Ask Dr. Drew - Masking & Quarantining Children: The Mental Health Impact w/ Dr. Lucy McBride – Ask Dr Drew – Episode 64

Episode Date: January 10, 2022

Dr. Lucy McBride is a practicing internist in Washington, D.C., who believes that mental and physical health are inseparable. Dr. McBride graduated from Princeton University and attended Harvard Medical School. She did her medical training at the Johns Hopkins Hospital. A native Washingtonian, she is married with three teenage kids. Website : https://lucymcbride.com  Facebook: https://facebook.com/drlucymcbride  Instagram: https://instagram.com/drlucymcbride  Twitter: https://twitter.com/drlucymcbride  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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please 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. So here we are back with you guys. We were also on the restream. We see you all out there. Also in Clubhouse. As always, we'll be taking calls off the Clubhouse. A big week coming up.

We have Jay Bhattacharya in here tomorrow. We have Vinay Prasad coming in Tuesday of next week. And today we are very fortunate to have Dr. Lucy McBride. You can see her website at Lucy McBride. You see why McBride.com. Also Facebook, Dr. Lucy McBride. Instagram, Dr. Lucy McBride. And Twitter, Dr. LucyMcBride.com, also Facebook, DrLucieMcBride, Instagram, DrLucieMcBride, and Twitter, DrLucieMcBride. All of this is the same.

Dr. McBride is a Harvard-trained physician, Johns Hopkins residency, internal medicine. She is a frequent media contributor, particularly to The Atlantic, and she is trying to help people make sense of the news, sound familiar. She and I, as she said to me in our warmup here, are two peas in a pod. She's also particularly interested in the confluence of illness, physical health, and mental health, much like you hear me talk about that as well. And her website and her newsletter,

which has become a source of important information for 16,000 people, helped people make sense in real time with fact-based information in the middle of this pandemic. Our laws as it pertains 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 for f***'s sake.

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. Anyone who's watched me over the years knows that I'm obsessed with Hydrolyte. In my opinion, the best oral rehydration product on the market. I literally use it every day. My family uses it. When I had COVID, I'm telling you, Hydrolyte contributed to my recovery, kept me hydrated. Now, with things finally reopening back around the country, the potential exposure to the common

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Again, that is h-y-d-r-a-l-y-t-e dot com slash d-r-d-r-e-w. Be sure to use the code drdrew25 for a special discount. Please welcome Dr. Lucy McBride. Drew, thanks for having me. I'm thrilled to be here. Thanks for having me. How do people get to be on the letter? Get your newsletter. How do we do that?

It's real easy. You go on my website and you can sign up. And you'll get a little delivery in your inbox every Monday. I'm trying to keep track of what's happening in real time and help people cut through all the noise. You know, there's so much information. People are overwhelmed. People are exhausted. And I'm trying to insert a little bit of my sort of silly humor and a little bit of my personality, if you will, and talk about how to manage these stressful times in addition to managing the virus and the risks of it itself. Yeah, I from the beginning have been deeply concerned about the panic that the press was inducing. And now I have spoken to decision makers and people that were advising decision makers.

What was that? Why did you close schools down? Why did you prevent people from lying towels down on the beach? What was that? And now they're starting to say out loud, oh, that was panic. That was panic.

We had to do something. And I thought, wow, can you imagine if you or I were making decisions at the bedside in an intensive care setting and started to panic, and that was driving our medical decision making? It's just, it's sort of disgusting to me. What do you think? Well, I think that, you know, hindsight, you know, certainly is 20-20. And I think we really didn't know a lot about this virus back in early 2020. But certainly now, with 20 plus months of accumulated knowledge

and real world data on the extraordinary effectiveness of these vaccines, and with a clear sense of how to control the virus. I mean, there's certainly a lot we don't know, right? But, you know, we know that the vaccines work extraordinarily well. We know that surface transmission is just not really a thing. We know that outdoors is safe. We know that kids are suffering from the emotional costs of ongoing pandemic restrictions. I mean, we should be tailoring our public health response a little more elegantly. Elegant is a kind word to use, at least taking into account risk reward analysis. And, you know, both of us have an interest in mental health, and that seems to have been

completely disregarded. Child development, child mental health, what it means to push people into poverty, substance use. I mean, they just completely ignorearded. Child development, child mental health, what it means to push people into poverty, substance use. I mean, they just completely ignored that and still seem to be blind to it. Well, that is my biggest frustration and sorrow right now is that, you know, as you, I think, agree, Drew, you know, health is about more than simply not getting a single respiratory virus, right? Health is about our everyday lived experiences. It's about our relationships, you know, with work, our relationships to ourselves. It's about having a job and being able to feed our families. It's about, you know, having the trusted sources of information. And so much of our sense of normalcy has been thrown out the window.

So it's not surprising that we're seeing, you know, overdose and opioid, you know, rates increase. We're seeing diseases of despair in parallel with the virus. And, you know, I really worry, as I think you probably do, that, you know, we're going to see the ripple effects of the, you know, the mental health toll for decades. I mean, you know, we know from, we know from traumas like 9-11, and that was, you know, a different trauma, of course, but that the physical, emotional, behavioral, medical manifestations can last for, for decades. And then, you know, about the data on adverse childhood events in children, right, ACEs. And, you know, I the data on adverse childhood events and children right aces and you know i would argue that most kids even if they look like they're fine masked up in a school and not communicating like they would normally would with their teachers seem fine that they're experiencing something that's not normally that will have lasting effects

hopefully not but i i don't see how it couldn't especially under the age of five and by the way let's be clear the World Health Organization is explicit against masking under the age of six because of this issue not just the fact that you are creating oppositional defiance against the parents when these two-year-olds don't want to wear a mask the fact is that particular developmental stage is when the face and not language is the way feeling states are communicated, the way emotional landscapes are built, the way regulatory systems in the brain are set up. Words do something, but it's mostly facial expression of the caretakers that transmit to essentially the midbrain regions of the emotional systems the capacity to name emotions experience emotions

feeling felt and regulate those emotions and we're i i was i was lecturing a group of teachers and they were talking about the distress they were seeing in kids and they said they asked me what what should we do and i said well you know get down to the kids level focus on their face show express with your face and appreciation what they're feeling and they just went to me they go yeah but the mask and i thought oh yeah possible it's just impossible yeah i mean i mean the argument that the kids don't mind and the kids are resilient you know is it's frustrating to me because sure there are kids who are pandemic proof but let's face it, as you just said, Drew, we need to see other people's faces to develop socially and emotionally at those ages. And certainly for reading and for learning, it's important to see other people's expressions and the full range of their, you know, emotions on their face. And it's not that the World Health Organization is kooky or nuts by recommending against masks in under five,

it's because they've thought about the harms of masking weighed against the benefits. So, yeah, I mean, I think, you know, you and I think about this all the time in patient care. You know, when I recommend anything in medicine, I think through the risks, I think through the benefits, and I communicate that with my patients, and we make a shared decision on what is right at that person's, you know, at the time. We need to really think hard about what harms, unintended consequences there are of these ongoing pandemic restrictions while mitigating the death and destruction from coronavirus itself because we can do both. We can walk and chew gum together. We just need clear instructions, clear communication, and to recognize ultimately that health is about our, you know, a mental health as well.

That mental health is health as well. Right, right. right right i i the fact i i the one thing that early on jumped out at me was that our public health officials seem unable to make a risk reward analysis they just don't seem to be trained to do that which i found astonishing um but it doesn't seem like they are understand or have no judgment at least around risk reward analysis when you know in world, that's all we're doing all the time. Every move we make, we do bad things to patients. Yeah, go ahead. Yeah, I mean, it is sort of shocking. I mean, we're seeing, you know, the ripple effect, the post-traumatic stress on our collective beings right now, and it's going to be ongoing. so you know i don't know what more it's going to take for for example you know outdoor masking for example um to be lifted in in schools for example

or for us to recognize that um you know i i get i get in a lot of trouble when I talk about children because I have a strong opinion about certain policies we have in place. But I think one of the reasons I'm so interested in thinking about kids and the collateral damage of pandemic restrictions on them is because as an adult physician, and I see adolescents and adults, so many of my patients' problems, like their challenges and their health and their behaviors are rooted in childhood issues like neglect, abuse, certainly, but neglect, anxiety, fear, sort of unmet needs in childhood that then led to say a wobbly relationship with food, a difficult relationship with alcohol, you know, difficulty regulating emotions, regulating sleep, and those things manifest in their health from blood pressure to blood sugar to their weight.

So when you when you every day see patients as you and I do, whose childhood had something to do with the medical problems they have as adults it's really hard to sit back and not say something about these ongoing restrictions that aren't always rooted in science that's well aren't always you're being kind again aren't always rooted in science we we're taking issue with the stuff that explicitly is not defensible and has adverse effect well let's also acknowledge that there are some things that are scientifically true like for example we know that masks you know they have some utility right but it's not about whether masks work or not although that's part of it it's about what are the harms against the benefits it's about a it's about a judgment yeah that's right it's about it's a risk-reward analysis exactly so so let's talk about math so the benefit of masks out of doors is zero because there's zero

transmission outdoors essentially zero approaching zero so no dispute about that that's signaling that's virtue that's's nothing, that does not follow science. Anybody says they're following science and wears a mask outdoors is not following science. Do we agree on that? Yeah, I mean, if you want to wear a mask outside, that's perfectly fine. But less than 1% is a pretty wide range, right? That includes zero of cases are derived from outdoor transmission. So certainly if you are someone who is floridly ill with COVID and you coughed in someone's open mouth outside at a park, yeah, you could transmit it, but let's be a problem. But let's talk about like,

no outdoor transmission is just not a thing. I wrote about it in the Atlantic back in the spring and I got like, you know, lots of good of good responses, but people were furious that I was just a proponent of child genocide for recommending kids not mask outside. Right, so that's insanity. Let's call that what that is. That's insanity because that's insanity. So let's talk about masks. So let's talk about masks more generally. So masks are not 0%.

We both agree that masks have some effect. It's not zero. It's definitely not zero, right? Yeah. And the only controlled studies we have were out of Bangladesh and Denmark, and they give us 12% to 20% or something. So let's give it the benefit of the doubt and say 20%. Let's say a 20% benefit. That's not zero.

That's real. That's 20%. I mean, it's not vaccine level protection, but it's something. So do we agree on that? Is 20% a reasonable number, at least based on what we know? Yeah. If you look at the best study done from researchers at Yale and Stanford done in Bangladesh, they showed that in people over 50, so adults, that surgical masks, not cloth masks, surgical masks offered an 11% reduction in transmission. So that's not nothing.

But remember, that was pre-vaccine. And that was in an area where there is low seroprevalence, meaning like people hadn't been exposed. So we're really stress testing those masks. In other words, it's not nothing, but it's also, I think we need to agree, although it's hard to get anyone to agree with anything anyone says these days, that the benefit of masking goes down as you've been vaccinated. Because when you're vaccinated, you are less likely to be carrying virus in your nose.

You can also neutralize the virus when you've been exposed. So the mask is no longer doing that 11 percent um you know after you've been vaccinated so again i've never said masks don't work um they they do it's just what are the what how much do they work and what are the harms of we can't mask forever right like we can't i mean we want to you can but we shouldn't mask kids forever and plus people behave as though what not wearing a mask is transmission it is not it is not at all it's not wearing a mask you're you're losing that 20 potential benefit or so so so that those are the good studies there are other studies there was a recent study that showed

53 or something it was a sort study that showed 53% or something. It was sort of a meta-analysis, a bunch of composited data. I don't know what to make of that. Composited, right. What did you do? Yeah. Well, it looked at six different studies. Very different than a controlled study.

Yeah. Yeah, it looked at six different studies, and I've had a lot of people smarter than me kind of help me dissect it and look through it. And, you know, a number of the studies had various biases. And again, like 50% seems high, but what I'm having a hard time with is like I saw on Facebook today, there was a teacher using the 53% metric to say how frustrating it is that he has to, you know, police the young kids in his classroom wearing masks because of the 50%, 53% chance of them transmitting the virus to him. And, you know,

he's vaccinated. So that's just the unfortunate thing is that the media has taken and some doctors have taken that 50%, 53% number as gospel, when you really need to look beyond the headline and look at the data and the studies themselves um with people who are trained to look at medical studies and you know i rely on my epi um public health colleagues a lot like i don't claim to know everything just ask my children um but you know when i went through that's the the that meta-analysis it was clear that it's hard to, you can't just say 53%. You have to look at the actual analysis. Right. Let's see. Let's give it 30%. Let's just, just for the, again, let's say, yeah, we'll give it 30%. How does the head of the CDC announce that it's 80%?

How did that even happen? What is she talking about? That was the most astonishing statement. One of the most astonishing statement what one of the most astonishing statements of the pandemic it was astonishing you know because it may sound strange but i i'm really rooting for rochelle walensky i mean i i would like her to be able to we need for public health institutions to you know know, be beacons of strength, honesty, and flexibility during a global pandemic. But when you say something like masks are 80% effective, and no one knows where that metric came from, it's really, really difficult to walk that back or to have people trust the CDC. Although, look, I think they're doing, I mean, it's complicated, but I think they're, as someone said, I can't remember who,

the CDC was a clunky organization in peacetime, so in wartime, it's going to be even more difficult, but they could definitely be messaging more clearly and more correctly. Yeah, I agree wholeheartedly with your wish for them. I, at the very beginning, kept saying, just listen to the CDC, listen to Dr. Fauci. I don't know about you, but I've been through five pandemics with Fauci. Fauci is the reason I got involved in radio in 1984. He was my guiding light during HIV. He was during H1N1, SARS-1, MERS. He was, I mean, just exceptional. And I'm hoping he reverts to his

mean in this particular pandemic, though he too seems to have been affected by the politics somehow. And I don't know what to do with that. And to hear Walensky say 80%. Go ahead. I mean, he, like a lot of people in public health, should know, and I know he does because he's a really smart person, to know that the lessons we've learned

from the HIV epidemic, for example, really need to apply here. That, you know, the notion that abstinence only is not a good public health strategy, and that harm reduction is. Harm reduction meaning a strategy where we meet people where they are, we understand that people naturally take risks because they're human beings, not robots, and we arm them with tools and information to manage the complex, messy, and risky world we live in. You know, when I talk to patients, for example, like I saw a patient this morning who's obese, like I have a number of obese patients. Obesity is an epidemic in this country. If I said to my patient, you know,

right before Thanksgiving in particular, never drink alcohol, never have a piece of sugar, never have pumpkin pie, exercise an hour a day, and didn't talk to her about the fact that she's under enormous stress, is, you know, overeating because she's not sleeping enough, and she's trying to stay awake at work and parenting kids on, you know, who are dealing with emotional challenges and didn't help her manage sort of the everyday contours of her her life or just talk about stress you know in other words if i was sort of preaching from a pulpit of you know abstinence only that one first of all she'd never come back probably to see me again and second of all it's just not an effective way of counseling people um and right you know instead we've got

one step further we've gone one step further we've said because of your transgressive behaviors you can't go to the hospital if you get sick I mean think about those to my patients that do drugs we said we go to an ER if you want to see that you know who's who's in the ER it's my patients it's people making bad choices if not taking a vaccine bad choice but there are lots of bad choices that people make and we give them health care. It's really that was another astonishing moment in this pandemic. But I'll let you comment. Astonishing.

And the moralization of human behavior. I mean, you know, I want to say to some of these people who are moralizing human behavior, like who made you the arbiter of sort of purity? Right. I mean, I'm flawed. You're flawed. Maybe you're not flawed. Maybe you're just, you know, flawed, flawed, flawed. Where am I? Proudly. Totally. I mean, I do the best I can. I am not not perfect. Don't claim to be. So I think that we need to be honest with ourselves as people who are, you know, talking publicly to other human beings that, that, that we're all, you know, we're not all trying to do

the best we can. Some people don't have good intentions, but I think we shouldn't be shaming and blaming people. It's not a good strategy for making, for, for helping people enact a behavioral change. I mean, behavioral change is the hardest part of my job, right? Helping people quit smoking, leave an abusive marriage, cut back on alcohol, limit their sugar intake. But most people I see, they want to make those changes they they want to it's like, they have an intent. And then they have an execution. And it's the it's the difference, right? It's like minding the gap

between intention and execution. And it's the difference, right? It's like minding the gap between intention and execution. And even my patients who are vaccine hesitant or a couple of minor vaccine refusers, you know, they are not bad people. And moreover, if I suggested that they were bad people in my attempts to convince them to get vaccinated, it would really not go well. Yeah, they're not dumb people either. But the public health, as you pointed out, you're using, you must keep an eye on Monica Gandhi also, who has been championing. I mean, Monica is a dear friend of mine. I love Monica. Yeah, yeah.

And she's great. And I retweet her stuff all day long. And she, but I would go one step further than the harm avoidance sort of strategy, which we not only learn that you can't stand on high and mandate don't have sex. You can't do that. We tried to do that during the HIV epidemic. It did not work. What we found is a whole discipline developed on how to shape health behaviors from a public health standpoint, an actual discipline developed. And to my amazement, they abandoned that discipline during this pandemic. And that is, what you do is you show

narratives, you have relatable sources, like the characters are relatable to you in the narrative, you show consequences of people's health choices. You use humor and music, and that's it. That's how you shape behavior. You or I in a box does not change behavior. It just doesn't. It really doesn't. The way I'm able to help someone, for example, quit smoking or cut back on alcohol or whatever it is they need to do to change their behaviors, to change their health and improve their health is by relating to them, by offering empathy, offering compassion, and then offering them tools and meeting them where they are.

And so the same applies to public health. The problem is, and this is why I feel I have empathy, believe it or not, for Rochelle Walensky and Dr. Fauci, is that they're trying to message, I'm trying to message to an individual patient, which is hard. They're trying to message to people who on the one hand don't believe COVID exists, and on the other hand, are triple vaxxed N95 masking, you know, outside. I mean, that's a tall order, right? So the problem is we are, now that we have vaccines that are extraordinarily effective, we need to, you know, not cater and organize our behaviors and our entire lives around a virus that for most people, once they've been fully vaccinated is a mild illness.

Right, but same thing is true though, of people under the age of 25. And so, which is another really interesting piece of this, that we've sacrificed youth for the elderly, which is, I've never seen happen before, but that's not a diathesis, that's not a construct that I would sign off on if I could. I would prefer to support the youth and sacrifice myself.

Ask any parent. That's essentially what we do. But okay. In any event, so there's another sort of, as long as we're talking about astonishing moments, I had peers say to me the following words that I found, well, I'm going to call it what it was. I thought they were stupid because it didn't make sense. It was literally nonsense. What they would say to me, in the middle of a pandemic, and pandemics are defined by excess death. So if you are in a pandemic,

there are more people dying in that year than is ordinary. That's excess death defines pandemic. And what I heard from peers was one death is too many. And I thought, Oh my God, what do you, what does that even mean? What do you mean by that?

We're in a pandemic. We are going to have excess death. That's the pandemic. That's what that means. Now, we're going to minimize that and take it to an absolute... We're going to fight like hell to develop responses to it and keep it down and figure out how to treat people to keep them from dying. But safety uber alice became this weird construct that I've never really seen before. So living, living was a sort of, um, almost like some sort of incidental concern, but safety Uber Alice was what, what was prevailing. That was weird to me. That was another astonishing moment. What are your thoughts on that?

Yeah, I think, no, my thoughts on that are very parallel to what you're saying. I mean, if you think about it this way, I mean, we somehow have tolerated every year 20 to 40,000 American lives lost due to influenza. I'm not saying that we should. In fact, I think we've learned so many lessons from the pandemic and people maybe didn't have their eyes open to the fact that we lost that many people every year. And maybe people will get their flu shots. I hope they do. I got mine. I hope you got yours.

Everyone should get a flu shot in addition to their COVID shots. But we cannot scrub and sanitize the world from endemic viruses. Yes, in a pandemic, we are doing everything we can to limit excess death and destruction and basically to not overwhelm our hospital systems. But to expect no death, to expect zero COVID is really, I mean, it's just not scientifically possible because A, we have animal vectors, B, people spread this virus without even having symptoms, and C, the vaccines aren't perfect.

So it's not possible. So what we can do is, as Monica says, take the fangs away from the virus by getting vaccinated, and then protect ourselves from despair by living our lives in tandem with being cautious against about COVID, protecting ourselves, our families and our communities, we can do both. But to say that we should have no zero deaths from COVID heretofore would

mean that we'd have to lock ourselves in saran wrap and never leave our houses. And that's not a life worth living for most people. I don't mean to be glib about this, but we've sort of forgotten how lucky we are. I was struck, I don't know if you used to watch the TV show, The Nick. I really liked that show. And it's about a New York hospital at the turn of the 20th century and a group of surgeons just trying to do things. Everybody died no matter what they did. And so they were just trying stuff because if they could get somebody not to die, it was an extraordinary success. And there was a eulogy one of these surgeons was presenting in the first episode. And he goes, medicine is making great strides as we

enter the 20th century a child born today can expect to live to the age of 42 and i thought wow he's that's that was only 100 so years ago and you really forget about how lucky we are and how extraordinary that this is in in the in the history of humanity that i at the age of 63 can feel as good as i do and have my prostate cancer treated and take my flu shot and do all these things and get through COVID without taking monoclonal antibody that got me through COVID. I mean, that's amazing. We should be grateful for that. We are living in an embarrassment of riches with the amount of vaccines that are so incredibly effective with access, if people are lucky enough to have it, to monoclonal antibodies with two incredible oral antivirals on the pipeline, Molnupiravir and Paxlovid, which I do think will be game changers when we pair them with rapid tests that hopefully are coming to be more accessible and affordable to people and hopefully free. We are in a very, very luxurious privileged position in this country. Yet, the divide between the haves and the have-nots is getting worse um in large part because of these restrictions and lockdowns and um it's it's it's tragedy i mean yeah and and we have put into place

explicitly racist policies explicitly we would that segregate people who are trying to make choices but don't know who to trust to get the right information. So rather than an outreach to those people to try to help build that trust, we're segregating. And these are racist policies. Let's make no mistake about it. When you see a, they're systemically racist, let's put it at least that way. It's a policy that looks at how the percentage of vaccine acceptance is breaking down and says, we're going to exclude these people. And it has a specific racial breakdown. I don't know what else you can call it, as opposed to trying to solve the problem of reaching and building trust and helping people make good choices. I am, to me, that's breathtaking. Breathtaking. I totally agree. I think, you know, structural racism, it infiltrates every pore of society right now as by definition. And I think, I mean, I just come back to the basic fundamental facts of how we relate to each other as human beings. And this is certainly true in the doctor's office is, you know,

empathy, listening, acceptance, and then trust and compassion. And, you know, at the end of the day, I mean, I think we all want the same thing. I mean, we may want different variations of the same thing. We want to protect our loved ones. We want to have food at our table. We want to have ideally meaningful work, but we want to have work. And we want to be connected and feel loved.

Play. And at the risk of sounding cheesy. I'm going to interrupt you. Work, love, play. Play is part of health. I mean, those are the three. Yeah. and at the risk of sounding cheesy work i'm gonna i'm gonna interrupt you work love play we play as part of health i mean those are the three yeah so i'm hoping that on thanksgiving we can look at each other as not just vectors of disease but as vessels of compassion right like i hope you know we will because we are going to be at the thanksgiving table it's my parents who are vaccinated my brothers my nieces who are partially vaccinated.

We'll do a little rapid testing to make sure no one's bringing in infectious levels of virus in that very moment. But, you know, we're going to kind of like make it normal because we are grateful for science and the wonders of these vaccines. So let me make a couple of specific topics I want to bring up. I'm watching a restream chat while we talk here and people are, a lot of questions about myocarditis and I guess we'll get into that. Okay, sure.

Let me just ask one. Yeah. Yeah, one of the questions was, cause I don't know what to make of the stories that I hear. Are you making anything of the young athletes that seem to be, I don't know if they're having sudden death or syncope or what? I can't get the data on that together. Are we to make anything of that?

You mean, are you talking about from COVID? No, I've been ignoring it because it's been so anecdotal. But somebody is asking, so I'm just asking it do we make anything of the anecdotes that are flying around about athletes I think they're implying that there's a sudden death on the soccer fields and there are people having syncope on the soccer soccer fields and being found to have myocarditis related to their vaccines that's sort of the implication I can't find it collated or or in any way reported in a source that I find reliable. Well, I watched in real time a European soccer player collapse because of a

sudden cardiac arrest. Did you see that? It was a couple months ago. My kids are soccer players. Yes, I did. But as far as I know, that wasn't vaccine-related or COVID-related. But here are the facts because, of course, anecdotes are interesting and make headlines, but we want to look at data. Myocarditis is a real but very rare potential complication of the mRNA vaccines, the Pfizer and the Moderna vaccines, more commonly for Moderna in teenage boys and young men, it is very, very rare, but it's also a thing. Usually it's treatable, usually it's mild, and moreover, COVID itself can cause myocarditis. Myocarditis is inflammation of the muscle of the heart. So I have a 17 year old son. I have two sons. I have one who's 19. My boys, I'm going to not rush out to get them a third dose because A, they're at low

risk for poor outcomes from COVID to begin with. And B, because they're in the age category that it puts them at a little bit higher risk. And it's just there's no – I'm not seeing the benefit of vaccinating them three times when they're young boys. Exactly. I completely agree. So the incidence of myocarditis, pericarditis also is somewhere around 1 to 5, 1 to 6,000 per injection. And it's all so far been mild and self-limited and no big deal. But when we start vaccinating millions of people, there may be some big deal. And the question becomes, how do you help? I don't know how to do this because I'm not a pediatrician. How do you

help parents make the choice whether risk reward is worth it? The probability of getting serious myocarditis or serious COVID for a nine-year-old is zero. And for the vaccine, it's one in 5,000, which is nearly zero. So I, I, it's a confusing territory for me. It is. And this is where we really need, you know, to risk stratify kids. So a kid who is obese, a kid who has type one diabetes, a kid who's immune suppressed, absolutely. I'd get them one or two shots. But for healthy kids, you know, I still, I still, you know, look, I'm not a pediatrician either, but I, you know, I have lots of pediatrician friends. I am a mother and I do follow the data pretty darn closely. So the, the, I'm recommending the vaccine to, to kids because number one, so look at it this way. We are all going to be exposed to coronavirus at

some point. It's not a question of if, it's when. And I'd rather my five-year-old have vaccine induced immunity than coronavirus induced immunity from getting the infection itself. Because the safety data is there, because we've already vaccinated so many kids. I can't remember the number at this point. It's 3 million kids, kids i think one does um and we haven't seen any we haven't seen any safety single so far on the real estate the world stage so you're bringing up another topic which is people are starting to say finally under their breath that we are probably all going to have hybrid immunity one day uh that endemic is code for the virus constantly circulates, and we all get it, and it comes in waves and up and down

in terms of its incidence. But ultimately, we're all going to have something called hybrid immunity, which is the vaccine and then the illness itself, which will give us a very broad immunity that will probably dampen this thing out over time quite nicely. And now that we have the antiviral therapies, so we have three, we have sort of two ways to make the illness itself incidental. A, the vaccine, so you're pretty much guaranteed to have mild illness. And two, you take the antivirals when you test positive.

The interesting thing to me is, do you think we'll hit a time when we will start advocating to get exposed in the six months after your second vaccine when you're optimally vaccinated rather than waiting until your immunity wanes and risking more severe illness down the road when you eventually get exposed to COVID? Isn't that kind of interesting yeah i mean yeah so you're not going to hear me recommend like going out and just it's hard yeah to like let it rip but you but but you might say but you might say take our mask off and if you get it well you're at least optimally vaccinated now. So there's a difference between recognizing reality, which is that we will be exposed, and recommending putting yourself out there intentionally or unintentionally, right? So it's a little bit of a different posture, although, you know, there's a little bit of semantics. But the point is that once you've been vaccinated, you're not bulletproof.

And certainly there are some people who are at higher risk for poor outcomes, even though they've had the vaccine. If they're elderly or infirm, organ transplant patients. But the truth is, yes, once we have lifted restrictions, and even now, we're all going to be exposed to coronavirus at some point. And getting a little microdose of virus is certainly going to top off our immunity. And some of us won't even have symptoms. Some of us will have mild symptoms. I'll be interested in hearing you

and Jay Bhattacharya's conversation and what he says about, you know, encouraging people to get COVID. I don't think ethically you can encourage somebody because you're putting people at risk of an unforeseen bad outcome. But I think to say, hey, look, wearing your mask in the six months after you're vaccinated may not be the smartest thing. Because, yeah, you're sure, you know, yeah, you don't want COVID. But should you get it? The time to get it is the six months after you're vaccinated. I don't know.

I don't know what to do with that. It's just a thought experiment flying around in my head. And because people are starting to talk about. Go ahead. Let's look at what happened this summer with RSV, right? That was largely because of an immunity debt, you know, because kids weren't, you know, doing their normal kid thing. And they, that all of a sudden RSV surged. And, you know, I don't have a perfect explanation of why RSV surged when it did.

But certainly part of it is because kids had an immunity debt. And so, our immune systems need to be worked out like our muscles at the gym, right? So, without little exposures here and there, our immune system doesn't get tested. It's not to say, again, in all caps, we're not encouraging people going out and getting coronavirus, but the reality is that we will be exposed and we will develop hybrid immunity over time, vaccine-induced plus infection-induced immunity that will get us through to the other side.

I, by the way, think, I have a suspicion, I have hybrid immunity. I had bad COVID, then I got Johnson & Johnson vaccine. By the way, I woke up on day two after my J&J vaccine with spontaneous raccoon eyes, which is the presenting feature of the transverse sinus thrombosis,

which was a lovely thought as I looked in the mirror. Yeah, and I had no other symptoms and it all went away spontaneously, but I definitely had some sort of platelet consumptive something going on uh just fortunately it didn't isn't that yeah yeah it was pretty i i knew you know i was felt fine but looking in the mirror at the at the black eye i thought i i know what this means i know what this could potentially mean and it's not a good thing uh but it all passed. But I don't look forward to taking

a second J&J vaccine. Anyway, so I have hybrid immunity. I've been testing broad antibody panels on myself, and my neutralizing antibodies went up recently. I think I may have been re-exposed and had no clinical symptoms. It's kind of interesting that maybe, you know, with good hybrid immunity, you can sustain it with, you know, with community exposure. You know what I mean? It's sort of another interesting thing no one's talking about. Yeah. Yeah. No, and that is the reality of life with an endemic virus, which ultimately SARS-CoV-2 will be like other four coronaviruses. And we will have little micro exposures. We'll get colds from COVID. We will get mild flus in some cases, and then we'll get a little top off

of our immunity. And who knows if we'll need vaccines for COVID once a year. But to people who say, oh gosh, three shots, does this mean every year? And they're kind of hand-wringing about it. I say i say look worst case scenario we need a shot once a year i mean that's just not a big deal particularly in this wealthy country we live in where we have so many doses available um i think you know as you yeah go ahead finish please as you as you as you might agree i mean i think you know i wish we could take the third doses we're giving to healthy people overseas to people who don't even have access to the first dose not just because i'm a nice person i'm a pretty nice person but because it's also it's

also a way to to tamp down the virus globally um but it's also the right thing to do anyway that's i don't have that in my powers yeah and most of the the unpleasant vaccine side effects we're seeing are it really after that second dose and as as in europe they're stretching it out to 12 weeks with kids and you're seeing less of those unpleasant side effects and so the booster is less likely to give you trouble. I want to take a little break and when we come back, talk about antivirals specifically. I think I've been left with this weird COVID symptom, which my thinking blocks inevitably. If I have a conversation of one hour duration, I'll have something, all of a sudden I'll be unable to produce whatever it was I was thinking. And that's happening to me right now.

So I don't know what it was I was going to say about vaccine therapy, but I did have, it was vitally important. I'm sure. Oh, I know what it was. It was that, you know, what I tell people is that it's a three-part series, much like adults, much like HPV. It's not, it's not a booster. It's a three-part vaccine series.

And then we'll see what boostering is after that. That's what we're learning. Yeah. Okay. I will take a little break. We are here with Dr. Lucy McBride and be right back talking about what we're going to do therapeutically

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We are back with Dr. Lucy McBride. Go to her website, lucymcbride.com to get the newsletter where you can get more information like we're describing. Lucy, my producer has jumped in and asked us to take calls before we go into the conversation about the antivirals. So we're on Clubhouse. Those of you on Clubhouse, raise your hand. I'll bring you up to the podium. And again, we'll be streaming out on multiple platforms.

You agree to such as when you come up to the platform. Casey, what's going on? Hey, Dr. Drew, Dr. McBride. platforms you agree to such as when you come up to the platform casey what's going on hey dr drew dr mcbride got a quick question here um so i had a couple kids that i work with uh that uh stop by and see me every now and then and uh they all are they've gotten their uh first two uh shots uh vaccinations and uh they're hearing about kids getting sick from booster shots and stuff like this, and they don't want to take it, even though their parents and their teachers are saying they have to. So the question I have is, at what point do you allow kids to make this decision on their

own? What age group are we talking about? At what age? What age are you talking about? 11, 12, 13, 14. And somebody is requiring a booster? That doesn't sound right. Yeah, they were.

Well, they just stopped by yesterday and they were like, yeah, we have to get our boosters and we don't want to get them. Lucy? Well, boosters are not even recommended right now by the CDC. So I, I would not boost, I would not boost an 11 or 12 year old for a number of reasons. One, because it's not, it's not recommended right now. It's,

it's still on emergency use authorization. And, and two, because kids are relatively low risk for poor outcomes from COVID. And so I, I think they don't, yeah, they don't need boosters.

Are you sure they're not talking about the second vaccine? They all said we've already had two and now they want us to get one more. No, no, that is, I would argue that is not just unethical. Who are they? Yeah, but possibly illegal. Well, you guys actually met one of them. Jorge was one of them.

No, no, who is requiring them oh they they they oh I'm sorry uh I I'm assuming it's going to be this the school board the school itself what what city uh it would be Santa Barbara sheesh I don't know what to make of it but uh I would make some noise unusual it sounds so almost sounds like uh like maybe a little bit of overreach or i i i don't i'd like to know what what should happen is whoever's saying that needs to be counseled by a medical professional that's right well santa barbara we may learn down the road that it's a three-shot series for kids, but we do not have data to support that recommendation right now. Exactly.

So understand, for medical professionals of any stripe to be recommending something, there has to be an evidence basis for it, or at least the evidence, the provisional evidence for evidence, something that leads us some objective data. And now, no, we don't have that. That's very bizarre. All right, so let's go to the antivirals. Yeah, so I was very interested in the Molnupiravir data, the Merck product. And then I saw the Pfizer data with the Paxlovid and I was blown away by what that looks like. So my question really is, how do you think we're going to use these? I almost feel like molnupiravir, my sort of spidey sense is the molnupiravir is going to really be the new um here's my covet brain again um the the flu the anti-flu anti-influenza

medication it's gonna be the new tama flu and while pax levier pax levid rather is gonna be really to treat illness it's gonna be ciprofloxacin you know what i mean uh what do you think i think you have a good spidey sense i love that that word um because we're still watching the data play out and what i what i what i do feel pretty strongly about is that we need to get more rapid testing available to people um ideally for free because it's not going to make a difference if we have oodles of antiviral medications that can be taken by mouth if we don't have the tests accessible and affordable for people to, because remember, you have to take these medicines when you have a new diagnosis of COVID-19 in the

first three to five days after the diagnosis. So we can't have, you know, testing delays, we need a lot of rapid tests to couple with the prescription. So it's going to be an interesting time. But I do think that these oral medicines combined with ongoing vaccination are going to really take us forward and hasten our, basically turn this from a pandemic to an epidemic. Right. End an endemic. Yeah. And I'm a little concerned about the rigid requirement of a positive test. I would hope that they would also add a high index of suspicion on behalf of the physician. For instance, I don't know if you've seen some of this stuff, but I personally was a case in point. I didn't convert on the rapid antigen until day four, and I was really sick by that point. And the molipiravir may not have that

much effect by the time I got that sick. Absolutely. I mean, like everything in medicine, there has to be a clinical judgment and-test probability. So like if I have a patient who has a family, a household full of flu members, right? Like let's say her whole family has influenza and she herself has body aches, fever, and a cough and her flu test is negative. I don't really believe that test because my pre-test probability is so high. In other words, we have to be able to use clinical judgment. I will put that person on Tamiflu and get a second test if I can. Similarly, we should be able to exercise clinical judgment with these medications. And I also will

be interested to see if we can use them down the road for post-exposure prophylaxis. So if you have a household full of COVID family members or you have a high risk individual um could you put them on it before before they get sick that's i'll put i would i i put my bet on that's going to be moldy pure bear that's what that's i think so i'm going to get to hemiflu yeah yeah um the one of the other astonishing things in the pandemic was uh pharmacists refusing physician orders. I worry that that's going to get involved here when people start, you know, learning how to use antivirals. I'm very concerned about that.

I mean, there are so many concerns and so much worry that I have about the state of medicine and medical care in this country. It's like, where to even begin? I mean, first of all, as you know, 80 million Americans plus don't have access to a primary care provider, which to me should be the hub for problem solving, the place where you go to get your medical information. You know, we didn't even get vaccine access for our patients, which seems crazy because who more do you trust than your primary care doctor to dispense like facts-based information? But yeah, the pharmacists, I mean, at the same time, I love the pharmacists that I work with. They're wonderful people and they're essential workers. But we have a lot of work to do in this country on health care and the providing of it.

Yeah, the way our peers froze primary care just was not uh i don't know i i don't like the way it went down uh in the pandemic it was not what i'm accustomed to or at least what i'm trained to do which is to improvise use what i have on hand do the best i can for the patient in the moment, not send them home until their oxygen saturation drops below a certain level. That was another astonishing moment in this thing. Yeah, I mean... Like, we can't treat you, just go home, what? Yeah, I mean, yeah, I wrote an article for MedPage about primary care and how,

you know, of course I'm biased because I'm a primary care doctor, but, you know, particularly as we start to recover from what I'm calling a collective trauma of the pandemic, you know, people are going to need so much more care than they did before. I mean, people have left their underlying conditions on dealt with people have gained weight. People have been drinking more, you know, substance use disorder is raging, people are depressed and anxious, and people aren't well. And where better to put all of those issues in a primary care doctor's office if that person has access to a primary care doctor and the doctor has time and doctors in primary care are incentivized to talk to patients about their everyday lived experiences

and not just check the boxes and say, oh, wait, you gained weight over the pandemic or cholesterol is high. Here's more Lipitor. Exercise more. See you next year. We need really to invest in primary care as the hub for problem solving. Yeah. It seems like the collective sort of response is that, oh,

we'll give you more physician extenders. That's how we're going to deal with this. And that's great. And they're well-trained physician extenders out there. And I value them, but I'm not sure that's what we're really, I don't know, it misses the point a little bit, doesn't it? Well, you know, I think we need more, I think we need to incentivize medical students to go into primary care as a field. But why would you want to go into primary care right now if primary care is being treated as sort of the stepchild of medicine, right? If you have five minutes to see a patient who's on 15 medications and you can't connect with them and learn about their relationship to stress and all the things

that matter when you're caring for human beings. So, you know, again, we have our work cut out for us. The pandemic has really laid bare our vulnerabilities as human beings, but also in our healthcare system. Yeah. Back to the physician extenders. So their response, so I keep hearing is, well, you'll just, you'll just, you know, supervise physician extenders. So I keep hearing, well, you'll just supervise physician extenders, and they'll spend the time with the patient. And you will supervise 20 of them and accept all the liability for every decision made. It's impossible. It just doesn't work like that. It's like, all right.

Let's take another call here. Hold on a second here. Josh, get you up to the podium. Go ahead, Josh. Hey, thanks for taking my call. So I wanted to talk about the other countries, most notably France. And I wanted to talk about the riots that are going on there. Mm-hmm. And what are we, what am I missing? Because we're not rioting here. I don't feel any real need to riot. I might be a little upset, but I want to know what's going on in the other countries that we're not seeing, because I believe the young people. I'm one of the people that does.

Well, the young people are the ones rioting in France, not so much in Germany and Austria. It's a different thing in Germany. It's funny. Each country has their own sort of version of this. And before I adulterate things, thanks for the question, Josh. Lucy, what do you say to that? I mean, I think people are upset with the expectations that they can go on in sort of a state of suspended animation for much longer.

And people want to be heard by their government. You know, the United States of America is a very heterogeneous place, right? I mean, and, you know, how can I say, like, we have a lot more liberty, um, in a sense, but of course that comes with a cost. Um, and so I don't know. I mean, I think, I think, I think that people are fed up. I mean, we saw the, I saw those images in Rome of people, you know, protesting against the government. People are fed up. They need to be be handed they need to feel heard they want to have tools to to to manage the enormous stress of the pandemic they need jobs um they need to feed their families and they don't want to be talked down to and they don't want to have draconian restrictions imposed upon them when they're doing the best they can to

get through the day. I can only speak to what was happening in France because we were there about six weeks ago. And what is happening there is the converse of here, the opposite of here, the young people, meaning really 25 and under, maybe under 30, but particularly 25 and under, are saying explicitly, now hold on a second. You told us we were at low risk of complication from this illness, and now you're mandating that I put something in my body? You're mandating that? You're not recommending it?

You're not offering it? You're mandating it? A government shouldn't be doing that. And in their mind, it's actual echoes of 1790. They will say it explicitly. My French is pretty good. I talked to a lot of young people there. And they would say, they would say,

liberté, fraternité, that's it. Égalité, that's it. Liberté. They would stand up and show me their fist. They go, liberté, it's important. This is challenging the basic principles of the revolution of 1790 upon which this government is founded. And they are really energized by it. They are completely mobilized. It's not a medical question to them. It's a

question of the legitimacy and the principles upon which that government was founded. It's kind of interesting. It's very interesting, isn't it? I think it's fascinating. And I think, I don't know, I just worry about how we're going to recover from the politicization of this pandemic. I don't know. There's so many things to worry about

and to lose sleep over, but yeah. Yeah. The politicization here is a totally different thing. Completely different thing, right? and to lose sleep over. But yeah. Yeah, that's, oh, the politicization here is a totally different thing. Completely different thing, right? I mean, this was this weird, I don't want to get into that because somebody's got,

do you believe they will write a postmortem on this thing? Don't you think somebody's got to do a dispassionate, careful analysis? But I'm fearful that's going to be politicized. I'm fearful they won't do it dispassionately. There'll be many. I mean, they's going to be politicized. I'm fearful. There'll be many. I mean, they're being written right now. I mean, there's so much analysis that needs to be done. I mean, like you, I'm interested in how, you know, the thing that I'm most interested in right now is how we think about health and how we define health in this country.

Because right now it feels like we're defining health as a negative PCR test or not having COVID-19. When I think you agree, health is more than the absence of disease. It's about having access to medical care. It's about being heard, being seen. It's about being heard, being seen. It's about not being lectured to. It's about having open communication with a trusted guide. Yep. And health should be part of a good life.

And we don't have conversations about what does it mean to live a good life. And you sort of tilted you tilted at it earlier, work, love, play, meaningful work, good relationships, all these things, this is what, and then making a difference for other people, which is part of meaningful work, right? And addressing our mental health. I mean, mental health is ground zero

for our whole health, right? I mean, we all have anxieties. We all have worries. We all have moods. We all have relationships. We all experience grief and loss. Those feelings and thoughts drive our behaviors and our behaviors drive our health outcomes. So it's, it's only appropriate to address mental health in the doctor's office and the primary care doctor's office. And what is suffering right

now for so many people is mental health, which is, you know, at the core of how we feel every day and the core of how we live every day. And so finally mental health is having this moment. It's not just a hashtag anymore, although maybe it is for some people and people are finally realizing mental health matters. So that's what I'm most interested in. And how do we capitalize on this moment to help people realize that health is about mental and physical health in tandem. It's about these parallel train tracks. And there's a corollary there, which is, yes, childhood developmental experiences affect our health behaviors later, but that we shouldn't be treating the brain differently than any other organ from the standpoint of its medical management.

It's another organ. It has a very set of specialized functions, and it gets sick, and there are treatments for it. And that's that. That's right. Yeah. Russ, Russ, you want to make a comment or question? Go ahead. Yeah. I just had a quick question about the VAERS database, V-A-E-R-S. You had a guest, I believe it was last week, who was adamant about querying theirs and getting information on the adverse effects. Is that something that lots of doctors are using? Is that something, Dr. McBride, that you reference regularly? Or is it such a small percentage overall that it's something you just sort of spot check? You know, it's a good database, but it's also not,

anybody can report into VAERS. You know, it's not, it's- It was never, ever, I'm a little irritated because you're not the first person to ask me this, Russ. I'm not irritated at you. Oh, okay. It's never designed for something for physicians to look at on a regular basis to help them make

decisions. It was never designed that way ever, ever, ever. It was designed for the government and for the manufacturers. I dare say in my 40 years of practicing medicine, I've looked at the VAERS data once and it helped not at all. And so, Lucy, maybe you feel differently than me. No, I love your clear and passionate description of it. I think it exists for a reason, but I've never used it and it's never changed clinical management. For example, right now, when you think about the vaccine safety, I mean, all we need is the world stage and real world data to see how very effective and safe these vaccines are. VAERS is not something I turn towards. It was never meant for practice.

Yeah, not meant. It's not. If somebody used the data and published a peer reviewed article in the journal where they were drawing conclusions from the data, we would be exposed to that. But this is not designed to look under the hood and go, oh, this is what's it's not a thermometer for us. You know, it doesn't tell us anything. It's a very mishmashy collection of data, again, designed for the government and designed for the manufacturers. So they're the ones that primarily use it. So yeah, it's weird to me that people think we're somehow involved with that. There's many other systems like that out there that doctors don't check. They're not a part of it. It's not how we develop our judgment. It just has nothing to do with it, which is, I guess,

surprising to people. Well, right. I mean, even, you know, peer-reviewed studies, I guess, surprising to people. Well, right. I mean, even peer-reviewed studies, which is what you and I is sort of the gospel, you still have to layer clinical judgment when you're looking at studies and address the patient in front of you using the data. That's right. Not only, I get very frustrated with this too, Lucy, which is I was sometimes deal with medical students and residents who will come up with these studies and go, look, you see this, this medicine is destroying somebody. I'm like, that study suggests that read the entire landscape of the other peer reviewed journals that are out there, read it in the context of all the other literature that's out there, then we can have this conversation. It's just a data point at this point. It's not, maybe, you know, maybe a turn. That's right. It's context. It's absolutely, and that's what medicine and public health is about, right? It's about using evidence and science, you know, layered on top of the situation or in the case of a patient, the

patient at hand, and then making a shared decision based on science and the person you're dealing with. Yeah, that's right. So you go to physicians for their judgment, not their knowledge base. The knowledge goes without saying. Most of the things that you're getting exposed to around this pandemic are things we've known since second year of medical school. We then took that and applied it in clinical settings and then expanded our understanding through keeping an eye on the medical literature, which was constantly expanding and exploring and developing our understanding of these of these issues it gets very very complicated so when you see something hundreds of times

and you know the basic physiology and you've kept your eye on the on the peer-reviewed literature it gives you the capacity to make a judgment and to improvise a little bit too but to make the right call for that human being in that particular clinical presentation, which is unlike any, it's like other ones, but it's unique. Absolutely. It's about nuance. It's about context. It's about listening to the patient, which is what you and I started out talking about in the beginning. Listening is arguably the best tool in our armamentarium as physicians, listening to our patients, understanding what their goals are, their needs, their everyday lived experiences,

and how those affect their health. And so the data is crucial, but as you said, it's judgment as well. Yep. That's why you go. You go to to make the right call and that's why there's different opinions on what the right treatment is for a given situation that and that's why we scream at each other and share our ideas and we stopped doing that during the pandemic we started calling somebody bad person if they had a difference of opinion which is isn't that amazing again it's so it's amazing i don't think people would say half the things they say on Twitter in person. Um,

but still it's, it's, it's horrifying. What kind of stuff do you get out there in social media? Oh, because I'm talking about thinking about off ramps for kids in schools vis-a-vis masking. Once.

So my argument is, is, is nuanced, but it's that once kids have been insured access to the vaccine, that we need to start thinking about unmasking children because of the harms of masks and the diminishing returns on unmasking, the benefit, the diminishing returns on the benefits once they the benefit, the diminishing returns on the benefits once they've been vaccinated. And so, you know, I get accused of being a child killer and proponent of child genocide or blase or flip or privileged, which the privilege thing, look, I'm a privileged person, acknowledge fully that,

but that's not a good argument when you're talking about allowing children to be children. The kids who are disproportionately affected by school closures and the restrictions on them are kids who are at highest risk because of learning disabilities, language and speech delays, autism, black and brown children who are suffering disproportionately during the pandemic so um the the anyway so the the i take getting blowback as a as a compliment in a way because it means i'm the message is resonating but i also you know i'm trying to convey nuance and context and and not and it's hard for people yeah Yeah, it's hard for people to understand.

Do a mask review generally. People are shocked to hear how slim the data is on masks when you really evaluate it. The other thing, in terms of you being a child killer, let's remember that there are, in the United States so far,

700 pediatric deaths from COVID and 20 of those in otherwise healthy children so there have been 680 in children with severe illnesses and 20 cases of pediatric deaths in a healthy child 20. so right I don't know that and then nominal effective mask in the face of vaccine. Which is, of course, as you know, and I will say this out loud, it's not to dismiss the lives of those children, not to dismiss children with comorbidities. That's just a fact. It's a fact that kids who have certain comorbidities are at higher risk, which is distinct from saying we don't care about those children. In fact, we do. And arguably, that's why you vaccinate the teachers, is to protect the vulnerable children

because they're at higher risk. And maybe you do mask those kids. Maybe we do mask them, do everything possible to protect those kids, which includes masking or masking around those kids. Yeah, good. I have no problem with that. But pushing kids into oppositional defiance disorder,

other emotional difficulties, poverty, that is by the millions, that's a much greater impact on children than COVID itself. By much greater. The other thing that's important to get rid of. That's what we're trying to raise awareness about. The other thing we've got to get rid of ultimately, and I think you could argue to do it right now, is quarantines. Because I think a lot of parents aren't necessarily anxious about their kid getting COVID as much as they are anxious about their kid having to be out for 10 days or 14 days. I mean, parents need to work. Kids can't always do virtual school. I mean, the amount of suffering that kids are doing when they're at home away from their peers and doing virtual school, if it's even offered, is crazy. So we need to get these tests to stay programs in

place so, you know, we aren't quarantining healthy children. There's really no reason when we have tests to stay, these rapid tests, you know, that in existence to send a healthy child home from school because of exposure when we when we're when for a knowledge deficit and the knowledge deficit can be completely solved by a rapid test every day after their exposure yes uh and again i have to shake my head when we have these conversations about rational approaches to saving people from the consequences of some of these draconian actions or really the panic that has caused some of these choices. I just shake my head. I don't know what the public health policy professionals are thinking. It's so confusing to me.

I just don't get it. I don't, I don't, it's so confusing to me. I just don't get it. I don't really know. I mean, I think, I think that it's, I think that it's hard for people to admit they're wrong. Look, I don't like admitting I'm wrong. Ask my husband. I don't like acknowledging that I have to shift my position on things, but I do and I have to in my professional life and my personal life.

Otherwise, I wouldn't have any friends or patients. The point is that I think it's hard to shift the mindset from protect against COVID at all costs to a more nuanced one, but we have to. We have to. Yeah. We have to. I agree. Let's kind of leave it at that.

Susan, do you have any questions for Dr. McBride? Nope. Nope. Okay. We said it all, as Howard Stern would say. I'm looking at those of you on the restream to see if there's anything more that you guys... There's a lot of talk on the stream here about Sweden. I don't know quite what they want to ask about Sweden.

Comparing countries, I'm not sure is a super... Go ahead. Sweden, you know, I wish I knew. I'm sure the people who are listening know, but Sweden didn't mask kids in schools. They just had normal school. And it turned out that Sweden... Okay, i don't want to i'm not 100 of them but sweden you know the schools weren't like on fire with covid despite not masking

children that's what i think they're asking about but again i i don't know i mean we do have data that that in the us when you control for vaccination rates in the community and you control for teacher vaccination rates that lifting masks don't make that big of a difference in schools for school transmission but again i will be accused of being blase flip about children's health or teacher health um in some capacity by just saying that. But the data is there. The data is the data, as we say. That's that. And why they're not. In God we trust everyone else's data.

Yeah. Yeah, exactly. That's it. All right. Well, it's been a pleasure to spend a little time with you and chat with you. We'll get the newsletter at lucymcbride.com right is that where i get it that's exactly right drew thanks for having me it's it's a pleasure to talk to you and i i hope we can talk again thank you thank you for sharing your training and your wisdom and your judgment and uh turning it into a source of

information that i hope people can trust. Again, that's, that's to me is the biggest problem right now. They don't know where to turn to get solid information. And I think you're, you're one of those folks. And so there's the news. I have no agenda. I have no agenda other than to help people. And if people don't want to subscribe, they can unsubscribe.

And you just, you, there's an archive and you just, what do you get the updates you click on get my updates and they just put your email in and that's it yeah there it is that's it that's it that's it and then every monday you'll get a little missive kind of i usually write these over the weekend or on sunday kind of this week was about preparing for thanksgiving um Sometimes I'll write about managing, you know, anxiety. Sometimes I'll write about depression. Sometimes I'll write about relationships and how we talk to our family about controversial subjects like the vaccine in mixed company. Because again, health to me is about more than just this single virus. It's about all of it. A good life. And I'm all signed up. So I'll be reading your newsletter on Monday.

Oh, good. And hopefully you won't be a stranger and we'll get a chance to meet in person sometime. I'd be fine. I'd love it. Thanks, Drew. Thank you so much, everybody. Keep doing the hard work. Yeah. Dr. Lucy McBride with us today. Thank you so much.

And tomorrow, Dr. My pleasure. And tomorrow, Dr. Bhattacharya. That's right. And then on Monday, Alex Berenson. On Tuesday, Dr. Vinay Prasad, who I've been trying to get here for quite some time. I used to have a nervous breakdown every December 2nd. Remember?

I don't remember it being December 2nd. I remember it being towards the holidays. The first week of December. Because? I don't know. I had all these kids, and then I was always preparing for Thanksgiving, and then I had to have Christmas cards in the mail by December 1st or whatever, and we'd have to have the pictures, and then I'd have to address them all. And then, you know, we had to decorate for, we just got off of

decorating for Halloween and then we have to decorate for Thanksgiving. And then after that, you have to decorate for Christmas and take care of kids. And then they're all in the musicals at school and you have to do exams and right you're right I mean it used to you know and then I would always have a rush of patients rather oh yeah and all your old people would get sick at the same time and then I would have an anxiety attack and want to check into Las Encinas yeah or maybe I just drive you over there i really really wanted to one time he said i'm going to check you in because i wanted to jump out of the car and you go i'm

going to check you in las encinas and i said please do yeah please please i need it please give me seven days off but you know what i did i quit doing christmas cards before everybody else you know and you stopped wanting to jump out of moving vehicles on the freeway like i got a christmas card from caleb today and it's beautiful it's his baby and it's the only one i'll probably put on display maybe peewee herman i like his baby sends one every year but i don't know why people really do that unless they have little babies or the you know it's kind of like a baby announcement yeah i think i know when i get a picture of a couple and there it is there it is oh look at him he's doing the happiest baby ever look at that oh oh it's a white santa though

you're not allowed to do that according to the yeah did you know they're gonna have uh they have black santas at disney now? Which is good. Yeah. Everything's – that's okay. It's okay. He's too cute. Don't worry about that stuff. He is cute. And so thank you, Caleb, for today's show.

Appreciate it. And we've got, again, some really interesting stuff coming down the line here, people I wanted to talk to for a while. Dr. McBride is one of those people. Dr. Patachari, we want to check back in with. Yeah, we kind of did a regroup Dr. Style.group doctor style yeah dr barron it's always the same stuff we know it but yeah susan's being critical of me because we review the same stuff but what that's what doctors do that's okay i mean i'm testing to see if there's differences of opinion amongst different not really there is it i know well you can get um dr victory i like the question

though if i had an 11 to 13 year old i would not be getting him a booster it's not recommended but but if we want to get dr victory in here she'll have different ideas then but the one kid has um ms right was it didn't have ms or something and that's like a really tough situation. Well, he certainly wouldn't get fully vaccinated. I don't know about booster, but definitely wouldn't get fully vaccinated. They don't want to get the infection for sure. Thank you over on Clubhouse. I'm going to end the room on Clubhouse. Thanks for joining us.

Appreciate you joining us. We'll be back in tomorrow with Dr. Bhattacharya. What's Dr. Bhattacharya going to talk about? I don't know. I just want an update from him. I may not talk that long, actually, because he's just a really smart guy who keeps his eye on the data and just see what the trends are, what's bothering him. Maybe he can do a little... Let's talk about how to handle this during the holidays. Remember, he didn't do a residency, so he's not a clinical person. He's

a numbers person. And he could really kind of help us predict the future. That's what I'm interested in with Dr. Patriciari. So he's a psychic? No, no, he's a scientist. Okay, no, that's good. No, I'm just joking around. I know he's not a psychic. All right. Thank you guys for stopping by. We'll be here tomorrow at three o'clock. 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.