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Three years into the pandemic, roughly 65 million people suffering from Long COVID worldwide are still looking for answers to the mix of symptoms that has baffled doctors and experts. Dr. Eric Topal and three researchers suffering from the condition themselves published a new study laying out the newest major findings and preventative measures. Andy asks Eric about the likelihood of getting chronic symptoms from an infection, what those symptoms typically are, and how the data influences his own precautions.

Keep up with Andy on Twitter and Post @ASlavitt.

Follow Eric Topol on Twitter @EricTopol.

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Check out these resources from today’s episode: 

• Read the study Eric co-authored with Hannah E. Davis, Lisa McCorkell, and Julia Moore Vogel, “Long COVID: major findings, mechanisms and recommendations”: https://www.nature.com/articles/s41579-022-00846-2
• Find vaccines, masks, testing, treatments, and other resources in your community: https://www.covid.gov/
• Order Andy’s book, “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response”: https://us.macmillan.com/books/9781250770165

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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Eric Topol

Andy Slavitt  00:18

This is IN THE BUBBLE with Andy Slavitt. Don’t forget to email me at andy@lemonadamedia.com, you have been emailing me, you’ve been telling me what you’d like to hear. You know, look, we’ve been covering some incredibly interesting topics that you’re in our domain here, the pandemic. And where we are now, of course, we are just moving to a place where in a couple of months, we’re going to have the National Emergency over. But also topics of real salience in our society. Whether it’s how women are treated in Afghanistan, the postdocs world, the economy and inflation, equity in our society, homelessness, artificial intelligence, crypto, all the things that are relevant to our modern society. But I think it’s important that many of you found us originally because of the way we covered COVID. And while we hope to cover all these other topics, in a similar way, it is important that we continue to be your place to go for information on COVID that you need to know. And so, you know, we are making it a habit and we’ll make it a habit throughout the year to periodically whether it’s weekly or bi weekly, depending on what’s happening in the news to cover the most relevant things around COVID And today, we have Eric Topol on to talk about the latest research into long COVID. And, you know, for those of us who may be feeling better about the idea of being exposed to COVID, or even getting COVID, and many of us have the fear that lays out there still is this fear of getting COVID and that in some way, will stick with us will be a chronic condition that will have symptoms that will last for a long time. In some cases, that’s months in some cases, it’s longer. But today, we’re at a place where we know more about long COVID than we have in the past. We have a couple years of data after all people who have been living with COVID and we know what that means. Eric Topol is the founder and director of the Scripps Research translational Institute. He is a cardiologist. He’s a scientist. He’s an author. He is one of the leading thinkers and writers about technology about public health about the pandemic, very outspoken. So Eric has summarized along with some others. For Nature magazine, he summarized all the research that’s known abroad survey and everything that’s known about long COVID. He’ll talk about in a second he really interesting approach to who he co-authored this paper with. So it is very credible, it is the latest, it has everything you need to know about long COVID. And that’s what you should come to this episode for. But if you come for the information along COVID, and the science, I think you’ll want to stay for the rants. The very classic rants that Eric and I get into. And we’ll get into at the end of this episode. That’s always the most fun when we can have a guest on who’s willing to just rant. When they do that we don’t we kind of forget that the mic is on. And we just kind of talk and hope that you get to witness something you wouldn’t otherwise get to listen to that. We do that with a lot of our guests. I think the rent with Eric at the end of this will be pretty classic. Let’s bring him in.

Andy Slavitt  03:50

Well, hello, Eric.

Eric Topol  04:01

Hello, Andy.

Andy Slavitt  04:02

Welcome back.

Eric Topol  04:03

Thank you. Good to be with you.

Andy Slavitt  04:05

I thought maybe we could start by focusing in on long COVID. It occurs to me that this is an issue in question taking on more and more importance. We’re used to talking about COVID as an acute event that you either survive or you don’t. But increasingly, it feels like, do we need to be thinking about it as a chronic illness?

Eric Topol  04:26

Yeah, I don’t think there’s any question of that. Andy. I think we’ve underestimated the toll of COVID as a chronic problem, you know, from pretty much from the get go, even though the good part is that over time, the frequency of long COVID in its chronicity is less as our populations develop more immunity with infections and vaccines and boosters in combination. So in more recent times, it’s not as high a new burden. But if you go back to the first Couple of years when the frequency was particularly high, so many of these people are still suffering. And we don’t really know, have an end in sight. We don’t have a treatment. We don’t have a biomarker. So there’s a lot of unsettled aspects of this multi system syndrome. That really is frustrating.

Andy Slavitt  05:21

Yeah, I think this scares a lot of people. And, you know, the people that I know that are still suffering are people that got COVID early, my son among them, although he’s doing a lot, lot better. Occasionally it rears up. He’s 21. And it seems really, really hard to pinpoint these multi system kind of syndromes where people’s symptoms are so variable. So I’m wondering, maybe we should just start with the basics. What do we know, now that we have a few years of data about what it actually is how it goes about working in the body? And the various ways that it then can impact us?

Eric Topol  06:03

Sure. Well, I think, you know, it’s fair to say we’re long our mechanisms, and a lot of a lot of ways to get to long COVID. And they have a common thread, which is the immune system, inflammation is run amok, that is, it’s really dysregulated, it’s gone haywire. And so that could come in many different ways it could come in developing autoimmunity, it could be that there’s remnants of the virus or reservoirs of the virus that have been noted in many people. So that’s another threat. And then you know, the, the difference of for example, some people have more of this cardiovascular symptoms, like so called pots, postural orthostatic, tachycardia, where they stand up, and all of a sudden, their heart rate goes to 120. And they’re very dizzy, and they get sucked out of, you know, energy. And that can be just neuro inflammation that is much more segmented to the autonomic nervous system. So there’s lots of ways it can target either more generally, or specifically. But there’s a common thread. And so, for example, when the lining of the blood vessel walls gets inflamed, that would lead to these micro blood clots. So, you know, everything kind of goes to the common thread, but it’s just Dan can go sort into many sub types of, you know, either symptoms, or across whether it’s cardiovascular or neurologic, pulmonary GI all the different systems that can be affected. And that’s, of course, kind of a different components of long COVID. Because most people think of the symptoms, but they don’t think of the fact that it puts people at risk for clots like heart attacks and strokes, heart dysfunction, or a arrhythmias and then, you know, the neurologic the brain fog and other neuropsychiatric manifestations. So, you know, I think that’s some of the muddled aspects, or the confusion that I think that people have.

Andy Slavitt  08:08

Is there a system that save, it seems like you’ve mentioned, pretty much every system in our body,

Eric Topol  08:13

Every system, you got the reproductive system could be sperm count, it could be you know, many aspects of that, I mean, there is no system spared, it can affect any part of the body. Now, it this is not the first post viral syndrome by any means, that has been shown to do that. I mean, we known for years that myalgic encephalomyelitis, chronic fatigue syndrome is an issue, you know, for decades. And we can see it even with influenza and other viruses. Of course, the problem here is we’ve got a gazillion people who’ve had COVID, it’s estimated that two to 3% of people who’ve had COVID, you know, worldwide have these […]. Now some, like hopefully your son is going to have full recovery. But many are still in the same boat as they were when they first were hit weeks after their initial infection.

Andy Slavitt  09:08

So, it can hit us in a whole number of ways. As you say, it shouldn’t be surprising to people who study viruses. Is there some part of the sequelae that is more common and more typical? Or is it really random? I guess what I’m wondering is how the body is functioning, and how the virus is functioning that would cause it to go one path versus another versus not at all and just to be defeated by the immune system, and people to just have full recovery with no symptoms.

Eric Topol  09:42

Yeah, well, I think you’re bringing out kind of the mystery factor here is why is it so diverse? Why is it not more consistent across people? And it may just be speaking about the vulnerability that certain people have whether it’s their immune system, genetic which really striking is how it hits healthy, relatively young people, the main group is between in the 30s and 40s. And as you know, Andy, it’s more common in women. And we do know that women are more common affected by autoimmune conditions, whether it be lupus or rheumatoid arthritis, or multiple sclerosis, or systemic sclerosis. So the peak are people 30 to 40s. And these are healthy people. There’s nothing about them having comorbidity. I mean, the people I know, and there are many, who are, you know, they were athletes, they were, you know, runners, and then they’re hit by this. And now they really have a hard time to function in all of their daily activities. Now, it’s different day to day. So not only is it diverse, across the population, but in any given person who’s affected, they may have really good days where they feel like, oh, wow, I’m making progress, and then they’re just back to ground zero. So it’s really a tough nut to crack in that we have good bonafide evidence of mechanisms. But we’ve come up with basically nothing validated for treatment.

Andy Slavitt  11:09

I’ve heard this number, that it seems to be around 10% of the people who get COVID in it. And I imagine that all on COVID is created equally as was we talked about some long COVID cases seem to dissipate within months. And we still call it long, but six months or nine months or a year out, people are feeling fine. Right? Right. There’s also some long COVID, where people, as you documented in your paper literally can’t get out of bed, or they can’t go to work. Is there any way to help us think about what portion of the cases do eventually, you know, within some period of time, months or so? heal themselves? And also, what portion of these are the really severe type where people are really debilitated?

Eric Topol  11:58

Yeah. That’s a great question you’re bringing up Andy, because we are now only starting to see a very limited two year follow up, and people. But overall, you know, I think it’s fair to say when we estimated the 65 million people worldwide based on many studies that we put forward together. I mean, this was meant to be a compilation of every significant paper that has been published along COVID. So far, that would really include people who are actively impaired by long COVID. or partially, you know, it may be that it’s largely resolved, you know, that, that there’s only minimal symptoms, but still, they’re not back to baseline. And I think that’s a fair estimate. As I mentioned, at the top, it’s fortunately getting less frequent. And the biggest burden were those in the first year, the second year. But as we’ve gotten more immunity built towards the virus, even as the virus has evolved, certainly the fear of someone getting one COVID is reduced now, but it’s still out there. And there’s no question about that.

Andy Slavitt  13:02

All right, let’s take a break. And I want to come back. And we’re going to talk a little bit more with Eric, about some advice for those who are still nervous about entering normal life for fear of getting long COVID. Let’s talk about how various interventions have had or we think are having an impact or can have an impact on either preventing long COVID in the first place, or dealing with it and let’s start with two let’s talk about what the data show the impact of being vaccinated in with various levels of boosters. And then secondly, some of the oral therapeutics like Paxil COVID.

Eric Topol  14:08

Right? Well, I think we can say that, with at least moderate to high certainty that vaccinations and boosters are helping to reduce long COVID likelihood, it ranges from 15% to 50%, with most of the studies coming somewhere in that in the mid-range, so it isn’t foolproof. People still can get long COVID but probably at least a third reduction of the chance of getting it. So I think that’s the one thing we have now if you’ve have long COVID Were getting a vaccine help reduce the symptoms. That’s where it’s much more fuzzy. We have mixed data about that.

Andy Slavitt  14:49

Okay, and how about Paxlovid? Does it work to reduce the odds even further.

Eric Topol  14:54

The only thing there is it’s intriguing because there’s several case reports are limited either so […] or several people in a series where it seemed to make a difference. People who got Paxlovid to treat their infection, whether it had vaccinations or not had overall a 26% reduction of long COVID subsequently.

Andy Slavitt  15:15

Got it. So when you take it together if you are vaccinated, and as you say, with more than one, whether it’s two or three, and if you are able to take Paxlovid then you take Paxlovid. I think people what people really want to know is what are my ads? If I get COVID? What are my ads? Because the way I look at people today is most folks are back to dining in restaurants, indoors without a mask. Most folks who are flying in airplanes are flying without a mask. And I don’t think most of these people are people that want to get COVID or completely dismiss it on hand. I just think it becomes easier. It’s a social norm. But I know that many of them worry, gosh, if there’s a percentage chance that I end up with something that sticks with me for months or years in any of the ways we’ve been talking about. That’s kind of what they want to know. And if that chance were zero, I think a lot of people would be a lot happier. It’s not zero, it’s not zero. But with all this protection, is there anything we can say about the frequency with which these kinds of systems will persist?

Eric Topol  16:18

Yes, the worry for long COVID Now is certainly less with a new infection. It isn’t zero. We still know people in recent times in recent months that have had it or are suffering from it. But yes, it’s much better now. Does that mean we should abandon mitigation? You know, I think this is a person’s choice. I mean, I’m much less worried than I used to be. And I know that if I never had COVID. But I know that if I got it, I will get to pecs a bit early, just because of the data I just mentioned. And I don’t want to get long COVID It’s a horror show in some people that I have seen colleagues who I work with, and you know, so many and patients who I have, I just don’t want that. But I my fear of it now is reduced. It isn’t zero, I think that’s the real issue that you’re bringing up is the roulette wheel here. You just don’t know that, you know, you get it. And then you know, you feel better. You took Paxlovid, all the right stuff. And then you know, a couple weeks later, you’ve got some symptoms that are troubling. It happens. And I fortunately the alarm, the fear factor for that is markedly reduced. And I think we are gradually moving on to know that where you were a lot of people went there earlier, where they just said, I’ve had enough of this crap, I’m moving on. There’s more to substantiate that. But still, there’s a risk. And it’s an it’s an unknown unpredictable issue that people have to grapple with and make decisions for themselves.

Andy Slavitt  17:55

Yeah. And then of course, if, if those variables are different for you, personally, we get older, your immune system has problems, you’ve got other risk factors or like me, you’re not eligible for Paxlovid for other reasons, then, you know, you’ve got to, you’ve got to constantly adjust. And I don’t know whether or not this is still going on. But I know at one point, it felt like people who if you had long COVID, they were dubious. There was some stigma and I still think in, in the various dark places of the internet, there’s still a lot of that, that goes around where people are saying, long COVID doesn’t exist. It’s not real. It’s big made up?

Eric Topol  18:33

Oh, I think this is a much bigger deal than a lot of people think so. The decision of law and COVID the fact that people are saying it’s, you know, a psychiatric issue, or maybe it exists, but it’s so rare. These are the kinds of things that you see written by physicians, okay, not just being you know, not just people. This is not just the anti-science, denial stuff. This is this is a really big deal. And so the problem is the people that are affected, without question they have, they might go to a doctor and just say, the doctor looks at them skeptically, right, and basically is just dismissing their symptom. And this is not at all uncommon. Now, that was why when the nature journal asked me to write the review, I said, Well, I don’t have long COVID How could I write the review? I can review the literature. So I recruited three long COVID experts by that I mean, they have long COVID Still Oh wow. So Hannah Davis, Lisa McCorkle and Julia […]. These are three people who are leaders. They’re all terrific researchers, but they are still affected significantly.

Andy Slavitt  19:50

That’s brilliant. I didn’t know that.

Eric Topol  19:52

Yeah, but to me, that’s actually Well, that was the most important thing I think about that review is we had the checks and balances were by, you know, they obviously are in the midst of it, they, some of the time it took to get the review, we had to go through many rounds of peer review and editor reviews and but sometimes any one of them couldn’t do work on it, because they were hit, you know, and but anyway, I learned substantially from them. And I think, you know, my questioning of various papers they would cite or points they would make, it was like a check and balance on what is, you know, the real deal here. And together, you know, I think it was a very effective way to get this review done. You know, I don’t think I could have possibly been as comprehensive and balanced without involving people with long COVID. So, you know, Andy, we talk a lot about in medicine about patient centered, this patient centered that, but a lot of it is just, you know, bogus. To me, it’s much more important, we get patients, actual patients involved with our efforts, whether it’s like something like this a review, or in designing a trial. I mean, for example, the US-NIH has put a billion dollars into research into long COVID. But it isn’t factoring in what long COVID patients want the most, which is a drug or treatment that works to get them out of the woods. And there’s very little work being done on that a lot of frustration. So, in every in every way, one of the ways we can get out of this long COVID situation we’re in is getting more direct involvement of the people who are affected.

Andy Slavitt  21:38

I can hear people standing up and applauding what you did there. I just think it’s such a brilliant example. And I really applaud you for doing this. It’s one of the best examples of how our system can be better.

Eric Topol  21:55

Thank you.

Andy Slavitt  21:56

All right, let’s take one more break. And then Eric, you and I are gonna do what we love to do when people love to listen to. We’re gonna rant. Let’s go rant on a couple other topics before we’re done. Did you and I like to do that? Okay, the FDA came out and said boosters once a year. I like the flu. There is this. I don’t know if it’s a controversy or an argument around at what age people should be getting boosted with some saying, it doesn’t hurt to do it at all ages, even though your risks may be lower as you get younger. There’s other reasons like, like the lung COVID arrest, there’s also a very minimal risk to getting boosted. And then there’s others that say no data would say that it’s really not worth it on people who are under 50. Talk a little bit about what you think and why and whether that the other point of view has some merit to it or not.

Eric Topol  23:19

Yeah, this is fairly, I’m glad you asked it because this is the epitome of what we call subgroup analysis, right? Whereby the data shows unequivocally down to age 80. There’s consistent reduction of COVID hospitalizations with boosters. And whether it’s the third or the fourth booster, you know, it’s unequivocal. However, as you’re pointing out, the absolute reduction, the relative reduction is the same, you know, 70 80%, the absolute reduction to just keeps getting lower as you get down lower ages below age 40, below 30. You know, so the data supports the US government’s decision to buy big and boosters. But obviously, then you have to make the call is where do you draw the line and absolute benefit? And it does decrease no question as you get certainly below age 50 and 40. And you know, and so there is a risk of boosters, in young men, teens all the way to 30 some odd years. It’s small five per 100,000 of myocarditis. And you have to, you know, you have to weigh these sorts of things into, but overall, I mean, I recommend if you’re 50 and older, you’re really going to get benefit from a bi-vaillant booster but you can argue with the data that shows it some benefit across the board.

Andy Slavitt  24:44

So next thing I want us to rant about is the fact that we’re sort of stuck on generation one of vaccines in residence going to be much hope, interest or funding for the next generation of vaccines and you’ve heard about a couple of innovations. And I’ll talk about two of them and nasal vaccine and the universal vaccine, which maybe you could just re explain to the audience, what they are, and what good they would do.

Eric Topol  25:13

Right. So unfortunately, ever since Omicron came along, late in 2021, well over a year ago, and all of its lineages since we lost a lot of our ability to inhibit infections, with vaccines. And that’s why these vaccines aren’t working well, they are working for severe COVID. But they lost a lot of their ability to inhibit infections. And we could get that back if we worked on it. And you know, there’s certainly 100 different nasal vaccine candidates, some are pretty far along. I mean, India has already rolled out their nasal vaccine. But at any rate, I’m confident that there will be effective nasal vaccines for blocking infections better than shots, because that’s how the darn virus gets into our body. So it’ll work. The question is, is it just for a few months, you know, what, I don’t mind I’ll take a spray every few months, I rather have that than a shot, you know, I get sicker than hell from each of these shots. I mean, really don’t want to go near those if I could avoid it. For a couple of days. I’m just you know, knocked out. So yeah, take a spray. And so I’m very enthusiastic about what that can do. mechanistically and changing the fear of infections where you could even be more confident about resuming totally everything you do. And so the fact that we’re so limp and weak about pursuing nasal vaccines is highly frustrating to me, because this is a minimal investment. And Ashish Jha is really fighting hard to get the funding for this, as I think, you know.

Andy Slavitt  26:47

The White House coordinator.

Eric Topol  26:49

I mean, he’s just come up to roadblocks, you know, in Congress, and the pandemic is over stuff. And, you know, he can’t he can’t even get the Secretary of HHS to find some money in his drawers there, you know, desk drawers. I mean, there’s got to be a way to pursue this. So it isn’t being done in all these other countries outside the US. And I don’t really want to go to Tijuana to get my nasal vaccine. You know?

Andy Slavitt  27:11

You’re close to Tijuana. I mean, you know, you’re in San Diego.

Eric Topol  27:14

I pick Tijuana, because it would be Yeah. But you know, there is a company, by the way, a US company that’s in licensed the India vaccine oxygen, and they’re going to market it as soon as they can. But we don’t even have an FDA that supportive of these vaccines, because they haven’t, they haven’t put out guidelines or what they would want to get an approvable measles vaccine. So that’s going to be a leg too.

Andy Slavitt  27:37

Now, we understand that the federal government in this Congress won’t fund anything productive, let alone something that you could help a pandemic that many of them don’t even believe in. It’s federal government, the only buyer? Is there a commercial market in the US that would be interested in paying for these vaccines? I mean those how pharma companies are used to developing products, right?

Eric Topol  28:04

Right. Another insightful question. So the problem is, is that the vaccine companies, you know, like Moderna, Pfizer, J&J and whatnot, they have been spoiled by Operation Warp Speed. And they had where they were de risked, and maybe not Pfizer, but all the others whereby they could make up a gazillion doses. And if it didn’t work, and the trials, they would get paid. So we don’t have any funds. We don’t have an operation warp speed, like interest. And that was heroic what was done there. I mean, you recall, when we first spoke on in the bubble, that was a day that Pfizer’s vaccine had their first data output. That’s right. And before then, you know, people thought, Oh, my God, I could die from this, and they could, and then we had a vaccine that really helped prevent deaths, you know, 95% reduction of what were the deaths, and people who just forget that and it’s still reducing deaths, it’s still reducing severe COVID hospitalizations, and what and long COVID too, but what we, unfortunately have not learned from that great success, which I still consider one of the greatest successes in biomedical history that we don’t reload and redo this again, for nasal vaccines and, and universal vaccines. When I say universal, I mean, ones that really last for multiple years against all variants, with less side effects. We can do this, but it’s just like, there’s no will.

Andy Slavitt  29:33

Yeah. Well, look, I think the proper way to look at it is that first vaccine was the emergency vaccine to save as many lives as possible. That was its job. And it did it. It wasn’t set to optimize it. All of the processes were streamlined, so that we could solve for that one goal. So the hope was that, that a logical country with good decision makers, who made smart investments would say okay, great now that we’re doing that, it gives us some time to work on the more permanent answer, more permanent answer, something that lasts longer, something that covers more variance, something that prevents infection. And as I listened to you, I’m hearing well, US scientists put us at rest of the world, US scientists are up for this job. They are up for this job. They can do this, they understand this virus well enough. They understand the vaccinology well enough. But we here in the US, when this is ready for primetime, aren’t set up to reach the benefit from it. I mean, the only fortunate thing is that someone else we’ll get there first, if it’s the Chinese people will look at an envy and say, Oh, my God, what have we done? And then hopefully correct themselves?

Eric Topol  30:45

Exactly. You know, on the one hand, if things kind of wind down now, we don’t see a new family by beyond Omicron. Share? Well, the investment was oh, that was smart. We didn’t put in billions of dollars for this. And whatever efforts that are going around the globe, were interesting, but not so vital, after all, but that is that how you plan for the worst case scenario? No, you get ready. And that’s why I think it’s so essential that we do this, because this virus has, if it’s anything we’ve learned for three years, it just keeps evolving, it finds new ways. I mean, the variant that took over in the XBB15, it was, you know, not only a combination fusion of two different variants, and then on top of that, two critical mutations. And so that’s a whole new twist.

Andy Slavitt  31:35

It is miraculous, the more I’ve learned what science can do when you unleash it, let me ask you this, if I were still running CMS, which folks who don’t know what that stands for, it’s the Centers for Medicare and Medicaid Services, basically charge for paying for care for Medicare and Medicaid beneficiaries. I’d be inclined to say, if you build an effective nasal vaccine, or universal vaccine for COVID, we will pay for it, I would be inclined to just say that to try to create a commercial market through Medicare, which again, only covers people over 65 and Medicaid, which the states are involved in, you know, only covers people that are lower income or disabled. Would that be enough? And I’d have to get grabbed […] to release some guidance as well. But would that help?

Eric Topol  32:24

I think you’d be ginormous, in terms of helping to push this thing along. But we’ve never had that show of support. And I think that’s really critical to get it. And that would be the highest risk people of course, 65 and older. It’s perfect.

Andy Slavitt  32:38

Why don’t you and I will get to do this real time on the show. Why don’t you and I co write a letter to Chiquita, the head of CMS for those who don’t know, Chiquita Brooks ashore. But I’m happy to cosign it with you.

Eric Topol  32:50

I’ve absolutely no, I think it’s a fantastic idea. It can’t it can’t possibly detract from this. And it could be the impetus to make this a reality, which right now it shouldn’t going nowhere.

Andy Slavitt  33:02

Yeah. So anyway, if you want I leave that out, too. If you want to put something together, I’m happy to sign it […] and get it to her. You know, same thing is like I love ranting with you. But this might have actually been a productive rant, we might actually have gotten somewhere, at least to some effort.

Eric Topol  33:18

Yeah, I think so. I mean, it’s always fun to have a discussion with you. And, you know, the kind of astute way you look at all these things. You always ask them the right and the tough questions. And I think having an action plan. That’s a bonus. It didn’t anticipate that when we got together. W

Andy Slavitt  33:36

Okay, good. And we’ll hit […] if it’s same time to I think that’d be, I think that’d be fun. He’ll love to hear from us. Believe me. Love to hear. You know, I just Eric I’d Saturday evening, I just had dinner with the director of the JPL, the Jet Propulsion Lab, which is part of NASA. They’re responsible for the Mars Rover program. And they’re setting the next mission to the moon. They’re about to name their astronaut candidates reason I bring this up. Because I was seated next to her and I asked her, I’m gonna have her on the show, because she’s amazing person. I said, how do you continue to get funded, funding from Congress for something which people view as not needed that necessary? We’ve clearly underfunded the space program for so many years? How do you do it? And of course, I was thinking about the very question you’re asking, which is how do we get funding to fight diseases that we know we can tackle? And she said, Oh, I just tell them to Chinese we’ll get there first. Yeah, if we don’t find this, yeah, we’ll just gonna watch the Chinese collect ourselves. We’ve got a bunch of samples sitting in test tubes along on Mars that the rover has built and they’re just sitting there. She said the Chinese will pick them up.

Eric Topol  34:46

Yeah, it’s true. It’s true. I mean, you’ve already seen it in the in the pandemic. That right of course, their Corona vaccine wasn’t the best vaccine out there. But that doesn’t mean they can’t come up with one that does […]

Andy Slavitt  35:00

We’re not even in the race.

Eric Topol  35:01

No, we’re not. We’re not in the race. I liked that philosophy. Yeah, maybe we got it, we got to pull out all the stuff because you know, what, if we’re going to be reactive in 2024, when this new sigma or PI family of arrogance comes along, it’s all we should have done it. How stupid would that be? When we could have done it already? So I’m with you.

Andy Slavitt  35:22

So I’ll let’s close on this. I would say my final My advice to public health community. When people in public health community, bemoan the fact that Congress doesn’t fund public health initiatives appropriately, which is true, is that we don’t even play the game. Like people who want money out of Congress, actually are selling this. I mean, do you think that Lockheed Martin just goes boy, I hope that they, they hope that they decide to pick a new air bomber fighter, let me just cross my fingers. And let me bone the fact that they’re using old technology. No, they go in with pictures of new, beautiful looking planes. And they paint a picture and they spend money and they sell and I I’ve been saying to anyone who listen to me in the public health community, that we need to adopt that motto, you need to out lobby, the cigarette companies you need to outloud be the gun manufacturers, you need to help lobby, all the people who are destroying public health with something compelling, and that compelling thing is not motherhood and apple pie. Sometimes it’s national security. We need this for national security.

CREDITS  39:48

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.