The Dr. Hyman Show - The Real Story About COVID Vaccines: What We Know, What We Don’t with Dale Harrison

Episode Date: January 27, 2021

The Real Story About COVID Vaccines: What We Know, What We Don’t | This episode is brought to you by Bioptimizers, Thrive Market, and Athletic Greens. There’s no way around it, we’re being bombarded by an insane amount of information when it comes to COVID-19, and not all of it makes sense. As vaccines make their way across the country, the questions are only increasing and it can feel overwhelming to find answers from expert sources. While we don’t have all the answers, we are learning more every day. We’ve seen that for people 15 and older, COVID-19 can double our risk of dying this year. And while we know chronic disease puts us at an increased risk for severity and death, we don’t know why some perfectly healthy people still can’t fight this virus off. We’re seeing that vaccines will be a dramatic help for this virus, helping to reduce the risk of severe symptoms and death, but that they won’t stop transmission. I really wanted to talk to someone in-depth about where we are with COVID-19, what we can count on with the vaccines, and what we still don’t know. I knew Dale Harrison would be the perfect scientist to help me break down this topic. Dale is a senior executive with more than 20 years of experience in the biotech industry. He has held multiple VP and C-level positions with companies in the research tools and molecular diagnostics sectors. Dale currently works as a consultant with companies that are developing new clinical diagnostic platforms, including a company developing a CRISPR-based COVID test for the OTC market, and a metagenomics-based NGS platform for infectious disease testing in the human transplant market. This episode is brought to you by Bioptimizers, Thrive Market, and Athletic Greens. Right now you can try Bioptimizers Magnesium Breakthrough for 10% off, just go to bioptimizers.com/hyman and use the code HYMAN10 at checkout. Thrive is offering all Doctor's Farmacy listeners an amazing deal. You will receive an extra 25% off your first purchase and a free gift when you sign up for Thrive Market. Just head over to thrivemarket.com/Hyman.  Athletic Greens is offering Doctor’s Farmacy listeners a full year supply of their Vitamin D3/K2 Liquid Formula free with your first purchase, plus 5 free travel packs. Just go to athleticgreens.com/hyman to take advantage of this great offer. Here are more of the details from our interview: How COVID-19 vaccines are different from traditional vaccines (9:07) COVID risk considerations for young and healthy individuals (17:22) Unique elements of the AstraZeneca vaccine study, what vaccine effectiveness means, and why you can still spread the virus even if you are vaccinated (32:17) How the COVID vaccine is different from the measles and polio vaccines (38:10) What we do and do not know about potential short-term and long-term reactions to the vaccine (45:39) What the COVID vaccine does and does not protect against (58:30) The four things needed to achieve herd immunity and why Dale does not think it is realistic to think we will reach it (1:02:23) Weighing the effectiveness of wearing masks and social distancing (1:10:32) Vaccine mandates (1:27:25) How regularly will vaccination be needed to maintain immune protection? (1:33:59) Vaccine supply concerns and considerations (1:37:07) Protecting yourself from COVID-19 through diet, sleep, stress reduction, and other therapies (1:50:33) Subscribe to Dale’s Covid Updates Newsletter at https://dalewharrison.substack.com/ and access articles he’s written below: Results from the AstraZeneca/Oxford Vaccine Trials https://dalewharrison.substack.com/p/results-from-the-astrazenecaoxford Pfizer Vaccine Report to FDA https://dalewharrison.substack.com/p/pfizer-vaccine-report-to-fda Covid Vaccines Confer No Sterilizing Immunity https://dalewharrison.substack.com/p/covid-vaccines-confer-no-sterilzing New UK Coronavirus Variant https://dalewharrison.substack.com/p/new-uk-coronavirus-variant Covid – YEAR 1 https://dalewharrison.substack.com/p/covid-year-1 Covid Testing & Autoimmune Disease https://dalewharrison.substack.com/p/covid-testing-and-autoimmune-disease Masks – Choosing Masks & Eye Protection for Covid-19 https://dalewharrison.substack.com/p/masks Hosted on Acast. See acast.com/privacy for more information.

Coming up on this episode of The Doctor's Pharmacy. So the vaccine isn't, you know, isn't a bulletproof vest. It's, you know, the virus can still colonize, you can still pass it on, and you still have, albeit a greatly reduced risk of disease, you still have some risk of producing disease. Hey everyone, it's Dr. Hyman. Supplements are one of those things that I'm always being asked about. Is it worth spending money on them?

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Hyman. And now let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman. That's pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you're concerned about COVID and you're confused about vaccines, this conversation is one you want to listen to very carefully. It's with an incredible scientist who I've gotten to know lately through some of his writings around COVID and vaccines and immunity, Dale Harrison. He's a senior executive with more than 20 years of experience in the biotech industry. He's held multiple C-suite positions in many companies using research tools and molecular

diagnostics, particularly around viruses. He's really been thoughtful about his analyzing and analysis of the overwhelming, confusing, and often misleading research that we get to hear in the headlines. We're going to go way below the headlines today to talk about vaccines, what we know, what we don't know, and how we navigate this next period of COVID-19 in our culture. So welcome to the doctor's pharmacy, Dale. Thank you. All right. So here we are. It's early January, and we are seeing record numbers of cases a day over 300,000, record numbers of deaths over 4,000.

We'd expect by now that we are going to see a decline or improvement or that it will get better, but it's actually getting worse, which is very concerning to me as a physician. The hospitals are being overloaded. We're seeing incredible burdens on society. All the measures that we seem to have taken around mitigation have not really worked that well. Although when we were really locked down, the cases did go down,

but as people started to be a little bit lax and we can see over the holidays, the Thanksgiving, there was a spike after that. Christmas, there was a big spike now in January after that. So we're seeing that this is not going, and we have to figure out how to navigate this next period of COVID and humanity. I want to invite you to talk about some of the stories about vaccines because vaccines are a very hot topic.

They're highly polarizing. I think there are a few topics out there in science and medicine that are just so volatile that often we get focused on ideology rather than facts. We focus on vaccines good, vaccines bad. Maybe the pro-vaxxers or anti-vaxxers. I would say I'm not pro or anti-vaccine. I'm for safe vaccines, effective vaccines. And I think just like I'm for safe flying and safe planes, it doesn't mean I'm anti-flying. It just means I want the thing to be safe. And I think vaccines historically have been something that's really made a huge difference in public health, whether it's tetanus vaccines, measles vaccines, polio vaccines. I mean, I think we forget how much our society was ravaged by

these really horrible infectious diseases, and vaccines have been a huge advance in public health. The problem over the last decades is a couple of things. I'm just going to set the stage before we get into the conversation, is that we've had a situation where the government, in order to get vaccine makers to make vaccines, which often is a low-profit business for pharmaceutical companies, they've indemnified the vaccine makers against liability. What that means is if there's a problem with the vaccine, the government takes the hit. The government has a vaccine court, and it's paid out about $4 or $5 billion in vaccine injury cases. It doesn't mean vaccines are all bad. It

just means that it's complicated. And I think the other issue is that there's been a plethora of vaccines on the market now for everything. And the question is, do we need all of them? And does everybody need all of them when we're supposed to get them? And I think that's a sort of a separate topic. And it's why this is such a confusing issue. However, today we're going to talk about COVID vaccines. Now, we need to think about how we solve this problem holistically of COVID in our society. We can't just simply hope it's going to go away. We have to be thoughtful. And I do believe, and probably some people will be taking much dissatisfaction at my

position here, but I do believe that COVID vaccines are important and will play a role. However, they are not a panacea, they are not perfect, and there's a lot we don't know about them. So today we're going to talk with Dale about the vaccines that we have, what we know, what we don't know, and what we need to find out still about the vaccine. So Dale, let's start with just a general overview of the COVID vaccines. How are they different from traditional vaccines, and how do they work? So, these are, in some ways, quite a bit different than a traditional vaccine, and in many ways, far simpler than a traditional vaccine. The traditional vaccine, you basically take

either an attenuated virus, meaning a virus that is weakened to the point that it won't cause disease, or you take fragments of a virus and you inject that into a person and the immune system responds to the virus, produces antibodies, and now you've got some protection when the more lethal variant of that virus comes. The way these work are quite different. The vaccine is basically a delivery vehicle to take what's called messenger RNA to cells, mostly cells in the liver. And so mRNA is basically a blueprint, a molecular blueprint

for fabricating a protein. And so all the proteins in our bodies all start out as an mRNA blueprint that the cells then use to fabricate the protein with. So in this case, the mRNA that the vaccine is delivering to the cell in the recipient is basically a blueprint to fabricate a portion of the spike protein from the SARS-CoV-2 virus. So the spike protein is the, if you've seen the pictures of the virus, these spikes that are coming out with a sort of a mushroom head on top and so what these vaccines are doing they're actually uh uh fabricating what's called the s2 unit of the spike protein which is is essentially the mushroom head of the protein the s1 unit is the stalk that attaches it to the the surface of the virus so you're taking just a fraction of the of the spike protein and you're manufacturing it. So so what happens is the vaccine basically delivers the mRNA to cells. Cells will then use that to make these proteins. Your immune system will recognize that this is a foreign protein, will then respond by producing antibodies to this foreign protein. And once you've got the antibodies

produced, now they're ready for the potential of becoming infected with a real SARS-CoV-2 virus. So now you've got immune protection. So essentially, basically, you're taking an RNA that is being given to the body, which then uses it to produce this little protein that's on the SARS-CoV-2. And then our immune system then responds to that foreign protein by creating antibodies, which makes us hopefully immune, right? Right. Well, and the other advantage too, is that it's highly targeted. So there's a, there's a virologist in Berlin named Drosten, who's considered one of the leading experts in coronaviruses. And he has this phrase he talks about when he talks about immune response to coronaviruses, which is is a sloppy immune response that that people tend to have a very sort of a very poorly formed immune response to coronaviruses.

And part of the problem is these viruses are enormous in size in terms of the size of their of their genome. And as a result, they're producing a very large number of proteins, many of which have have no no use directly in the production of new viruses. And so all of these proteins are being dumped into your system when you're infected. And your immune system is targeting everything. But the problem is that almost all of these are worthless in terms of protecting you from severe disease. And one of the things that you're seeing is, and this is a very recent paper that came out where patients in the ICU with very severe disease, very severe COVID, but that have very high antibody titers, meaning very high levels of antibodies in their bloodstream. When they

analyze the antibodies, what they're finding is that their immune system targeted the wrong proteins, that instead of targeting the spike protein, it targeted a nucleocapsid protein or some random non-structural protein. So these are various other proteins the virus produces. And so even though they have a strong immune response, their antibodies are of no help in protecting them from the virus. And so the great thing about these vaccines is that they will give you a dramatically superior immune protection from the virus than natural disease will give you. You know, so this is a much better way to be protected than to actually catch the virus. That's incredible. Well, you know, just to back up a little bit,

to give people context, you know, this is a coronavirus, which is a common virus that's causing a common cold in many people, but a very kind of unique one. It seems to be extremely contagious, far more contagious than the flu, for example. It's also more lethal than the common cold. So it's not just like getting a cold, even though it's a coronavirus, which is one that often causes colds. And it spreads very easily and it spreads asymptomatically. So we kind of have a perfect storm of a virus that doesn't kill everybody, that spreads really easily, that can whip through a population very quickly, and that causes a lot of havoc in the body. So it's kind of a very unique virus. And it sort of worries me because it's got all these characteristics that

makes it particularly dangerous. And then it affects not just the respiratory tract, but it affects all the organs in the body, all the lining of your blood vessels, your lungs, your heart, your brain. I mean, it's quite a nasty virus. So this is not something we've really seen before, anything like this, where we've got such a powerful virus that doesn't kill everybody, that spreads so rapidly, that becomes sort of everywhere. And it's kind of terrifying to people. How do you help people understand the context of what this virus is and how it's different? Well, I mean, if you think about viruses in general, they're really going to be characterized by two things, the rate at which they infect people

and the rate at which they kill people. And, you know, and so, you know, right now we've got a virus that is significantly more contagious than the cold. I mean, just dramatically more contagious than flu. And, you know, and potentially, you know, we've got this new variant out of the UK that is, you know, where you're seeing as much as a 70% increase in infectiousness. So, you know, and the data is still not fully gathered on that, but if the early studies pan out, it means that this new variant is on par with smallpox in terms of the level of infectiousness. And again, no one alive today has living memory of smallpox. But if you read historically about how smallpox could just

tear through an entire city in a matter of weeks, that's a concern. But then couple that with the fact that it's reasonably deadly. Now, again, it's nothing compared to smallpox. It's nothing compared to a lot of the historical viruses. But you've got something that in the absence of a vaccine and in the absence of an effective therapeutic, you're seeing a death rate that's roughly 10 times greater than the death rate of catching the flu. And so, again, you've got something that is more contagious than a cold and 10 times deadlier than the flu. And that's a very dangerous

combination. And it's really, it's sort of the multiplication of both of those two factors, this resulting in the hospitals and the ICUs being full of patients right now. But other people say, you know, it just affects the old or the sick or the overweight. But, you know, most people who are relatively young and healthy don't have to worry about it in terms of causing severe issues. Is that true? Well, I mean, it's true and it's not true. So, you know, most of the people who are dying are older.

Well, I mean, and it turns out that pretty much any infectious disease, that's the case. Most of the people who are dying are older simply because they've got less ability to mount an immune response. They've often have comorbidities, other issues that they've spent a lifetime developing where younger people are healthier. But here's the thing that's interesting with this virus. If you ask the question, what's the increase in likelihood that I will die this year if I catch the virus compared to the chance of me dying this year if I didn't? It roughly doubles your risk of senior death, irrespective of age, above the age of 15. Now, under age of 15, there seems to be much less impact. But if you're 15 or older, if you catch this virus,

you're going to double your chance of having died this year. Now, the fact is, if you have a room full of 90-year-olds and a room full of 20 year olds, you know, you're going to expect more of those 90 year olds to die this year than those 20 year olds to die. And, and so, you know, if you double the chance of death of each group, you're going to have a lot more 95 year olds dying. But the fact is, is that, you know, for each one of us, whatever our age is, that if we catch this thing, we have essentially doubled our risk of dying this year. Yeah, I mean, you know, we had that 41 year old Republican congressman who just got elected, who was healthy, and just is now dead. So we think it mostly doesn't kill the young and the healthy,

but it can, and it's unpredictable. And that's the thing that scares me about it. It's unpredictable. You don't know what everybody's underlying risks are, underlying immune function is, genetic variations. There's a lot of unknowns. So you really want to be careful about getting this. It's not just like getting the flu and you get better and you're fine two weeks later. But there's also, there's an interesting paper that came out about two months ago out of the Scripps Institute looking, doing a very detailed study of immune response over time. It was featured in The New York Times. It's got a lot of publicity.

A lot of the publicity, I think, is not, doesn't accurately reflect what the paper says, but if you actually read the paper, one of the things they talk about is this idea of, of a highly heterogeneous immune response, meaning that, you know, irrespective of age, underlying health conditions, that what you see is a, is a very, very large range of immune responses where some people have a very effective immune response. Some people have a very ineffective immune response, and it doesn't really seem to be tied to age. Now, again, as you're older, you're more vulnerable. And so, you know, you're going to be more likely to die, but it's really spinning the roulette wheel. And the problem is, is that, and this was one of the other outcomes of the study, was that

they were unable to find any predictors for the variance in immune response, meaning that you couldn't look at, you know, a comorbidity or a measurable parameter on a blood test, for instance, that would let them predict who is going to have an ineffective response versus an effective response. And so, you know, what you see are people where it's literally nothing but a cold. And then you see other people, you know, where it, you know, in three weeks time, they're dead. And the problem is, is that no one understands why you have this heterogeneity and immune response. And no one knows how to predict it.

And so the only way to know whether you're going to be, you know, whether it's going to be a cold or a trip to the ICU is to catch it. And so that's a, that's not a, you know, that's not good. Well, here, here's the other thing that worries me about this. And this is a pattern we've been seeing as well documented in the science, which is what they're calling long hauler or post-COVID syndrome. And this can happen to anybody. And I've seen it happen in young, healthy people who get COVID, and they just don't get better. And then we talked about this in the podcast, but in one study that was sort of looking at people who've been hospitalized at 60 days, 87% were still sick. They still had symptoms of fatigue,

muscle aches, cognitive issues, headaches, and they weren't well. There's a whole group of people who are not even hospitalized who do also get this long-hauler syndrome where they just don't get better after months and months. These can be young, healthy people. That's what concerns me even more than COVID because if you've got it and your risk of death is 1%, and you're kind of in the category where maybe it's not a big issue, as is it if you're chronically ill or obese or elderly, you could still get this long-hauler syndrome. If you're talking about 50, 100 million Americans getting COVID and maybe, you know, maybe 5%, 10%, I don't know how many are going to get this long-hauler syndrome. We're talking about millions and millions and millions of people who are going

to be chronically ill, like chronic fatigue syndrome, for years after they get COVID. So this is what really concerns me and why I think this conversation about vaccines is so important. And the question is, you know, what do the vaccines do? What do they not do? What do we know about them? So I want to sort of start to dig into a little bit of that. Based on these studies, you know, from Pfizer, Moderna, And I was sort of struck by what he said was that it doesn't prevent transmission. It doesn't prevent you necessarily from getting sick. So we think if you get this big infection, you get sick and we know what happens.

You get the vaccine, you think you don't get sick and you're protected. That's what happens when you get the measles vaccine. It's a very different kind of vaccine here we're talking about. It's not like what we call sterilizing immunity. So can you just break down for people the difference between what we call disease immunity and sterilizing immunity, what the study showed and what they didn't show, so that people can have a real

sort of comprehensive context of how to understand these vaccines and their risks and their benefits. So, you know, we've got a growing body of scientific literature now. So we've got preliminary data from the Moderna, the Pfizer, and the AstraZeneca vaccine trials on humans. But there are also quite a number of animal trials that have been done on all three of those, plus the Johnson & Johnson vaccine, on both what are called transgenic mice. So these are genetically engineered mice to mimic, to make the mouse look like a human being to the virus. In rhesus monkeys, which is important because the rhesus monkeys is a good model for immune response in humans and ferrets, which is another laboratory animal that is particularly easy to infect with this virus. And and so what they what they've done in these trials. So the animal trials are some of the human trials. You have placebo groups and you have except in the placebo group.

They just don't give them anything in the vaccine group. they just don't give them anything. In the vaccine group, they vaccinate them. But with the animals, one of the advantages is that you can do things like kill the animal and autopsy it at the end. You tend to do this with the mice studies, not the monkey studies, but you're able to get much more information. And you're also able to do what are called challenge trials, meaning that you directly expose the animal to the virus. So in the human trials, like the Pfizer or the Moderna trial, you basically vaccinate a lot of people. And then you just wait to see which ones of them naturally get the virus from the environment. The animal studies are a lot more effective in the sense that you can directly infect

the animals with the virus and see how effective the vaccines are. So if we look at these studies overall, one of the things that comes out of it is that all of these vaccines are showing highly effective what's called disease immunity, meaning the kind of a mechanical level. It means that they're very effective at producing antibodies in the bloodstream, and they're very effective at preventing the virus from jumping from the upper respiratory region to the bloodstream. And so a lot of the severe disease that puts people in ICUs and kills people is once the virus has jumped to the bloodstream. If you can constrain the virus to just the upper respiratory region, you've essentially

turned it into a bad cold or a mild case of the flu. And one of the other important considerations here, you're talking about the long haulers. So there's a growing body of evidence to support a theory behind what's causing the long hauler syndrome. These people have no evidence of any sort of low-level viral infection. So these are people that are six months, eight months after their initial infection. There's no evidence that there's some low level of ongoing viral infection. They seem to be entirely clear of virus. They often have very strong antibody responses. So the theory is that because this virus produces such a large number of proteins, all of these proteins are seen as foreign. And so your immune system is going to attempt to build antibodies against a very wide range of proteins. They're going to build antibodies to anything that doesn't look, you know, that looks foreign.

Some of when you start to produce very large numbers of antibodies, you run the risk that some fraction of those are going to also attack native tissue. So essentially produce autoimmune responses. You see this in things like lupus and multiple sclerosis and psoriatic arthritis, some types of rheumatoid arthritis, where it's your own immune system that's attacking particular tissue types. And so the the the current thinking is that these long haulers are essentially experiencing new categories of autoimmune diseases that have not been previously seen, which, again, is more of a reason to avoid having infection. And one of the great benefits of the vaccines is that if you can keep the virus out of the bloodstream, you're going to minimize that sort of risk of developing an autoimmune response. So the first thing definitely is the vaccines are quite good at keeping the virus out of the bloodstream, which means that

you're not going to see all of the internal organ damage that you're seeing in people. And you're not going to see a lot of the really severe disease that you're seeing in people. So the good news about the vaccine is one, it will prevent it from getting in your bloodstream. So you won't get the long-term consequences, hopefully, of these autoimmune-related diseases. We don't know for sure. And two, they prevent you from getting really sick and ending up in the hospital and the ICU, which right now our medical system is buckling under the weight of COVID-19. And so this is sort of a good thing in the long-term, even though it doesn't necessarily prevent infection. And reading your article on the AstraZeneca vaccine and some of the other issues,

it was pretty striking that, you know, it doesn't really prevent you from getting infected. Right. That about 40% of people will still get infected. It doesn't prevent you from getting reinfected. If you already had it, the vaccine won't prevent you from getting another infection. So it really only prevents more severe disease and death is what we're saying. Right. Hey everyone, it's Dr. Mark. My main goal with diet is to use food as medicine, but even when

we eat super well, most of us are missing out on certain essential nutrients. Our soils have become depleted and our digestive tracts just aren't working so great. They're compromised by stress and toxins and they just can't absorb nutrients as efficiently as they should. And that's why I always use, and I recommend to my patients, a multivitamin mineral as nutritional insurance. It covers the basics for all our day-to-day body functions, all the things that we need that our food might be missing. But there are so many products out there I wouldn't go near because they contain artificial fillers or

inactive ingredients and you have to be pretty picky. The one I trust and take myself is Athletic Greens. They use high quality, highly absorbable forms of vitamins and nutrients from real whole foods. Athletic Greens comes in a powder that tastes great and mixes easily with water or smoothies and specifically supports my gut health, immunity, energy, and recovery. And it's not just vitamins and minerals. It has phytonutrient-rich superfoods and adaptogens and pre and probiotics and even digestive enzymes. I love that they add the digestive support in their powder since so much of our immune strength and overall wellness starts in the gut. It's really one supplement that covers so many bases and you'd be hard-pressed to find something else in this comprehensive form in any single other product. I use Athletic Greens in

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and I promise you'll feel the difference Athletic Greens can make in your daily wellness routine. Again, that's athleticgreens.com forward slash Hyman. Now let's get back to this week's episode of The Doctor's Pharmacy. So the AstraZeneca study is probably the most thorough of all of the vaccine studies that have been done so far. So It's really an extraordinarily well-designed protocol. And so one of the things that AstraZeneca did that none of the other vaccine studies have done is that every participant in the study was tested once a week through the entire duration of the study to look for infection. This was entirely separate from their looking for symptoms because the basic way that the study worked was people had to report whether or not they had experienced one or more of a specific list of symptoms.

And these are fairly basic symptoms, shortness of breath, cough, fever, fatigue. And so what the vaccine was targeting was to reduce that specific list of mild to moderate symptoms. And when they say the vaccine is 90% effective or 94% effective, what that means is it's 94% effective at reducing or eliminating that list of specific symptoms. Now, what they didn't look at was the death rate or the rate of severe illness. But the assumption is that you would probably see both of those go down significantly if the vaccine is able to reduce mild to moderate symptomatic disease. But here's where the study gets interesting.

So in the AstraZeneca study, every single patient in both the placebo and the vaccine arm of the trial was given a laboratory-run PCR test each week to look for infection. The other thing that was interesting in the study was that, unlike the other studies, the AstraZeneca study permitted what were called seropositives into the study, meaning people that already had antibodies in their bloodstream from an infection. And so everyone that entered the study got an antibody test. And these were very high quality laboratory run antibody tests, as well as a medical history.

And so in there, you had people who had already been infected that got vaccinated, as well as people who had not been infected. And then they were tested for infection weekly during the during the study so here were a couple of interesting things that come out of it um that that you were seeing about 40 to 45 percent of the participants were testing positive um but asymptomatic. So, you know, and this was of the people in the vaccine arm. You actually had another block of people who were positive with symptoms, but symptoms that were below the level of what would be triggered to declare you having gotten disease. So, you know, what you're seeing was really about 50% or more of those who had been vaccinated ended up getting infected compared to the placebo group. Again, the absolute numbers, it's not 50% of everyone in the study, but it's your rate of infection was about 50% the rate of people who had gotten no vaccine at all.

Here's the other interesting. So that's asymptomatic infections. Or mildly symptomatic. So you're saying about half the people almost who got the vaccine still got infected. Well, no, you have to be. it was a it was a it was a fraction it was a tiny fraction but the idea was your risk of getting infected with the vaccine was about half of the risk of having gotten infected during the same time period if you had not gotten the vaccine yes so so. So this is a relative risk.

So it's better, but it's not zero, right? It's better than getting nothing. Right. But it actually does not prevent you from getting the vaccine. And it also doesn't prevent you from spreading it, which is another sort of striking thing. Because people are like, oh, I'm going to get the vaccine. I'm going to be fine.

I'm going to be immune. I can run around. I don't need to wear a mask. I don't need to socially distance. I'm like, great. Well, you might not die or get really sick, but you could become a super spreader because you could be spreading this asymptomatically if you're not careful. And I think that's a really important factor that people are not hearing about in the news. And this is what the difference is between a sterilizing immunity, which means you get the measles vaccine, you're never going to get infected with measles versus a coronavirus vaccine where you may not get really sick and die, but you still get the infection and you can still spread it. Right. Right. Right. It's even more striking in the animal trials, because in the animal trials, what you're seeing was only about 20 percent of protective immunity, protective sterilizing immunity from the vaccine, meaning that that the you know, if you compare the group of animals who were vaccinated versus the group that were not vaccinated, you still had about 80% chance of catching the virus, even if you didn't develop

disease. And the retransmission rate was identical. You know, once you had picked up the infection, you're passing it, at least again, in the animal studies, you're passing it to other animals at exactly the same rate that the animals who had not been vaccinated were. And to drop back to kind of what's the machinery of this. So when you're injected, the the vaccine goes into the bloodstream. It basically deposits the mRNA mostly in the liver. It produces these, you know, S1 subunit or S2 subunit of the spike protein. And you get an immune response. And now you have antibodies in your bloodstream. This is part, this is why the vaccine is highly effective at preventing

the virus from jumping from the lungs into the bloodstream because you've got the, you've got, you know, you've got a very effective ability to, you know, to produce a lot of antibodies that's in the bloodstream. But the problem is, is that anybody's in the bloodstream doesn't help with in mucosal tissue. So that's an entirely different sort of immune response. And you see a lot of RNA viruses, especially a lot of RNA upper respiratory viruses, that never produce an effective, what's called humoral mucosal immune response.

Yeah. Meaning that you end up with B cells in the mucous membranes in the nose and throat that are able to then produce antibodies directly in those areas. So that as soon as you breathe the virus in, it's immediately attacked and destroyed. And so what that means is that even if the virus stays out of the lower lungs and out of the bloodstream, it can still colonize the nose, throat, upper lungs. And the way that this virus is, because this is an airborne virus, so the way that we infect other people is by breathing out. And what we're breathing out isn't stuff deep in our lungs. What we're breathing out is the virus that's in mostly the throat and the upper lungs. And so, you know, without effective sterilizing

immunity, you're still going to be able to both acquire an infection, it may be very mild, you know, or it may be completely asymptomatic, but you're going to still be able to infect others, which means that the virus remains in circulation within the population. And that's a very difficult thing. This is quite different than the measles virus, where if you get vaccinated for measles, you develop a very strong mucosal immune response, which means you can walk into a room full of people with measles

and you're not going to catch anything. The other thing, and so a lot of people's sort of naive intuition about vaccines is really informed by the childhood vaccines that people are familiar with. Most of these are sterilizing. The ones that are not sterilizing, the lack of sterilizing immunity turns out not to be an issue. And so a very famous one of these is the polio vaccine. So polio vaccine is non-sterilizing, meaning that, that, and you see, you see these hidden polio outbreaks in different places. There was an interesting one a few years ago in Iceland where nobody had developed any symptoms, but, but you clearly had an outbreak where people were getting infected and they were reinfecting others. And now again, with polio, part of the problem there isn't the nose and throat. Polio is primarily transmitted through fecal transmission. And so the other place that

you can have a lack of sterilizing immunity is in the gut. And that's the deal with the polio vaccine is that it doesn't produce sterilized immunity in the gut. The virus is able to colonize the gut and then pass through feces into the environment and then infect others. But if you're vaccinated, it's not going to get into the bloodstream and it tends not to develop any sort of symptomatic disease. And so you get these sort of silent outbreaks. The other one is the seasonal influenza vaccine. So it produces only partial sterilizing immunity, which means that a lot of people who get that vaccine can still get infected and still can infect others. And in fact, influenza has a significant fraction of asymptomatic

carriers and transmitters as well, which is not, that's not sort of understood popularly. But one of the reasons that the influenza, you know, people talk about the seasonal flu vaccine is 10 to 40 percent effective. Some of that is because they may not have hit exactly the right strain because they have to begin the work on the vaccine so many months ahead and the vaccine is a fast mutator. But the big part of why the flu vaccine isn't effective is it doesn't keep people from being infected, even if they're asymptomatic, and it doesn't keep the from being infected, even if they're asymptomatic. And it doesn't keep the virus from spreading through the population.

And and you still have some fraction of people. And again, you hear these stories, you know, I got you know, I got the flu vaccine and I still got the flu. Well, what happens is if you pick it up because you don't have sterilized immunity, some fraction of the people that pick it up will still develop disease. And, and again, you're seeing this in these vaccine trials, because, you know, you, you still got 10 to 30% of the people in with the vaccine that once infected are still developing disease. And, you know, so, so the vaccine isn't, you know, isn't a bulletproof vest. It's, you know, the virus can still colonize, you can still pass it on. And you've still have,

albeit a greatly reduced risk of disease, you still have some risk of producing disease. And so people have to understand that this is not this is not sort of a perfect bulletproof kind of response to the virus. Yeah, I think most of the media is sort of like vaccines are coming. They're going to save us. We can go back to normal. Everything's gonna be great. And yes, vaccines have a role, but they're like they're not a panacea, as you said. And the kind of virus we're dealing with are different than other things like measles virus, where we're not getting the same type of protection. So just to kind of recap what you said, it does reduce the incidence of moderate to severe

disease. It doesn't necessarily prevent you from getting it. In 40 percent of the percent of the people compared to the placebo group got the virus right you can still spread it asymptomatically hopefully and i don't know if this is the case with all all the cases that were found it does uh prevent it from getting in the bloodstream although i'm not sure that's a hundred percent no because again people were still getting you know they were still getting, you know, they were still getting disease. You know, they're still getting symptomatic disease after vaccination. Yes. So, again, things like the measles vaccine is such a miracle vaccine because, you know, it has strong sterilizing immunity and very strong disease immunity. You know, once you've got that vaccine, you really are nearly perfectly protected.

And but but the measles vaccine is the outlier. You know, lots and lots of vaccines are simply not entirely effective. Yeah. And the other the other thing, just to kind of trip for a minute. The other thing we don't really know is, one, you know, what the long-term side effects, if any, because often, you know, we just had a few months into this. What if we wait six months or a year and one of them instead of 30,000 people, we have 30 million people vaccinated. And the 30,000 people were a very specific select group. When you take the heterogeneous population, young, old, thin, overweight, you know, sick, not sick. I mean, autoimmune, autoimmune, you're going to see a

whole different range of different effects. And so we don't really know what those are. We also don't know how long the antibodies last. So does the protection last two months, six months, a year, five years? We don't know. Do you need the vaccine every year? Do you need it every two years? Do you need it every six months? I mean, these are the kinds of questions that I think are coming up. So yes, this is an incredible scientific advance. Yes, we've rapidly created a number of vaccines which seem to be effective in reducing the severity of the disease. But there's a lot of still questions out there. So can you kind of address some of these concerns? Because I think people are wondering about this and we're not hearing a lot about it in the media. Right. So, and I have to say early on, because I'm very familiar with the history of vaccine development. And early on, I was very skeptical that we were going to see an effective vaccine before probably 2024, 2025. And I was also very skeptical in terms of the ability to produce not only an effective vaccine, but a safe vaccine. And as time has gone along and I've seen more and more data and more and more sort of good research papers have come out now,

I'm becoming increasingly comfortable with the safety of the vaccine. And so, so you have to think about risk in terms of, of less in terms of what might happen to you if you're unlucky versus what's your chances of being unlucky. These are two different things. So, you know, what, what's the chance that that next airplane ride I take, you know, will crash is quite different than if that next airplane crashes, will I die? Right. And so a lot of the fear mongering, quite frankly, is about how horrible it is when the airplane you're on crashes, which is really not the important question. The important question is, what's the risk that airplane is going to crash? And so, the way to think about that is the incident rate per 10,000,

per 100,000, per million, per 10 million people getting vaccinated. And so, what the studies, and the studies were very heavily focused on the safety aspect. But because of the size and the duration of the study, what they were able to do was to basically look for adverse reactions. And again, there's two types of adverse reactions. There's a short-term reaction and then long-term reactions. And so they're looking mostly for short- to mid-term adverse reactions at the rate of about one per 10,000 participants. And, you know, and what you saw out of the studies was that you had one to three day, you know, relatively manageable, you know, mild to moderate adverse reactions, like soreness in the arm, you know, getting a fever, maybe getting chills for a day,

but nothing that represented a medically significant issue. And they were able to show that there were no adverse reactions up to about the rate of one in 10,000. Now, you know, we've now embarked on very massive vaccination programs. And so we're seeing rarer versions of this, of reactions. So what's in the news are these allergic reactions. But they're occurring at about the rate of 1 in 100,000, which is why they didn't show up in the original vaccine studies. So 1 in 100,000 is roughly your risk of dying from a lightning strike. It's pretty rare. And, and the other thing is, is that the, the nice thing about the allergic reaction is that it's extremely manageable and it occurs, it tends to occur almost immediately. And so

if you haven't, you know, if you haven't started to have that reaction within 15 to 30 minutes after vaccination, you probably aren't going to have the reaction. The other thing here is that there's a reasonably good understanding, again, going back to the scientific literature lipid, a fat molecule that's used to create the the envelope that carries the RNA. 15 years in certain chemotherapy drugs to be able to carry a highly targeted chemotherapy drug that will only attach to a malignant cell, but not to non-malignant cells. And so it's a very similar technology to this, except it's carrying a drug instead of carrying mRNA. And what they've seen is about a one in a hundred thousand allergic reaction rate to this particular lipid. And so the thinking is, is that that's the, that's what's behind the, the current rate, but you know, in the first, in the first 2.3 million vaccinations in the U S you had 21 21 cases so very very low incident uh and very

manageable um the the because the different vaccines from the different manufacturers are fabricated in different ways this is probably only going to be a problem with the moderna and the pfizer vaccine because they use lipid the synthetic uh what i call that it? That's the allergic reaction, but there could be other longer term things. There could be other ones. No, I mean, there's a joke that I read in the New England Journal of Medicine once, which is make sure you use the new drugs as soon as they come out before the side effects develop, right? It's different when you study a drug and you look at 15,000 people, they're all identical, and then you put it in 15 million or 150 or 300 million people.

All of a sudden, you're kind of changing the conversation. And I think we don't know. But what you're saying basically is this seems to be a very safe vaccine. In the short term, there's just sort of, you know, common reactions that are probably, you know, one in 10,000, such as local inflammation or feeling sick. You know, a friend of mine just got the vaccine and she felt like she had the flu for a few days. Those are common. Those are probably 1 in 10,000, which on 300 million people would be like 30,000 people getting sick, right? But in terms of the real severe reactions, that's 1 in 100,000, which is far less. But then long-term, we don't know, does this trigger autoimmunity? Does it have other effects? Can you give it in pregnant women? What about kids? And what about people with autoimmune disease? We just don't know the answers to these questions yet. Right. Yeah. And it's just too early. But again, the studies did a fairly good job of pulling in a pretty wide range of people.

And again, going back to the AstraZeneca study, AstraZeneca study was just so well designed. And one of the things that they did was they pulled in immunocompromised patients into the study. So they had a much wider range of people. And what you saw out of the AstraZeneca data was nothing that hadn't been seen in all of the other data, that these people did quite well with the vaccine. So, just personally looking at the literature and looking at the data, I think that any sort of really significant reaction is probably going to be on the order of one in a million to one in 10 million. We've seen a single interesting reaction that's been in the news, a doctor in Miami who recently died. And he had a highly, they understand what happened,

is an extraordinarily rare type of immune response that basically caused his platelet count to go to zero and, and it couldn't be reversed. But the, the, again, just looking at the numbers that looks like about a one in 10 million or less response, you know, reaction. So, you know, but. And then put it in perspective. If you get COVID, your risk of dying is one in a hundred. Right. Yeah. Right. So one in a million, right? Right. But, or one in 10 million, but, but we're embarking on, you know, we're definitely embarking on an experiment here where, where we're going to be vaccinating an unprecedented

number of people. So if you look at most of the vaccines on the market, the typical number of doses administered in a year in the U.S. is around four to five million for any given vaccine, which is roughly equal to the number of people that are born each year, which makes sense because most of these are one time vaccinations. The exception is the flu vaccine and to some extent the pneumococcal vaccine. But the flu vaccine, we're doing about 150, 160 million people a year. You know, we're going to kind of need to do 250, 300 million people with this. You know, so, you know, this is going to be unprecedented, but we're also facing a pretty unprecedented situation where the disease rate and the fatality rate, if you have no protection, is very high, as well as the long term morbidity rate. You know, the the you know, all of these potential long term effects that people are going to have is going to be a huge weight on the on the health care system for potentially decades if we don't get to get out ahead of this. And, you know, so the evidence is the vaccine is really, really effective at preventing these severe, you know, these sort of severe disease responses. It's got, you know, a reasonably low side effect rate. And quite frankly, you know, most of the side effects that I'm hearing from people taking it right now

is, you know, soreness, fever, chills, you know, they may end up in bed for a day. Well, you know, in September, I got the seasonal influenza and the pneumococcal dual vaccine. And I ended up in bed for two days with fever and chills. Yeah. And it doesn't happen often. It'll happen about every maybe 10 years when I, you know, when I take those. But, you know, it's a risk with, you know, even a pretty well understood and a fairly simple vaccine like the, the influenza vaccine. Yeah. So, and, but you know, the, the other thing that I always say is, you know, no one's allergic reaction has ever put them, has ever caused them to end up in the ICU on a ventilator.

Yeah, that's true. But COVID is doing that thousands of times a day. Yeah. Yeah. Serious. So again, it goes back to, you know, what's the risk of, you know, of the plane crashing and then and then what's your risk when the plane crashes? And and, you know, the alternative here is if you don't if you are not protected, you know, your risk are not only much higher, you know, the risk of the plane crashing is much higher. And then what happens when the plane crashes is a lot worse. If you don't have, if you don't have any kind of protection. And so, you know, the other analogy I always use is, is, you know, if I know I'm going into a gunfight and all I have access to is a mediocre bulletproof

vest, I'll take that over going into that gunfight, you know, wearing nothing but a snarky t-shirt. So, you know, you can't think in terms of absolute risk and absolute protection. You have to think in terms of, you know, what, you know, what are my relative options to be able to, to basically optimize the odds in my favor in this current environment. Yeah. And, and, and so that's a more nuanced, you know, it's a more nuanced thing than saying, you know, this is the perfect vaccine with no side effects. Well, that doesn't exist. So let's talk about, let's talk about some of the other things you bring up in your, in your writings. So it sort of seems like we have a pretty balanced view now of what the

vaccine's doing, what they don't do. As you sort of reviewed, they do create antibodies that prevent you hopefully from getting severe or moderate disease and ending up dead or in the ICU. They don't prevent you from getting the infection at all, and they don't prevent you from spreading it. They don't prevent you from getting it again if you've already had it. So the reinfection rates are still there. Yeah, and let me throw one other thing in there on that. Very interesting bit of data buried deep inside the AstraZeneca study. Because they brought seropositives into the study, meaning

people who had already had COVID previously. Yes. And because they were testing for infection weekly. You had a very, and there is no other data set in existence that looked at this. You had this chance to look at a pretty significant population of people that had already had the disease and follow them for a period of time, a period of several months. So if we look at just the placebo group, that the people in the placebo group during the duration of the study, you had 1.7% of those people became infected during that period. If you look at the seropositives in

the placebo group, 2.1% became infected. That the people who had already had COVID, they were getting reinfected at exactly the same rate as the people who had never had COVID. That's right. That's concerning. Yeah, that's a remarkable piece of data that really says that reinfection is a real thing and that you probably have relatively little durable immunity against reinfection after having initially had COVID. That's concerning. Okay, so we know all those facts. We also know that the common mild reactions are about 1 in 10,000, and that serious reactions are 1 in a million to 1 in 10 million,

which is far less than the risk of 1% of getting dead from COVID, or 20% of ending up in the hospital, which is quite high. We also know that the vaccine will not necessarily allow society to open up again, that it won't create a possibility of herd immunity, that it won't prevent the spread of the virus to the population, and that it actually may not even reduce the death rate overall. The number of people dying might reduce the percentage of people dying, but the overall number of people dying might go up as we increase vaccination because people will be lax about protective measures such as wearing masks or socially distancing or washing their hands or

not going to large gatherings. So this is sort of the sort of sense overall of the vaccine. Can you talk more about, you know, what is what is the future look like with the vaccine? Let's say let's assume that we get over the fact that half of the population doesn't want to get the vaccine. Let's say we get up to 70, 80, 90 percent. Are we home free or not? Are we going to be able to sort of open up and go to sports games and concerts and everything just back to normal? Or what's going to be the future of the 2020s with COVID? I mean, I think anything anyone says is speculation, simply because the data doesn't exist yet. And, and, you know, we've got to run that experiment with, you know, 300 million people.

And we're going to do that this year, but you know, this is, you know, my look at the data and my understanding of the underlying virology and, and, and how infectious disease works. You know, what I see is probably no possibility of herd immunity. And if you think about herd immunity, you really need four things for that to occur. So you need an effective vaccine that's going to offer a durable lifetime immune protection. What is herd immunity?

Just so people can... So herd immunity is what we have with measles and polio and smallpox, meaning that you have enough people vaccinated that you have fewer and fewer cases until you finally, the virus finally essentially burns out of the population. You may have very tiny isolated outbreaks, especially among non-vaccinated people. You see that with meas people. You see that with measles. You see that in the third world with polio. But generally, polio, measles, rubella, smallpox, all of these things that they've developed effective vaccines for just don't exist in, you know,

other than in rare small pockets of outbreaks. They're just not a part of our life anymore the way they were 60, 70 years ago. So, you know, so the idea of herd immunity is you get enough immunity, enough people in the population that's immune, that even if you don't have everybody immune, the virus doesn't have enough chances to spread that it eventually burns out. And you see a version of this with flu in the springtime, because the deal with influenza is that the warmer the weather is, the less contagious it is. And by typically around sometime in April, the weather, at least in the Northern Hemisphere, the weather has gotten warm enough that each person that catches the flu ends up giving the flu to fewer than one other people

on average. And so basically you get, you know, within about a two week period, you see flu just drop off the drop off the cliff and go to zero. And and then during the warm months, it largely isn't around. And then in September, it starts to pick back up as the weather cools down because the infectiousness of the flu of the flu virus is tied to temperature. A coronavirus is not like that. I'm sorry. Yeah. But the virus is not like that. Actually, the COVID virus appears to also have a similar seasonality. But the problem is that there's an R0 number that probably everyone has heard by now. And the idea is that if a disease has an R0 below one, then it's going to burn out of the population. If the R0 is above above one it'll continue to spread

and that means how many people will uh one person infect if one person will affect more than one person then it continues if right person infects less than one person it burns out right and so so flu has an r0 of about 1.1 to 1.2 coldses have an R0 of around two. What you tend to see is these upper respiratory viruses, well, their R0 will drop in the summer by about a factor of a third. And so what that means is that both the R0 of flu and of coles drop below one by sometime in late spring. And that's why you don't have everybody catching a cold in the middle of the summer and you don't hear about people catching the flu. It's possible to catch the flu in the summer, but it's very rare. With COVID, COVID is somewhere between 3.5

and 5 or not, which means that even if you lobbed off a third of its infectiousness in the warm months, you still have something that is significantly more infectious than a cold. And so, you know, and I think that's why you saw over the summer, you tended to see, even though we had the big summer surge, part of that was because you had sort of virgin populations that had not had significant exposure previously. But there's no reason to think that COVID is going to go away in the summer, but it likely will reduce its rate of infection compared to how it is in the winter. And again, massive spike we're in right now. So talk more about the herd immunity, because what you're saying is it will never get

herd immunity with coronavirus, which is what everybody's talking about as a way out of this. And you're saying this isn't happening. Why? So herd immunity requires four things. So you need an effective vaccine that offers a durable lifetime immune protection. You need a critical percentage of the population to be vaccinated. And the more infectious the disease, the higher that percentage is. The actual formula is one minus one over R0, which means that with COVID, we need about 70 or 80 percent of the population vaccinated. Now, the problem there is that we now have a new, significantly more infectious variant that is starting to take over.

It's completely taken over in the UK. It's already in the US and it's already in Europe. And this is on top of being already one of the most infectious viruses out there. So this is like more infectious than the most infectious already. Right. And so based on the estimates of the R0 of this new variant, we're going to need north of 90% of the population vaccinated. This is why, again, measles burned out when we were able to achieve above 90 percent vaccination rates and why we're starting to get outbreaks, because there are blocks of people who won't get vaccinated and we're starting to get close to that 90 percent line. So given the resistance to vaccines for COVID and the conspiracy theories and the confusion, we're never going to get to 90%.

Maybe we'll get to 50 or 60. But the third condition for herd immunity is that the vaccine has to confer sterilizing immunity because you need to be able to stop the transmission. And so again, if you look at measles, measles is very effective at blocking the transmission of the virus. And so, you know, so measles vaccines are effective at conferring sterilized or effective at producing herd immunity. But and again, even if the vaccine is partially sterilizing, you know, let's say half of the people are protected from infection, you still have a large amount of the population that can still potentially get infected and then retransmit that to others, even if it's largely asymptomatic. It becomes less of an issue if you have 90% vaccination rate, becomes a huge issue if you've got 50% vaccination rate. And then the fourth thing that isn't talked about as much is that the vaccine, I'm sorry, the virus needs to not have an animal reservoir. And so, you know, one of the reasons that, that, you know, we've been so effective

eliminating smallpox is that smallpox never had an effective animal reservoir. And, you know, and you had extremely high vaccination rates, you know, and you had a vaccine that was very effective at producing both sterilizing immunity and a strong, durable lifetime disease immunity. So the smallpox vaccine hit all four of those. And as a result, nobody's even getting a smallpox vaccine anymore because smallpox simply doesn't exist anymore. You know, we've got, you know, we achieve, you know, by the late 1970s, we had achieved global herd immunity on smallpox. The problem is with COVID, it seems unlikely that we're going to hit any one of those four key components that are required for herd immunity. And again, you know, the thing that you hear in the news is really only about, we only need a certain percentage of the population,

you know, protected. But it's more than that, you know, it's how you're protected. And it's things like the animal reservoirs, and it's things like the rate at which you can get, you know, a large enough fraction of the population to be willing to be protected. So, you know, in the absence of that, you know, there are two potential paths going forward in 2021 and beyond, which is we maintain the current level of mitigation. So masking, distancing, reduced social density, closures, this sort of thing.

Because those have actually been extraordinarily effective. What you've done is you've taken a virus with an R0 of about 3.5 to 5 and you've reduced it to an R0 of between 0.9 to about 1.2. So in other words, you've, you've all of this masking, this sort of historically unprecedented number amount of mitigation has basically reduced the effective infectiousness of COVID to about the flu.

So you're saying is the average person would have infected over three people if they had COVID and now it's like about one. Right. So, and as a comparison. What evidence do we have that the mitigation measures like masks are doing that? Because I think a lot of people are dubious about masks and their effectiveness. And you hear just tremendous amount of controversy about this. So, what's your perspective on that um i'm pretty sure i wouldn't want to have open heart surgery with the surgical team unmasked

i mean it's it's you know masks are very effective um and most of the so where does it where does it come from that mass may not be effective or that they don't really reduce it or there's no evidence or there's no trials or they're all rigged or i mean where does it all come from i mean it's it's i it's the deniers and the conspiracy theorist um and uh you know and the fact is is there's enormous evidence that they're effective and and you know not perfect but they do reduce the spread but again it goes back to the analogy I use with mask is the analogy I use with a bulletproof vest. If I'm going into a gun fight, you know, I'll take a 70% effective bulletproof vest, you know, over going in with

a snarky t-shirt, um, um, because I'm not an idiot. Um, and, you know, and the mask are probably somewhere in the, you know, the 50 to 70 percent effective range, depending on which mask you get and how you wear the mask. You know, so there's huge variability there. But, you know, so are bulletproof vests. You know, if you don't you know, if you don't cinch down a bulletproof vest and you get shot, you'll still get killed. Yeah. You know, so if you wear it wrong it doesn't work um you know that shouldn't be a surprise and a lot of people wear it wrong so um i mean the mass like down over their nose or you know cloth masks which aren't as effective um but overall if you look at our mitigation rates know, we've pushed the the R effective of the virus down to something comparable to the flu. And to give you a comparison in an in a typical flu season.

So we look back over the last 25 years of flu seasons during flu season. We're seeing about four to five million flu cases a week in the US. Right now, we're seeing about six to seven million COVID cases in the U.S., so about, you know, 30 to 50 percent above the number of flu cases with an extraordinarily contagious virus, which means, you know, our mitigation efforts have pushed this down to where COVID is roughly as contagious as the flu. You know, what's going, what happens is, is if people start to push, and I think there's going to be an enormous amount of political pressure once vaccinations are widely available for, well, everybody who's got, who wanted the vaccine has now got it. So it's

time to open everything back up and drop all the requirements. And, and if we do that, we're going to push the, the R effective, you know, the effective infectiousness of the virus, you know, up to, you know, up to its R naught, which is quite high. You mean top to three, you mean three people will be infected for every person instead of one, three to five. Yeah. Yeah. Which is the range. And, you know, and maybe something more like five to seven, you know, with this new, you know, more infectious variant.

So you've got a lot of people running around who've been vaccinated, think they're great. The society wants to open back up. Everything opens back up. So the people who got the vaccine may be protected. The rest of the people who aren't getting vaccinated are at much higher risk. Right. But even if you assume, you know, so the best estimates are that this vaccine will likely reduce mortality by a factor of 10. So instead of having a 1% chance of dying, you've got a 0.1% chance, which now pushes the fatality rate down comparable to catching the flu, which I think a lot of people are fairly comfortable with the idea of catching the flu. You know, I certainly am. Although I still get a flu vaccine every year because I want to tilt the odds in my favor. But so if we make two assumptions, we assume that the vaccine will be effective in pushing the fatality rate down by a factor of 10.

And we assume that that you don't have effective sterilizing immunity. And then we assume that there's a political push to fully reopen the economy and to drop mitigation. And what will happen is the virus will go endemic, meaning it will start to look more like a cold, a common cold, in terms of the rate at which it spreads through the population. The thing in the U.S. is every year, 93% of the population catches at least one cold a year. We have a billion colds a year in the U.S., and the average person catches three colds a year. And on average, you've got roughly two months, about eight to 10 weeks of immune protection for most people. Now, again, some people have as little as two weeks and some people actually will have as much as a year of immune protection

after catching a cold. So again, these upper respiratory RNA viruses and coronaviruses tend to have a very heterogeneous immune response. But, you know, on average, across 330 million people, we're getting a billion colds a year. The average person catches three a year in the roughly eight month cold season. That's what an endemic virus looks like, which means that, you know, instead of getting, instead of getting five to 7 million cases a week, we could see 20 or 25 million cases a week if we drop all mitigation. And so now you've got, even with the vaccine. Well, right. Yeah.

But, but, but, and again, part of it depends on how effective the partial sterilizing immunity is. You know, it does, does half the population, you know, or is half the population that, you know, assuming you had a hundred percent vaccination rate, well half the population still be susceptible to, to infection and retransmission. But and that's a, that's an entirely an unknown at this point. You know,

we're not going to know to run that experiment on 200 million people. But here's the risk. Even with 100% vaccination, but in no mitigation efforts, if the virus goes endemic, meaning we see 20 plus million cases a week, but most of those cases look like the common cold or even asymptomatic, you'd still are going to have roughly 10% of those cases develop disease, some sort of significant disease symptoms. And even if you can push the fatality rate down by a factor of 10, if you have two to three times as many people a week catching it, but, uh, uh, I'm sorry if you, um, yeah, I mean, if you go times as many, yeah. Yeah. I mean, if you have 10 times as many people catching it, um, uh, but you have one 10th of fatality rate,

you're going to end up with the same absolute number of people dying. So the percent of people dying will be less, but the number of people will be, which means our hospitals will still be overwhelmed and flooded, even if we are all vaccinated, if we don't continue to also do mitigation measures. Some level of mitigation, right. Okay, so how long are we talking here, Dale? Because, you know, are we talking a year?

Are we talking five years? Are we talking 10 years, forever? Like, are we all wearing masks for the rest of our lives? What does the future look like? Yeah, I mean, again, I don't think anybody knows at this point. Now, there is one interesting, there's actually a couple of these, but there's one particularly interesting historical data point. So right now, there are about a third of all colds are caused by one of

four coronaviruses that are split into two families. So it's called alpha corona and beta coronaviruses. So there is pretty solid evidence that the beta corona family originated about sometime around 1880 out of China, where it jumped from bat population to human population and then spread across Russia into Europe and then into the U.S. and then South America. So in the 1880s to up into the early 1890s, you had this massive global epidemic. And they refer to it as the Russian flu. But again, there's pretty solid evidence now that, in fact, it wasn't the flu, it was a coronavirus. And in fact, it was the coronavirus that causes a significant fraction of colds today. And what you saw is from the time it jumped, which the estimates are about 1880,

until about 1900, about 20 years, the virus gradually mutated and attenuated until it literally just, you know, it went from something that was roughly 10 times deadlier than the flu to something that literally is now just the common cold. And so coronaviruses are very, very slow mutators. Part of this is because, so they're quite different than HIV or influenza, which are fast mutators. Part of this is because they carry what's called a proofreading enzyme, meaning that they have a molecule that actually proofreads when they're translating from the RNA and the virus to a protein and will actually make corrections if their errors occur. And so you end up getting a very, very slow mutation rate with the coronavirus, which is why the current vaccines are going to be good for a long time,

because the virus is probably not going to significantly mutate away from the vaccine. But the downside is it takes a long time for the virus to mutate to an attenuated form. And the one data point we've got with the beta coronaviruses is something on the order of 10 to 20 years to reach a fully mutated form. Now, so what you're saying is that basically we're stuck with masks for 10 to 20 years and no sports games and concerts and big gatherings. Well, but if everybody gets vaccinated and the vaccine basically turns a fairly deadly vascular disease into a fairly manageable upper respiratory disease, it's going to be a lot easier to start to reactivate large portions of people's lives, but it doesn't mean you get to go back to 2019. You know, so, so I think there's something between, you know, how, how hard we had to lock down in 2020 versus the free for all of 2019. And the future is going to be somewhere in between.

So, and I'll tell you just in terms of my own kind of personal risk calculus. So, you know, I fully intend to get the vaccine basically as soon as it's available for my age group. So I'm guessing I'm probably going to get it sometime in the March or April timeframe. Once that happens, I'm going to be relatively comfortable flying again. So I normally do a fair amount of travel. I've done no travel whatsoever in 2020. So I'm going to be comfortable flying again. I'll be comfortable going to certain public venues. I will not be comfortable dispensing with masks. I'm still going to be very cautious about who I socialize with if I think that they're being irresponsible in terms of protecting themselves. Because I'll know that even with a vaccine, I'm still at the risk of catching it and passing it to others. And I'm still going to be at risk

of catching it and developing disease. Just much, much lower risk of developing severe disease or developing a fatal disease. So, so, you know, what I'm expecting in my own personal life is I'm going to start to, you know, once I get vaccinated, I'm going to be able to start to open up the range of activities, but I'm not going to be able to go back to how it was in 2019. I'm still going to wear a mask. I'm still going to, you know, practice distancing. I'm still going to be, you know, because the deal is, you know, in the wintertime, I don't like catching the flu. I wash my hands and I stay away from people coughing on me.

And, you know, not because I'm living in fear, but because I just don't want the hassle of catching the flu. And I can do a few simple things to tilt the odds in my favor. And every winter I get a flu vaccine. And so, you know, I still go out and do lots of things knowing that I could get the flu. But I'm going to do a few basic things that's going to tilt the table in my favor. And it's the same thing here. It's just that we now have a much more contagious virus, which means that the risk of simple things that you need to do to tilt the odds in your favor are going to be more extensive. And so I'm probably never going back to, you know, shopping the way I did in stores. You know, I'm probably going to continue to use Instacart, you know, for reasons even beyond the virus.

It would become such a massive convenience in my life to not have to go to the grocery store. You know, I'm probably going to continue to rely far more heavily on, you know, ordering goods online. You know, some of this is because it's going to it's going to minimize the number of sort of meaningless contacts I make, which is going to minimize my chance of catching this even with a vaccine. And these are very simple things to do. So, yeah, but, you know, I also which have been hard to convince the population to do. I know. I know. So once I get vaccinated, I'm going to be comfortable flying. But with a mask, you know, I'm going to wash my hands year round the way I do during flu season. You know, I'm going to avoid people coughing on me, you know, and I'm going to quite frankly, I'm going to avoid people who I think are acting like idiots.

Yeah. Because, you know, I don't want you know, I don't want these people breathing on me. Um, because I don't, you know, because I still don't want to get it, even if I know that I'm largely protected. Yeah. Um, but I'm going to go, you know, I'm going to be comfortable going back to, you know, things like restaurants and probably some music venues. Um, um, you know, and things like inviting people over. I'm going to be a lot more comfortable with that, again, depending on, especially if they're all vaccinated as well,

then I know that we're all fairly protected. I think the real danger here is, and the greatest danger point from a societal standpoint is when we have 50% of the population vaccinated and coupled with a growing pressure to drop mitigation. And I think that's going to be an absolute danger zone because if you've got half of the population just buck naked and you start to drop the mitigation measures and you have a non-sterilizing vaccine, you know, that's a lethal combination where you're going to end up really starting to push the virus through

the unvaccinated population at a really accelerated rate. And so, you know, we could easily see, you know, with the sort of expected maybe 40 to 60 percent vaccination rate in a year, which is seems to be the kind of the consensus among a lot of public health people. Yeah. That, you know, I think next next November, next December, we could see both case rates and death rates significantly above what we what we saw, what we're seeing right now. So what do you think of that sort of conversation about vaccine mandates? Because I think there's this whole view that, you know, we should maintain our civil liberties, that we should have medical freedom, that we should have choice. And yet we're in a situation where we've got so much misinformation,

disinformation, confusion, even about the real science. I mean, you know, we aren't, even when we talk about vaccines, we're not having these detailed conversations like you and I just had about the nuances of what it does and what it doesn't do. And if we're really facing, you know, an acceleration of COVID and increase in the number of deaths and increased destabilization of society and the economy. If we all don't get vaccinated, how do you have a conversation with someone who is so convinced that these vaccines are harmful and don't want to take them?

Well, and I think that's going to be tough. And I'm not sure. Personally, I think I'd be shocked to see universal mandates. And but partly because it's going to be difficult to get compliance, but partly because I don't think they're going to be necessary. And the reason why is I think that there are other things that are going to come from delta airlines carnival cruise lines you know passport control in paris because they're not going to let you in the freaking country if you don't have a vaccination yeah yeah um you know the local governments aren't going to be mandating it but businesses can right you can't walk into a store without a mask even if you don't believe in masks right you can't get on a plane unless without a mask, even if you don't believe in masks. Right. You can't get on a plane unless you get a vaccination, even if you don't believe in vaccinations.

Right. So I think that's going to change everything. I think that's I think it's going to be the it's going to be nongovernmental entities largely that are going to end up driving it. And part of that is because people are not going to want to get sick. And so, you know, you look at the airlines, which I thought were extraordinarily irresponsible in the spring, you know, where they resisted any attempt at a mandate to where, you know, now they're, you know, they're pretty rigorously enforcing masking. And they're now openly talking about requiring vaccination cards. So, you know, they've really progressed and they've

progressed because they felt market pressure. And, and you look at the cruise lines, you know, every single attempt in the last six months to restart cruising has ended in just complete, total disaster. And, you know, because these things are like giant floating Petri dishes. Yeah, yeah, yeah. And, you know, with buffet lines. And, you know, and so I think, you know, and the cruise industry has got maybe 12 to 18 months of cash max before they're permanently dead. And so they're going to be under enormous amount of pressure to restart cruising. And I don't see how they're going to do that without vaccination cards. And, you know, the other thing is, you know, a lot of countries are already smart enough to not let Americans in.

You know, it's damn hard to get into South Korea or get into Singapore or get into New Zealand right now if you're an American. And I think you're going to see this universal that if you want to travel and expect to clear passport control, you better have a vaccination card. Yeah. Yeah. And so and then I think you're going to see it come down to businesses as well, because because business continuity issues around, you know, so assume that the vaccine, that you've got an effective vaccine, but you're still going to have an increased number of people with cold or flu-like symptoms. It's going to cause them to lose work, even with the vaccine, because you have this endemic virus. You're already going to have a business continuity issue. If you then stir into that mix half of your employees who refuse to take a vaccine, you're going to come down to a point to where the vaccination is going to be a requirement for employment in a lot of businesses.

It is now. So as a doctor, when I work in the hospitals, I have to get the hepatitis vaccines. I have to get the flu vaccine. There's mandated vaccines if you want to work in certain environments today. I mean, that exists in businesses and businesses have the ability to make those choices. So and I could also see the same thing happen with, you know, certain types of stores, you know, where you've got to show a card to get in the store because right now you've got to be wearing a mask to get in the store. So, you know, and the vaccine is going to be dramatically more effective than wearing a mask. So why did why did Redfield, the CDC director, say that he thought the masks are more effective than vaccines?

Because he it was interesting when he said that. So he says that in in late August, early September, the, the, the initial, uh, data from Pfizer and from Moderna had started to become available. And at that point, we started to see a lot of the animal studies, the transgenic mice and the rhesus monkey studies. And what was clear was that, um, you know, already by July, it was quite clear that none of these vaccines were producing effective sterilizing immunity and that you're going to have to keep wearing a mask to avoid transmission. And so around late August, you started to see Hahn at FDA, you started to see Fauci, and you started to see Redfield at CDC, all began to talk about, you know, began to sort of lay down hints that masks were not going to be going away and that people needed to, you know, the vaccine

was not going to be able to eliminate the need for that. And I think that they were doing it because they were all looking at the same data that all the rest of us were looking at that were following the scientific literature. You know, the early animal studies, you know, this was back in early June when the first of these transgenic mice studies on the Pfizer and the Johnson and Johnson vaccines hit the preprint servers. And, you know, it was pretty damn clear when you saw those papers that, you know, this vaccine was going to work a lot like the flu vaccine in terms of reasonably effective at reducing disease severity, fairly ineffective at producing sterilizing immunity.

You're still going to catch it and retransmit it, even if you didn't develop full disease. So do you think we're going to need an annual coronavirus vaccine, COVID vaccine? Or every six months, right? Here's my prediction on this. So if you go back to the Scripps Institute study, so this is a really, really good study that where basically the people at Scripps at their Institute for Immunology,

they're tracking people who had had COVID. And so they're following both antibody levels and B-cell and T-cell production. Now, again, measuring things- And B-cell and T-cells are the cells that are part of your immune system. The B-cells make antibodies. The T-cells basically have a different way of fighting infection. Yeah. So, and one way to think about it is B cells keep you from getting infected, T cells keep you from dying once you're infected. It's kind of a very rough way of thinking about it. They each have a job, but they're slightly different. They have a different, you know,

they focus on a different phase of the infection and disease. But so out of that study, you saw, you know, really significant heterogeneity in the in the immune response. So you had patients that that showed, you know, that had almost no antibody levels in their bloodstream within two weeks of recovery. You had other people six months after because they're only able to look six months that that although their antibody levels were were clearly declining, they were still at a reasonably high level. And at least at that rate of decline, they could see them having effective levels out to probably at least a year, maybe for some small fraction of the population,

maybe out to two years. Again, this precisely matches what's been known for a long time about coronavirus infections causing the common cold, that most people lose immune protection typically within two to four months. There are some people that have immune protection up to 18 to 24 months. The average is around six months, which is why you just keep getting colds over and over again. So given that, what I'm predicting is that what you're going to see is people are going to end up needing to take weekly or monthly home antibody tests. So probably a cheap lateral flow strip, you know, pinprick antibody tests that they can be able to buy at CVS and take it at home. And those tests are going to look, basically going to look for, you know, what's your current antibody levels. And once the antibody

level drops below a certain level based on the test, you then go in and get a booster. So for some people that might be, you know, booster. So for some people, that might be every three months. Other people, it might be every two years because I think there's going to be so much range in the level of durable immunity that you're not going to be able to come up with a standard, everyone has to get vaccinated once every six months, once every 12 months.

It's going to be different for different people. I mean, this is really a striking deal because what you're saying is that an average vaccine produces about 4 million doses a year. We're talking about the need for billions of doses. So that brings up a whole nother question of what is our capacity to produce and manufacture the vaccines? And can we actually, if everybody wanted to get vaccinated, vaccinate everybody on that schedule? So, I mean, this is what's great, especially about the Pfizer and Moderna vaccines

that use these, what do you call them, viral-like particles, these synthetically produced viral envelopes that carry the RNA, that those can be produced at massive scale. You know, so you really have the ability to manufacture these things at absolutely a mass industrial scale. We're not there yet, but there's no real inhibition. And the turnaround rate, the length of time it takes to produce a dose is relatively short compared to a traditional vaccine.

So you look at something like the flu vaccine, they start manufacturing usually in March or April. The first doses aren't available until late August or early September. So it takes months of manufacturing to be able to start to produce doses. So this newer generation of vaccines, I think have the potential to really allow you to produce a billion doses or 10 billion doses a year, which in fact is what we're going to need. I mean, we're going to need, you know, we're going to need, you know, something more on the order of probably 10 billion doses a year globally.

And, and it's going to be unprecedented. I mean, nothing, nothing. No vaccine is the largest produced in the largest quantities of any vaccine. And it's only about one hundred and sixty five million doses a year in the US. Yeah. So. Yeah. So this is staggering. It's staggering. OK, last last question is, you know, we're hearing talk of getting the first vaccination of two vaccinations that are required out of the population as quickly as possible, which would mean that we're potentially going to have a delay with the second vaccine, because if we're using up all the first doses and don't reserve the second dose for each person, we're going to kind of run out of vaccines. Is that realistic? Is that a problem? Yeah. We're not worried about it. So I think it's a problem.

I'm not sure it's something we should worry about. And here's why. The calculus, I think, that people are making is that sometime late this month, we'll probably will see the AstraZeneca vaccine be approved. I think by late February to early March, we'll see an EUA approval for the Johnson & Johnson vaccine. These things are already been in manufacturing for months now. And so there are already pre-existing stockpiles that simply can't be released. And so I think part of the calculus is that if we can get these additional stockpiles released, approved and released, we're going to be able within a couple of months, uh, start to have

significantly more doses. Um, and that, you know, so the idea is, is that, um, that the supply side of the problem will largely take care of itself. Plus the other thing is that even the current, the Pfizer and the Moderna, they're still, you know, significantly ramping up their scale of production, you know? And so every month, you month, I think we should expect to see larger and larger quantities of vaccine being manufactured by those companies. So I think that the supply side of the problem will take care of itself within a few months. The bigger problem seems to be kind of the last mile logistics. You know, how do you get people lined up to to get poked in the arm? And, you know, and I think the other issue is going to be getting people to come back for the second dose.

Now, you know, each of the vaccines has a different timeline based on the what was designed into the original study. So, we have no data on what it looks like to go two months before you get the second dose versus one month. But again, from people that I've talked to and from things I've read in the scientific literature, nobody seems to be particularly concerned about whether the second dose is three weeks four weeks six weeks or eight weeks later probably can't be six months later but but the exact timing is probably not important um what's going to be more important is you're not necessarily protected after the first dose right and? And that's the, here's the other, this is the much bigger concern about a single dose regime

is that if you've got partial immunity, you now set up the condition to start to foster large numbers of variants, large numbers of mutational variants. And because what happens is, is that you're getting these mutational variants. And because what happens is, is that you're getting these mutational variants all the time, you know, you get sick with the virus, you're getting you're producing all kinds of variants, but most of those are in very, very small numbers.

And your immune system is ramping up your immune system, you know, even without the vaccine, your immune system, you know, will ultimately clear the virus from your body. And so, so those, most of those mutants never get a chance to, to get passed on to other people. So they die inside you. If you now have a partial level of immunity, what happens is that if you, if you develop a single mutant variant that, you know, single mutated variant that is antibody resistant, the antibodies, you know, the partial antibody protection you've got will basically kill off everything that is easy to kill off and will leave behind that one rare mutation that is antibody resistant. But now that mutation has the ability to recolonize and fully grow.

And so now that becomes the dominant variant of the virus in you. And you're now breathing this out. What you're saying is if you get both vaccinations, that is less likely to happen and likely to cover the mutated viruses. So we're hearing about these mutated viruses. Will the vaccines work on those as well? What you're saying is yes. Yeah. Yeah. And the reason why there is that the virus is a very, very slow mutator. So if you look at the, so there's now been tens of thousands of sequencing studies done since the original, what was called the Wuhan isolate,

was sequenced back in mid-January. And what you're seeing is that most variants differ from the Wuhan isolate by an average of between one and two, what I call single nucleotide variants per month, meaning out of a 30,000 nucleotide genome, most of these viruses are different from the original one by only about one or two variants per month. So you're slowly getting more mutation, but it's an extraordinarily slow rate. And most of these will have no impact whatsoever. And even the ones that affect like the UK variant, it doesn't look like it's going to have any impact on the vaccine. And partly because the protein that the vaccines are producing is several hundred amino acids, so somewhere around two, three hundred amino acids in length. And these mutations only represent one or two or three isolated variants within that protein.

And so the basic shape of the protein doesn't really change. And so as a result, the vaccine basically won't even notice that there are these pinprick changes, you know, randomly scattered through the protein. It'll still be able to bind to the bulk of that protein without any issues whatsoever. So that's pretty good news. Yeah, so that's quite good news. So I think most of these variants we're seeing are likely to have no impact for a long time on any of the vaccines. All right. Well, this has been an incredible conversation, Dale.

I just want to try to summarize because we've covered a lot of ground. And I think people are maybe still a little bit confused. So first of all, vaccines seem to be quite safe. Two, they don't protect you necessarily from getting COVID don't practice mitigation, if you don't practice mask wearing, washing your hands, social distancing, et cetera, you're going to be a vector for disease and spread it in your family and community. And it can be an accelerated growth in the population if we're not careful. Right. that we still have a lot to learn and then to track and update the story maybe in a couple of months with you about what we're learning about the effects of vaccines, the reaction rates, how long immunity lasts. There's still a lot of unknowns, whether they're safe in autoimmune patients, pregnant patients, and so forth. But at the end of the day, vaccines are not going to

save us. They're going to help dramatically. They're going to reduce the lethality of it and if we practice it along with the mitigation measures we'll be in a position where we'll start to be able to open up a little bit but we're not looking at at full back to normal from what i hear you saying for potentially 5 10 even 20 years where people can just go party their hearts out. Is that what you're saying? Yeah, basically, yes. The one subtle distinction is, I think it's important to, because a lot of bad news articles come from not understanding this distinction. So COVID is the disease you get, the symptomatic disease you get from a SARS-CoV-2 infection. And so the vaccine is quite good at protecting against COVID, meaning symptomatic disease. It's not as good at protecting against SARS-CoV-2 infection. And so there's a sort of subtlety in language there, but it's important because a lot of the

research papers will talk about essentially COVID protection or COVID immunity, which is protection against symptomatic disease, which is not exactly the same thing as protection against viral infection. Right. And so people are two important terms. There is efficacy and then there is effectiveness. And so efficacy is what you measure in a highly controlled trial. Effectiveness is what happens when that vaccine is then introduced into the broad general population. And what you typically see is a significant drop between efficacy to effectiveness as you deploy a vaccine. And, you know, so that 90, 95 percent efficacy is, you know, this is a small, highly controlled study group where that number is coming from. The general population is not going to entirely look like that study group, and they're not going to entirely respond.

And most of the response differences are going to translate into less effective, not more effective. And I'll throw one other interesting bit of data buried deep, deep down inside the AstraZeneca study that I find a bit fascinating. So if you look at, again, you look at the placebo arm of the AstraZeneca trial, so they're testing people weekly for infection. For the duration of that trial, the people in that study were getting infected at 30% the rate of the general population. And so these were the people that had no vaccine, no protection whatsoever, and they were getting infected at only 30% of the rate. And this is 30% of the rate after adjusting for age, gender, race, geography, and nationality, and comorbidities. So if you adjust for all of those factors, they're still getting infected at only 30% of the rate.

And what that implies is this was a highly unusual, you know, the people who volunteered for those studies were highly unusual compared to the general population. And were likely already engaging in really significant mitigation measures. Yeah. And which means that some fraction of that study is the vaccine combined with extensive mitigation measures as opposed to just the vaccine. Yes, that's important to understand. So we still got to take care of each other. This is a long process, but hopefully the vaccine will mitigate the long-term side effects of COVID, which I'm most worried about, this long-hauler post-COVID syndrome. of people had chronic fatigue at three months who survived. If that's the case with this one, we're in big trouble if we don't get smart about either getting vaccinated or getting really smart about not getting the virus through mitigation. I mean, we've had other podcasts looking at other therapies like ozone and diet and nutritional supplements and other things, which I believe are also extremely important in protecting yourself from getting sick. So we've covered that a lot. But don't forget, if you're listening to this,

that it's not just a vaccine or masks. It's how you take care of your overall health. It's your diet, it's sleep, it's exercise, it's stress reduction. It's making sure your nutritional levels are at a good amount. For example, vitamin D is critical, zinc, vitamin C and so forth. There are a lot of things we can do. And of course, there's other therapies out there that are being explored around the world like ozone therapy and peptides and so forth, which seem to be helpful and may even be more effective than some of the medications that are being studied. So therapeutics is another topic we didn't really cover. And we're doing a little bit better on that front, but not that much better because we're still seeing 4,000 deaths a day. And if we had a good therapeutic, we wouldn't see that. So I'm really grateful, Dale, that you came on the

Doctors Pharmacy podcast. You helped navigate this extremely controversial, very difficult subject. I know we're going to get a lot of flack about this podcast, but I felt it's really important to bring in a scientist who really understands these issues, has read the studies as I have, and really go into the nuances, because what you're hearing is the headlines and not between the lines. For those listening, there's going to be in the show notes of the podcast on my website, there is going to be a link to a number of articles that discuss these issues in great detail. You can get into the nuances even more if you want. If you love this podcast and you

want to share with your friends in Pimlin, I bet you do, because this one's going to be a keeper. Just share with everybody on social media. Leave a comment. We'd love to hear from you, even if they're not nice comments. We want to hear what you're really thinking and what your questions are, and we'll try to answer those as well. I mean, be nice, but you can ask hard questions. And of course, subscribe wherever you get your podcasts.

And we'll see you next time on The Doctor's Pharmacy. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do. And introducing you to all the experts that I know and I love and that I've learned so much from.

And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter.

I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you do is go to drhyman.com forward slash pics to sign up. That's drhyman.com forward slash pics, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Hi, everyone. I hope you enjoyed this week's episode.

Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. Thank you.