In the Bubble with Andy Slavitt: Our Shot

How We Win the Battle with COVID (with Ed Yong)

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Andy calls up The Atlantic’s Ed Yong, who won the 2021 Pulitzer Prize for his coverage of the pandemic, to talk about how we got where we are now and where we need to go next. They cover what went wrong up to this point, why we can’t think of vaccines as a panacea, and what Ed thinks about giving people in the US booster shots before many people around the world get their first dose. Plus, Andy weighs in on President Biden’s vaccinate-or-test requirements.

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

Follow Ed @edyong209 on Twitter.

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Andy Slavitt, Ed Yong

Andy Slavitt  00:22

Welcome to IN THE BUBBLE. I’m your host, Andy Slavitt. If you heard some Australian voices and some clicking of action, that’s because right now, we’re all on 60 Minutes Australia. That’s right. There’s a 60 Minutes in Australia. I’ll tell you about that in a second. But first, I want to tell you about a great show. We’ve got today, Ed Yong, who just won the Pulitzer Prize for his reporting on COVID journalism, who’s amazing, and I’m sure all of you many of you know who he is writer for The Atlantic. It has been quite an interesting week, as if they’re all not interesting. First of all, go back and listen to the Tony Fauci episode. If you haven’t, or play it again, why not? Let me tell you about the announcement that the President made on Thursday. Now, I’m actually recording this on Wednesday. But because I’ve been working on the announcement, and because this is playing on Monday, I can talk about something that’s not yet public, because we’re in a bit of a time warp.

Andy Slavitt 

You’ve probably heard already, but I’ll give you some of the highlights. A big focus. Number one on vaccinating the unvaccinated through a series of I’d say more assertive vaccine or test requirements. What does that mean? That means for businesses, 100 employees or more, for venues, they’re going to be requirement that people who enter are either vaccinated, or they’re tested. Now, as I’ve talked about before, I think that a very reasonable compromise, they keep people safe. Because as we know, a lot of people can’t get vaccinated because they’re under 12. So big bold move. I wasn’t able to record this, I am not able to tell you what the outcry was or the reaction over the weekend. I’m sure there was some that’s predictable. But it’s a bold move, that I think a lot of people also are applauding and saying, you know, it’s time we do this and move forward.

Andy Slavitt  02:19

The second category of things the President talked about, was furthering protection for the vaccinated. And I think we have kind of a whole set of conversations that we’ve been having around boosters, masks, other kinds of things to make sure that even as immunity wanes, people are continuing to be safe, third, are keeping schools open safely, the President was about as strong as he could be, in saying that he strongly urges school districts to have vaccine requirements. That is something that I think was probably not popular with the teachers unions. But important for him to say and do. And I think he probably maybe at the extent of his authority, testing, testing and masking, but let me talk about testing, both to increase testing and to make sure that it’s available at a low cost at a number of retail outlets.

Andy Slavitt 

So I think we’re going to really need to see that kind of testing get ubiquitous. And then he talked about a couple of other things that are very important things that will help focus on the economy and economic recovery, and improving care for those with COVID. Now, I think these were big, bold steps, I can’t tell you how well they played politically, I do think this is the president trying to seize back control of the narrative that sort of got in the way a little bit. But this is good policy is good, strong, policy, not everybody’s gonna agree with it. Not everybody’s gonna love it. So it brings me a little bit to my conversation in the program, when I’m on 60 minutes, Australia, on Sunday, just completed that interview, a lot of tough and interesting questions about what we experienced here in the US and kind of what advice we have for people in Australia, basically just a nicer version of Americans, people in Australia, right? They’re just nicer.

Andy Slavitt  04:08

But they get the same sets of issues. They’ve got, obviously, indigenous populations, they’ve got sort of this sort of freedom loving spirit that we do here, and a sort of state-by-state system. And they’re sort of in 2021, dealing with a lot of the challenges that we’re dealing with there. So get you on that YouTube, if you want to see what I had to say I haven’t seen it yet because we’ve just recorded it. Any case. Let us get to Ed Yong, I think you’re gonna love this. It is a very dynamic in-depth conversation, almost a debate at times. And it’s just so smart and has so many opinions, which I respect, but we were able to sort of take each other on and I think the best moments on the show are only when we kind of forget that we’re recording and we kind of have these arguments and I hopefully we got to that I think you’ll really enjoy that. It’s just treasure

Andy Slavitt 

So, Ed, you know, I think I speak for a lot of people say that you’re kind of in depth, thoughts and analysis have become probably one of the Mainstays. For people who really want to understand things. And I’m not even gonna mention this small little prize that you won, maybe I’ll mention later.

Ed Yong 

That is also how I refer to it. I still can’t say the word. So that’s better for everyone.

Andy Slavitt 

Better for everybody. What did we get wrong? Going into this year? We kind of thought we’d be in a very different place right now. What didn’t we see?

Ed Yong 

Yeah, that’s a really, really good question. I think, you know, just thinking back to the start of this year, we were obviously still in the middle of the winter surge. But I think that people were pretty hopeful by the time the spring rolled around, because of the initially fast rollout of vaccines. And because that that winter surge seemed to have subsided. I think that, you know, I think people were booed by an administration that seemed to be taking things seriously, by the arrival of vaccines, they were more effective, and they’re being developed more quickly than anyone had anticipated. But I think the mistake that we made, was to put all of our eggs into that vaccine basket, you know, almost to the exclusion of other things. Like even last year, people with were talking about the Swiss cheese model of pandemic defense, where you have lots of different countermeasures, working together, each complementing for the holes of the other.

Ed Yong  06:59

And I think we forgot that; I think we really thought that the vaccines were so effective that they could act as a single layer. And I think because of that, we began letting our guard down and stripping some of the others away, masks most notably. But I think even you know, we’re now in a situation where testing is still insufficient, where you’re, we’re still having to beat the same drum about everything else, at a time when vaccination rates have stalled. And I don’t think these are new errors. I recently went back and look at the piece I wrote in September of 2020. America’s trapped in a pandemic spiral, in which I identified nine errors of intuition that we were repeatedly making, and they were costing our pandemic response. And the very first one was serial monogamy of solutions. We were just bouncing from one thing to the next, and not putting multiple layers in place. And, you know, at the time, some of the things that we were bouncing from were ludicrous, like hydroxychloroquine. But it’s telling that even at a time when we actually had very efficient countermeasures, that the vaccines, we really went all in on them. And I think a lot of sociologists of science, a lot of like, social epidemiologists would not be surprised by this.

Andy Slavitt  08:33

We thought we found a piece of cheddar cheese. We thought we found a really hard block of sharp cheddar, but we could put in front of all the twists and dropped and get rid of all the Swiss because I mean, because remember, remember in December, November, last year, people, we said, oh 96% effective vaccine. Right? And that headline. So I’m curious how you think about how we could have done this better, but I feel like we didn’t say is that against getting the virus? Is that against getting the disease? You know, we didn’t really explain what that meant. It sounded like, hey, pizza cheddar cheese, soon as we give it to you a game over. Right?

Ed Yong

Right. And I think there’s, you know, there’s obviously two, I think, probably three important things there. One is that, you know, only half the country got the cheese, right. So that, that one layer for a star is only protecting one and two people, you know, so even if it was perfectly protective, which of course it’s not, that would be a big issue. And of course, it’s not perfectly protective. Even back then I agree that there were issues with how well people communicated, what the vaccines were actually protecting against and how much protection they were offering. But you know, even taking the highest of those numbers. It’s not perfect that you know that you’re block of cheddar still has holes in it. And then of course, you have variants like Delta that are eroding into some of the effectiveness that the vaccines once had. So, you know, all of those factors put together mean that for an individual, the vaccines are still extraordinary, right? The people who are listening to this show have been fully vaccinated, have done the single best thing that they can to try and protect themselves. But, it means that societies cannot simply put all of their eggs in the vaccine basket.

Ed Yong  10:36

And they, you know, there are good sociological reasons for doing that. And there’s just some basic mathematical ones. Just the simple numbers of Delta’s spread mean that this cannot be our only solution. And, you know, as I wanted to say earlier, like this is, this is sort of part of the modern American malaise that we regularly and repeatedly look for biomedical panaceas, that are going to lead us out of massive problems that are like, hugely social in nature, that we look for the one drug, or the one vaccine, or the one thing that you put in your arm, and that makes everything better. And you know, sometimes it works. But that leaves behind a huge bedrock of social weakness and vulnerability that goes unaddressed.

Andy Slavitt 

This comes directly from your article in my book, which in which was which, by the way, quoted you directly a number of times, with that a lot to deal with weed, and we’re not going to get better until we figure out how to care about one another and the impact of all of these, this on one another. Because otherwise, if you don’t, then there’s really no point then that none of these measures are going to get adopted by people who don’t feel like they’re at risk and likely to die. And so, you know, but if that when that chip is gone, you know, you get increasingly sort of pushed into this view that, that I need a long ball solution, because I can’t count on my common citizen any longer. And this was proven, I think, really, by delta. So if I go back to last year, and I listened to all of the podcast episodes, and I read through all of the scientists, I talked to nobody, nobody was talking, at least at any real depth, about mutations to the virus getting worse, except one person. And that one person, I thought was just the biggest curmudgeon and downer, and I didn’t even want to listen to him. It was Bill Joy. And Bill Joy said, everyone’s saying these viruses get better and better and less harmful over time. It actually is going to work the other way here. And nobody else was saying that. And so nobody was really wanted to listen to Bill. But what happened is, you know, I think to some extent, we created a cheddar cheese for the lesser virus. But I don’t think we foresaw a 2021 with a worse virus, or did we? How did we miss that?

Ed Yong  13:22

I mean, I think I actually certainly towards the end of the year, a lot of people I was talking to you know, we’re taking that possibility seriously. But I think that you can see some of the same issues that plagued our from this to let’s use a different word that, that affected that hampered our initial response to the vanilla Coronavirus back in early 2020. At play in our response to Delta, one researcher, some skeptics took up enough of Northwestern positive me that in part of it is just this very Western hubris that, you know, you see a new variant crop up in India and absolutely devastated. And somehow think that that’s not going to be a problem in the US. Maybe because some people like the country was quote, unquote, highly vaccinated, even though half of people were still not in that category. Or because, you know, there was some assumption about relative quality of medical care on offer to people. Whatever the reason, you know, in 2020, we saw the original virus tear its way through East Asia, and did not do enough. This year, we saw a variant territory through South Asia and did not do enough. And once again, we don’t have enough testing. Once again, we have debates about masking and all the other interventions that are on the table. And I think that, I do think there’s something to this idea about hubris being part of the equation.

Andy Slavitt  15:39

There’s a school of thought that put forward by many of the anti-vax community, that the reason we’re having variances entirely because of the vaccine. So we start with that, that one posture. And then there are flavors of that that aren’t quite so I would say what I think of that theory, but that aren’t quite so extreme, that really relate to how slowly or quickly we vaccinate The world will have given a chance for the viruses to feel the pressure to evolve. So before I go any more armchair..

Ed Yong  16:18

Alright, I will say that, I will, I will do my best to answer this question if your listeners want a much better longer and more considered on so I would strongly recommend a piece that my colleague Katie Wu, just wrote to the Atlantic called the Coronavirus could get worse, which is, you know, obviously a somewhat alarming headline, but it is absolutely a piece that looks very, very deeply at the evolutionary possibilities ahead of the virus, and I think does justify that, you know, this idea that Yeah, then things could get worse. Very early on last year, people were telling me, rightly, that, you know, you cannot predict which way this is going to go, like evolution could make things better or worse. Worse is always on the carts. Yes, the question about vaccines, let’s first I can take that idea seriously, and not dismiss it like I think at the core of that idea is the assumption that the virus will only evolve the ability to escape from immunity, if it gets into someone who already has some degree of it. So if it finds the selection pressure around it to become better at immune escape, it will do that.

Ed Yong 

And the corollary of that is that if you, if the virus doesn’t have that pressure, if it’s just in people who have no immunity, then why would it evolve the ability to escape from it? I think that idea is totally understandable, but also wrong. Because we know that viruses mutate spontaneously all the time, we know that they are, you know, without deliberation, of course, like just testing out a different mutational routes that it could go down. And that occurs in people like in everyone in people who are unvaccinated and vaccinated. And one model for how the evolution of the virus could occur, which I think is right, is that a bunch of mutations happen just, you know, just as part of the natural course of the virus infecting someone, and viruses with the right constellation of mutations to have some degree of immune escape, then get into people with a degree of immunity and can spread from that, right? So I think that the point here is that the trait that might evolve, doesn’t have to first arise in the arena where the selection pressure is strongest, right?

Ed Yong  18:59

It can just arise elsewhere, and then gain a foothold or find an advantage in somewhere else. Which is all a long way of saying that. No, I think that that idea is wrong. I think that it is much more likely that if we continue allowing the virus to spread uncontrolled, which mostly happens in unvaccinated populations, the more chances that we’ll have to evolve into worse variants. You know, I don’t think it’s the case that the vaccines triggered to the evolution of bad variants like Delta and Alpha, you know, like, quite the opposite. I think that that does make however very strong argument for getting the pandemic under control as quickly as possible and as wide a swath of the world as possible, which is yet another reason why all these calls for vaccine equity are so important. The US cannot and should not consider itself protected even if like magically everyone in the country who was yet to get their vaccines decided to do so tomorrow, the pandemic still wouldn’t be over for us because it wouldn’t be over for other people either. Like, again, it comes back to this idea of connectivity and community. And we are still very much in this together.

Andy Slavitt  20:27

So that’s obviously a very hot topic right now. And maybe let me lay the stage for where that conversation sits, and then ask you about it. We’ve done about 5 billion vaccines across the globe, 75% of them in 10 of the wealthiest countries. But we’re now vaccinating about 36 million people a day. It’s mostly centered in Asia. But if you did 36 million a day, and continue to be able to do 36 million a day, that’s about a billion every month. And if you did about a billion every month, and you could continue that, then, you know, you would be able to sensibly get the world vaccinated in the very early part of next year. Now, for everyone’s baseline, the G20 is sort of said that it’ll be the end of 2022, before we get the majority of the world vaccinated. And that’s just simply too long. But the implication of that, and if you follow those numbers, and all believe those numbers is that we are producing enough vaccines to vaccinate the globe in the early part of next year. But that doesn’t mean we will.

Andy Slavitt

Because the logistical barriers, the same things that we inherited in the Biden administration in the US, cold storage, logistics to distribution in the developing world is a monumental task. And myself along with the people from PEPFAR and others are about to release. In fact, we just released a letter to the world leaders in advance of the United Nations meeting here in September, saying that the world needs to work together to vaccinate the globe by the early part of next year. And it is indeed possible. But a lot of things need to happen that aren’t happening now, namely, unified leadership around solving some of these very hard problems. So with that as a backdrop, every time a vaccine dose doesn’t go into someone’s arm brand new, as you said, we are increasing the risk that new variants evolve. And at the same time, of course, the wealthy nations are saying no, we want to get to our third vaccine dose. So inherent in this question for you Ed is there’s a lot there’s does immunity wane, there’s what’s the highest and best use of vaccines. And there’s really how to manage this challenge globally?

Ed Yong  22:53

Yeah, there is a lot of to unpack there. And again, you know, I do want to defer to colleagues of mine who’ve done more reporting on these particular things. I’ve already talked about Katherine Wu, and she has done fantastic work on many of the intricacies of how the immune system reacts to the vaccine. She’s working on a piece about waning immunity now. So I’m going to get my touch on these issue in a broad way. What I want to say, based on my own reporting, is that I think it is very clear that the impact of a vaccine shot is going to be much greater in someone who has received zero than in someone who has received two, Eleanor Murray, an incredible epidemiologist and statistician at Boston University has done is crunch these numbers very well. And very tellingly, I think, men shown to my mind very convincingly, that the effect of a booster is going to be pretty incremental as compared to the impact of vaccinating someone who is fully unvaccinated.

Ed Yong  24:07

And I think because of the dynamics, we have already identified the sheer number of people around the world who remain unvaccinated including high risk groups. In many countries. I just don’t think one can morally justify having a widespread booster campaign in a country such as this, when there is so much of an equity issue at play around the world. I think that and making efforts to reach, to continue reaching on vaccinated people in this country and may continue the steady but unabated progress on that should be the main like should be our main goals. And I think that’s going to achieve more in the long run for the entire global community then giving people who are already vaccinated, and you’ll have, you know, some degree of immune privilege, a bit of extra personal protection. And again, this goes back to the individual versus collective idea, right? Like, what is the best thing for me, a fully vaccinated person right now?

Ed Yong 

Well, for me, it might be to get a third shot that might, you know, I don’t think that’s going to, I personally, I haven’t seen that enough evidence. So that’s going to make a huge difference. But it’s not going to make like zero difference. But what is the best thing for the world right now? I think it’s to get those shots to people who’ve never had them before. and by extension there, what is the best thing for me, it’s actually to do that other thing, right? Because if we don’t do that, then I do worry about the possibility of even worse variants arising that really do stop punching through the whatever shield I currently possess. So, you know, I still think that it’s in my self-interest to sort out the big picture.

Andy Slavitt  26:36

To oversimplify, you know, the one way that I think it’s possible to describe these terms is, are you willing to suffer symptoms, if you know, your risk of death is, and hospitalization is incredibly low, in exchange for that benefit you just described, which is both a moral one, but also a longer term protective one. Because, you know, it’s possible that, tell me if you agree with this, that a boost really keeps your antibody levels higher, more quickly. And when you’ve got a much more rapidly spreading with a lower incubation period, virus like you do with Delta, you could see symptom reduction. But are we taking first world symptom reduction and putting it against lives in developing countries?

Ed Yong 

Yeah, I think that’s a very fair way of putting it. And I think my answer to your question is yes, yes, I am absolutely willing to bear that risk. And I know it, there is a risk. But I also feel that, you know, it’s not as if I don’t have any other options, besides get a booster or not get a booster and, you know, swan dive into a crowd of people indoors and get COVID. I think that I have options that are afforded to me, by living in a prosperous, wealthy nation.

Andy Slavitt  28:02

There’s a couple wrinkles. I’m sure you’d agree around the fact that we have at 70% of our population is unvaccinated under 12-year-olds who can’t get vaccinated? Yeah, you know, and I think there’s immunocompromised people, which are interesting exception.

Ed Yong 

Yes, to be clear, the wrinkles are people who either did not fully benefit from, to    run the vaccine, like many immunocompromised people, or people who are at very high risk. So like the elderly, I think that there is a strong moral argument for giving boosters to those populations, but not as a general policy for like the entire adult.

Andy Slavitt 

And how does long COVID figure into that, I know, you just wrote a piece on long COVID How does the risk of lung COVID figure into that equation? Because people are fearful that if they get COVID, that those symptoms might stick around?

Ed Yong  28:54

Yeah, people are very fearful. And I think rightly so. You know, I think one thing I say in this piece, is that competent predictions about long COVID are unwarranted because so much is still unknown about it. You know, the only confident prediction that I’m willing to make to you is that it is a problem. And we still don’t know enough about what causes it? Well, no, we know that we know what causes but we don’t know enough about how and why it occurs in general and in specific people to really make like big proclamations. So for example, for a long time, the discussion about breakthrough infections has correctly been that they are going to be milder than cases of COVID in people who are not vaccinated. The common response the long-haul community to that has been, well, you said mild infections would not be a problem at the start of last year.

Ed Yong  30:04

And we know full well what a mild infection can do. We know that like an infection, but it doesn’t send me to the hospital can leave me with symptoms for months, for years. So you know, this idea that mild infection like breakthrough infections of mild areas of cold comfort. Now to that, many of the immunologists and scientists I’ve spoken to have, I’ve argued that a mild infection in a vaccinated person and an unvaccinated person are not the same and should not be treated as the same because in the vaccinated person, that is the infection is mild, after the immune system has already been stamping on the virus, which should theoretically be different. So on that ground, you would expect the risk of long COVID to be lower after a breakthrough infection. But the wrinkle there is, as I said, we still don’t know enough about long COVID. So one possibility is that it is essentially an autoimmune condition, where you get exposure to the virus and your immune system for whatever reason starts attacking itself.

Ed Yong 

The fact that there have been some cases of long COVID in people who’ve been fully vaccinated with a massive caveat that we don’t know what the rate of those is, at all. But the fact that there have been some might suggest that if the autoimmune theory is right, that it might only take a small amount of exposure to the virus to trigger it. So again, that brings us to the question of okay, but what, like if it, what risk does a milder infection pose? And I think because we still are in the dark of the like mechanistic causal links between seeing the virus and developing long COVID, it is very difficult to then predict how those dynamics will play out in a vaccinated person, or in a situation in the future when the virus becomes endemic and just becomes a natural part of our lives. And it is therefore very difficult to answer this question of whether boosters would reduce the risk of long COVID or not like my sort of gut reaction based on everything I’ve just told you is that if it is correct, that a small amount of virus might be sufficient to trigger an autoimmune reaction that leads to long COVID in some people, for whatever reason, then I struggle to think why having a third dose of the vaccine is going to make a difference, right? If that hypothesis were correct, then what’s probably happening is that the amount of hours it’s getting into your respiratory tract at the start, before it is controlled by the immune response that the vaccines trigger, which are mainly circulatory before that happens, that amount is enough to trigger some kind of autoimmune cascade. And if that’s the case, then boosting the vaccine induced response isn’t going to help matters. Is my guess at the moment, but massive caveat, we really don’t know.

Andy Slavitt 

That’s right. It does make the booster for conversation versus using those doses in countries that haven’t had their first shot. Slightly more complex.

Ed Yong 

I’m not actually sure it massively complicates the booster question. I think it complicates a lot of things. I think it complicates like, our understanding of how to deal with the virus in an endemic a future it complicates like..

Andy Slavitt 

No, here’s why I think it does. And look, one of the things that makes you such a great writer, is, you’re a science writer, that doesn’t just write about the hard sciences, but to write about, people don’t like when I say soft sciences. I’ve been corrected on this. But you write about the social sciences, you write about the interplay between the social sciences and the physical sciences. And, you know, one of those is political science. And the notion that, you know, taxpayers expect with their tax dollars, the government will do everything they can to protect them from things that put them at risk of getting sick, and that we have no, we have no effectively, we have no central governance for the globe. We only have national governance. And if every wealthy country has citizens who are saying you could protect me and you’re choosing not to, that political science, particularly when there are concerns valid concerns around things like lung COVID makes it more difficult to expect a politician to defy you know, what essentially the concerns of their own population.

Ed Yong 

Right. But what I’m saying is that I am not convinced that there is enough of rationale to say that a booster shot would dramatically, would significantly reduce your risk of lung COVID. based on whatever we currently know, to make that claim. I think that you’re right that a politician, politicians that absolutely should be factoring long COVID into their calculus about what policy measures to call for. But I think if you take that route, then you’re much more talking about measures, like other preventive measures, like the so-called term I truly despise non-pharmaceutical interventions, you’re talking about things like masks, you’re talking about things like distancing, you’re talking about more serious means of preventing infections in the community.

Ed Yong 

I don’t think that it naturally follows that if everyone was to suddenly take long COVID seriously, the natural recourse then is to go for a booster strategy. I think that a lot of long holders would actually say the opposite. I think what they feel is that a lot of the decisions that have been made this year, including things like the CDC is initial reversal of its indoor masking policy for fully vaccinated people. Those things were a reflection of the administration not taking long COVID seriously enough. And that prioritizing a much more holistic attitude towards the prevention of respiratory infections, that is a would be a much clearer indication of truly addressing the potential future threats of long COVID.

Andy Slavitt  36:37

Yep. So, I underestimate it maybe you underestimate, I don’t know, if you do. But if you don’t underestimate, I suspect, at times, you might even forget how much the public can’t stand not much of the public, non-pharmaceutical interventions, and of course, you understand it, because it goes back to the individual versus collective conversation. But I’m gonna use it in a little bit differently, which is that there’s a large part of the population, at least some of the data that I’ve seen suggests that people can stomach NPIs, like masks, etc. If they know they’re temporary. And if they serve a short-term purpose, and even then, you know, you get Governor DeSantis, who doesn’t want schools to require masks, etc. But by and large, the public isn’t with him on that. But if you tell the public that this is going to be something that is going to be a new part of life, it is amazing how large parts of the population in the US at least I haven’t studied this in other places, really despise that idea? Is that going to change over time as people get accustomed to it? Or do you think? No, this is probably one of those things that is forcing us back to look at the physical sciences, because there’s really gonna be no way to change people on that.

Ed Yong  38:04

Regardless of how optimistic or pessimistic I feel about the possibility of that kind of change, I don’t think that any of us have the luxury of pessimism with it. Because I think that if we cannot enact that kind of cultural change, we’re screwed. I think we’re screwed with a pandemic. I think we’re screwed with climate change. I think we’re really in problems, if we can’t address these problems in a more collectivist, more community minded way. And I do think that that is, if not likely, then certainly possible. And there have always, there have been signs of that possibility throughout the year plus of this crisis, you know, there have been signs of very clear public support for masking and other such measures, especially during you know, especially when searches are actually happening, which is when they needed the most right. I think that the considering this country’s famous proclivities towards individualism, it is in remarkable how many people wore masks last year from a baseline of nothing. I think that big social change is possible, even if it is unpalatable, but I think it requires strong, consistent leadership and messaging to put it in place. And I don’t know what is realistic to expect, and I don’t want to make predictions about it. But I do maintain that if we cannot find a better way to address these issues, including many of the cultural flaw Was that we started talking about at the start of this interview, then this is not gonna be the last time we have this conversation.

Andy Slavitt  40:08

Right. Let me close with one question. What should be our goal now?

Ed Yong 

The way I see it is this, get as many people vaccinated as possible as quickly as possible, and do everything we can to spread out infections among everyone else over as long a time period as possible. I think that’s it; I think that at some point, we will hit endemicity, you’ll probably stumble into it. But that is the end point. I think we want to get there with as little damage as possible through some combination of vaccines and other strategies.

Andy Slavitt 

And you wrote about this, but be sad particularly this at some point in time. The good scenario is that COVID-19 begins to be put into the category that we consider of our unborn unfortunate, but manageable challenges. Yeah, I live in Southern California, the traffic is horrible. Yet, it doesn’t prevent me from living my life. People who live in areas with extreme weather and other kinds of things. These are manageable challenges, but they but they don’t dominate the day to day, if you had to guess. When do you think we move into that state? Is it uneven move? What do you see?

Ed Yong

No, I actually don’t know the answer the question and no one I talked to could confidently make a prediction on that. What I do want to say, though, is there are a lot of things that we tolerate, and that we don’t let dominate our lives. But that maybe we should not dominate, but that we can and should address to a much better degree than we currently do. You know, you talked about that extreme weather, you know, I’m not sure anyone can look at the current situation and think like our preparedness for wildfires, or for hurricanes or for any of these threats, is, you know, is going to leave us in good stead over the next century or so. So many people use this rhetoric of, you know, when, blah, blah, blah COVID is going to eventually get to a point where it’s no worse than the flu. And we obviously don’t shut down society for the flu. Well, firstly, no one’s talking about shutting down society. And secondly, the flu is still a big deal. Right? A bad flu season is a horrible experience and horrible experience that we have both normalized to and could not. You know, there are things that we do in our lives that are less than convenient, but that help us you know, seatbelts. Right? Like just generally like, washing our hands like this the way applying sunscreen brushing our teeth.

Andy Slavitt 

You make such a great point. I mean, the things we’re willing to tolerate school shootings, that we become accustomed to, we’re now okay with the fact that 3000 kids per week are getting admitted to the hospital. And we tell ourselves, we’re okay, because most they’re almost entirely not dying. So we’re okay with eight-year-olds getting 104-degree fevers and struggling for breath and needing to get oxygen assistance, and waiting hours in hospitals to do that, where we, you know, we become okay with things far too easily. So I think you make an excellent point.

Ed Yong 

And let me just end on this note, right. I think, let’s also be clear on what it means to normalize these things. Because when we do normalize these things, the burden almost always disproportionately falls on the least socially privileged among us, as minority groups, poorer rural groups. Like, that’s always the case, and then those burdens become additive onto them. If you if you get COVID to a position where it only affects the most vulnerable, then it’s layering on top of other chronic illnesses, maternal mortality, or like all the rest of it.

Andy Slavitt  44:42

100% that’s not only the effect, that’s also part of the cause. Part of the reason why we get away with it.

Ed Yong 

Yes, yes, absolutely. And, you know, as we discussed before, this ain’t going to be the last pandemic. So this is our chance. To in the end game of COVID, to set up systems that are going to protect us in the future. And wouldn’t you know it, those are the same systems that would help us manage the slide into endemicity. A little bit more easily.

Andy Slavitt

Great. Well, I want to thank you for coming on your favorite podcast.

Ed Yong 

You’re welcome. Always a pleasure.

Andy Slavitt 

And Diane on our podcast. I talked about the small prize she won earlier. And I think people are assuming that it’s the in the bubble prize for best episode. But in addition to that, you were honored with a Pulitzer Prize for your work over the past few years. And I have to say, I’m guessing it even means more to you that the reaction to you winning that award was so universally, I’ve almost there very few things in people where I’ve seen hundreds and hundreds of people universally, saying, Wow, the right thing just happened. And I know you weren’t necessarily one of them, because it’s not the kind of thing you were looking for. But I hope that reaction to your winning the prize, you do focus on because you are a gift.

Ed Yong  46:18

Thanks, Andy. That means a lot and I did appreciate it. The outpouring was immense. And I felt it all very much. It’s not the kind of work that I was expecting or hoping to do. And it’s not work that I ever hoped would be necessary. But I’m glad that it is helpful to people.

Andy Slavitt 

That really is, really is.

Ed Yong 

All right. Thanks, man. Thanks for having me on. Again. I appreciate it. You take care of yourself.

Andy Slavitt 

Okay, thank you to Ed, a couple things to look forward to. If one Pulitzer Prize winning journalist in a week isn’t enough. Laurie Garrett is on the show on Wednesday, we get into another intense conversation, but it really kind of one of the more sciency conversations I really asked her to take us through how does this all work? Like really work? And she’s just so great at explaining it. And then next week, a couple great shows. One of them is going to be a toolkit on boosters. with David Agus, the physician will talk about the science around boosters. And Tom Moriarty, senior executive from CVS who’s going to talk about booster distribution, and answer your questions on this toolkit. Have a great rest of the week. If you’re looking for stuff to do, just go back and listen to old episodes and tell your friends. Thanks, everybody. Stay safe.


Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen and please stay safe, share some joy and we will get through this together.

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