I think covid was regarding Trust a major step backwards it it wouldn't be what I would have guessed I mean if you look at the way this played out early on you had a virus that raised its head in Wuhan China in late 2019 within a month we had isolated that virus and sequenced it so we could make a vaccine and then using a technology that we had never used to make a vaccine before which with there was no previous experience in 11 months we had done two large clinical trials the size of any typical adult or pediatric vaccine Tri to show that the vaccine was clearly effective and safe and then we started immunizing people you know million people Day 2 million people day 3 million people Day by July of 2021 we had immunized 70% of the US population

yeah I think they should make it very clear right from the beginning this is what we know now this is what we think we know now here's SARS one which raised its head in 2002 that killed no people in the United States that that only caused serious infection and so so you knew who was contagious because there was no asymptomatic spread Ms you know 10 years later 2012 same story nobody died in the United States from that pandemic potential virus and so I think we initially likened this virus to that that we thought that it were really just going to be people who had seriously wrong

was the the if you looked at the trials the fiser and Mna trials those vaccines were roughly 95% effective against mild moderate or severe disease wow this is a short incubation period mucosal infection 95% effective against mild disease I mean what short incubation period mucosal infection can claim that was influenza being the best example

so then the critical question is who's getting hospitalized and who's dying and the answer to that question is high-risk groups people who are elderly or relle walinsky God bless her uses the term elderly elderly which I appreciate because by that she meant over 75 so I'm still good um or people who have high-risk medical conditions like chronic lung disease heart disease obesity diabetes people who are pregnant and people who are immune compromise because that's who's getting hospitalized

in terms of preventing mild infection um it's just not that's not a public health strategy to the goal is to keep people out of the hospital and so you could also argue well let's just vaccinate everybody all the time to decrease the general transmission which will also protect those people but we're well beyond that people people haven't accepted that nor nor should they I don't think a healthy 16 year-old should get another dose of vaccine if assume they've had three doses or two doses in a natural infection

well when you go on National Television or or or interviewed you know with national media groups and then you say I think we should Target these groups you're a bad guy I mean you're s now you're off the bus and and regarding Public Health you're on the bus or you're off the bus and I think that's it's unfortunate

when you do science for a living um and you have a conclusion so you do studies and you say I think these two surface proteins are critical for inducing a protective immune response and then you present it at a meeting um you want to be criticized you want people to say you know I I didn't do the right controls it's not robust it's not internally consistent you didn't do the right animal model whatever you want that criticism because that's how your science gets better

we could talk about if you want but that that vaccine was not in advance it wasn't it was a side it was a step to the side it was no better than what we have but it it certainly was no worse but was sold to something better

I think that it's almost scary to say that the government is trying to figure out the best way to convince us to get this thing done for our health as opposed to just tell us the truth and allow us to decide right because the whole principle of autonomy when we're being doctors in a room is to allow the patient to decide for themselves what the best choice is and inform them as accurately as possible

I mean I were all I guess uh um scarred by our past experiences mine is that I live through the 1991 Philadelphia measles epidemic where 1,400 kids had Diesel and nine children died I mean that was a horrifying moment people were scared to come into the city we vaccinated down to 6 months of age it was an awful awful time and I I I just think I don't think people remember measles

there was only one instance in this country ever where you had compulsory vaccination so a mandate is that you have to get a vaccine or you pay some sort of price in the case of Henning Jacobson $5 which would have been $175 today so it wasn't trivial um or you don't get to go to school don't get to go to your your favorite bar Sport whatever sporting event whatever um a compulsory vaccination is you're vaccinated whether you want to be or not

what they were doing was perfectly legal um but they refused to take that case um because what they said was that while you they recognize a religious exemption to vaccination here that quote you don't have the right to Marty your children to your religion and so we vaccinated those kids against their parents who and the parents were fine

Dr Joseph lappo who is the Surgeon General of the State of Florida Most states don't have certain generals I think there's only four but Florida's one interesting so he um he put forward a directive to the healthc Care Professionals in Florida um which basically said that the MRNA vaccines are contaminated with fragments of DNA

there was a lot of denialism early on I mean uh um former president Trump would say this is going to be over by Easter meaning by mid April 2020

in August 18th of 2021 when President Biden stood up in front of the American public and said as of the week of September 20th so roughly one month in the future we are going to have a booster dose for everybody over 12 years of age

so so in 2020 um before we had a vaccine or before we had any high level of natural immunity um our hospital was flooded with children with covid and and the most common thing we saw was this so-called multi-stem inflammatory disease of children

I think the benefits are clear but I think for people who aren't in a high-risk group uh getting another dose of vaccine is at best low risk low reward

the risk is likely low I think the reward is generally short-term in terms of protection against mild illness

if you give somebody medicine and you say this is going to work for you this is great stuff as compared to give them medicine say I think this is going to work for you they're more likely to do well with the first thing

it really looks like in in many cases of people who were putting out bad information voluminously is that they were funded by the dietary supplement industry

I think that people shouldn't be allowed to put out information to put others In Harm's Way

disinformation is information that people know is wrong and there still putting it out there

I think he represents the political agenda of his Governor I think he is doing what his Governor wants him to do which is to scare people about vaccines

health officials that were representing this vaccine kept saying that they kept saying this is better this is better and so I wrote a perspective piece in the New England Journal of Medicine saying it's not better and there were two papers that were published one out of Harvard by Dan bro one out of Columbia by David H showing the immunologically it's no different

what that what happens is when you get when you got that original vaccine and then you got it again and again the Wuhan one strand you made an antibody response to they all the the immunological determinance I.E epitopes on that that SARS K2 Spike protein when you then got this this and you added in in the same vial this Omron strain the Omron strain does share epitopes or immunologically distinct regions with that original strain

I think it was more the horses out of the barn got it so they weren't saying hey you missed this in your scientific evaluation of this no I think they just felt this was the message that was to be given given the way this vaccine was constructed independent of what the data showed

so what do they do I mean they really look to in many ways the advisory committees which at least collectively have read those papers collectively have that expertise

how do you um how do you get people to um feel reassured by the healthy debate that comes with how do you interpret data without feeling like they're lost because you're asking them to make that decision based on when they don't really have the expertise or Comfort to make that decision

so people can influence large numbers of people in a negative way what what are the controls for that yeah the controls have to be that social media platforms have to have some sort of skin in the game and I know there's that whole debate of whether or not they're a publisher or they're just a forum allowing people to post etc etc but if you're going to say that you're part of our society you have to put some safeguards in place and they don't have to solve the problem altogether like I don't think medicine solves all of our problems I think there are some tools that work well in some cases versus others

I'm curious your take on how often we should be looking at modern medicine and our current algorithms for treatment guidelines and how often we should be updating them starting with strep throat and rheumatic fever because when I ask my residents these days why are you treating strep throat with um antibiotics a lot of them don't know they'll say oh to shorten course of illness well that's really mild 18 hours a day maybe in symptom control yeah well it's because we don't want them to get really sick well it's already a mild infection they're not going to really get sick but they don't know about the rheumatic fever component because they didn't live through the time when rheumatic fever pre-antibiotic era was a problem

I think there is value in debating um how one could interpret data but and I think there is value in determining how did things become political or why is it that we've lost trust I think those are all perfectly reasonable because people can have different ideas about that y but you can't debate whether or not the polio vaccine worked I I mean Robert F Kennedy Jr's notion is that the polio vaccine causes cancer and that far more people died from cancer than were ever saved by the polio vaccine that's just wrong

I mean how do you debate somebody like that and and then and then two years later he goes to Lancaster County and talking about measles say say sarcastically saying you know hey I mean I had measles and I got to stay home with my family and watch TV and have dinner and if you look at the transcript I actually wrot write this thing called a suback which is the next one that comes out next week is has this story I got that original transcript and you can see in that transcript he's got these two little smiley faces to to make the point that this was no big deal this was two years after 83 children died because of his action

I still struggle with that because I want to be there in the way that we want to disprove misinformation but if someone says one and 1+ 1 equals 5 how do we disprove it right I I still have yet to find that and you you have books on this subject right and you're the expert that I would look to as motivation to disprove it but I don't have the answer to it yet me either because if we could I mean this would be very powerful in in the heart of Public Health I think it really would

so you sit down with RFK Jr for example and you start to debate five minutes in nobody knows who the expert is they remember the fight far more than the facts and nothing is gained but I could be wrong I mean I did one on there was something called a show called democracy Now with Amy Goodman and um she wanted me to debate an antivaccine activist named Mary Holland who wrote a book called something like the vaccine epidemic something like that and it was clearly a antivaccine book

so while a cultural controversy or political controversy I don't think it's a scientific controversy I'll explain why so so so what what what is true the the um there is a the Wuhan Institute of Virology that is located about that is located in Wuhan why is it there it's there because uh it's a large metropolitan area in um in China

what do you have you have um in the western section of the Hunan wholesale seafood market you have all the original cases emanated from there and then in concentric circles out of there China actually went and did studies took samples and then did genetic analysis for things like the cages the um the materials that were used to kill the animals

there's a great um podcast called decoding the gurus which is about 2 hours and 45 minutes long and it features three evolutionary biologists Michael Warby um um Chris Anderson and Eddie Holmes those three evolutionary biologists and they go through all the data could not be clear animal to human spillover event that occurred in the western section of the island market

I think the scariness of all of this is are we postmodern truth era where like truth doesn't mean anything anymore and I don't feel that we're there do you feel like we're there yes really I think I think science is losing its place as a source of truth I think it's just another voice in the room and that's what's so scary about this to me you just simply declare your own truths including scientific truths to a much greater extent than I've ever seen before

I think it's up to uh the next leaders of tomorrow to do this better than us because I I'm worried about the fate of social media of how the idea of AI is going to factor into all this

well it's real I mean long Co is real but it's more than one thing I I think there are several different um causes arguably for this these prolonged symptoms I mean flu also can cause prolonged symptoms so can hepatitis B virus so can epine bar virus that causes mono so the notion of prolonged symptoms following infec disas is not novel

then I think that um the other thing is that you have can have these sort of blood clots that have can these micro kind of blood clots that can appear in lungs and other organs in some people has also been say there was a case a report in uh in Italy of of sort of that phenomenon

so so should you take Pax lovid early in illness which will de re reduce um uh the amount the virus is replicating and then put you a lesser risk of long covid I I would guess the answer is probably yes but I worry about that Pax lovit is not a trivial drug