The Next COVID Threats Emerging Around the Globe (with Katherine Wu)

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COVID-19 variants are evolving around the world, impacting the trajectory of the pandemic and our ability to fight it. Andy speaks with microbiologist Katherine Wu, who’s been writing for the Atlantic about how surges in North Korea, China, and South Africa will affect the U.S. and what we can do about it. She expresses cautious optimism about variant-specific vaccines, worry over zero-COVID policies in parts of Asia, and insight into what the virus will do next.

Keep up with Andy on Twitter @ASlavitt.

Follow Katherine Wu on Twitter @KatherineJWu.

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Andy Slavitt, Katherine Wu

Andy Slavitt  00:17

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. It is now Monday, or whatever day it is, when you’re listening to this podcast, we have a lot going on around the world. As we know and today we’re going to talk about the things that are going on around the world with regard to the pandemic and the pandemic we’re so used to using interchangeably with COVID-19, or at least I am. But this last week has been a reminder that there are other public health outbreaks out there. And in fact, on Wednesday, we’re going to be talking about one of them, which is a new outbreak of monkey pox. And many folks may not even have heard of monkey pox before this last week. So I will be talking to that through on Wednesday explaining what’s happening, what to be worried about, there’s a little to be concerned about. And I think, particularly if you’re worried about being the type of person that worries about other people, there may be a little less to worry about regard to your individual health. This is a little bit less of a stealthy virus, but it is concerning and we’ll talk about it, we’ll make sure you have all the information that you need, there are cases in the US and that’s no joke. Today, we’re going to talk with Katherine Wu from the Atlantic, she’s a great reporter, we’ve had on the show before she’s a super explainer. She’s been looking at many of the current hot issues that should be on our minds. And I wanted to spend a second before we get into this interview, to give you some of my thinking about how we should be thinking about what’s on our minds, we look to things that we look out the window and talk about today. The cases, the hospitalizations, the deaths, et cetera, those are all really important to look at because do they tell us how to stay safe, they tell us what we should be worried about. But we largely can’t do much about it. We can do things to keep themselves safe. And people we love safe. But we can’t do anything to prevent a wave that’s currently here. The only way we can really think about things that we can do that are actionable, is to look at the things that might be happening four or five months from now, because it’s really the things that are happening four or five months ago, that generated the wave we’re seeing today, the emergence of new variants of Omicron.

Andy Slavitt  02:41

And it’s the things that are happening today, that if we pay attention to we can influence that will have an impact on what happens in the fall in the winter. It’s that very thing that I think is really important to pay attention to because there’s some weird things going on around the world, we should pay attention to, number one, the frequency of variants coming out of South Africa, and the nature of those variants, what they look like. Number two, the events in China and to a different degree North Korea, taking countries that had been closed and had zero COVID policies that are largely unvaccinated. There is a dam about to break in China, that much like the first time we saw COVID in China soon impacted us greatly. The same could be true again. We have a witch’s brew of factors, older people that haven’t been vaccinated people that have been in doors, a virus that is spreading way too rapidly for the Chinese authorities, even with their lockdowns to prevent from happening. And similar and even more dire circumstances in North Korea, we could see millions of deaths in those two countries alone. And furthermore, we could see a spillover effect with the increased pace, even more changes and more surprises in the virus. And it’s important that we look at it and understand it. I would say that today is one of the most optimistic episodes you’re going to hear. And it’s not really intended to be optimistic or pessimistic. It’s really an exploration of the facts and some of the things going on. And I don’t mean to leave you with additional worries that you didn’t have coming into the podcast that is not the purpose of the podcast. In fact, I believe that information, knowledge and understanding will ultimately reduce our fears need to worry getting those facts right, getting the right information and misinformation from reliable sources like Catherine R. helpful, but I will tell you that there are some new things on the horizon here that are worth paying attention to defeat. And a lot of it also comes down to this battle between science and the virus. The virus,

Andy Slavitt 

from an evolutionary perspective, spends efforts to outsmart the protective measures that we take, we put forward protective measures to try to outsmart the virus. And it’s kind of a wildly contest, it goes back and forth. And I just want to tell you, that science will ultimately win. I 100% believe that there’s nothing that’s so clever about this virus, that the more we understand it that our scientists can’t understand it better. That doesn’t mean that there won’t be periods of time, when it will feel like the virus is getting the best of us and in China and North Korea right now, what’s happening in South Africa, I think it’s important to say, science says work to do. And by the way, that science doesn’t just extend to what happens in the lab, it extends to how that science gets implemented in the real world. Because we can create the best vaccine in the world. But if no one takes it doesn’t do any good. And you know, that’s in part what we’re dealing with in North Korea, and in China right now. And I’m really fearful for what we’re going to see in those countries and the loss of life alone, even with the fact that we can protect ourselves well, from what we see. And we’ll continue to, I think these are things we need to watch. And I’m grateful Katherine came on to talk about it with us. Hi, Katherine.

Katherine Wu  06:43

Hello, how are you, Andy?

Andy Slavitt 

I’m good. Thank you. It’s been a little while.

Katherine Wu 

It has millions and millions of eons and pandemic time. But right, I’m good, I guess, to another year, another chapter of this.

Andy Slavitt

Another chapter. That’s probably where we should start, I guess. First of all, I love your reporting. And I love your writing, even separately from your reporting, I think it might be interesting to just begin by asking the simple question of having you paint the picture of where we are now in this chapter. What are the realities? We’re learning about Omicron? And, you know, how should we be feeling? What should be our temperature check?

Katherine Wu 

You call this question simple, right? Yeah, it is a great question. And I’m actually going to parse it apart by how we’re actually defining we, I suspect that you and I belong to a cadre of people for whom we could say the pandemic is going a lot better. If I were to get sick, I could probably, you know, do pretty well, I might be able to get my hands on some treatments, some tests very, very quickly and feel pretty good about my risk being super low, I’d be able to isolate, I’d be able to protect my family, and not worry all that much. Because I know I have my vaccine and my booster behind me. I know that the hospitals locally are pretty well equipped to treat me. And that would be great. If I expand we out to the US. Ah, I don’t know, I don’t feel that great about things right now. It’s certainly not the worst place we have ever been. But cases are absolutely rising. hospitalizations are luckily not following suit to quite the same extent. But I am worried about the lower severity applications. And then if we go all the way out to the world, I’d say things are still looking pretty bad. We don’t have to look that far outside of this country to figure out that the pandemic is absolutely still raging. And it is looking terrible in some parts of the world that are under vaccinated and don’t have access to some of the resources that we do.

Andy Slavitt  08:57

It feels like there’s reason to feel like okay, things are getting back to normal. We have, as you say, the tools, the vaccines, the boosters, the therapies, better knowledge of how to treat things so that we don’t have to be all consumed. And then there are these kind of probably moments of panic, or anxiety or uncertainty because we kind of have been trained to see that. We don’t know what’s going to happen 90 days out from now at any point. Is that the right way to be feeling like we’re just caught in between without really having a sense of what’s to come.

Katherine Wu 

Yeah, that’s a good question. I mean, I definitely feel like I am living with a lot of uncertainty right now. You know, things do feel better, and I do think we can afford to appreciate how far we’ve come and how much better off we are in terms of like having the tools, as you say, but I think, you know, there’s one extreme where we feel 100% Certain and 100%, complacent and another extreme where we live in constant chaos and are anxious and terrified all the time. And I don’t want to set either extreme. I think people have a lot stronger sense now of what risks they feel comfortable taking of you know how to sort of navigate all this day to day uncertainty. But it is still really exhausting. It’s a lot to deal with. And I fully appreciate how fed up people are, at this point with reading all of these headlines with being surprised and caught off guard every day, I totally get the impulse to want to check out of this.

Andy Slavitt  10:45

Well, let’s talk about that uncertainty a little bit. I think for a while, our conception was okay, this will someday be over there, we’ll be back to normal that I think we adjusted to okay, maybe there’s no such thing as herd immunity, because the virus will persist. But maybe it’s getting milder. And maybe it’ll be like the flu or seasonal for people who are vaccinated and boosted. And then increasingly, there seems to be a different sense of things with Omicron. And I’m wondering if you can tell us a little bit about how you’re thinking about it, about a virus, it’s continually evolving, not seasonal. And that as it reacts to all of the blanket immunity or levels of immunity, it’s adapting to be a kind of a constant and more frequent part of our life like a really bad common cold, that doesn’t go away, just keep circulating. That’s pretty scary.

Katherine Wu 

That notion definitely is scary, but I don’t think we yet have a guarantee that what’s that is what is going to be like, I think we could eventually see that this does settle into a more predictable seasonal pattern, it may look kind of like flu where we have, you know, a big fat winter surge, roughly every year in the northern and southern hemisphere, it could be by annual like we get some sort of summer surge, some sort of winter surge, it could continue to be sort of like this, but each wave being a little smaller than we have now. I don’t think we have a good sense of how predictable that is. I mean, we have other viruses that circulate through the population, and aren’t perfectly seasonal. So there’s a lot of precedent that could pave the path here. But I think what is likely to happen is that waves will get less frequent waves will get less intense. I just can’t say anything about the exact cadence or the magnitude right now. And it may still take quite a bit of time for things to settle. And things may not settle to the same degree in different parts of the world.

Andy Slavitt  12:46

Okay, so let’s, let’s get into that. I think it’s good to start with how we’re feeling because that’s a good pulse check. But then maybe let’s get into some of the facts. So maybe we’ll take a bit of a tour, can you start with what we’re seeing, and learning about Omicron Evolution, what we’re seeing, and how it behaves behaving in South Africa, and what that suggests about what we’re likely to continue to see here, in this sort of Omicron period that we’re in.

Katherine Wu 

Yeah, and it’s interesting to call it the Omicron period, because it does seem like Omicron has been on a bit of a roll lately, like we’re getting all of these sub-variants that all sort of belong to this lineage. And we haven’t really totally seen that before. You know, before we had alpha that was replaced by delta, which was replaced by Omicron. But they weren’t directly giving rise to each other. You know, Delta was not a descendant of Alfa Omar Khan was not a descendant of Delta. But then Omicron arrived, and now it’s just splintering off into all these successful sub variants that all kind of belong to roughly the same branch of the family tree. And that’s pretty interesting. You know, I know that this is something that you’ve talked about before, but we have this idea of like, ladder like evolution with other viruses like the flu, you know, this year successful strains beget next year, successful strains beget next year successful strains. It’s not always perfectly like that. But there’s this sort of stepwise ratcheting forward of evolution that makes it a lot easier to sort of get a sense of where the next threat might be coming from, and also importantly, how to design our next vaccines. There is more predictability there. And, you know, it’s possible that this may be the start of this happening with this Coronavirus. But, you know, pretty much everyone I’ve been talking to has been a little wary of saying, we’ve got our flu like evolution. This could just be you know, the virus continuing it’s sort of radial Starburst pattern, less ladder like and more like, you know, spokes erupting out of a center of a bicycle wheel. But this book just happens to be kind of a longer one that it really, really likes and it’s going to be a fat spoke, but in a few months, we could easily get another Greek letter. And I think it’s also important to keep in mind that even though all of these you know, be EA 1-5 variants do technically fall into the Omicron umbrella, they’re really different from each other, the virus definitely hasn’t given up on its strategy of, you know, changing its appearance to get around our antibodies and other parts of our immunity. You know, the differences between, say like BA4, BA5 and BA1, they’re huge, arguably, you know, some of those differences could warrant giving some of the BA’s, their own Greek letter.

Andy Slavitt 

So let’s talk about this evolutionary battle that seems to be going on between the virus and our attempts to defend ourselves from the virus. What is happening, who’s winning that battle? And, and what very precisely is, do we know about what, what the virus in these various democratic lineage forms is doing?

Katherine Wu 

Yeah, I mean, it’s, it’s messy, and I would hesitate to declare a victor anytime soon. I guess I sort of picture it as a really extended race, and I have no finish line here in mind. The virus is certainly mutating at a pace that we can’t really totally keep up with, especially not with our vaccines.

Andy Slavitt  16:15

Is this a reaction to so much vaccination and so much prior infection, is this the bug saying, hey, wait a minute, I’ve got to start to evolve differently?

Katherine Wu 

Yeah, you know, I think sometimes it’s pretty easy to anthropomorphize this thing, but truly, it is just going about its way it is mutating randomly. And sometimes those random mutations, give it an advantage that help it get around some of our immune defenses. And that is what takes off, there is no purposefulness here. There is no virus being like, Oh, god, look at all these vaccinated people. I know what to do about that. Throughout this entire pandemic, the virus has really had one goal keep infecting people, keep infecting as many people as quickly as possible. Early on, in the pandemic, no one was immune, and the virus had a ton of success, just being fast speed was really enough to get it by move from person to person as quickly as you can. But now that more and more people are immune speed is not really enough anymore. And it’s sort of switching to this regime of stealth, how do we sort of get around people’s defenses? That is what is helping the virus still spread as fast as spreading?

Andy Slavitt  17:55

So let’s talk about our response or scientific response. You know, what are the benefits that we always talk about the mRNA platform is how adaptable it is, how we can slot in different iterations, if you will, of the vaccine, and adjust it as the virus adjusts, which should allow us to take this competition to the next place. You’ve written, I think, a great piece about this, which we will of course link to, in the notes to the show. But can you describe a little bit about what you see happening? And what the challenge of creating a vaccine to combat this side of widely survival oriented viruses?

Katherine Wu  18:41

Yeah, so I think it’s actually useful to turn back to flu as a comparator here. So every year we update the flu vaccine. And we have about six or so months of lead time to do that. The flu vaccine technology is slower, it takes more time to update than mRNA vaccines. But there’s enough predictability in how the flu spreads. You know, we get a northern hemisphere wave and then a southern hemisphere wave. And so we get a sense of what’s spreading on the other side of the world. Let’s put that in the flu vaccine for this hemisphere this year. As we talked about earlier, we don’t really have that predictability. With SARS-CoV-2, we don’t have that much lead time. And even though the mRNA platforms are a lot faster, you know, I think Pfizer’s some Pfizer’s best estimates are that we can feasibly get an update to a vaccine within about 100 days. That has not been fast enough. I mean, Pfizer did start that process when it when micron was first detected and Botswana in South Africa back in November.

Andy Slavitt 

We’re way past 100 days.

Katherine Wu 

Yeah, we’re way past 100 days and we don’t have an Omicron vaccine and overcome vaccine a BA1 vaccine is being slotted for fall. And BA1 is pretty much gone. It’s out the door.

Andy Slavitt 

And so this is what you write about which is you know, even with this quote unquote speed, you know, it’s not seven years it’s months Whatever, whatever we want to say about the about the platform, as a practical execution matter, they started working on this in November with BA1. Yes, they can make the vaccine quickly. But they’ve got to run a whole bunch of tests on people. By the time they get done running these tests evaluated data, BA1 is history, right history, and went to […] whatever you want to call it. We’re like not in that boat anymore. And so how do we keep up with this? And what should be the right strategy for developing a new vaccine for the fall the US, which is what I think we all anticipate.

Katherine Wu  20:45

Right, so this is, I think, incredibly messy. I do think that if we do continue to update these vaccines regularly, which could become an annual thing like we do for flu, it will go faster. In future iterations, we won’t necessarily have to have trials that are this protracted, we may be able to have smaller trials. And you know, once I think that the gears are oiled, and all these vaccine companies, these updates can come faster. But you know, as we’re pointing out, it’s probably never going to be as fast as the virus is evolving. It’s tricky. I think we can expect that with growing immunity, there’s a very good chance that the virus will slingshot variants our way at a slower clip. But I wouldn’t count on it necessarily. So what do we do if we’re always a few steps behind? It feels like we’re kind of playing variant whack a mole, and the virus is eight steps ahead of us every single time. I think there are, you know, ideas in the pipeline. You know, a lot of people have been thinking about what if we spray vaccines up our noses? And will that do a better job at preventing transmission and infection? Will that help slow down viral evolution? Will that keep cases down? Will it have these knock on effects, so that we’re keeping pace a little bit better? Another idea is to you know, sort of cram a bunch of different versions of Spike proteins into the same shot, maybe teach the body a ton of breath at once. And if we sort of design those shots correctly, there could even be, you know, a universal aspect to them, it could teach the body to, in theory, anticipate or, you know, recognize variants that don’t even exist yet. And that would be really incredible. It would give us breath in one fell swoop. I think those are really promising ideas. But we don’t have those yet. So I think this fall, might be a little rough next fall might be a little rough.

Andy Slavitt  22:33

Those are 5 to 10 year ideas, they sound like to me, yeah. Which is to say like this battle of science against the virus, if I were going to make my long term bet, I bet on science, but I would also say that at any given moment, the virus could be leading. And right now I think we’re at a period where the virus is winning. And in these battles, it feels like we’re seeing if this year is any guide, you know, we may sink COVID-19, three times a year, right? It’s only four months or so, between the South African cycles four to six months, right? So two to three times a year, a wave two to three times a year would be a very different future than it was a year flu cycle.

Katherine Wu 

It would, I don’t think we have a guarantee that that’s what things are going to be like, you know, we are still very much in the pandemic.

Andy Slavitt 

I want a guarantee. I want a guarantee.

Katherine Wu 

I think we can guarantee that the virus is going to stick around in some form for at least a while.

Andy Slavitt 

There we go. Thank you. I feel like the genie that rubbed the bottle and […] made the wrong wish.

Katherine Wu 

I mean, this is messy, right. And like I will be the first one to admit this. This sucks. We are getting so much more of we are getting so many more waves than I think anyone would like. But you know, I don’t want people to be afraid that they’re going to be doomed to be reinfected three times a year in perpetuity for the rest of their lives. We don’t really have anything that does that. But you know, the longer we keep ourselves in the pandemic, I think the more frequently those things will happen.

Andy Slavitt  24:13

I want to ask you one other question about the vaccines before we move on. And I’ve asked this question if Peter marks I asked that of the CEO of Pfizer and Moderna and also, Ashish Jha recently, and I guess, Rob Califf. So I’ll ask you as well. Do we think we ever have a hope of getting back to a vaccine and by ever, I mean, this next cycle that not only prevents hospitalizations and deaths, but can be effective at preventing infection and preventing, essentially then preventing much more contagion?

Katherine Wu 

There’s always the chance. But I think with this next cycle in the nearest term future, it’s going to be really difficult. We’re still relying on the same technology and as we’ve talked about worse still gonna be a few steps behind with regard to viral evolution. I think even if we slotted BA1 into our shots right now, there is going to be some trickiness, the variants that are starting to dominate here in the US and other parts of the world, they are able to get around some of the defenses raised by BA1 infections, and they are able to get around some of the defenses raised by the original recipe vaccines. And, you know, obviously, it is wonderful that our vaccines are still preventing severe disease and death. But it is incredibly difficult for any vaccine to prevent symptoms and infection really, really, really long term. And I think that means we are probably going to have to turn to additional technologies, different types of vaccines, or look outside of vaccines, if we really want to keep transmission down long term.

Andy Slavitt 

We’ll go next is maybe continue to just talk about what’s happening in other parts of the world. If you have some thoughts, it is interesting that South Africa appears to be the place that is where at least they’re having the first discoveries of the first cycles, and then things move here. But there’s other things happening in other parts of the world, which are interesting and worth watching. There are a set of the zero COVID countries, which, you know, were effective for a variety of reasons for a long, long time and holding off COVID from coming to their shores, in earlier iterations. North Korea, you know, Australia for a time New Zealand for a time, China because of its policies. And, you know, now given what’s happened around the globe, they’re now dealing with the introduction of a much more contagious version. And in many of those cases, they have very low vaccination rates or less effective, effective vaccines. Feels like a dangerous recipe, not just for those countries, which is sad enough, but also for the evolutionary potential of virus, doesn’t it?

Katherine Wu 

Yeah, absolutely. I think the countries that you’re mentioning, you know, North Korea and China especially, they are definitely in very, very precarious spots right now. You know, we’ve seen them have huge outbreaks, you know, China’s sort of coming off of one, North Korea’s is really just starting right now. And I am really concerned about what’s going on over there. I think especially because of the low vaccination rates, especially among elderly people in China. And pretty much everyone in North Korea, as far as we’re aware, you know, this virus now moves way too fast, that we can’t sustainably keep it out of our population, this is probably going to become a forever virus for us. And while those strategies maybe had some sense early on, in the pandemic, when cases are still extremely, extremely low and not spreading at this speed across the world, this is not a sustainable policy, not against the virus and not for the people who have to whether it’s effects.

Andy Slavitt 

So what’s gonna happen? Well, maybe you could start with what’s happening now, to your knowledge reporting in China and in North Korea. And tell us how you see that evolving?

Katherine Wu  28:09

Yeah. So you know, to my understanding, you know, North Korea, I guess I can start there. There is a huge outbreak going on there right now. And I think, you know, they’re calling them fever cases, sort of euphemistically, pretty much no one is vaccinated because the country refused vaccine and vaccines and aid from other countries. And we know there are a lot of vulnerable people there. The country has a malnutrition problem. There are many parts of the country that don’t have access to good medical resources. This is going to be very, very, very bad. And I think this is a real demonstration of probably two things, you know, having an unvaccinated population that is, unfortunately a failure to prepare to take proactive preventive measures to steal a population against a virus. And you know, we’ve got a lot of, unfortunately, skewed messaging about, you know, how quote unquote, mild variants of Omicron are, and this is a real proof that that is absolutely not the case. When you have a population that doesn’t have immunity. A virus can absolutely rip through it and cause immense debilitating disease and death. The reason that hospitalizations have dropped in other parts of the world is largely because immunity has built up but where it’s lacking. We’re not seeing that effect.

Andy Slavitt 

It’s a really sad but interesting, scientific case study to look at the question of is it that it is getting more mild or is it that we are getting better layers of protection? Because North Korea is sitting, as you say, in a place where it doesn’t have it’s been a closed country, they haven’t vaccinated and they’re facing this and when all said and done if you look at those death rates the IFR, and it looks like it did in the 2020 version here in the US, it will be sort of a relatively definitive piece of evidence, won’t it that it’s actually not getting more mild, we’re just getting with this is moving away from a novel virus to something that we have various levels of protection against.

Katherine Wu  30:15

Right. And, you know, definitely the fear is that if we continue to let this virus spread, as it has, in some of these countries that we’re talking about, we are going to see more variants, and there is no guarantee that the next one we see is going to be mild, milder, any iteration of that word, it could be more severe, it could be worse than Delta, which is arguably the worst iteration of the virus we’ve seen so far in terms of severity.

Andy Slavitt 

Right. And as you said earlier, if you are given human characteristics, again, you’d say it does naturally look for ways to overcome the kind of immunity that we put up not necessarily to kill us. Because that’s not a great recipe for the virus either. But, you know, our defenses are something that it seems to be adapting to. What about China? That’s a really fascinating, scary situation. And one of these kinds of dilemmas that I can’t figure out what to do.

Katherine Wu 

Yeah, I mean, they continue to double down on their zero COVID strategy, wanting to keep the virus completely out, which they did manage to do for a stretch. But that has certainly not been the case for the past few months. You know, omicron, I think just proved too overwhelming for that strategy. And what I’m honestly, I guess there’s two main things that I’m worried about there is that people are still being asked to adhere to these pretty extreme behavioral measures, you know, they can’t go outside, it’s really having a severe impact on the economy and people’s mental and physical well-being, and the virus still is slipping through. And you know, the other big problem is absolutely not enough of the older population is vaccinated. You know, and we know that the vaccines that they’re using, while they’re decent vaccines, they’re certainly nowhere near performing, as well as the mRNA vaccines we have here. Boosters aren’t widespread, and, you know, the population has some immunity, but it’s absolutely not maxing out on the immunity that they could have.

Andy Slavitt  32:12

So let’s just be very specific in this kind of dilemma. You know, if China, let’s go of its zero COVID policies entirely. Given the vaccination level among seniors, the numbers seem to suggest that we could lose millions and millions of people.

Katherine Wu 

I think that is exactly the bind the country is in, you know, it’s almost this bizarre and horrific sunk cost fallacy, like they have done this euro COVID strategy, they have not maybe prepared as much as they could in terms of vaccination, because zero COVID was working. And now they’re in this bind, where they’re in a very precarious spot, they, you know, release one pedal, they’re gonna get massive, massive, massive disease and death, if they, you know, release the other, or, I guess keep holding the other, which is maintaining the zero COVID policy, it’s just not going to be sustainable. Either way, it seems like this dam is about to break. And you know, that the best thing we can hope is that they do get vaccination rates up before the stem breaks to the degree that we’re expecting it to.

Andy Slavitt 

It doesn’t appear to be happening for everything I’m reading, do you know. So it’s, it’s really this very, very odd situation where it started there, it’s boomerang back there locking people down. The reports from even Western reporters who are in the country, about the really kind of severe nature of this lockdown is startling. If you’ve if anyone wants to read any of those accounts. These are not large residences where people are living in and being not able to go outside at all, for any reason, is pretty dramatic. I mean, there’s something like 40% of the country is on lockdown from what I saw. And then the spillover effects? Well, I think we’d all agree, secondary to talk about relative to the human life, of how much of the economy in a world economy is, comes out of China. There is there is you look at sort of what’s happening in the kind of global stock markets to just pick an indicator of what people are seeing. You know, there are a lot of economists I’ve talked to who said that the world’s just not built for China to be at a standstill that everything from supply chains, to food supply, to everything else, just as a risk, because everything now so global. Yeah.

Katherine Wu  34:35

I mean, I think this is one thing that we’ve confronted repeatedly throughout this pandemic. You know, we have this global economy. We have markets that work globally, but we have not really had a unified front and when it comes to public health and infection prevention, and so we’re seeing these two things collide in ways that are incredibly tragic. I don’t know what’s going to happen next. Isn’t going to be good?

Andy Slavitt

So what should we pay attention to now, I mean, that’s kind of a sense of what’s going on around the globe. And as with everything, it’s been very hard to predict kind of one season to the next, what happens? And it feels like there are so many unanticipated consequences of what could come out of China, the reason we went to this conversation is because what comes next could be related to some combination of what’s happening in North Korea, China, South Africa, other parts of the world that, you know, are hard to predict, but will be easy to explain after the fact. How are you processing it all? And what are you thinking about as the things we should be watching for?

Katherine Wu  36:09

I guess there’s two categories of things that I’m thinking about. I’m thinking about what the virus could be doing right now and what we could be doing right now and maybe or not, to start with the virus. I mean, I don’t know where all of these variants are coming from no one knows exactly, for sure. But there are some interesting things to talk about. You know, I certainly think the motif here is that the more the virus is allowed to copy itself and mutate, the worse that is that could be happening in us. So the more cases we have, the more infections we have, that is going to be worse for us. And exactly as you’ve been pointing out, you know, growing immunity does put different pressures on the virus, we’re walking it into a corner, so it’s slipping around us and finding somewhere else to play. It’s also worth keeping in mind that, you know, the more we let it spread among us, the more it has a chance to jump into other species kind of explore the space there and pop variants out that way. What’s really fascinating about what’s going on with Omar Khan is that there does seem to be at least some reservoir somewhere, whether it’s in the wild or in a person who doesn’t have a fully functional immune system. And it’s making it very easy for the virus to just pop variants out at this astonishing clip. And, you know, the way to prevent that is the is to prevent cases from going as crazy as they have been.

Andy Slavitt 

And as you say, not just incremental changes, there’s something going on, which is allowing this to make pretty significant changes in the spike,

Katherine Wu

right. And we’re not quite sure what that is, like, why whatever environment it’s hanging out in is so permissive, but you know, certainly the more shots on goal this virus is allowed to take, the more it’s going to make. But I think it also is worth pointing out that it doesn’t seem like this virus needs to make that many changes, to really slip around some of our defenses and other coronaviruses have definitely shown this capacity as well. You know, you you’ve squeezed the virus and one part of its anatomy, it sort of bulges out and another to draw sort of clumsy analogy here. But it is a really flexible virus. And I think we just can’t take that for granted.

Andy Slavitt  38:12

So that’s one of the things you’re looking at. The second thing you mentioned, was how we’re responding?

Katherine Wu 

Right. And, you know, definitely worth looking at what the US isn’t, is not doing right now, I think, you know, thinking about what we just talked about with North Korea and China. Those are unsustainable ways to manage the pandemic and what we are hopefully working toward after the pandemic, I think these are the things that we need to start thinking about, how are we going to handle future outbreaks? How are we going to, you know, live sustainably with this virus living with COVID is not letting it run roughshod over us. It’s having a plan, what do we do when cases start rising? You know, how do we reckon with when cases rise? But hospitalizations don’t. What is the right time to act? And what can people tolerate? Especially after two years of, you know, so much suffering? You know, there aren’t easy answers to these questions. But something that I am always thinking about is not just what tools we have available to us, but you know, to whom they are available. I think there is this common tendency to sort of look at where we are at the pinnacle. You know, what do people have access to when they have access to everything, if the people who have the access to the most resources can get tests and packs loaded and excellent masks and they have vaccines and boosters and you know, they can get you know, a plus care at the hospital that is one mile from their house. That’s phenomenal. Their risk is relatively low. But what does that say about everyone who is you know, eight 910 degrees removed from that. I’m constantly thinking about, you know, the least common denominator. If we don’t have those same resources accessible to at least you know, some partial degree. That is what defines what the pandemic It looks like in a country, it is the denominator, you know, the foundation, the bottom of this mountain, where we have to be looking, and the goal is to elevate the bottom, not just keep pushing the top up, I think if we don’t do that we are just going to exacerbate the disparities between these groups. And that is what is gonna keep outbreaks going. That is what is going to fuel I think, more suffering for much, much, much, much longer,

Andy Slavitt  40:26

Which you say is true. And of course, it’s true at a time when the vaccines are free to everybody in this country. Presuming they can even you know, that they can access them, they at least don’t have to pay for them. You know, we’re now looking at least a potential future where if Congress doesn’t act, that will no longer be the case. And the resources that go into not only producing a vaccine and distributing it, but making people aware of it, getting it into doctors’ offices, educating people, because as we know, you know, we can’t live with a with a vaccine that’s 60% effective taken by 30% of the public. Right, that’s just not enough. So the strategy of equity is a strategy that such as good for some people, that’s a strategy that’s good for everybody, when it comes to fighting an infectious disease.

Katherine Wu

And I mean, that the funding question is huge right now, you know, we’re not allocating enough domestically at we’re absolutely not allocating enough internationally, I think there will continue to be, you know, pieces that move 10 countries, and, you know, if we don’t pay attention to the global picture, the US will continue to suffer because of it. But you know, the plan going forward, I am incredibly nervous about it. I don’t even know what is going to happen this fall, will there be enough vaccines for the people who really, really, really need them? The people who really, really need them? And then what about the rest of us? It is a pretty scary time, like if this virus is with us permanently, our response to it has to be with us permanently. And I’m not sure I see that right now.

Andy Slavitt  42:06

Right? That leads me to believe, which is why I think I started the conversation this way that our response is very science dependent. Because we’re very much not shown a willingness to do very much that requires any amount of sacrifice that’s hard. That, particularly now that most people feel individually. Like they’ve got ways to keep themselves alive. When people felt like, you know, their life was threatened or their someone in their household life was threatened. They maybe responded differently. But this feeling of feeling more safe now means that the tools available, are really limited to, you know, what can be done scientifically, and then what we’re willing to pay for and distribute that wrong.

Katherine Wu 

It’s an interesting way to think about it, I think, you know, there are things to absolutely focus on the science and technology side, you know, we knowing that, you know, human behavior is an incredibly big factor here, I think it absolutely is worth paying attention to some interventions that could have public health benefit without asking people to take a ton of individual behaviors and individual decisions that will sort of tax people’s, you know, pandemic psychological budget every day ventilation, making treatments free and available, making tests free and available, increasing booster uptake, you get one shot a year, and you’re kind of set for a while. I mean, booster uptake in this country is a disaster. As you know, we only have a third of the country there, these sort of base level productions, I think are what will help raise the foundation that I talked about, it will lower risk across the board if we’re actually able to distribute those things equitably. And we could get to a point where, you know, we are pretty much never asking people to put on a mask, mandate masks, things like that. But I think that’s going to take enormous long term investment. And we do have to make sure that that supply is there. But I don’t think we can ever fully take the behavioral aspect off the table. Like, you know, there was a really interesting analysis done a few months ago, looking at, you know, which countries did well during this pandemic and why and, you know, trust in government, trust in people’s community members, trust in each other, makes a huge, huge, huge difference. And that is incredibly fractured in this country. I think if we don’t have trust in leadership, if we don’t have a communal mindset that makes me think about not just how I’m doing but how you’re doing, how my neighbor is doing. We’re not going to have a sustainable policy going forward. I mean, it’s very clear that individual decision making and you know me, for me does not work when the threat is collective like this. It is going to stay collective it is going to be you know, continually collective especially knowing that, you know, we have these disparities and who has access to what? And who was safe from what? If we don’t, again, think about the foundation, we are going to get ourselves into a lot of trouble because the virus gets worse. That is something that affects all of us, even those at the very top who have access to everything right now.

Andy Slavitt 

Oh, 100%. So I’d say that this was on edge. I would say this was kind of a relatively pessimistic conversation, would you say? Oh,

Katherine Wu 

Not one of my curious now.

Andy Slavitt

And look, I don’t think we’re, I think we’re calling it as we see it. I don’t think we’re trying to color this more or less optimistic or pessimistic. But the outlook is what I think it find so fascinating. Just looking around the globe, as we’ve covered today, it’s always insightful to have you in here, I don’t think we should manufacture any optimism that doesn’t exist. But I will leave you with an opportunity for the last word. If there are things you’re looking at that we didn’t cover, or that give me a reason it gives me said to be a little more hopeful than we’ve covered.

Katherine Wu  46:02

There is one thing I am really excited about. And that is next month, hopefully getting to ways for Moderna and Pfizer’s vaccines for kids under five. I don’t think that that is going to end the pandemic on its own. But it will offer hopefully hundreds of 1000s of kids millions of kids the opportunity to have some production have some immunity, especially for the kids who are too little to be masking and you know for whom parents have been worrying for years on end now.

Andy Slavitt 

For those parents every day is a century. Between now and when that can happen. We still got a lot of challenges we got to work on. Thank you for coming in the bubble again. It’s such a delight when you do. You did a great job explaining to everybody the current state of affairs.

Katherine Wu 

Always a pleasure to be here and sorry, I couldn’t be a little cheer here today.

Andy Slavitt

It wasn’t you; it was actually it’s was much me than anything else.

Katherine Wu 

All right, I’ll let you take the blame for this one.

Andy Slavitt

On Wednesday, we are going to find out what we need to do about monkey pox. You’ve probably seen it in the headlines. What should you be worried about what you’d just be aware of? We’ve talked to Andrew […], who is the director of the Center for Global and Immigrant Health at UCLA. She is an expert on monkey pox. We’re grateful that she has chosen our show to come talk about things. Friday, we’ve got a Friday conversation, where we’re going to talk about one of the things I know that’s on everybody’s mind, which is the price of gas, the price of food, the availability of gas, the availability of food, particularly important going into Memorial Day weekend. Next week, Beto O’Rourke, who is running for governor in the state of Texas, we’re going to talk to him about his race and the issues that are emerging there. General Gustave Perna, oh, I’m so excited for this general partner was the head of Operation warp speed. He is a four star general, amazing guy, inspiring guy, Larry Summers, is going to be on to talk about the economy. He is the former Secretary of Treasury, Scott Kirby, who’s the CEO of United Airlines. We’re going to talk about pilot shortage and travel and transportation issues around masking and mainly the other things that impact us as we head into the summer. So very excited for all those shows. Glad you’re staying with us. Look, your job now is to very simply have a great Tuesday, and we’ll see you Wednesday.


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

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