Polio has been detected in New York wastewater following the case of a man infected and paralyzed by the virus in July. How much is the virus circulating and what does that mean for you and young children at greatest risk? Andy speaks with New York State Health Commissioner Dr. Mary T. Bassett and Stanford Professor of Pediatrics Dr. Yvonne “Bonnie” Maldonado about how a disease eliminated from the Western Hemisphere in 1994 returned and what we must do now.
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Check out these resources from today’s episode:
- Read Mary’s piece about why even a single case of polio is a threat: https://www.nytimes.com/2022/08/21/opinion/even-a-single-case-of-polio-is-a-threat.html
- Read Bonnie’s piece explaining how global health failures that spread COVID and monkeypox also brought polio back: https://www.latimes.com/opinion/story/2022-08-22/polio-vaccines-united-states-global-health
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Andy Slavitt, Bonnie Maldonado, Mary Bassett
Andy Slavitt 00:18
Welcome to IN THE BUBBLE. This is Andy Slavitt. And it’s Friday, August 26th. Polio on top of monkey pox, on top of COVID-19. No, I want to answer your question. We are not living in biblical times, we’re really not. There’s lots of wonderful things that are happening in the world. But we do have some plagues upon us. Now, even though we’re not living in biblical times, if I were Satan, okay, this is a thought experiment for you. and I were going to inflict polio in developed countries, I might do it just after I completely exhausted the public with a prior pandemic. And a public that is less prepared, and less willing to do the common sense basic things for a preventable condition like polio, are the perfect conditions to inflict polio upon people. In other words, unlike COVID-19, we have a 99% effective vaccine, but a very, very tired public. And as those who’ve been following the news, no, we have now seen what was a disease that had been eradicated in this country for 30 years, show up again, in the US. It’s a case in Rockland County of a man who been infected, and paralyzed by polio virus. So today, we’re going to look at what this circulation of the virus means for our country, what it means for you, with the two very, very best people you could ever possibly hope to talk to about this topic. First, is the New York State Health Commissioner, Dr. Mary Bassett. Welcome, Mary.
Mary Bassett 02:03
Thanks very much for having me.
Andy Slavitt 02:05
And Mary has given me permission to refer to her as Mary. But under other circumstances, not on show I would be referring to as madam Commissioner, it’s wonderful for you to be here in the midst of dealing with this attack. And we have Dr. Bonnie Maldonado, who is Professor of Pediatrics at Stanford, and she chairs the American Academy of Pediatrics on infectious diseases, who better to have joining Mary, then Bonnie, welcome, Bonnie.
Bonnie Maldonado 02:36
Oh, thank you, Andy, for inviting me. And it’s lovely to be here with you and Mary.
Andy Slavitt 02:42
So Mary, tell us what’s going on. We know about this case of polio in Rockland County. Give us a little bit of summary of the news. Is this the only case? And what does this tell you about what we think is happening here in the US with polio?
Mary Bassett 02:58
Sure. And actually, as it happens, I picked up the phone and talk with Bonnie about our situation in New York State as it was unfolding. So on July 21st, we reported that a young adult unvaccinated young adult had been diagnosed with a paralytic disease with polio. And at that time, we started looking at how we could get insight into whether or not there was circulating virus. This individual didn’t have a travel history that made us think that they had acquired polio anywhere but locally. And so we started looking at wastewater, which is a polite word for sewage. Because people shed the virus when they get infected, whether or not they develop symptoms into wastewater. So we started testing the wastewater and we found positive samples for a genetically linked virus in wastewater in Rockland County, later in Orange County. We saw it beginning in May, and up through we’ve had some positive samples in August. So this was a sign that we had a circulating virus that could cause polio, and not just one unlucky individual.
Andy Slavitt 04:16
Is there any way to estimate based on your experience? How much and how widely we you think polio might be circulating?
Mary Bassett 04:24
Well, we said that for you know, the we use the phrase tip of the iceberg, which is accurate. The proportion of people who get infected with develop paralytic disease is less than 1%. So it stands to reason that we could have hundreds of individuals, but we don’t have that we’d have not identified those individuals. What we know is that we have shedding into wastewater over months preceding the diagnosis of this individual and also found afterwards in a geographically dispersed area. So we don’t know are the numbers, but they could be hundreds, they could be higher than that.
Andy Slavitt 05:05
Bonnie can you give us a bit of polio virus 101? How does it spread? When does it spread? What are the symptoms? How often is it asymptomatic? How contagious is it?
Bonnie Maldonado 05:19
Yeah, so Polio is an intestinal virus. It’s in the family called enteroviruses. So there are over 100 different types of enteroviruses and polio viruses are three of them what type one, two, and three. And these are unique in that they only occur naturally in humans. And so theoretically, it’s possible to eradicate them, because if you vaccinated all the children in the world, you could prevent shedding and transmission of this virus over time. And we were very close to eradicating the wild type virus. So this is the naturally occurring virus. Last year, there were only six cases of this virus in the world to this so far, there have been about just under two dozen cases in the world. So in theory, this is a virus that passes you get infected, it passes through your intestinal tract, you excrete it in a little bit in the respiratory tract, but mostly in the intestinal tract of feces. And that’s why it’s spread mostly through places where there is bad hygiene and bad sanitation or even in developed settings where people don’t wash their hands. So detecting it in sewage, in a lesser resource country would mean that people could get it by drinking that water. But in the US and other developed settings, it means that people are shedding it into good sanitation, but they could be transmitting it by hand to mouth or touching each other without washing their hands, in communities and households. So they’re a little bit different mechanisms of transmission, depending on where you live. But if you are vaccinated, you are protected against disease. So the dilemma here is that if people just are vaccinated, there’s nothing to be worried about. It’s really the unvaccinated and the community who can develop paralysis.
Andy Slavitt 07:10
I want to get to the conversation about vaccines, and which is going to get into the conversation, it’s going to naturally I’m sure get a new conversation about why people aren’t vaccinated and about misinformation about all those things. But first, I want to just make sure we’re grounded completely enough in an understanding when I listened to you, Barney, talk about how it spreads. What I picture and tell me if I’ve got this wrong, our little kids in the playground, gone to the washroom, perhaps maybe didn’t wash their hands. We’re talking about unvaccinated now. Because if we vaccinated as you said, there’s nothing to worry about. I’m trying to get an understanding of how it spreads, and how contagious it is, how likely it is to get and then I believe you said Mary, that in many cases, it’s asymptomatic. In fewer cases, but still […] number, there may be some mild flu like type symptoms, and about one in 100. It can cause paralysis. Did I get all that? Right?
Bonnie Maldonado 08:11
Yeah, I’ve been doing studies for polio for over 25 years now. Looking at transmission, exactly looking at transmission of the virus, primarily among indigenous populations. In fact, we’re doing some now to try to track how the virus moves from one person to another, but likely, it’s just dirty hands or dirty water. That’s the most likely scenario.
Andy Slavitt 08:34
So something has to go to the mouth to get the digestive tract. And that’s happened quickly. And then if someone you know, many parents, you know, when they see their kids sick, they think the worst Oh, this could be this. What are the things to watch for that could say, Hey, this is something that’s worth checking out. It’s a kind of symptom that could lead to a more severe outcome, like paralysis. Is there anything in that spectrum?
Bonnie Maldonado 09:00
Yeah. So polio tends to affect people in the lower limbs, usually one limb and not both, but it can be both. It can also affect the whole body, but it’s mostly lower limb. So when you go into in the old days, when we really weren’t tracking polio outside of developed countries, you would do lameness survey. So people would go into different countries and check to see who was lame. And that was a way to detect whether how prevalent polio was. So this is what you see at the endpoint at the beginning, what you see in kids, you think the child is lethargic, and maybe they’re not moving? Well, and then if you get a good neurologic exam, what you find is that they have no reflexes, they’re really not moving their legs there or they may be weak reflexes. So it may not be a complete paralysis with a deep, deep loss of tendon reflexes, but and that’s and it can progress generally doesn’t progress a lot but it can progress and in about a third of people who actually wind up with paralytic disease, they wind up doing fine and getting better, about a third have residual disease. And another third will have permanent paralysis and whatever they presented with, but there’s also a post-polio syndrome that happens 20 or 30 years later, and it seems to be some kind of inflammatory response, where many, many years later people can actually re-experience the same paralytic phenomena that they had.
Andy Slavitt 10:27
We’re hearing about this.
Mary Bassett 10:29
Is the sort of take home on this, though is don’t, looking after your kid in terms of polio, by looking for symptoms is not the way to go? Right? We want to see kids protected from getting these symptoms. Because once a child has polio, you know, you’re now rolling the dice.
Andy Slavitt 10:52
Alright, let’s take a quick break. And then let’s come back and talk about what could happen if we don’t improve polio vaccinations pretty quickly what some of the things we could wake up to in six months or a year from now? In your nightmare, Mary, if we close our eyes to this if we don’t improve vaccination rates if people don’t pay attention? What’s the situation six months from now? Or a year from now? Could we wake up and face, could we see large numbers of cases? Can we see widespread? Can we see this in every community in the country? I don’t want to ask you to scare us. But I do want you to paint the nightmare scenario of what happens if we don’t start to take some of the measures countermeasures, we’re going to talk about.
Bonnie Maldonado 11:55
Let me just say that I think she should scare us. This is scary.
Mary Bassett 12:01
I tend to be a pretty calm person. And I’ve been losing sleep over this scenario, because we have not had community circulation of a polio virus that can cause paralysis. In in ages, the last case in New York State was in 1990. And the last case in the US was an introduced case, these were introduced cases where people went somewhere. And either because they were under vaccinated, or, you know, there were high rates of circulating virus, but this is here, we know that we have a circulating virus here. And so that means potentially anyone who is unvaccinated or under vaccinated is at risk. And it’s a risk that we do not need to take. You know, the idea that we would turn to pediatricians to keep an eye on sick children as a way of keeping track of polio in our community, I think is pretty misguided. I mean, I have complete trust in the diagnostic abilities of pediatricians. But we have a passive way of keeping track of polio virus. That’s the wastewater surveillance that I’ve mentioned to you. And here we have, effectively a human tragedy. That’s proof.
Andy Slavitt 13:19
How many cases could this turn into?
Bonnie Maldonado 13:22
Let me tell you what’s happening in other countries where they are under vaccinated and they’re seeing this exact type of virus. We’ve seen outbreaks of dozens of cases, overall globally, we have over 140 laboratories around the world tracking wastewater, to look for polio, we don’t do it in the US, because we are highly vaccinated. And we don’t worry about transmission until now. But around the world, we’re seeing clusters of overall last year, we had almost 700 cases of paralytic disease, just like this primarily and under the highly under vaccinated countries.
Mary Bassett 13:58
And Syrian refugees, right, that was quite a big outbreak go over 70 cases. So there can be dozens and dozens. You know, I don’t think there’ll be 1000s which because we do have reasonable vaccine coverage. But you know, people should understand that paralysis can be permanent, and one case is reason to respond as an outbreak.
Andy Slavitt 14:24
So do you think we could see if we don’t respond dozens of cases. Bonnie, when you look at the is that an image when you use look at a couple years from now, when you think about the low levels of vaccination in certain communities? Is that your fear as well?
Bonnie Maldonado 14:40
Well, I don’t have to look forward. I can look back to see what happened a few years ago when we had a tremendous measles outbreak with hundreds of cases. And this was all in unvaccinated communities. We almost lost our measles elimination status because that outbreak lasted over almost a year. And that was only mid negated because of vaccination. And so we could see hundreds of cases in the US and they would be clustered in unvaccinated populations. And unfortunately, a lot of those could be very vulnerable and very hard to find and to mitigate. So it puts everybody at risk. And we’re facing a disease here that was literally eliminated from the Western Hemisphere in 1994. So we are allowing a disease to reemerge in a highly resourced country.
Andy Slavitt 15:31
In some ways, I can’t think of anything crueler than a disease which takes someone who is entering the most energetic time of their lives with so much to look forward to, and renders them unable to play, to walk in many cases. And it’s a lifelong affliction. Most of people alive today in the US, don’t remember this. Maybe they’ve seen footage of FDR and maybe they’ve seen footage of kids. But they don’t have a seared in their memories. This just feels like an especially cruel manifestation of a virus. And even if we’re talking about dozens and dozens instead of hundreds and hundreds or 1000s of 1000s. That feels like an incredibly cruel disease.
Bonnie Maldonado 16:21
It’s absolutely a travesty to see this happen. And I think Mary’s point about vaccination is important. Because this is a really a canary in the coalmine, mine tip of the iceberg, whatever metaphor you want to use, we have protected this country from 30,000 plus deaths a year and children alone not to mention adults who can be vaccinated against other diseases. And that is based on what these viruses and bacteria that we have vaccines for, protected us from over the last several decades. And if we go backwards, and we are going backwards, there is evidence now that we are seeing lower rates of vaccination around the country during after the COVID pandemic. We don’t know why we can talk about that in a bit. But we are seeing lower rates not dangerously low, but they are starting to slip. And that’s worrisome because we can prevent deaths, we can prevent hospitalizations, and as you said, devastating impacts on young lives and adult lives too, with simple and safe, extremely safe measures and choosing not to do so I think is very cruel.
Andy Slavitt 17:32
So let’s talk about vaccines here. Very seldom do we get presented with a problem, that we have a very, very good answer for most of the time, the world too complex. We need to deal with global climate change. We need to deal with refugees, we need to deal with very complex issues that unfortunately don’t have a very simple off the shelf silver bullet. Do we have a silver bullet here, Mary?
Mary Bassett 18:01
Absolutely. And I just want to underscore what Bonnie has just said that the occurrence of circulating poliovirus is, is really a shocking observation. And it is a sign of going backwards and we have a safe and effective vaccine. We’ve had it for decades, we’ve been immunizing people, since the 1950s. It’s based on base, frankly, old fashioned vaccine technology. And this doesn’t have to happen. We can really turn this around this is very different than the new presentation of a of a known virus, which happened with monkey pox or a novel virus. This is something this is an ancient scourge, that 20th century public health and science was able to put push to the brink of eradication, and that’s still within reach. But we have a whole set of complex issues that have to do with how people feel about vaccines. That is the barrier to this.
Andy Slavitt 19:14
Alright, well, let’s get into talking about those barriers, and how to overcome them. Because it really is the heart of the matter, right after the break. You know, we do know that with COVID-19. There were a number of people who said, and I think quite a reasonable question to ask, hey, this is new. How do we know it’s safe? I’ve always believed that that’s a reasonable question to ask and it deserves a straight and fair answer. And what they were saying is hey, this ain’t the polio vaccine, which we’ve been giving people forever. Okay, now, this is the polio vaccine. So maybe you start with you, Barney. Why do we think people are not getting vaccinated in that getting their kids vaccinated?
Bonnie Maldonado 20:15
Well, as you mentioned, I just actually rotated off being Chair of the Committee on infectious diseases for the American Academy of Pediatrics. But while I worked with them for 12 years, I was really fortunate to be able to work with a pediatric leadership around the country and actually around the world around these issues of vaccine hesitancy. There’s just so many different reasons. But let me just give you a very simple minded for me, I mean, the way I think of it simply scenario, and this is when a new family, as you said, never seen any of these diseases, because we’ve been successful. They walk in the door, they have their brand new baby, this perfect little bean. And they come in to see their pediatrician and they see this, you know, all these shots that the baby needs to get, and yet they see no disease. They say, Well, why should I give these shots to my baby, there’s no polio, there’s no measles. There’s very little pneumococcal disease, there’s all of these things that we’ve never seen. So in many ways, public health people, officials, like Mary, really are victims of their own success, I think, I think it’s hard to prove a negative. So the fact that something’s not there is really hard to impress on families now, talking to pediatricians around the country. And you know, the American Academy represents 67,000 pediatricians, so they’re dealing with this on the frontlines every day. And what most of them have done, in my view, is really sit down with families and explain it. This is why you need this, most of us who are old enough, saw these diseases every single week, in our practice, in our hospitals, children dying, or being, you know, mained for life or having other complications. Honestly, if you haven’t seen it, you can’t explain it to people. But every single night that I was on call in the 80s and 90s, I was thinking, okay, when is that kid with meningitis gonna walk in the door? When is that next kid gonna die, we have protocols for all this stuff. We had children die every single week here at this hospital. And all around the world from these diseases, and they’re not gone. They’re just, we’re just protected. So you wouldn’t stop your insulin or your antihypertensives or your statin, because you’re better you keep taking them. And this is the same thing at a population level. We need to continue these vaccines because those viruses and bacteria are still out there.
Andy Slavitt 22:43
So I’ve been asked this question cautiously, because I’m really reluctant to use the term anti-vax, if there are communities that are under vaccinated, those are ones that are vulnerable here. Then there are people, organizations that are fighting the in legislatures, I think in dozens of states right now, there’s proposed legislation to make childhood vaccination requirements at schools illegal to make vaccinations in certain locations illegal. So there’s a big effort here, and I’m not on both sides are not trying to give equal time to their point of view. But I do want you to help us address the skeptics and the critics and the deniers a bit because let’s say it’s a young parent is at a school and they run into another parent who’s loaded up with some of these messages and is not getting their child vaccinated. Presumably, we want to try to start with a level of understanding what is going on this parents had they’re not a dumb person, they love their kids. All those things, help us understand a little bit better. So, maybe the conversation be had or maybe it helps as people think about how to have this conversation, Bonnie, maybe ask you to start on that.
Bonnie Maldonado 24:00
Well, you know, our we have a pediatrician in the California State Legislature and he passed also the non-medical exemption law and he gets regularly routinely gets death threats. So yeah, it’s frightening. And I do think what you said and the I don’t know what you think, Mary, I think some of these people truly have decided they’re going to believe it. I don’t know if they in their hearts believe it, but they have decided that they’re going to believe this stuff.
Mary Bassett 24:26
Yeah, and I think that part of it is a source of identity. We talked about loss of social solidarity, but people you know, get into these groups and get, you know, a lot of affirmation and reinforcement and a sense of worth.
Andy Slavitt 24:43
Yeah, you’re I think you’re right. I think once you’re there, if you meet other people who are there, it’s so self-reinforcing. Mary, you’ve written about how in addition to I think there’s various two points that Bonnie makes that you’re asked me to protect my child against something that I can’t see and hasn’t been here for years. That the messenger when the messenger is the government, people rebel with the government and the message is someone in authority. People are repelled. Can you talk a little bit about that, and how to get around that?
Mary Bassett 25:18
I think that there’s a growing distrust of government. We are all very aware of that. And it’s extends to a growing distrust of public health authorities, which is something that we have to work really hard, well, I think it’s by being trustworthy. And I think having the opportunity to have conversations like this, and say that people who have questions should discuss them and the people I would like to see people talking with about their questions about vaccines as their pediatrician or their family doctor, I would plead with them, not to go to the internet. But to take your question to the person who your child is going to take responsibility for your child’s health over the coming years. That’s, that’s the place to have those conversations. But we all know that communities that are under vaccinated often are targeted by misinformation in New York City during the measles outbreak that Bonnie mentioned, there was clear targeting of under vaccinated zip codes with misinformation. So it’s a combination of parents legitimate concern about protecting their tiny, their tiny, perfect newborn, we recommend that people start vaccinating their kids that two months for polio, that’s pretty young. But it’s also just the incredible amount of misinformation that’s out there. Let’s turn to the pediatricians and the family doctors and ask your health department as well.
Bonnie Maldonado 26:57
Yeah, you know, I think Mary is absolutely correct that here in Stanford, California, our county health officials we work hand in hand with them, it really has to be a partnership, it really needs to be done. I think mostly at the local level, clearly the federal level is important to support. But the local and state, public health officials need to be supported by trusted voices in the community, it’s critical to have that combination, people trust people that they know. And the problem with social media is you’ve got a bot there that you think is a person and you think that you know them, and they’re just feeding you a lot of bad information. So knowing a real person is important. I think that gives we talked about at the local level, really trying to engage with individuals. And what we’ve found in general, not only at the US level, but actually globally now is the majority of people are, can are feeling like they can be convinced they just need to hear more, they need to be dealt with at the local level, they need to understand what they need to be heard. But there is a core group of people who really have a variety of motivations. Some of them are, you know, you my body, my choice kind of thing, which interestingly doesn’t happen when you’re pregnant. But it can happen for this. And then other political motivations that I can’t even begin to imagine.
Andy Slavitt 28:24
And religious as well, right?
Bonnie Maldonado 28:26
We cite the religious documents that say you can be vaccinated, so I think people can, they can jump over these. But the point here is that there are other motivations that go behind some of these groups. And they started to team up even more during the pandemic. And this is really a political core of people who are using this and a variety of other issues. I really don’t know what to do about those groups, but I think one of the things that we try to do, at least is in the pediatric community, is really try to focus on the overall community focus on the people that you can convince work with those individuals. You know, one other issue, for example, you can’t, you know, when you talk about the public health, and what’s the public good, where does Where do your rights and somebody else, right, stop. We don’t tell people, it’s optional for you to stop at a red light. It’s optional for you to wear a seatbelt. All of those things, pay taxes. Exactly. And so And actually, we’ve gone there, right, there are people who do think that there are certain limits to what the public health can do. But there is precedent and I would urge us to continue to push on legislation that legislation that you mentioned, and the firing of public health officials who back vaccination is really bone chilling, it’s insidious. We are at very high risk for these people. So I don’t have an answer, but I think we need to congratulate people like Mary who do this work every day.
Mary Bassett 30:00
Also New York state, got rid of religious exemptions some time ago. So we have a pretty robust commitment. There are medical reasons that that some people may not be able to receive vaccines. And those are should be documented. And they’re reasonable. it those are the individuals that all of us are seeking to protect when we get vaccinated the people who are unable to be vaccinated. But I agree that and when we talk some about, you know, the notion of, of social solidarity, and the ways in which this has ceased to be a compelling argument for many people in this country, and that’s a source of great concern.
Andy Slavitt 30:47
I mean, there’s so few problems we’re capable of addressing on our own truly, without the help of others. And we can’t forget that, you know, I’ve had governors share with me letters that they received from, again, I don’t want to say anti-vaccine, but people who are really trying to get rid of all these protections and restrictions. And the governor asked me his opinion of a letter he sent me recently. And I said, Well, it’s 40 lines long. And there’s 11 lies in it. That I found, totally 40 lines long. And I can’t tell whether or not the person who wrote it believed what they were writing, or didn’t, I have no way of knowing. But I do know that if I didn’t know they were lies. It could scare me, because they are they were really absurd statements. I think what you pointed out Bonnie, to wrap this up, and gives us some hope that Mary’s work will go rewarded, which is there are still a large number of people a far larger number of unvaccinated people that probably aren’t doing it for reasons like I haven’t seen polio in this country, as you said, so why would I do it? Or that are saying, I don’t really want to stick a needle into my baby, if I can avoid it. And I think all you need to tell people who are in that category. It’s here. And we have an answer that has worked for decades. And 99%. And it is not the live virus, because that’s a rumor that goes around that people get concerned about. And we will never get everybody in this country. We will never get everybody. I also want to close give each of you a chance to have the last word, Bonnie.
Bonnie Maldonado 32:33
Yeah, thank you for, for having us on. I think this is a really important time to highlight the successes that public health and science have brought together to improve the lives of people in the US and around the world. Today, 30,000 children a year don’t die from diseases in the US and 3 million children a year don’t die around the world, from diseases that are still lurking out there in soil, in other places, in animals. And we can keep those diseases away from our children, we can keep them healthy, and keep them alive and thriving. But we need to really invest in our public health infrastructure. We need to learn how to build better communication skills from the federal level to the state and local community levels, and make these public private partnerships available so that everyone can be protected and that everyone can realize that these are scientifically based, proven, effective interventions, and that we should believe in science as well, while we’re doing it, because we just want to see that next generation thrive. We don’t want to go backwards. Like it looks like we are now but I think we have hope that we can continue to move forward.
Andy Slavitt 33:53
Mary Bassett 33:54
Well, thanks very much, Andy, I think conversations like this are part of what we need to confront the problem that we’re facing in New York, which is that we have a circulating polio virus identified definitively in several counties, which can cause paralysis. And the answer to this is for people who are unvaccinated to get vaccinated. We it also means that people were behind not getting vaccinated, meaning that I haven’t vaccinated their kids yet to get vaccinated. And I know that every parent, every caregiver loves their children, and they want to see them protected. So I’m going to rely on the facts and the fact that everyone really cares about preventing bad things from happening to their kids and, and that’s how we’re going to get vaccination coverage up in New York State.
Andy Slavitt 34:47
Well, bless you and thank you for your great work and being up front of this and we wish you all the luck and Godspeed. Thank you for all your great work and your continued great work.
Mary Bassett 34:57
Thanks very much.
Bonnie Maldonado 34:58
Andy Slavitt 35:12
Okay, let me tell you what is coming up as we head towards the end of summer. We’ve got a few things relative to kids heading back to school. Monday show is about school ventilation, Rich Corsi who is a show favorite, and Jim Rosenthal, they have created a way to take any room and ventilated school classroom anywhere else. They’ve been doing a lot of work with schools. I know that’s on people’s mind. But it’s not just for parents. It’s also for people who want to have good indoor air ventilation because they don’t want to get COVID or inhale smoke from fires. So it’s a cool episode. Wednesday, Rochelle Walensky, the Director of the CDC is going to be on when she’s going to open up for the first time in a real way about what is going on with the CDC what led her to take the position she did, which was to say that CDC is broken a very unusual thing for Director have anything to say that will be interesting. final week, we’ve got Sanjay Gupta coming on, who’s a good friend. And we also have a conversation around learning loss as kids are back to school. Pretty profoundly interesting research around what’s going on with kids and how to help make up that time and we’ll have lots of good shows around that. So thanks for tuning in. Have a great weekend.
Andy Slavitt 36:37
Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.