Ask Dr. Drew - COVID-19 Boosters with Infectious Diseases Expert Dr. Peter Chin-Hong – Ask Dr. Drew – Episode 57

Episode Date: December 3, 2021

Infectious diseases expert Dr. Peter Chin-Hong believes a booster dose could move the vaccines from preventing serious illness or death to preventing contraction of COVID-19 altogether. He discusses his research with Dr. Drew LIVE. Dr. Peter Chin-Hong is Associate Dean for Regional Campuses. He is a medical educator who specializes in treating infectious diseases, particularly infections that develop in patients who have suppressed immune systems. He directs the immunocompromised host infectious diseases program at UCSF. His research focuses on donor derived infections in transplant recipients and molecular diagnostics of infectious diseases in patients with suppressed immune systems. Follow him on Twitter at https://twitter.com/PCH_SF  Ask Dr. Drew is produced by Kaleb Nation ( https://kalebnation.com) and Susan Pinsky (https://twitter.com/FirstLadyOfLove). SPONSORS • BLUE MICS – After more than 30 years in broadcasting, Dr. Drew’s iconic voice has reached pristine clarity through Blue Microphones. But you don’t need a fancy studio to sound great with Blue’s lineup: ranging from high-quality USB mics like the Yeti, to studio-grade XLR mics like Dr. Drew’s Blueberry. Find your best sound at https://drdrew.com/blue  • HYDRALYTE – “In my opinion, the best oral rehydration product on the market.” Dr. Drew recommends Hydralyte’s easy-to-use packets of fast-absorbing electrolytes. Learn more about Hydralyte and use DRDREW25 at checkout for a special discount at https://drdrew.com/hydralyte  • ELGATO – Every week, Dr. Drew broadcasts live shows from his home studio under soft, clean lighting from Elgato’s Key Lights. From the control room, the producers manage Dr. Drew’s streams with a Stream Deck XL, and ingest HD video with a Camlink 4K. Add a professional touch to your streams or Zoom calls with Elgato. See how Elgato’s lights transformed Dr. Drew’s set: https://drdrew.com/sponsors/elgato/  THE SHOW: For over 30 years, Dr. Drew Pinsky has taken calls from all corners of the globe, answering thousands of questions from teens and young adults. To millions, he is a beacon of truth, integrity, fairness, and common sense. Now, after decades of hosting Loveline and multiple hit TV shows – including Celebrity Rehab, Teen Mom OG, Lifechangers, and more – Dr. Drew is opening his phone lines to the world by streaming LIVE from his home studio in California. On Ask Dr. Drew, no question is too extreme or embarrassing because the Dr. has heard it all. Don’t hold in your deepest, darkest questions any longer. Ask Dr. Drew and get real answers today. This show is not a substitute for medical advice, diagnosis, or treatment. All information exchanged during participation in this program, including interactions with DrDrew.com and any affiliated websites, are intended for educational and/or entertainment purposes only. Learn more about your ad choices. Visit megaphone.fm/adchoices

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contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. The guest is Dr. Peter Chin Hong, Associate Dean of Regional Campuses, Medical Director specializing in ID infectious diseases, particularly diseases in immune compromised patients. He directs the Immunocompromised Host Infectious Disease Program at UCSF. He has research focusing on donor-derived infections in transplant recipients, as well as molecular diagnostics of infectious diseases in those with suppressed immune systems. Our laws as it pertained to substances are

draconian and bizarre. The psychopath started this. He was an alcoholic because of social media and pornography, PTSD, love addiction, fentanyl and heroin. Ridiculous. I'm a doctor. Where the hell do you think I learned that? I'm just saying, you go to treatment before you kill people. I am a clinician. I observe things about these chemicals. Let's just deal with what's real. We used to get these calls on Loveline all the time. Educate adolescents and to prevent and to treat. If you have trouble, you can't stop and you want to help stop it, I can help. I got a lot to say.

I got a lot more to say. I want to give a shout out to our good friends at Blue Mics. If you've heard my voice on this show any time over the past year, including right now, you've been listening to Blue Microphones. And let me tell you, after more than 30 years in broadcasting, I don't think I have ever sounded better. But you don't need to be a pro or have a fancy studio to benefit from a quality mic. You may not realize it, but if you've been working from home or using Zoom to chat with friends,

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Be sure to use the code drdrew25 for a special discount. Dr. Chin Hong, welcome to the program. Thanks so much for having me on, Dr. Drew. Am I pronouncing your name correctly? I didn't want to screw that up. You pronounced it perfectly. Even my mom would recognize it. Okay.

So I'm guessing when you talk about, I just want to start with the basics. When you're talking about your research on donor-derived infections, I'm guessing cytomegalovirus. What else? What else are we looking at that's donor-derived? Also kind of strange things like worms, extrongloides, things that we use ivermectin for, you know, malaria, you know, all these Chagas disease. So I think a lot of times, you know, when we have donors that donate organs, their immune system is intact. So many chronic diseases they might have been exposed to during childhood that are kept in check. When we suppress the immune system in the recipient after the organs have been transplanted, they kind of come alive, almost

like walking dead. So it's our job to kind of adjudicate the donor, make sure it's safe. When it gets in the recipient, we make sure that we institute meds, additional therapeutics that we need to kind of anticipate the bad stuff that can happen. How do you deal with chagas? That's not something you typically see in this country. Actually, it's more common than you think because, yeah. Although I would say, hollywood made it seem it seemed like anybody could get a tt fly bite and develop sleeping sickness but the shock is transmitted other ways as well obviously this way but go ahead yeah through blood transfusion

so we started you know the we in the u.., we started screening blood products for Chagas disease. And in transplantation, it was really recognized early because when people might have been exposed to Chagas in Central or South America, come to this country, or even if they weren't there and they were exposed by birth through maternal transmission. Again, they die in a car accident. They fortunately donate organs to someone, but then that chagas can come alive in the recipient. So crazy. And strontuloides, for people that don't know, is a worm that comes in through your feet. Again, these are all essentially tropical illnesses, things we don't see here that much. But in terms of things that are here, does leptospira and Borrelia,

and I'm imagining tularemia and all, everything gets in, I guess, this way. Yeah, everybody can get lots of things, but I think of the things that we most worry about in the US.S. from U.S. transplantation in terms of things that recipients can get, the big three are HIV, hepatitis B, and hepatitis C. But we've done a lot of good molecular screening, moved away from antibody testing to looking, you know, using PCRs to look for fragments of

these viruses in donors so that it makes it safer for recipients. So those are examples of things that we've done a lot with. I mean, in California, we worry about COXI from, you know, valley fever. A lot of times people don't know they have it in them, but then we see it in the recipient. West Nile virus, those are things that we've seen recently. And not CMV, huh? I always think of that as the one that is so, or is that just axiomatic? 80% of people have been exposed to CMV.

So it is something, the reason why I guess I hadn't mentioned it because it's so, I think well worked out and well honed out and we have good therapy in terms of preventing people from having it rare up later on. But it is still very challenging. Didn't mean to minimize it. The only reason I bring it up, it's on the MKSAP board reviews for infectious disease. They make a lot of CMV, but not every year. It's an every three-year thing. It's weird what they decide to put in the MKSAP. It just depends on who the contributors are. I remember at least two out of the last nine years, CMV was a big deal. So I assumed it was something you guys were struggling with all the time. No, no, definitely. I mean, yeah, somebody must like CMV who writes those questions. True. Exactly.

Just to make the boards more challenging. So let's talk a little bit of COVID here and vaccine therapies and whatnot. I want to get to vaccine, but before I do, do you have any opinion about some of the antivirals that are coming our way, the molnupiravir and some of the other products that may yet hit market. I am so excited about molnupiravir. First of all, who wouldn't be excited about a medicine that's named after Thor? It is kind of a real great inspiration,

but nevertheless, it's the first oral agent that's an antiviral that I think is so hopeful. And although the results that we've been seeing and for which they've submitted FDA approval for is really in the realm of early treatment, similar to monoclonal antibodies. But the real benefit will also be in post-exposure prophylaxis. So somebody in a nursing home has COVID, the other people around, they don't have COVID yet. You give them this pill we do with influenza and Tamiflu, and it's likely that it would not progress to COVID. Household, similar thing with post-exposure prophylaxis, easily available, probably from a drug store. You just run it on and get it.

And at least in the trial so far with early treatment, prevents about 50% of people from getting into the hospital within treatment of five days, similar to what we do with Tamiflu. And relatively well-tolerated. In fact, people who were on placebo, more people discontinued drug on placebo than who actually got molnupiravir. Interesting.

And do you worry about medication resistance? Are you worried we're gonna need to put combo therapies together? I'm curious, I've not seen much about that. It sort of struck me as curious that people aren't worrying about that. Yes, I mean, interestingly with influenza I've not seen much about that. It sort of struck me as curious that people aren't worrying about that. Yes. I mean, I, you know, interestingly with influenza and Tamiflu, we hadn't seen, we haven't seen

too much resistance. But I think that is always something in the back of my mind, particularly with, when you think about a virus. And if you think about the history and story of HIV, you put somebody in one thing for treatment and then over time it develops resistance. So, you know, it's something that's definitely going to be watched out for. And again, molnupiravir is the first gen kind of drug. Roche and Pfizer working other drug oral agents too. And you're right, in the future forward, we can imagine combination therapy that people might institute at some point as an oral option.

And I guess it's not, you know, these are not prolonged therapeutics the way it is for HIV. So there's not so much time for the virus to develop a resistance pattern. So that may be why it's not a prominent in people's thinking right now. The other question I had is I want you to address a sort of rumor that's flying around out there, which is that vaccines can accelerate drug resistance through putting evolutionary pressures on the virus. Address why that does not happen. And by the way, he embedded, it seems to me, in that story is this notion that the present mRNA therapies are therapeutic rather than vaccine. I think a vaccine is anything that prophylactically activates the immune system to prevent an infection. That's a vaccine therapy. But what about the evolutionary

pressures caused by vaccine versus therapeutics? Well, first of all, just the idea of a vaccine being preventative, as you said, there's nothing there there. So like the traditional way we think about resistance on an individual probably won't happen because, again, there's no virus mutating because you're preventing the virus from getting there in the first place. From a population perspective, which is what you're getting to, could it be that vaccines will somehow lead to people, lead to the virus mutating in a way that it's going to evade the vaccine? I don't think that's going to be true. So far, if you were a virus and you had a superpower that you could hold on to, And so far, viruses, SARS-CoV-2 seems to

hang on to one superpower. And the superpowers you have in your menu include, are you going to be more transmissible, be more vaccine resistant, or are you going to cause people to get sicker? It turns out that the one that survives the most, the one that seems to be viruses or SARS-CoV-2 variants that prize transmissibility, the one with vaccine resistance and the ones that we know about so far, like beta in South Africa or gamma in Brazil, they tend to not proliferate as much as Delta has overtaken our landscape. So, you know, I don't think that the vaccine resistant types will emerge. And I don't think that vaccines would lead to the rise of the mutants, so to speak. So that doesn't keep you up at night so much.

That's what I worry about is some sort of, I don't, I don't believe the argument does increased evolutionary pressures on the virus for the, for the very reason, the way you set it up, which is there's no virus there getting pressured. It doesn't, it's not, that's not how it works. It's when it's under pressure is when it, and when it evolves in a certain direction and that's therapeutics. I do worry about that. I worry about, but then again, it's not about the infectivity. It's about surviving the therapeutic. It's about getting around the therapeutic,

which is a superpower, right? I mean, that's what infective agents have, a superpower, another one, or a sub-superpower. And there's a couple of sub-deltas out there that are maybe a little more infectious. Why don't those take over? That's an interesting question, but I also think it's something we don't fully know yet. I mean, many people blame the rise of the recent surge in the UK based on a sub lineage of Delta.

You know, we've heard about Delta plus before, but it's like one of those Delta pluses. And, you know, it could be that that's just the strain that's prevalent in a particular region and doesn't have extra transmissibility or vaccine resistance. But as we increase and open our borders more to international travel, including people from the UK, where this sub-lineage is more common. It will be interesting to see whether or not it takes over the landscape. But the good news for these variants of Delta so far is the parent is Delta. It's still vaccine sensitive. It's still monoclonal antibody sensitive.

Even if it takes over, it's really predominantly in people who are still more susceptible, meaning they don't have an immunity either from natural infection or from vaccines. And it's not really going to take over the body of somebody who's been vaccinated, so to speak. Excellent. So I wanted to ask some specific vaccine type questions. I'm starting to wonder, much like the HPV vaccine, if we shouldn't be thinking about the Pfizer vaccine as a three vaccine series. One, two, six months later, three. That's a vaccine series. That's not a booster. Is that what's likely to happen with Pfizer? Or is it going to be an ongoing booster relationship with the host? So like every infectious disease doctor, my answer is it depends. But I think the first possibility, what you mentioned, is my prediction.

I think there are many, many vaccines, as you pointed out, Drew, that are given in threes, measles, mumps, and rubella, human papillomavirus and hepatitis B vaccines. And if you look back retrospectively at what happened with Pfizer and Moderna, they were really concentrating on the one, two hits within a month. And if you look at some of the other vaccines

we normally give, you kind of have to give the immune system a little bit of rest and then remind it several months later. And that boost is really what takes us across the finish line many years, more than, you know, six months is what people are worried about. You know, maybe the boost is only the last six months, but personally looking at the experience of other vaccines, it probably will last years. But the caveat is, if there is some super variant that's vaccine resistant or appreciably looking so different that the vaccine antibodies don't recognize them, we may need a reminder not for our immune system

from the original variant, but because it looks so different. But I think overall, I think that the one to wait several months, number three, will probably last much longer than just six months, or it's not going to be an every year thing unless we have a scary new variant. Got it. Got it. So what about natural immunity? I'm finding their landscape a little confusing with that. We have full antibody, not really a widely commercially available antibody profile myself. So I'm an N of one. I'm an anecdote. And as an N of one, I have had sustained nuclear capsid antibodies, spike, everything. My antibody has been way, way up, including neutralizing antibodies have remained way up, which has been very reassuring.

I couldn't move about without getting the vaccine, so I got the Johnson & Johnson vaccine just so I could move around and show my vaccine card. But I didn't think I needed it. And it did boost, of course, my spike protein. And some of my neutralizing antibodies went up a little bit too, which was interesting. And just to flesh my story out,

people have heard me tell this story, which is I woke up day two after the Johnson & Johnson vaccine with a spontaneous raccoon's eye on the right, which is the presenting feature of transverse sinus thrombosis, which freaked me the hell out. You had a black eye.

I had no headache. I had no vision problems. I had just a spontaneous raccoons. And I thought looking in the mirror going, really, I'm going to be the only male with the transverse sinus thrombosis. That's what's going to happen here. Now I had to go put the dog in the cage. Sorry, Drew. No, that's fine. But did you guys talk about switching vaccines? We're getting into that's what I'm heading towards. So so with that background, natural immunity, weird reactions to J&J. Before I ask you, should I switch vaccines? What about taking a second Johnson and Johnson vaccine and completing that vaccine series?

Should I do that? Or is it an unnecessary medical procedure? That's a great question, Dr. Drew. I think to answer that question, let's go back and first talk about natural immunity by itself. I love natural immunity. You ask any infectious disease doctor, they love the idea that many times when you get a pathogen naturally, you get a really robust immune system. The problem is this is a shapeshifter of a virus, and we don't know what the enemy coming up next is. And it turns out that natural immunity by itself in the history of COVID hasn't been that great in the long haul.

In other words, the people in Manaus in Brazil, they got hit hard first, and then they got hit hard again by the Brazilian variant, which is gamma. So that's like the natural experiment. And then we have the state of Kentucky where people were cataloged who got infected in 2020. And lo and behold, they got cataloged again in 2021. They had the same people, everybody in database. If you go vaccinated, you were twice less likely to get Delta as somebody who was unvaccinated. So you go vaccinated, you are twice less likely to get Delta as somebody who is unvaccinated. First of all, you could get reinfected

if you were infected naturally and if you were gotten the vaccine based on the new variant, but it turns out you are much less likely to get reinfected, at least from that data, if you were vaccinated.

Let's hang on. And then lastly, I want to wait, hold on before you keep going to the last thing, because that may be that may be an expression of the variance of the antibody response in that my understanding it it it clusters into three groups right rapid fall off an antibody mildly you know six months drop off and sustained antibody response so the reinfect reinfection might have just just been in the lower 60 percent group right correct but we can't really predict who is going to get who has, unless you do. Well, we could, we could,

we, we could develop technologies that could do that. Right. But we've just said vaccine everybody as opposed to, I've been watching myself and, and I'm trying to be a little more sophisticated about it and take the vaccine when it's warranted, but we could do it.

We just haven't yet standardized how to identify immunity. Right. Correct. So therein lies the difference between like a public health population intervention and an individual intervention, which I think we have the technology for. We can like phenotype your T cells. I can tell you what your T cell response is. I can like biopsy your bone marrow and your lymph nodes and tell you what immune cells are there. You wouldn't like it. You probably wouldn't like it.

You would hate it more than your raccoon's eyes. But I mean, it is something that I can do. No, I totally understand. That's a very funny response. I just think you should take the Pfizer. Well, all right. So I interrupted your talk about natural immunity. You said, lastly, you were about to complete that thought.

Yeah. I interrupted your talk about natural immunity. You said, lastly, you were about to complete that thought. Oh, yeah. Lastly, I think when you look at the biology, it is actually quite fascinating because people who got infected naturally have a very long-lasting immunity when you look more than 12 months so far in these various tissues I talked about. The holy grail, actually actually is neither vaccine, probably natural immunity, it's the hybrid immunity, which you have. So I think those responses,

which is called hybrid immunity, vaccine plus natural, ends up giving you the best of all, because we look at all these antibodies, but the T cell repertoire is probably going to be much greater with hybrid immunity. It's just hard to figure out on a policy level how we can determine this person has that, this person has that, they don't need it. But for you personally, you're probably okay. But, you know, to give you the benefit of doubt, say you didn't have COVID before, I would follow up with J&J probably with an mRNA vaccine, you know, given, you know, we can talk about the NIH study, even though there's not clinical outcomes. But I think the robust antibody response in that and the easy availability of mRNA vaccines

as a booster would probably be my recommendation, just like Sue said. Okay. Okay. All right. I want to dig into that a little bit deeper. But first I want to talk about hybrid immunity and that is quietly under people's breath. And I've even saw it on the CDC website for five minutes and they took it down. There's sort of a, well, we're not really saying this out loud, but really we think everybody eventually is going to have to have hybrid immunity. Is that true? Is that really the, that's the long ball. That's the long game, right? Which is get mild illness, treat it with Molnupiravir. Well, get mild illness because you're vaccinated, get the hybrid immunity and get a short illness

because you treat it with Molnupiravir. That's what the world's going to look like in a year or two, no? I think so. I mean, some pundits say that COVID is going to march around the world until it's touched everyone at least once. I mean, it may look very different, like you pointed out. That's a very benign look that I think people will be fine. You wake up, you're vaccinated, you have a cold, you go to the pharmacy, you get your molnupiravir that you have prescribed, you take it within five days, you have reduced symptoms, you can go back to work, and then you have the superpower of hybrid immunity

that will probably take you on through and then COVID will go away in the world. Well, it will be minimized. Yeah, minimized. Right. That's what I think. I think that's what we're going to have to aim for. I really do. And it's, and the fact this world where it's zero COVID, zero COVID is just like an insanely maladaptive, inappropriate goal. It should be, it should be hybrid immunity, mild illness. Let's get on with this. Yeah, I mean, the experiments of Australia, New Zealand, even Singapore, I mean, they all failed. And it's really surprising to me that China is still trying to go for zero COVID. I think it will fail, but we can see what will happen. But my question really was, you've confirmed my

opinion, but my question really was, are people saying this out loud in important circles where people are thinking about these things? People are starting to talk about it. I think the reason why it's been quiet and hush-hush is because people don't want to put all the eggs in the natural immunity basket. And I think there's a fear that by exposing the power of natural immunity, that it may deter people from getting vaccinations. But like we were both saying, it's the combination of both that probably is the holy grail. And I think personally,

vaccines is more reliable, standardized. So I'd probably get a vaccine first for sure. And I wouldn't like risk getting natural COVID first. That's all. And the hybrid immunity of vaccine, then infection is the same as the hybrid immunity from infection then vaccine uh probably but there's a riskier enterprise by getting the natural infection right no long covid of course of course of course clearly and and everybody if

you're gonna do the risky way have the monoclonal antibodies and steroids ready to hand. I think the steroid story, I don't know how you feel about this, but I think the steroid story is more powerful than we really have figured out yet. Because people that do well, early on in the infection, I inadvertently treated somebody with steroids thinking she was having just an exacerbation of COPD. And she did really well and really should not have because she was all set up for bad trouble. So I've been watching that. And I think that's more of a thing than we yet know. You agree? Yeah, totally.

I mean, if you look at there are some other sort of anecdotes or data that's interesting to indirectly. So in my own PEEPS, the immunocompromised patients, we expected them to do really, really poorly with COVID, but actually didn't. And because a lot of them are already on anti-inflammatories, and the same is with people with some rheumatologic diseases. They ended up not doing as bad as we thought because probably their anti-inflammatories like steroids modulated their response. Because if you remember, of course, there's the viral phase, the virus making more of

itself, and then the body gets angry by making the inflammation and it's the inflammation and the immune response that kills you. So if you're like set up shop where your immune system is meant to be very sluggish, it sure increases your susceptibility to get infected. But if you, your body doesn't get ever super angry to really cause you to, to do poorly and go to the ICU and all of that stuff. Yeah. I've seen more enthusiasm for the JK inhibitors lately. Should we be using those early? I think it's hard to say. I mean, I think some of

the other anti-inflammatory drugs like tocilizumab and baricitinib, they haven't really panned out in the data as well. And they only have panned out really for sub-segments of people. So in other words, somebody who's about to go to the ICU, but they're not really on a vent, you might think about one of them. Somebody, early mechanical ventilation might get another one. But you're right. But who knows if they would have done better in earlier disease. But so far, the studies haven't looked at that huge, that population hasn't been as huge in the early disease part for those other anti-inflammatories.

But steroids are cheap. They're like $7 a pop, versus like $1,000 to $2,000. Yeah, yeah. I am, though, hearing more enthusiasm for baricitinib. I mean, toxaluzumab is already in clinical pathways in some hospitals, but baricitinib keeps coming up when I talk to people,

but may or may not be real. Who knows? J.Jr. Kindergarten, they're saying, Sean is saying, is J.K.Jr. Kindergarten. No, it's the cytokine storm inhibitor it's the paracetamol um we get censored this week if you're on youtube we'll see you over on rumble we're using a lot of big words here today but well now that we're not using the i know i was surprised by any big words you're using

well we're not we're not using the forbidden words i I was talking to a guy from Cleveland Clinic last week, and he mentioned the use of hydroxychloroquine early before anybody knew what was going on. And I had to say, I said, were we allowed to say that now that doctors were doing that? Can we say that we still can't use the you use the word to treat strong. We're not allowed to say that word on YouTube. Do you know that? Oh, no, I didn't. Well, we can. You're not allowed to say. It's I look as an anti-health meant that every refugee from a foreign country who comes this country has to take the CDC has it on their Web site. They must take it for five days after entry into the country if you're a refugee but you're not allowed to say it on youtube what if i was giving a what if i was giving a lecture on strong loidy i know well you can't do it on youtube that that's that's the insanity you the the ai will kick you out and then when you try to make an appeal, they're idiots and don't understand what you're asking them.

And so you just go, just don't do it again, is sort of their response. It's really bad. It's really bad. Go ahead. I was just going to say, what if I wanted to treat drug-resistant lice or Norwegian scabies? Then I would also be limited. You can't say the word. What if I want to treat lupus with the HC drug?

Well, you can say hydroxychloroquine now. That one all of a sudden you can say again. Yeah, because we said it with the- Not here. All right. Well, not the two together in any way. Not now. But if I want to say, you know, I want to keep my lupus patient on hydroxychloroquine

during pregnancy because it's so inert and safe, now I can say that. But six months ago, I couldn't say that. This is the insanity of what we're into these days. Anyway, I want to get to the switching from J&J to mRNA vaccine. There was pretty good data on J&J as showing very powerful response in the naturally immune patient. I felt pretty good that I took J&J. But in spite of that data, that was after the one vaccine, but in spite of that data, you still say switch over to mRNA. Why such enthusiasm to switch from J&J to mRNA?

Well, I'm not, I wouldn't say that I'm wildly enthusiastic, but if I had a, if, you know, if I had a choice and I'm mainly, again, thinking about maximizing the immune response, first of all, J&J, team J&J has always had been neglected a little bit, mainly because we didn't have enough, you know, population to have robust data to make some recommendations about. And I think they were always number three in the medals count. It was an outreach vaccine originally conceptualized. Many people thought J&J should have been a two dose vaccine, just like AstraZeneca. It is now, really.

Yeah. So now it's back to two. And then, you know, I think that, you know, that's kind of where we're coming from. There have been a little bit more issues with clots, with J&J. But again, that's not limiting my enthusiasm. And I think with all things being equal, you had a response that was like four times. If you had J&J followed by Pfizer, it's like 32 times immune response several weeks later. If you had J&J followed by Moderna, you had like 76 times response.

Sure, it's not like fewer people going to the hospital or having symptomatic infection, but it was really kind of where things were going. At the end of the day, I'm not really saying use this or use that, but maybe the mRNA vaccines are definitely more common. You call up any Walgreens, you probably have to go hunting to find one that has J&J. Like a zillion of them will have either Pfizer or Moderna. So that's what I'm saying.

If it's convenient, it's flexible, it's safe. And I wouldn't necessarily rush to get a J&J just because I had a J&J. I like the idea. Although there are good things with J&J too. Such as? There are good things about J&J. There've been this small study

that people don't really talk about a lot. But when you look at although it's like the bronze medalist in the olympics of vaccines and operation warp speed the the um when you look over six months when you do get an immune response it doesn't really seem to waver over the six months versus pfizer moderna also a little bit less steep than Pfizer in terms of decline. But J&J is like swimming along at six months, which is kind of interesting, I think. And the reason why, you know, I think when he did get protection from J&J, it was a little bit more durable. And that was kind of an interesting feel.

And also, it's a gift that keeps on giving. So the more you check antibody levels after a second shot in the J&J booster studies, the antibody response keeps on getting better. So it's like fine wine. You check it at four weeks, two weeks is this, then it's several fold higher at eight weeks, and then it just keeps on going up. I'm inclined to get another J&J, I got to tell you. I am. What do we think the mechanism is of the clotting? It's the PF4, right? System? Yeah, so it's a PF4.

It's similar. Yeah, it's basically, yeah, I'm not that expert in clotting associated with J&J and that particular adenovirus vector vaccine, but it basically, you know, stimulates the, you know, something similar to a clotting feature we see in people who get seriously ill with sepsis or infection in blood where you have this, you know, clotting and unclotting and using up of factors, but then you should have thinner blood, but then you over-clot. So that's essentially the path of Fizz. Do you think, I've been thinking about that. That's a good way of describing it, by the way.

And I've been thinking about it and I've been trying to decide, is aspirin therapy an appropriate thing going if somebody is worried about J&J reaction? Because bleeding is one of the problems with J&J as well. So what do you think? I think if you are eligible to take aspirin for prophylaxis, I don't think it will hurt, but not like a therapeutic dose of aspirin for a therapeutic blood thinning or anticoagulation. But say you're eligible to

take an aspirin, why not? If it makes you take the aspirin for other reasons. Yeah, a baby aspirin, 81 milligrams. And yeah. So, but again, there's no data around that. Where are you and children? I know we just today, the FDA approved, or at least provisionally approved, 5 to 12. What are your thoughts? I think the, I support giving kids 5 to 11 vaccines for a few reasons. Mandating? The first is, sorry? Mandating?

No, well, I think that eventually, you know, with enough notice mandating, not mandating it now, I think it has to have full FDA approval. I think we have to have enough experience in the population. And then I think a mandate in the future would not be out of realm. It's kind of early to say for sure what the experience in the population would be. I'm very optimistic. It's one third the dose. We already see fewer chills and fewer fevers in the trial of 2200, although small, compared to the full dose in older adolescents and young adults. So I'm hopeful

that we won't see any untoward effects. Most of the bad stuff with vaccines when you look back at development of kid vaccines happened in the first two months and we haven't seen anything here yet um so far so you know i'm i'm holding on hope and and i don't think that i'll be wrong in this situation discuss if you can uh people who are nervous about how drug companies report their data for vaccine research and therapies, as well as how somebody like you and I look at things like the VAERS system and other reporting system once there's widespread distribution of a vaccine. Because I will just say that non-clinical people don't understand what we see. When there's trouble, we see it. It's obvious.

We start seeing it right away. It comes in. But help people understand if they're worried about, first of all, the drug company distorting data or something, the VAERS system underreporting or not being watched or not being made prominent and what it means to, you know, why physicians know when things are in trouble. Those are sort of three topics. Go ahead, see if you can make something of that. Yeah, that's a complex three-part question, Drew. I'd probably be sort of like puzzling over that on the exam if I had to but let's take the first one uh drug trials they are you know they are very very very controlled it's right control is the second letter

in a three-word randomized control trial rct so control also means that people are like doting over these people in trials so when you get a side effect you have to describe it as an investigator. Is it likely, unlikely? You know, and then you put all those things down. There's a category of serious adverse effect that would probably drive someone to the hospital. So these are all cataloged. But the problem with drug trials in general is that, you know, maybe it's inherently biased because a company is running the ship. But again, the company wants something that will work out for them in the long haul, which is to try to be as responsible as possible. Maybe I'm being naive in that sense. But again,

if you want to maximize profits, you don't want to like fudge data because it's not good for the long haul. It's maybe good for the first six months before people figure you out. But again, you probably want to do things right. That's how we've approved lots of drugs. The second thing is once it's out, then people start using in real life and they report it to VAERS. And I think the story of J&J is probably a good illustration of what happened. So, yeah, so people start getting things. So this thing, blood clot in the cavernous venous sinus system, or CVS or CSV, depending on how you say it, people start noticing that it wasn't in the trials. So what they did in the U.S. was they saw it in Europe coming. It was kind of like the storm

coming over with AstraZeneca. And then with J&J, we started seeing that in younger women. So what they did was, first of all, they went to the virus system. There might have been a signal there. And what they did was pause. So pausing does a few things. We think pausing means people don't run out and get it, but it also leads clinicians to say, retrospectively, look at the patients who they've seen and maybe say, hey, I saw that person with a clot. Did they get a vaccine then? Because I might've thought the clot was due to something else. So that pausing allows that to happen. And then they go back to the data and refine it. But, you know, it is as good as, you know, it could be, but it's not a precise science because lots of people can get things in real life and coincident with getting the vaccine as, you know, it's hard to necessarily ascribe causation.

So then you look at other things like, what's the risk benefits and all these kinds of things. You can get more clotting, several full high with COVID than with the vaccine. And these are all things that go into the final population level recommendation, which may be different from an individual patient in front of you. Yeah, that's I I think, is the point, is that the practitioners start to see this stuff,

and then it gets correlated with population data. And that's how we, I mean, it's almost uncanny to me how quickly information passes in our profession. I mean, very quickly, people are alerting each other what's going on. I mean, I had never heard of something called cytokine storm. And five days into the sort of this thing hitting the country, I was discussing that with my peers or something we were calling cytokine storm. And in that five days, how we look at inflammation in an ICU setting changed completely right then. Boom. And something we learned about this illness was shared throughout the country, which was nice.

But at the same time, some super uncanny things happened, such as we kind of froze in place and became afraid to think for ourselves. I want to talk to you about that. But more importantly, I want to talk about something that's happening now is why isn't every physician aware of the monoclonal antibody therapeutics? It's so bizarre to me that it's just uncanny to me that people aren't aware of that. But I have to take a quick break and we'll come back and we'll discuss those topics. I see you shaking your head and you're as incredulous as I am, but I hope you have some hypothesis as to why this happened.

It's really kind of weird to me. I received monoclonal antibodies last December. You know, we're talking a year ago, and it kept me out of the hospital. One of the things that I immediately did was went out on social media trying to educate people because I was shocked that the public health officials weren't educating the public about how to stay out of the hospital. They were, stay home, stay home. No, if you get sick, find a physician, use telemedicine, get the monoclonal antibodies, stay out of the hospital, talk to your doctor about steroids. There's a lot we can do. They did none of that ever. And to me, this is all an astonishing part of the story of the COVID pandemic. So we'll talk about that. I'll get your thoughts on it in just about three

minutes. Be right back. Here with my daughter, paulina to share an exciting new project over the years we've talked to a ton of young people about what they really want to know about relationships it's difficult to know who you are and what you want especially as a teenager and not everyone has access to an expert in their house like i did of course it wasn't like I was always that receptive to that advice. Right, no kidding. But now we have written the book on consent. It is called It Doesn't Have to be Awkward and it explores relationships, romantic relationships, and sex. It's a great guide for teens, parents, and educators to go beyond the talk and have honest and meaningful conversations. It Doesn't Have to be Awkward'll be on sale September 21st.

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Read the book, have the conversation. It doesn't have to be awkward. On sale September 21st. We are here with Dr. Peter Chin Hong. He is a medical educator at UC San Francisco Medical School, where he is a dean as well. And we were discussing before the break the incredulity that he and I both have at the fact that our peers seem to be unknowledgeable about one of the, and steroids too, to some extent, they seem reluctant to use that. But certainly the MABs, I'm shocked.

What is your understanding of how that happened and why that is the case well when you were mentioning or introducing the topic the only thing that was popping into my head was demonic possession because i that's the only reason why somebody shouldn't know about this medicine uh it is like you said it's like one of the like truly evidence-based therapies that we have for early disease. There's actually more evidence for monoclonal antibodies, and the evidence is better than for things like remdesivir, where the p-values like steroids, there's more, you know, there's a lot of statistically significant benefit and we haven't used it. It's free. The government spent more than $3 billion pre-buying a lot of monoclonal antibodies. It's effective against Delta. And we've only used about 50% of the supply, which is weird considering that 700,000 people have died

in this country from COVID and could have benefited from monoclonal antibodies. If you look at the history, we've had an emergency use authorization since late, you know, last year for one of the products and then two more subsequently this year. So, you know, it is mystifying. I think when I step back and I think about, you know, as an educator, why this block is there, I can only think it's information overload and then there are so many permutations and combinations. But again, of all the therapies we talked about, you know, there are a few that rise to the top of what is really evidence-based and monoclonal antibodies is among them. So I'm not sure why it's not getting played, but I know,

you know, it may be resources, the siloing between outpatient and inpatient. I think it's easier to medicalize and treat a lot of people with things once you get into the hospital. But if you're on the outpatient, it's almost like the Wild West or you kind of have to go through the desert or you're Mad Max on a motorbike and you're trying to find the monoclonal antibodies because it's not easy to find and people don't know about it.

So long diatribe to say that I'm not sure. I get you. And I think it varies state by state i talked to somebody in florida this morning who had was middle age mild covid found it went got it and they gave it to the wife for exposure prophylaxis and i was like this is fantastic it's fantastic right that's florida that's florida well florida democratized getting monoclonal antibodies by having patients self-attest um whereas it's kind of locked in many other areas and states so patients self-attest and the other way they dealt with in florida is they had it at churches and theaters and community centers.

Like the person called you, you can kind of go and get it. And it's not like they're not using evidence, but it is both for treatment of early disease and for post-exposure prophylaxis. And it's available because the government bought out a lot of it. And people, the public thinks it's expensive and not for me, it's for special people. Wrong, it's for everybody. Your tax dollars already bought it, number one. And then the doctors,

this is the more interesting part of the story for you and me, have been weirdly frozen in place since the beginning of the pandemic. And it's been the weirdest thing I've ever seen. And I think that some of it is that more of our peers are employees than we realize. And they're sort of stuck with whatever the system is telling them rather than allowing them to practice medicine, I suspect. Also, they became fearful of the social media and the mob and getting their license encumbered for God knows what.

I feel like there was a panic amongst physicians in addition to being encumbered by being an employee. I mean, that could be it because there is, again, there's been a lot of barriers to giving it in hospital systems. That's why it really has to be embraced either by another body, like a political body or public health body that's higher than the system. And or it has or the system has to believe in it. Mayo Clinic believed in it.

So they like were able to give, you know, which is huge for a system. It doesn't sound like a lot, like something like 280 treatments a week. I mean, I think there's Ochsner in Louisiana. During the Louisiana surge, was able to get up to over a thousand patients a week, which sounds respectable. But again, if you think about your average academic medical center, you feel great when you're able to give 30 people a week.

Because again, the outpatient versus inpatient silo is real. You kind of have to have nurses, you have to have people worried about infection, because even the Uber to get there, you know, you can't get an Uber, somebody has to bring you there because people are worried about getting infected. Because again, it's the difference between outpatient and inpatient. People have to observe you after getting the monoclonal antibody, which isn't necessarily a barrier. People have been trying to get around that by giving injections in drive-through clinics at homes.

But I think the case of Florida is an instructive one because they, again, made it for the people and kind of disseminated broadly whereas otherwise it's kind of like a secret message and you kind of have to have the password to know about it right all right i got it as from an infusion nurse in my home and that's what was provided through caremark at the time uh which was great which is absolutely absolutely standard care and should be the standard care, but God knows why it's not. But yeah, there's so many. Well, do you, as you look back on the pandemic, are there lessons to be learned that you sort

of are thinking about? Yes. I mean, I think there are a lot of lessons to be learned. I think one of the lessons that I learned was something you mentioned, Drew, which was that, you know, the way we as healthcare providers get information, you know, not, you know, I think early on in the pandemic, we were all learning together. So I think social media was very powerful then by people sharing how we took care of patients, how we developed guidelines without somebody giving you a nice flow chart before we were building the plane as we flew it.

And then what happens is that's the clinical thing. And then there are all these therapeutics that get introduced in rapid succession throughout. And not only do we have to learn therapeutics, we have to prioritize them and then we have to readjust our schemas. So that and reaching out to a community was probably the first lesson that was very remarkable during this time.

We couldn't have done it in 1918 when we had the influenza Spanish flu because nobody, we couldn't share information that way. So it was remarkable. The number two thing I think I probably learned, lessons learned is that, you know, I think, you know, it's, it's been, this has really been a political disease and, you know, I think it's mystifying, but then you, you know, one can say that was a naive view as a healthcare provider where, you know, we use masks so often in the hospital for lots of things. And as infectious disease doctor, we use masks a lot of times with TB and all these other reasons. So I think the politicization was kind of difficult for me to swallow because, again, I was just thinking health systems and health care and what's the evidence.

And in this setting, I want to use this versus like thinking about what people thought it meant from a political perspective. So that was a little bit sad to me. And then number three was again, you know, a lot of times we, you know, we have to like, and then this is kind of like the 2021 thing looking globally, not because we necessarily have to think only about equity, but we can use patterns around the world to help predict what is coming. So Delta is a case in point. We saw Delta actually coming like a storm before it hit the us and i think we didn't look outside uh with that clarity to see it go from india to the uk and then to the us so we

could have probably done a little bit more preparation and anticipation again prevention and then hindsight is always 2020 so those are just some of the lessons we learned. I mean, I learned that I love, I really prioritize hugging. And I never thought I would miss hugging as much as I did. And I learned to make a lot of banana bread. But those are the silver linings from the pandemic. And yeah, I mean, mRNA therapies and molnupiravir and lots of interesting Zoom and sort of technological advances in terms of how we care for patients through electronic media. But you sort of hinted at the mask thing.

Yeah, to me, that we shouldn't let panic dictate public health policy the fact that to me the the highest level of incompetence was public health officials not allowing people to lie down on the beach you could go on the beach but you couldn't put a towel down that's disgusting incompetence and it should be called out as such it is frank incompetence and that was a gigantic error and they should call it out uh and they should have been encouraging us to go out on the beach and going to the parks where this thing doesn't transmit. And you mentioned masks. What do we do with mask data? Do you make anything of the Danish study or the Bangladesh study? I mean, I just, you know, they are all, you can examine these studies from and then kind of look for flaws or not for flaws as is generalizable to where I'm at.

Like every study. Like every study. We do that with every study. Yeah, people wear the mask a ton or they kind of half wear it. But at the end of the day, the way I think about masks is the way I think about it in medicine. It's not like the be all and end all it's not going to prevent you like a like a force field but it is something that's easy to wear and i'll slap it on if i feel like it but i'm not going to put all my eggs in the mask basket

um so that's the way that i overall feel about mass it's kind of like the icing on the cake but it's not the core way in which, you know, because I have other things now. Yeah, that's, well, that's kind of the way I think of it. I think of it too, which is a Danish study. So it didn't, neither the Bangladesh or the dangerous Danish studies really didn't show zero effect. It's, it's, it showed some effect. And if we want to have some effect, well, you can wear these things, but to pretend as though you're killing grandma, if you don't wear a mask, well, that's insane. Now we're insane again. Now we're aligned preventing people from going to the beach again. This is, this is, this is the back to the panicsville. And that's the part I've objected to so much, this whole thing.

And the other thing is I've learned about public health, the way we distribute public health authority. I mean, we gave it to a sociologist and non-clinicians were making major decisions that had huge risk reward concerns that were not taken into account at all. And now we have those concerns coming to bear, i.e. mental health consequences, et cetera. And that to me was just troubling, just deeply troubling. I think what you're getting to, Drew, is the whole idea of how we might change, put science onto a policy landscape or into the society, which is,

I was on left, right, and center with Josh a few weeks ago. And I think he put it most eloquently when he said, you know, scientists can give the science, but it's up to society to use values to translate that science into what people want to do.

So I think, you know, at the end of the day, speaking to your sociologist comment, you know, that is what I think, you know, that's how the dust settles. I heard Vinay Prasad say almost that exact same phrase about science being, just being, say it again, what was the phrase you used?

The science having a value to it or? Yeah, science gives, it's a guide but then society has values in which you can interpret the science and and then put in so what society wants yeah yeah the science needs to be interpreted within within the context of the values of the culture i guess is what somebody on youtube named charlieitt said, I'm so embarrassed that I caved in and listened to my wife and left the mail outside for two hours before bringing it inside. Well, that was, that was during the panic and people were, you know, didn't know we were watching YouTube videos and how to wash your, you know, how to treat, treat your produce. Like it was,

they were surgical instruments for use inside the body. That was crazy. I never, I never cleaned my groceries. I never did that. No, we went to, we went to New Orleans and they lifted the mask mandate. And then I got my nails done when I came back to Pasadena and I had to go next door. I was going to pick up some, some cupcakes and i forgot my mask i forgot about the masking everybody had mass walking down the street in pasadena outdoors and i and i walked in and she's like you have to put a mask and i go i can't my hand my nails are wet i can't do it and i said ah forget it i don't want these stupid cupcakes and i walked out i was

just like when is this going to stop forever This will forever go down as the cupcake incident. Yeah, I know, I was just thinking whether or not you got cupcakes at the end of the day, because I probably would have. No, I didn't need the calories. Did you get the pancake or not? That's really funny. Well, listen, it was a pleasure to talk with you.

And I feel like I learned, there was a lot of information you gave me at the beginning about infectious disease and dormant infection and donors. I didn't realize there was so much of that. I always thought of the big three, as you say, and CMV. But that's fascinating. That's an interesting way to see a lot of disease that you might not see in any other context in this state anyway.

Although I used to see a lot of worms of all types not strontoloides because that really is african right but from central and south america a lot of different kind of worms including uh chinese liver flukes and uh and uh oh wow that's all kinds of all kinds of ascaris and remember i saw something in a common bile duct but you know we use these anti-anti- anti-helminthic medications like crazy. They were gigantic breakthroughs. They were a huge deal. And now I can't say the word on YouTube.

Dr. Peter, do you have a quick minute? Dr. Peter, this is Caleb in the control room. I actually have a quick question. So I have severe Crohn's disease. And so part of that that you had mentioned earlier about immunocompromised people that you had noticed that strangely enough they didn't seem to be getting covet in higher numbers right as covet was starting no they didn't get they didn't get no no caleb they didn't get the cytokine storm oh they didn't get the cytokine storm

okay that makes more because i was confused i've been very confused as to how i never caught covid because i was literally in the hospital in the end of february in 2020 when nobody really knew what was going on they weren't doing any protection i went into the hospital severe symptoms i spent almost like eight or nine days there i went in there they weren't doing anything by the time i came out on humera for 10 years and steroids and steroids, I did that, had surgeries. Then I went back six months later and I never got never caught COVID. And I feel like I would have been very highly likely. Have you noticed anything that's that could explain why I was in the middle of Los Angeles as well?

I mean, there are two explanations. One is that you might have gotten it and not known it because, again, you were on these anti-inflammatories. So like your your inflammatory system was kind of dampened. The second explanation is and then the not knowing part is that they didn't test you. Or because in the beginning, nobody was, you know, getting the test was like gold. You know, you kind of had to be an NBA player or like Tom Hanks or something to get it. But now, you know, it's everywhere. And the second reason is, you know, what we know from the second reason is just that you were lucky or killed.

There's a good Swedish study where they looked like the entire population, Swedish and Scandinavia. They have like all these population databases. They looked at Crohn's in particular. And like what Dr. Drew was saying, the people with Crohn's tended to get infected more, like they went to hospital, but they didn't die more than the general population, which again suggests that

even though your immune system is compromised because of the medicines you take, that bounces off with like not having that cytokine storm right right okay that that makes a lot of sense to me i was just i was shocked whenever i i actually moved out of los angeles a few months ago and i never caught it i got tested for it many times and i seemed like i was the perfect candidate to get it of being right there at ground zero you know lucky i guess for you to check your antibodies like dr drew and see yeah yeah i didn't know it i should do that yeah enough problems yeah it's like he's done for the year

i know no more leave that guy alone he had a psoas muscle abscess that he was walking around with for within three months that they finally identified. Yeah, it was bad. I couldn't even lift my leg up all of a sudden. And it was bad. And that was after on Humira for 10 years and as immunocompromised as I could possibly be. And I somehow made it out without it. And then the vaccine came out.

And yeah, I'm lucky. I'm lucky with the psoas muscle. I'm lucky with the COVID. Exactly. I'd rather have COVID. I'm lucky. I'm lucky with the psoas muscle, lucky with the COVID. Exactly. I'd rather have COVID. There you go. All right, well, thank you, Caleb. And I wanna take a couple of calls off Clubhouse,

but first I wanna let Dr. Chin Hong go. Thank you so much. We will follow you at PCH on Twitter, PCH, capital letters, PCH underscore SF, PCH underscore SF. You have to tell us what that means. What is Pacific Coast Highway, San Francisco? Pacific Coast Highway, Peter Chin Hong. You can have lots of weights for PCH.

Oh, PCH. There you go. Yeah, it's his name. I love it. I didn't even. And he's in San Francisco. I got the San Francisco part. I didn't notice his name, which is foolish on my part.

So anyway, thank you for spending some time with us. And I hope if new stuff comes up, you'll be available to kind of help us make sense of it. We appreciate it. And if we get censored on YouTube, we're also on Rumble, Facebook, and Twitter. And you can always get me cupcakes too yeah next time we can hopefully get me some cupcakes that would be nice that'd be great if you're down here let us know please and we're going to show a picture of drew's black eye pretty soon oh is that right oh no i found a picture on the mike corona show fantastic all right let me uh take a couple

calls here. Thank you guys. Some people have been waiting for quite some time and I want to try to get to them very, very quickly. We have a few more minutes for calls and we appreciate you guys hanging out on Clubhouse with us, as well as those of you on the restream. I'm watching that carefully.

I have clicked on somebody here who may have- We had to weed out the weak week we want the real strong calls i wonder if this uh emma homestead has left the building if you're on clubhouse wake up we're over here we're ready we're ready for you okay i'm gonna try another one that seems to have been around for a while i think we got demonetized on youtube so that's probably why we're not getting any more strikes maybe hi jordan hi there can you hear me all right we got demonetized on YouTube, so that's probably why we're not getting any more strikes. Maybe. Hi, Jordan. Hi there. Can you hear me all right? We got you.

Okay, awesome. My question has to do with, I guess, natural immunity and the vaccines and the sort of hybrid immunity you and Dr. Peter were talking about. So I'm just wondering if you're familiar with the idea of original antigenic sin at all. It's also called imprinting or the Hoskins effect. Yeah, I looked it up once and did not spend a lot of time with it, but go ahead. Okay, so I've just got a study in front of me here that's showing that for breakthrough infections, only about 26% of people are developing the anti-nucleocapsid antibodies compared to about 82% of people

who are unvaccinated. I'm just wondering if there might be some effects on where to get the vax first or infection first. Right. So you're making a case that if you want to get hybrid immunity, you should get the infection first. So you get all those nuclear capsid responses as well. It seems to me, yeah. Yeah. He said he didn't know when I asked him that because I kind of asked that question. He said, well, probably the same. But that's fascinating to me. I'm wondering how long after the natural infection

were people being studied? Because I'm wondering if they had it and just it wore out. 60% are going to have a drop in their nucleocapsid antibodies. For the breakthrough infections, it says it was within a median of 30 days. Okay. So the breakthrough, and those are the ones that had the lower capsid, nucleocapsid antibodies? That's right. Only 26%. I don't have an opinion. I'm not sure he would have an opinion, but I appreciate you bringing that up.

This is the kind of thing that we need to be thinking about. I don't know. Think about it. Let's say that's accurate. I still don't know that it's worth the risk of getting the natural infection first, right? If we're going to get hybrid infection anyway, I'm not sure if that's worth it.

Starla, is that you? You suddenly came in here and kicked Jordan out. Starla, there you are. Yeah, I made it up here, but I do have a question. So I also have a couple of autoimmune issues and right now I'm just treating it with prednisone. I've been exposed multiple times to COVID and I've not actually come down with it. We've even done the nose swabs. And is there something with the prednisone? And even when I was taking some of the rheumatoid medications that may be preventing me. So if you heard what Dr. Chin Hong was just saying to Caleb, who is somebody immunosuppressed with Crohn's, it doesn't appear to, in fact, they seem to maybe get infected at a little higher rate. They just don't get the complications at a higher rate,

or it's similar to, or maybe less than what you would get if you were just somebody without immunosuppressants on board, which makes perfect sense. I mean, we're giving people immunosuppressants once they get sick to prevent the cytokine activation and the inflammatory component of the disease. And plus he's on steroids all the time.

So he stays with the steroids, but he didn't get infected is the thing. And so Starla's asking, you know, why not, is it affecting my ability to get infected? And the answer is nobody has really studied that. We don't believe that to be so we would just but some people have innate resistance to the infection too i mean you could be one of those people right like me right susan seems to be one of those people but the we we are at least from the standpoint of what

pch was just saying what i've been thinking is it's really the complications that are reduced not the whether you get infected or not and also not whether or not you have significant illness. It's really whether you get the really serious piece of the illness, which is the inflammatory piece. Okay, guys, I have to kind of wrap things up here. Time is up. We appreciate it very much. You have some very interesting things coming up.

Dr. Antonio Damasio coming in here next Monday. That is a big deal is it oh my goodness he is one of the by the way michelle poe is killing it yep she's the master booker of doctors and she just said she thought she did a pretty good job today yes this was good today i'm giving her a shout out and thanks caleb for producing thank you michelle for booking but dr dimasio is one probably the i i you know he is the leader in neuroscience and psychiatry and thinking about things like consciousness and feeling and self and he is really we've had dr alan shore in here who's one of the leaders in interpersonal neurobiology. Dr. Damasio is the international sort of superstar in this space.

Somebody just said Dr. Kelly. He wrote an important book called Descartes' Error. He also wrote The Feeling of What Happened, something like that, or The Feeling of the Self Comes to Mind. Self Comes to Mind, I think is his other one. And I think he wrote even another one called Brain on Fire or something. Maybe that was not him. But Descartes' Error is sort of his classic book. And he has a new one out where he has really reformulated the importance of feelings so-called, what feelings are. And so we're going to get deep into the conversation about feelings emotions where they come from how they're regulated how they're perceived and that relationship of that with consciousness it's going to be a bit of a heady discussion i suspect but that'll be monday at what

time everybody next week monday at what time no tuesday wait monday at wait you're talking about next week we don't get back till monday it's Tuesday. It's Monday. We have another guest on Tuesday. I'll tell you about in a second. 4 p.m. Pacific. Let's be hopeful that our... 4 p.m. Pacific on Monday. All right. Hopefully our flight will make it back.

Right. Right. And then Tuesday, let's see. We had somebody then too. Did we not? Or is that because I'm leaving, we're not doing anything Tuesday? No, Tuesday. We might have to move that guy a day leaving we're not doing anything tuesday no tuesday we might have to move that guy a day if we have oh you're leaving that day but we're going to be here

till wednesday and then back on monday and don drew will be out of town for a week so okay so we're doing something you guys can catch up on your last episodes are you saying we're doing something tomorrow right yes with dax holt and and his buddy from their podcast that you are on. Yes. Very fun guy. I can't remember his name. Used to see him on TMZ. He was the guy holding up the disgraceful picture.

He was a nice guy at TMZ. Yes, he was. And then we have a lot of your mom's house fans here. I just want to say hi. Great. On YouTube. Excellent. Probably, I don't know.

Do we have a little clip, Caleb? Oh, I'm going to play that at the end. I have it lined up after the disclaimer. It says, honor my degree. I don't know what that means. What does that mean? Stay tuned for the latest episode on After Dark. All right.

I'm just looking at your comments here on the restream to see if there's anything else. I think we're not. after dark. All right, I'm just looking at your comments here on the restream to see if there's anything else. I think we're not. There was a lot of call to get Robert Paul Champagne in here, which I suggested something like that over to the, or is it be at your mom's house? I'm not sure that's gonna happen. It's kinda, they're a gig, so.

That and he sort of used for the live shows. So I'm begging on some stuff there. Thank you to the folks over- They're afraid we'll leak out too much information. Thanks for the guys over at Clubhouse. We'll be back there again. Great calls at Clubhouse. Thanks, everybody.

Probably tomorrow. Thank you for hanging in there. And then everyone on all the other streaming sites, we appreciate you guys being here. And we will be back tomorrow at 4 o'clock, 4.15, something like that, Pacific with Dax Holt and then Monday with Dr. Antonio Damasio. We'll see you then. Ask Dr. Drew is produced by Caleb Nation and Susan Pinsky. As a reminder, the discussions here are not a substitute for medical care, diagnosis,

or treatment. This show is intended for educational and informational purposes only. I am a licensed physician, but I am not a replacement for your personal doctor, and I am not practicing medicine here. Always remember that our understanding of medicine and science is constantly evolving. Though my opinion is based on the information that is available to me today, some of the contents of this show could be outdated in the future. Be sure to check with trusted resources in case any of the information has been updated since this was published. If you or someone you know is in immediate danger, don't call me. Call 911. If you're feeling hopeless or suicidal,

call the National Suicide Prevention Lifeline at 800-273-8255. You can find more of my recommended organizations and helpful resources at drdrew.com slash help.