In the Bubble Says Goodbye, Part 1

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Andy calls four of his most trusted COVID experts to discuss their favorite memories from the past three years of the show. Dr. Eric Topol, Dr. Ashish Jha, Dr. Katelyn Jetelina and Dr. Bob Wachter candidly reflect on the pandemic. They remember the highs and lows, and spotlight  the importance of banding together to fight the virus. They also share the resources you should follow for the latest COVID news after the podcast is over. Plus Andy considers five important lessons he learned from other past guests.

Keep up with Andy on Post and Twitter @ASlavitt.

Follow @EricTopol @ashishkjha @dr_kkjetelina & Bob_Wachter on Twitter.

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Ashish Jha, Bob Wachter, Eric Topol, Katelyn Jetelina, Andy Slavitt

Andy Slavitt  00:18

This is IN THE BUBBLE with Andy Slavitt. Welcome to the show. Thank you all, for the very kind emails that you’ve sent in over the last week or so since we announced that this would be our last couple shows, was really kind of you really nice to read. And of course, keep sending him if you’d like, Andy at lemon We’re also going to play some voicemails on our last episode, which is next week, if you want to leave a voicemail and have us play it on the show. It’s pretty simple, just call 8334-LEMONADA. Or if you don’t feel like figuring out how to dial 8334-LEMONADA, just dial 833-453-6662. Then just pick the number four, pick the number four. That’s it. Special show today, we’ve brought on some of your favorites. Some of the people who have been really stalwarts, talking about COVID throughout the last few years. But first I’ve got a few things to say. And look, while I still have this mic, I might as well say them. So buckle in. A lot of you writing to me in the last week, made a similar point to me, which was that this show helps you through hard times. And when the shows not here again, you’re going to kind of go oh my god hard times, again, what am I going to do with that in the bubble. So I went to the next section, really. So you can play it over and over and over again, every time you need to, it’s gonna be that insightful. But really, I think that a lot of what this show was intended to be about was to help us all together through those hard times. And please don’t think that I wasn’t going through them at the same time. I learned a lot from the guests on this show, we’re gonna go through kind of five of the lessons that stood out to me. And these are lessons that kind of consistent with the way the show operates. Some of them were very fact based, right? Some of them were like, I need to know the truth. I need to know what’s going on out there. A lot of them were also emotional based, how do we talk to each other? How do we hear information? How are we feeling? Is it okay to be feeling the way we’re feeling? And some of them were kind of a little more gut based? They were just more of the what’s the right thing to do here? And can you take a stand? And is there a black and white issue here? It’s kind of like what the Romans used to call ethos, pathos, logos, right, which is you got to think with all of those parts of yourself. And by the way, like, if you want to think about that lesson, I mean, people like Larry Brilliant and his his kind of way of thinking and reasoning and talking to people that she’s John, just people very much keep that mentality with you. So less than one. Search for the commonality with others, not just the differences. The differences are actually quite easy to spot. So do better, and try to find the commonality, particularly with people that you think you might disagree with. Matthew McConaughey, and I had a great conversation about this, if you want to go back and listen to that episode. And he really demonstrated that there was an article that was written about me a number of years ago in the New York Times Magazine, titled Andy Slavitt wants to unite America on healthcare. So to Thailand, we were very divided. And it says in the article, you know that Andy says, if you give him 15 minutes with any American, he’ll create a common bond around healthcare. What did I mean by that? What I meant was, you know, we all have all these opinions about health care and policy, and we start to argue, but show me somebody who spent an hour in a waiting room while their wife or husband, or child or parent was going through surgery, when I’ll show you somebody who I can really connect with because that experience penetrates what we think in our heads, and it creates something we can all talk about and share. And people can feel visible and seen and heard in those moments. And I really believe that it’s also about embracing dualities, right, you know, we can think that we know the answer to things we can think that there’s one way of doing things. But it’s true that Belonging Matters, but so does independence. It’s true that community is really important, but so is the characteristic of self reliance. Humanity and openness towards everyone is great. But there’s also really bad people out there and we don’t want to get pushed around. And part of being an adult for me was learning how to embrace these dualities.

Andy Slavitt  04:58

We got to number two, the Number two is pretty simple. For me. It’s just remember that you’re not in middle school anymore. Whatever was the most embarrassing time of your life, you carry those scars with you, or at least most of us do. And we think, oh my god, I’m gonna be embarrassed. And that prevents us from seeking help from doing the right things. There’s a really moving episode we had with Jason Kander, who was on a couple times, I would encourage you to listen to both of them. He talked about how he almost didn’t seek help for his PTSD, because he was embarrassed. And he was, thought he was going to be judged. And you know, it’s just time to maybe we all stop caring what other people think. And, you know, we’re not gonna get the kids in the class are gonna go, ooh, and make us all feel shame anymore, misses our lives. And it’s time to really stop caring. And I will tell you, the other person who made me think very much, that was Tony Fauci, because he would just get continued amount of abuse heaped onto him by people who really wouldn’t take time or didn’t care, to think about those issues. And it just never and never deterred him. Number three, and what surprise you that I will say, when in trouble, find the helpers. That’s obviously Fred Rogers is one of the influence for this show. But I would also say, don’t just find the helper be the helper, because at various points in time, you’re going to be going through absolute hell, and other people are going to be fine. And there’s going to be other times when you’re going to be doing fine. But other people are going to be going through challenges. And I really do believe this is one of the greatest gifts that we’ve been given each other, it’s each other. And so use that ability, you have to make someone’s day better, their week better, five seconds better, and have people who you care about around you when you need that, as well. I don’t think there’s more important advice. If you want to hear about episodes where I really learned that lesson, you can listen to an earlier episode we did with Pete Buttigieg, talking about the allies that supported him and his life. And Adam Smith, who talked about his own anxiety. He’s a prominent congressperson with phenomenal episode number four, speak up and call out bullies.

Andy Slavitt  07:25

When you see them. There is no situation that is more intolerable than someone being bullied. And I really, when I asked myself, Why not at moments of life that I would like to do over again, it’s probably anytime I was in a situation where someone was getting bullied. And I didn’t have the courage to speak up. Steve Kerr, who is the great NBA basketball coach talked a lot about this on the episode he was on, after his father was murdered. He speaks up on any topic and every topic, no matter. Lori Lightfoot, who was being bullied herself, by the police unions came on the show. She’s the mayor of Chicago, Admiral Rachel Levine, talking about trans kids getting bullied. And just simply letting them know that you’ve got their back and that you’re on their side, mean so much. And it’s it really consistent with this idea around actions and intentions that I think are so important. You know, we all want to be judged based on our intentions, as if people can see them, but we only judge others based on their actions, what they actually do. And I just wonder what would be like if we tried for a day, to just judge ourselves based on our actions and judge others based on their intentions, we’d be much more forgiving. But this action orientation was really, really driven home to me by Jose Andres, the great chef who is in all the disaster zones and was such a great help to people during the pandemic. You know, I strive to be as action oriented as he is. Final point I make number five here is to remember the Euro miracle. So my by the way, what is that my my I am religious miracle scientific miracle. I don’t really care how you want to look at it. But you know, they’re scientists that estimate that the likelihood that we even had intelligent life on this planet could be as little as one in a million billion, which strikes me as very small. One in a million billion. He took an asteroid, destroying the earth rest to be here talking about duality is destruction. And then life.

Andy Slavitt  09:47

And for us to be here, intelligent life, as we have for the last couple billion years. It’s pretty astounding. And this is the life we have and Not only do we have it, but we have a really glorious time. And I think, just ask somebody who came out of the Middle Ages or, or the Mesozoic era, to look at our lives and say, I think we understand how lucky we are at a very different level. And look, not only are you here, but whatever has been thrown at you, whatever, it’s been hard, whatever the bad stuff has been the hard times, you survived. you’ve knocked it all down. So that’s a miracle and of itself, too. Anyway, this sense of this miracle that we are, there’s a bunch of episodes that are that comes to mind, but Laurie Leshan, from NASA, as someone that I think really helps you put some of that in perspective. So anyway, thanks for letting me have the mic. Isn’t that just for these few minutes here this morning, but for the last few years, don’t forget, you can leave us a voicemail. 833-453-6662 hit four, leave us a voicemail. We’ll try to play it on the last show. And now I’m going to bring in guests who I think exemplify a lot of lessons that we talked about on the show. You’ve heard it before a number of times. Eric Topol, Bob Walker, Katelyn Jetelina, Ashish Jha, four people who really helped us get through the pandemic, here they are.

Andy Slavitt  11:35

appreciate you all being here, I should go without saying how much respect I have for you that I wanted to do this. I better go back to this concept of ethos, pathos, logos, you know, which means starting with the facts, a low dose. My guest today did that they informed us. And then they connected also with how we were feeling the overlapping of pathos. My guess were exemplars of staying true to the truth as they knew it, but communicating in ways that accounted for people’s feelings and human pressures. We were all under the emotions that helped them in the emotions that blocked them. And then, of course, what I really admire about like guests today is that they had an ethos and ethos for the truth in ethos to support science, and ethos to speak up, no matter the personal consequences. At a time when we needed guidance, they were the eyes in the back of our heads. They were the voices that stirred us. And assurance that there were adults in the room. We’ve had many of great guests. I could have chosen from a number of them. But today, you will not be surprised that I’m joined by Eric Topol, Bob Wachter, Katelyn Jetelina, and soon Ashish Jha. They I think are best to help me with three things to help us reflect a bit to help us predict and then to make sure to provide you with great resources. Welcome, everyone. Welcome, Katelyn.

Katelyn Jetelina  13:24

Andy, you’re gonna make me cry.

Andy Slavitt  13:33

Eric, how are you, buddy?

Eric Topol  13:34

Oh, good. It’s great to be with you. Katelyn, Bob. And Ashish. Wow, what a group.

Andy Slavitt  13:41

And Dr. Wachter, how are you?

Bob Wachter  13:45

I’m already crying. It’s an honor to be here. And not just with you. But these are in some ways my this is the pantheon of my heroes over the last three years. So it’s really an honor to be part of it.

Andy Slavitt  13:58

Yeah, well, you guys have done so much during the course of this pandemic. And I don’t know that as a as a nation, or even us as individuals have had a perfect chance to reflect. There has never been really a breaking point. We were sort of in the middle of it, and then things change a little bit. So let’s reflect a little bit. What’s everybody’s most memorable moments for the pandemic?

Katelyn Jetelina  14:20

Andy, this is gonna sound I think cheesy, especially being on your show. But as everyone knows my word I don’t know if anyone knows but my newsletter started from nothing. It started from me talking to students and faculty about what was going on. And it grew and it grew. And then Omicron hit and it exploded. And the one of the reasons I knew it exploded with Seth McFarland. We tweeted one of my my articles and then you Andy reached out to me to go on in the bubble and I was I was freaking out and And because it it, it showed the need for relay information in such a confusing time and in such a rapidly changing time.

Andy Slavitt  15:12

I think we should come back and talk about your newsletter. And they could do that in the last segment into why it took off. Because it really did.

Eric Topol  15:19

Yeah. Katelyn went from your local epidemiologist, to your national, your global epidemiology, you know, for me, and the the moment I’ll never forget, was the day that we came together that coincided by happenstance with the first vaccine to get out, and that would be Pfizer November to get the trial results that exceeded all expectations. And it was a day in the history of biomedicine that I don’t think anybody can ever forget. Because what, you know, we were facing this existential crisis, we had these ideas that it could take till 2033 to get a vaccine that would be effective against SARS. cov. To and within months, literally, from the time of the virus being sequenced in January to the same year completing trials of over 70,000 people with 95% of efficacy. I mean, you just can’t even dream this stuff out. And we share that excitement together. Yeah, I’ll never forget it, because it was so exhilarating. And it just happened by accident. It wasn’t even you know, that wasn’t even the plan. That was going to be the morning of the big news. And in reflecting back. You know how we take that for granted? You know, it’s extraordinary.

Andy Slavitt  16:43

That’s so true. Do you guys want to listen to a clip of that? When Eric was on it really did happen? Just as Eric said.

Katelyn Jetelina  16:51

Let’s do it.

Eric Topol  16:55

Hello, there.

Andy Slavitt  16:59

All right. All right. Good to see what a day to be doing the show, huh?

Eric Topol  17:03

It’s a big day, the best day of the pandemic, I think right here today.

Andy Slavitt  17:08

So there’s a lot of things to be excited about. But for those who don’t know, we’re talking about news this morning, out of Pfizer, and German company that I think it’s called Bio and tech. How excited were you this morning when you hear it? First of all, tell us what the news is. And and and tell us what you would what you felt like when you heard the news?

Eric Topol  17:29

Well, I woke up this morning, it was about 5am. And I’m looking at my emails, and I’ve seen oh my gosh, Pfizer is announcing 90%. at least 90% of. As you know, Andy, we were looking at, they were looking at 60% We’d be happy even met 60%. So the fact that it was 90 Plus the fact that it was 94 events rather than 32, which was going to be their first interim. It was it was enthralling. It was definitely the kind of news we need right now. Because things are overall looking so bleak. And this is the beginning of the turnaround. This is a day of inflection.

Andy Slavitt  18:10

So Bob, you can hear it in our voices. And I’m sure you must have felt similarly, it’s hard for me to even recall the state of mind we had back then, like the day before, we heard that a vaccine was going to be here soon.

Bob Wachter  18:24

Yeah, I had the same feeling. I remember when that news came out, I literally jumped for joy. And I don’t jump very well or very high. And it was. So it was very clear when I used to play a little basketball. It was an astounding moment, because it was clear that the end whatever the and it was also clear at the end was gonna be messy. But at the end was near we I think as Eric said, it was a true inflection point. And up to that point, all the news was grim. And for all we knew that the vaccine would be 50 or 60% effective, or it would take another six months or another year. I mean, there was no way to be sure that these things were going to work. And the fact that they worked with a novel technology that had never been used this way before it was. It was astounding.

Andy Slavitt  19:11

Do you remember a moment when you’re most scared?

Bob Wachter  19:15

Yeah, I remember the first death of a physician of a prominent physician was John Murray, who Eric will remember from his residency at UCSF. John was a spectacular pulmonary critical care physician at San Francisco General Hospital and died in Paris very early in the, in the pandemic, and that was when it felt super real. And I do also remember, I think it’s March 18. The first day I started tweeting was I was really kind of sitting there feeling like you know, this could be the end of our society. This could be end of my life, my family’s life. It really had that kind of gravity.

Andy Slavitt  19:57

Let’s take a quick break. She’s John’s gonna join us All in a moment, we’re gonna keep talking. We’ll be right back

Andy Slavitt  20:24

Ashis’ joining us now. So let’s let’s add Ashish into into the show. Let’s wait for Ashish to get situated here. And we’ll pull him in.

Eric Topol  20:34

Can I ask you a question? While we’re warming up there? Andy, you were recruited to the White House. And you had to give up, you know, your life, your family to live in DC. That must not have been such an easy call, right.

Andy Slavitt  20:52

You know, I had, for a lot of reasons, pledged not to go back into the Biden administration. And he had received a couple of calls, sort of feeling me out about different roles that I had, politely declined them. And in fact, in general, felt really good about the fact that there are a number of younger people who I’ve worked with, who were really ready for those challenges ready for those jobs hadn’t had a chance to serve in the way that I had. But I got a third call around Christmas time, in 2020. And that was, I was almost no longer being asked, I was being told in some ways that I had to come in and do this. And she’s she’s obviously screaming and served after I did in a far, far easier period. But but but the truth is, like, I didn’t bring anything unique, other than the fact that the set of people who around the table at the time around claim, Jeff Zients knew me, and I’ve worked with them before. And I’d worked with them in a crisis. And they basically said, We don’t have time. We need we need people we know we need to be able to move fast. And you need to come in and you know, so it was a completely scary set of moments that a complete honor to serve. But yeah, it was, was one of those things. That just I think happened. And then it happened later. To you, Ashish.

Ashish Jha  22:28

I think, obviously, the very early days. And just like, when it first really hit me what we were about to go through as a country. I remember in March of 2022, things, some of those moments really stand out. I remember my first call with Debbie Birx when she was at the White House, and she had a whole series of questions. And I remember getting back to her with answers and thoughts on a lot of those things and realizing that her ability to translate those into real policy actions was being very much stymied by others in the White House. I obviously remember, like, on a very personal level, getting the call from the from the White House from Ron Klain about potentially coming in then meeting the President. And I, you know, in terms of joyous moments, I did feel an incredible amount of joy when President Biden was elected, because I really thought it would change the trajectory of the pandemic. And it did. I think it made a very, very large difference. And I don’t just say that because I worked and obviously served under the President, I really think it was a very different response. I spend a lot of time thinking about what would have happened if Donald Trump had been reelected? What would that first year the response or even the following time? What would that have looked like? I think it would have been much, much worse. So there a lot of important moments. Those are just some of the first ones I think of as you were speaking, Andy.

Andy Slavitt  24:00

If only we country valued competency more, we feel good. You know, Eric talked about a joyous moment, certainly Kailyn Bob is putting aside the personal success of obviously, the both of you have had in communicating to the public and your thoughts, but but just in terms of the Ark of the pandemic, was there a moment where either of you felt was a particularly positive moment coming out of this?

Katelyn Jetelina  24:29

I mean, I wish I’ll just back up what I said earlier about the ability to get the vaccine and standing in that stadium, honestly, to get a vaccine and in I think mine was January 4, and the amount of joy and relief I felt as a public health person on the ground that help was here and it was coming. And I’ve not felt that much joy in my field ever or, and I don’t know if I ever will again, because it was just that grand.

Bob Wachter  25:07

I think that that first year and a half to two years, was one of the most I sort of almost hate saying this. It sounds like we were having fun. Nobody was having fun. But it was one of the most dynamic scientifically and, and politically interesting. And, and gratifying things I’ve certainly ever done in my life. And a lot of it is owing to the people on this call. I mean, the the idea of waking up in the morning and seeing something Eric could put together annotating some article in science that I probably would not have seen. And then reading Caitlin’s interpretation of what it would mean from an epidemiologic standpoint, listening to your show about Andy listening to Ashish, on one of the 7000 News appearances he would make that day. It was it was coming fast and furious. And those of us who I think were privileged to be people, that that, folks, not everybody, but at least many folks trusted to take this firehose of information translate into something that was accessible and useful in an environment that obviously was politically challenging where the facts were changing all the time, because they were because we were learning new things all the time. No, that wasn’t fun. But it was really gratifying. And you know, a lot of us, part of what we do every day is try to make a difference in people’s health and healthcare. And it will be hard to top that feeling of that kind of reach that kind of access, and filling that kind of need. This wasn’t, you know, this was an area where everybody in the world wanted to know what was going on and what they should do. And there was no textbook that they could pick up to figure that out. So it was immensely gratifying.

Andy Slavitt  26:56

I do remember, my male moment of really profound emotion was, you know, you will recall that there were family members that had been separated from one another for the entire, you know, an entire year, if not more, you know, people in nursing homes, who, who couldn’t see their kids or their grandkids couldn’t have visitors. And we were all working very hard on making progress on a number of fronts. And I kept wondering, well, what’s gonna feel like, like when we get to a different place, and then somebody saw a woman tweeted out a picture of her and her newborn baby, after they’d been vaccinated, visiting her grandmother, so the child’s great grandmother in a nursing home, after seeing so many pictures of people who were just arrest, you know, separated by a window or glass or waving to each other from, you know, 20 feet away. And it was a very, very first picture as I was posted on, on the platform that we all used to call Twitter. And it actually began a deluge like, the next couple of weeks after that was like a few weeks after the first vaccines had gone in, we started to see hundreds and hundreds of those pictures. But man, I looked at that picture of these, this little baby, this older woman, and this young lady standing next to each other, finally doing something very simple, just being near each other. And man, that was, I felt like incredible burst of energy from that. Let’s just go quickly through a kind of what we think we got most right, and what we got most wrong, whether there’s lessons to learn, and I’m not talking about a fixing blame. And I’m not talking about saying, of course, we did. We did what we only knew at the time. You know, I think we’ve all we all say that all the time. But But when we think about something that we got most most to start with, we’ve got minutes wrong. What do you look at and say that either you as an individual, or us as a collective set of experts got wrong?

Bob Wachter  29:08

Well, the facile answer is the schools and I think that’s probably right. You know, I think it’s probably correct that we got that wrong. Not because the decisions at the time were reasonable, because to me, I think they were it is I think we’ve come to understand the toll that closing the schools has on education, on socialization on mental health. And, you know, for each of these decisions, you’re you’re weighing risks and benefits as you decide to enforce mandates. So you make all these decisions. So I think the next time I think we’ve got to do a better job of appreciating weighing the downsides of that. And I think as you talked about your example, Andy, I think the same thing probably is true of some of the isolation precautions in hospitals and nursing homes. You know, we had plenty of people die, isolated their family, we’re not allowed to come in and visit them. I think we could have figured out a way to facilitate that. And again, these were not irrational decisions at the time knowing what we know. But I think we learned something, and I hope they’ll do better next time.

Eric Topol  30:10

You know, I think Andy, the thing that was so disappointing is that we didn’t unite against the common enemy of the virus. That in fact, that was an opportunity to diminish the divisiveness in order to come together to fight. What was such a serious threat. In fact, all that happened throughout this time has just been a growing gap, and a toxic type of situation with the MIS and disinformation. It’s really unfortunate, I would have not thought that that could be the outcome, when we we had such a common purpose of getting through this and, you know, such good fortune of having, you know, not just a course of vaccine, but then as a sheesh led the whole PACs of a campaign to get it to be out there, practically. And, you know, so many victories that were unprecedented if you go back in history, the annals of medicine, but instead, we had you know, all the infighting and accusations of, you know, misinformation from the people who are doing their best to give it straight down and tell the truth. It’s, it’s a sad recollection that we went through all there.

Andy Slavitt  31:32

Ashish and Katelyn, anything you want to add?

Ashish Jha  31:34

I’m gonna iterate two things that I do think we got a lot of school policies wrong. And I do think we got a lot of hospital visitor policies wrong. And those both of those were very costly in very personal ways. And policy wise, I have to say, I have been thinking about, you know, I was very supportive of vaccine mandates. My record on that is unequivocal. I do wonder to what extent that further polarized our country in a way, that ultimately was not helpful. I think it saved a lot of lives when we did it, when the when the Biden ministration did it I did wasn’t there, but I certainly advocated for it. But I think as we unwound those vaccine mandates when I was there, I’ve had a lot of chance to go back and think about to what extent that contributed. And maybe one last quick point is, you know, I, one of the lessons I have personally learned is, I spent a lot of time thinking about what’s the best way to share this information? How do I share it in a way that’s honest and authentic? And sort of really that supply side of information? And I spent less time thinking about the demand side of information of what’s on people’s minds, what are they worried about? And I worry that if we keep thinking about the right messenger, the right message, but not enough on what really is bothering people, upsetting people, what’s on their minds, what do they want to know, if we don’t spend more time thinking about demand of information, we are never going to fix this problem of meeting people where they are. And that is something that I think we just got to do way, way better than we did this grant.

Andy Slavitt  33:12

That’s pretty profound, actually, really wise.

Katelyn Jetelina  33:15

Ashish took my my idea, but I sorry, it’s okay. But I mean, thinking about all of this, I think there is one theme, and I think it’s the greatest lesson I personally learned was the value of listening, and the value of opening up a bi directional relationship. I was helping the response in Texas, and it will forever be thankful for that. Because it quite literally forced me to listen, I mean, open we open schools and August of 2020. And I was certainly not happy about that. But it really made me listen to how other people are interpreting data and how they’re also assigning their values to that data and how we all kind of assign our different values to this foundation. And in order to understand each other better. We we just have to figure out how to listen in a systematic way, in order to provide that information, like Ashish said in a useful way so people can make evidence based decisions, we don’t make decisions for them. And also to help them wade through all this noise that we all kind of had to figure out together.

Andy Slavitt  34:31

Yeah, I think what we believed about the vaccine before Delta, and then what delta changed, taught me so much less than in in humility, and being a little more cautious. You know, we certainly believed that people couldn’t get bounced back infections, we believe that the virus and once you get vaccinated, there’s a lot of things we believe to be true and communicated. But between, you know, call it December of 2020 and June of 2021, that I think caused us to lose a lot of credibility with people because things didn’t turn out the way we I think, quite confidently communicated.

Ashish Jha  35:15

Can I jump in on that for one second Andy? I learned something about this, really from Eric. And I want to give a shout out to Eric I, in May, and June, even into July as the data on the booster was becoming clearer and clearer. I was so still very stuck on this model that people did not need the booster. And this is, as I said, probably June into early July. And Eric sent me some stuff sent me papers was writing about it. And I realized I so deeply wanted to believe that two shots was enough, because I wanted more Americans to get the two shots and the world to get two shots, that I was not being an honest broker of evidence at that moment, because of my own biases. And I remember the day like he sent me something I pushed back. And then I was I realized, I’m just pushing back, because I don’t want to believe now because it’s not true. And I at that point, did a 180. But it is a great reminder of how we all can get stuck in our views. And stop reading the evidence thoughtfully and carefully. And I have huge respect for Eric for not doing that. And a lesson learned for me have I got to do better when I get caught up in my own. In my own sort of stated public positions.

Bob Wachter  36:36

Let me shout out to you Ashish, that when you were in the White House, you had a group, I think probably all of us who you would call, and you would honestly say, here’s what I’m thinking or here’s what the policy might be, what do you think and you were you you’re you’re sort of wide open to alternative views and recognizing that you were in a bubble and might make the wrong call. And sometimes that shifted what you were going to do, I thought that was very impressive, that you were open to that and that you actually sought that kind of input.

Andy Slavitt  37:07

Alright, let’s take one final break. And we’re going to come back. And we’re going to leave you with the best sources that we think are available to you around the pandemic and public health. Hint, hint, I think you’ll find one of them, actually, it’s one of our guests.

Andy Slavitt  37:45

Okay, back from break, we’re gonna finish up with Bob. And Caitlin, two of our mainstays. Bob was obviously a guest host for quite a while. And Katelyn has been just such a great, great wire and a great guest. So before we get to predictions, I’m curious what we think we got most correct.

Katelyn Jetelina  38:09

I think the biggest success, and I think this is something that you Bob said earlier was just the spirit of teamwork. I have never seen this level of collaboration on such a global scale. I mean, we’re now friends with virologists in Germany and England and South Africa. All because we’re trying to work together to figure out what was happening, and then translate that further. And it was quite an honor to be a part of that and watch it unfold. Honestly, I’ve never seen a globe work towards one problem before and stay so focused on it that it was a that was certainly something I thought we got right at least in the scientific world.

Bob Wachter  39:00

Yeah. And Matt, you know, as as terrible as our current information ecosystem is and how much bad stuff happens via social media. It also was magical. It was remarkable. For someone like me who’s a generalist, to be able to say I need to follow worldclass, epidemiologists and virologists and aerosol scientists and political scientists and sociologists. And who are they and then just tap into their brain and be able to see what they’re thinking and what they’re reading in real time was enormously helpful. And yeah, I don’t think anything has ever happened. Exactly like it before. And answer your question at I have a hard time not saying that warp speed was the most impressive.

Katelyn Jetelina  39:46

Yeah, we’re just gonna say public private partnerships.

Bob Wachter  39:49

Yes. And I that’s exactly where I was gonna go with it. Yeah, that, you know, I think most people would guess my political predilections and my feelings about the former president of But on that one, they got it right and got it right in a way that I not sure the Democrats would have gotten right. I think if it was the dems, it would have been more strings attached more process more, a whole lot of stuff that maybe less trusting of the private sector. And this may be just sort of good luck that it worked out that way. But the idea of giving a ton of money to the private sector, and mostly trusting them to get it right with a fair amount of oversight, but, but not stifling amount of oversight, in retrospect, was genius and lead to a vaccine coming out, I think fat far faster than one can envision, under many other circumstances and under other administrations that I happen to like better.

Andy Slavitt  40:46

Although don’t forget that Pfizer didn’t participate, and was still first, and look, and the part of a worksheet that I liked the best was that they took a portfolio play, they bet on six or eight candidates, and then they embedded FDA folks in the team to shorten the process. And I loved seeing development processes shortened by collaboration. I thought that was terrific. And they give the FDA particularly who dreamed that up a lot of a lot of credit. Now, the reality is Pfizer, which had one of the two best vaccines at first, the Trump administration didn’t want to buy and didn’t buy enough and made actually more mistakes. But, you know, we bailed them out. But, you know, they were offered many times to buy to buy the vaccine in the US, and they didn’t so But I agree with you, in general, the portfolio play is smart.

Katelyn Jetelina  41:38

I mean, there are many other I think, examples of public private partnerships that worked out really well. CVS, Walgreens and vaccine distribution, Google data and looking at trends on epidemiological trends on where are people moving, so we can understand antigen tests and the United States Postal Office. And so, you know, I think they’re totally cool. Yeah, private public partnerships happen fast.

Andy Slavitt  42:04

They happen fast.

Katelyn Jetelina  42:05

They happen fast. And you know what, the public health world is not comfortable with these because they make them easy, because businesses are out for the bottom line.

Andy Slavitt  42:16

So it was making some money.

Katelyn Jetelina  42:19

But you know, I think that what it proved to me was that it brings public health to a whole new level, and that we need this whole new level in order to reimagine public health for the 21st century. And so I’m, I mean, I’m all for it. That’s cool.

Andy Slavitt  42:36

Now, that’s cool. That’s it. It’s a good read. I will say, like, Bob, you’re in a much better position than I have to speak to this. But I was impressed with the speed at which best practices adapted with inpatient treatment being one notable example. You know, we always hear about how it takes years, seven years is the standard people use.

Bob Wachter  42:59

17 as the standardfrom an innovation to make it into widespread practice.

Andy Slavitt  43:05

Right. And you know, there was so much experimentation going on, in terms of how who had a ventilator, and the idea that they should be preowned, you know, and a bunch of these other things that, you know, I don’t know about you, but I imagined, you heard, like, someone said, oh, there’s a realization that this isn’t the right way. And when I heard those things, I was like, Oh, wow, how are we going to get that information out to people? That insight, because in healthcare, it just doesn’t happen. And there’s so much resistance. And I thought that the adaptability of the healthcare system to things like that to things like virtual healthcare, to all this sort of innovative things, I thought was a pretty interesting thread. Okay, enough reflection, let’s, let’s get to some predictions. Always dangerous. We’re coming up on the winter 2023 20/24 season, What’s COVID going to feel like? Do we think over this next period of time when we have historically in the past? Been a time where we’ve seen some peaks?

Bob Wachter  44:08

I guess I would say that that the last The most surprising thing about the last 18 months, is how unsurprising it has been, it feels like we can make correct me on this, but ever feels like we have settled into a pattern that has by and large not been violated since the probably March a year and a half ago, you know, that there’s a surge and it comes down and there’s a surge and then it comes down and usually not always associated with a new variant that’s a little bit better at its business of infecting people and or evading immunity than the one before it. And packs of it will still work and your vaccines will still work and you need a booster when it’s time for you to get a booster and your home tests will still work. I mean, that to me, if you think about the first two years, where there was a surprise, curveball every three months. I’d say the last two years have been pretty predictable. And so I don’t see any good reason to think that the next year or two or five will violate that pattern. Of course it could. But at least based on the evidence that we have now, it’s probably you know, we’ll see another winter surge. I think the difference is that in most parts of the country, no one is pulling their masks out anymore. A lot of people, most people are not getting vaccinate anymore. And so we’re, we’re increasingly dependent on the immunity that you have from your infection and the vaccine that you got a year and a half ago, and very few people are going to wear masks anymore, even if there’s a surge, which is unfortunate, but I think represents what people it’s their revealed preferences. I mean, wearing a mask, people seem to feel is enough of a bummer. Whether it’s because it’s truly uncomfortable, or it just reminds them of something they don’t want to think about, but they’re just not pulling it out anymore.

Katelyn Jetelina  45:51

Yeah, I mean, I think I think I agree with you, Bob, that the story is going to get less and less exciting over time. I think there’s a couple of reasons for that. One is hopefully this virus is finding this ladder like a pattern of evolution where small incremental changes, of course, that could change any moment. And we saw it already changed with like the two dot 86. But I also think that what’s also changing is more behavioral is that we’re getting more used, or anxiety is decreasing. We’re getting more used to having SARS, cov. Two in our repertoire of threats. So I don’t know and then But then, so I’m torn. Then I go back to the 1918 flu, where after the emergency was the biggest surge of deaths because of people kind of relaxing. So I don’t, I’m not good at making predictions. But I will say it’s been absolutely fascinating to watch all of this play out in real time. It’s something that us in public health haven’t really been able to do in modern times to see how a virus becomes endemic, and the surprises along the way. So we’ll see.

Andy Slavitt  47:05

Let me ask another question. Last prediction question. You know, we went 100 years without something that became a national public health emergency, I’m not going to ask you when something comes up again. But we all know that there were scares in between, certainly emerged SARS-CoV 1, Ebola, other other bad fluids. And now I think we have stuck in our mind in our imagination, that this is what a pandemic looks like and feels like. But of course, Ebola behave very differently. Each of these things behave very differently. And help us understand as we’re looking forward, the kinds of things that are potentially different, that the public should be prepared to think about as what’s coming next. And then give a little prognosis on how, at least from a science standpoint, we’ll be able to respond when when some new or different things happens.

Bob Wachter  48:03

I guess I’d start by amplifying what I said before, which is I think the misinformation engine has gotten much better at its job. And and think about how that gets gets amplified with with GPT. And, and deep fakes and the ability to do have anybody’s appear to say anything. That’s the part that scares me more than with the pathogen, I’ll be better at its job than then SARS-CoV 2 was, although that scares me too. I remember interviewing Mike Ghoster, home for, for my grand rounds. You know, somebody studied pandemics for 30-40 years. And I said, how did it feel after talking about and warning about the big one for 40 years to finally have it? And he said, this wasn’t the big one. He says, think you can easily envision something’s that’s this infectious, but as far far more lethal than this. And so, you know, there’s that there’s bioterrorism, there’s climate, there’s so many threats. It’s almost hard to get up in the morning. But I think the misinformation, if you don’t start with everybody believing the facts and being able to act on them. I don’t know how you get to the to the, to your goal, and that that I think we’re in that position now where the misinformation machine is really good. And it’s only going to get better because the tools are getting better.

Katelyn Jetelina  49:15

I mean, I agree that misinformation will act as a catalyst among any emergency. I mean, we’re seeing that play out right now in Israel and Gaza. But considering epidemiological Yeah, I mean, there’s always emerging threats. But I’m, I’m a bit more concerned about three other things. One is antibiotic resistance. The second is tropical diseases becoming endemic in the United States because of climate change. And then the third is just our old diseases coming back because of a decrease in trust in vaccines and trust in institutions and trust in public health like measles and polio. Oh, that unfortunately, I think a lot of generations just have to kind of see what that disease is to, to talk them into getting vaccinated again. And so, like I said, yeah, there’s always going to be biosecurity threats, there’s always going to be emerging threats. But really, it’s these closer threats. And I’m most concerned about at least in the shorter term.

Andy Slavitt  50:25

Okay, let’s, let’s finish up by talking about predictions and advice for people. You know, there’s not going to have in the bubble around, I would argue that the bubble hasn’t really played that role, predominantly for quite some time. And certainly, some of the guests, the two of you, for sure, but you know, when we had things going on, came on and played that role intermittently. But there, unlike the beginning of the pandemic, there are plenty of good sources out there now, for people. So maybe we can just close that we’ll go to rounds. First, Bob, what are some of the best sources for information you would advise people? What general advice would you give people? If they’re feeling like they need a place to commit to should something happen?

Bob Wachter  51:15

Well, this will sound odd, but I would say Katelyn’s newsletter and Eric’s newsletter are the two best things that I see out there that they’re still summarizing the state of the universe in ways that are supremely helpful. I also think that the threat has gone down considerably, there’s less interest in what’s new, because what’s new is not that new anymore. I think it’s perfectly reasonable, even someone who’s fairly COVID careful to basically keep half an eye on the news. And see if there’s a surge and if there’s a surge, then it’s time to pull the mask out and think again, about indoor dining. And if there’s not a surge, whatever lifestyle you’ve decided to live these days is feels appropriate. So I don’t think you have to have the granularity of information that we needed a year, a year and a half ago about number of cases brought up without you can’t get it anyway. But I it’s you don’t need to be that up to date every minute in order to decide on how to live your life. COVID wise.

Andy Slavitt  52:12

Katelyn, love your answer, and then maybe asking the additional question, which we’ll come back to our bonus. Just give us any closing thoughts. This is our second last episode. So finish up with anything you’d like.

Katelyn Jetelina  52:24

Yeah, so related to health care, information. I mean, COVID Yeah. Eric Topol is, is great. Caitlin rivers force of infection has been a fantastic kind of weather report that I’ve appreciated. I know that the health care alliances, put putting out some really helpful information around businesses and how to keep their employers healthy. But I will tell you that it’s that’s about it. Like I can’t AAPs great. There’s the normal players.

Andy Slavitt  53:01

We’ll put all of these links into the show notes for people, just so people don’t feel like they’ve got to write all this down. We’ll put some that but those are places that inform you best for when you put your newsletter together.

Katelyn Jetelina  53:12

They informed me biased, you know, what helps me a lot is also really great health science reporters at the Atlantic at NPR at politico, Washington. I mean, they’re doing some incredible work. And they’re scientists themselves. So I trust a lot about what they write. But unfortunately, there isn’t a very great space. And so I’m thinking through with a lot of people on what is a Health Trust initiative? Where can people go what is what misinformation is circulating? And so I do know that people are working towards a better place and source for health information, but it’s it’s probably going to take time. But I do know, that is one of the biggest lessons learned during this pandemic is the need for timely and nimble, helpful evidence based a political information. And we need to do better than that.

Andy Slavitt  54:07

Any closing thoughts you want to give us?

Katelyn Jetelina  54:10

No, but thank you, Andy, for everything. You don’t have to put this on the recording. But thank you so much for everything you did. Surely, it’s um, it was a lot of work. And it helped me personally. But it also helped me professionally.

Andy Slavitt  54:26

Of course. Well, thank you, Katelyn. Don’t be a stranger. I know you’re gonna have to hop off the bat, but I’ll just finish up. So certainly, well, certainly I think Katelyn’s newsletter just one of the reasons why I feel very comfortable that people will have a really understandable human access to what I consider to be good information, which is it’s sourced. It’s clear. It’s clear what what she knows is clear what she doesn’t know. I think she’s done. She’s done a fantastic job and I’m not I’m not at all surprised. Bob the Caitlin’s gotten the following that she has, she seems to play it just just right. Not too hot, not too cold.

Bob Wachter  55:09

Yeah, I mean, it’s been, it’s been interesting watching the people that have emerged as leaders, communication leaders, and we would never have discovered them. But for this pandemic, I mean, Caitlin, I’m sure you know, her, her sensible approach and thoughtful approach was what she’s always taken. And probably five people followed her newsletter. And now 1000s and 1000s. I mean, you were very well known before in the bubble, but in the same way, you weren’t a household name. And this elevated you in a way that is appropriate, because you brought incredible knowledge and empathy and your ability. I mean, you’re such a far ranging thinker, sort of doesn’t matter what the topic is, you’ve got deep knowledge of it, and deep understanding and, and you’re also a mentioned and so you know, and I watching Ashish, on TV, it was, you know, it was like, boys, you go to this. And you know, so these people kind of emerged and all to kind of slightly different lanes. But it’s, it’s actually quite gratifying being on a show with all of them, because in many ways, they were my sources of information over the past several years. And I think they did immense good.

Andy Slavitt  56:16

Yeah. And of course, you as well, I remember getting texts from somebody, we’d say they saw you in the grocery store, and didn’t think it was okay to talk to you.

Bob Wachter  56:31

I have to tell you one last quick story, it was a Nate Silver, you know, it was very prominent writer about politics and statistics, and then called me several months ago, and said, Can I take you out to dinner in San Francisco, I’m writing a book about the role of statistics, and I want a chapter on medicine, I’d love to interview you. So he interviews me, he’s wearing a baseball hat, which I assume is so he’s not gonna get recognized. And we’re sitting at a restaurant San Francisco, and a couple gets up to leave, and they kind of do a half look at our table. And then they finally come over. And they say, Are you Bob Walker? I’m sitting here with Nate Silver. And Nate says, How often does that happen?

Andy Slavitt  57:07

Probably happens quite a bit to you. Wrap it around here. Yeah, right here? Well, you know, I think you personally, you struck a chord with people and how you communicated, which was without panic. At a time when people were feeling panicked, you may have felt worried, but and you were never afraid to say this is a worrying thing. But I think people for a long time, particularly the beginning wanted to know that there was an adult on the case. You know, that while there was a lot of chaos, and I think he did that, well. And thank you, look, there’s a reason why, when I went to the White House, I asked you to guest host the show, and there’s a reason why I wanted to finish this episode, with just you and I, to reflect it. And certainly, as I look back in the three and a half years, I’m not over feeling overly reflective, because I feel like, you know, the show did its job as it needed to. But you know, I know that. I guess, you’re the only other person that I know, who, you know, sits, you know, staring into the screen, with a giant microphone in front of you. And, you know, 10s and hundreds of 1000s of people going to listen. And, you know, knowing that the emotion that people are feeling is equally powerful to the information need that they have and the chain of trying to fill both, and I appreciate you, Bob, you did you did a hell of a job. And he came on the show, for that period of time. And I thank you for that.

Bob Wachter  58:44

Well, it was wow, it was an amazing honor to be given your baby. And he has to make sure to take good care of, of it. And it was an amazingly gratifying period. Because the chance to say what are the important issues in in the most important issue of the world at the time, and who would be best to talk about them. And something I learned from you is, you can do it factually. And you can get the information out there. But you have to do it with heart. And it was always clear to me as every step of the way that you were caring deeply about everybody in your audience and you were focusing on their needs and you did a masterful job and sad to see it go away but I think you’re going away at the top of your game and going away partly because it did fill a need that doesn’t exist anymore, and that’s a good thing.

Andy Slavitt  59:30

Well, let’s go make the world a better place and onward man.

Bob Wachter  59:35

Let’s do it.

Andy Slavitt  59:48

We get one big show left. I hope you’ll tune into it. It’s next week. Gonna do a number of things going to have some of the people who brought you the show on the show. Did 99.9% of the work. I would love to talk to them with you gonna have some of my family come on the show. My mom will be on for bet. But you haven’t. My wife lon hadn’t are sons, Caleb and Zach are going to be on. Some of you remember Zack? And maybe Tony Fauci. Oh, he’s not a family member. But I think we’ll have him on because it’s the last episode. Yeah, so thank you, again, for listening up to this point, you only have make it through one more episode. And I know you can do it. And if it leaves you wanting to say something, let me give you that voicemail number. Again, it’s 833-453-6662. Then you could just punch four. And talk to your heart’s content to say what you want to say about the show. I really want to thank Eric, Ashish, Bob and Kailyn. We got up in the middle of a bunch of stuff they were doing, and they were all kind enough to come on the show, because they have a number of times. And and all the other COVID related guests and other guests that we’ve had come on the show. Thanks to them as well. All right, be good for the next week. Do it again on Wednesday.

CREDITS 1:01:19

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Martin Macias 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.

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