Delta Variant: BFD or NBD?

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S1: How much do you know about the new variant of the coronavirus, the one they’re calling Delta?

S2: This is the story of the

S1: Delta variant, that variant now spreading so rapidly in the United States that it’s expected to become the dominant strain in the next few weeks. And hospitalizations are spiking. Maybe, you know, it was first detected in India. Maybe, you know, it’s more transmissible than other strains, warning the Delta

S3: strain of Covid can be transmitted within seconds.

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S1: Maybe you’ve heard it’s causing hospitals to get crowded again. June so far seeing more Covid patients than any of the three previous months. And one hospital CEO says his facility is now more full than it was in the peak of winter. But Dr. Monica Gandhi, she wants you to rethink what you’ve heard. She works in San Francisco, says when she walks into her hospital, it’s kind of empty. She doesn’t feel any of the urgency she sees on the TV news.

S4: Yeah, I feel a real disconnect, actually.

S1: She worries a little bit that this new variant is causing some doctors to dust off an old playbook, using fear to try to change behavior.

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S4: There’s very much a negative messaging. So my only theory on this is that scientists think if they are very negative and doom and gloom, people will get scared and vaccinate or still on the fence.

S1: You seem very chill, which is very different than what I hear when I turn on the news.

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S4: Yeah, because I watch the numbers every day

S1: in the Bay Area, the numbers when it comes to Covid are really good. The city leads the nation in terms of vaccination. It’s already blown past President Biden’s goal of getting 70 percent of its residents their shots before the 4th of July. But it isn’t just a privileged perch that gives Dr. Gandhi her confidence. Earlier this week, Covid deaths dipped below 300 a day. Nationwide, hospitalizations are likewise plummeting and the national infection rate, it keeps creeping closer and closer to 10000 a day, which Dr. Anthony Fauci has set as a benchmark for when he’d start to consider the virus under control.

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S4: So all of the numbers are going in the right direction.

S1: Yeah, I’ve heard some scientists worry the media is getting the public riled up about what they’re calling scary. It’s like, yeah, variants that are scary or pushing the idea of mutant porn, the idea that these mutations are really bad and they’re out to get you.

S4: Do you agree with that? I do, actually. I really do. I keep on thinking, why not be celebratory? Because there is so much to celebrate. I feel really lucky, really lucky to live in an age where a terrible pandemic happened and a vaccine got developed seven months later. I pinch myself every day

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S1: like today on the show. Some physicians seem unconcerned about this new variant of the coronavirus. We’re going to try to figure out why. I’m Mary Harris. You’re listening to what next? Stick around. Throughout the pandemic, Dr. Monica Gandhi has been one of many doctors and scientists interpreting data using the megaphone of Twitter. But if you look at Dr. Gandy’s feed, you’ll see her being a bit of a contrarian. Early on, she was saying it was a good idea for everyone to mask up even before mask mandates became commonplace. And this year, before the CDC updated its guidelines, she was already saying you could probably ditch a mask outside. Now she’s urging calm about the Delta variant. Monica says she likes being straightforward. She doesn’t feel the need to scare people into compliance with health guidelines like some other scientists. It’s a lesson she learned from her work as an HIV doctor that scaring people, it can backfire.

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S4: Yes, I mean, at the very beginning of the HIV epidemic, everything seemed scary. Any possible risk of getting HIV seemed scary. So it was why the words stay away from each other and don’t have sex was used instead of, hey, actually oral sex is really safe and let’s do that or let me show you how to stay safe with other types of sex. And and those lessons were learned later. So actually, the way that people are talking now, scientists are talking now, was how scientists were talking the beginning of the HIV epidemic. It took some time and everyone was scared and screaming, just like we are now at the beginning of the HIV epidemic. And it led to distrust because the public knew because just from experience that this type of sex was more risky to get HIV than this type of sex. They just knew it. They saw what was happening. And that led to distrust of public health officials and politicians who said everything was scary and who used doom and gloom to message. And actually, it led to a paradoxical rise in infections. And what harm reduction means is you’re trying to decrease infections by taking into account the totality of everyone’s experience, what they need out of their life. Intimacy needs being around people. In the case of Covid wanting to see other people and not being socially isolated, you take the totality of experience and you try to decrease infections that way.

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S1: Did you say it led to a rise in infections because people just sort of threw all the advice out the window?

S4: Yes, because people distrust people distrust. If you blink it when it’s quite obvious that not every exposure was as risky as other exposures. And then people distrust the public health official and then that can lead to covid activity that leads to an increase in infections. Good examples. Christmas holidays in the winter in the United States where there was so much with covid just saying that the only way is to stay at home, lock your door, do not go outside that step that led to distrust. And then people went inside and there were rises of infection,

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S1: that kind of alarmist tone. It was present back in March during a press conference from CDC director Rochelle Walensky.

S2: I’m going to pause here. I’m going to lose the script and I’m going to reflect on the recurring feeling I have of impending doom. We have so much to look forward to, so much promise and potential of where we are and so much reason for hope. But right now, I’m scared.

S1: She’s clearly worried. Of course, we did not see the surge that she feared. I wonder if you as a doctor have seen patients talk about moments like that and sort of use them as ammunition for. Well, I just can’t trust anything.

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S4: Yes. I mean, I think that’s kind of messaging is to go back to let’s scare people so they’ll stay with the restrictions. Where it leads to distrust is someone said to me, my doctor said that to me and I had cancer and they said, there’s nothing you can do about it. It’s just all doom. I’m so scared I would throw that doctor out the window. That’s what my patient said, because what that my patient was trying to say is inspire confidence, inspire faith in the science. Everything changed. Once we got vaccines, we’re going to have bumps and ups and downs. And we’ve had a few ups and downs. But actually steadily since we started rolling out vaccines, it’s been pretty smooth and I’m so grateful for that. And so, yeah, it is a public health messenger. As a scientist, I would have message the effectiveness of the vaccines. It’s actually why on May 13th when Dr. Wineskin, Dr. Fauci and everyone talked about taking off your mask when you’re vaccinated, it seemed completely out of the blue because there hadn’t been a consistent messaging up to that point that the vaccines are really effective and that the vaccines will work against the variance. And so that wouldn’t have seemed out of the blue and so startling to people if there had been a steady, calm messaging of optimism the entire time.

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S1: You seem really confident in the fact that you’re just not worried about these variants, but. I want to push back on that a little bit because I talked to plenty of researchers and reporters back in the winter who were really concerned and their concern was not necessarily about the individual variance, but the buildup of variance and the fact that the more the virus mutates, the less effective a vaccine might be. So why don’t you have that

S4: fear because of immunology. So very early on in January, there was a paper from the UK that showed that as B one one seven or alpha variant was rising in the UK, anyone who had had the infection before couldn’t get B one one seven and they did a deep dive on T cells. It was a pre-print that showed that T cells go across the entire spike protein so that you can’t evade T cell immunity from the variants. And then I knew something else from HIV, which is that a virus can keep on mutating forever because HIV, the virus mutates a lot to evade our antiretroviral medications and it becomes less fit by mutating. There’s actually a fitness cost. It it it compromises itself to mutate, to become more transmissible. So I knew it couldn’t become more transmissible, more virulent and evade the vaccines at the same time. There’s one other thing I want to add, not just t cells, but there’s something called memory B cells that when you get infected or you get a vaccine, you produce memory B cells and they go into these hidden places like the lymph nodes and bone marrow. And we’ve seen them. And there was a paper just last week that showed us that these memory B cells that they see a variant in the future, they’ll make the perfect antibody for that variant. They’re not going to make it old antibody for an old type of strain. They saw they adapt their antibodies to that variant.

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S1: And this is because it’s familiar with the entire spike protein and so little changes on the spike protein. They can just sort of like, OK, we’ll adapt to that. But it’s formed a response to the whole thing. And so that means it’s like a gestalt. They’re looking at the whole thing.

S4: Yes, exactly. The memory B cells are sitting in your bone marrow ready to fight if they see that virus again. And this paper just from last week showed us that if you see a variant that was memory B, cells are going to make antibodies that are perfectly adapted for that variant, perfectly adapted because that’s a memory B cells. Do they they they come out with antibodies to fight the virus that they see, not the virus that they remember.

S1: Here’s what I think is interesting about the reporting about the Delta variant, which is I’ll see headlines that say things like the Delta variant could create two Americas or Anthony Fauci is declaring the Delta variant the greatest threat to the nation’s efforts to eliminate Covid. But then when you read the reporting in full, the story is a little bit more nuanced and it really focuses on vaccination. It basically shows that the Delta variant is spreading and potentially causing surges in under vaccinated areas of the country. And I find like that’s an editorial choice to say the variant is the problem versus the lack of adequate vaccination. I wonder what you think about that.

S4: Yes, I think what you just said is a brilliant way to explain it, is that I think why they’re using more scary terminology as they’re trying to motivate vaccination. But actually vaccination still going well. There’s still vaccinations happening. So the concern is places where we have distrust of vaccinations. And I keep on thinking what’s a better way to increase trust? And I would be more trustful if I saw a headline that said something less scary. But that like, look, let me tell you about this effectiveness that is going to work against the Delta variant. Actually, it’s going to work really well. And and let me explain to you why I think you should get vaccinated and let me make it easy for you. So you’re right. It’s a good point. And I’d actually that is reporting maybe that is it. Scientists, maybe that’s just how it’s reported. And then that would have to go back to you all in the media. And what’s going on on that end?

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S1: Do you feel a little bit like I know you’re pushing back against the fear based messaging, but the way I see it is you kind of need both at different times, like to get people to take the virus seriously. In the beginning, we needed that phone call where Nancy Messenger from the CDC said, I talked to my family today about how our lives are going to change because you know what? That gets your attention. And you think, oh, that person speaking in terms I’m not used to hearing them speaking, but then as we go, we need to modify. And the question is really just how quickly we move from one kind of messaging to another.

S4: Yeah, I think that’s really fair. And, you know, maybe injecting more fear in it than I have is appropriate at times. And maybe we need someone like me who is often very optimistic and then we need someone on the other end who’s very fearful. And then you put it together and that’s the right thing. And so I’m not going to say no, the best answer to that. But all I can say is that I can’t I will never get over that. We created a vaccine to this this fast. And I am all I want is for everyone in the world who need it to get this vaccine. And it makes me so happy that we don’t have to go through what we went through with the 1918 influenza pandemic, where 50 million people died, as opposed to four million right now and counting. And if we could get around the vaccine, we wouldn’t be in any situation where anyone not.

S1: When we come back, how Dr. Monica Gandhi convinces people who are hesitant to get the shot anyway. The main reason Dr. Monica Gandhi seems so unbothered by this new Delta variant is that the same vaccines we’re already using will prevent the spread of this new strain. But this week, the Biden administration announced it was going to fall short of its goal of having 70 percent of Americans fully immunized before July 4th. Right now, the biggest holdup is young people, 18 to 26 year olds. I understand that you’ve had some success in convincing hesitant people to get the vaccine. And what do you mean? Walk me through a couple of stories of conversations you’ve had with patients where they’ve said, listen, I just don’t think I need it or maybe I don’t want it. And you’ve sort of walked them through reasoning for why they might change their mind.

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S4: I mean, I I have a lot of one on one conversations with patients, and because I’m a long term primary care doctor as an HIV doctor, so I’ve known them a long time and there have been seven people who said absolutely not. And then we talked it through and six out of those seven took the vaccine after we had a probably 30 minute to forty five minute conversation. And the kind of things that we talked about were why did it come out so fast? And I talked about the fact there were 20, 20 and and it had halted life. And we have the technology and and all of this money was thrown on it and thrown at it and the problem was solved. And they really are safe. And I talked about the safety and what I’ve been seeing with the safety and I talked about how the world is turned around in places. We may not admit it, but the world is normalizing in places that have the vaccine. And it is going terribly in places that don’t have a vaccine like India with this last wave, and that this is a very severe illness. And I know they don’t feel much at risk, but even any of this virus around, we don’t want it. And then we go through distrust, we go through distrust of public health messaging. And they said, you know, people told me that everyone’s going to be in the hospital and they’re not after March. And I said, all right, that was that was weird. And I think everyone’s kind of using an approach to scare people. And I agree with you. Let’s not use scare. Let’s use OK to motivate these vaccines. And I have gotten six people to say, OK, I trust you. I get it. See, you went through it. I’m going to take it. And then one person finally said, stop, I’m not going to do it, stop talking. And I said, absolutely. And I stopped. Because it wasn’t my place to keep on pushing,

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S1: was that hard, like, was it a confrontation where the person was like, please, no

S4: gas? No, she was angry, actually, because I was with the medical the medical student was watching me. They were in training and she was I was pushing too much. And she she yelled as she should. She said, Dr. Gunby, stop, I’m not going to. And that is my limit. That is when you have to respect that person’s autonomy and understand that there are factors beyond what I can explain. And this is the other part of herd immunity is that when I think of the people who really just simply won’t take it, I want to work on the people who I can help. And if they say no and if someone has said no, then the answer is no. At a certain point the answer is no. And it was hard, but I have to accept it.

S1: Do you think that’s part of the challenge here for doctors, like accepting that there’s a moment where they have to accept no as an answer?

S4: You know, I think it is hard for doctors and scientists and public health messengers to accept. No, and I think that’s why all these machinations are happening about the Delta variant or about that. I feel a lot of fear or doom. I think that’s what’s going on. It’s kind of a desperate attempt in a way to be coercive. And I, I it I don’t think we need to be coercive. I think we need to be cheery. I know that just sounds really weird for me to see that, but I think I wrote this piece in February so early on where it said message that vaccine optimism to decrease vaccine hesitancy. And my entire point, even in February before like even the alpha variant was was the thing was use optimism as opposed to doom and gloom to decrease vaccine hesitancy, because why would I want to take a vaccine? If you’re telling me that the vaccine may be less effective or I mean, you just said it may be less effective. That makes me wonder why. What’s the point? Why should I take a vaccine instead vexed its messaging optimism. And I think what’s going on right now and what I’m seeing in the public messaging is we can’t we can’t believe how these vaccines are and we can’t seem to want to use optimism.

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S1: Well, it’s a fine line between saying you’re talking about being coercive. And I just think there’s a little bit of an element of it with scientists. It’s like these are great vaccines, don’t be dumb. And people hear that. They hear you calling them dumb in your head and they respond.

S4: Yeah. No, I mean, I it’s a very interesting, unprecedented time in human history. How do you message this? How do you tell the young why they should take it, which they, by the way, should? Because the sooner we get this out of our system, the sooner we get this in the lowest levels ever in our country. Even eleven thousand cases we don’t want. Ten thousand would be better. Less than ten thousand even better. How do you say that in a way to motivate people? I think I think it’s just giving out the data.

S1: Hmm. We might have listeners who are trying to figure out what to do with themselves in the world with this variant out there. Like, should I send my kid to camp this summer? Should I go on a trip, especially to a place where maybe there’s not as much vaccination as there is where they live? What would you say to folks about how they need to be thinking through their summer, given the emergence of the Delta variant?

S4: I would say that if they’re vaccinated, they and their children are unvaccinated because they can’t yet get the vaccine. Children are not more susceptible to the Delta variant, three fold, less likely to get any infection with any variant, with any ancestral strain. And they’re half as likely to spread it and they can mask on the plane as they should. And and you yourself are completely protected against the Delta variant. And you should go and enjoy your summer. And you really it’s been a hard time and people should have their summer delta variant, Doltish Mary and I will.

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S1: Is that your official advice?

S4: That is my official term and I will use this. Why I will keep on posting why I mean this and I’ll put it like

S1: you are such an optimist. Have you always been an optimist?

S4: No. My husband died of cancer in November of twenty nineteen. I’m not an optimist. And that’s the other thing that I really want to explain is that I’m not I’m not inherently Malkmus. Terrible things that happened to me. I have two young children and a widow. It’s not about that. I really mean it. Like I’m right on this.

S1: I’m really glad you said that because I would have assumed that this was like a personality failure.

S4: But no. Yeah, I’m not this person. No, I’m not. I just know vaccines and I know immunology.

S1: Dr. Gandhi, thank you so much for joining me.

S4: Thank you very much.

S1: Dr. Monica Gandhi is a professor of infectious disease and HIV at University of California, San Francisco. And that is our show, What Next is produced by David Land, Danielle, Hewitt, Mary Wilson Carmel Delshad and Elena Schwartz were led by Allison Benedict and Alicia Montgomery. And I’m Mary Harris. If you’re still looking for ways to convince a friend or a loved one to get vaccinated, go check out Slocomb. Our friend Will Saletan wrote a great piece called Maybe We’re Asking Vaccine Skeptics the Wrong Question. Oh, and stay tuned to this feed tomorrow. Lizzie O’Leary is going to be here with our Friday show. What next? TBD. She’ll take you inside the El Salvador Beach town that’s decided to embrace Bitcoin. Now the rest of the country is getting in on it. OK, I’ll catch you back in his feed on Monday.