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How bad will this winter’s COVID-19 wave be? That’s what Andy asks epidemiologist Katelyn Jetelina, who’s been watching Europe closely and combing through the data on new variants. She predicts that a winter wave is about 90% likely and explains her biggest worries – an Omicron subvariant called BQ.1.1 and a simultaneous flu wave with fewer masking requirements. She and Andy also discuss how the fall bivalent booster will hold up against new winter variants, why uptake is still so low, and how to plan for gatherings with friends and family this holiday season.

Keep up with Andy on Twitter @ASlavitt.

Follow Katelyn Jetelina on Twitter @dr_kkjetelina.

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Check out these resources from today’s episode: 

• Subscribe to Katelyn’s newsletter, “Your Local Epidemiologist”: https://yourlocalepidemiologist.substack.com/about
• 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

Andy Slavitt, Katelyn Jetelina

Andy Slavitt  00:17

This is IN THE BUBBLE with Andy Slavitt. We’re here to talk about COVID today. And as you saw from the episode title, what we’re likely to see in the winter wave is the winter wave guaranteed? How should this affect our winter? I think we all kind of remember that last winter, starting thanksgiving was not so good. That’s what Omicron appeared to the surface. And Katelyn Jetelina, Lena is going to give us a sense of what to expect. This winter. There’s a few things that are important, right? You’re probably thinking about family plans and holiday plans. And you’re also thinking about, probably, are we getting to a stage or place where this thing is going to become more and more predictable? I’ll use a word that’s often misused, which is endemic. Or is it going to be something that is going to kind of bring back some of the more difficult times we’ve had? There are a couple of things that will help us answer that question. One is, are we seeing new variants? And if so, how are our boosters holding up against them? It’s also important to know that the booster does absolutely no good sitting in the vial. So what does it mean that not a lot of people have gotten boosted? There’s a few other relevant things. So which is asking the question of how well, our treatments and our drugs and our tests hold up against these new variants. And unfortunately, early indication is one of the things that we’ve come to rely on isn’t doing so well. So we’re going to talk with Katelyn I want to ask her about that. And then, of course, the first thing you got to do is say, well, we got to know what’s going to happen in the US. We got to ask what’s going to happen, what’s happening in Europe, because there’s usually a four to six week lag before we figure that. And so I think we’ll start there with Caitlin. We’re talking to her fresh off winning a very prestigious award. So I want to embarrass her shortly at the beginning of the conversation with it’s very well deserved honor and then we’ll get into these questions. Hey, let’s bring in Katelyn Jetelina.

Andy Slavitt  02:24

Okay, Katelyn Jetelina. Welcome to in the bubble. I think people are here to hear your take and us to talk about what they can expect this winter from COVID. And we’re gonna get into that. But let’s start with something a little more personally exciting. You were just named a quite a prestigious award, the National Academy named you an award winner for Excellence in Science Communication. Congratulations.

Katelyn Jetelina  02:48

Thank you. It was yeah, huge honor. And I am so pleased that science communication is being recognized. It was a missing puzzle in our pandemic, I think.

Andy Slavitt  03:01

Yes, yes. And I actually probably make sense for us to talk about what’s going to happen next. And we’ll come back at the end of the show to talk about, like how we communicate public health, because I’m so glad you get recognized for that. I’m so glad they’re finally recognizing people for that. But for people who don’t know, the National Academies is a BFD. It’s a really BFD. And for those of you who don’t get Katelyn’s newsletter, your local epidemiologist, you should. But I got to ask you what was more of a thrill winning that award or getting to meet me in person?

Katelyn Jetelina  03:35

Getting to meet you in person, of course.

Andy Slavitt  03:38

Katelyn, and I just spent two and a half days with the governor of California, who is deeply interested in how to make California the healthiest state and so there probably more on that later, we’ll have Gavin Newsom on the show at some point soon. But let’s get to the more immediate, the more immediate is taking a look at this winter. Normally, Caitlin, if we’re going to see something in the US, we have a few different types of warning signs. One of them is Europe, right? We’ve had this habit of, you know, wave happens sometimes that’s in South Africa or somewhere, it goes to Europe. And then four weeks later, two weeks later, six weeks later, it comes to the US. So what is Europe telling us right now as we sit here in October?

Katelyn Jetelina  04:21

Yeah, Europe is getting hit hard right now with SARS-CoV-2, it’s actually quite interesting. Particularly we’re watching Germany, it is spreading like wildfire over there. Unfortunately, it also means that their hospital employees are missing work too. And so it’s kind of deja vu of what we saw last winter and where the health a lot of people need health care, but the health care workers are also not healthy. And so they’re running into a lot of capacity issues. The most interesting thing I think about the Europe in Korea As of SARS-CoV-2 is that no new variant is driving this, it is being driven by behavior and by weather changes, which is really something we haven’t seen yet. And so, this is a bit nerve wracking because we also know that some variants are brewing under the surface as well. And so what happens when this new sub variants come to the surface and interact with this increase of behaviors should be interesting. I will say that Germany just finished Oktoberfest. And there have been quite a few analyses. And it looks like that October fest was a super spreader event. But we will need to look at that more closely.

Andy Slavitt  05:50

Yeah, go blame it on the beer. What do we do about severity? I mean, we’ve sort of learned that there’s like a set of standard questions. Now, we asked each of these waves, so maybe we should go through them. Is there anything about this, which tells us that there’s either more or less severity than in the recent kind of BA waves we’ve seen over the course of the year?

Katelyn Jetelina  06:12

Well, that’s kind of one of the questions we have, and we’re looking to physicians, anecdotes on the ground. How are these patients doing in the hospital? I think one really important thing to recognize is that there are some European countries that have figured out this for COVID verse with COVID, in hospitals, and Germany is one of those countries where they only count hospitalizations for COVID-19. And it’s the highest it’s ever been, you know, ICUs don’t seem overwhelmed. Right now, there have been anecdotes of different types of symptoms like diarrhea, for example. But again, we have to kind of watch this in real time and see how it plays out.

Andy Slavitt  07:02

Any pattern different either age group, that’s more or less affected, vaccination status, do we know anything? That gives us a clue as to how this wave might be in any way different than prior waves?

Katelyn Jetelina  07:14

I haven’t tried to find this. And it’s hard, because it’s all being done in real time. There are some analyses showing that it is younger in some countries and older and other countries, I will say and also, not all countries are increasing right now. For example, Denmark is not increasing, which is interesting, because it’s colder there. And so there’s quite a few odd patterns going on making the overall picture a little difficult to grasp right now.

Andy Slavitt  07:47

You mentioned variants. So I think we’ll talk about the bi-vaillant and the booster and take up and all of that a bit. But we’ve got something that at least it aims to be tailored at the BA5 variant into something we’ve talked about as a bi-vaillant, which combines that with the original vaccine. But one of the things we worry about is fast evolution variants, because one of the things that is troubling is you could get this thing we all call immune escape, which is that the vaccine stopped becoming as effective. So can you tell us what we know about variants? What are we seeing? Are we seeing different types of variants and in prevalence?

Katelyn Jetelina  08:29

So currently, we have this sub variant soup that’s on the horizon. So Omicron continues to mutate. In fact, this is the first year in which we’ve only had one, variant Omicron dominate. I’m gonna knock on wood that this doesn’t happen. But it continues to be omicron. Is that good news? I think it’s good news. For a few reasons, one, previous immunity is really going to continue to help, two, maybe this is finally where we start to see that ladder like evolution that we finally start to see where this virus is going. And it’s going to become predictable. But again, we have no idea. So if it’s going to have to mutate, I guess I’d rather it be Omicron than some random Delta come back. But yeah, so there’s lots of these sub variants on this horizon. And all of them are kind of mutating to do the same thing to continue to escape immunity so it can survive. And that means that our immune system defense, at least the first line of defense is crumbling away, so it’ll be more and more likely for us to be infected. The good news is, though, that are other lines of defense, thanks to vaccines and prior infections aren’t crumbling. And so we think our hospitals and our ICU at the curves won’t go out of control like last winter. But again, we don’t know.

Andy Slavitt  10:05

Now, I want to ask you a question that would like, is not intended to be as provocative as some people might take it, which is if we’re seeing more ladder like variance, meaning that one falls from the next as opposed to coming from left field. And if we are seeing this as a respiratory illness that is largely controllable for large parts of the population, with some of the mechanisms we have, is it time to start thinking about this similar to the way we think about the flu?

Katelyn Jetelina  10:36

I guess I have, I think that this winter will tell us a lot. And I want us to be patient to see how this one turbos out, we haven’t had the opportunity to see SARS-CoV-2 in a predictable pattern, it keeps going into these couple month waves. And as an epidemiologist, our job is to look for patterns. And we just don’t have that yet. And so I think what really only know if SARS-CoV-2 is endemic, like the flu, once we can predict those patterns, and it’s just not there yet.

Andy Slavitt  11:18

We’ll take a quick break, we’ll come back, I want to talk with Katelyn about what we’re seeing in the US how we’re picking things up, powers binding and what some of the scenarios can look like. Okay, we’re back with Katelyn Jetelina. We’re talking about the coming winter wave to the US. We talked about Europe, which is one indicator, we have other indicators. Wastewater in the US is another indicator, what are we seeing, and some of the new variants, and some of the growth of cases beginning to happen yet in parts of the US.

Katelyn Jetelina  12:10

So the growth is there, these variants are growing fast about 10% advantage over BA5. And that’s why we think this is also going to create a wave eventually, the number of those variants are really small, the proportion of those variants are small. And so we know that those variants are not pushing away right now, just like we know, they’re not pushing the wave in Europe. behavior change is impacting transmission. Right now, weather changes are impacting transmission. So yeah, a lot of us, epidemiologists are paying attention to wastewater, wastewater was decreasing pretty quickly and rapidly across the entire United States. Over the past couple of weeks, it’s plateaued in every region. And so unfortunately, I think this may be a signal that it’s going to start up taking soon, if you start looking hyperlocal. So for example, on Boston, there was just a really large increase in wastewater in the past couple of weeks, it started to plateau again, but it may continue to increase as well. And wastewater is really the only thing we can use right now to determine when and where we’re in a wave of infection.

Andy Slavitt  13:33

So I want to make a distinction between the type of waves, we can have these kinds of waves, it could really be worse than others. And there’s types of waves that could be ones that were more used to or at least have the tools for. So one type of wave could be the type of wave that shows an increase in cases, but doesn’t show increases in severity doesn’t necessarily overly strain or hospital system because we have tools that because people tend to even if they have dropped a lot of precautions marginally react, and where the variant isn’t doing anything that’s such a large leap from the variance prior. In other words, it may be a small step on the ladder, that type of a call it manageable, seasonal type of wave, what’s the probability that we’re going to see a wave that’s at least like that, in the winter months?

Katelyn Jetelina  14:26

Oh, what’s the probability 90%? I mean, it’s pretty high that we’re gonna see a wave of infections.

Andy Slavitt  14:35

Okay. By the way, I don’t want to minimize that wave. Okay, just to say it. It puts a lot of people out of work. It takes a lot of people out of schools that takes a lot of nurses off the job. That hurts the economy that causes lung COVID cases. So when I say manageable, I don’t want to be misunderstood as to say that it doesn’t cause real pain and real harm. And of course in subpopulations, that includes loss of life. But then there’s a second type of wave, which is even worse, which would be wave that puts a lot more people in the hospital that is much more severe. And where, you know, by definition, the prior immunity here, either from infection or vaccines isn’t working well enough. How would you rate the possibility of that type of wave, which, sadly, we could still remember?

Katelyn Jetelina  15:21

Yeah, the probability of that is much lower. I think the last number I saw was 20%-30%. And that’s really, the only way that that could truly happen is if we get another Omicron like event, where, for example, Delta comes out of nowhere, again, or another beta, and our vaccines aren’t great, and previous infections aren’t doing very well. But the probability is decreasing over time. And so I’m hopeful that this winter won’t be last winter. But we’ll see. I think there’s another interesting thing, Andy is that this is probably going to be the first winter in which we have a COVID-19 wave plus a flu wave. And we haven’t seen that yet. And we don’t know what that means for our healthcare systems either. And so each winter, we kind of have a different reason for the wave. And the negatives of that wave are different. And so I’m also kind of holding my breath about that. Because even just during a regular flu season, pre-pandemic was stressful for our healthcare systems.

Andy Slavitt  16:41

Well, you’ve kind of said three things, actually, you said a COVID wave, which is 90% likelihood of flu wave, which can combination couldn’t make it worse. And you said a third thing, which is, this could be the first winter that we go through with very limited precautions. You know, there’s not going to be a lot of mask wearing on planes in school. Certainly, it’ll be regional and cultural. And, by the way, important point to insert, just because the crowds doing what the crowd is doing doesn’t mean that’s what you have to do. So I know it’s hard, but you walk into a room and you get 30 people not wearing a mask. See plenty people have said yeah, I’m gonna wear a mask anyway. So you can protect yourself very well by doing what you think is right for you and your family. So that’s going to have an effect as well, right?

Katelyn Jetelina  17:26

Yeah, it does. I mean, behaviors has an impact on transmission. We’re seeing that right now in Europe. And, yeah, this will be the first winter where I think masks aren’t going to be heavily debated by 330 million Americans. And so it’ll be again, interesting, I think, what will also be a big drivers the behavior around getting a fall booster or not. We are not doing good with fall booster uptake right now. And that will influence how big not only the infection wave is this winter, but the severity of hospitalizations this winter as well.

Andy Slavitt  18:10

That’s right. It’s not just masks, we have other tools to protect ourselves. And I’m gonna get to why we’re not using them. They’re probably dovetails into this conversation about communications and pandemics as well. So maybe we’ll get to that. Are you worried about surveillance at this point? You know, you mentioned wastewater, we mentioned Europe, I guess I want to just kind of close that conversation out by saying our, you know, it seemed like we had a lot more data points coming in from other countries. Are you worried that there’s a possibility that if things are brewing somewhere in the world, a bad variant, for example, that we’re not going to see it until later than we would have if we were doing a better job at global surveillance?

Katelyn Jetelina  18:52

Yeah, that’s another big issue right now, right? Each of these tools are getting pulled back, which is going to make this even harder and harder. And one of those tools is genomic surveillance. So what variants are popping up where and when, according to the WHO, genomic surveillance has decreased 90% since last winter, which means across the globe, which means that there could be another variant somewhere that we just don’t know about, and that could really hit us hard. We knew Omicron was coming very, very early on because of South Africa’s amazing surveillance and warning the world. We can debate whether we use that warning to our advantage or not. But it is an important tool, at least for us epidemiologists and I am afraid something is out there that we don’t know about yet.

Andy Slavitt  19:46

Let me do something fun. I’m going to take on the persona of a congressperson who is against additional funding for public health and surveillance and vaccines and otherwise and you can tell On the role of Caitlyn Jenner, Lina, you know, the more money we put into COVID, the more you guys will find, the more you’ll scare us about. And it’s really irrelevant. So you’ll find some new things, but it’s really not stuff that’s moving the needle, you’re going to scare the public into things that are really not material. And, you know, you already have enough. It’s an endless bottomless pit, you know, this thing is over the public’s moved on, you know, you guys got more than enough money. And by the way, you public health people didn’t perform very well. To begin with, there’s only one person who did well, did you have a […] Katelyn Jetelina, and everybody else did terrible, the CDC did terrible. So why would we ever throw money to that pit?

Katelyn Jetelina  20:43

I mean, I would first say that, let’s change the angle, it’s not just about COVID-19, we are going to see more viruses come, maybe I shouldn’t bring up climate change. But there are more viruses coming. And we see this and not only more viruses coming, but our behaviors are changing. We’re seeing polio right now; we have to stop this cycle of panic and neglect. The only way to do that is through public health funding and strengthening our public health system. And I would argue that if we have that in place, we don’t need fear, there will not be fear, because we will be prepared.

Andy Slavitt  21:28

So look, I will give you this, I think at all likelihood, at some point, in the next year of your life, you’re going to be having a conversation like this with a reluctant politician about supporting them. So I’m gonna give you this for whatever it’s worth, work in the term national security, work in the term bioterrorism threat. You want to talk to people about things that they care about, start talking about it in terms of defense, and national competitive advantage and strategic advantage. And I think you may be have a better chance for talking about why this is important. Because for certain set of people, this is just an imagined threat. And maybe they’ll say it happened once every 100 years. So why should I fund it now, you and I would sit here with a straight face and say, we’re going to be 100 years. That’d be 100 years. So we face this again. But it’s hard to convince people that don’t want to spend money on this. So anyway, take that for what it’s worth, if you end up in one of those conversations, throw in the term national security.

Katelyn Jetelina  22:26

I’m writing that down. I think that’s great. We need those buzzwords.

Andy Slavitt  22:31

Okay, well, that was fun. Let’s take a quick break. And let’s come back and talk to Kaitlyn about how our booster uptake or lack thereof, is likely to affect what we’re gonna see this winter.

Andy Slavitt  22:42

So that does get a little bit into this topic of communication. And let’s begin where you started, which is, science is doing, give science a grade, but I think science with a pretty good job, you came up with a set of therapeutics came up with something, even for people who are immunocompromised, […], it’s come up with new boosters and updated booster. So tell us first of all, before we get to communication, please tell us what we know about the effectiveness of the booster. What we know about how these various therapeutics, […] and so forth, are holding up are likely to hold up in the face of what may be a coming wave.

Katelyn Jetelina  23:44

Yeah, so the boosters were rolled out in the United States are different than the boosters in Europe. And so unfortunately, we’ve always been relying on your surveillance on how boosters are doing in real time. And we won’t really necessarily have that this round. But regardless, we think they’re going to work well. We originally had some data on mice, that that looked like it worked very well. And actually today, Pfizer came out with the first human analysis showing that yeah, these boosters work great. In the lab, the challenge with those lab studies is it’s not the real world. So we’ll see, you know, I think that the boosters gonna do a decent job, maybe 60% efficacy against infection for a couple months, but it will certainly help with hospitalization and death, specifically among those over 65.

Andy Slavitt  24:44

And by the way, that 60%, just to clarify that 60% improvement over people who don’t have it, correct?

Katelyn Jetelina  24:50

That’s right. Yes. And also to clarify it, that was a complete gasifying, there’s no data around that but it’s your guess I think it’ll be around out there. Okay. So then we go to therapeutics, unfortunately, we have gotten a few preprints through in the past two or three weeks, showing that with these new sub variants of Omicron that are growing in the United States and in Europe, Evushield is not going to work and monoclonal antibodies are not going to work. It definitely depends on which sub variant takes hold. It’s not necessarily guaranteed the severance will take over, but we are worried that we’re going to be losing more tools like that. We think Paxlovid will continue to work.

Andy Slavitt  25:39

Okay, so the boosters sound like they’re doing better than the prior boosters, and certainly far better to get boosted than not, it sounds like Paxlovid continues to be a good tool. And if the wrong variants come here, we could have a concern for every shield, which is really important for people who are immunocompromised and can’t get vaccinated. That’s the summary. Now we get to the communication part. Why do we see booster uptake? So low? And if you would be willing, would you touch on also the latest around boosters for kids?

Katelyn Jetelina  26:16

Why is uptake so low? I think it goes back to what you said a little earlier, and Dan, which are hard science, moved mountains during this pandemic, we got vaccines, we got therapeutics, the one thing we did not leverage was social sciences on vaccine hesitancy, on communication, on outreach, on community building. And we’re seeing that we’re seeing that in vaccine hesitancy, we’re seeing that in vaccine uptake. And so I truly believe that is one of the reasons why booster uptake is so low right now, we just haven’t communicated that message clearly to people who need it to. And your second question was among kids. Yeah, latest news is that now kids can get the fall booster. So any kid five years and older can get the fall booster. And there’s already misinformation circulating around that there was misinformation last week Miss circulating around that because I think smartly in their case, because they knew the rollout was coming this week. And so booster uptake, but if we just take boosters away among kids, it’s the primary series kids aren’t even getting in the first place. I think for under-fives, it’s about what 7% of under five year olds have had their primary series. And so we have a massive problem here and not just with COVID-19. But of course with other vaccines like polio.

Andy Slavitt  27:49

Well, in the case of COVID, different from polio, different from MMR. There are a lot of parents and indeed a lot of scientists who would say it’s not as necessary to get your kids boosted for COVID-19. And I don’t know that I blame that on communication. Maybe you do. But I do think that people are deciding for themselves based on the risks that they perceive. And I think people do pay a lot of attention when it comes to their kids. I don’t think they want to take unnecessary risks. Obviously, there are people that are floating misinformation, and there’s irrational actors and all that. But I don’t I don’t necessarily want to say that that’s 100% of what’s going on.

Katelyn Jetelina  28:26

No, I don’t think so. I think a lot of it has to do with trust. I think a lot of it has to do with the previous Omicron waves at a ton of kids were infected. And so they do have some level of protection. And I do think it I mean, it has to do is also communication, what’s the value of the vaccine? Not only what are the risks of the vaccine just haven’t been highlighted? Enough. I think

Andy Slavitt  28:56

one other thing that’s happened recently is people talk about long COVID. There’s this new thing people are talking about, called medium COVID, which seems to describe what happens when people have COVID that lasts, you know, three months, four months, five months, which is getting a lot longer than an acute episode, but where the symptoms eventually go away. That feels like a new type of learning. It perhaps gives people some hope that yes, the symptoms can linger. But in a lot of cases that go away.

Katelyn Jetelina  29:29

The disease severity and duration of severity with long COVID greatly ranges. And we think that’s because there may be multiple mechanisms, multiple things causing long COVID For certain people. For certain people. It’s a hyper immune response, your immune system just goes out of whack for a couple of months. Another is maybe these are reservoirs of virus that are sitting in people’s bodies and create Even symptoms over a year. And so, because of these different mechanisms, we’re going to see different pathways and peep in which people experience long COVID. And unfortunately, or fortunately, with time, we’ll learn more and more about it and hopefully be able to prevent it or at least treat it depending on which mechanism is affecting which person.

Andy Slavitt  30:26

And are you paying attention to the variant in Singapore? This what they call this XBB? And if so, can you talk about what that is telling us? And whether or not that is any cause of concern for you?

Katelyn Jetelina  30:39

Yeah, so XBB is one of those variant soups on the horizon that we’ve been paying attention to. It has three significant changes on this spike protein that we know impacts in Unity. I will say this isn’t the quote unquote, scariest one, I guess that is trying to dominate this space. Right now, there’s another one I’m paying really close attention to called BQ 1.1. But XBB would be significant for at least us in the United States, because that is the wine, it came off of BA2 instead of BA5. And so that means that the effectiveness of our fall booster shots may not be as great as a sub-variant that came off of BA5. I don’t know if that made any sense.

Andy Slavitt  31:38

It does. But does it have the kind of evolutionary traits that you think could cause it to grow and be a dominant variant? Or is it immune evasive, but it doesn’t look like it’s going to help compete?

Katelyn Jetelina  31:48

It does, it does. So all of these sub variants from Omicron all have about a 10% advantage per day growth advantage per day, over BA5, which means it has the potential to cause a wave, I think what will be even more interesting is to see how these variants then out compete each other. So how does XBB out compete, or does it BQ 1.1. And which one will win, or for the first time are both of them going to win, and we’re going to start seeing co circulating viruses like we do with the flu. So for example, in Singapore region, we’re gonna have XBB, but maybe in the Americas, we’re gonna have BQ 1.1. So it’ll be really interesting to see what happens when these start kind of colliding and trying to gain space, but all of them are just trying to survive. All they want to do is transmit and to do it the best way possible. So it can continue to survive.

Andy Slavitt  32:53

Real quickly. You said BQ 1.1., where did you? What about it? What about it worries you.

Katelyn Jetelina  32:59

So BQ 1.1 has five changes we’re paying attention to it has the most changes on that sub variant spike compared to like I said, XBB, which only has three. And so I think it has the potential to do even better than those three changes. We’ve also seen BQ 1.1. In the United States already and wastewater sampling. And so and that is what is growing the fastest in Europe right now. And so I think a lot of eyes are on that.

Katelyn Jetelina  33:36

Oh, yeah, it mean, it’s very possible. In fact, a lot of virologists thought that that was kind of going to happen, and it hasn’t happened yet. And so we may have 234 co circulating at the same time, especially if they all kind of have the same changes. And so they don’t really have an advantage over each other they kind of just coexist and dominate certain social networks is that

Andy Slavitt  33:36

Is it possible we have a wave here in the winter that has 20% of the population in the US getting XBB. 20% BQ 1.1., some portion BA 4.6, I mean, I hate to make it sound like we’re talking these ridiculous codes. But I don’t know any better way to do it. But is it possible that not one wins out in the US, but we have a number of just competing strains, as you say, a little bit like the flu?

Andy Slavitt  34:29

better or worse for us from a fighting the disease standpoint, if that kind of thing happens?

Katelyn Jetelina  34:33

It wouldn’t matter. I mean, you would be exposed to what other whatever variant was in your social circle and all of our vaccines, and all of our therapeutics kind of work similarly against these and so maybe if you came across a BA five sub variant instead of a BA2, you would do a little better, but in the end, I don’t think it would make huge population swings.

Andy Slavitt  35:00

So let’s close up by talking about public health communication. And, you know, it leads to a lot of things we talked about. We have low levels of booster takeout, we have low levels of Paxlovid take up and Paxlovid particularly for people 60+, and particularly for people 80+, is really being underutilized in certain parts of this country. From your perspective, what do we need to start doing differently, Katelyn? And I also want to talk about who is in a position to do it, because it’s unclear whether or not the CDC is starting from a clean slate. And as much as I it was a slavish devotion or to your newsletter, a newsletter feels like the wrong answer for the country. How do you think through that?

Katelyn Jetelina  35:54

Yeah, so one thing we need to change is we need to recognize that public health communication is not just top down, it’s also bottom up that we need to listen to people’s concerns and questions, to answer them, to help guide them to understand where they’re at in this pandemic. If we don’t do that, we will start speeding off things that we think is helpful, but is not and is not a concern, perhaps among people. So I think that’s the number one, I think the number two is that we need a way to process this info demic to distill this info demic for people, it’s been a fire hose of information, which some of its true, some of its not, but has caused a ton of anxiety, confusion, and people just stop listening to public health people all together, and I don’t blame them at all. So that’s more proactive communication. I think the third is this reactive communication. How are we going to treat misinformation and disinformation as a biosecurity threat? Like you were saying earlier, Andy, like, can we treat it as a disease? Does it need surveillance? Does it need to figure out a way to know where it’s spreading and why and how to combat it and prevent it? And so I think those are three big things. The second to your question, and your point is, who should be doing it is a really good question. And I don’t know the answer to that. I’ll be quite frank, I always thought throughout the pandemic, it was supposed to be the CDC. But the CDC is political. They have to be careful also what they say. They are walking, I guess, on eggshells. And if you’re going to have effective communication, you have to be able to take risks. You have to be able to make mistakes, unapologetically. And you have to have some sort of voice and face. And I think that’s all possible with CDC, but it needs incredible revamping if they’re going to be doing that. So I don’t know. And I agree, I don’t think a substance. I newsletter from an epidemiologist is the right idea, either maybe it is a nonprofit that works directly with the CDC to get fast science out that can build that trust, but we need to figure out a solution. And do it fast.

Andy Slavitt  38:43

So number one thing, keep on the back of your mind, right? This doesn’t have to be the front of your mind. But we’re still in a pandemic, we will likely have a winter wave in the United States. And we do have things that we can do to make ourselves safer. As a young person with kids, honestly, my thought is, how do we keep the older populations as safe as possible? Use antigen tests before you go see grandpa for the holidays, make sure you get your boosters, everyone gets their boosters, wear a mask. If you don’t want to miss a holiday event, you know, we had we keep talking about this retreat, but I didn’t want to miss it. So I wore a mask for five days, N95. And I was the only one doing it. But I was not going to have COVID. So there are still things you can do on just try to do your best and we’ll make it through the winter.

Andy Slavitt  38:43

Yeah, I mean, it I think it probably depends on what you’re trying to communicate, it feels like at this stage of the pandemic, when you have populations that are, let’s say, particularly a risk, let’s say, you know, 78 year old woman who really would benefit from getting boosted very clearly and would benefit if she did get COVID from taking Paxlovid. When she goes to desperate pharmacy renewal or calls up on the pharmacy line. Why isn’t she getting reminded? And when she talks to her physician, if she’s lucky enough to have a physician, or go to a federally qualified health center, if that’s where she gets care, safety net, hospital, or even an emergency room? Like, why aren’t we getting really good at being that being the place where we say, hey, if you have 10 more minutes, we can make sure you’re protected for the season. And I know it doesn’t enter the large question of fixing all communication. But I do think maybe you fix communication brick by brick. Let leave people with what they need to know. Kaitlyn, bring it home. You’re giving advice to your sister, your mother or your aunt and neighbor? What do they need to know about the coming wave this winter? And most importantly, what actions can they do if they’re interested in protecting themselves and their families.

Andy Slavitt  40:57

Well, congratulations again on your award. It was fun to meet you in person. And I know that was just so exciting for you, as your as it’s amazingly prestigious award, but really, truly well deserved. And thanks for coming in the bubble. And giving people a sense of what to expect. My take away is a little bit to knock on wood and hope for some luck. It’s not out of the question, that we have something more severe or something that looks a little bit like we had last winter. But it’s also pretty likely that we’re going to see some more cases and reasons to pay attention. And we’ve got to do the best we can to minimize others pain and suffering that always should be in our minds. And I think following the advice you laid out will help us do it.

Katelyn Jetelina  41:45

Thanks for having me. Andy always love being on here.

Andy Slavitt  42:01

Our focus on health continues this week. And we are very excited to have the godfather of all healthcare in the US the Secretary of Health and Human Services. Xavier Becerra on the show, it’s a rare opportunity. I don’t think he does a lot of these shows. But I have known Xavier for a decade or so. And I guess it’d be a really great show because we’re going to talk about the pandemic. We’re going to talk about monkeypox, we’re going to talk about polio. But we’re also going to talk about the cost of prescription drugs. We’re going to talk about healthcare inflation. We’re going to talk about all kinds of things that are on our minds when it comes to health. I think it’s a not to be missed conversation, frankly. And then more had Friday conversation and more things leading up to the election as we focus on all those kinds of issues. So please tune in on Wednesday. It will be so embarrassing for me to have the Secretary on and have you not listen. I don’t know how to explain it to him. All right, have a good couple days.

CREDITS  43:11

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.