Science Vs - Omicron: Do You Need to Freak Out?

Episode Date: December 3, 2021

Welp, the pandemic has served up yet another poop sandwich, and it’s called omicron. This variant is popping up in dozens of countries across the world, and scientists are racing to get a handle on it. So how bad could this be? And could it sneak past our vaccines? To find out, we talk to virologist and immunologist Professor Ann Sheehy, Prof. Art Wallace, epidemiologist Dr. Barbara Cohn, immunologist Dr. Ali Ellebedy and virologist Dr. John Tembo. UPDATE 12/6/21: A previous version of this episode incorrectly said that genes tell our bodies how to make amino acids -- it’s been corrected to say that genes tell our bodies how to string together amino acids. Find our transcript here: https://bit.ly/31rpKit This episode was produced by Wendy Zukerman, Rose Rimler, Meryl Horn, Michelle Dang, and Ekedi Fausther-Keeys. We’re edited by Blythe Terrell. Fact checking by Nick DelRose. Mix and sound design by Bumi Hidaka. Music written by Bumi Hidaka, Peter Leonard, Emma Munger and Bobby Lord. Thanks to the researchers we got in touch with for this episode, including Prof. Paul Bieniasz, Katarina Grande, and Prof. David O'Connor. Special thanks to Mia Malan, Musa Malaza, Hunter, Jack Weinstein, the Zukerman family Rachel Ward and Joseph Lavelle Wilson. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman, and you're listening to Science Versus from Gimlet. This is the show where we pit facts against phi. Turns out it's one of the last letters of the Greek alphabet, and I hope we never have to learn anything more about it. Because this week, we were introduced to Omicron. WHO has now named this variant Omicron. They are rushing to learn more. It was spotted in southern Africa in samples from a few weeks ago,

and it's now been found in dozens of countries. Has now spread across Europe to Australia and Hong Kong. A San Francisco resident has the first known US case. Nations are shutting borders, mostly to places in southern Africa. And the World Health Organization jumped on this variant basically right away and started freaking out about it. This is likely to pose a very high global risk. Now things are just moving so quickly here. There's so much confusion that we don't even know how to pronounce this thing.

This new Omicron variant. Is it Omicron? Omicron? It's called the Omicron. Oh. Omicron. So on today's show, do we really need to be that worried about Omicron? And if we do need to be freaking out here, what can we do about it? After months of fisticuffs around whether healthy adults need booster shots at all,

just this week, President Biden said that this was our best weapon against Omicron. But is that right? When it comes to the coronavirus, there's lots of letters of the Greek alphabet. But then there's science. Science vs Omicron is coming up just after the break. What does the AI revolution mean for jobs, for getting things done? Who are the people creating this technology and what do they think? I'm Rana El-Khelyoubi, an AI scientist, entrepreneur, investor, and now host of the new podcast, Pioneers of AI. Think of it as your guide for all things AI,

with the most human issues at the center. Join me every Wednesday for Pioneers of AI. And don't forget to subscribe wherever you tune in. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist? And where is Jan 11?

I'm here, astrophysicist and co-host, ready for anything. That's right. I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm Jan 11.

I'm Steve Strogatz. And this is... Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Welcome back. Today on the show, Omicron. It's the new variant of the coronavirus.

And it feels like this virus has just gone, oops, I did it again, all over our holiday plans. But how bad is this really going to be? If you've been watching the news, it seems like this variant is scaring the bejesus out of everyone because it's got a ton of mutations. There's a bunch of headlines calling it a super mutant. Unusually high number of mutations. It's the most heavily mutated variant we've seen to date. And it was actually these mutations that got the World Health Organization all hot and bothered. So to find out more about them, we called up our old friend Anne Sheehy, a virologist and immunologist at the College of the Holy Cross in Massachusetts. Anne is on day 99 billion of this pandemic, just like the rest of us.

I have found myself wandering around my house and I'll catch myself in the mirror and I'm like, why am I wearing a mask? On top of faithfully wearing her mask, Anne has been following all these new mutations. And she told us that while Delta had around 20 compared to the original strain of the coronavirus, Omicron has something like 50 changes. And what's getting people's knickers in a twist is that more than half of those mutations

are to the infamous spike protein. So I think if you look at where these mutations are, that's the crux of where the anxiety is coming from. So whenever we see a variant that seems to have accumulated mutations in that now well-known spike protein, that people sit up and take notice and want to know more. And zooming in on the mutations that we're seeing in the spike, Anne told us that we're seeing changes to this one particular spot that could end up being really important here. It's where some of our antibodies meet the spike, recognize it, and basically say, oh, hello, coronavirus,

and then whack it in its, oh, so punchable face. Now, back to high school biology just for a second here. Genes tell us how to put together strings of these things called amino acids. And by looking through the genetic code of Omicron, we can see that one amino acid has switched in that meat and punch spot. And to understand why this might be important, you also have to know that the spike is made up of a tiny string of amino acids that twirl together, a bit like a rubber band when

you twist it up. Think about how big spike is. Spike is a thousand amino acids or something, something on that order. And one thing that affects how they all twirl together is the fact that some of those amino acids have a charge. If you have a negatively charged one, that loves to attract a positively charged one, just like you would imagine a magnet. And so if you change a charge, you could change the shape. And as soon as I start to change one, so if I change, you know, something that's negatively charged and I make it positively charged or I make it neutral, maybe it does not interact in the same way. By looking at the genetic code of Omicron, scientists can see that it has switched out one of the amino acids in the spike protein from a negative charge to something neutral.

And so the shape might shift because you've changed that charge. You could imagine it making the spike all wonky. Yes, exactly. And that is just one mutation out of 15 in that meat and punch spot. So bottom line, if this switcheroo and others like it change the shape of spike, then our antibodies might have trouble with Omicron because they use the shape to recognize the coronavirus. And so perhaps our vaccines won't work as well. And there is some lab work suggesting that we might have a problem here. Like one experiment has already tested a genetically engineered virus that had some of the

same mutations as Omicron. And it found that, yes, it was really good at escaping the antibodies that we have made from our vaccines and from getting infected. But still, this lab-created virus was not the same as Omicron. In fact, Omicron has a whole bunch of mutations that we haven't studied yet, and we don't know what they're going to do or how they're going to interact with each other. It may be bad news for the virus. It might be bad news for us. We don't know.

You can't tell until you go into the laboratory or you look in a patient because sometimes the shape change is subtle and sometimes it's huge. don't know. You can't tell until you go into the laboratory or you look in a patient because sometimes the shape changes subtle and sometimes it's huge. We don't know. We don't know. So right now we're speculating. We're guessing, well, these are the things that it could do if it's in this area. But what we really have to do is we have to go back into the laboratory and then do the experiments to show what happens to the virus when you actually do this, what happens to spike. Producer Rose Rimla asked Anne about all this. It's interesting because, you know, the other people who have spoken to the media have said

much more like freaky things. Like somebody, I think it was the president of Moderna, he told the New York Times, this virus is a Frankenstein mix of all the greatest hits from other variants. And then another researcher said this variant is completely insane. That's a quote. What would you call it? What would you say? So I guess I would be a little bit more conservative. I don't have the data to be freaked out or to be exultant. And I'm going to be patient

before I panic and patient before I celebrate. So it was the genetic code, the biology of this beast that first raised the alarm. But now it's the behavior of the beast that has kept that alarm ringing, especially in South Africa. Omicron now makes up 74% of the cases over there. And this happened fast, just in the last few weeks. For comparison, Delta took several months to dominate in South Africa. And meanwhile, there's been a surge of new cases over there. So it looks like Omicron might be driving a new outbreak in South Africa. All right, so next question. So when it comes to our vaccines, when are we going to know if Omicron is public enemy number one? That is, when are we going to find out if our vaccines still work

against this guy? Well, here, it's helpful to look at what happened with Delta and to find out how long it took for scientists to start realizing that Delta was affecting our vaccines. And luckily, we've got two scientists who were right in the middle of this. First up, meet Professor Art Wallace. He's an anesthesiologist from Veterans Affairs Medical Center in San Francisco. And he's been working in that hospital throughout this pandemic. How are you doing? Oh, it's been a wonderful two years. It's been fantastic.

Best of your life. It's great. And say hello to Barbara Cohn, an epidemiologist from Child Health and Development Studies. Hey, Barbara. And say hello to Barbara Cohn, an epidemiologist from Child Health and Development Studies. Hey, Barbara. Hi, how are you? So as scientists across the country and around the world were scrambling to understand what was going on with Delta and our vaccines, Barbara and Art were in the perfect position to get a handle on what was happening. And that's because they have access to this amazing database.

It's of U.S. veterans, and it tracks the health of millions of vets in this incredibly detailed way. I know every med they're taking. I know everything that's happened. And I can follow them up because they come back and I can see what symptoms they have. Wow. This is like the most beautiful Christmas present for a scientist, right? It's better than that. Oh, it's better than that. Especially in the United States, we do not have this kind of real-time data. The CDC doesn't even have it.

So that meant this team was in prime position to find out what exactly was the Delta variant doing to our jabs. In the US, in May, Delta made up just 1.3% of cases. But by the end of June, it was the dominant strain, and it stayed that way ever since. So as things started getting hairy in the US in around July, Barbara and Art start combing through their database, analysing the information of nearly 800,000 veterans. And they were looking to see whether the veterans who got vaccinated were getting more and more breakthrough infections. And the thing is, even with this beautiful database, things took time.

For one, they couldn't just use their home laptop to run their data. They had to use a computer at Veterans Affairs. I'm imagining this on like a computer that's still printing out the like, in a basement somewhere. It's an evil lair. There's a castle with lightning behind it. No, it's the corporate data warehouse. It's a big computer, but you have to set it up and tell it to go. And it takes 20 minutes to come back and give you the result because it's looking through 800,000 patient records and it takes some time. It's not trivial. This meant they were really busting their butts, pulling wild hours. So is this an emergency or what? So we worked round the clock on this, round the clock.

And yet, it still took around a month for the team to start to see a picture of what might be happening. So we're in August now. We had those data by then. You're not making it dramatic enough, Barbara. Barbara called me on a Friday night at about five o'clock. She goes, oh my God, did you see this? This is amazing. We have to publish tonight. I'm like, okay, wait, wait, wait, wait, wait. I have to figure this out. Is that actually true? Is that actually true? It's actually true. Like, oh my God, this is a big deal. And the big deal that they were seeing is that more and more people who had gotten vaccinated were now getting infected. By the end of their study, once Delta had completely taken over, Johnson & Johnson fell to an estimated 13% effective at preventing people from getting coronavirus.

So 13%. Pfizer and Moderna were roughly 50% effective. So, not useless. Now, the vaccine still did a lot better at preventing death, but even there, there was a drop-off. And around this time, other studies around the world were showing similar trends, though sometimes it didn't look quite as bad. Back at the evil lair, Barbara and Art were seeing something else. Breakthrough infections weren't just affecting older folks. Our data says everyone, our data says everyone. And we're looking at this, and those curves that are in our paper

show no age difference in the breakthroughs. And we're going, what about these younger people? They have families, they have grandparents, and they're going to be spreading this thing. The team took some more time checking and rechecking their data, making sure that what they were seeing was real. And by the time they went public with all this, it was November 4th. So that was more than six months after Delta showed up in the US.

In Israel, they started getting data on this sooner, partly because they had higher vaccination rates and Delta became dominant faster. So by July, they could start to see that vaccine effectiveness was taking a hit. And this brings us back to Omicron. That's a weird name, but anyway. Sounds like a superhero. I know. Transformer, Omicron. From here, Art and Barbara will be keeping a close eye on that fancy database to see if they get a whiff of Omicron,

say, another drop in our immunity. And how quickly we'll know what's going on here will depend on how contagious Omicron turns out to be and whether a bunch of vaxxed people start getting sick. But we did just get an early draft of a study that doesn't look good. It suggests that there have been an unusual number of re-infections in South Africa over the last month, suggesting that people who should have some immunity from COVID are now getting infected again, maybe with the Omicron variant. It's early days here, and we don't know how many of those people were vaccinated,

but it's some of the only real data we have right now. And then there's the question of how nasty this is if you do get it. And so with Omicron, based on what we know right now, is it possible that it's going to be less deadly? Maybe this will become like the flu, like a good year of the flu. It could be whatever. We don't know. But we have to figure that out.

I wouldn't, I mean, I would hope for that. But I have a feeling it's going to be unpleasant. While initial reports were suggesting that people with Omicron weren't getting that sick, a lot of those cases were in younger people, and the World Health Organization has said that it'll be days or weeks before we know how bad this is. So given all this uncertainty, what should we do now? Biden reckons that booster shots are the way to go. But is he right?

Science vs. the president, coming up. Welcome back. We just heard that it could be a while before we really know what we're up against with Omicron. Still, though, at a press conference earlier this week, President Joe Biden said that the best way to fight against this variant, for adults who have been vaxxed, is to go out and get a booster shot. Go get the booster shot today. Do not wait. Go get your booster if it's time for you to do so.

And this feels a little odd because for months, scientists have been in a tussle over whether healthy adults actually need booster shots at all. And now this new variant walks into town that we have basically no data on. And all of a sudden they're like, go, go, go, go, go. Because if we are really worried about dealing with a whole new enemy, will doubling down on our old vaccines really help? Because as we know, those vaccines, they were based on the original strain of the coronavirus. And the original strain doesn't circulate anymore.

It's not around anymore. It's completely replaced by Delta. This is Ali El-Abadi at Washington University School of Medicine in St. Louis. And he studies the immune system and specifically these cells that are key to understanding whether booster shots are a good idea here. They're called memory B cells. And they help us pump out antibodies to fight off viruses. So after you get infected or you get the COVID vaccine, these cells stick around.

And it's like they remember the virus so that when we actually get exposed... We will be able to respond quickly and not only that, respond with cells that are much better. And the way that we make these memory B cells is key to this do-you-need-a-booster question. It turns out that the B cells compete in a high-stakes death-defying battle, where the battlefield is your lymph nodes. In our lymph nodes, there is a lot going on.

It is literally a competition for life or death. Life or death. It all starts when you get that jab. The vaccine goes into your arm, and now it's time for the B cells to prove their worth. They are trying to win, and that's actually what those B cells are doing. So imagine them standing in a line.

Say you're one of these B cells and you're competing against all the other B cells. And to win this battle, what you have to do is show the immune system that you can take on your sworn enemy, the infamous spike protein. You do this by latching onto it. So one by one, you approach the spike and try to latch on, not to the whole thing, just a piece of it. And if you can't manage it, bad news for you. As a B-cell, you die. But if you can, the immune system says you live.

The best part is it's a survival for, we call it survival for the fetus. And the competition becomes much harder. The B cells go through round after round of this for months. And what's awesome is that they have to get better and better at latching onto the spike. Because the whole point of this is that we will end up with the best and badassest B cells that will remember that part of the spike that they grabbed onto. And so when the time comes and you are exposed to this virus, that'll help you make the best antibodies.

You think you got the vaccine three months ago and you don't even think about it, but actually it's still ongoing. Even as you're just sitting down, doing nothing, not thinking about it. And what's remarkable is that Ali and his team have conducted the first study to show that this was happening in the human body after you get the coronavirus vaccine. He got around a dozen people who had been vaccinated with Pfizer, sucked up B cells from their lymph nodes and then tested them. He did this for six months, pulling out the B cells periodically and then checking them. And as time went on, he found that the B cells were getting better and better and better at their job.

So you could see that in the lymph nodes? You could see those changes? Yes. We can actually see as these cells improve. I can see the twinkle in your eyes. Oh, absolutely. It's just we never had a chance before to actually see it in actual humans.

And the real cream of the crop here, they go hide out in the bone marrow. In Ali's study, he looked for them there. And in most of the people, his team found them. Now, technically, the cells in your bone marrow are the B-cells babies. But for simplicity here, we're just going to keep calling them the B cells. Ali gave us approval. So back to his study. And that for me was amazing part. I mean, the whole thing is fascinating, but that was me. The cells that we send to our bone marrow are the best of the best.

So those are the highest trained. Those are our elite troops. In my bone marrow right now are my best trained B cells. And those best trained B cells are sitting next to your best trained B cells against influenza, against tetanus, against measles. They are all sitting now and they have new company with those COVID ones. It's amazing, right? Yeah. So that's all well and good.

But like we said, all this training was happening for the original strain of the coronavirus, which takes us back to our question. Why get a booster? Why keep training our immune cells on an enemy that isn't around anymore? Well, late last week, Ali got his booster shot. Once he started hearing about Omicron, were you like, oh crap, why did I bother? Oh no, I thought right away that was the right thing to do. He told us that boosters in general make sense because they give your B cells another round of competition. So you end up with more B cells who are better fighters. And this could still help us against the variants, and here's why. The B cells that you have right now, if you've been vaccinated,

have been trained to fight against different parts of the spike protein, not the whole thing. So in that life or death competition, if they latched onto the spot on the left side of the spike, that's what they now battle against. And while the spike does seem to be changing with these new variants, that doesn't mean it'll be totally unrecognizable. Think about it like this.

Maybe it's gotten a nose job, but some of your B cells would know those eyes anywhere. Or as Ali puts it. Yes, it's not completely changed and the majority of the parts are actually still there. So you're boosted, like in your body right now, all this training that's happening to the original virus, you're still getting better and better B cells for the part of the spike that's still there,

that's still there with Delta, that's still there with Omicron. Absolutely. Absolutely. Well, for Delta, that's still there with Omicron? Absolutely, absolutely. Well, for Delta, we know for sure. For Omicron, we think it's still intact. Obviously, the data are pending. But yeah, we think we have a very good chance. That's great. That's great. And it's not just our B cells that could step up if Omicron comes around. We've got other immune cells here that could help out. So while some of our elite fighters may become obsolete with these new variants, many are probably still good to go. And this isn't just theoretical. We know that with

Delta at least, boosters can work. In a study from Israel, they looked at more than a million people over 60 who had been fully vaccinated with Pfizer. And they found that those who got a booster shot were more than 10 times less likely to get infected with COVID. And they were even less likely to get really sick. And that was against Delta. So even though we don't know for sure if the boosters are going to help us against Omicron, there are decent scientific reasons to think that they might.

And in the meantime, from what we know now, all around the world except for South Africa, Delta is the one knocking on your door. I think there's somewhat of an assumption that Omicron's going to come and now be the new hotshot. But actually, this could just end up being a blip and Delta's like, see you later, I'm still better. Yes, it is going to be a clash of the titans.

Right. This week, the CDC said that every vaxxed adult should get another jab. So if you've got Moderna or Pfizer, they reckon waiting six months after you're fully vaxxed before you get another shot. And for Johnson & Johnson, the CDC recommends getting a second shot after just two months. But let's zoom out for a moment here. Because the bigger game in town is that we need to stop this coronavirus in its tracks all around the world. And what this variant Omicron highlighted is that to do that, we really need to vaccinate everyone, right? Not just to keep people safe, but to stop more of these mutations popping up. It serves no purpose if everyone in the US is vaccinated

and then we have another variant pop up somewhere where the vaccination rate is at 1%. This is Dr. John Tembo, a virologist who studies infectious diseases at a non-profit called Herpes in Zambia, where the vaccination rate is around 8% of its target. And John was not surprised at all when Omicron showed up. Scientists had, like, warned about this to begin with, right? The warnings were given long before all these variants popped up

that we needed to have to vaccinate everyone. And once everyone was safe, then, you know, it would be a benefit for all of us. And have you been able to get vaccinated? Yes, yes, I'm fully vaccinated. I've been pondering getting a third shot, but I'm a bit reticent to do that because that's a shot that could be used on someone else. So, yeah, so it's a catch-22.

So I haven't gotten a booster shot yet. Should I not? Because instead I should be making a stand to say my booster shot should be going to these other countries? I don't think that, yeah. I think if you've got access to the booster shot, just get it. It's not like it will come down here anytime soon anyway. John says that if we really want to pump up access to vaccines across Africa,

we need to be thinking bigger, maybe doing stuff like opening up patents so that these countries can pump out their own vaccines. But that's over the long term. So what do we need to be doing right now? Well, John says that although Zambia is going to need more vaccines in several months, for now, they actually have enough to work with. In fact, one of the biggest hurdles at the moment is just getting those vaccines to people who need them. More than half of Zambia's population lives in rural areas, which can be hard to reach.

John walked me through what would need to happen to get vaccines from the capital, Lusaka, to one remote district in Zambia. What would our journey be like? We've packed our sandwiches, where do we go? So you need like a bunch of ice packs. You need to definitely pack sandwiches and it will be at least an eight hour drive. Maybe to get halfway, John says, we could use a big truck with good refrigeration. But from there on, it's like four wheel drive because there's no road.

It's like, it's dirt. So it's us, our Jeep and our ice pack. As you can imagine, keeping the kind of cold chain that you need for some of the vaccines in this area is basically impossible. So for now, they're using vaccines like AstraZeneca and Sinopharm.

That's the one from China. Okay, our journey isn't over though. We still need to make our way through swampy marshes on a pontoon. That's a boat that can carry a car. Sometimes the pontoon's not working, so then we'd have to get on a canoe. And then... A canoe? Yes, yes, yes. So you get onto the canoe with your vaccine, hoping that you've got a nice fisherman who's willing to take your price. And then you get to your healthcare facility and then you have to now start dispensing your vaccines. And even after the team has done all this, John says that sometimes they run into another hurdle.

It's one that's going to sound very familiar. Vaccine hesitancy. Exactly. And with social media, people are sharing these things with each other. So what started as a rumor in the U.S. becomes, you know, becomes the next conspiracy

that I'm answering in the clinic the next day. I know in the U.S. and in Australia, there's vaccine hesitancy and all these rumors floating around the internet. Is there like a rumor you've heard about the vaccine that just feels like very Zambian? Oh, a rumor about the vaccine that feels very Zambian. So mostly it's our distrust of anything that comes from the West. People will talk to me, especially those who've got like access to internet and stuff like that. They'll talk to me about, oh, the Tuskegee experiments.

And like, you know, so then, yeah, then I, yes, that was a case in which the, what was actually being done was unethical. But this is not one of those cases. We're actually just trying to keep all of you alive. And over in the US, we're kind of in the same spot, trying to get shots in the arms of people who don't want them. Art, our veterans doctor, has come up against this over and over again. He told us about one of his patients who had a whole list of concerns about the vaccine. He was concerned that it might have been done with an embryonic stem cell.

I said, no, that wasn't right. And he was concerned about, you know, was this tested involuntarily? I'm like, no, it wasn't. And we went through all the possible objections. And then he finally said, well, I said, listen, if you care about people getting hurt, we've been working on this thing in the hospital. I've had friends die from this disease. I've had lots of people get it. I've beaten myself into the ground to treat it. Could you do it to protect us, the clinicians? And he said, well, I don't care about you. And I thought to myself, wow,

there's someone who's honest. And I didn't change how I treated him. I didn't do anything different, but it hurt that this patient not only didn't care about anybody around him getting the disease he didn't care about the the anesthesiologist who just kept him alive for 12 hours in the operating room what did you what did you say when he says i don't care about you just spit in his jello just a little. No, I gave him the best care possible. And that's the thing about where we're up to in this pandemic with these vaccines and the variants. We don't know how bad Omicron is, but we can be pretty darn sure that these mutants are going to keep on coming as long as there are unvaccinated people,

whether they're in Zambia or South Africa or in the US. We are going to keep reporting on it. Anne is going to run out of analogies for what the spike protein is doing. Scientists like Barb and Art will have to keep trawling through the veterans' database. And eventually, we are going to run out of letters in the Greek alphabet. But perhaps hope isn't lost. John in Zambia told us about one woman with HIV who'd messaged him.

She really wasn't sure about the vaccines, but studies had shown that, yes, people with HIV not only can safely take the COVID vaccines, but it's super important that they do. So John texts her all this. And it worked. She told him she'd get vaccinated. I actually had access to information and could alleviate someone's fears.

And they were actually open to the information. And the moment I presented them a paper, they didn't send me like a YouTube link of some video that they watched. So that was refreshing. What a success. That's science versus hello hello hi wendy hi rose how are you doing how's it going jinx personal how many citations in this week's episode uh this week there are 150 150 i think so wait i think it's a race one it's 149 it was 150 like a second ago i wonder where the other one went oh no no sorry no no 150 what a journey we've been on um wow if people want to see these citations, where should they go? They can click the link in our show notes to our transcript and they're all in the transcript.

Beautiful. Thanks so much, Rose. Thanks, Wendy. Bye. Bye. This episode was produced by me, Wendy Zuckerman, Rose Rimler, Meryl Horne, Michelle Dang and Aketi Foster-Keys. We're edited by Blythe Terrell. Fact-checking by Nick Delrose. Mix and sound design by Bumi Hidaka.

Music written by Bumi Hidaka, Peter Leonard, Emma Munger and Bobby Lord. A huge thanks to all the researchers we got in touch with for this episode, including Professor Paul Beinosh, Katerina Grand, Professor David O'Connor, a special thanks to Mia Milan, Musa Malaza, Hunter,

Jack Weinstein, the Zuckerman family, Rachel Ward, and Joseph Llewell-Wilson. I'm Wendy Zuckerman. I'll fact you next time. I'm a crime. Omicron? I think, am I saying it wrong?

No, I've said it too many times. Omicron. Omicron? Elmo. Elmo?