Is Our Winter COVID Wave Coming? (with Katelyn Jetelina)

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Despite some uptick in cases and hospitalizations, COVID is disrupting life less this winter compared to winters past. Why, and what does that mean as we enter 2023? Andy speaks with epidemiologist and ITB favorite Katelyn Jetelina, who offers an hypothesis for why new mutations are not wreaking havoc like Omicron did last year. She also breaks down the added dangers of flu and RSV and predicts the worldwide implications if China relaxes its zero COVID policies.

As an added bonus, today’s episode includes an important conversation from the “Voices From the Frontlines” series, featuring Donnie Nelson and Dr. Nona Yunzhu Mei discussing their work in palliative care and how their holistic approach guided them through the pandemic.

Keep up with Andy on Post and Twitter @ASlavitt.

Follow Katelyn Jetelina on Twitter @dr_kkjetelina.

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Andy Slavitt, Katelyn Jetelina

Andy Slavitt  00:18

This is IN THE BUBBLE with Andy Slavitt. Look, public health people get a bad rap maybe deserved rap some time for telling us all the bad news. And look, someone’s got to present the news to us good or bad. And public health people, you know, call it as they see it. Caitlyn Jenner. Lena is on the program today because I think she’s one of the most balanced of the public health people. We know. And I think the real question is, why is this winter? Different from our past winters? And will it remain? So if you go back to the year 2020. We didn’t yet have a vaccine. It was a horrible winter, people were dying, the vaccine was beginning to roll out 1000s of people were dying every day. So we thought, okay, this is going to be our last bad winter, because now we’re vaccinating people. Then last winter, the winter of 2021, we had Omicron emerge, and Omicron emerged just after Thanksgiving. And at that point in time, we had people being highly disruptive, not being able to see their families not being able to find tests, and a lot of real frustration that the pandemic wasn’t over. And now here we sit in 2022. And we’re going through yet another winter. And while there has been some uptick in cases, and some uptick in hospitalizations, this is at least so far. The winter that I think we probably hoped for last year, there’s 10s of 1000s of cases. And even if you don’t trust cases, the sewage sampling suggests that we don’t have out of control cases. And even though we have new variants, which we’re going to talk with Caitlin about, and even though those new variants are do something scary, like evade immunity, we’re still not seeing massive number of cases. Now, to be sure, there are still people getting COVID To be sure, there are people getting the flu. And we’re going through a season where a lot of people are getting other respiratory illnesses like RSV. And so you know, as we talk about and as public health people are apt to do, you know, we’ll talk about how the news isn’t all good. But my real question, and I think a real question is, is this going to last through January, February? And if it does, what does that tell us? This is tell us that we’re in a better place, because of all the vaccinations and all of the prior infections that have occurred. So I know people are out there with continued worries about COVID continue to worries about long COVID People who have small kids in particular are worried about RSV. And the flu kills 10s of 1000s of people a year. But this shouldn’t prevent us from asking the question, are we at a more normalized state and that’s what Katelyn Jetelina and I are going to talk about I talked to Caitlyn, a few days ago from my house. I’m now at my office in New York. So you might notice a little bit of a different sound. But great update on everything going on with COVID what the impact of the policies in China are. And of course, this question of how is the winner going to be this year as we face these new variants? Let’s bring her on.

Andy Slavitt  03:59

Hey, Katelyn, how are you?

Katelyn Jetelina  04:00

Hey, Andy, I’m good.

Andy Slavitt  04:02

Let’s just take a little bit of perspective, you know, we’re in the post-Thanksgiving period of 2022. The post-Thanksgiving period of 2021 was pretty awful. The post-Thanksgiving bear 2020 was one very standard rolling out vaccine. So they were having a lot of deaths to our progress year to year to year where we sit in this holiday period 2022 compared to where we were a year ago, two years ago.

Katelyn Jetelina  04:27

So every winter during this pandemic has been unique, you know, and with it very unique challenges. Like you said first winter no vaccines. We also have very little knowledge compared to what we know right now. I think you know, during that first winter, the who hadn’t even recognized SARS-CoV-2 was airborne yet, come winter number two, quite a few people had vaccines. But what really defined last winter was Omicron right? This huge jump in evolution that made it yes less severe than delta but highly more transmissive both through escaping immunity, you know, it really became, like someone said that last week like the wind, we could divert its path a little, but it was coming full force. And that’s what happened. Now, this winter is unique because not only do we have COVID-19 in our repertoire of threats, but all of our normal viruses are back too. And so for the first time, we’re really seeing how our quote unquote normal winters go with this new virus in our repertoire

Andy Slavitt  05:29

to period COVID, this year to a year ago.

Katelyn Jetelina  05:33

COVID is doing really weird things right now. COVID continues to mutate, they’re I think there’s about 500 different sub variants right now across the globe. And they are continuing to take over from each other. For example, BA5 is more than 50% prevalent right now in the United States. The interesting thing, though, is for the first time, we’re not seeing a big wave when BQ one, for example, took over. And this is very interesting. And you know, as epidemiologists have a few hypotheses of why this is happening. But I think one of the biggest ones is we just have a really complex immunity while now and maybe COVID 19 is finally getting slowed down because of that immunity wall.

Andy Slavitt  06:22

So we have new variants. But unlike last year, we’re not seeing a new wave. It may be too early to call it you know; we still have a couple months ahead. But given the if someone would have told you we’d have a new variant on the scene that was immune evasive, would you expect it? We’d be seeing more cases now than we are?

Katelyn Jetelina  06:41

Yes, yes, absolutely. I was actually expecting a wave a couple of weeks ago. And it just really has been plateauing. And not just cases, right? I don’t really pay attention to reported case anymore. But wastewater, I think what’s really interesting is what you brought up in the intro is that Thanksgiving was a week ago. And we’ve started to slowly see an uptick in both wastewater, as well as unfortunately hospitalizations among those over 70 years old. And so, we may be at the beginning of something, but like throughout the whole entire pandemic, time will tell.

Andy Slavitt  07:19

Tell us why you think that despite that we have a disease. It’s like the wind. And we’re certainly not wearing masks, and we’re certainly participating fully in life as we ever have been over the last few years. Even if there becomes a slight wave, it’s far, far different from what we’ve experienced the prior winters.\

Katelyn Jetelina  07:40

That’s right. You know, like I said, I think we finally have some sort of immunity wall that is challenging the movement of COVID-19. And this is regardless of what our lab data is showing that these sub variants like BQ, it can continue to get better and better at partially escaping our immunity. You know, sometimes in epidemiology lab data does not equal what you see in the real world and epidemiological data. Throughout the pandemic, it has been a very good indicator of what we’ll see in the real world, but for the first time, it’s not marrying each other. And that’s why it’s important to get both perspectives. But like you said, I think we really need to hold off on sweeping conclusions. Like for example, if this pandemic is over, there’s a lot of different moving parts right now, weather changes, our surveillance is also sub optimal. B, q1 is different, for example, than […]. B, there may be something like viral interference, I mean, there’s a ton of stuff going on too. And we should hold off any protections until the end of the winter.

Andy Slavitt  08:48

Well, and people are still getting COVID I mean, someone in my family whose name I won’t mention because they listen to this podcast, and this personal health information has COVID right now, thankfully, not very severely, but like it’s making me wonder and as someone who’s in a high risk group, that between, you know, being vaccinated and boosted whichever one has the option to do and the oral therapeutics and the fact that we’ve got this walls of immunity that for a lot of people, and unfortunately not everybody can live in this world but for a lot of people it’s time to take COVID in stride. That’s my challenging question to you.

Katelyn Jetelina  09:28

You know, I guess it depends what you mean take it in stride. You know, I think that yeah, this is good news for individuals that have really done everything to protect themselves. If you’re fully vaccinated, which means you brought the fall booster and you’re not high risk. I think this is really great news. I think that the among those high risk, like for example, those over 60 Those over 50 I still would be protected. You know, using a mask doing A lot of antigen testing because there is still, you know, some risk. I also don’t think that we can write off long COVID. I know, you know, it’s very debilitating, it’s still happening even if you’re vaccinated, and to some people, including myself, it’s still worth not getting infected and doing all we can to not get infected.

Andy Slavitt  10:22

Yeah, we have friends, who, particularly COVID, early on, when they had a really bad first version, before there was any vaccine therapeutics. And those are the people that in my life are struggling the most with long COVID. This is not scientific. But there is this sort of medium COVID, which is a sort of extended COVID, that people who’ve added more recently, sometimes are struggling with, but tough to get real data. But you make an excellent point. There are a number of people that aren’t living the same lives, they’re not running as fast, don’t have as much energy. They have anxiety from being ventilated. They have anxiety from being cooped up, but they have some physical symptoms, whether it’s cardiac, neurological or otherwise. So I think you answered the question should it is a time to take it in stride. In the way I would have answered it. Ye there’s unmistakable good news to what you said. Let’s take a quick break. I want to come back and talk about flu and RSV, and then talk about some of the things happening around the world that are very interesting. They could be worrying to this picture.

Andy Slavitt  11:31

We’re back with Katelyn Jetelina. Katelyn, RSV. What is it? What’s going on with her right now?

Katelyn Jetelina  11:31

Yeah, RSV is another respiratory virus. It’s been around, it’s not new. It’s certainly not new to us parents. But it was tampered down in the past two and a half years because of the pandemic. And it is back and it is back with vengeance. Cases continue to skyrocket. We think through testing data that we may be getting to a peak soon. But with all those social networks changing last week, because of Thanksgiving, we really don’t know what’s going to be happening. But RSV is most severe for our little kids, those under five years old, because their airways are just so small that it takes very little inflammation to stop that air from getting through.

Andy Slavitt  12:45

So what does it feel like to have RSV? What are kids experiencing when they have RSV?

Katelyn Jetelina  12:51

There’s a lot of different symptoms. You know, some kids get a fever. And actually some kids do not get a fever. But it’s typically the most severe cases is difficulty breathing, wheezing, flared nostrils, because they’re trying to get more air etc.

Andy Slavitt  13:07

Yeah, our little one then he was like a one year old had RSV, he’s now 24. So it’s funny to think of him as a little baby, but he was in such distress. I know you’re not a doctor. But is it clear if you’ve got a kid or and it’s certainly happening to adults as well what the best protocols are?

Katelyn Jetelina  13:27

Not really, unfortunately, we just don’t have that many tools against RSV. We don’t have a vaccine; we do not have treatments. We do have one monoclonal antibody, but it’s super expensive. And it’s hard to get. And so we really only say that for the highest of risk kids like you know, premature newborns, for example. Other than that, it’s keeping track of symptoms. Even if a child gets hospitalized, they treat the symptoms, they help them get oxygen. And thankfully, the odds of dying from RSV given the high hospitalization rates is quote, unquote, rare. About 100 to 500 kids before the pandemic each year died of RSV, but as a parent, I know, that doesn’t calm my nerves at all.

Andy Slavitt  14:17

Okay, and flu I mean, look, flu is flu, and I think a lot of people aren’t gonna get their heart rate too fired up with flu. But it’s interesting to remind people who never thought about flu this way that there are 10s of 1000s of people that die every year from the flu, and that particularly older people are at risk. And then there’s this other effect where people like me, middle aged men, become really whiny babies and very demanding and complain a lot. Because I know it’s not as important as the impacts on older people, but still it’s very real.

Katelyn Jetelina  14:49

Yeah, it is very real. And it’s not fun. You know, it isn’t not fun getting the flu. You know, flu data actually just came out today from the CDC. The CDC updates their data every week, and I think I tweeted holy crap, like the amount of flu activity right now is insanely high.

Andy Slavitt  15:09

Give us a statistic. What did the CDC data say?

Katelyn Jetelina  15:15

So the biggest was their flu activity map. And almost every state in the United States has very high flu activity, which is purple or red. This purple category is new for the CDC. So there’s a lot of flu out there. There’s a lot of respiratory distress out there. And like you said, Andy, yeah, for the majority of people, this means a really crappy, you know, week or two. But what’s also very concerning is the cases of flu and nursing homes right now is starting to exponentially increase, which worries me a lot. And of course, hospital systems and the strain on our hospitals and hospital staffs and hospital systems.

Andy Slavitt  15:57

Okay, so look, that’s the picture, we’ve got the normal stuff, we’ve got COVID, which is approaching normal, although what they think the very important exceptions that Katelyn made, you know, that I would say, if it continued to the kind of season we would hope for if last season looked more like this season, we would have been happy with that. But let’s turn to talk about some things on the horizon that causes concern where things could really change, because, you know, we’re I don’t think either of us is ready to predict that even if this is a good winter, for COVID. The next winter is going to look like this winter. And to do that I want to talk about China, which you’ve recently written about. We did a show on Friday, about the protests in China, around the zero COVID policy and the reaction of the government. And it appears, you know, our experts in China basically said she has positioned his entire identity homos as a leader. And we are the only country in the world that has managed COVID correctly, and people around the world are dying everywhere and I protecting you. And the reality on the ground is what zero COVID looks like in China is different than kind of what we might think of it, we hear the term lockdown. I mean, these are literally people being imprisoned in their homes and their apartments, not being able to leave most days, and causing tremendous stress and people’s economic lives. People’s health, people’s ability to just lead normal lives. So it puts the Chinese government in a very difficult place. Because if they don’t ease the restrictions, they end up with his tough political situation, which is going to turn violent on behalf of the government, very likely. And if they do, then we’re going to be in a very different scenario. And that’s what I want to explore with you. So let’s start with this. What are the rates of COVID in China look like currently, what do we know?

Katelyn Jetelina  17:57

The last number that I saw was a couple of days ago now, but was about 40,000 new infections per day. So that’s not exploding. I mean, last winter in the United States, we had close to a million infections a day. I mean, so to put it into perspective, it hasn’t necessarily exploded yet. But I would say it’s very much on the verge of exploding, especially given these protests and people mingling very closely maybe, right, you know, rightfully so. But health wise, it gives me a little pause.

Andy Slavitt  18:32

Yeah, but 40,000 still ain’t zero. That’s right. So you might just talk about the scenario of what happens if they do relax their zero COVID policies. What’s the coverage look like in the population maybe started by talking about the vaccine that are used in China? How widely it’s been adopted? And how effectively protected we think the population is something that can rip through the population infecting 10s of millions, or are people more protected than we think?

Katelyn Jetelina  19:05

Yeah, so China actually has a very highly vaccinated population for the primary series. I think it’s about 90% vaccinated with the primary series, which is for the record higher than the United States. The challenge is, though, that quality of the vaccine is important. China rolled out central farm and central vac, which are inactivated vaccines, and unfortunately, just not very effective against Omicron. how effective they are against severe disease. We don’t know we don’t have very good data on this. We think that, you know, a good majority of those people will be protected against severe disease, but it’s been a long time since they got those vaccines. The virus has changed a lot etc. The one thing I’m incredibly worried about, and probably even more so than the quality of that vaccine is their booster rate among older adults, only about 30% of 80 year olds have one booster. And we have plenty of evidence showing the importance of boosters among the most vulnerable against severe disease. So I think there was this study run in the Lancet a couple of weeks ago showing that if China drops the zero COVID policy, they expect within six months for about 1.5 million people to die, and 75% of them will be over the age of 60.

Andy Slavitt  20:30

And that’s taking some assessment of the effectiveness of the original series and the booster against whatever current variants there might be?

Katelyn Jetelina  20:40

That’s correct. And also, you know, given the infection rates, given the use or not use of masks, for example, they ran a ton of models, but every model looked very grim. And I’m very concerned about the people in China.

Andy Slavitt  20:56

Well, another million and a half people dying would be tragic. It certainly it would also fly in the face of the narrative that she is trying to put forward, which I think would have other consequences, which we talked about on Friday. But there’s also a chance for what’s going on in China from COVID perspective to impact the rest of the world. I want to take a quick break, finish up with Katelyn Jetelina and talk about how what we’re seeing in China, the picture that Katelyn just laid out, could influence things here in America. We’re back here with Katelyn Jetelina. Okay, so you’re concerned about China. And what happens if COVID really takes off there? It feels like this pressure cooker, right? Where if you do have an unprotected population, and you do have constantly changing variants, that they can’t do this forever. But COVID, because it’s not going to go away. And so eventually, people either have to get vaccinated, or it’s going to rip through the population. And if it rips through the population, I’m wondering if you can comment on what you think that might mean, or could mean for the development of new variants for mutations that could be impacting us here in the US and in the rest of the world?

Katelyn Jetelina  22:33

Yeah, you know, like we’ve seen throughout the pandemic, what happens in one country can directly impact everyone else. I know a lot of people are talking about the economy, which I completely agree about. But from an epidemiological perspective, there may also be something that happens, which is viral evolution, if the floodgates open in China, there’ll be very little to stop the virus from jumping person to person in this network of 1.4 billion people, it’s 20% of the global population. And mutations typically arise when they jump from person to person, because that’s when the virus has an opportunity to randomly mutate. This is, for example, how Delta came across. And so how big is that possibility that a variant of concern comes out of China? You know, that I don’t know if the probability is that big, but there’s certainly a possibility, and that would have implications for the rest of the world.

Andy Slavitt  23:29

And, you know, given the lack of surveillance, given the lack of investment in new vaccine capabilities and platforms, it would certainly be the kind of thing that could take us by surprise. Or I should say, maybe it wouldn’t take you by surprise, but it would be something we wouldn’t be necessarily prepared for.

Katelyn Jetelina  23:44

Yeah, that’s right. So Global’s surveillance, genomic surveillance of COVID-19 is down. 90%. You know, one of the benefits we had about last winter was South Africa caught Omicron incredibly quickly. And that allowed other countries to prepare. Now, if we prepared or not, that’s a whole different discussion. But we had a warning, we will not have a lot of warning right now, because of that surveillance is down. And in fact, I think it’s really interesting that we don’t even know what Omicron Severian is causing the current wave in China. We have no idea we can give you guesses, but that’s how poor surveillance is right now.

Andy Slavitt  24:26

Okay, so let’s bring it back to where we started as we conclude, and I’m just gonna go back to this sort of metaphor of our December’s, you go all the way back to December 2019. Is when COVID was first seen, you know, in Wuhan, China. A year later 2020 We were on the breakthrough vaccine, but had gone through an awful year. And we’re on our way towards half a million and soon to be a million deaths in the US and millions more around the world. And we were all very scared because we didn’t have any tools. 2021 a year later, we had some good news and that we had treatments emerging we had vaccines, some portion of the population was vaccinated. But we learned very much the power or potential of this virus to mutate both, as it had during Delta earlier in the year and then an Omicron. And we were sitting here in December, very frustrated two years out, with a lot of people impacted. Although they say not nearly as severe 2022 could be we can’t conclude yet, but could be based on what we’re seeing so far. The year we’d hoped for a few years before the circulating virus for sure, when that’s dangerous to certain people when this dangerous to people that have been protected themselves, but is highly survivable. And the spread just isn’t what it could be, we’re not seeing the waves that we could see given the mutations. So that’s what we know, we could sit here in January and saying that that was very foolish to say that, but that’s what we know in December. So let’s cut ahead now to 2023. And close by, you know, everything that we’re seeing, there’s still activity in the world, there’s still things that are threats. But if I were to say to you, what’s the probability that 2023? Because if 2023, feels like 2022 currently feels, we’re gonna feel like we’re approaching kind of an endemic type pattern. If 2023 feels like 2021, then that’s a different story. How would you lay out the odds?

Katelyn Jetelina  26:31

Yeah, I, it’s going to be very rare for us to go backwards. And that’s because our immune systems are just incredible things, it’s going to take in a very, very big mutation for us to go backwards. And I’m not saying that that’s not possible, but I don’t think it’s probable in 2023. But I do want to approach this with a lot of humility, because I feel like every winter I’m like, Oh, well, no, in April, and every April, I’m like, okay, well, let’s see how this year plays out. So I think that bottom line, we’re gonna learn a lot of where we are in this pandemic, this winter, it’ll give us a huge indication of where we are in this emergency or not. And a huge indication of where we are in this transition to an endemic state. Time will tell and we have a few months to play it out. We just need to be a little patient to see how this goes.

Andy Slavitt  27:28

Finally, any advice for people over the holidays, around their concerns around being around loved ones, people who are vulnerable to COVID?

Katelyn Jetelina  27:35

Just be cognizant, please do all you can to break transmission chains before seeing grandparents before seeing vulnerable people, not just with COVID But like we said earlier, flu, RSV is going around, if you have a kid under six months old, please be careful. Don’t let anyone else hold them or kiss them, you know, wear them in my baby carrier. Because there’s a lot of nasty stuff going around. And we really all need to work together to protect those vulnerable people as much as we can.

Andy Slavitt  28:07

Katelyn Jetelina, it’s awesome to have you in the bubble.

Katelyn Jetelina  28:11

Thank you for having me.

Andy Slavitt  28:26

Thanks, Katelyn, reminder, our show on Friday, it’s going to be a big one. We’re going to have great guests who will reveal to you we’re going to be talking about the rise of anti semitism and some of the more public and long lasting impacts from those public events we’re seeing before you go away. We have a very special edition for you if you’re willing to hang out and listen, your threat the pandemic. We brought you stories from the frontlines as we’ve tried to make sense of the pandemic and what it looks like for us moving forward. We’ve got a really important conversation today that I’m gonna play right now that I have between two colleagues, Donnie, Nelson and Dr. Nona May who are discussing their work in palliative care, and how their approach which is very much centered around providing holistic care to patients, guided them during the COVID 19 pandemic. It’s recorded and produced by StoryCorps studios. This is a story that’s part of a series it’s called Voices from the front lines, which is a project that was created by something called hashtag first responders first, which is an initiative put together by a bunch of people including Harvard, TH Chan School of Public Health, and some others including Thrive global and Creative Artists Agency Foundation. And you know, their idea is to take is an entirely human centered approach to the health care worker, and their well-being. And then additional supports also provided by the doctor Lorna Breen heroes Foundation. And of course, if you liked this and you want to listen to more stories like it and access resources, you could just visit the website all in for Hope you enjoy it. And we will look forward to talk to you on Friday with our episode on anti semitism.

CREDITS  33:37

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

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