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Is the new BA 2.86 variant the latest in a wave of deadly outbreaks, or just a “scariant” that is all hype? Will the new COVID booster shots work against this latest variant, and when is the best time to get an updated vaccine to be protected this winter? These are just some of the key questions that Andy asks epidemiologist and In the Bubble fan fave Dr. Katelyn Jetelina on this week’s episode. This episode is everything you’ve wanted to know about COVID for this fall, all in one show.

Keep up with Andy on Post and X @ASlavitt.

Follow Katelyn Jetelina on X @dr_kkjetelina.

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Check out these resources from today’s episode: 

• Read Katelyn’s Substack newsletters: https://yourlocalepidemiologist.substack.com/
• Find vaccines, masks, testing, treatments, and other resources in your community: https://www.covid.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

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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Katelyn Jetelina, Andy Slavitt

Andy Slavitt  00:18

This is IN THE BUBBLE with Andy Slavitt. Hi, everybody, email me, andy@lemonadamedia.com. Go ahead and write a review in Apple, because I know you’re looking for an assignment from me and tell your friends about the show a lot of you have questions about COVID, a lot of questions have come in about COVID. And I think people are wanting to remember that at times like this, when cases are going up, the danger has not cleared. And even if you don’t feel personally, at risk, there are a number of people who do. And so I wanted to take stock. Allah, the in the bubble episodes of the first couple years of exactly what was going on with the variants that are emerging cases. And how are our vaccines, our tests are drugs that we have available, going to be ready, and then roll out definitely the fall look like. So of course, I invited Katelyn Jetelina, your local epidemiologist on the show. And that’s going to be as always with Katelyn, a great dialogue. She’s done a lot of work. She’s gotten a lot of analysis, she’s explained that incredibly well. And the reality is she is getting her hands around this new, quite mysterious variant that we’ve all been kind of scratching our heads around. And she’s going to share that news with us. As we dig into this, that ba 286, which is not the make and model of an automobile. It’s actually a variant of COVID-19 with a whole bunch of mutations. And I think she’s going to tell us, whether that’s going to be a beast, or whether it’s going to be just a tiny little mouse, as well as talking about the things that are going to happen in the fall. And now you should know that Monday, the FDA approved these new boosters that are going to be coming to you very very soon. And we’re going to talk about that as well. And enjoy this look at where we are and where we might be with COVID-19, here’s Katelyn Jetelina.

Andy Slavitt  02:54

There she is your local epidemiologist

Katelyn Jetelina  02:59

Hi, Andy, how are you?

Andy Slavitt  03:00

I’m so good. How are you?

Katelyn Jetelina  03:02

I’m good.

Andy Slavitt  03:03

Welcome back to the bubble for your empty your time.

Katelyn Jetelina  03:06

Thanks for having me.

Andy Slavitt  03:08

You know, I think the overlap on Katelyn Jetelina fans in the bubble listeners is probably pretty good.

Katelyn Jetelina  03:14

It is you know how many emails I received after you mentioned I was coming on in the bubble maybe a week or two ago. And I didn’t know I was coming on in the bubble.

Andy Slavitt  03:25

Oh, wow. So I was being presumptuous? Well, thank you for letting me presume your presence. I get a lot of feedback for people who saying my shows your shows with Katelyn are among the best one today which said I don’t love when you have government officials on because they’re always in the talking points. You know, and I’m like, my job is to get them you know, whether it’s a Shishir science or Mandy to you know, go deeper and be honest. And if I’m doing my job, they’re doing that. But I think there’s nothing like hearing from a truth teller and a great communicator like you.

Katelyn Jetelina  04:00

Yeah, you know, I think that the reality is that there’s, there’s pressures and a lot of those government jobs, and they’re not impermeable to them. And that’s one benefit that I have of being independent. Honestly, I can be organic, and I can kind of say, what I want for better.

Andy Slavitt  04:19

Yeah, no, it’s good. It look, it’s for better because you help people with understanding. Maybe you just paint a picture of where we are. We know 2020 felt like we know what 2021 felt like we know what 22 felt like 2023 We’re kind of allowed ourselves to kind of go like this. I’m making a hand motion where I’m wiping them back up and down to say we’re done. I don’t have to stop thinking about this again. And a lot of respects I think that’s extraordinarily Healthy People getting back to priorities your life school work, friends family. But but really, where are we We’re going into another winter. Where are we?

Katelyn Jetelina  04:58

Yeah, so I think you’re right Andy that there There’s been a significant mind shift from last winter. And I think we’re also in that same sort of mind shift this winter as a population. And I, like you said, I think it’s fair, we are in a very different place and March of 2020. The challenge is, we don’t really know what this winter is going to look like. And, and there’s a couple of reasons for that is one SARS. cov. Two continues to mutate. And that’s no surprise, we just hope we don’t get some massive mutations out of nowhere. And also, there’s pretty good scientific agreement that COVID-19 is not seasonal yet that we continue to see this ebb and flow of waves that are pretty unpredictable. And to a lot of epidemiologists, that means that we’re not necessarily in this endemic stage yet. And it’s going to take time for that virus to find a good cadence in our population with the amount of immunity we have. So a lot of us epidemiologists are very curious of how things are going to unfold this winter, particularly also around healthcare capacity, given that we haven’t really built or expanded our health care capacity, although we’ve gained a new virus in our repertoire of threats.

Andy Slavitt  06:18

So, you know, in 2020, there were some people that were basically trying to classify COVID Oh, so it’s just the flu. And because it was a novel virus, that was killing people. That was no immunity. It felt like that was a really bad comparison. Today, though, and 2023. I do hear people start. Now that there is layer there are layers of immunity to talk about COVID in the same breath as other respiratory viruses, as a similar kind of feeling threat, is that the right way for people to think about it? Or is the relative newness and the potential for variants still so high that, you know, people should be more anxious about COVID than that would lead on?

Katelyn Jetelina  07:11

Yeah, I don’t know if people need to be more anxious about COVID. But I think that, you know, I’m, I’m looping in COVID with RSV, and flu as well, in my newsletter, I’m looping it in as a respiratory virus. But that doesn’t necessarily mean they’re all the same, and they should be all treated the same. For example, we know flu kills, or COVID kills four times more than the flu.

Andy Slavitt  07:36

So four times, that’s it four times the death rate, or is it four times when you account for the spread? Times the death rate?

Katelyn Jetelina  07:44

Oh, that’s a good question. Um, when you account for this spread, so the burden, okay, um, is four times the death of the flu.

Andy Slavitt  07:53

Okay, so what that doesn’t mean, if you get the flu, and you get COVID, you’re four times more likely to die. Right? It just said, Well, what it is saying is that four times more, four times as many people are likely to die, because a combination of factors including how fast it spreads.

Katelyn Jetelina  08:09

Yeah, that’s right. So that’s on, its on population level, rather than individual base. Okay, um, but yeah, and again, it’s more contagious. So we’re going to get more people infected every year, for example, the flu infects about 10% of our population a year, and in just one wave COVID, one factor 15 to 20% of Americans. The other important aspect that I think is kind of in the background, but again, important to keep in mind with COVID is that people usually get the flu when they’re young. And so they have a lot of a memory about what a flu looks like, and can adjust to it. The challenge with COVID, especially among our older population is they saw COVID, or were exposed to COVID, when they are over 40, or 50, over 60. And the challenge with that is that our immune memories are just not the same as if they were exposed at a younger age. And so it’s getting harder and harder to mount a long protection among those people as well. And so, again, I think, I don’t know if you have to be more anxious, but there are certainly different approaches. For example, flu you go home after 24 You can go to school, 24 hours after a fever, because you’re 83% of people are not contagious after 24 hours of fever. We will COVID That’s it’s very different. And so I want us to be careful about applying flu things we do on an individual level two things we do on it with four COVID.

Andy Slavitt  09:43

That makes a lot of sense. There’s two other things that people point to, which make them more nervous about COVID. They’re worth paying attention to I’m not sure whether or not you would think they’re both exactly right. One of them is it’s long COVID And the reason I’m not sure that that’s exactly right. It’s because there’s certainly also long influenza. But it’s certainly something that importantly worries people. A second thing would be, you know, COVID is impact that people are immunocompromised is that different than the flu? Is that more worrisome? And then the third, of course, is that, you know, we kind of understand flu variants that come and go, they come every year, and some are both, you know, we don’t always have a vaccine that works just as well against others. But the flu tends to mutate in a predictable way. And as we’ll talk, we’ll talk about ba dot 2.86, shortly, so you don’t have to go there yet. But the fact that there can still be surprises in mutations, more so than with leukocyte, it’s not it’s also not impossible with flu. So in each of those three areas, lung, the impact on particularly people who are immunocompromised, and the more unpredictable nature variants are those three things that are also, you know, things that are appropriate to be way more nervous about or not so much.

Katelyn Jetelina  11:05

Yeah, you know, long COVID is an interesting line. And that, personally, is a reason I still, for example, wear a mask at the height of a wave. And there, you’re right, there is such thing as a long flu, however, long COVID is more likely. And there was a few studies done a year or two ago that shows that long COVID is about six times more likely than long flu. So I think long COVID is a legitimate concern. Um, but over time, the risk has decreased and have long COVID Because of vaccines because of antivirals. And I think that we need to keep that in mind as well. The second thing is immunocompromised, immune compromised, there’s a very, very small bucket of immuno compromised, that the vaccine does not work on in the beginning. Yeah, the primary series wasn’t working for immunocompromised, even the third shot wasn’t working. But once we got to that fourth shot, immunocompromised people started mounting a response. Now there’s two groups that don’t one is, for example, active organ transplants, and they do still have to be very careful, because they they just can’t. And then the third, you said, is predictability. And I completely agree with that, you know, we, we’ve had Omicron for the past almost two years, which is a good thing that we’ve seen Omicron change and incremental steps. And that’s good, because we can predict where it’s going. And we use that prediction to our benefit to mount a proactive response like XB B vaccines this fall. However, it’s only been four years, since SARS cov. Two has been around and one of our big concerns is again, a variant of concern coming out of the woodworks out of nowhere, and not necessarily starting over with our response. We won’t go be going back to March of 2020. But we will be less prepared, our vaccines will probably be less match at less. Hopefully, our packs loaded would still work or antivirals, hopefully, or antigen tests would still work. But there’s a lot of unknowns. And so yeah, that unpredictability is certainly something on the forefront of us epidemiologists.

Andy Slavitt  13:27

Okay, well, let’s take a quick break, and then we’ll come back we’re going to talk about ba 286. Is it? Is it bad? Is it the big bad new thing? Is it not? But before I do, I just want to make one point in long COVID I’m such a baby, Katelyn, that for me, two hours is long would be long. COVID. Like if I feel lousy for two hours. Like I’m making everybody around me miserable. And I’m like, That’s too long for me to be to be sick. So I don’t know if there’s any precious dainty souls like me out there. But if so, the idea of long is that’s where I go. Okay, we’ll be right back

Andy Slavitt  14:24

Okay, we are back. Katelyn. It’s interesting. You reacted very negatively to when I said the word should people have anxiety. But you were not disputing the fact that there are things to be nervous about or cautious. And I just I felt I noticed affordable and that the word anxiety itself triggered something new which is like no, don’t be anxious. And I want to just get to that for a second before we get to be a day to day tasks. Which is that you know, if you let yourself worry a About unknown unpredictable things that could happen in the future. It’s a recipe for misery and disaster, because there’s always unknown things that can happen. And as we talked about ba 286, you know, no one breaks the probability of a variant against the probability of being hit by a car, or hurricane quake dado like we just had in California. I mean, there’s all kinds of that stuff. But we don’t live our lives in constant fear and anxiety. So I don’t know if that’s what you were reacting to, or what I observed as right. But I do think this idea, I know, there’s a lot of people that are still worried about COVID, and still know that we’re living with COVID. But this idea that I think we’ve tried to promote this knowledge should relieve anxiety, not the other way around.

Katelyn Jetelina  15:49

Yeah. So I think you can relieve anxiety through just having smarter tools. And if if we’re always in an emergency, we’re never in an emergency. And having constantly in this fight, or flight mode, is not sustainable. And I think that after year one, or you’re probably year two of the pandemic, I recognize that we are in a marathon, and we’re not in a sprint, and my approach my personal approach, and my family’s approach shifted a little because of that. And so I hope that people are not living in fear of the unknown. There is a lot of unknown. And I think we can alleviate a lot of that fear from conversations like this, as well as communicating what we’re seeing in real time.

Andy Slavitt  16:40

Yeah, I once got a fair amount of Twitter hate. And by the way, what other kinds of Twitter is there besides Twitter hate? By saying what kind of you know, if you’ve gotten vaccinated, pick up parts of your life that have value to you, and meaning and purpose, you know, obviously, deal with whatever number of characters to say it. So I’m sure I didn’t say it very eloquently. But I do think there’s a constant balance here. And we have to make those decisions for ourselves. And what I always try to tell us like, the thing that I don’t think is healthy is judging how other people make their choices. If somebody wants to wear masks, all the time, if someone wants to wear masks part of the time, if someone doesn’t want to wear masks, so long as they’re not endangering other people, then, you know, I think we ought to not be so judgy. But that’s more of a personal personal thing. And I think, be informed. Like read read your local epidemiologist, newsletter, let’s talk about BA, dot 2.86. And the reason we’re talking about is because interestingly enough, it is got a lot of mutations. It’s different enough from the SBB variable that were out there now. That it’s the kind of thing that if we weren’t going to see like the next new thing, that was very different in cause a lot of cases with Eric, it would have a lot of mutations. So when it first came out, you kind of said, Hey, guys, let’s pay attention to this. Tell us what we’ve since learned about B, A to B. A, well, you know what I’m gonna say ba to me this, what do you think?

Katelyn Jetelina  18:22

Yeah, so you’re right, the 35 mutations on the spike protein got a lot of attention among even the cool headed scientists. And the reason for that is we just want to know when the virus is becoming smarter of entry into our cells. But the challenge is, we needed to wait to see the puzzle pieces, the puzzle pieces and the lab data, the puzzle pieces and epidemiological data to see the real world implications. And all of us gave a pretty big sigh of relief earlier this week, when we saw lab data trickling in showing that, you know, these 35 mutations didn’t completely translate into disaster that yeah, it escapes our immunity a little more incrementally. It’s surprisingly less infectious and other currently circulating variants. And so the implications of that are not like another Omicron. Like events. We don’t think now that what happens in the lab is very different than what happens in real life. And so we also are looking very closely at epidemiological data in real time, and we are seeing that this is spreading and has enough arm to be spreading. We don’t know necessarily how quickly it’s spreading, but initial estimates show that it’s not necessarily a tsunami, like, if we were to see a wave it would be more of our seasonal waves that we’re seeing. But we still have a lot of puzzle pieces to put together. For example this morning, the you Okay, I gave a risk assessment, showing that there was a attack rate of BA two dot 86 and a nursing home of 86%, which is really high.

Andy Slavitt  20:12

What does that mean an attack rate of 86%. What does that mean?

Katelyn Jetelina  20:15

That means that out of all the nursing home residents, 86% of them were infected with VA to DOD 86, over 90% of them were vaccinated, and a few of them are hospitalized. So we still have some unanswered questions about what are the implications of this? Is it because they’re in a long term care home? With very close contact? Is it because there’s high viral load? Is it because they weren’t? I don’t, do we have a lot of unanswered questions still. So we’re still trying to put together this picture. But so far, it does not look like it’s going to be a tsunami. But that doesn’t mean there won’t be sickness or suffering.

Andy Slavitt  21:00

Okay, so there’s a useful framework here, you’ve written about, and I’ll butcher it up a little bit, but you’re looking at kind of, I think, the four questions you ask when there’s a new variant or so, number one, does it escape immunity? In other words, in a worst case, wow, all that built up immunity in whether for vaccines or prior infection doesn’t do anything? That’s one question. Second, is, is there something about it that makes it grow faster? You know, in other words, will it become the dominant virus? Because if not, then it’ll get crowded out by things that are that are more powerful. The third is does it cause people to become sicker? And the fourth is do our tools work through our door rapid antigen tests, our antigen tests? And most importantly, our vaccines and backflow COVID. work just as well. Are they knocked over?

Katelyn Jetelina  21:54

Yeah, I like that framework. It’s way more cleaner. So when is Amin Medscape, that bat dot 86 has about a two to three fold increase in immune escape compared to xB. B. And that’s not that much, we actually expected about a tenfold increase. And so that means that it can escape our immunity a little bit not as bad as we expected/

Andy Slavitt  22:18

it by escaping immunity, does that include memory B cells and T cells? Or does that just include kind of frontline immunity?

Katelyn Jetelina  22:26

That’s a good question. It’s just the first line of defense, which is neutralizing antibodies, which protects against infection. SARS Cov Two isn’t really evolving to escape our T cells, which protects us against severe disease and death.

Andy Slavitt  22:41

Great news. Great news. Don’t bury the lede here, Katelyn.

Katelyn Jetelina  22:47

It is great news. For those of us that can keep a memory response, those over 65 have a really challenging time doing that, because of their thymus and all these other reasons. Anyways, okay, so that’s. So the second is transmissibility is how contagious is this? And that’s what we’re trying to get with? Well, one, the lab data shows it’s less contagious in the lab, meaning the ability for it to latch onto a cell attached to a cell and insert viral DNA. It’s not very great at doing that.

Andy Slavitt  23:23

Well, it let’s just pause there for a second, because there’s a reason why none of us really remember alpha, beta. And gamma particularly well, because there were there were, in fact, mutations. They just never really went anywhere, because they didn’t have the ability to reproduce as fast as something else was out there. So in other words, there have been very input lots of mutations, but they never really affected a whole lot of people. And I think that’s part of what’s important. In what you what you’re telling us. Is that this one is seem to be spreading like wildfire.

Katelyn Jetelina  23:58

Yeah, I mean, and alpha did cause some waves, particularly in Michigan, which was weird, but other examples is like iota or mu. I mean, I guarantee you people don’t even know what those were.

Andy Slavitt  24:11

I love the new period. I’d love to that period.

Katelyn Jetelina  24:15

But they did sizzle out. They looked scary, but they weren’t fit enough for the current environment. So they fizzled out. And we’re hoping that that’s kind of what ba two dot 86 does to the third question was severity. That same nursing home data we saw from the UK today showed us that it does not look like the two diabetes six causes more severe disease, which is fantastic news. And then the fourth and probably the most important is how well our tools work against ba 286. Pack SLOVAN works. antigen tests work. monoclonal antibodies do not work but they also don’t work currently against x BB and our vaccines Oh, we’re getting great data from Maderna showing how these updated fall vaccine COVID vaccines work pretty darn well against VA today. 86. So, in general, it’s looking very good. And like I said, a lot of us gave a sigh of relief this week.

Andy Slavitt  25:18

Let’s take one more break. And we’re gonna come back and address a lot of questions that you the audience have sent me about the next gen project nasal vaccines about COVID apathy and fatigue about what’s happening with kids go back to school. We’ll be right back. And we’ll of course end with a prediction at exactly how many COVID cases we’ll see you this coming week. We’ll be right back. We’re back after our second and final break. And, yeah, there’s a whole host of other topics that I think people are concerned about, you know, we are seeing, you know, over the course of August and September, an increase in hospitalizations, a lot of that was driven by kind of weather which keep people indoors. Now we have kids in school and indoors. And, you know, I think for people who are like, I’m still focused on COVID, they’re probably feeling like very much in the minority, that they’re probably feeling like, why is there so much apathy? And why is there so much fatigue? And how do I deal with this? I think it would be great to start with, who are the kinds of people that are most likely to be hospitalized? If they are to catch COVID right now?

Katelyn Jetelina  27:06

Yeah, I think that’s a really important point is when we we look at these hospitalization rates going up, it’s not your average general population. These people in the hospital right now are vastly unvaccinated. Still, um, and then too much older, so around 60 years old plus ending up at the hospital. And again, that’s just because of their weaker immune systems, we’re also seeing a very different type of illness right now than we were in the beginning of the pandemic, we’re not seeing this COVID pneumonia with ventilators and headed into the ICU, we’re mainly seeing comorbidities really flaring up because of COVID 19 infection, not the body just overwhelmed by trying to find all of these things at once that they end up in the hospital. I don’t think one’s better than the other, but there is a different type of sickness. And I think that’s important to recognize when we are calibrating our risk tolerance.

Andy Slavitt  28:11

Right, like, like, we still have a little PTSD from like cytokine, storms, and, you know, ventilation and all that stuff. And when we hear people are hospitalized, we all remember, like when the news was fresh, that’s when we got our first impressions of COVID. That’s what was happening. And I think what you’re saying is, if you’re older, you have other pre existing conditions, you know, it’s likely to throw your Wii, you know, into a weaker spot and potentially cause you to be hospitalized, because it’s a tough thing for the body to fight, which is a bit different. And if you get vaccinated, you’re far less likely to have a serious reaction. So what about the upcoming booster 100% Focus on the variant we face today? The dominant variant? What do we know about how it works? And should people get it? If there’s people who really don’t need to get it? Who are those people?

Katelyn Jetelina  29:09

Yeah, so we have an updated formula vaccine coming out this fall, like you said, it’s targeting X BB, which is an Omicron, some variant that is the majority of cases right now. It’s not a big change as previous vaccine. So we’re relying on a lot of lab data to show us that it’s effective just like we do with the flu. So for me, I picture it as a few word changes on a Word document rather than a completely new document. So it’s just updating it and hcip. CDC is going to determine who is eligible. I would not be surprised if they made a sweeping conclusion that everyone over six months is eligible for a COVID-19 vaccine this fall because that’s what we do with the flu every year to do And I anticipate they’re going to be presenting a lot of data, not just on the benefits and risks of getting a vaccine like myocarditis, but also for the first time cost effectiveness, because this vaccine is privatized. So to be determined, but if if I’m eligible, I’m certainly getting it.

Andy Slavitt  30:25

So let’s talk about what the booster actually does. I mean, it’s assumed that everyone has some degree of protection from prior infection, or a prior vaccine, or both. Cuz I think that is, I haven’t met anybody that hasn’t had one or the other. And plenty people have had both. What’s the benefit? What’s the additional benefit to getting a booster now? Is it that it makes it less likely that you’ll contract COVID, but it really doesn’t do much for severe disease protection? Because you sort of already have that? What is the rationale?

Katelyn Jetelina  31:10

So there’s three main things that an updated Booster will do. The first is, particularly among older adults, is that it’ll better protect you against severe disease and death. Last fall vaccines, I had about 60% additional benefit over those that didn’t get the vaccine, but were previously infected. And I think a lot of us older adults would like that additional benefit.

Andy Slavitt  31:37

Are you calling yourself an older adult?

Katelyn Jetelina  31:40

I didn’t.

Andy Slavitt  31:41

You said a lot of us older adults, I just wanted to be sure.

Katelyn Jetelina  31:43

Well, I just I didn’t know that the audience was in the bubble.

Andy Slavitt  31:49

Okay, all right. As long as you’re not saying you’re an older adult, I think we can all we can all give that a pass. For as long as you’re not saying I’m an older adult, that would be even worse.

Katelyn Jetelina  31:58

I’m not saying you’re an older adult, very vigorous. The second benefit is a lot shorter term, it’s a neutralizing antibodies, which will prevent us against infection and transmission. This lasts, unfortunately, very short timing, maybe three months, maybe four months. And so if you’re looking for the booster to help protect against infection, you’ll want to try and time that follow vaccine with a wave, which is challenging to do.

Andy Slavitt  32:30

Okay, let’s take a look. Click on that for one second. Okay, so booster becomes available second half of September. So kind of like this next week, or so, most likely. So three to four months, October, November, December, January. And you’ve written about how we think COVID will peak kind of late December, although that could obviously slip a few weeks. And it’s happened in January before as well. Does that imply that it’s the smartest time to get it is in October? What what’s what’s I know you said we shouldn’t time it. But I also think we don’t want people to take it too early to the point that it wears off.

Katelyn Jetelina  33:17

So what I am telling my family and friends and what I’ll be doing myself is I’ll be waiting, probably the role I’m giving everyone is get all three of our vaccines, right? RSV, flu and COVID If you’re eligible before Halloween, and I think that’s a pretty good bet with timing. Again, we don’t know what any this is gonna really peak. But that’s my advice. Yeah, take it or leave it.

Andy Slavitt  33:41

Ya know, what I think it’s important about that advice is if you’re getting together with your family over Thanksgiving, getting it before Halloween, gives you enough time to have the vaccine, fully firing and working. So for that reason, no reason to go later than Halloween. Obviously, if you’ve got some major risky activity, you know earlier than that, then maybe that causes you to change, but also very justified in getting closer to Halloween. If you have nothing that you’re kind of over to worried about in the next few weeks.

Katelyn Jetelina  34:19

The only reason I would wait until after Halloween I could see this scenario is if someone just got infected with SARS, cov. Two in September, because you want yeah, you want enough time between your infection and your next vaccine, where it’ll be beneficial. And what we see is within the first 234 months of an infection, there’s really no huge additional benefit. There’s no risk, but there’s really no reason either.

Andy Slavitt  34:48

That’s great. That’s great. Okay, and you mentioned, I cut you off you’re about to mention the third benefit of a vaccine.

Katelyn Jetelina  34:55

third benefit is it updates our B cells. And so B cells are antibody factories just like we have factories for cars, it will update our factory. And when it updates our factory, it’ll show us that we need to be well prepared against currently circulating variants, which is x BB. So severe disease protection against infection transmission, at least in the short term and our antibody factories.

Andy Slavitt  35:26

Just say, the more I’ve learned, I think, the coolest invention that’s ever been made as the human body, like I am amazed, at like, all of these crazy cool things our bodies do to protect itself and adjust and make us better and heal. Like, I can’t think of anything that says cool.

Katelyn Jetelina  35:54

Yeah, our immune system in particular is just it’s so complex, but I think it’s a good it shows why as humans are dominant species. I mean, it’s it’s really quite incredible evolution.

Andy Slavitt  36:09

Yeah, I brag about our immune systems that are opposable thumbs to my dog all the time. Because he doesn’t have them. Okay, couple more things back to school, parents sending the kids back to school. What should they be thinking about talking about and of course fighting with other parents about because that’s seems to be not not don’t fight with other parents.

Katelyn Jetelina  36:32

The biggest challenge that as parents have, because I am a parent, so I can say us now is isolation is how long do we keep our kids at home because there’s a benefit for them going back to school. But again, we don’t want them going back to school infectious. And currently, CDC and I agree with this, where kids is isolate for five days, and then go back to school if they’re still testing positive on an antigen test with a mask until they’re not testing positive. And I think that’s the best thing you can do for fellow students. And as a good community member.

Andy Slavitt  37:08

Next gen vaccines, we want nasal vaccines with universal vaccines, are we making enough progress is going fast enough?

Katelyn Jetelina  37:15

Well, we now have $5 billion for next gen vaccines, which is fantastic. I think that people don’t realize how challenging it is to make a good nasal vaccine. And are we going fast enough? I mean, I guess we’re never going fast enough. It would be great to have a vaccine today that stops transmission. But I think we’re going as fast as we can in the current political landscape that we are in. If not faster, I was pretty impressed of getting that money for next gen vaccines and treatments. Yeah, hats

Andy Slavitt  37:49

off to Ashish Shah for getting that. But there should be no more politics because we kept it. So it’s about the scientists and the NIH and drug companies and, and whether the science works in any field, I know there’s people that are impatient for this. And it’s hard when you’re in the middle of a process because you don’t know whether or not something’s working or progressing or not deep. Do you have a feel?

Katelyn Jetelina  38:14

Yeah, so there’s a couple in the clinical trial pipeline, particularly with made as a booster, which I think makes sense given that we have so much immunity right now, they’re not trying to make a primary vaccine series. But get but again, I want to underline how difficult it is to make a mucosal vaccine that achieves the balance between safety and efficacy. There is a huge scientific barrier at each step of this process. And that just hasn’t been achieved yet. And we’re trying to push that scientific discovery forward just like we did with mRNA vaccine. So to be determined.

Andy Slavitt  38:54

Okay, final question. Before we go to our premium episode, I’m not going to ask you to tell us exactly how many cases we’re going to have or exactly what hospitalization is going to be. But I am going to ask you kind of just a more of a low medium high question for what we what your prediction based on everything you’re seeing is, do we think this is a another angle, if we call it the last winter, kind of on the low side? And recall before that, on the high side? Do we predict low, medium or high kind of winter ahead? And maybe more importantly than that, like, when will we really know?

Katelyn Jetelina  39:31

We won’t know until it’s passed. And I think that we’ll we’ll have a good idea and seeing how this virus continues to mutate, seeing how the 286 works in this landscape. But we won’t I mean, we won’t really know. Um, I think that if we look at the southern hemisphere, they had a pretty middle of the road, respiratory season with COVID, RSV and flu. So I hope that we kind of have a repeat of last year and I think you categorized It’s low, but low to medium, a shareholder. But we’ll see what happens.

Andy Slavitt  40:08

Okay. Well, thank you so much for being in our bubble with us. And for all your fantastic work. I’ll tell you again, if you don’t get the your local epidemiologist, newsletter, you’re missing, like the most human understandable report on what’s going on out there, not just COVID, but other like interesting and important topics. Thank you, Katelyn.

Katelyn Jetelina  40:38

Yeah, thanks for having me.

Andy Slavitt  40:52

Thank you, Katelyn. I have a very special episode. Next week. Franklin, for who is a great writer for The Atlantic has written a book on the first two years of the Biden presidency. I really enjoyed the read. By enjoy talking to Frank, I was proud of the source material, and then featured a couple of pages in the book. That’s why I’m having him on. As we move towards the election. I think it really, really important to get insights into the first two years of Joe Biden, some of the mythology that’s out there about him some of the BS that’s out there, some of the reality and I think Frank took a incredible up close luck. So we’ll have him on next week. In the meantime, I hope everyone is getting back to school and work and enjoying the remaining days of warm weather. And we’ll talk to you next week.

CREDITS  41:58

Thank you for listening IN THE BUBBLE. If you like what you heard, rate and review and most importantly, tell a friend about the show. tell anyone about the show. We’re a production of Lemonada Media. Kyle Shiely is the Senior Producer of our show. He’s the main guy, and he rocks it with me every week. The mix is by Noah Smith. He’s a wizard. He does all the technical stuff and he’s a cool guy. Steve Nelson is the vice president of weekly content. He’s well above average. And of course, the ultimate big bosses are Jessica Cordova Kramer and Stephanie Wittels Wachs. They are wonderful, inspiring, and they put the sugar in the lemonade. They executive produced the show along with me. Our theme was composed by Dan Molad and Oliver Hill, and additional music is by Ivan Kuraev. You can find out more about our show on social media at @LemonadMedia where you can also get a transcript of the show and buy some in the bubble gear. Email me directly at andy@lemonadamedia.com. You can find my Twitter feed at @Slavitt and you can download in the bubble wherever you get your podcasts or listen ad free on Amazon music. It’s a prime membership. Thank you for listening.