Subscribe to Lemonada Premium for Bonus Content

Description

With BA.5 infecting and reinfecting people around the world, Andy wants to know why some people keep getting COVID while others seemingly never contract the virus. Apart from your daily safety decisions, it may have to do with your genetics, gut microbiome, and defense proteins called interferons. Physician and scientist Eric Topol breaks down these theories for Andy as they discuss BA.5’s severity compared to earlier versions of Omicron and what variant could come next.

Keep up with Andy on Twitter @ASlavitt.

Follow Eric Topol on Twitter @EricTopol.

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/

Check out these resources from today’s episode: 

• Read Eric’s Substack article on the three lines of defense against COVID-19 in our immune system: https://erictopol.substack.com/p/its-the-virus-stupid
• Find vaccines, masks, testing, treatments, and other resources in your community: https://www.covid.gov/
• Order Andy’s book, “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response”: https://us.macmillan.com/books/9781250770165

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, Eric Topol

Andy Slavitt  00:26

Welcome to IN THE BUBBLE. This is Andy Slavitt. Today is Wednesday, July 27th. We have a really great show today Eric Topol is coming on. Eric is a great scientist and friend he’d been on the show before, we’re going to talk with Eric, about why some people seem to be getting COVID more than others, and why some getting worse than others. Why some are more prone. And there’s a lot of work that research in this area. Eric has also done, I think quite a bit of work, which we’re going to talk about around BA5. And we’re going to just give an update on what the B five wave looks like. So I tested positive this morning, I test pretty regularly, woke up to a bit of a well, you don’t need to hear all the details. I don’t want to give you TMI but just a little bit of a head cold and sore throat you probably can hear took a test, which I’ve done probably 50 times. And I’m used to coming back negative in this morning. It didn’t. Thankfully, at least so far, Lana’s is negative. So she’s okay. Although I don’t think I’ll be seeing her for at least a few days. So how did I get it? I really don’t know. I mean, I have been traveling when and when not to see the boys in New York, we went back to Minnesota, I wore a mask almost all the time, although I’m sure there were occasions when I know there were occasions when I sat around chatting with people where I didn’t have a mask. So spent the morning making sure those people will aware. Hopefully, I was around them before I got positive, but who knows that they’re off testing. So we will learn. Anyway, I don’t think we’re gonna have like President Biden, I’m gonna have a doctor’s report issued every day. So far, you know, my usual kind of wonderful self, although no one will know it. Except for you guys, because I’m on my own for a few days. But I will report back on symptoms if they change. But so far, in a bit of a headache, cold, sore throat, you’ve all been through it, I was getting a little cocky, to be honest. I was thinking, maybe I’m the only guy in the planet, that’s not going to get it. But hopefully, that will be enough of a lesson to all the rest of you who haven’t gotten it yet. And it is possible it comes in hopefully a lot of won’t get it. So the show with Eric is great. It’s really timely. And we actually covered so much that we are going to do a second episode with Eric next week. And next week, we’re going to focus on some of the solutions that he sees, to moving us out of the current rut that we’re in, and particularly a really important idea around some innovations in vaccines. So my voice will probably sound a little bit less gravelly, when you hear me talking to Eric because it was recorded the day before. But I hope you enjoy it. I think we’ll learn a lot. Thanks a lot. Talk to you at the end of the interview.

Andy Slavitt  04:35

Hi, Eric.

Eric Topol  04:36

Hey, Andy.

Andy Slavitt  04:37

How you doing? Are you doing okay?

Eric Topol  04:38

Yeah, no, I’m fine. I’ve stayed COVID free. But the definitely the group is getting more rarefied all the time.

Andy Slavitt  04:47

Is that because each proceeding variant mutates in a way that it just seems to ignore whatever protections we’ve given it?

Eric Topol  04:56

Right. I mean, that was why you know, I called BA5 the worst variant, not because it’s causing more deaths and more hospitalizations than previously, but because its properties, its biology. It just as you say it has the most immune escape. Thereby, the most transmissibility, the most fitness of the virus, the most growth advantage. So that’s why it’s just picking off these people who have remained cautious. But it’s just so hyper transmissible. And, of course, it’s causing a lot of reinfections too which is the most reinfections we’ve seen today. I mean, many will be able to escape it, there are some inherent advantages that some people have, that they are endowed with. And of course, there are some people who had asymptomatic infections they didn’t know it, didn’t have an immune response. But so there will be people who, for one reason or another, escaped BA5 and subsequent variants. But the message I think about the virus, that supposedly the myth that it will get less severe, more mild over time, and then fade away. That couldn’t be further from the truth

Andy Slavitt  06:04

Is BA5 from a severity standpoint, what do we know about its severity, compared to even earlier versions of Omicron?

Eric Topol  06:13

Yeah, I think the BA5, there was a big jump from BA1, BA2, and then there was one in the middle BA2121. And when we went to BA2121 we acquired, the virus acquired this mutation at a site called L452. Now, that’s really important, because that was a driver of Delta. And so remember Andy, when months ago, we had this Deltacron, and people were all afraid. And that was a false alarm. But now we kind of have a pseudo Delta crime because we have a key mutation that brought in BA2121. And then what has been built on that is BA5, BA4 just didn’t really compete. Well, BA5 is really the global dominant. And we have only seen four global dominant variants in the whole course of the pandemic, you know, after the initial is just Alpha, Delta, Omicron. And then this one. So you know, this is the China tells you how if you take over the world, and you get out compete everything else out there, that the mutations that it’s acquired beyond Omicron are really important. And we need to stop looking at a viruses threat by you know, the number of people who die, we should be looking more at the true number of people who are infected who could go on to long COVID. No less that yeah, there are increasing deaths and hospitalizations. But would I call it the boiling frog, and that is, we have this tension, this competing objectives. On the one hand, the virus is getting stronger, more fit, and more immune evasive, that it our immune system just doesn’t see or recognize the virus nearly as well, even though we have all this immunity built. And on the other hand, we’re building the immunity from all the infections. So what’s winning out here? Well, the virus is winning out because our immunity, while it’s being built from infections from vaccinations and from boosters, is never as good as what the virus is doing and finding new hosts or repeat hosts. But it masks, it obfuscates the true power of the virus, because if it wasn’t our immunity being built that wall, it would look horrendous. Just think if we had BA5 instead of BA1, BA5 came first,  we thought VA one was bad in terms of the number of people infected, you know, 2-3 million Americans a day, BA5 would have been worse. The only reason why it’s been blunted is because we had this, you know, 40-50% of Americans got BA1.

Andy Slavitt  08:52

So we’re getting some benefit. Let’s talk about maybe some of the qualities here that make this as you say, the worst one yet. One of them seems to me to be speed of mutation. You could imagine if this thing were mutating and coming to each country once a year, like the flu seasonally, we would have an opportunity to plan we would have an opportunity to live most of the year. Without the virus, we would I think people would tolerate masking regularly and most importantly, you know, our scientists would be able to be on a cycle or producing boosters, that whatever they saw in January and February, they would see in October, this thing seems to be mutating three, four times a year.

Eric Topol  09:34

Right. So this is a really important distinction, Andy, you’re getting it because we went the whole first year the pandemic, you know, through all of 2020. And then the first part of 21′, where we didn’t see any substantive mutation. There were mutations obviously all the time and it’s got 30,000 letters that can mutate. But none of them were causing a functional change in the virus. And then you know it really taken off, because if you look at the time that we sat in Delta, we’ve already gone through five different Omicron, you know, and it’s just acquiring more mutations. And remember, the biggest jump was the one to Omicron because that was likely coming from an immunocompromised host that had this accelerated evolution of the virus picked up 50 some mutations, and that led to the biggest change of the virus. And then that whole new virus in many respects, with all those, you know, peppered with mutations, not just in the spike protein, but throughout the entire virus. You know, we just keep adding more to that. And yet, we may see another one of these because we have 10s of millions of immunocompromised people out there in the world, any one of them could have another path of accelerated evolution, and then infect other people. And we could see, you know, another very tough family of variants like we’re seeing now so it’s accelerated. It still though, Andy, nothing like influenza. That’s the interesting thing. You know, we’re looking at SARS-CoV-2 and saying, oh, my gosh, it’s mutating a lot, but it’s, it’s lightweight, compared to Influenza. Influenza has both a head and a stock and the head is just incredibly hyper mutating. We’ve never been able to keep up with Influenza. You know, we got these quadrivalent vaccines that are, you know, 30% efficacy, but you know, SARS-CoV-2, even with its mutations that have accelerated it’s still lightweight, compared to the challenge of Influenza.

Andy Slavitt  11:34

Let’s take a break, and then we’ll come back, Eric, let’s talk about why pa five is spreading and mutating so quickly. Why do we think it’s accelerated going from once a year to a couple times a year to now, you know, three four times a year?

Eric Topol  14:39

Yeah, well, I think it’s just that the virus is under pressure. So what we have now is we have this immunity wall. But the virus wants so badly to find more people to live in and hijack their cells. And then you know we have all these different paths for the virus to do mutate more that we didn’t have in the beginning of the pandemic. So we got all these immunocompromised hosts, I mentioned, we’ve got animal reservoirs. And we’ve had documented spillover from various species that include, you know, hamsters and mink and deer and cats. And we have, you know, uncontained virus throughout the world, largely in the United States, but now, you know, throughout Europe, throughout Japan, Australia, New Zealand, and so that gives it opportunities to spread and mutate more. So, you know, the under pressure from the immunity wall of prior infections and the vaccines we’ve thrown at it. You know, it’s, it’s finding ways, and it has more ways to go. I mean, every time you think this virus is going to finally hit the wall, you know, it just, you know, I thought, you know, when we were coming in the end of June 2021, that things were gonna really looking really good. I, I’m an optimist, you know, I’m thinking, we’re finally going to get through this, and then their biggest curveball was is Omicron. No one could have predicted the extent of those mutations and those exact mutations. And wow, and we could obviously, say it again, now. So each time we, we prolong the pandemic, we have that much more chance of prolonging the pandemic further.

Andy Slavitt  16:18

It makes it confusing for people who particularly don’t follow it so closely. And who can blame people for wanting to take a break from following it super closely? Is that one basic question I think a lot of people have is, you know, how long might their immunity lasts? And I know that that’s probably an evolving answer. But if someone were to get, say, you know, a version of Omicron, one month ago, or vaccinated one or two months ago, there’s a lot of variables at work here, obviously. But in general, is there an expectation now that people were people should expect that to be effective? Or would you say, hey, all bets are off at this point, prior exposure, prior immunity isn’t doing much good at all?

Eric Topol  17:01

Yeah, I mean, I think we’ll never completely use lose some immunity that’s been built. But as you know, we’ve lost a lot of the immunity we had previously against infections and transmission. I mean, the vaccines are leaking terribly, giving kind of a misimpression that they still do a really good job of preventing deaths and hospitalizations. But what concerns me about this, especially Andy, is that with the latest BA5, we are seeing cracks in that severe disease protection, not a, you know, […], but some. And that’s evidenced by the latest CDC report, which, you know, brought down note the numbers really were dropping down, we used to see restoration of severe disease protection from the vaccines with a booster, Delta 95%. Now we’re lucky, you know, it, we’re being the 70s. And that’s still good, but it’s not what we had. So the ability for our immune response to stay as intact as it was, and of course, correcting for the waning factor by the boosting, we’re seeing some slippage. And that’s what is likely, it’s not going to be like an on off switch, where all of a sudden, there’s this, you know, […] variant, but rather, you know, this slippage that people would like to deny it, because..

Andy Slavitt  18:24

It’s not a fun fact,

Eric Topol  18:26

I mean, you know, you don’t want to be transmitting the bad news, right? And doesn’t make you at all popular, happy talk goes over much better in the pandemic. I know that. But you know, I’m just trying to look at the data objectively, there’s multiple sources that show that there’s some crack in this severe disease protection that we don’t want to see. And of course, we’re liable to see somewhat more.

Andy Slavitt  18:49

And with that, because it’s impacting not just the antibody titers, but also the memory B-cells and T-cells as well?

Eric Topol  18:55

Yeah, so I tried to explain that, as best I could, a new subject I put out yesterday, and that is, there’s the three lines of defense. And what’s interesting is and we haven’t paid enough attention to it, the first line is the innate immunity by the interferons. As the variants have progressed to Omicron, they’re taking down our interferons.

Andy Slavitt  19:18

Explain what the interferons do to people. I think this is a really you’re one of the few people I’ve seen make this point. educate us a little bit on that place.

Eric Topol  19:26

Yeah, so I mean, this is our first line of defense, and they tend to get neglected. Everybody talks about neutralizing antibodies and the T-cells. But long before the neutralizing antibodies, which are fast. The very first thing that happens are the interference. Now that’s a very complex set. I mean, there’s lots of different here for interference. They have their own Greek letters, but the most important thing is they can inactivate the virus. And what’s really interesting, Andy is that we now know that about 10% of people either have genetic issues with your interferon, or they develop antibodies to interference which put them at either higher risk of getting COVID, or more severe COVID. They’re really important. And it kind of held up, we saw little tricks, there’s lots of different ways that the virus has been able to work on interference, work against them. But more recently, with Omicron, and especially with BA5, it’s become more and more loss of our interferon defense. inactivating that pathway, not fully.

Andy Slavitt  20:35

Does it damage, the interference for other things, mean is it make us more likely to get sick from other things as well?

Eric Topol  20:41

There hasn’t been any evidence of that. It appears to be at least so far, I mean, a lot of this is new, there’s just a preprint last week about the BA5 and interferon activity. But it looks real, it looks important. And then you get to the next layer, second layer, which is neutralizing antibodies, which work fast. But you know, what we didn’t expect was that the neutralizing antibodies would be so prominent with this virus, right that you have to keep those levels up to see the most protection. And then the other third line, which is incorporating memory, B cells, memory T cells, and, you know, cytotoxic T cells and all these other cellular immunity, that’s what we’re relying on for protection from severe disease and death to a large extent. But the problem is, they don’t work fast, you know, it’s the neutralizing antibodies in the interference that kick in, you know, in seconds, you know, as soon as you get hit. And that’s I think the problem is that we have lost sight of how the virus has figured out multiple ways to take down our defenses. It’s pierce through interference, it’s pierce through the neutralizing antibodies, the neutralizing antibodies we get from our current vaccines, BA5 are markedly you know, diminished, doesn’t mean that our original vaccines don’t help they broaden our immunity, but they don’t work like they should, like we want them to. So, you know, it’s basically punching holes in our immune response. Now, the T-cells, as you well know, they’re not as sensitive to variants, but they are, to some extent, there has been some documented T cell escape. They aren’t nearly as fidgety about the different mutations, they just, you know, are going after, but those T- cells take time to really do their job in the lungs and other organs.

Andy Slavitt  22:30

Meaning that if you’re someone who is at risk, in that intervening time, it could hit you hard, and you could end up hospitalized. And that’s what you’re saying that there’s a little more severe disease than there has been in the past. Coming up, what variant or sub variants going to take over after BA5. We saw I think if I’m not mistaken, wouldn’t be a fire first got in the scene. We saw in South Africa very little in the way of increased hospitalizations and deaths. And in Portugal by contrast, which has an older population We saw an increase of marked increase, if I’m not mistaken in hospitalizations and deaths, and is that explainable by the age of the population? Is that how you would describe that? And is that how you’d ask you to guess that we think about our own risks?

Eric Topol  25:16

Yeah, it’s a really important question, you’re gearing up because that was our first window into what would BA4 and BA5 would do to us. But what’s interesting is, yeah, the South Africa population is much, much younger than Portugal, much less vaccinated than Portugal, Portugal being one of the top vaccination places in the world. But what’s interesting that people haven’t really paid enough attention to I don’t think is that, remember, South Africa was the main place where the Beta variant hit, they had a monster wave from the Beta variant. And the beta variant is the most immune escape variant we’ve seen except for Omicron. So what I think is that prior infections with beta really prep them in South Africa for you know, less of a hit. Whereas what we’re seeing in the rest of the world, I mean, my goodness, if you look at Japan, there’s just no letup, BA5 looks so much worse than BA5, if you’re looking at New Zealand, Australia and many other places, BA5 is doing some major damage and infections, but not just hospitalizations now hit a record in Australia now, over BA5, deaths as a record in New Zealand over BA1, it’s having its toll, especially when there’s not a lot of prior infections to add to the vaccines. So I think what we’ve learned is that South Africa was the best case scenario. And yes, it was partly due young age. But I think the prior infections that were very heavy with Beta may be part of the story.

Andy Slavitt  26:48

And I hate to even ask this, because we’re still dealing with BA5. But what’s next is BA275?. What we have to look forward to next?

Eric Topol  26:57

Yeah, well, firstly, you know, there was a new report from the UK Health Security Agency, which has been terrific throughout the pandemic, you know, every, every week or two coming up with great data. And we’re already seeing these BA5, BA55.2 that have some growth advantage over BA5 so we could see, you know, more in this sub variant story, where it looks like that’s evolving under our nose right now. So, you know, that’s certainly a concern. This BA2.75 was noted, especially in India. And it’s competed to some extent with BA5, but we don’t see that happening yet anywhere else in the world. And we have some BA2.75 in many countries, but we’ve yet to see a lift off. So I think it’s because BA5 is just more formidable. There’s different reports about his BA2.75 as immune evasive as […], I’m not as concerned about that. I mean, we still keep an eye on it, of course, but I had labeled it as more of a scarier, meaning that with every new variant, we should consider it innocent until proven guilty. And so if you only see it in one place, not that, you know, India is not an important place, okay. But if you only see it in one place, and it doesn’t compete, it doesn’t grow anywhere, doesn’t spread anywhere the place, then it doesn’t mean doesn’t look like a global dominant type story, like we’re seeing right now. So the jury’s still out on 2.75 I think it’s more likely we’ll see other Omicron. And we’ll probably unless we’re very fortunate to see a whole new family of variants that is very different than Omicron.

Andy Slavitt  28:46

Are we seeing variants of concern that are branching out from different places besides Omicron?

Eric Topol  28:51

Yeah, I mean, I think the fact that we saw we’re seeing all these recombinant out there, you know, because we have such great sequencing in many parts of the world, we see these pieces of Delta with Omicron, or, you know, different things, we’re probably going to see even more of that, because there’s lots of these fusions in the sequencing that that are being manifest now. So, you know, that’s a little bit like the bird flu story, right? You know, when you had human and bird influenza, with fusions. And so when you start to get different pieces of the virus from different sources come together, we could, like we saw, essentially with Omicron arrival. There’s the potential looms, we sure don’t want to see this. We don’t want to see a whole another you know, alien. SARS-CoV-2, we just don’t need that right now, but it’s possible.

Andy Slavitt  29:47

We have a link to your substack in the show notes. And I highly encourage people who are just getting a taste in this conversation for what is happening to subscribe, to look at Eric’s substack it’s really become, I think one of the most authoritative places for understanding what’s going on. And I think it’s you said the news, isn’t it? This is unfiltered. It’s not good. It’s not bad. It’s just is. And I think that’s what people want to switch to a question that I think is a very interesting one that we have not been able to answer now. And we still don’t have a complete answer. What makes people more likely to get COVID? And what makes them more likely, if they get it to be more severe than others? I think we’re just beginning and understanding. But if we go all the way back, there just lots of explanations where the people would get a very similar level of exposure to the virus. Some people would get COVID some people wouldn’t, you know, within the same household, within the same office, what have you, there wasn’t always easy to explain. So I know that there’s been some work done in some research in this area, what do we know, Eric?

Eric Topol  30:59

Yeah, we we’ve learned a lot. And we can’t explain, you know, in any individual why they were resistant to COVID, or they fared so well, with such you know, mild illness. But what we have learned, so there’s different categories. One is, a whole lot of these genome wide association studies have been done, where across the genome, which looked at in, you know, 1000s of people who resisted getting COVID, especially, you know, with exposure. And what’s interesting is some of the variants that have been found not in the virus free variants, but the variants of, of our genome, the human genome, have really pretty interesting effects of providing a resistance to getting COVID, or, on the other hand, getting much more severe COVID. So going both ways. So, you know, that kind of started out with this very interesting chromosome three locus that was derived from Neanderthals. And then we’ve understood that more, the blood groups abo, but now we’ve extended it to common haplotypes. And so there are a bunch of these that have reached the so called genome wide significance, meaning that there’s something going on there. It doesn’t pinpoint for any given individual, but at least we know that some of this is hosted vantage in our genome.

Andy Slavitt  32:19

Can you do a 23andme and figure out whether you’re more susceptible or not? Or is isn’t that at that level of detail?

Eric Topol  32:26

I think probably a couple years from now, or the cumulative evidence will be on a 23andme type panel. Right now, they’re working on cilantro and other things. But I think eventually we’ll get there.

Andy Slavitt  32:38

I did say to in your set of studies, you forwarded and rejected this a 23andme and asked me to get on that.

Eric Topol  32:44

I think, you know, we will have a genetic risk of getting COVID Or getting severe COVID. It’s a lot of accumulating evidence from many different sources, papers, groups. So that’s one thing. The second one is really interesting. And you may remember, sometime early in the pandemic, it was theorized that our common cold exposure, remember the four, corona viruses that are common cold that maybe that would lead to some people being resistant to COVID. As it turns out, some people have just a broad, great antibody response, a T-cell response excuse me, and that would include B-cells making antibodies. But that is actually striking is that after all this time, that theory, it isn’t for most people, but some people actually from having multiple coronavirus common cold exposure. They do it, they do a good job and they’re lucky.  wish everybody could do that. Right?

Andy Slavitt  33:50

Is that effect big lost as we get into Omicron? say just do we think that’s gonna hold up?

Eric Topol  33:55

A probably will be to some extent. But yeah, you’re right. I mean, it’s probably going to have a blunted impact, right. I mean, a lot of things that we see now are studies that were prior to Omicron, as this one was right. So you’re probably right. And then a third thing that I already touched on, which is really fascinating, is going back to our interferon friend, because now there’s really important studies published in Science, where people who have […] antibodies fare worse and people, interferon antibodies fare worse. I’m just talking about type one diabetes at first, and also that, you know, that the interferon pathway is a very critical one for how we are early response to people who have are endowed with, you know, very agile, rapid interferon will fight against this virus really well, but anyone who has auto antibodies to it, is looking for trouble. So that’s a single digit percent of you know, high five to 10%. But that’s not if you look at all the people in the species. That’s a lot of people. Right?

Andy Slavitt  35:07

Did I read something else you posted about the microbiome?

Eric Topol  35:13

Yeah. So that’s another one that is really interesting. And that is that I’m glad you mentioned that. Our skin and our gut microbiome, some of us develop an immune response to those that overlaps. That cross reacts to the virus was fascinating. It wasn’t anticipated. But yes, that’s just that’s part of that. I link it with the common cold is certain people are able to delve a broad antibody said cover SARS-CoV-2.

Andy Slavitt  35:46

And that’s if you’ve had some bacterial exposure. That’s basically the opposite of what the opposite of what Trump said, don’t swallow bleach, swallow dirt? I could be president.

Eric Topol  36:00

Yeah, this one. This one definitely came as a surprise to many, to me. But yeah, it’s a very interesting, and I think rigorous study to say that some people’s microbiome response gives them the kind of resistance that that you’d like to see in everybody.

Andy Slavitt  36:16

So first summarize, I would say we’re at the beginnings, it sounds like of understanding, it sounds like there’s both genetic differences, as well as environmental and prior exposure differences, for things that may make some people more likely to get COVID Or maybe likely to get it more severely than others. And there’s not much you can do about this, right? I mean, it’s about I think over time, it sounds like it could be a promising field or a way to understand risks, or even, perhaps, create new ways of making people more immune.

Eric Topol  36:51

Absolutely. I think the lessons we learn from these natural paths could be harnessed in the future. So yeah, I mean, I think, you know, everything that we cumulatively learned throughout the pandemic should put us in better stand.

Andy Slavitt  37:07

Okay, this was a very real kind of episode and conversation. You’ve been on the show many times and sometimes the news has been better than others. What we’re gonna do is Eric’s gonna be on next week, we’re gonna, Eric’s gonna come back down in a week and talk about a really interesting, promising approach that he’s been championing. That could be a game changer by overstating it.

Eric Topol  37:30

No, I think we’re talking about essential, vital need right now. Urgent need.

Andy Slavitt  37:36

Okay. Well, we’re gonna have you on next week, and we’re gonna go deep on that, because I think it’s a really exciting area. Thanks for being on Eric. I really appreciate it.

Eric Topol  37:45

Oh, thanks very much. Glad to be here.

Andy Slavitt  38:01

Great set of shows upcoming. We’ve got a Friday conversation about monkey pox with two amazing experts Dr. J. Varma and Dr. Joseph […]. Next week, we’re going to have the second part of our Eric Topol conversation, and we’re going to have an update coming up for the Feds meeting today on interest rates, and what impact that’s going to likely have on the economy, costs, inflation, other episodes that you’ll see here shortly. Tony Fauci, Jamie Raskin for the January 6th Committee, and the committee and Patton Oswalt. So lots of good episodes coming up, and I plan to be healthy enough to record them. Okay. Thanks, everybody. Stay well and enjoy the next couple of days. We talk on Friday.

Andy Slavitt  38:55

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.