless. The whole point of what vaccines can do needs to be thought about what the point of the vaccines was, the point of the vaccines is that in 2020, there was only one way of getting immunity against SARS-CoV-2 and that was being infected. So the point of the vaccines was to provide as good as or better protection than convalescent immunity. And in fact, like we were saying from that quote that we listen to the recording of me earlier, but in fact we’re seeing is better than convalescent immunity. And the vaccines are excellent in that way, you know, you can choose between being infected and taking that risk or having a vaccine, right, which is much, much, much preferable.

Andy Slavitt 

So, to wrap up and give people a sense of expectations, you’re suggesting that we will, we’ll likely see is we see another third wave is A, a reminder that this thing isn’t gone, you know, cases don’t just continue to drop. But it’s unlikely to be anywhere close to what we’ve seen with Omicron and BA1 Omicron. But in fact, it could be even less than it is in Europe. And that I think the other factor here and it’s really important to say this is because of this. What you described on the last episode is layered immunity including lots of people with various stages of being boosted and not etc. But at least with underlying vaccination. That it doesn’t seem like this is going to drive a lot of hospitalizations, relatively speaking. Would that be your conclusion?

Bill Hanage 

Yeah, I think that’s correct. and the width and the science has moved a little bit since we were last chatting as well. There was a paper that was published in The Lancet yesterday, which, again comes from the UK, which seems to have a large number of people scrutinizing infections continuously, actually, the funding for that has just been pulled. So we’re going to be going into the next bar and a bit more blind. But what the researchers found was that if they compare to delta with Omicron, over the same period, people infected with Omicron, were less likely to be hospitalized. But even more importantly, this effect got greater with age. So older people were even less likely to be hospitalized with Omicron relative to Delta. And as you know, one of the worst things that has happened for the entire pandemic as this steeply climbing age, age increasing increases the risk of fatality, which has been very difficult. And that means that Omicron is much, much more likely to produce things which are comparatively manageable. Now, that was BA1. We don’t know if it’s also true for BA2. There are a couple of features about it, which you can ask a virologist if you like, I’m not a virologist, I’m an epidemiologist and evolutionary biologist. But if they’re a couple of features of a virus, which makes some people a little bit worried that it might be causing more serious disease, it looks like it’s able to infect cells deeper in the lung. But the early data from the UK suggests that this is not the case, there is not this signal, which is very large certainly, that suggests that bat was more likely to lead to hospitalization than BA1. But there are lots of confounders in that, you know, at the moment, the data suggests that it’s very similar in terms of risk. But as time goes on, I can tell you one thing we’re gonna find out.

Andy Slavitt 

So let’s talk about what we could agree on as we end this, I think, number one is, let’s be prepared. Let’s not ever head in the sand.

Bill Hanage

Oh, yeah, that was like my, that was my pinned tweet for the first year of the pandemic, don’t panic, do prepare.

Andy Slavitt  42:01

And I think I’d say even double both of those statements. Don’t panic, no reason to panic, because we have tools, because we could see things coming, be prepared. And also understand, I would say that it’s less likely that your neighbor, your unknown neighbor, is going to be as prepared are taken as seriously maybe as they did a year ago. So take that into account. And I suggest to people is that I said this on CBS News. It’s just because your governor tells you, you’re not required to wear a mask doesn’t mean that you shouldn’t wear a mask, if it’s self-protecting, whether you’re it’s a kid going to school or you going in to work or anywhere else. And that’s just going to have to become part of the ethos. People in Hong Kong and Asia, routinely slap on masks, and they never have Basque requirements. And they haven’t had any mask requirements throughout in Hong Kong, at least throughout the entire pandemic, yet they are very compliant with wearing masks, because why they want to protect themselves. So I think that I think we agree on is for the vast, vast majority of us. And unfortunately, there are some exceptions. We have the tools and we can take action to protect ourselves. I mean, I love it, and that it’s temporary. And I think it’s the other thing. I’d say it’s that if you’re going to have to slap back on a mask again, you don’t have the anxiety you have to have anxiety that oh my god, we’re in this forever.

Andy Slavitt 

That’s right. You weren’t you’re wearing a mask when there’s a big surge when there’s like, when the virus is in the community. That’s absolutely right. Get that right. The other thing which I think we should mention is that there are folks who will be wearing masks because they are immunocompromised. You know, that’s now or they have they live with somebody who’s immunocompromised. There are lots of very legitimate reasons, reasons to wear a mask, even up to and including that you’re going on vacation next week.

Andy Slavitt  44:01

As I told you last time, and I hope you remember I don’t like being sick, because I’m a total baby when I get sick. And nobody wants me to be a baby because when I run 100-degree temperature, I expect soup like to come to me magically. So no one no one wants that. I mean, and I say this jokingly but the truth is like it doesn’t have to be life threatening to want to avoid it.

Bill Hanage 

No, that’s absolutely right. I actually exchanged messages with a friend of mine who recently contracted COVID last night and you know, his I just said I hear you’re not feeling well. And he’s just response was saying thanks science for the vaccines. COVID is horrible.

Andy Slavitt 

Thanks science. Finally, just any buzzwords that we should predict. We played this game last time, any buzzword?

Bill Hanage 

You came up with lull. I can’t really think of one I think there’s going to be, I think that the next time we talk, it’s probably going to be it may well be Sunbelt surge time again, but that’s going to be that if it kicks off, we’ll be kicking off July August. So maybe we’ll talk before then, the BA2 bump, the bump, maybe bump is the word.

Andy Slavitt 

Yeah, I think people are gonna go nuts on the word mild. I mean, nuts. I think people are gonna say, we have it, but it’s mild to have it, but it’s mild. And like the mild, which has already lost all meaning in my mind, because we’re talking about, like, let’s slightly lower hospitalization rates, etc. But serious risks. I think when this thing comes, I think we’re gonna have a lot of people who are just going to fall back on mild as a reason to say nothing to see here, folks.

Bill Hanage 

Yeah, I think we’ve seen a little bit of that with Omicron already. But yeah, I think I think you’re right, mild, your fingers on the pulse, I think there’s gonna be a lot of that. And it should be noted that mild diseases if they in fact, lots and lots and lots of people can still have severe large numbers, in terms of population consequences.

Andy Slavitt  46:16

That’s right, like just because it’s mild for you doesn’t mean it’s bad for everybody.

Bill Hanage 

I know of 50 somethings who are intubated with you know, right now, with Omicron. There is a range of illness and also when people are saying something as mild, they really mean it keeps you out of the hospital, right, which is and you know, mild means different things to different people. If you talk to an oncologist and they tell you this treatment as well tolerated. It’s still might be a treatment, which is has some pretty bad side effects. And these were things mean different things to different people.

Andy Slavitt 

To me mild is when you’re sick. When I’m sick, that’s not mild. But when you’re sick, oh, it’s you know, you’re 202 degrees, but you’ll be back to work next week. Okay, that sounds mild. But you know, when it’s you going through it, that’s doesn’t feel that way.

Bill Hanage 

This may actually be true, because a lot of the issues of the pandemic has been the struggle that people have feeling empathy for others already some people. So when they’re looking at other when they’re looking at other people being sick, and it’s mild, when you’re looking at the risk being predominantly for old people, it’s mild, if you’re looking at the risk being for people who have comorbidities well, it doesn’t affect you. Surely not. But actually, you know, the numbers just start to add up when you get a huge number thrown.

Andy Slavitt 

Well, Bill, stay mild. We’ll talk to you in six weeks.

Bill Hanage 

Keep mild, yes, six weeks.

Andy Slavitt 

Alright, I hope that conversation shed a little bit of light, and not too much heat on the topic of what’s coming next. We’ll obviously track that closely here in the bubble. You keep listening, we’ll keep talking about it. Let me tell you the episodes that we have coming up, we have another episode that is related to the pandemic on Wednesday, with Jeff Zients from the White House and Zeke Emanuel from Penn, we’re going to be talking very specifically with Jeff who has just announced by the way that he is leaving the White House to be replaced by another special frequent guest in the bubble. Ashish Jha about the funding package that we need in Congress if we’re going to continue to invest in the infrastructure, fighting this pandemic, both here and abroad. So Jeff is going to talk about that and Zeke is going to talk about that Zeke and I both just signed on to a letter to Congress, really demanding that they put the $15 billion in place. Next Monday, Rachel Levine her title is the Assistant Secretary of Health for the US government. She was the Head of Public Health in Pennsylvania. She is the highest-ranking transgender woman in the US government. She is a the I think also the only four-star transgender woman. She’s remarkable. I think you’re gonna love this conversation with her. And then on Wednesday, documentary filmmaker, Ken Burns, who is a really cool guy. So we’re gonna go from really smart. To really amazing. To really interesting, two really cool. Hope you join us for all of them. Thank you so much. Have a great couple days we’ll talk on Wednesday.

CREDITS

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.

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