Brian Lehrer: Brian Lehrer on WNYC. We're in our 30 Issues in 30 Days election series on the show. The next three episodes are about public health as an issue in this year's elections. We arrive at issue 11, does either party have a plan for our COVID endemic future? The New York Times COVID Tracker reports today that deaths remain troublingly high, but they are experiencing their first sustained decline in several months. The number of deaths has fallen by 8% in the past two weeks, but it's still just a little under 400 per day according to The New York Times COVID Tracker.

As we've been discussing this summer here on the show, 400 Americans a day continue to die from COVID, and yet all the rules are coming off. The average in the last two weeks to be precise. According to that, New York Times COVID Tracker is 382 people per day, and that's with a decline in deaths they referred to. Yet, in the last few weeks, Governor Hochul in New York lifted the mask mandate for mass transit and let her COVID emergency powers expire. President Biden a few weeks ago said this on 60 Minutes.

President Biden: The pandemic is over. We still have a problem with COVID. We're still doing a lot of work on it, but the pandemic is over. If you notice, no one's wearing a mask. Everybody seems to be in pretty good shape and so I think it's changing.

Brian Lehrer: If Biden is saying that, are both parties leaders, basically Ron DeSantis now, does either party have a plan for our endemic future? Our guest for this is Dr. Eric Topol, cardiologist and founder and director of the Scripps Research Translational Institute, originally known as the Scripps Translational Science Institute, which focuses on research on the human genome and digital technology to improve healthcare.

Dr. Topol is also a professor of molecular medicine and executive vice president at Scripps Research and he writes a Substack newsletter on Health called Ground Truths. Dr. Topol, thanks for coming on today. Welcome back to WNYC.

Eric Topol: Thanks, Brian. Good to be with you.

Brian Lehrer: We'll talk plenty of science in this segment, but can I get your take first on the Biden clip for you as a doctor and scientist? Is the pandemic over? Should we be using some other word now?

Eric Topol: No, it's not over. We've got some rough roads ahead still, unfortunately. It's not over when there are nearly 400 people dying a day when we have nothing to address on COVID and when we have some major, very difficult variants to contend with in the weeks ahead. We're in a lull where cases have come down as they have in the past. You may remember Brian, back in June of 2021, people were saying the pandemic was over, then came Omicron, and everything got reignited.

It's premature. The only way to say that pandemic is overlooking backward, months and months where there's minimal severe outbreaks. No major ways the virus is contained. We're not there yet by any means.

Brian Lehrer: The President said everybody seems to be in good shape. That was part of that clip but The New York Times COVID Tracker says, we're still losing around 400 people every day. COVID this year is the country's third leading cause of death behind heart disease and cancer. He says, "No one's wearing a mask." As if that's a sign of no risk, even as we all know, people who are getting COVID every time we turn around, it feels like.

On a policy level, do you see the Republicans and Democrats as being any different from each other at this point?

Eric Topol: Yes. Fundamentally, the Democrats are looking to try to get more funding, or at least they were before the declaration of the pandemic is over, whereby there would be investments in things like nasal vaccines and variant proof pan coronavirus vaccines, a new generation of vaccines that are taking on the patching up the holes of the formidable problems that we've run into ever since Omicron appeared almost a year ago now.

There was interest in that, but that's been blocked as far as I understand in Congress. There's no funding to pursue another operation at warp speed where we had immense success in getting the first COVID vaccines just 10 months after the virus was sequenced, which is truly unprecedented. We could do that again, but there's no funding and it doesn't appear that the Democrats are still pushing on this because they've come up against the wall.

Brian Lehrer: The Republicans don't want the funding for the next level prevention and treatment research that the Biden administration wants them to fund and so at least that is the difference between the parties at this point. We had the US Surgeon General, Dr. Vivek Murthy on the show recently, and I asked him to explain his boss, the president's declaration that the pandemic is over and this is part of how he put it. I think we'll have Dr. Murthy in just a second. You'll hear when we get this clip ready that he says two things can be true at the same time that the pandemic can be over or that we've made progress, but also at the same time that we have more work to do. Here he is.

Vivek Murthy: Two things can be true at the same time that we've made progress and that we have more work to do. That work ahead of us involves making sure that we protect as many people as possible going forward from COVID. That means making sure people are up to date with their vaccines.

Brian Lehrer: Up to date with their vaccines was one thing the surgeon general cited there and then he talks about treatment.

Vivek Murthy: I think outside of government, I think workplaces and schools, and other institutions should be sensitive to this too. Should recognize it as we move into this next phase with our COVID response, we've all got to be sensitive to the fact that there are going to be people around us who are at higher risk. That might mean that we need to make special accommodations for them. It might mean that they would choose to wear masks in settings where we may choose not to. We've got to recognize that those choices are appropriate for people to make based on their risk and we should be supporting them in that regard.

Brian Lehrer: Dr. Topol, that was all about individuals or individual workplaces making their own individual decisions. I want to get back to the science that we started talking about before in a minute. I know you have a particular interest in nasal vaccines, which people might think is only an interesting area because, "Oh, I'd rather sniff something than take a shot." It's really more profound than that. We'll talk about that in a minute.

After those clips of Dr. Murthy and the president, do the rules of the road have no more place once we reach the endemic phase of COVID or if we're still in the pandemic phase even today and politically maybe the Republicans simply won on what the required standards of behavior should be, you think?

Eric Topol: You're making an important point about the idea that you seed evidence-based recommendations because that's the popular, that's what people want. Everyone wants this pandemic to be over, but unfortunately, we can't will it to be over. We can't be in denial. The issue here, for one the idea that up-to-date vaccine is the wrong term. It needs to be, if you haven't had a booster, you haven't been fully vaccinated.

That's to start with. The idea that you basically are compromising what is the minimal vaccine program that each person should have, which is at least three now, and now we're already getting into the fifth vaccine for many. This is a problem is that you're trying to accommodate the lack of using mitigation measures, isolation, and vaccines, this is not going to help. The idea of displacing or shirking the risk to the individual level rather than the government and public health agencies taking the responsibility of trying to shirk that is not acceptable.

Brian Lehrer: Do you have a take, though, as a scientist on how much two-way masking is better than one-way masking? Because when we move the risk to the individual, it's about, "If you want extra protection for yourself because you think you're at risk of serious disease or for any other reason, you can wear a mask and it works really well. If it's an N95 or an equivalent mask, we don't need everybody to mask around you as a matter of law or rule." Is there data on that?

Eric Topol: There's some data, there's been lots of modeling data and I think as much epidemiologic data as we might be able to get. The issue here is, first you mentioned the importance of high-quality masks like N95 or KN95. Second, it depends on the people you're talking about. Immunocompromised people, there's more than 7 million Americans that fit in that category. They may have cancer, they may have had an organ transplant, or they maybe important immunosuppressive drugs.

For them to wear a mask, that's one thing. Obviously, they need to, because even with vaccines and now with Evusheld preventive treatment, they still are at risk. They're going to be a whole lot safer if other people around them are also wearing a mask who could have an asymptomatic infection or just before they're going to develop symptoms and are very contagious. It's really about the people and their characteristics that make the mask story and the extent of masking all the more important.

Brian Lehrer: Similarly on how much other people being vaccinated is needed to prevent transmission or to protect the people who are vulnerable to serious disease if they are all vaccinated themselves. Let's say they've had their fifth shot because we know that vaccines have been really great at preventing serious cases and death. I think the death rate among those 392 or so people who are dying per day in this country, according to The New York Times COVID Tracker, you're six times more likely to be one of those people if you're not vaccinated than if you are, but we see vaccinated people getting the Omicron variants plenty.

Is there data on how much vaccine mandates matter to death rates, let's keep it at death rates, in the vulnerable if they themselves are fully vaccinated.

Eric Topol: This is a very important dichotomy which I think has to be understood very clearly. When Omicron came and all its descendants from BA.1 through BA.5 and now we have many more in the works, things fell apart with respect to protection from infections and transmission. They're still with vaccines, some, 30%, 40%, but it's fleeting after a couple of months, and that's why we've had lots of leaking of vaccines for infections and spread. On the other hand, protection from death and hospitalization, and severe disease has held up quite well. Not perfectly, but there have been some dents in that protection, but it's nothing like what we've seen for infection.

I don't favor any mandates for vaccines because unfortunately, again, our country has not recognized prior COVID as an important way of deriving immunity. Not that we want anyone to get COVID, but if they survive COVID they have an immune protection that's different and complimentary to vaccines so-called hybrid immunity. If you've had a recent BA.5 infection in the summer, getting a BA.5 bivalent booster really isn't going to make a lot of difference, but we try to dumb it down for the entire population and we don't recognize, or at least our CDC the importance of prior infection relative to this different form of immunity where you're seeing the entire virus, not just despite protein, which is what you get with vaccines.

Now, I think this is the problem is that the hole in the story and why there's so much disenchantment with vaccines is because even though there's great protection from severe disease. Just in 2021, over 20 million lives were saved around the world, that's not even taking into account what's happened this year, but the problem is the disenchant of all the infections that you've alluded to, you've touched on that, Brian. That's why we have to have a new fix, a new patch, and we're not going to get that from shots, and those people who've already had the bivalent vaccine, there's many who have had even in the recent weeks have had an infection with that backing. We have to do better than just shots to go forward.

Brian Lehrer: All right, that's where we're going to pick up when we continue with Dr. Eric Topol from the Scripps Translational Institute. We can take your phone calls for him too on where we go from here. He says we're still in the pandemic phase. President Biden says the pandemic is over. Maybe we're entering the endemic phase. We'll talk about what that would mean if we are there or if, when, and when we get there and pick it up right where he says about the new treatments and vaccines that are needed.

We can take some phone calls for him on this 30 Issues in 30 Days election series episode 11. Does either party have a plan for our endemic future? 212-433-WNYC. 212-433-9692. I see some Twitter questions coming in, we'll get to some of those right after this.

[music]

Brian Lehrer on WNYC as we continue on issue 11 in 30 Issues in 30 Days our midterm election series. Does either party have a plan for our endemic future with Dr. Eric Topol, cardiologist, and co-founder of the Scripps Translational Institute? He also writes a Substack newsletter on immunity and other related things called Ground Truths. Here's a tweet question for you that's come in and since you're a cardiologist, I think this is especially relevant.

A listener writes, "I'm a healthy, touring singer and musician and one of the only people still masking and concerned about cardiac risks that come with even mild infection. How do I navigate making a living and still protecting myself? It's very confusing." Dr. Topol, can you give that musician, any tips for protecting himself in the current behavioral environment, but also for you as a cardiologist how would you characterize what he called cardiac risks that come with even mild infection?

Eric Topol: Unfortunately, there are some risks. They're low for mild infection of COVID and whether it's a risk of a blood clot, stroke, heart arrhythmias, myocarditis. There's many different cardiovascular complications that can occur even though the risk is quite low, but increased with COVID, and the severity of the COVID, of course, is tied in with a higher increase in risk. For one, these risks are out there.

There have been several studies that indicate this is no question that they exist and we're starting to understand the mechanisms, but for protection, you got the tools that we have today, which are certainly all the vaccines and boosters as this individual mentioned, the use of mask certainly when indoors and n crowds when possible. Obviously, anything that can be done to improve air quality, ventilation, and filtration, those things are really helpful as well, but if we could stop infection spread, the chain of transmission, that would be the ticket where people would have much more confidence in being with others and being in crowds, and that's what we don't have right now.

Brian Lehrer: Kathy in Fallon, you're on WNYC. Hi, Kathy.

Kathy: Oh, hi Brian. Thanks for taking my call. I had listened to the last segment you did before the commercial, and I was a little confused at what the doctor had said. I wasn't sure if he was saying that if you did have the Omicron variant that the protection that you would have from those antibodies would be somewhat better than if you actually got the booster or if that was something for people that never had the sickness. I just wanted him to clarify that point.

Eric Topol: Sure, Kathy. I think the point here I'm trying to make is that if you had a recent infection of COVID and that would be July and August BA.5. The bivalent vaccine, which is BA.5 directed specific, it's a combination of that with the original strain, isn't going to make much difference because you already had the real deal and just getting this spike protein of that particular strain isn't going to augment your immunity to any significant degree.

The other thing, of course, is once you've gone four months from the most recent infection, that's the time to get another booster. Not because you've had a recent infection or because about BA.5, but each time you get a booster, you get a broadening of immunity. You get a lot more neutralizing antibodies, you get better T-cell immunity. When you've gone out four months more than your most recent booster, it's time to get another one, and so that's, I hope, trying to clear up your question.

Brian Lehrer: So people don't wind up confused just to clarify even more, or even just restate what you said, you're not against this latest fifth dose bivalent as they call it because it attacks both the original variant and Omicron bivalent fifth dose booster. You're not shrugging your shoulders at that. You're saying people who are four months out from their last booster or their most recent infection should get it?

Eric Topol: Yes, exactly that. If you're just a couple few months out and you had an infection it almost invariably was BA.5. You're not going to derive, there's no rush at this point but once you get past four, five, six months, you're going to be vulnerable again and especially as you increase in age over age 50 that's where you see survival benefit of the extra boosters consistently throughout the whole pandemic vaccination and booster phase.

Brian Lehrer: This is WNYC FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Net Com, and WNJO 90.3 Tom River. We are New York and New Jersey Public Radio and live streaming at wnyc.org. A few more minutes with Dr. Eric Topol as we ask our question number 11 in our series 30 issues in 30 days for the midterm elections, does either party have a plan for our endemic future?

Dr. Topol, you've written in your newsletter about still evolving omicron sub variance. What do you see coming at us, say this winter?

Eric Topol: There's already a lot going on in Europe and also in Singapore. In Singapore, there's a variant called XBB which is quite worrisome that is now driving a major wave. In Europe, in several countries, including the UK and Germany there's a variant called BQ.1.1. We have it here in the US as well. Those are the two most concerning variants. There are others. They are way downstream in terms of many more mutations beyond BA.5 and the Omicron family.

They deserve new Greek letter designations, but for whatever reason, the WHO is not doing that. Nonetheless, the problem with these variants, the new ones, Brian, is that they will take over in this country. They're going to cause a significant increase in infections and they have an immune escape. They may challenge our vaccines to some extent in terms of holding up completely as far as protection from severe disease, they're certainly going to be a problem with infections, reinfections spread, and most concerning too is that our antibodies are not going to work anymore.

They have that much more immune escape so that the monoclonal antibodies we use for treatment or the Evusheld that we used for prevention for the people who are immunocompromised will no longer have efficacy. We're just going further along in this challenge of the virus. Keep running ahead of the behind-chasing strategies that we're using right now.

Brian Lehrer: You advocate more rapid development of nasal vaccines rather than injections. Can you talk about where the science is on that and why you think they would be important?

Eric Topol: Yes. The science is pretty extraordinary because the only way the virus can get into us is through our upper airway, particularly our nasal mucosa. This idea of getting mucosal immunity from a nasal spray or an oral vaccine we already have two that are approved. One in India, one in China, and many more in the works. Unfortunately, there's no priority here in the United States but even if these last for just a few months and they block transmission because you have this very high level of IgA antibody which is different than what you get in shots that protects the route of entry for the virus to get into your body.

That's what's so appealing here is that if you could just take a spray even though it's every three months or four months, you'd have strong protection during that period of time that changes everything. Obviously, it's much easier than having to take shots. It doesn't have nearly the side effect profile of just in those days after people get shots and boosters. This has just enormous appeal but we're not pursuing it here in the United States and it's really, I think, a dreadful omission.

Brian Lehrer: Is that one of the things that you were referring to before that President Biden and the Democrats want to fast-track research on but the Republicans are blocking the funding in Congress?

Eric Topol: That's right. They have tried to get specific funding. They haven't been able to make any inroads, but on the other hand, Brian, they ordered a purchase of 171 million booster doses so that costs billions of dollars for this bivalent. It's only 4% of people have taken them bivalent so far. It's possible that if they had redirected their priorities with the funding that they have had they could have-- Operation Warp Speed, they got us the first vaccines that only cost $10 billion relative to trillions that we spent on the pandemic. Any investment we make here would be prudent.

Unfortunately, I think from the Democrat side we haven't necessarily allocated what funds that do exist although it obviously would be easier if we could get incremental support right now and push on this so that we don't have to get these vaccines from other countries that are going to likely have a very big favorable impact.

Brian Lehrer: The listener tweets, "Thank you, Dr. Topol, for good info. Two of my friends just got COVID last week and were extremely sick. No one is masking anymore because if you're younger, you look like a freak what to do?" A related question I think coming in on the phones from Thomasina in Bergen County. Thomasina, you're on WNYC. Hello.

Thomasina: Hi. Great to be here. I have so much to say about this. I'm a teacher and my union has totally given up on any kind of mitigation. We don't have any contract language for pandemics. Most of our contracts in New Jersey, they're settled locally by the district. We have no mitigation at all. We have no HVAC upgrades and that's why New York City is also having their issue. Why are you going to bring people back into a building if you haven't mitigated the building?

The government has basically dropped the ball doing nothing and I'm so upset with the Democrats. We can't even file for workman's compensation. All these claims are being denied when we say that we got it at work. They're saying how do you know? There's no support at all for workers in America. The Democrats have basically done nothing to mitigate COVID. We don't even have smaller air filtration that we could put in rooms for COVID. That doesn't exist.

I'm a teacher. I can't even get teachers to keep the windows open if their windows are working. It's a mess. Trumka, the president of AFL-CIO, unfortunately, he passed away. I don't know if it was from COVID, but he filed immediate labor rights violations that really the government, nobody's even talking about the Trumka filing of government mitigation for workers in America. We lost so many workers. The nurses are being ignored. We never hear a word from the doctors. The doctors are a total disappointment. Where are the doctors? The AMA, nobody's saying anything. Obviously, I have a lot to say about this, but the unions are doing absolutely nothing to ensure that there is safety on the job. I'm just so frustrated.

Brian Lehrer: Thomasina, thank you for all of that. Dr. Topol, we're running out of time in the segment. There are a few points in there but obviously, it has to do with neither the employers in the public schools where she works or even the unions seeming to be very vigilant about rules anymore.

Eric Topol: I share the frustration. There's just no reason for a letdown. We got tougher times ahead. This is really a mistake where we're dealing with the descent of BA.5, that we should be capitalizing on this situation and we're not getting ready for the next wave. It's going to be with us within the next couple of months. If you just watch what's happening in Europe right now in places like Austria and Germany you know what in the UK it's going to happen here. Certainly, the problems in schools and indoors is a big reason why even before the variant set in that there's vulnerability.

Brian Lehrer: Is the Bivalent vaccine that they're offering now effective as far as you know against these new variants that you say are currently already in Europe?

Eric Topol: They're not going to be as effective as against BA.5 which is fading. That's why you chase these variants you're always going to be a step behind the way this virus now is evolving so exceptionally fast. They will help because as I mentioned earlier, Brian, you just get this broadening of immunity. You get your neutralizing antibodies up to very high levels, your cellular immunity. It helps, but it isn't ideal. That's why we need a variant of proof vaccine which we could have that too. Not just the nasal vaccines, but again, we're not making that a priority in this country.

Brian Lehrer: All right. Does either party-- Oh, we started by you disagreeing with President Biden that the pandemic is over. If the pandemic is not over, at what point do we reach something called endemic, that people are talking about more, and what would that mean?

Eric Topol: Well, if you take what I would consider a simple term of containing the virus, and we did that, for example back briefly in the period of May and June of 2021. If that is sustained where you have some outbreaks in certain places, but overall things are relatively under control, that would be what I would picture as an acceptable endemic. We can live with this phase, but we're just not near there yet. You only really don't know that you're in this, what I call, endemic controlled contained phase until you go a period of months and you see you've really hit this stable course.

It's still very rocky right now. I don't see how anyone could make this premature proclamation that the pandemic is over when we have as many problems as we have, and we can see that this is a worldwide issue, of course. We can see hot spots in many parts of the world that are going to come to haunt us here, unfortunately.

Brian Lehrer: Dr. Eric Topol, cardiologist and founder and director of The Scripps Research Translational Institute, originally known as The Scripps Translational Science Institute, which focuses on research on the human genome a digital technology to improve healthcare. Doctor Topol is also a professor of molecular medicine and executive vice president at Scripps Research and writes a Substack newsletter called Ground Truths. Thank you so much for joining us.

Eric Topol: Thank you, Brian.

Copyright © 2022 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.