Shelly Sood 00:05
All right, so welcome. We have Dr. Vin Gupta, critical care pulmonologist global health policy expert, affiliate Assistant Professor of Health Metrics Sciences at the University of Washington. Thank you for joining us.
Dr. Vin Gupta 00:17
Thanks for having me.
Shelly Sood 00:20
Absolutely. So today we’re going to talk about, COVID-19, we’re going to talk about the Delta variant, we’re going to talk about where the country is at right now with this horrible pandemic. And we’d love to hear some insights from Dr. Gupta here. So thanks
Dr. Vin Gupta 00:35
Of course.
Shelly Sood 00:36
So today, you know, everybody is worried today about the Delta variant and the transmission of the Delta variant. And there’s a lot of myths out there. People don’t really understand that this is a different variant. This is a different monster as compared to when this pandemic really started. So tell us a little bit then about, you know, your experiences with the transmission. How does it differ from previous variants?
Dr. Vin Gupta 00:58
Delta variant is fundamentally almost a different virus than the original wild type version of COVID of Coronavirus, causing COVID-19 that first emerged in the end of 2019. In the course of the last 20 months what this contagious class of viruses Coronavirus is more broadly, SARS COV, to more specifically, what it’s done is that it’s able, it’s mutated. It’s the critical component of its outer structure, the spike protein sort of the harpoon that allows it to attach onto our lung cells. It’s mutated really significantly, so that it can more easily attach to surface receptors on our lung cells. And it actually that spike protein has changed to such a significant degree that antibodies produced naturally, if we’d been naturally infected or from vaccination are less effective at blocking that harpooning effect. The attachment of the spike protein to our long receptors, standard bodies are intended to block that interaction to block that docking effect. And they’ve just proven to be less effective at doing so as Coronavirus has changed.
Shelly Sood 02:17
So what’s the end result? The end result is that people that get infected with the adult variant tend to have more virus in them because of this contagiousness. There’s just more of it in people’s noses, ultimately in their lungs, especially if they’re not vaccinated.
Dr. Vin Gupta 02:34
What we’ve also noticed – there’s the biology of what’s happened under the microscope. What we’ve noticed just in sort of real world, a real world understanding of this of this virus as it changes is that more of it is getting spread in tiny droplets, so-called airborne particles or aerosols to use it another word, it’s confusing for the general public. If you’re not living and breathing this terminology, these words, day in and day out like I do as pulmonologist. But the idea here is that these small droplets, these aerosols can travel further distances than just say three or six feet. We’ve been told social distancing mean six feet from your from your neighbor, for example, if they’re out in a grocery store, you know, waiting in a cash register line. That distancing probably is a marginal benefit, if it’s of any utility, as this virus has changed in a real world context to become more aerosol transmitted, we think 50 times more transmissible via the airborne route, not just to large droplets, the way the flu is transmitted. So what does this mean? It just means that the mitigation measures that we put into place early on in the pandemic – distancing, even masking with just cloth masks – are probably ineffective now. Right now we’re talking about high quality masks, of course masking and then ultimately therapeutics, if somebody decides to remain vaccinated as our true safeguards in addition to ventilation.
Shelly Sood 04:13
So, you know, if somebody is in contact with somebody who has COVID-19, especially the Delta variant, you know, are they easily gonna get this virus if they’re passing by? Or do they have to be with this person for a while or how does that really work?
Dr. Vin Gupta 04:30
Certainly, the belief now is that even a few minutes of exposure, if you’re on vaccinated and you’re exposed to somebody else who’s unvaccinated who’s carrying the virus, maybe as an unwitting transmitter, that previously we thought you needed 15 minutes of close contact, meaning 15 minutes within six feet of an individual who’s actively spreading the virus into the atmosphere. Now we think, honestly, that there’s a lot of uncertainty. But then even a few minutes of exposure proximity to an individual positive for this newer, more contagious variant might be sufficient to get enough exposure to cause you to get infected. And then ultimately sick, especially if you’re unvaccinated. So that’s why we’re really worried about unvaccinated people exposing other unvaccinated people in the workplace setting? Because it doesn’t take a lot.
Shelly Sood 05:28
Yeah, absolutely. So now studies have shown that Pfizer’s about 64% protection against COVID-19 with the vaccine, especially the Delta variant. Is that true for Moderna? Is that true for other vaccines? Or what are your thoughts on that?
Dr. Vin Gupta 05:45
No, I think this comes ultimately down to “what is the purpose of vaccination?” This is where I feel like the the conversations that we’re literally having, in the current day about booster shots, who should and should not get a booster shot who may get a booster shot, so the operative word should versus may, as we all become eligible, regardless of our risks, and risk factors for severe COVID. The purpose of vaccination here and really being clear about why we get vaccinated, it’s going to be important for lay understanding of making sure the unvaccinated get vaccinated making sure that those who absolutely should get a booster booster. It’s my view that when we look at waning immunity from the vaccine – so you got two doses of Pfizer, two doses of Moderna on January 1 2021, and your otherwise without serious medical conditions less than 65. What’s your protection like now on November 17, 2021? As we’re having this discussion, turns out, it’s pretty darn good. Shelly, if we’re talking about controlling against you ending up in the hospital or severe illness, it’s still 90 plus percent effective at keeping you out of the hospital. Ten to eleven months out, I’m two doses in in December of 2020. I’m an ICU Doc, I get to get my booster because I think I’m following the science. And I’m worried here that we’ve lost control of the narrative here that the purpose of vaccination is not to prevent a positive test. We’re always going to be chasing our tail if that’s what the end goal is here or even to prevent mild symptoms. That’s a crazy unrealistic goal without precedents in history, when we talk about vaccinated against other pathogens, we’ve never said the goal here is to prevent a positive test, especially against a contagious respiratory virus, otherwise known as sterilizing immunity. We’ve never established that as the goal. Why are we doing that now? It’s really, really difficult and causes a lot of confusion. When we think about the purpose of vaccination as keeping the hospital, Pfizer, Moderna, frankly, the Johnson and Johnson are all pretty darn effective outside of six months at doing the same thing, keeping the hospital to the tune of 90%. Plus, when we start loosening that criteria and saying I just don’t want to get test positive. Well, then that’s when people start to justify giving boosters to everybody, because that that protection does wane over time.
Shelly Sood 08:28
Okay, how about for the immunocompromised folks?
Dr. Vin Gupta 08:31
I think that that to me is not controversial. It is very realistic to expect that individuals who are high risk because of their age, or because of their underlying medical conditions, because they’ve had a solid organ kidney transplant, or because there are have dialysis needs because of chronic kidney disease serious underlying medical conditions. This would not be precedent setting. We know that these individuals for flu for other types of vaccines, pneumococcal pneumonia, they need more frequent shots, they need more vigilance in between their shots, to keep them safe and healthy. So to say that you’re good at two if you don’t have a serious underlying medical condition or are younger than 65. But if those but to meet any of the high risk criteria need a shot. I don’t think that’s complicated. And so if you’re immunocompromised – and 3% of America is – get a booster. That’s not a complicated message. If we say that the end goal is to save your life, keep you out of the hospital, I think people think it’s complicated and it’s not. We just have lost our ability, sadly, early on to clearly communicate to the public, why you get vaccinated, what the vaccines are good at, and what they remain good at, over the course of time. And that’s simply to prevent your lungs from developing severe pneumonia from handing in the hospital? If we’re choosing any other criteria, surely, we’re setting ourselves up for failure. And we’re setting ourselves up to continue to confuse the public. And also to piss off, frankly, the rest of the world here. We’re over boosting ourselves while the rest of the world continues to burn with COVID.
Shelly Sood 10:19
Yeah, absolutely. So where do you see this pandemic headed in the next three to five years, in your professional opinion?
Dr. Vin Gupta 10:29
I suspect that we’re headed for reprieve by the end of spring, or end of winter, early spring 2022. So, end of March of 2022. You will, if you’re unvaccinated, you likely will have been infected with COVID, then either you got lucky and you didn’t end up in the hospital, or you did. And you survived, you got lucky again, or you died. And there’s still going to be a significant death toll week over week, through the end of March of 2022. We’re talking about 10,000 fellow Americans dying week over week, well into the into the winter, early spring, that’s a lot of people done. So we’re still going to be in the thick of it, there’s cold and flu season around us, who knows how that’s gonna impact the next four to five months. Come April, I think this, this changes, and we’re going to be in for a reprieve where people either will have some measure of natural immunity, or they will have decided to get vaccinated, transmission rates will have become lower, less people will end up in the hospital because less people are going to be vulnerable. So we’re going to really reach an endemic state where people will continue to die. And we’ll probably approach a seasonality effect where cold and flu season, not only will we have to worry about influenza A and B as it changes, but we’ll have to worry about the next variant of COVID as it changes, and as it potentially remains a threat to the unvaccinated.
Shelly Sood 12:01
This is going to become an endemic seasonal illness that will absolutely kill people. In some seasons, it’s going to be like flu where we could lose 100 to 150,000 people within a three to four month span. So over the next three to five years, I expect we’re going to have the seasonal epidemics of respiratory viruses writ large, and stress our healthcare systems from November to February. And now we’re, we’re in that era of globalization and respiratory virus pandemics and epidemics that I think, in my view, will remain relevant for the next five to 10 years at minimum. Yeah, absolutely. So when COVID-19 started, and this pandemic started, this country was not prepared at all. And as you know, there were a lot of mistakes that were made, we didn’t have enough PPE, a lot of glitches in the whole process. What do you do? How do you feel about the healthcare system right now? Do you feel like they’re really have everything covered? And we’re prepared for the next phase of this pandemic? Or what are your thoughts?
Dr. Vin Gupta 13:12
Well, it’s really hard because the the critical bottleneck right now is people and it’s skilled healthcare workers, which are the hardest to just ramp up and, and provide a ready supply of, for what I suspect is going to be another challenging 16 to 20 weeks ahead. We are losing 40% of our nursing workforce, a lot of them ICU nurses that we desperately are lacking. In the next decade, we’re going to lose 30% of our physicians, we’re chronically under supply from a PCP standpoint, definitely don’t have enough ICU providers. And we the docs that we do have, the providers that we do have are not practicing top of licensed medicine, are often mired in just paperwork. And that’s causing burnout, in addition to just the impact of COVID. And all the elements of burnout, that that you’re constantly hearing about. This is going to be the big crisis of our time here. It’s not necessarily supplies of vaccines, or therapeutics, or PPE or tests; I think we’re actually making phenomenal progress towards writing those supply constraints. There has been incredible innovation, across diagnostics, therapeutics, vaccines, and discussions on equity to make sure that this is not just innovations that will benefit, high income, high income countries, but lower middle income. I really do think we’re actually unlocking some serious improvements in regards to all of those solutions. And yet the big bottleneck that will remain that’s the most difficult to solve here is how do we actually get more healthcare workers through training so that we have enough health care cost raise across the spectrum to care for individuals when they’re sick, we’re going to have a huge supply demand problem, no readily available solution to solve that problem.
Shelly Sood 15:08
And when you look, frankly, at hospital senses, and we think about ICU capacities when you’re hearing media headlines saying, “Idaho is invoking crisis standards of care,” when you look closely, surely, the problem is not enough physical beds is enough staffed beds. So that is ultimately going to continue to rear its head, not just now in the next 16 to 20 weeks, it’s winter cold flu. But it’s going to be the situation in winter of 2022, and winter of 2023, so on and so forth. And if we think that pandemics are here to stay, and that this is just the first of a cycle of them down the road, and that the most likely next pandemic will remain respiratory, because it’s the most easily transmitted. We’re in a big problem here, we have to think big and thoughtfully about ways to solve this problem. Yeah, absolutely. So the latest news on COVID-19 Is everything that’s happening in Germany right now. And there’s about 60% of their population vaccinated, which is actually a pretty low number compared to the rest of Europe. What is your opinion? And how is what is happening in Germany impacting the United States? And do you foresee what’s happening in Germany to happen in the US eventually.
Dr. Vin Gupta 16:34
As we’re looking, I’m actually drawing up our Germany forecast from the University of Washington, I want to make sure I’m adequately looking at forecasts, just give me one moment.
Shelly Sood 16:47
But for your listeners here, to your point, Germany, as of this moment, right now is on an upswing, so it’s experiencing what 300 daily deaths. We think the most likely scenario is that debt total is going to double by the beginning of the year. So 600 daily deaths, which for Germany is a big deal. That’s almost like losing 2,500 Americans day over day, just because of just given sort of relative comparisons here. But it could get a lot worse, we could be looking at 2,000 Germans dying day over day, into the new year. So to your point, this is simple math, and goes back to your initial question on the purpose of on the under threat that the Delta variant poses to all of us, which is that it is so contagious. Exposure and infection can occur in such a limited period of time that if you have even 20% of your high risk population not fully vaccinated, and by “high risk,” I’m really putting in anybody 18 and older, then that’s enough to cause a pretty significant death toll. We saw this in Florida; frankly, surely, I mean, frankly, Florida has 80% of its 65 and older crowd fully vaccinated and look what happened in August and September: they were having daily death tolls exceeding 1,000 Just to the state of Florida. And that was a combination the Delta variant, the fact that 20% of the 65 and older crowd still remained unvaccinated, you would think Gosh, 80% uptake 65 and older. Isn’t that phenomenal? It shows how dangerous this virus is – that it finds the unvaccinated, it preys on them, and lands them in the hospital. That’s why Florida seemingly protected was actually quite vulnerable. So when I look at Germany’s numbers, I don’t look at 60% fully vaccinated rate, to your point as anything to really celebrate.
Dr. Vin Gupta 18:52
I think that they remain quite vulnerable. The state of Colorado – I was having this conversation with colleagues at UC Denver – somebody said, “Well, gosh, we have our first our first dose vaccine uptake rate at 72%. Why are we experiencing full capacity in our ICUs? It’s a combination of things that we’ve just talked about one. It’s not full capacity of all the ICU beds that exist in the state of Colorado; it’s that they don’t have enough staff beds. 60% of their actual bed census is actually stacked. So if you think about that, we’re already operating at that significantly reduced capacity. Because we just had enough people, you layer on the fact that 30% of high risk Coloradans are not yet fully vaccinated. That’s a recipe for disaster. And that’s exactly those are the forces that are going to shape this hopefully final surge of the pandemic which is why we’re still going to experience pretty significant death toll well into the depths of winter. Yeah, absolutely.
Shelly Sood 19:57
So let’s talk about herd immunity. I know you addressed it a little bit. But where are we at in terms of herd immunity? Is that a myth? Or is that something that is still being explored as a possibility?
Dr. Vin Gupta 20:10
I don’t think it’s a myth at all. I just think that a number that we need vaccinated or protected – however you define that – I do believe natural immunity connotes some protection, that’s just not as good. And it’s pretty clear, it’s not as good as the vaccine of protection from vaccination. But it’s also clear now that if we felt like we needed 70% for coverage of our population with the vaccine, when we had this initial discussion on herd immunity back in summer of 2020, if that was the initial goal, Shelly, I think that number now is 85 to 90% is the belief here, that we’re already seeing 70% uptake in places like Colorado, we saw 80% uptake of high risk individuals of the vaccine amongst high risk individuals in Florida, yet they experience a surge What does that mean? That means that to really protect the hospitals, you need a higher number. And it’s really hard. So that’s what we’re talking about 85 to 90%. And some people think it’s goalposts moving, and you’re never going to change their minds, you’re never going to be able to reason with a certain segment of our society. And I think we have to accept that there are some trade offs here with us being able to explain just the changing evolution of virus and people believing it. That number is just a lot higher now. And probably unachievable, which is why the death toll that we’re going to experience, losing an additional 100 150,000 Americans by April 1, while entirely avoidable, seems likely.
Shelly Sood 21:49
So what would you say Dr. Gupta, to the public today about the importance of vaccines and mass and what would be your biggest message to the public?
Dr. Vin Gupta 22:01
You know, I think more than anything, it would be not to talk; to use as minimal words as possible. But what I found when trying to reach those individuals, who have not been moved by statistics or data is to share stories. So I would try a different tactic here, which is minimize statistics, sharing of figures and really emphasize anecdotes that I’ve seen personally as an ICU doc, the bedside, the younger people ending up in the hospital trying to change that perception. I love showing images of lungs, for example, really leaning into strategy, Shelly, that we use so successfully for the anti smoking campaign, struggling that we’ve decided to let all of those go at the highest levels. We’re just yammering and talking about statistics and being pedantic and dogmatic to people that don’t want to hear it, or are willing to hear it, but want to hear it in a non judgmental, respectful way, who don’t have trusted relationships with medical providers, for whatever reason, who don’t watch cable news all the time, consume information differently, I think we have to message those people differently. And we have to use different tactics and the tactics that I’ve deployed that have been effective, when they’d been affected to those groups that remain unvaccinated had had been storytelling, targeting the audience segment and understand where they’re coming from, directly answer the questions. Direct engagement, more than anything, is extremely helpful. It’s really hard to scale but really helpful. Because mass messaging at this point ain’t going to do a thing. If people that are going to get vaccinated, because the mass messaging or well vaccinated, they’re probably thinking about boosters at this point. Those that at this point that we need to reach – either we’re going to reach them through direct engagement or through these different messaging tactics that, in my view, have been underutilized. But those are going to be the best ways forward. So I would try to actually minimize mass messaging and really try to tailor messaging as much as possible to the individual. Fireside chats, direct engagement, and trying to scale that approach has been really effective.
Shelly Sood 24:20
Okay, how about mandates to force people to get vaccinated, not entry to public restaurants or, buses? What are your thoughts on that? I think friction to travel and to engage in leisure activities, it makes a ton of sense. And so the Department of Transportation, I don’t know why they haven’t moved yet on something like that, because that’s really going to increase. In my view, especially if it weren’t challenged from a legal standpoint, it would definitely increase uptake of the vaccine because people want to travel.
Dr. Vin Gupta 25:00
If we’re doing it for international travelers, it doesn’t feel like a reach to do it for domestic travelers. And there’s a lot of science behind why doing so would make just an airplane cabin even more safe than it already is. For the workplace, it’s hard to argue that when maximum vaccine mandates are implemented, they work. You can look at the example of United Airlines and Tyson Foods as two vivid examples that do work, that there’s minimal attrition, so I’m not against them. However, I will say that, you know, just talking to a broad spectrum of organizations, a cross section of our society over the last many months, people have legitimate questions. They consume information differently than the way in which we consume it on Twitter or again, on cable news. And I think there’s an expectation that everybody is on the same timeline. That everybody’s approaching this with the same level of comprehension, because they’re consuming the same information at the exact same time. And they’re just not, they’re not. And that leads to judgment and frankly, disrespectful dialogue. I worry about the fact that more than 50% of Americans are tuning out somebody like Dr. Anthony Fauci, by far and away the leading expert in infectious diseases, in the country. It’s now polarizing. And when you think about that, what that means for the next pandemic, that’s not good. And the notion that we can mandate our way out of every single threat – it’s not going to work. And so really rebuilding trust through direct engagement, better messaging tactics, less judgmental dialogue, across cable news, lowering the temperature and some of the anger that the vaccinated feel against the unvaccinated. I think all of those things will be helpful. And frankly, to this day, there’s there’s public health messengers, who have large platforms who I think just are getting it wrong and are confusing people, namely about the purpose of vaccination, and why you should or should not get a booster shot. All this stuff continues in the current day, and it’s just serving to really frustrate people. And I, to some degree, empathize.
Shelly Sood 27:31
Yeah, no, absolutely. There’s just too much mixed messages out there. I mean, people don’t know who to believe what to read, who to listen to, they have their own political views on things. There’s too much of a mesh between what’s happening with the pandemic, as well as their political views. So it should be separated, in my opinion. But that would be an ideal type of environment.
Dr. Vin Gupta 27:56
I couldn’t agree with you more, Shelly, that is my worry with this discussion on mandates. That’s exactly why the Sixth Circuit Court of Appeals in Cincinnati is likely going to stay the recent ETS from OSHA (the emergency temporary standard), requiring proof of vaccination or weekly testing for large employers or employees of large employers. This is not going to stand a legal test, in my view, because rarely does OSHA actually win any of those legal battles. And so, here we are, at the end of the day, we are we’re not actually going to be able to lean on mandates, we’re going to only be able to lean on reaching people through direct engagement and messaging. And not only is that a good short term strategy, strategy, but it’s a I think it’s the only way to actually rebuild trust in our public health institutions and our leading public health messengers. So that we’re better positioned more than anything. Whether it’s COVID, or smoking, or, or what to eat, how to eat. It’s pretty darn clear that at the end of the day, it’s relatively, it’s often common sense. When you think about ways to keep yourself safe from a health threat, whether it’s communicable, non communicable, at the end of the day, its behavior and the ability of us in healthcare to persuade. That is usually the rate limiting step. And so that’s why more than anything, we really have to get the message in, right?
Shelly Sood 29:31
Absolutely. And the ability of another person to care for another human being to protect themselves so they don’t get infected. So they don’t have a severe case. That compassion is totally lacking. And I feel like – after 9/11 I compare, I go back to what the world was like, post 9/11 and this country came together. This country was united after 911 but we’re just not seeing that at all. At this point in time, and it saddens me that this country is going in that kind of direction.
Dr. Vin Gupta 30:06
I agree. I agree with you and yet, I also think that there is…what I when I listen as a, as an analyst for news organizations NBC and MSNBC, I, as a moderate, somebody who sort of politically a moderate… And I just really believe that that’s where the majority of Americans are – somewhere in the middle ground. I think they’re very reasonable critiques that I’ve seen come from the center-right on ways to better message, on ways to better persuade, and frankly, as health communicators, doctors, other public health professionals are not taught to be masters of persuasion. Which is why it’s been so darn easy, Shelley, for people to misinform, and to spread misinformation because frankly You know, I love Dr. Fauci. And I had actually idolized Dr. Deborah Birx, prior to seeing her reputation get tarnished and 2020. I mean, she was a pillar of respect in public health and military officer 20 year researcher, an HIV, just fantastic clinician, there’s a lot I really admired there and want to emulate. And yet when you think about it, many of the leaders in public health are not equipped to mass message and to persuade. And as a result, more than any other industry, maybe outside of politics. It is so darn easy to misinformed when it comes to public health. Oh, yeah. And that is, and that is reflective of not the mechanisms of distributing misinformation like social media, it’s because there’s a gap in adequately informing. And it’s not because we don’t have the right information. We do. There’s the New England Journal of Medicine, draw up any Twitter feed that you prefer; there’s the right information up there. It’s just that people are not persuaded by it, because it’s either complicated, poorly delivered, or people just don’t trust it, because there’s not the human connection. So unless we really solve for that we’re going to be in this problem. Not just now, but in the future.
Shelly Sood 32:16
Yeah, absolutely. And doctors, they’re not salespeople, they really are not.
Dr. Vin Gupta 32:21
And you know, sadly, they sort of need to be. They need to be better marketers, you want to be able to unlock people’s trust. And the fact that Fauci is polarizing to more than half the country is something that the powers that be today are probably not going to want to wrestle with, because the old guard in health care and academic medicine – the way they reached the heights is through a journey very similar to Dr. Fauci. And it’s going to be hard for them to say, you know what, maybe we’re not the best physician to lead on on these issues or a message on these issues can help with moving forward, it’s going to require a slightly different skill set. So it’s going to take some time, a lot of self awareness, a lot of accountability, to say, what can we do better moving forward? I think those conversations are happening, surely; we need more of them. We need a little bit more awareness and self identification amongst our highest leaders that we can get the right people in some of these roles.
Shelly Sood 33:25
Absolutely. Well, thank you so much for joining us today.
Dr. Vin Gupta 33:30
Thanks for having me. So it’s great to see you and just be reconnected. Thank you for the invitation.
Shelly Sood 33:35
Absolutely. Thank you.
