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Description

Reinfections across the country are being driven by an explosion in cases of BA.5, the latest variant of COVID-19. Andy asks Harvard epidemiologist Bill Hanage whether our vaccines and immune systems have a fighting chance, if infections are more severe than other Omicron offshoots, and what we need to do to safely get through the summer and fall. Will those who have managed to avoid the virus for years finally succumb to this wave? Find out.

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Transcript

SPEAKERS

Bill Hanage, Andy Slavitt, Bill

Andy Slavitt  00:18

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. It’s Wednesday, July 13th. How are you doing? We have an episode today, that’s going to focus squarely on what’s the evolving picture looks like, from the BA5 areas, as it makes its presence known here in the US. To do that we have on the show the same person that I invite on every time we have a new variant with Omicron, Bill Hanage, from Harvard, Bill is a delight, you’re really going to get a lot out of this show, we’re gonna get right into it. But let me tell you, can get a little bit of a painting of the picture for you, BA5, along with BA four. But I think BA5 is the more relevant and stronger of the two are making its way around the country infecting a lot of people, particularly so in the south, starting to hit in Florida. And we’ve got a lot of open questions. And my most important questions are, number one, what’s happening to our immune system? What’s happening to our immune system? Is our prior immunity holding, or is BA5 dodging? I think there’s a lot to be learned there. We’re going to go there with Bill. Secondly, is this thing more severe, we get some mixed data from different parts of the world, some of which says it might be more severe, some of which says it might not. And then Bill’s really good a piece of that apart and saying, well, what’s an illusion? What’s the reality? What might be causing things? And then, you know, what do we need to do? What do we need to do about it? As we get through the summer and the fall? The conversation with Bill is both analytical and scientific. And it usually becomes a little bit philosophical at times, about how we as a country, we as individuals, he, as a person, kind of react to things. All right, let’s get into this conversation. We’re gonna learn a lot from Bill.

Andy Slavitt  02:07

All right, Bill, you’re probably our official in the bubble variant expert. Not a thing you ever wanted to be. I’m sure. But thank you for being on call for us, when we have complex new variants coming to haunt us. Latest, of course, is BA5, which the CDC says makes up itself over half the cases in the country. So how is this different from our current swath of variants?

Bill Hanage

So BA5 is often grouped together with BA5, okay. And there’s a good reason for that, they are very, very similar, for the point of view of the immune system thinks the immune system cannot really tell them apart. And that’s important to remember, these guys are different from BA2, which has just kind of come through and caused his own little type of havoc, and that they have a mutation at this 400 and 52nd position of spyke. Interestingly enough, that’s exactly the same place that BA2121, which you remember, hearing about in the northeast, had a different mutation there. So it seems likely that these guys have got some immune evasion property associated with that. I mean, whatever happened with 2121 in the northeast, it wasn’t enough to stop BA5, because it has taken off here. But it may have delayed it just by having some general immunity in the population. But you know, what’s really cool, Andy, what really interesting, at any rate, from my point of view, because BA4 and BA5 are so similar. From the point of view of the immune system, the fact that BA5 is consistently taking over everywhere we look suggests it must have something else, some other special sauce, which is making it a little bit more transmissible on top of everything else. And that’s one of the reasons why, you know, we’re looking at it with a certain amount of justified concern.

Andy Slavitt  04:15

Is the similarity mean that if you get BA4, it’s like getting BA5 from an immune system perspective?

Bill Hanage 

First approximation, yeah, but people with BA4, you know, the numbers are dropping all the time, because BA5 is stamping on it.

Andy Slavitt 

So I think we’re getting like there’s a set of routine questions now that we know to ask with every new variant. And so let’s ask them, and we’ll see what we know. One of them of course, you just spoke to a little better you least alluded to, which is it has to be more contagious. If it is working its way through the population and replacing past variants. I’ve seen numbers thrown around like this is 20% more contagious. It feels like they’re all always 20% more contagious, though. So I just feel like that’s some, someone backing the envelope, is it indeed more contagious.

Bill 

I mean, well, well, what do you mean by more contagious? Is it finding it easier to infect people, but what’s making that happen? Part of it is going to be the immune evasion, right? And part of it’s going to be whatever else it is. So those two things go together. If you want to get into the epidemiology, it’s even more complicated, because this is, it’s actually really kind of cool when you think about it.

Andy Slavitt 

Believe it or not, I love this stuff. I mean, I don’t love the fact that it’s happening. But I really want to understand.

Bill Hanage 

Oh, it’s so neat. Think about generation times. So imagine you’re infected with something that would transmit to 10 people. But it would take a month to do so as opposed to something else that would transmit to just two, but would do it in a couple of days. Well, that’s the second one, even though overall, of the former would transmit two more, all things being equal, in a growing population, you’re going to select for the first one. So it could be generation time that’s involved. And I’m just, I’m not trying to say this to muddy the waters, I just want to point out something that’s really important to state at this stage. And actually, I think the first person who saw that, who I saw, say this really clearly was Niall Ferguson, who sort of he shares, or at least he shares an accent with me, depending on how far I have drifted from my roots. He’s a British epidemiologist, and around the turn of the year when he was talking about Omicron. He just said, frankly, there’s a lot of moving parts, you know, there are lots of parameters. And there’s a lot of uncertainty around all of them. And so it becomes really quite challenging to be able to roll that tape forward.

Andy Slavitt  06:42

So, it sounds like the real legit answer is we don’t know if it’s inherently more contagious. We do know that there’s something about it. And we’re going to talk about the immune evasion in a second. That’s making it spread.

Bill Hanage 

Yeah. I mean, it’s definitely I mean, contagious, contagious, doesn’t, you know, it is spreading, it is increasing as a proportion in the population. And it’s caused waves elsewhere. So, you know, let’s just think about the facts. And the facts are that this is coming.

Andy Slavitt 

And so the net effect is that if you walk into a business, a store, a restaurant, with BA5 present in your community, and the same place you would have walked into before BA5, unmasked, you’re more likely to get COVID than you were before BA5, whether or not that’s because of immune evasion, or because there’s something in the properties that makes it more instantly contagious. That’s the net effect on people.

Bill Hanage 

Yeah, you nailed it right there. And I don’t want people to think that BA5 means that we are back at square one, because we’re not, I mean, I hope we’re gonna get to talk about the fact that there’s a lot of the immunity is now quite variable. You know, you have people who’ve were infected yesterday, you have people who were boosted yesterday, and so on and so forth. But what BA5 was plainly good at doing is infecting those people whose immunity is waning, and they become vulnerable to reinfection for other variants are able to get to.

Andy Slavitt  08:14

What I heard somebody say, and I would say that the person who said this was on a computer program called rhymes with schmitter. It was something to the effect of now you can just walk into a room for, you know, 30 seconds and get infected. That’s how contagious this is. It was on Twitter. So it had to be true. But the perception that it’s less exposure to viral load, with BA5, is there anything to that? Or are people conflating what we were just talking about that? In fact, no, […] do a good job, but there’s nothing about how long your exposure is, that is different here? Or do we not know?

Bill Hanage 

Yeah, we don’t know. I mean, as you must have noticed, Twitter is a place where people can say, all kinds of things. And they don’t necessarily have to explain their evidence. That’s putting it mildly. But we do not know. I mean, I think it’s a more reasonable thing to say just that kind of the way that we were talking about it before, which is that if you have an exposure, which you could have got infected before, you’re more likely to get infected with BA5 than you were.

Andy Slavitt 

And leave it at that. Let’s talk about severity. Because that matters. And there’s all kinds of severity. And I think as we get better at this, we probably should be talking about acute severity and severity of long term symptoms. But let’s start with the acute side, which is what sends people to the hospital. You know, it seems to be that in different countries. We’ve had some really different observations of when they’ve had BA4-BA5, South Africa didn’t appear to see a significant increase in hospitalizations, if I’m not mistaken. Portugal, on the other hand, did. Now, there’s a lot of things that in this very highly controlled experiment of Portugal versus South Africa. Like, how long when was the last one there? And what did it look like? And all sorts of other things. But what do you surmise about severity from what we’ve seen so far?

Bill Hanage  10:32

Well, I mean, the first thing to say is in regards to Portugal versus South Africa was to remember that Portugal had, has an older population. So we expect to see more of those. And the other interesting thing about more recent waves is that it’s finding easier to get into those older populations, whereas previously, they’ve not really been exposed. So I think that’s something that’s important. And I think that’s going to be really important with the BA5 here, potentially, as well. But in terms of severity, I mean, the very comforting thing about Omicron was not only is it blunted by increased immunity in the population, it looks like it really is less serious than Delta. Now, don’t run away thinking that makes everything mild, because, you know, you notice my words, it means that it is roughly speaking about as dangerous as the OG virus back in 2020. Very roughly speaking, but it’s increasingly difficult to untangle that, because of the fact that as I said, we have many different overlapping situations with different amounts of immunity, blah, blah, blah. But it is very relevant to places like China, for instance, because we have what some people call hybrid immunity, which is to say, we’ve got quite a lot of audio, we call that layered immunity at one point where you have immunity from vaccines and from infections, sometimes multiple infections, sometimes mix and match vaccines. It’s very variable. And the more hybrid it gets, it looks, at least to the immunologists, I know, like we’re getting better able to face future waves. And that exact history may have a big impact on what BA5 does in different places, and when, but it’s very important for places like China, because China has very little in the way of hybrid immunity. It’s vaccines are not terrible, but they’re not great either. And uptake is not as high as you might wish. And something like BA5 is going to be a struggle to control. You know, we’re seeing these repeated lockdowns. And it’s astonishing that China’s controlling it at all, but it’s going to keep having to do so this is not a sustainable long term strategy.

Andy Slavitt 

So here in the US, we don’t know what’s going to happen with hospitalizations. I think in some part of what you’re saying is, it depends on if it gets into older communities, older parts of the population that are at risk, like Portugal. And that we should anticipate that that is possible. But then I think you’ve mentioned a number of factors around immunity. And let me repeat the back to hear what you said. One of them is, have you been vaccinated? And that there has have you had COVID, and others if you had Omicron itself? Which version? Another is how recently were you vaccinated and boosted because there’s a waning? And so all those means that I guess on the one hand, it’s a no longer novel virus, right? This is no longer 2020. Where or like it is in China, other countries where it’s hitting many people for the first time. But what you’re also saying is all of us are a bit different. And how our immunity is working. So how important are those differences? Really, like if I had COVID, three times, but I’ve never been vaccinated, turns out I’ve never had COVID and I’ve been vaccinated four times, but let’s just say, that’s me, I’d be that guy. And you’re the guy who’s been fully vaccinated, as of, you know, three or four months ago. How different does our immune system actually look? Is it marginally different or are these very different scenarios?

Bill Hanage  14:29

But you have to remember that people are pretty different in their immune responses anyway. So on top of that, you’ve got the fact that some people are and you know, when you hear about folks who have been reinfected several times or vaccinated and infected, breakthrough infection several times, that’s not likely to be a random sample of the population. They’re more likely to have been exposed and they are more likely to have been infected possibly because of their immune system is not quite as good as those folks who didn’t get infected. So we’ve got to recognize all of those things are going into what we’re actually seeing. But there is substantial variability. I mean, look, in 2020, we, the human population, were a blank sheet on which the virus could write its own story. That’s not true anymore. And that’s not to suggest that we don’t have a serious public health problem going forward with the virus. But it does mean it’s very different. And it does mean that we’re going to probably we’re going to see different patterns about of transmission, which are going to vary among people and also among regions, like we were saying, Portugal, South Africa, very different experiences. The UK, a very different experience. Once again, Portugal and South Africa have in common that they did not have a big BA2 wave. Not true for the UK, the UK had a whopping great BA2 wave. That hasn’t stopped to be a five, but it may have delayed it somewhat.

Andy Slavitt 

Well, when we come back, we’re gonna continue to talk about whose immune system is better, Bill’s or mine. Before I get to what’s happening with our immune system, talk about this notion of incidental hospitalization and how you interpret that, explain it to people.

Bill Hanage  16:33

So called incidental hospitalizations are people who are in hospital with Covid, but not for Covid. They are folks who are pitching up with I don’t know a broken leg or what have you. And they get a test because they have to have a test before they’re hospitalized. And they are found to be […] positive, they have Covid. But they would never realize otherwise. It is important to distinguish those things. And recently, for instance, the BA2 waves where people have been looking really hard suggest that 20% to 30% of hospitalizations have fallen into that category. Here in Massachusetts, we might do it by checking out who’s having dexamethasone, which is a therapy, which is given to people who have severe Covid. But then it’s often used to say, Oh, it doesn’t matter. They’re all incidental. Well, no, they’re not all incidental. And having somebody in your hospital with Covid is itself really disruptive, because they have the potential to infect staff. And once the staff are off then whoa, you know, that’s starting to eat into your healthcare capacity. And it’s a real headache for infection control. So, yeah, incidental hospitalizations, it is important to think about them separately. But it doesn’t mean that we can ignore them. And I will say, by the way, one of the really depressing things is just how poor the data are, in general. states vary and how they report it, hospitals vary and how they report it. And it’s a real, it’s a real headache making head or tail of it. And you know, just add another spanner in the works. The most recent technical briefing from the UK is health security agency. I got to say that name by the way, as an aside, that may very Orwellian, isn’t it? Health Security Agency, the latest technical briefing suggested that the infection hospitalization rate was starting to go up. So people who were infected were more likely to be getting hospitalized. But again, we have a nightmare with this because we are counting cases less well, because more people with mild infections are doing tests at home, and then never reporting them. So we are losing, we are losing our grip on the situational awareness of what’s going on.

Andy Slavitt  18:48

Well, it sadly, I had report, we have an elderly cousin that was hospitalized about two weeks ago for a fall in she died of Covid in the hospital.

Bill Hanage 

I’m sorry to hear that. But that I’m very sorry to hear that. But it’s an exact it’s a perfect example of the sort of thing that we are that I’ve just been talking about.

Andy Slavitt 

And you know, I don’t know, nobody has ever went anywhere else. Whether or not if she hadn’t gotten infected with Covid, whether she would have survived and didn’t come out of the hospital. And it’s all possible she would have I really don’t know this for sure.

Bill Hanage 

Yeah, it’s also possible that Covid could itself contribute to fainting or loss of consciousness, which could lead to a fall and so on and so forth. There are all kinds of different ways in which the virus can mess with us.

Andy Slavitt 

And you know, and when you’re older, and you’re frail and you’re fragile. We tend to mentally say, oh, you know, they were older and frail. And speaking as someone who every day gets closer to being older and frail. And I don’t know that I like that so much. And, you know, BA5 I think people would like to put under the category of, well, it’s probably not going to cause a problem for me. Because I’ve had, I’m not super frail or all right. But, you know, every time we need to do variants come, I think it’d be reasonably sobering to understand that it’s all random. And we just don’t know what each one’s gonna bring.

Bill Hanage  20:22

Yeah, the interesting thing is this, what you were saying that speaks to something which is really, which is extremely challenging. And, I mean, I can talk to you about science, I can talk to you about the evidence for what the BA5 does, what it’s like, the consequences are, what I would expect to be effective interventions against it, and so on and so forth. But the question of what you do about it, and how somebody responds, if they feel like they are not themselves, particularly at risk, that ends up being more about values, you know, and my values are such that I don’t want to be infected, I don’t want to be in a situation where I would put people at risk, you know, I’m going to be traveling shortly. And I’m going to be seeing my father in law who’s older, and I don’t want to be infected before I meet him. So you know, I’m going to be making a special effort to not be infected. But other folks are not necessarily going to think that way.

Andy Slavitt 

Do you think of that kind of is, for now, or for the foreseeable future? Part of the adjustments we just have to make to our lives. It’s a part of this, this new steady state, certain times certain situations, we just have to be more careful. That’s kind of here to stay. Is that kind of how you mentally grapple with it? Or do you feel like, oh, it’s temporary thing? And maybe a year from now? Or two years from now? That’ll be different?

Bill Hanage 

Oh, I think that years from now it will be it’ll be gone. I really think and I think that for a lot of people, we are functionally at that place already. But I think that it’s important to note that we don’t actually know what’s going to be happening in the fall and winter. I know that a lot of people would like to hear that mask mandates are gone forever. But you know, what come the fall and winter, if we find that there’s a number of people who are vulnerable to severe infection with whatever is circulating then, we might want to be being thinking about them again, in certain places like public transportation, I pick public transportation, because, you know, you can’t choose really to not use it, it’s, you know, and the vulnerable folks don’t, you know, can’t be just walled up within their house for that period. So it’s a way of just, you know, helping your community.

Andy Slavitt  22:36

I think Los Angeles is going to have mask mandates back.

Bill Hanage 

Really, that’s interesting. Yeah. And I also think it’s reasonable to go I think having an on again, off again, thing, depending on epidemiological context is not crazy. And in the end, remember, we’re not in a situation where we’re aiming to stop all infections. But we are trying to come up in a situation where we can give the very best care to the people who are going to need that and avoid a very, very large force of infection in the community, which is going to make a lot of vulnerable people sick quick.

Andy Slavitt 

It’s also important to note that what I didn’t hear you say is, you know, Andy, I’m gonna go see my father in law in a few weeks, and life’s gonna be absolutely intolerable, until that point, I can’t have any pleasure and enjoyment out of life, which you said was I gotta take a few more precautions wear mask, probably not going to dine indoors. I didn’t hear you say that you were compromising in ways that are unacceptable.

Bill Hanage 

Now, I mean, maybe it’s just me, but I don’t find wearing a mask in some settings to be a particular burden. I mean, you know, I mean, I can’t remember if I said it elsewhere, but I realize this might not be true for everybody. But I don’t go to the grocery store to show off my boyish good looks. I go there to get groceries. And I can get groceries while wearing a mask. So why not? I, you know, I’ve been to several scientific meetings recently. And while I was at them, you know, lots of people together in person. I wore a mask indoors other than a few occasions when I might remove it to have a sip of coffee or something like that. The fact that I’m removing it doesn’t instantly magically make it completely invalid or completely removed the benefit of wearing on other occasions. It’s a little bit more risky, but only a little bit.

Andy Slavitt  24:27

Great. I thought so about what we expected now and in the fall. I think we’re hearing is that we can anticipate another wave of cases from BA5.

Bill Hanage 

Yeah, probably across the south. You can see that Florida. Good old Covid curious Florida has already got quite a lot of BA5

Andy Slavitt 

Yeah, Florida is special case. And then we don’t really know what will happen with hospitalizations. But we have reason to be concerned with some of the elderly population in Florida. hospitalizations do appear to be moving up in Florida from what I saw.

Bill

Yeah. But I mean, again, the reporting makes it difficult to disentangle. It’s going in a direction, which we’d rather it wasn’t.

Andy Slavitt 

And it’s, it’s safe to say I get this question a lot. Now that people are anticipating that there’s going to be a new formulation for the booster in the fall, people who are 4 or 5 months away from the last booster asking, should I get boosted again? Or should I wait for the new formula? Given how much waning seems to matter here? Or doesn’t matter here with B five? Do you have an answer to that for people?

Bill Hanage 

Yeah. I think it depends on your personal circumstances, and the extent to which you are vulnerable. I wouldn’t want to encourage people to get infected for the, you know, for the benefit of the immunity that comes from that. But younger people are less likely to have the burden of severe disease as a result, older folks, I think it would be more reasonable to be looking at a booster vulnerable folks as well.

Andy Slavitt  26:02

So would you say that just sort of pick some I don’t know, Column 55, reasonably handsome, yeah, for the sake of argument, you know, very funny guy, let’s just say, but making this up, you know, we might as well stick with it, with that kind of example. But, you know, somebody who’s in their, in their, you know, color with their 50s, where it’s kind of at the border between, you know, 60s and 70s. I think we noticed they boosted but in some mediums. Like, how far would you say, you would expect to be comfortable not being boosted? When you get four months, five months? I mean, it seems to be very much a very a lot of imprecision around how frequently people should be boosted.

Bill Hanage 

No, there is that’s because there is a lot of imposition, and, and it makes it even more uncomfortable. It depends on the circumstances you’re in, it’s like, you know, I’m not as advanced in yours as the funny gentleman you’re talking about. But where I think that I would think that it would be more, it would depend on how much disease was around locally and how much was expected to be, for instance, Florida, you’ve got a good chance of being exposed to BA5 pretty soon, here in the Northeast is not so clear, actually, at the moment, we might have a because we tend to have less disease than the South does in the summer. But it’s really the Fallen winter that I think we’re looking at, and we don’t know what’s going to be circulating then. Although I don’t know if we’re going to get to BA2.75 which he may have lined up. But you know, that’s the latest variant, which is making people you know, shift in their seat nervously. This is really, really early on. So 2.75 was reported in India, seeming to increase a lot. But it’s since then spread to a number of countries, including the UK and the United States. The reason it’s interesting is it’s got a lot of changes in spike not one, not two, but I think it’s eight, including a switchback, and then mutations that if you saw one of them, you might think, oh, that’s a bit worrying. But when you see it all together, you think, oh, that looks nasty, because of the fact that the previous variants, as you know, have all been marked by these big jumps in spike, lots of changes all occurring at once. And this is the first time we’ve seen something like that emerge from within one of the previously significant variants. Now, I want to be very clear, this is not necessarily going to sweep the world, it has yet to be seriously in competition with BA five and once it comes up and goes toe to toe would BA5, BA5 might just kind of kick it back into the C right. So keep an eye on it. But there’s a reason why we’re looking at this and there’s a reason why surveillance continued surveillance matters.

Andy Slavitt 

Got it. All right, well, we’re gonna come back we’re gonna finish by talking about what’s coming up in the fall about booster strategy and get vaccinated and how to protect ourselves. Okay, so we got a fall coming up. And I think if this fall in winter is like our past falls in winters, we’ve seen a lot of cases, we’ve seen a lot of spikes. So now we have the FDA. That is indicating that they’re going to introduce a bi-vaillant vaccine for the fall. So let’s talk about how science put aside the fact that we’re having difficulty getting people to keep up with their boosters. I think that’s another thing to talked about. But just sort of a purely scientific approach, how good do we feel about what we’re seeing from Pfizer and Moderna around what will essentially be kind of a BA5 dominant world.

Bill Hanage  30:12

So we have some new vaccines on the scene which have been made to deal with the original AMI to add the original Omicron. We have by Vaillant vaccines which include the original virus and be a one Omicron. Now, it can’t have escaped your notice that VA one is actually quite a long way away from the virus is currently circulating. And, you know, six months on from BA1, the stuff that we’re talking about was, you know, not even a twinkle in BA1’s eye six months ago. So we don’t really have a sense for exactly what’s going to be circulating come the fall and winter. Having said that, it’s reasonable to think that it will be something that’s closer to be BA5 than to the original virus. And so that’s, I think, a good motivation for using those vaccines as boosters, because but I do always want to point out that it’s not completely unfamiliar, I mean, every year we talk about flu, trying to figure out what’s going to be circulating in the winter and making a vaccine formulation. But if you think about this point, last year, lots of people were saying to me, oh, we should be changing to have a delta booster. And then Omicron came along and tore up that script. So I want to be really, you know, I think that it’s good to have these boosters. And they would be better than another shot of the existing vaccines, I think dealing with BA4 and BA5. But we’re not going to know for sure. And because of the fact that we’ve now got a situation where as I said, everybody has their own different types of immunity, it’s much harder to do proper sort of efficacy trials, we have to do effectiveness trials, or effectiveness studies, rather, and they end up being subjected to all kinds of biases. So we are in a much more fuzzy world when it comes to this. So I’m you know, I’m glad that they exist, I will, in due course probably be getting one myself. They’re a great weapon to have in our arsenal, but they are also going to the vaccines are going to be a moving target as well, just like the virus.

Andy Slavitt  32:34

I think you’ve been told you’re not allowed to use the word Arsenal on the show. But that’s another matter. I’m kidding. Am I wrong? Did Pfizer release some sort of data about how their vaccine stood up to BA5? When they submit it to the FDA?

Bill Hanage 

If you’re talking about standing up? I mean, we have to always think about standing up in terms of correlates of protection, you know, that fancy term, you know, you can see how many antibodies or how neutralizing antibodies are impacted. But then there’s another question over whether that is durable, you know, how long does it last? There’s a question of, well, these antibodies look good. But what do they really do on the street? As it were, once you’ve actually got this out there? So yeah, I mean, these days, the data that we’ve been getting from vaccines, or the name from the vaccine manufacturers are comforting. Don’t get me wrong, it’s good. I mean, these are vaccines, which continue to help us and save millions upon millions of lives. But we’re that, you know, they’re not an endpoint.

Andy Slavitt 

Is it realistic to just start to describe the vaccines this way, which is, for a period of a couple of few months, maybe, maybe a little longer, the vaccines are able to offer a reasonably good protection against getting infected. And as far as we know, except for people with a lot of risk factors, they continue to be very good at keeping us away from the most, the worst acute events against put aside, put aside chronic events. And that that’s really the way to think about them?

Bill Hanage  34:17

Yeah, I mean, they are a subset of pupil will continue to be protected outside of a few months, because, you know, everybody has their own flavor of immunity, and some people are protected against infection, you know, for all that people treated Omicron as if it was a complete escaped variant. You should note that even though a lot of people got infected with Omicron very quickly, if it was half as transmissible, as people claim, and as we think it would have infected way more and completely susceptible population. So some people were still immune to infection, and that’s going to be the case also going forward with these other things. But you know, what’s going to be one thing, which is important that we haven’t thought about, we now have this continuous resupply of susceptibles, which is that people are dropping off from that point of being uninfectable to being infectable, and it happens to everybody at different rates. And so that is going to change the dynamics of the future waves that we see.

Andy Slavitt 

Right, our immunity isn’t what we thought it was what we hoped it was, at least with regard to preventing infection again, we now all know people who’ve been infected multiple times. And that’s the disappointing piece of this. So I won’t name them, but some […] publication, asked me to write an article for them, which I agreed to do. And I don’t want to brag bill, but they’re paying $300. Count it, buddy. It’s interesting. The illusion of bragging about my […], what they want me to write an article about is like, it seems like we’re stuck in this rut. And what could possibly go right that will take us out of this rut? We hear enough about what could go wrong, what could go right. And it occurs to me in thinking about this because I have yet to type a word, that limit things you were just talking about, which is as fast as we can make new vaccines, if we can’t make them as fast as new mutations occur, then unlike the flu, we’ll be making yesterday’s vaccine every time every year. And so conceivably, if this thing doesn’t slow down, you know, scientifically, we’re just going to be chasing it, which again, even if we’re preventing deaths and hospitalizations, just loads of cases, loads of people missing work, loads of people having to alter their life, et cetera. If this thing is going to three, four times a year, it sort of seems to be circulating at the kind of rate of the common cold. But with more serious consequences, exactly more serious consequences. Is it conceivable that the rate of variant change, which is driving us all, driving a lot of our challenges could slow down?

Bill Hanage 

That’s very difficult question to answer. I mean, it all depends. It depends on a number of things, including where exactly variants come from, how many infections there are, which could produce them, you know, what we’d call a mutation supply rate, and shifting selection, I don’t think it’s reasonable to suggests that variants are really going to slow down marketly, I do think it’s reasonable to think that most of the waves that we see will be smaller, certainly less consequential. Coming back to Portugal, by the way, I want to point out that the deaths that they saw with BA5 was similar to the deaths they saw with BA1, but both were much less than what they saw previously in the pandemic. So that’s an important thing to remember. One thing that people seem to be forgetting, and it does my head and the people forget this, but you know, most people are not me, it’s fair enough. We are living at a time when there is a huge amount, a huge, historically significant amount of severe respiratory disease, if you were to take the daily deaths, and the weekly deaths that we’re seeing at the moment, and it’s time when people have been saying that, Oh, this is relatively good. And you rolled them out over a whole year, you’d have two bad flu seasons. But the thing is that most folks don’t remember when the last bad flu season was present on the roads. They don’t they don’t work in this space. And so it’s something which happens in the background, I suspect, we are going to carry on a journey in that direction.

Andy Slavitt  38:45

Okay. Well, I’m share my $150, of my $300, with you for that.

Andy Slavitt 

We’re starting to also hear in each of these different variants that occasionally the symptoms are different. And indeed, that in some cases, the chances of getting long COVID are different for a variety of the factors that we’ve talked about. It could be because of immunity; it could be because of something in the mutations. There was a study out of the UK, which showed a 20% write less likely had of getting long Covid from Omicron versus delta which was which is positive news. And then you know, we’re hearing that baby smell and taste aren’t as impacted by BA5. This all feels very early and anecdotal. But are there are there things that we should be thinking about relative to either the acute stage or the longer term stage of this new variant that are different? We come back to long COVID on the show probably every three to four weeks, five weeks to give an update. But it’s probably useful to just see if there’s anything here that pops up.

Bill Hanage 

Thank you.

Bill Hanage 

Yeah, I mean, the loss of the association with anosmia loss of taste and the sense of taste and smell is actually something which has been noted with some of the other Omicron variants. And the thing I’ll say about the data, it’s noticeable to me. And I don’t want to run out and say, oh, no, look, this is definitely true, we obviously need to investigate it. But it’s been very noticeable how often those anecdotes have actually turned out to carry water, once we really look into them. It doesn’t look as if BA5 is much more serious at the moment. But we don’t really have enough data to say, I mean, you know, I checked out the European CDCs website earlier, just to make sure that they have nothing, they just say too early to say. We do need to think about long Covid. It is hugely significant. And however many deaths or how many hospitalizations, there are going to be many, many more people with long term health conditions as a result of this. And it doesn’t need to be a large proportion of those infected to end up being a big deal. You know, this is how we’re going to have lots of preexisting conditions in the coming decades that were not there before the pandemic. Now, unfortunately, the only way to completely stop that happening would be to eradicate the virus. And that’s not in prospect, anytime soon. So what we need to do instead is perhaps give people their best chance. And that’s why, as you noted, it looks like Omicron is less likely to cause lung Covid. Some of that could be because it causes less severe disease, it also could be that it’s in an environment with more immunity, because we do not know exactly what goes on in long Covid. But everybody’s prior would be that more immunity is more likely to help with it. And indeed, we see this from some people who have sort of, if you look at vaccine efficacy versus non-COVID, there does appear to be some, so we should be working to bring it down. We should be working to understand it better. These people deserve lots more care than they’re getting at the moment.

Andy Slavitt  42:10

Yes, that’s right. I talked to a few people a week probably with long Covid. Fortunately, now there are more and more places where they can get treated. And we know more all the time, but still not enough focus. And the one thing that they always say is as you so glad you pointed out is don’t forget about us. Don’t let us get lost in the shuffle here.

Bill Hanage 

Yeah, I remember back in like 2020 saying like, no, just focusing only on deaths is understandable. But there’s more to health than not dying.

Andy Slavitt 

Right. Well, thank you, Bill. I love having you on. Appreciate you getting us all up. I feel like we’re current for now. Which means in about six or eight weeks, we will have no idea what’s going on again.

Bill Hanage 

Oh, that’s so true. So depressing and true. Always good being here, take care.

Andy Slavitt 

Friday, you’re gonna want to listen to the conversation. We talk an awful lot about problems on the show about challenges. We try to focus on solutions. And a solution is becoming available in the area of mental health, particularly crisis, people in crisis, people who are thinking about doing something, they may be feeling suicidal, they may be risk harming in themselves and others. And on Saturday, the 988 hotline is launching. So I decided to bring it out to people on the show who run crisis call centers before, who had been following the development of 98 about what’s truly different and what’s not. And people who have experienced suicide attempt themselves. So that’s what the show is about. I wouldn’t say it’s the most bright and uplifting topic. But it’s actually quite an uplifting show, because we are talking about solutions that are really going to be out there to help people or at least that’s the aim on Monday. We have Senator Chris Murphy from Connecticut Senator Chris Murphy, for the last 10 years, has been working to get some progress on gun legislation. And he got it done. He got a lot done. Is it enough? Is it going to help? What does it do? And then what did the fact that it passed, what does that say about our ability as a country to make progress on this issue? I would have told you weeks ago, it was zero chance. We’d get a lot past zero chance. I was wrong. We now have something done. That tells me we can surprise ourselves. But what does that tell us about whether or not we can continue to make progress on this issue? Whether people have loosened up from their corners or not? Chris is fantastic. Kind enough to come on the show and share his thoughts with us. So we’ll do that. And many, many, many more shows coming up throughout July and August. Thank you

CREDITS

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.