In the Bubble with Andy Slavitt: Our Shot

Is the Pandemic Over If We Decide It Is? (with David Ho)

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As mask mandates and vaccine requirements go away and life starts to look similar to the way it did in February 2020, Andy talks with world-renowned virologist David Ho, who says his career has been defined by two pandemics: HIV/AIDS and COVID-19. David tells Andy what he makes of people relaxing their precautions, how long he thinks COVID will remain problematic for us as a society, and what future vaccines and therapies could look like. Plus, David recounts his decades researching HIV/AIDS, which led to him being named TIME Magazine’s Person of the Year in 1996.

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Dr. David Ho, Andy Slavitt

Dr. David Ho  00:00

The cases are coming down. People are feeling much more relaxed compared to a couple months ago and are going about with pretty much normal lifestyle now, even though we know the virus is still around, and who knows what may come next. You know, the CDC doesn’t decide when the pandemic is over, I think the public’s kind of make that decision.

Andy Slavitt 

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. It’s March 9th, 2022. That voice you heard at the opening was none other than Dr. David Ho, the world-renowned AIDS researcher, also COVID researcher making a very compelling point about where we stand right now with a pandemic and kind of what decides, who decides when a pandemic is over? I mean, look around the WHO and the CDC, are they the ones that decide, or your friends and neighbors? I love bringing you interviews with amazing people here in the bubble, David Ho is one of them, he is my guest today. He was the Time Person of the Year in 1996. For his work, treating and understanding the HIV virus and ultimately curing AIDS. He is a remarkable person. He was actually I believe the first scientist and medical researcher to be named Time Person of the Year. And it was really a foreshadowing of what was to come in the next several decades as we saw Ebola and now COVID. He is really the definition of a first responder. He is at the forefront when it comes to what comes next in the research of COVID vaccines and therapeutics. And he does a lot of amazing work. He has some really interesting and also some slightly concerning observations to make, including what he thinks about the new antivirals, Paxlovid. And these are in some respects warnings from the person who really was responsible for helping to create the cocktail, that treated HIV-AIDS.

Andy Slavitt  02:37

It’s a fascinating conversation, I wanted to explore many of these advances that are coming next around SARS-CoV-2, I think he has a better look into what the future might hold for SARS-CoV-2 than most, and also some of the similarities between HIV virus and SARS-CoV-2, but I also wanted to have you hear his story, which is an amazing story. He will reference at one point during the interview that we saw each other in Cleveland recently, we actually sat next to one another, along with Kareem Abdul Jabbar at an event that we were all invited to present at, during the NBA All Star game a couple of weeks ago, if you would have taken me back to Andy Slavitt, 1996 the year Dr. Ho was named Person of the Year from Time magazine, and Kareem Abdul Jabbar was not only a basketball legend, but a human rights icon and told me you’re gonna put me on the stage with the two of them. I’m not sure I would have believed you. But life has a funny way of evolving. They are both really two incredible heroes. And, you know, you talk about heroes, you talk about being humbled by what people have contributed. It’s very hard to find someone who has done more for us or more accomplished than the two of them. And certainly, David, it reminds me of the Mr. Rogers line that launched this podcast, which is what I think of still is the ultimate compliment that when you’re feeling scared, you look for the helpers. And Dr. Ho, is certainly one of the great helpers of our time. I hope you enjoy this interview.

Andy Slavitt  04:39

I was certainly pleased to be sitting next to you in Cleveland and to get a chance to chat. There was there are a couple of things that we talked about there that may be worth launching off, David. One of the things that you said was I think a question the country is really wrestling with now, which is, is the pandemic over? And you said something that I’ll paraphrase you can correct to the fact of the pandemic is really in effect over when the public decides it’s over. And the public seems to have decided that now. Can you explain what that means?

Dr. David Ho 

Yeah, I said that because I, you know, previously have read about the influenza pandemic 100 years ago. And there, the lesson learned was that the pandemic actually lasted several years with different waves. But pretty much after a year or two, the public decided it was over and all the precautions were dropped. And there were major waves occurring after the public decided that pandemic was over. So I think we’re at that is, it seems that we’re at that juncture at this point. The cases are coming down, people are feeling much more relaxed, compared to a couple months ago. And, you know, the trailing indicators still suggest is a lot of death, but we know that those will lag for some period of time. So, you know, and I see it every day now, people are dropping, you know, the mask mandate, vaccine mandate and all the other precautions, and going about with pretty much normal lifestyle now, even though we know the virus is still around. And who knows what may come next. So I think the, you know, the CDC doesn’t decide when the pandemic is over, I think the public’s kind of make that decision.

Andy Slavitt  06:46

It seems like there’s some equation that has to do with how much threat do I personally feel under? Who is dying? Is it marginalized groups? Or is it people I know, you know, who’s most at risk, and then just probably some element of time that people have felt deprived of the things that they are used to, it feels like those things are kind of coming together to say, well, there may be a lot of numbers of people dying. But increasingly, they’re kind of quote unquote, other people may be there other people that either they’re older, they haven’t been vaccinated. They’re people who may be hourly workers, there will be city, you know, or something. And so I feel relatively safe. And I’ve been sacrificing for so long. Is that, in fact, kind of how you see it? And is there? In that sense, is there a parallel to what you and we all experienced with HIV in the 90s and 80s?

Dr. David Ho 

Yeah, I think that’s pretty much it, a lot of people feel that they’re now well protected, because of prior infection, and because of vaccination, and, and boosting. So that A, I would say a small majority of individuals feel that they are pretty well protected. And even if they catch the virus, they’re not going to be severely ill or go to the hospital or die. And so those in the hospital generally have a reason. And, you know, they’re either not vaccinated or have some high-risk factors. And, and so people are becoming much more relaxed, and with the Omicron wave, ripping through the population, that contributed a great deal of herd immunity to the population, not just in the US, but worldwide. And obviously, a lot of people suffer from it, but that also at the same time-built herd immunity. And so between the vaccine and the Omicron wave, we’re seeing the immunity within the population go way up. And that I’m sure is contributing to the current attitude.

Andy Slavitt  09:10

Well, let’s talk about that herd immunity a little bit, how real is it and how long lasting is it? And I suppose that you could mean that in a few different ways. You could mean it with immunity to something severe, like hospitalization to death only, not just infections. You could mean it with regard to the current variant only. But hey, all bets are off for future variants. What’s your definition of what’s been achieved by the kind of all the prior infection plus vaccination?

Dr. David Ho 

Well, it’s having been exposed to either the virus or the spike protein of the virus to generate and antibody responses as well as T-cell immune responses. What I mean is that that sort of immunity will protect against symptomatic infection. So that’s what vaccine efficacy is have been measuring, of course, the, the efficacy against any infection would be lower, and then efficacy against hospitalization and death would be higher. And I think, largely those who’ve been who have immunity are not going to get very sick or die from a future infection. And so it may be more like a cold, like regular influenza infection. But it won’t be as severe as what we seen back in 2020.

Andy Slavitt  10:39

Is that true whether or not we’re talking about just Omicron? Does it also apply if a prior variant of concern like delta were to recur? And does it apply necessarily to future variants that we haven’t seen yet?

Dr. David Ho 

It these remarks applied to variants that we have seen. So includes Omicron, Delta, of course, Omicron, made things more difficult and make the vaccine efficacy lower because of the mutations the virus had made. And very few people were just infected with Omicron and not had vaccine or prior infection. So if you had no previous immunity and got infected with Omicron, then you may have some problem protecting against delta or previous strains, because the immune response to that alone is pretty specific. Now, none of these remarks apply to future variant that is antigenically. Very different that the virus has made many mutations to avoid the immune system. Of course, we don’t know whether that will come or not. The history of the last 18 months suggests that every six months or so we see a significant new variant. But that doesn’t necessarily mean another one will come. What we do know scientifically is for the variant to gain traction, it would have to be more transmissible than current variants. Otherwise, the current variants would just dominate and block it out. And also, given the extent of herd immunity, the future variants will probably have to be quite evasive to current immune responses. And whether that future variant would be more pathogenic, causing more severe disease. We don’t know but the virus probably wouldn’t care whether it’s causing more disease or not, as long as it’s allowed to transmit and spread.

Andy Slavitt  12:53

In those cases, how good a response do you think our T cells will provide us? Does it vary completely? Are all bets off with future variants with regard? Or should we feel confident that this thing can’t change so much, that our T cell or other memory cellular responses won’t offer protection protected against the worst possibilities?

Dr. David Ho 

Yeah, the studies that have been performed today suggests most of the mutations we see in SARS-CoV-2 suggest that they’re evading antibodies. And then if you look at variants like alpha, delta and Omicron, they’re still being recognized by the T-cell responses. So there’s not a great deal of escape on T-cell responses. And T-cell responses may not be all that helpful in preventing the initial infection, but could be crucial in controlling the infection and helping the patient recover.

Andy Slavitt  14:28

How long will we be worried about this impacting us? I mean, does it feel to you like you know, we’re going to see forms of this thing that are problematic and I guess I’m defining problematic very and clearly here but problematic in a way that brings unpredictable things to us, causes a lot of hardship and disruption on a semi regular basis.

Dr. David Ho 

My own guests and nothing more than a guess is that things will continue to improve, it won’t be as severe or dramatic as in the first year or two, we will gradually transition to an endemic situation. But it will remain problematic for some people, those who are not vaccinated those who have certain risk factors. If they catch this, they will face severe disease or even, you know, be hospitalized or die. That will still occur. We know that occurs with influenza annually, right? For certain individuals, particularly elderly and immunocompromised individuals. So I think, given enough time, we will reach that state. And if we, we think about it, and learn from other Corona viruses that cause common cold. And there’s some research done in recent years on the common cold Corona viruses. And we know we probably know that some of them occurred decades ago, maybe even hundreds of years ago. And cause pandemic, but then it gradually becomes endemic, continued to spread and doesn’t cause much harm in the population. But periodically, every 5, 10, 20 years, a new variant would appear. That’s no longer that recognizable by previous immunity. And then you have sort of a wave of a Corona, not huge way like what we’ve seen with Omicron, but still enough infections, to cause problems. And I think we will gradually transition to such a state.

Andy Slavitt  16:50

Got it, I want to come back at a bit and talk about the scientific response. We’re capable of mounting here. And we’ve already been mounting. But I think maybe an interesting way to do that would be to go back a little bit and tell your own story. You’re one of the most fascinating and celebrated people in our society, because of what you’ve accomplished and helped us all accomplish. And I’m sure you will very humbly say that you were among many with the HIV and AIDS crisis. Do you mind going back a couple of decades, you could start anywhere you want to tell that story from? But what are your first interactions and the developments that occurred? In that really quite frightening and miraculous period?

Dr. David Ho 

Yeah, so my career now has been defined by two pandemics. One, of course, HIV-AIDS, and in the last two years by the COVID pandemic. These are two very different pandemics. When I was a senior medical resident in Los Angeles, I encounter some of the early cases of HIV-AIDS. We didn’t know what they were at the time. But, you know, young gay man came into the hospital with a multitude of infections, suggesting that their immune system was impaired. And yet, they had no prior history of immunodeficiency. And some of these gay man had extensive sexual history and also sexually transmitted diseases. So that raise the thought that perhaps, there was some sexually transmitted disease that was underlying the whole process. And then scientists at UCLA first show that the CD for T-cells were rather low in each and every one of them, and that was the common denominator for these cases. And so it was acquired, it was immunodeficiency, and hence the name Acquired Immune Deficiency Syndrome. And it was a great mystery.

Andy Slavitt 

Had you seen anything before? Had we seen anything before? Where the immune system had been compromised that way?

Dr. David Ho 

Yes, in cancer patients on chemotherapy and transplant patients on immunosuppressive therapy, and the so-called opportunistic infections that we’re seeing in these early cases of HIV-AIDS, were almost identical to the type of infection seen in cancer or transplant immunodeficiency patients. And so, but other than that, if you looked in the textbook, without such chemotherapy or immunosuppression, the kind of infection we saw back in early 1980 was unheard of in a previously healthy person.

Andy Slavitt  20:07

So then there became a number of years. And it does amuse me sometimes when people talk about COVID-19, as the sort of black swan event, first pandemic, that we’ve dealt with, because it just reminds me how so many of us were able to go on with normal life, because this didn’t affect us. But can you talk a little bit about the worst of it? And what was happening? How many people we were losing the hopelessness, and where you started to find discovery in potential hope?

Dr. David Ho 

Yeah, I think, you know, some years into the pandemic, we realize that this virus has spread throughout the world, in having infected millions and millions of people, largely via sex. Of course, the gay, white male population in US and Europe was largely impacted. But in Sub Saharan Africa, it was completely heterosexual disease. And there was nothing one could do for a long, long time.

Andy Slavitt 

You get the virus, does it exaggerate should it say that it was a death sentence,

Dr. David Ho 

it’s a death sentence for 99% of those who are infected if follow for a period of 5 to 10 years. So it’s extremely lethal, if untreated, and for the from you know, from 1981, till about 1995-96′, there was not much significant that could be done for the patients. Yes, AZT came along in 1987, that prolonged lifespan by a few months, then in the years that followed, also to treatments were applied, but did not make much of a difference. And what transpired is the fact that as more therapies came along, we learn to attack the virus with a combination of drugs. And that emerge, at least for us, that emerged from the work that we have done to understand the dynamics of HIV, how fast does it replicate? How fast does it mutate? What are the mutation rates occurring each day. And if you understood the dynamics of the virus and the mutation rate, you could actually predict that if you treat this virus, one drug at a time, it’s inevitable that the virus will escape, because every mutation at every position of the viral genome will occur every single day. And so if by accident, one virus had the mutation that escaped from the one drug, then the resistant virus will appear and then dominate in short order. But if you also do the math, you could show that if you force the virus to make a combination of mutations in a single genome, that is increasingly improbable for the virus. And that’s how we came to that realization in 1995, and then launch several combination antiretroviral therapy regimens. And within a few weeks, we knew we had something different.

Andy Slavitt

That’s a magic moment. Give us a vivid sense of what that was like when you and your team made that discovery? That I think at the time, people refer to it as a cocktail, which was is just combination of therapies all applied at once, you know, obviously, there’s privacy to protect. But there were a few, obviously, fortunate people who were around at the time, and it survived long enough to be there at exactly that right moment, as patients. There was all of you, what was that, like? Can you just described the notice the science of it, but the emotions of it?

Dr. David Ho  24:17

As I said earlier, we launched three trials simultaneously with cocktail of three drugs. And obviously, at that time, there were a lot of very sick patients, and priority went to individuals with very advanced AIDS. And so we gave these patients the combination therapies, and then follow their viral load as measured in the blood. And, you know,  within days, we could see the viral load declined by tenfold, and within two to three weeks, we could see the viral load declined by a hundredfold.

Andy Slavitt 

Do you remember the moment when you saw the first result?

Dr. David Ho 

Sure, it very, very clearly. And what’s even more amazing on a human level, is the fact that some of these bedridden patients really improved so dramatically. And I would say within a month of being on such therapy, they actually got up and became functional citizens once again, you know, that sort of the Lazarus Effect. And you know, that was amazing to witness. And, of course, none of us have, have seen that before. And so we knew that this, you know, the cocktail therapies, this is back in 1995, we’re doing something that is unique from the previous treatment regimens. But, you know, we didn’t rush to publish or to announce, because we didn’t want to have this effect be gone after a few months. So we made the decision to keep treating. And what we found was that we could sustain the suppression of the virus for a year. And these individuals almost fully recover, becoming normal, although their immune system did not fully recover. So they regained some function but did not recover to a normal level. So we, we waited a whole year, for the results to be shared with the rest of the world, in middle of 1996. And since then, such an approach to HIV therapy became the standard of care. And as some would say, you know, the automatic death sentence now is a manageable condition, because of the combination antiretroviral therapies. And in the subsequent years, of course, the therapies have gotten better, the drugs have gotten better with fewer side effects. And so there have been lots of incremental developments in the field, with better and better drugs, but the approach has been pretty much the same ever since.

Andy Slavitt 

You know, of all the things in our world that seemed to have gotten worse, when you’re talking about the climate. You know, our democracy, people could point to a lot of things. This is a bellwether event in most of our lifetimes. That was a transformation for the positive. And I know, we all do, all of us who are old enough, know, people that were unfortunate enough to have HIV and AIDS and die of it. Before that time. Who would be alive today, my residential advisor at Penn died of AIDS, probably just before that time. All aboard all the more tragic because of these were young men, and this was the time, but you know, today, my wife and I know, an endless number of people that are living with HIV, and to whom it’s not even one of the top 5 or 10 things that they think about in their life.

Dr. David Ho  28:27

Well, you and I were in Cleveland, and we saw Magic Johnson there. Right? So looking quite healthy, quite well. And, you know, he was, as the public knows, he was diagnosed in 1991. And 30 some years later, he’s doing well, of course, that 1991 was prior to the combination therapy. But he certainly was one of the early patients to benefit from combination therapy. So he held on long enough to receive the benefits and of course, millions of people were lost prior to that.

Andy Slavitt 

Talk a little bit about magic, your modest person, but the role that you played at the time and with him and what his story told him. I think there’s probably both a scientific element and an overcoming stigma element to Magic’s story.

Dr. David Ho 

Yeah, I mean, I’ve been involved with his case from near the beginning, of course, I think what I’m going to say is public information. I do consult for his care, but I’ll just share what’s publicly known. He was diagnosed through an insurance test to be HIV positive, that came as quite a shock to him, his people reach out to me. And I’ve flew out to see him in LA and help confirm the diagnosis by running tests ourselves. And by not just doing a typical antibody tests, but by actually finding the virus within his blood. At the time, his wife was Cookie was pregnant, and then there’s so there was a great deal of concern about transmission to her and to the fetus. But fortunately, she remained negative. And so there was no threat to the baby. He didn’t want to hide it, unlike a lot of people. He wanted to make it public and in debt, so very promptly after the confirmation of the diagnosis and shock the world. And of course, at that time, you know, people viewed it as a death sentence. So he sort of reactively made the decision to retire.

Dr. David Ho  32:18

And of course, people know that ultimately, you know, with a vise from all of us that he could try to live as normal a life as possible. So he made a comeback for a period of time, but then face lots of issues with stigma and discrimination for even from fellow players. So ultimately, he decided to quit and focus on his business. He was treated with whatever, whatever was available to tie him over until 1995, when the combination therapy results were known. We put them all in combination therapy as one of the earliest patient.

Andy Slavitt 

But the virus did not disrupt into full blown AIDS before 95′?

Dr. David Ho 

Well, you know, he didn’t symptomatically developed full blown AIDS, but his CD4 T- cells were a bit low, and periodically will fit the definition. So he never develop opportunistic infection as a manifestation of AIDS. But he was borderline. But you know, on combination therapy, of course, his regimen has changed over the years, but he’s now a poster boy for what antiretroviral therapy could do. But he’s not alone. There are millions of millions of individuals around the world, I mean, somewhere around 25 million on cocktail therapy presently. And if they weren’t taking that 99% of them would patch.

Andy Slavitt  34:01

The treatment was an amazing breakthrough. And yet, a vaccine has been elusive.

Dr. David Ho 

Absolutely. Vaccine has been in the works since the discovery of HIV. And, you know, even our NIH director and Secretary of Health and Human Services, said back in 1984, we’re going to have a vaccine in a few months. And we still hunting for one. And in fact, you know, let’s bring it back to COVID. Some of the technologies that have been developed for COVID like the mRNA vaccine platform, by doctors Kericho and Wiseman, were initially try for HIV without success, and so it’s not a, it’s not due to lack of effort or funding or pursued by scientists, it’s been pursued vigorously without success, right? Whereas SARS-CoV-2 you just showed the immune system the protein and it works. So, these two viruses are quite different.

Andy Slavitt 

Is that being that really due to the fundamental fact that HIV attacks the immune system itself, and therefore, you can’t train a response because the body doesn’t respond automatically to it, it gets damaged by it, whereas with SARS-CoV-2 you know, your immune system knows how to, even before a vaccine would eventually overcome and defeated in many, many, many cases, the majority vast majority of cases, and therefore, the vaccine had an easier job to do. Is that a laypersons explanation?

Dr. David Ho  36:03

Yeah, that’s a part of the explanation. I think, you know, if you look at diseases, we’re self-control, the patient controlling the disease can occur, say, with flu, say with COVID, COVID 98% or so control the disease ultimately, on their own, right? Then that bodes well for vaccine success. If when you have 99% lethality, then that doesn’t bode well that means the virus ultimately wins, even though it may take many, many years. So the fact that, as you said, HIV targets the critical cell in the immune system, and alters and or impairs our immune response that’s gotta be contributing. But also, HIV, believe it or not, is even more mutable than SARS-CoV-2, and so the diversity seen in HIV is even greater. And the surface, sort of the spike protein equivalent of HIV is heavily coated with sugar, so it has a shield to protect it from antibodies. And it’s very tough to get antibodies that could penetrate that shield and hit the virus. And so it’s a multitude of reasons behind why we don’t have an HIV vaccine today.

Andy Slavitt 

So going back then to SARS-CoV-2, and the scientific breakthroughs that we haven’t yet seen there, the story that you told of the scientific developments around HIV AIDS was encouraged me that we are only at 1.O of vaccines and antivirals. So if that’s the case, what does […] likely look like both on the anti-viral front end on the vaccine front?

Dr. David Ho 

Yeah, I think on the vaccine front, we’re going for vaccines that will protect more broadly, and would and would focus on regions that would be less susceptible to viral mutations. So for example, many scientists, my live included are trying to go for a pan cyber call virus vaccine that is you would protect not only against SARS-CoV-2 but SARS and many of the similar viruses that have found in bats, and those are future threats, just like SARS-CoV-2, they could jump the species and get into humans and cause another outbreak. So we’re many people are working on that. On the treatment front. I think we’re just very, very early in its infancy. You know, the Merck drug and the Pfizer protease inhibitor. The, you know, Pax COVID is the one that’s out there with, you know, about 90% efficacy in avoiding hospitalization.

Andy Slavitt  

How excited are you about Paxlovid?

Dr. David Ho 

I think it’s in terms of chemical drugs is the best one right now with higher efficacy than what the Merck drug has shown. And, you know, it’s quite tolerable. But in the laboratory, we find that the virus has many solutions to evade that drug. So, sooner or later, resistance will develop. You know, especially as we heard from our president a few nights ago, that we’re going to move to diagnose and treat if we indiscriminately use Paxlovid, we’re going to have resistance occurring very quickly.

Andy Slavitt  40:15

Is this similar to antibiotic resistance?

Dr. David Ho 

Yes, exactly, I think you could see that, if you give it to a person who’s replicating the virus, within four or five days, there could be a resistant form, and that person should pass that virus on, the next person who gets the infection will not be held by Paxlovid. And so we need to be careful about usage the same way we think about antibiotics. And, and in the long run, I think maybe a combination of drugs will be needed to avoid the resistance problem. And many pharmaceutical companies are working on 2.0 versions of small molecule therapies.

Andy Slavitt 

And so we’re really are betting the continued arms race, if you will, between the virus, and our scientists, drug companies, and you’re feeling like we’re betting on the right horse, if we bet on our scientists to continue to develop?

Dr. David Ho 

Yeah, I think if you look at sort of the drug development dashboard, there are 20, some in in small molecule drugs in development, we need a few of those to succeed. And then there are new antibodies, therapies that are being developed. That’s an area of my lab is working on. And so we’ll have more and more weapons in our arsenal. And now, you know, having chased after different variants for almost two years, the scientific community is thinking of strategies that will anticipate some of the moves that the virus will make.

Andy Slavitt  42:01

And so do you think we’ll have those types of solutions in the vaccine front?

Dr. David Ho 

Those I think, are not going to be on the same timeline as what we have for Pfizer and Moderna vaccines. I think it’s going to take several years to come up with broader vaccines.

Andy Slavitt 

And you think those will be on the mRNA platform or potentially other platforms?

Dr. David Ho 

Yeah, I think mRNA is pretty flexible platform. But it’s really the design in the protein that then gets put into the vaccine.

Andy Slavitt 

So what I want to start to wrap up, maybe just the very start with something practical as we finish up. The future of us all getting boosted, I think is one that is still very much remains an open question. I think it’s open for a couple of reasons. One is, you know, I don’t think we’ve decided fully whether or not we’re going to promote a regiment that just protects people from getting infections every time something wanes, versus whether or not we’re really going to make this vaccine about maintaining protection against the more severe illness. How do you think about it, that we’re now crossing into policy? We’re crossing policy and science together here. But how should we be thinking about the right answer here?

Dr. David Ho 

I think the ultimate goal is to protect against people becoming very sick and dying with a vaccine. And if we think back to many of the vaccines that we have had in the past, they largely do not protect against infection, but protect against disease and death. And if we make that a goal, you know, we’ve been counting a lot of infections, and therefore there are a lot of vaccine failures. But most of those people are pretty well protected from severe disease and death. So that ought to be the ultimate goal. Now, with that, we know that the two shots followed by a boosts does protect quite well already, even against a very divergent virus like the Omicron. And I’m not one to advocate rushing out to get the four shot at this point. And we’ve been studying people who received third shot for shot. And we see that not only you know, with the third and fourth, you’re not only see elevation of the level of the antibody, but the qualitative features of the antibodies are also different and substantially improved. It’s what we call affinity maturation, that the antibodies actually get better qualitatively speaking. And that’s important and I think that tells me that we, you know, following third or fourth we may not need continuation of boosters. You know, all that said, though, we need to be aware of the fact that there could be a very different variant that emerges. And that might change, thinking quite a bit if that should happen.

Andy Slavitt 

Okay, so finally, what’s going on with the Lakers this year?

Dr. David Ho 

They look rather hopeless. And I don’t know why. LeBron’s playing well, of course, there are injuries, but the chemistry is not there. What do you think?

Andy Slavitt 

I like how you left it to science the good ingredients, but the chemistry is faulty chemistry. Well, great, David, thank you for being in the bubble. With us today. And for the gifts you’ve bestowed on humanity. You know, there’s a lot of people that I could say that too, but it’s just a tremendous pleasure. So grateful that you continue to keep your resources and your team focused on our latest problems.

Dr. David Ho  46:07

Well, thank you for having me in the bubble. I enjoy our conversation in Cleveland, and likewise today.

Andy Slavitt 

Thank you to Dr. Ho for that great conversation. And of course, you can’t really say it enough for his contributions to all of us. Life is different, because of people like David today than ever would have been. Got some great episodes next week. Let me tell you about them. Senator Tim Kaine, who was the vice-presidential running mate of Hillary Clinton. Also, the junior senator from Virginia is a terrific guy. He will be on the show, we’re going to be talking about a couple of things, including our response to supporting the people of Ukraine, but also his work and focus on long COVID. He disclosed recently that for the last two years, he has been suffering from symptoms and conditions of long COVID. And I think that’ll be a fascinating conversation. And then Rho Khanna, the very iconoclastic Congress person from Silicon Valley, California, and a really interesting, fascinating guy. He is on the Energy Services Committee, we’re going to be talking a lot about nuclear escalation, potential in other parts of the world, as well as in his outlook on our society, our economy, and where things go from here. I hope you enjoy them both. But I really hope you enjoy the rest of your week and your weekend, and we’ll talk to you on Monday.


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 and Veronica Rodriguez. Jessica Cordova Kramer and Stephanie Wittels Wachs are the executive producers of the show, we love them dearly. 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, please tell your friends and please stay safe, share some joy and we will definitely get through this together.

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