0
In the Bubble with Andy Slavitt: Our Shot
All Podcasts Omicron

Omicron

Subscribe to Lemonada Premium for Bonus Content

Description

Andy breaks down everything you need to know about the Omicron variant with epidemiologist Katelyn Jetelina. They cover what we know about Omicron’s transmissibility, the severity of illness it causes, and how it impacts immunity – whether from vaccination or prior infection. They discuss why Omicron worries scientists, how quickly the mRNA vaccines could be tailored to fight Omicron if needed, and what the emergence of this new variant says about global vaccine equity.

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

Follow Katelyn Jetelina on Twitter @dr_kkjetelina.

Joining Lemonada Premium is a great way to support our show and get bonus content. Subscribe today at bit.ly/lemonadapremium.

Support the show by checking out our sponsors!

  • Click this link for a list of current sponsors and discount codes for this show and all Lemonada shows: https://lemonadamedia.com/sponsors/
  • Throughout the pandemic, CVS Health has been there, bringing quality, affordable health care closer to home—so it’s never out of reach for anyone. 

Learn more at cvshealth.com.

Check out these resources from today’s episode: 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.

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

Transcript

SPEAKERS

Andy Slavitt & Katelyn Jetelina

Pres. Joe Biden  01:20

This variant is a cause for concern, not a cause for panic. We have the best vaccine in the world, the best medicines, the best scientist, and we’re learning more every single day and will fight this variant with scientific and knowledgeable actions and speed, not chaos and confusion. We have more tools today to fight the variant than we’ve ever had before. From vaccines to boosters, to vaccines for Children, five years and older and much more. A year ago, America was floundering against the first variant of COVID. We beat that variance significantly. And then we got hit by a far more powerful threat, the Delta variant. But we took action. And now we’re seeing deaths and delta come down. We’ll fight them. And look we’re gonna fight and beat this new variant as well. We’re learning more about this new variant every single day. And as we learn more, we’re going to share that information with American people candidly and promptly.

Andy Slavitt  02:41

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. That, of course, was Joe Biden talking in the White House on Monday, to the country about the new Omicron variant. Well, anyway, differences of opinion on that question. But let me talk about it a little bit more broadly. Before I introduce our guest today, we have the perfect guest. She’s your local epidemiologist, Katelyn Jetelina. She’s also the assistant professor with the School of Public Health at the University of Texas Health. She’s got a great blog, and she’s one of the best explainers out there about what’s going on. And she’s very much in the mix on Omicron, I think I’m gonna go with Omicron, unless I changed my mind. So let’s start at the highest level go down to the most personal level, your highest level, I think the things that we’ve heard people say over and over again, both on this show and other places, it was happening anywhere in the globe, it matters to us. And if people are not getting vaccinated quickly enough, particularly areas where we have people with compromised immune systems, we’re going to see a lot of replication and we’re gonna see risk variants.

Andy Slavitt 

Now, these variants replicate randomly, but if they replicate enough, a random could be not good. And I think, as you’ll hear, as we talked about Omicron, that is going to be the case. There’s something about this variant that we don’t like, we’ll talk about that. But it puts a lot of focus on this global effort and why it’s so important, why it’s not just about doing the right thing as a country, but why it’s about doing the things that make sure that more people are safe and can’t spread this virus. I will say that I did call up the administration to get a read on what’s being done directly in Africa. And it’s actually quite interesting in quite a good rundown of things that have been done. So far the US has shipped 93 million vaccines to Africa 13 million to Southern African countries, that 8 million directly to South Africa. And those 8 million in South Africa really only limited by The fact that in South Africa, they actually have a backlog of vaccines, they’ve asked Pfizer not to send more vaccines because they’re having some challenges as we have here. But even more so it sounds like in South Africa, with vaccine acceptance and hesitancy, USA in total, by the way, sent over 275 million vaccines out to countries around the world. And they’re sending about 3 million a day.

Andy Slavitt

Now, when I was in the White House, to give you a sense of things, we were vaccinated about 3 million people a day in the US, kind of a one of our high points. So I think that’s good news. Interesting to know. And of course, the whole of government from PEPFAR, which worked in the AIDS epidemic, to the NIH, to CDC to the very important USAID are all focused on this, and we’ll have someone from USAID come on the show. So far, they provided through us at about a quarter of a billion dollars in support, to just get people vaccinated once the vaccines arrive, training workers, etc. So this global issue is not going away. And I think we actually had an episode entitled, how not to have to go through the entire Greek alphabet, which was very much about addressing these things globally. And you know, the question is, when will we learn? Let’s just take a moment of honesty. When you first heard about Omicron was your first thought to worry about the people in Africa?

Andy Slavitt  06:25

Or was your first thought to worry about oh my god, it’s just gonna come here and disrupt my life. Look, there’s no shame in being human, there’s no shame in thinking about yourself, like your family. First, we all do it. The problem is with this virus is that that type of thinking exclusively, leads to continued repetition of this cycle. When we start thinking, with as much care and thought about people around the world, and making sure they’re protected, is the day we’ll we will get our hands around this thing in a better way. So let’s talk about the national response. I have been spending time talking to people in the administration, public officials, etc, you know, this is the kind of thing that they prepare for, this is the kind of thing they are prepared for, this kind of thing that vaccine manufacturers prepare for, we will get into those topics. And that’s, that’s something that I think we have to watch closely. CDC needs to communicate quite clearly. And the array of things we need to do our it starts with vaccine boosters; boosters are the most significant thing we can do.

Andy Slavitt 

But rapid antigen tests, at home tests abundance of those, and then this new Pfizer drug, this new Pfizer therapy, which we’ll also talk about with Caitlin is also fundamental because so far the senses that that’s gonna continue to work well. So we have these tools, not to mention, of course, well-fitting masks, better ventilated air. So this is not like COVID hitting us in 2020 by any means. It’s about using our tools intelligently. You got to use them. So people who aren’t getting vaccinated, you know, they’re going to be at risk. This spreads as fast as we think it might. What about us? What about us? What about our Christmas plans or holiday plans or New Year’s plans or travel plans? First of all, I just want to go out of my way to curse Farzad Mostashari because at the end of our episode on safe or unsafe, I asked the guest to predict how many more episodes we would do of safe or unsafe. And he said zero he said we’re done with this. And I sent him a note to tell him that he cursed us, that was not the right thing to say Farzad. So sorry, you’re probably not out of your contract yet. People still want to know what’s safe and unsafe. And with this Omicron as we learn more about it, and we will, we will learn what precautions to take. You’ll hear in the conversation that many questions are unanswered.

Andy Slavitt  09:00

But I think there’s a long list of what I would call the do anyway list. And, you know, no matter what the news is, there’s things I’m going to do anyway. I’m going to Dine outdoors. I’m going to avoid large crowds certainly without wearing a mask I feel more comfortable around people who are vaccinated than not vaccinated, I’m going to try to have been places that have ventilated air and I’m boosted, I’m boosted I said that on MSNBC this morning I’m a boosted she asked me that it’s definitely rule are you boosted I said yes. Are you? By the way, ,like how crazy is that when the host of a show ask you something and you’re like yes are you that was dumb response of mine. Why did I have to ask her if she was getting boosted? Anyway, she is getting boosted because you have a right to know America. But look, the facts don’t change the question of how do we feel about this? Cuz I know this feels crappy. I know this feels endless. I know what goes through everyone’s head, oh, it’s just gonna affect schools, my job, my stock portfolio, my father’s health, my child’s health who’s immunocompromised, I know all those feelings and their lousy feelings. And you know what? Go back to basics here. Look for the helpers. That’s us. That’s anyone around us. And it’s just get informed, get informed, and it’s usually never as bad as your worst fears. And I think we’ve all been kind of prone to this sort of what is the worst-case scenario. And I think it’s wise to plan for some of those things. But you know, we’ve learned a life, we’ll be able to proceed in a great way. If we do smart things, keep track of things. So I will keep you informed here in the bubble. And our guest is a start to that Katelyn Jetelina is going to come out now. And we’re going to talk about what is this Omicron thing?

Andy Slavitt 

How are you, Katelyn?

Katelyn Jetelina

I’m good. How are you doing?

Andy Slavitt 

I bet you had a great Thanksgiving.

Katelyn Jetelina

It was busy. It was not what I expected at all.

Andy Slavitt 

And you have a bunch of decision trees on a whiteboard behind you for those who can’t see you. So is one of them like turkey with mashed potatoes, turkey with cranberries?

Katelyn Jetelina 

Decision Making? Yeah, absolutely.

Andy Slavitt 

Is that how you make, does that make your Thanksgiving decisions?

Katelyn Jetelina

No, I wish it was that calculated. But no.

Andy Slavitt 

Yeah, I wish that this was about something is not your whiteboard was about something as innocuous as Turkey. at Thanksgiving. Yeah. Well, let’s get into the turkey of the topic today. Viruses mutate all the time. What’s different about Omicron?

Katelyn Jetelina  12:00

Yeah, they do mutate all the time. And we actually expect it to mutate and change. And what’s different with Omicron is that, you know, it had a huge jump in the number of mutations on the spike protein alone, we’re talking about 32 changes on the viruses key into ourselves. And as a comparison, Delta had about nine changes on the spike protein. So this really caught the attention of a lot of scientists, but thankfully caught the attention very early on.

Andy Slavitt 

So what’s different about it is the amount of change that happened, if nothing else, relative to what we saw with Delta, and what we saw with prior jumps. So it’s just the kind of thing that by itself should make you worried? Or can you talk a little bit about the 32, or some subset of the 32 changes? And what they tell you?

Katelyn Jetelina 

Yeah, so it is the, you know, raw number of changes, but the number of changes doesn’t necessarily equate to severity. It’s really the quality of changes. Um, and we are, we’ve seen some of these changes before on previous variants of concern like Delta, like Alpha, like Gamma, like Beta. And so that is what we’re really trying to figure out right now. So one, we know nine of these changes we’ve seen before and we’re particularly nervous about one of them that we’ve seen on Delta. We’ve seen other some..

Andy Slavitt

What about that one? What makes you so nervous about it?

Katelyn Jetelina

Yeah, it is called the P681H, and it is a fear and cleavage, which means it is more transmissible, we saw that with Delta a lot. And unfortunately, with Omicron, we see a second fear on cleavage change as well. We don’t know what that second one means. But it certainly has caught our attention as scientists.

Andy Slavitt  14:11

And it worries you because it means that it’s likely to make the virus more transmissible in your experience with that mutation.

Katelyn Jetelina

Right. So it probably makes it more transmissible and but we also look at changes for two other things as well. And if it can erode our vaccine immunity, or infection induced immunity, as well as if these changes, increased severity and disease.

Andy Slavitt 

Okay, so let’s look at all three of those. And I think that’s a really useful way for listeners to think about the dimensions of why does it matter if this virus mutates? And I’ll repeat those three, and then we’ll go into each of those three. The first is the increase in transmissibility. The second is the increase in severity. And the third is what it does to two different types of immunity. One is the immunity we get from vaccines and boosters, and the other is a vaccine we get from a prior infection. So let’s just start with transmissibility. And I want to say that you make an important distinction that there’s two ways we learned things at this early stage. One is what we learned from the lab or from analysis of the gene. And the other is through the real world, what are we actually observing? So maybe we can start with communicability? And talk about what we what we might know from the lab? And what might we know, based on real world observation?

Katelyn Jetelina 

Yeah, so you’re right. So we can currently look at the lab at the micro level of what we know about viruses and how those changes may impact transmissibility, for example. So can this virus get through our doors quicker? And if so, can we transmit it even more against person to person? So with transmissibility, what we’re really trying to answer is, if one person is infected, how many more people on average will they infect? So with Delta, we saw that this is about five to eight people and one infected person can go in fact, five to eight others? With Omicron. We don’t know what this number is, we think it is Delta or even higher than Delta. And so when we look at the lab, what are those individual changes? And then two, epidemiologist like myself, we look at the real-world data, what are the patterns? What are we seeing poppin on the ground? Unfortunately, or maybe it’s Fortunately, we’re really early in this. And so we actually are at the mercy of time to see how quickly this spreads and among who it spreads.

Andy Slavitt  16:55

Got it. So what you’re referring to how quickly it spreads is what all of us armchair epidemiologists now know are as the R-naught, and the R-naught, which we know is between two and three of the wild type virus in 2020, you just said was between five to eight and Delta, that people are throwing around all kinds of numbers for Omicron. And by the way, kind of our high watermark, it’s about 18. If I’m right about from measles, which is a very infectious airborne virus, we’re seeing people say that this could be five times as contagious as the wild type virus, which I would guess would be about a 12 to 13 or 14 R-naught. What evidence supports that? Is it modeling? What do you think of those numbers?

Katelyn Jetelina 

Yeah, so that’s I saw that yesterday, someone used modeling, so mathematical techniques to estimate what this R-naught is. And he came to the conclusion of yeah, about 10 to 13, which is incredibly transmissible and but this is based on mathematical models, and if so basically, it’s a hypothesis. And again, we just really have to see the real-world data to see if this is true. And that will take some time to digest.

Andy Slavitt  18:18

Yep. And we will come back to the question of kind of what does it matter and in other words, what would we do differently if it was 8, 9, 10, 12, 13, 17. But so we’ll come back to that, so I don’t want anybody to be overwhelmed by these numbers, other than to try to get an indication of something that’s highly infectious and airborne.

Andy Slavitt 

Now, the biggest outbreak has been in the country of South Africa. Can you tell us a little bit about what’s gone on there? And what that’s helped us understand about the contagiousness.

Katelyn Jetelina  22:02

Yeah, so this the first case was actually first detected in Botswana on November 11. And then it was quickly identified in South Africa three days later. And this isn’t surprising. South Africa has one of the best world class genomic surveillance systems, they are on top of it. And thanks to them, because they’re on top of it, we were able to understand what these mutations were, we were able to understand really quickly that a PCR test can detect this new variant. It doesn’t have to necessarily go to a lab, and we have to wait weeks to see it. And so thanks to their really swift response, scientists can start decoding this threat quickly. And I think we really all owe it to our South African friends down there.

Andy Slavitt

Let’s pause a little bit there. It’s to say a couple things. One is, you made a very important distinction. The first case that was detected was Botswana doesn’t mean that sort of the first case was the first case could have been in Chicago, we don’t know, But because of their surveillance capabilities in South Africa, we were able to see it there first, we’ve been seeing spikes in Europe, and it’s quite possible we’ll learn later. That Omicron was other places. So it’s an it’s a distinction that’s really important, particularly to people in Africa, who I think, to your point really gave the world a gift, and how quickly they diagnose things, and how much they’re sharing, with scientists around the world to help solve this problem.

Katelyn Jetelina 

Yeah, absolutely. And being very transparent, communicating very nicely on even an hourly basis of what they’re seeing on the ground there. And you’re right, this is where it was first detected. It could have started anywhere. And honestly, we’ll probably never know. And I don’t know if we do need to know, I think that the important thing is that we found it, and now we can respond to it.

Andy Slavitt  24:04

When we look observationally at where it is spread in South Africa. Does that tell us anything about the contagiousness?

Katelyn Jetelina 

Right. So when we look at South Africa, we actually look at a specific region, which is basically the epicenter of Omicron’s spread. And in just one week, test positivity rates. So the number of tests that become positive increased from 1% to 30%, which is incredibly fast for one week. And so that also kind of raised our suspicions on this variant, and it continues to increase. Now if we zoom out on South Africa as a whole, we are starting to see cases exponentially increase, last Tuesday, it was about 800. Then Wednesday was about 1300. Then on Thursday, it was about 3000. So we’re starting to see that exponential increase. So yeah, I think you know, in the real-world data we are seeing that transmissibility really play out. Okay, we have two other kind of signs that this is pretty transmissible. One is 200 cases from or one travel case from Hong Kong, I, we tested them, they came up positive while they are quarantining in Hong Kong after traveling from South Africa. And when we tested him, his viral load was incredibly high. So this means the amount of virus in his nasal cavity was very high, which means and gives us another clue that this is incredibly transmissible. The other kind of clue that we’ve had in the past few days is a flight that landed in the Netherlands, from South Africa. They test everyone right when they landed on the Tarmac and 61 people out of 600 tested positive, which is also you know, a 10% prevalence rate is very high for this kind of random testing. And so we think this little bugger is transmitting really quickly.

Andy Slavitt  26:15

Okay, so transmits quickly. Now, the one other question related to the transmissibility is how will it fare in areas where Delta is strong? That’s right. So what can you tell us about that? And why is that important?

Katelyn Jetelina

Yeah, that’s actually kind of the key question a lot of people in countries that have really high Delta right now, like the United States really need to know, South Africa actually was very low prevalence, very low transmission rates when Omicron was introduced. And this is not the case of the United States where our house is already on fire. And so what our key question is, is can Omicron push Delta out of the way, the only way it can do that is if it’s more transmissible. So if that R-naught is higher than Delta, then Omicron will take over places like the United States where Delta is very high.

Andy Slavitt

So if it doesn’t, and the word that people use is out compete, if it doesn’t out compete, Delta, should we be as worried about it?

Katelyn Jetelina

No, we shouldn’t be. But I will say from the United States perspective, we shouldn’t be that worried about it. We actually saw this with Mu. Mu, it was another variant that we discovered down in Colombia a few months ago and Mu is actually very threatening to our vaccine immunity. But the reason why this really wasn’t brought on our radar why we well, it was brought on our radar, why we weren’t too concerned about it, is because it was not more transmissible than delta, it couldn’t push Delta away. So Mew was not a threat to us in the United States. Really anything that can push Delta away is a threat.

Andy Slavitt  28:01

Okay, but under the scenario where it doesn’t out compete Delta, but it doesn’t, and we’ll get to this in a second, but it doesn’t respond to prior immunity in areas where there still people have not been affected by delta, even in the US. Then note for those individuals, that would make Omicron a threat.

Katelyn Jetelina

That’s correct, if it can catch ground and infiltrate those circles and that are not vaccinated or not protected yet.

Andy Slavitt

Got it. Okay. So that’s a little bit about the transmissibility. We’ll learn more. But it sounds like your bottom line is there’s some real-world evidence which suggests this is highly transmissible. Now, let’s, let’s talk about severity. And there have been, you know, a fair number of people have been paying attention to the press a fair number of have come loose or anecdotal comments, saying, oh, people seem to have mild symptoms, that doesn’t appear to be severe, etc. And given how early it is in the discovery, and given that those are just anecdotal reports, should we really be paying attention to that? Or is it too early to really know.

Katelyn Jetelina 

I think we should be cautiously optimistic. Um, there is a chance that this doesn’t create more severe disease than Delta, for example. So what that means is, if you’re infected with COVID 19, or SARS, cov. Two, is there a chance that you will be worse off than for example, with delta or another variant of a concern? And we just don’t know that yet. Like I said, we have a very, very small sample size right now. The other thing that we need to consider and keep in mind is that severe on a population level, severity or disease severity lags cases about three to four weeks. And so if you know South Africa is in the really the beginning of its wave that started just a few days ago, we will not see major changes in their hospitalizations on a population level for another few weeks. And so again, unfortunately, we’re kind of at the mercy of time.

Andy Slavitt  30:14

Right. Can you tell us a little bit about scientifically? What mutations would there be? Or what properties that the virus would have that would cause it to be more severe if that was indeed the case?

Katelyn Jetelina 

Yeah, so the virus can mutate a lot of different ways. One, it can be more transmissible, but it could also make disease more severe. And it does that by either entering yourselves a lot more quickly, being able to infect a lot more cells, and really kicking off the immune system. So your body starts getting overwhelmed with the immune response. And that’s what really triggers severe disease and death. And so we have to keep one look at those labs, that those mutations are there and not there. And then to see also what happens on an individual patient level.

Andy Slavitt 

So it really would be the speed at which it would enter the cells that would cause it to be, in this case, more severe or Delta acted more quickly, right, than the wild type. Which caused problems, certainly for people showing symptoms, even if they were vaccinated. Is that the kind of thing you’re talking about here? Is it something different?

Katelyn Jetelina

Yeah, its speed as well as number of viral particles, as well as number of ways that that virus can enter our cells and in fact, and damage our cells. And so it’s really kind of a gambit of all the above.

Andy Slavitt

Got it? Is it possible that it’s less severe? We talked about it being more severe or equal? Is there a potential that it could even be less severe than Delta?

Katelyn Jetelina

It could, it certainly could, viruses mutate randomly, and they don’t necessarily mutate to become more severe. Their goal viruses goal is to survive. And so if they, you know, kill off a ton of hosts, they’re not going to survive either. And so it could really go either way.

Andy Slavitt  32:16

Got it. Now, when people talk, this is a little bit of a fanciful question, because I’m going down the scenario, road, but when people talk about COVID-19, could eventually become just another strain of the common cold. And it could become something that at some point in the future, becomes less worrisome. Is that how it would happen, a more contagious version that was more mild, overtook the Delta variant, and all of a sudden, we were left with a very mild but highly contagious virus?

Katelyn Jetelina 

Like I said, it can, it certainly can, it can mutate to become less severe for us humans, we kind of we just don’t know, if it will, these things change at random and the ultimate goal this virus has, we don’t know what that will look like.

Andy Slavitt

Okay. So at this point in time, it could be either more or less severe. Interestingly enough, if it’s less severe, then it might not be the worst thing in the world for it to help you beat Delta. Is that a fair statement?

Katelyn Jetelina 

That could be a fair statement? Absolutely. Um, I think that is a fair statement, if your ultimate goal is to not kill people, which is a great ultimate goal. I think that we have other concerns as well with COVID-19, like long COVID. And so mortality isn’t necessarily the only outcome. It’s a complex question. Yeah, it’s a very complex question.

Andy Slavitt 

Got it. Okay. Well, look, you have young kids, so get used to getting complex questions that are very hard to answer. As we all know, as parents, you’re probably the one parent who can like answer all of your kids questions. The rest of us are like, let me sneak a peek on the internet for it.

Katelyn Jetelina  34:05

We have Google Now.

Andy Slavitt 

Google makes parents sound smarter. Let’s talk about the third dimension. Now. We’ve talked about contagiousness; we’ve talked about severity. Now let’s talk about its properties to evade immunity. And there’s two types of immunity we have just as a refresher, there’s immunity we get from taking a vaccine, which hopefully you’ve all done and being boosted. And then there’s immunity that you get if you’ve been infected before, what’s the latest you’ve seen on what it does to immunity there from prior infection and from vaccines?

Katelyn Jetelina 

So we haven’t seen that data yet. And we are still waiting on it. And the reason why we’re waiting on it is because it takes time for a lab scientist to one develop or engineer a virus and that you know, looks like Omicron and then it takes time to grow it in the lab. So we have enough of it to test whether our vaccines or infection induced immunity holds up against this new variant. So you know, I we’re gonna get some pretty solid evidence, I would say in about a week or two.

Andy Slavitt

Got it. Now, I’ve had some conversations with a few people who have been reviewing the South African, some real world South African data. And I think if you read the tea leaves and interpret the comments from people who have seen the data? Well, I think they haven’t come out with it yet. What I think it seems to indicate are numbers that look a lot like beta in real world. And what they have been able to do is look at people who’ve been fully vaccinated, and look at how often they’re getting COVID from Omicron. So maybe we’ll talk about that in a minute. But let’s just maybe keep it at a higher level, the idea that this could render a vaccine less effective or ineffective entirely. Tell us about that. And what that possibility looks like, and how that affects both infection, as well as a more severe illness.

Katelyn Jetelina  38:53

Yeah, so I think the common misconception here is that immune escape, it’s not a binary event. It’s not a yes, no event. If this happens if Omicron is, you know, a threat to our vaccines, it’s not going to we’re not going to start from square one. And this is because immune escape is more like corrosion, it kind of chips away at how effective our vaccines are. And it does this kind of on two ways. One is what you’re mentioning is antibodies. So we have antibodies that are floating around our system because of our vaccines. And we have many different types of antibodies, they can connect to very different ways on the spike protein. Now if the spike protein is changed a significant amount like it is on beta or even on Omicron then it gives our antibodies less places to hook on to and because of that there’s more opportunity for that virus to not be neutralized and then infect ourselves and start replicating And so what the number one question lab scientists are trying to figure out is, is there still room for this vaccine antibodies to attach to the virus key, we hypothesize that there is, the reason we hypothesize that there is, is because of this thing called evolution competition. So, for the virus to survive, it has to change enough to outsmart our vaccines. But importantly, it can’t change enough where the key doesn’t fit at all into our cell doors. And so if the key still fits, and it looks like it does, then our antibodies will probably still recognize parts of that key. And so that is kind of the one. So that’s the antibodies, we need to know how many antibodies still recognize this virus? And how many can attach on really tightly? And then the second part is, like you’re saying, is it the T-cell response. So this is really a secondary response. You know, if the antibodies can’t catch the virus, before it infects our cells, then T-cells really kick in. And what T cells do is, they are a second line of defense. And it’s really much harder for viruses to trick T-cells. And the reason for this is because T-cells can cover almost the entire spike protein, unlike antibodies, where they tend to focus on very small regions of the spike protein. So we are pretty optimistic that this virus isn’t going to completely escape our vaccine immunity. And we have to start from ground and you know, ground zero, but really, it’s going to chip away at ever effectiveness. And then the next question is, what do we do dependent on how much of our effectiveness is chipped away.

Andy Slavitt

Got it. So summarizing a little bit and also maybe throwing in a little bit of the prior knowledge that I have from some of the conversations that I’ve had.

Katelyn Jetelina  42:10

Yeah, I want to know what these conversations are?

Andy Slavitt 

Well. So look, I think, on a real-world basis, they’ve been able to look at a couple different things. One is the regions that have been highly vaccinated recently, and regions where Delta has spread recently, and they’ve been able to look and isolate people who have had that are within a month or so of having their second between one month to two months of having their second vaccine. So they have some real-world data down there, which I’m sure they’re going to share shortly. Which takes a look, and look, I don’t think I’m saying anything that you can’t tell from Tony Fauci’s comments. You know, I think he is acknowledging that the vaccines are highly likely to be less effective. And the probably even more the case equal, if not more the case for prior immunity. Again, this is based upon observations. So what I think Katelyn just said, and I think it’s important to realize is that there’s a lot of analysis that can go on to look at why is that the case? How does it reflect T-cells? How does it reflect to regular antibodies that reflect memory B cells? And how does it most importantly, how does it really reflect the most important thing, which is keeping us from getting very sick. But I would say that if you imagine that there is significant erosion, in the number of people that get infected, and less significant, but still meaningful erosion in the number of people that gets severe illness. That’s what it looks like, based upon again, just as one set of observations, we’ll have to see it against more data and love to see it against what goes on in their lab analysis.

Katelyn Jetelina 

Yeah, and I think one of the really big questions is do boosters play a significant role here, because we know that boosters really stimulate the immune system. So it means it can increase you know, the number of antibodies, so more can attach to these viruses. But to a lesser but even maybe even more important extent, boosters can also generate a more broader level of immunity. In other words, boosters can develop antibodies against more parts of the virus. And so we actually, you know, just saw this in a preprint SETI and so I think the really big question is, how do these boosters really impact Omicron? And is that enough protection for us going forward?

Andy Slavitt  44:42

Right, Katelyn, I just had a little sidebar, the question that we are, you know, wrestling with is both for people who’ve been vaccinated, where I think Caitlin’s point is that even if there’s erosion, it’s not complete erosion. It’s going to be something erosion. And then what we don’t know, is I think it’s an excellent point is whether or not the booster restores some of what’s been lost. And we’re going to study both of those things. The other question for people who haven’t been vaccinated, which probably isn’t a lot of the people on this call, but people who think they’ve got protection from prior infection, I think we’re gonna learn. And I think some of the data that I think we’re going to start to see emerging is likely going to confirm that if you’ve been infected with something prior to Omicron. It’s not going to be very helpful to Omicron.

Katelyn Jetelina 

Yeah, actually, WHO came out yesterday with their daily update briefing that they are seeing reinfection rate much higher among those that had infection induced immunity. And we already saw that way Delta, too, right? I’m not too surprised.

Andy Slavitt 

Yeah. But it will be news to Laura Ingraham and others on Fox who’ve been saying that there’s a 27-fold benefit over a vaccine if you’ve been prior infected. So there’s that to deal with. Well, look, you’re in Texas, so you probably hear a bit of that around you. Okay, so you’ve given us a sense of what we know, at this point in time. And I’m accredited. Thank you for that. Let’s now let’s wildly speculate. And I think the first thing I think to do is just to provide people a sense, I think, what will be a very comfortable fact, which is how these mRNA platforms are set up. And our confidence level and the confidence level of the scientists at places like Moderna and Pfizer, around what they see and what their options are, can you review a little bit of how quickly and how effectively we think the mRNA platform can adjust if, in fact, it needs to adjust to what it says in Omicron?

Katelyn Jetelina  46:42

Yeah, this is really where the beauty of mRNA biotechnology comes in, you know, it’s very easy for these vaccine sponsors to change the formula very quickly. In fact, you know, Moderna, and Pfizer have, I think Pfizer said 100 days that they need to one make the formula which they’ve already done, two, start testing it and people three, manufacture it, and then distribute it to arms. And so that doesn’t necessarily mean we need Omicron specific vaccine, and Moderna and Pfizer have already really come out saying they’re testing really three potential solutions, one developing full new vaccine, or, you know, an upgraded formula for mRNA. Vaccines, this would actually take the most time. The second is Moderna and Pfizer have actually already created a new vaccine formula against a Beta, another variant of concern. Omicron and Beta are very similar. They have a lot of similar mutations. And so I think the key question, and what they’re trying to answer would be does a beta specific booster that’s, you know, been tested on a couple 100 People work? And then the third option is, this one does a booster work? Or does a higher booster work? So for example, with Moderna, my booster was 50 micrograms, but they’re testing what 100 dose microgram would do. And this would actually cut out manufacturing distribution corners, and this would really get to us fastest because it’s already at pharmacies. And so we are really, vaccine sponsors are on top of this. And they’re really testing these three options, if and when we need to respond.

Andy Slavitt  48:35

That to tell us that even if we hear the words immune evasive, which I think I would signal is, you know, highly likely, at least to a large degree. And as Caitlin said, not fully, it is a little bit reminiscent of I hate making the flu comparison for obvious reasons, but it’s a little reminiscent of the fact that, you know, we get different mutations every year from the flu, and we do need updates. And so in that sense, this is a little bit familiar and not all that unusual.

Katelyn Jetelina

That’s true. Every year we need a new flu formula because it changes so often. We know that Coronavirus doesn’t mutate as quickly as the flu. It certainly mutates quicker than for example, measles that hasn’t changed since the 60s. But because transmission is so high around the globe right now. That is what’s really driving this to change really quickly. If and when we get transmission low enough for an endemic state. I don’t really don’t think that we’ll need to continue to have regular boosters, we just won’t need it because it won’t be changing as quickly, won’t be jumping from person to person.

Andy Slavitt 

Okay, we’ll cover a few final topics with you. You’ve been so generous with your time. Let’s start by talking about the importance of global vaccinations. Most of the rest of the world outside of Africa and some remote parts of Asia and South America have pretty high levels of vaccination. Now, the countries that don’t, many of them are in Africa where the average vaccination levels 10% or so there’s multiple reasons for that. People might assume it’s all because we don’t have enough vaccines that we’ve sent there. But the recent are a bit more complex. That is indeed a factor, of course. But there are other complexities like how to distribute the vaccines and vaccine hesitancy, and so forth, all the same things we face here that they’re facing other parts of the world. But for viruses to mutate effectively. They need hospitable environments, which as I understand it, are places where there are low vaccination levels, and particularly places where there are immunocompromised people, because that allows viruses to replicate for longer periods of time. It’s just a better environment. First of all, is that true? And secondly, what does that tell you about what our responsibility is here relative to what we should be doing in Africa?

Katelyn Jetelina  51:03

Yeah, it’s completely true. You know, this virus is going to mutate, as long as we have so had high transmission, it doesn’t matter if the transmission is in the United States or somewhere else where this is a globalized environment, we are all very much connected. And so what we need to help other countries get as vaccinated as protected as possible, not only to help them, but also to help us this is going to be a team effort. And you’re right, if this is more of a concern, and populations that are immunocompromised, with, for example, HIV infection, the virus can stick around and immunocompromised at lower levels would, but with the ability to change and mutate within that host. And so this is a global problem. And we need to figure out a solution whether that is I think you mentioned other vaccines that aren’t mRNA that you know, can be stored and can be traveled from hundreds of miles to towns. I think the other important concept that you briefly mentioned was vaccine hesitancy or this pandemic of misinformation. I’ve heard from multiple sources that South Africa has a very good vaccine supply, they actually told Pfizer to stop sending them vials, the problem that they’re having is vaccine hesitancy, similar to the United States because of misinformation, because of politically charged rhetoric. And we need to address that as quickly as possible as well.

Andy Slavitt  52:55

Got it. monoclonal antibodies, there are some studies that show that the monoclonal antibodies may need some adjustment as well. Is that true?

Katelyn Jetelina

Yeah, I would not be surprised if that was the case. And unlike antibodies that have a polyclonal response, so they can look at multiple different angles to connect on to the virus, monoclonal antibodies are not they look for really one spot. And so, um, we already had a look into that. monoclonal antibodies don’t work well with beta if at all. And so if we’re going on this theme that Omicron is very closely related to Beta then I wouldn’t be surprised that will need to change monoclonal antibodies.

Andy Slavitt

How readily adaptable is that platform? Any idea?

Katelyn Jetelina 

I assume it’s pretty adaptable.

Andy Slavitt

How about the oral antivirals that we’re all eagerly anticipating from Pfizer and Merck? Do we think that this would render them less effective?

Katelyn Jetelina  54:04

I don’t think so. I think that the treatments will still be effective, the challenge will be trying to catch the virus and the infection early enough. So those treatments can be effective. And we have we’re gonna have to do that through massive testing.

Andy Slavitt

Right. It’s PICCHIO testing. I have heard that the at home protein-based tests are still effective at discovering Omicron. Have you heard that as well?

Katelyn Jetelina

Yeah. So they’ll still be able to identify that you have the virus or not, they will not be able to tell you if you have Omicron or Beta or Delta for example. And so yeah, so you can still I really trust those at home testing’s.

Andy Slavitt 

Got it? So I have my next call with the White House today. This is the fun question for you. You got your white boards behind you. What would be the top three things you would suggest I advise them.

Katelyn Jetelina 

Get rid of this travel ban. This does not, it does not make sense. It is not evidence based, You know, omicron is already here. We haven’t identified it. But travel bans are not going to work for a few select countries.

Andy Slavitt 

And travel bans don’t work because people go hop from country to country. Travel bans don’t work, because they slow things down a little bit, but not significantly does explain why travel bans don’t work. And by the way, travel bans are harmful. And it’s so many other ways that it’s important that we understand whether they work or not.

Katelyn Jetelina 

So I will say a travel ban to every single country in the world wouldn’t might work. But a travel ban to a few select handful of countries, that’s not going to be effective. And I think one important thing you also mentioned was that this can do a lot of damage to perpetuate disease related stigma. And we really don’t want to do that because South Africa has really taken the lead with this virus and we need to treat them as such.

Andy Slavitt  56:16

Okay, that’s one piece. One other two pieces of advice would you like me to give them?

Katelyn Jetelina 

Second, I would tell them, tell them to advise everyone to get their vaccine. It may seem counterintuitive to say get your vaccine, with this language of immunity escaped floating around, but getting the vaccine specifically getting people their booster is going to need to be our number one priority right now. And the third thing, and this is something I’m passionate about is they need to communicate with the public. They need to bring the public along for the ride. I continue to be disheartened that we have not heard anything from the CDC. Except one little press briefing.

Andy Slavitt 

The President’s gonna speak in an hour.

Katelyn Jetelina

Oh, perfect. Good. So we’re gonna hear from them, but I think that, people fear what they don’t know, the immune system is incredibly complex. I still don’t know a lot of things about the immune system. But we really need to try to elevate the public to try and explain what’s going on and explain that we need to be cautiously optimistic and that there’s a lot of people working on this around the globe.

Andy Slavitt 

So you advise vaccines you’d bide by so let’s talk about what else we advise people, I assume, good ventilation and masks?

Katelyn Jetelina 

Yes, we need ventilation. We know that this is airborne. And so ventilation does a lot, masks, guess. I think we’re all getting sick of saying wear masks. But this is really important even for vaccinated indoors and test, antigen tests, we need the, you can tell Biden this too. We need more antigen tests that are freely available to people so they can take them at home on a weekly basis. And then isolate if you’re positive really but banks back to the basics.

Andy Slavitt  58:20

So a lot of the same. Now let me ask you the question that I’m sure we’re gonna start to get from a lot of people, is it still safe to travel over the Christmas holidays? And I think there are people that are planning, you know, certainly trips to see family. In other parts of the country, there probably are also people who are planning to travel outside of the country. How would you advise folks about that?

Katelyn Jetelina 

I’m getting the same question a lot on you know, from my followers and I hate to say this, but I don’t know yet. I weighed I don’t know, I would keep your plane tickets right now, knowing that you may have to cancel them in a few weeks if this one gets out of control, and two, once we know people may not be as protected as needed.

Andy Slavitt 

Got it. Okay. Finally, question for you. You had this wonderful Facebook blog, which you could get on sub stack, which I’ve signed up for, I’m paying you money which is called which is you go as your local epidemiologist. So, maybe talk a little about that, but I want to one thing in particular, you sign all of your blogs or all of your entries love, your local epidemiologist, can you talk about that?

Katelyn Jetelina

You know, I think that people really need someone to trust right now. I’m someone that keeps politics out of the science and so I tried to be endearing. I tried to understand that this is a very confusing time. A very hard landscape to navigate right now and so I tried to be as personal as possible, I honestly haven’t thought about using second thought about using that love until you brought it up. But that’s really been my goal. And this actually, this newsletter actually started as an email to our faculty and staff at my university, my dean asked me to, you know, keep everyone updated. And then one of my students asked me to start putting it online, so she could share it with family and friends. And so what started off as, you know, just a couple of 10s, 20s, 30 people, where I was signing it as love, your local epidemiologist has reached about 110 million people since and so it’s really grown, it’s really needed. And people really want to understand what’s going on in layman’s terms. And no one’s providing that. And so I’m happy to do so.

Andy Slavitt  1:00:55

It’s amazing. I mean, it’s really found exactly what you said, which is this place as a place where people can go to get very understandable, very reliable information. And there’s a warmth to it, I will tell you what love communicates to me on here, and I would encourage you not to give it a second thought. It just simply communicates that you care, that you care about people, and that you don’t just care about the science. And that, you know, we have a degree of empathy that people are going through challenging times when they’re reading about this, and then it might tense them up, it might cause us to tighten our shoulders. You know, when we’re reading about scary topics, and the fact that no matter what you close your note, in a way that just basically says, you know, I care, there’s someone that cares about you, I think is actually very, very powerful. I think it speaks volumes. And I wouldn’t be surprised if it is it another part of what endears you and the work you do to so many people.

Katelyn Jetelina  1:02:01

Well, thank you. Yeah, it’s been a lot of work. It’s been very exhausting. I think I’ve done more than 650 of these posts, but it seems needed and I’m happy to provide the service to my community, it’s the least that I can do.

Andy Slavitt 

Good. Well, thank you for doing what you do. Thank you for coming on IN THE BUBBLE. Information makes things less scary to people and it has to be digestible, or it looks like it’s created for somebody else, and that you’re not supposed to know it. And that’s just garbage. And we got to keep doing a better job of that. And you’re one of the ways we do. So, thank you, Katelyn.

Katelyn Jetelina 

Well, thanks for having me. And this is, this is fantastic.

Andy Slavitt

Thank you, Katelyn. Let’s talk about what’s coming up on our next shows, very timely episode on Monday, on a big change that happened in the healthcare system, which is where we get our care from, home, office, hospital, laptop, phone, SMS, Tiktok, who knows? Virtual care, it’s changing things. And I think with Omicron coming, it’s important that we all focus on how we get places to do things safely. A lot has been digitized. Finally, maybe is healthcare be digitized. Next, on Wednesday, more on the topic of Omicron. With a great guest and a great scientist to be revealed to you on Monday. I’m so excited. And then, just in time for Christmas, we have the question that’s on everybody’s mind. This is the other thing worrying us. Which is what is driving inflation? What is it with the supply chain? Where are things in particular, there’s one thing we’re missing and we’re gonna explore it, try to find it. And that’s Kryssy’s coat. So stay tuned. You didn’t know we were becoming one of those mystery podcasts. But we are okay. Have a great rest of your week.

CREDITS

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.

Spoil Your Inbox

Pods, news, special deals… oh my.

Join Us

See Open Positions

Discounts

Get Discount Codes

Lemonada Media. 2024 © All rights reserved. Site by AC.