#192 - COVID Part 2: Masks, long COVID, boosters, mandates, treatments, and more
This follow-up episode, featuring Drs. Marty Makary, Zubin Damania (ZDoggMD), and infectious disease specialist Dr. Monica Gandhi, addresses listener questions on COVID-19. They discuss new Omicron data, long COVID, mask efficacy, vaccine mandates, and treatments, emphasizing a fact-based approach over fear.
Deep Dive Analysis
20 Topic Outline
Introduction and Context for Follow-Up Discussion
New Data on Omicron Severity and Hospitalization Rates
Omicron's Inherent Mildness vs. Population Immunity
Evolutionary Trajectory of SARS-CoV-2 and Future Variants
Natural Immunity from Omicron vs. Vaccine-Induced Immunity
Understanding B Cells, T Cells, and Antibody Function
Vaccine Dosing Intervals, Types, and Myocarditis Risk
Arguments For and Against Vaccine Mandates
COVID Mortality Risk in Youth Compared to Other Causes
The Role of Emotion, Trust, and Public Health Messaging
Mask Efficacy: Protecting Self vs. Protecting Others
Defining Long COVID and Impact of Vaccination
COVID Policies for Children and Schools
Sweden's Non-Lockdown Strategy and Outcomes
Draconian COVID Measures in Canada
Antiviral Treatments and Convalescent Plasma
Critique of Dr. Robert Malone's Claims on Joe Rogan
Understanding Mass Formation Psychosis and Groupthink
Developing an Exit Strategy for the Pandemic
Critique of NIH Power and Funding Priorities
6 Key Concepts
B Cells
B cells are immune cells that serve as a 'recipe book' or template to produce more antibodies. Aided by T cells, they can adapt those antibodies to specific variants seen in the future, providing long-lasting cellular memory.
T Cells
T cells are the main arm of the immune system that fights viruses. They last for a long time as 'cellular memory' and directly kill virus-infected cells, also aiding B cells in antibody production.
Adaptive Immunity
Adaptive immunity refers to the immune system's ability to vary its response based on the specific variant or pathogen it encounters. B cells and T cells adapt to produce antibodies and cellular defenses tailored to new conditions, evolving to fight different variants.
Original Antigenic Sin
This term describes a phenomenon where the immune system, upon repeated exposure to a similar but slightly different antigen (like a new variant), tends to produce antibodies primarily against the initial antigen it first encountered, rather than developing a new, more effective response to the new variant.
Convalescent Plasma
Convalescent plasma is blood plasma collected from individuals who have recovered from a viral illness. This plasma contains diverse antibodies against that virus and can be infused into sick patients to provide passive immunity and aid in fighting the infection.
Mass Formation Psychosis
As described by Robert Malone, this is a societal phenomenon where a population, under conditions of isolation, dissatisfaction, and crisis, becomes 'hypnotized' into believing a single authoritative solution, leading to irrational behavior. It is paralleled to historical events like Nazi Germany.
11 Questions Answered
Yes, studies from South Africa and the US suggest Omicron is about 25% less virulent than Delta, and about two-thirds less virulent in young children, independent of population immunity.
Natural Omicron infection on top of vaccines leads to broadly neutralizing antibodies and T cells/B cells against all variants, providing a more in-depth immune response across the whole virus compared to spike-protein-only vaccines.
Spacing out vaccine doses, such as by eight weeks or more, can lead to a better and more robust T cell response and overall cellular memory, which is crucial for long-lasting immunity.
Arguments for mandates often cite the reduction of severe disease and hospital strain. Arguments against mandates highlight psychological reactance, distrust in government, and the potential for long-term damage to public health trust, as well as the logical inconsistency of applying blanket mandates without considering individual risk or natural immunity.
N95s with a good seal are highly effective (0.14% transmission risk in a 20-minute direct contact scenario), followed by N95s without a nose piece (4.2%), and surgical masks (10.4%). Cloth masks have shown little to no effect on population-level transmission.
Long COVID refers to lingering symptoms after a viral infection. Vaccination significantly reduces the risk of long COVID symptoms, even after mild breakthrough infections, and may also help treat existing long COVID by promoting a more adaptive immune response.
Sweden's strategy, which avoided strict lockdowns and kept schools open, resulted in a cumulative mortality rate of 1 in 663 people, compared to 1 in 387 in the United States. Their long-game approach, combined with high vaccine uptake and public trust, appears to have yielded positive outcomes with less social fabric disruption.
Only one of the three main monoclonal antibodies, Sotrovimab (GSK/VIR), is effective against Omicron. The other two primarily work on the Delta variant.
Despite studies showing a dramatic reduction in hospitalizations and improved survival in high-risk COVID patients, the NIH has concluded there is insufficient data to recommend it, leading to confusion and underutilization in clinical practice.
Convalescent plasma is blood plasma from recovered COVID-19 patients, containing diverse antibodies. Concentrated convalescent plasma has shown a dramatic 50% reduction in hospitalizations, but it has not received widespread attention or adoption, partly due to political backlash and lack of financial incentives for pharmaceutical companies.
The concentration of power and funding control within entities like the NIH, coupled with institutional concerns about public perception and social media backlash, has created an environment where academics and physicians fear losing funding or careers if they express views contrary to the prevailing narrative.
26 Actionable Insights
1. Space Out Vaccine Doses
If receiving a multi-dose vaccine, space out doses by at least eight weeks or longer to achieve a better and more enduring T-cell immune response, which provides long-lasting cellular memory. This strategy improves overall immune system response beyond just antibody levels.
2. Evaluate Boosters for Clinical Benefit
Consider boosters based on individual risk-versus-benefit analysis, primarily to reduce severe disease outcomes (e.g., for older, immunocompromised, or those with medical conditions). Avoid widespread boosting solely to reduce transmission, as this effect is often temporary and not a standard public health strategy.
3. Vaccinate to Mitigate Long COVID
Get vaccinated to reduce the risk of developing long COVID symptoms after infection, as adaptive immunity prevents the virus from spreading widely in the body and reduces inflammation. Vaccination may also help improve symptoms for those already experiencing long COVID by promoting more organized immunity.
4. Use High-Quality Masks for Protection
If concerned about exposure, wear high-quality masks such as N95s, KN95s, KF94s, FFP2s, double masks (cloth over surgical), or a cloth mask with a polypropylene filter. These masks effectively protect the individual, enabling ‘one-way masking’ where your mask protects you.
5. Adopt Pan-Viral Hygiene Practices
Implement a general public health hygiene strategy: wear a mask if you’ve been exposed to any virus, be cautious and maintain distance around vulnerable individuals, and stay home if you are sick. This approach is effective for all respiratory pathogens, not just COVID-19.
6. Seek Honest, Nuanced Information
Actively seek honest, non-tribal information about health topics, focusing on facts rather than fear-based messaging. Be humble and adaptable in your thinking, as scientific understanding and viral characteristics can change over time.
7. Assess Personal COVID Risk
Educate yourself on the facts about individual COVID risk, including hospitalization and death rates, especially considering age and comorbidities. This helps in making informed decisions and avoiding anxiety fueled by overestimated risks.
8. Recognize Natural Immunity’s Role
Acknowledge that natural immunity from prior infection provides robust protection, including broad T-cell and B-cell responses and diverse antibodies, which should be considered in health policies and personal risk assessments.
9. Use Sotrovimab Selectively for Omicron
If infected with Omicron and at high risk for severe disease, consider Sotrovimab (GSK/VIR biopharmaceutical product) as it is the only monoclonal antibody currently effective against this variant. Other monoclonal antibodies are primarily effective against the Delta variant.
10. Consider Fluvoxamine for High-Risk COVID
Be aware of fluvoxamine as a therapeutic option for high-risk COVID patients, as studies have shown it can dramatically reduce hospitalization and mortality, despite official recommendations sometimes lagging.
11. Explore Concentrated Convalescent Plasma
For severe COVID cases, be aware of concentrated convalescent plasma as a therapeutic option, which has shown a significant reduction in hospitalizations in well-done studies.
12. Prioritize Children’s Schooling & Normality
Advocate for policies that prioritize children’s well-being, including keeping schools open and returning to normal routines, recognizing the severe negative impacts of closures on mental health and learning.
13. Reflect on Personal Biases
Engage in self-reflection to understand your own agenda and biases when discussing health topics. Being transparent about these helps interpret information and foster more constructive dialogue.
14. End Tribalism in Discussions
Strive to end tribalism in health discussions by presenting data from multiple perspectives and allowing individuals to make their own informed decisions. Avoid automatic dismissal of differing opinions.
15. Engage Non-Judgmentally on Health
Approach conversations about health decisions, such as vaccination, with a non-judgmental attitude. Physicians, for example, should explain risks and benefits without shaming or mandating.
16. Question Authority & Incentives
Maintain a healthy skepticism towards concentrated power in public health and scientific funding, and question financial incentives within pharmaceutical companies and healthcare entities. This fosters scientific integrity and prevents groupthink.
17. Uphold Scientific Freedom
Advocate for scientific freedom, open debate, and transparency in data sharing, especially in public health. Resist pressures that silence dissenting scientific opinions or tie research funding to specific narratives.
18. Avoid Shame and Stigma
Refrain from shaming or stigmatizing individuals who contract an infection or make different health choices. This approach is counterproductive and damages public trust.
19. Understand Social Media’s Influence
Be aware of how social media can create and reinforce ‘hiveminds’ or groupthink, influencing beliefs and reactions without individual awareness. This understanding can help in critically evaluating information.
20. Hold Convictions Loosely
Cultivate a mindset of ‘strong convictions, loosely held,’ meaning be open to new evidence that could change your understanding or stance on a topic. This is crucial for nuanced thinking.
21. Advocate for Better Pandemic Response
Advocate for a more functional, data-driven, and rapid pandemic response system, including quick bedside clinical trials for therapeutics and a focus on diverse treatment options, to better prepare for future, potentially more severe, viruses.
22. Prioritize Key Research Funding
Advocate for public health funding bodies (like NIH) to prioritize research into critical gaps, such as natural immunity, virus transmission mechanisms, and mask efficacy, rather than disproportionately funding other areas or ignoring key questions.
23. Cultivate Empathy for Others
Develop empathy for individuals who hold differing views on health topics, even if you disagree with their scientific understanding. This can foster more productive dialogue and reduce societal division.
24. Broaden Public Health View
Recognize and address the broader public health threats facing society, such as suicide, homicide, drug overdoses, and motor vehicle accidents, rather than solely focusing on one disease.
25. Question Outdated Health Policies
Challenge health policies that are based on outdated data or variants, such as applying Beta/Delta-era rules to Omicron, and advocate for policies that reflect current scientific understanding and viral behavior.
26. Listen to Previous Episode
For additional context and background on the subject matter, listen to the previous COVID-19 podcast with Drs. Marty Macri and Zubin Damania, released on January 3rd.
7 Key Quotes
Ebola is a really dumb virus because it kills its host, and a virus that makes more copies of itself but doesn't kill its host, that's more evolutionary advantageous, just like the organisms want more children.
Monica Gandhi
If I had antibodies for every cold I've ever had in my body, I couldn't move because I'd be so thick.
Monica Gandhi
Never in the history of civilization has shame and fear forced someone to do the right thing.
Peter Attia
You are unclean, unpure, undesirable, and unwelcome if you are not vaccinated.
Zubin Damania
A Canadian is essentially an unarmed American with health insurance.
Marty Makary
Science isn't a dogma, it's a process.
Zubin Damania
I mean, if you don't operate, the odds of it killing you are X. And if you operate, the odds are Y, which are lower than X. But in the short term, there's this risk. I mean, yeah, it's like physicians are very good at having naturally Bayesian discussions.
Peter Attia
1 Protocols
Recommended Mask Types for Individual Protection
Monica Gandhi- N95s
- KN95s
- KF94s
- FFP2s
- A double mask (cloth and surgical)
- A cloth mask with a polypropylene filter inside