Dr. Topol on the Second Anniversary of the COVID-19 Pandemic

[MUSIC PLAYING] Welcome, everyone. I'm Dr. John Whyte, the chief medical officer at WebMD. And you're watching Coronavirus in Context. We're two years into this pandemic, done over 340 interviews on this topic, and we're still going at it.

So to help provide some guidance as to have we learned anything over the past two years and where we're going in terms of ending the pandemic, I've asked my good friend and frequent guest Dr. Eric Topol to join me today. Dr. Topol, it's always good to see you.

Same here, John. A real pleasure.

Let's start with the obvious. We're two years in, two years, two different administrations. Did you ever think when we were talking 18 more ago, 20 months ago, 24 months ago, that we'd be talking about the same things now, testing, vaccination? What have we learned?

Well, we have learned a lot. But unfortunately, the thing that's holding us back, really a combination is human behavior, the reluctance to get vaccinated and boosted, and not just, of course, in adults, but their children. And then the other thing, of course, is the vaccine only strategy that the administration unfortunately in this second year of the pandemic pretty much stuck with, rather than a much more comprehensive approach, which meant billions of rapid tests and PCR testing widely available for free with medical quality masks and all the other things that we could do, like having the anti-COVID pills, having ordered them last summer, so they'd be abundant for everyone now if you needed it.

So many things we could have done. But the mentality unfortunately has been the vaccines are going to do it and not to worry about these other things. And of course, they haven't, especially as we went on in time, waning Delta and now Omicron.

Are you surprised where we are two years in?

Absolutely. I thought this pandemic would have been over by last summer. And had we had our vaccination levels to the highest 90%, had we done all the things we could have done, we'd have it contained still now. There'd be many cases, perhaps, of Omicron, but you wouldn't see the hospitalizations, the ICU, the deaths, the medical resource staffing stressed to the max as we're getting to-- and we haven't even gotten to the highest level here in January 2022.

So much of this was preventable. And we haven't pulled out all the stops unfortunately.

I was looking down because I wanted to find one of your tweets. As I always talk about, we should all follow your Twitter handle. And this was from November 28, 2020. Not 2021. And you pinned it. And you said, "This will go down in history as one of science and medical research's greatest achievements, perhaps the most impressive," talking about the vaccine.

Does it feel like it's been our greatest achievement?

Well, I still think that's true, John. I mean, I think we've blown it here with only 62% vaccinated. And every day, the effective vaccination rate is actually getting lower because our booster rate is only 21%, whereas other countries are well over 50% of their population boosted.

So if we use the vaccines that are so remarkable, we would have this thing under wraps. But we're not using them here in the United States, the country of origin for both Pfizer and Moderna ironically. And we have an abundant supply. That's not the issue.

So the resistance to the vaccines has really held us back. But one thing that's-- it's short of a miracle, but it's astounding. If you look at Omicron, which is a reboot of this virus, right? I mean, it doesn't even look like the original ancestral Wuhan strain.

If you look at that with the 50 plus mutations all over the place, especially in the key business part of the virus, the receptor binding domain, you say how could vaccines still work that were directed against the ancestral strain? And what is amazing is that they work in 90% of people boosted.

So three doses of the same darn vaccine that was 95% effective in November, right, in 2020 is still getting over 90% against hospitalization here in 2022. So I still maintain this is one of the greatest medical triumphs. But we just have blown it in terms of getting everybody vaccinated.

You've been a proponent in the past of reformulating the vaccine, not just using the same exact formulation in every booster. Should we have done that?

Well, as it turns out, it probably wouldn't have made any difference even through Omicron. It might have helped with respect to the transmission, but it wouldn't have helped much more. You can't get beyond 94% in people aged 65 and older.

That's a tough call to get beyond that. So I do think the pan coronavirus vaccine, which is an essential step-- and we have one now in clinical trials from Walter Reed, but we have so many more that could go forward that are not because we don't have a priority to nail this family of viruses for good with a shot that would take them all down, including all the future variants.

So that's where I think there's been a lapse. And that's part of that vaccine only strategy. It's the vaccine we have right now, rather than the vaccine of the future. We also haven't pushed hard on oral and nasal vaccines, which would block transmission. And that would make a big difference. And it's doable, but it just hasn't been a priority.

What is going to guide us in the future that we've learned? Will we have stronger public health surveillance systems? Have we learned we need to do more genetic sequencing, more surveillance? Will that prepare us better? What did we learn that's going to prepare us for the next pandemic? Because let's be realistic, there's going to be another pandemic at some point. Will we be better prepared?

Well, the looks of it right now, no. The reason I say that is we can't even get booster data in this country, no less for hospitalization, no less any other meaningful data across the nation.

Why is that so difficult? I mean, we're not even getting the right data in terms of hospitalizations for COVID. Shouldn't we be separating out those people that came into the hospital for other conditions? And everyone gets a COVID test, so they count as a COVID case, but their hospitalization really is unrelated.

And then there's people who came in because they're unvaccinated or they have congestive heart failure, which pushed them over. Isn't that useful information, too? I mean, why can't we accurately get that data?

We have 140,000 people hospitalized with or for COVID right now, and we should have that data for every single one of them, whether they're vaccinated, whether they're boosted, what were the reasons for the hospitalizations.

Because it matters, doesn't it?

Yes. Absolutely. And the problem is with Omicron, it's so much more transmissible that there are some people who are having true incidental. But there are a lot of people-- like one that was just admitted here this morning, who had COPD, exacerbation, and comes in breathless and COVID positive. Well, what do you think? Do you classify that as a COVID incidental? No.

But here's the issue. There's a lot of gray matter here. But the point is we need to know all the data, and we have no data. And the real question, which is if we had genomic surveillance, if we had wastewater surveillance, if we had the mobility, if we had all these layers of data, which we should, sure, we'd have preparedness.

What about people that are arguing now, you know, we're talking too much about total number of cases? That in the aggregate is not as helpful as what's happening in local communities, what's happening in terms of hospitalizations and deaths. Do you agree with that in terms of too much focus by the news media on, OK, 600,000 positive cases today?

The point is we do want to know about the cases. And the reason I say that is we face the prospects of long COVID with Omicron. We have no idea what's going to happen with that. And we only are now detecting a fraction of the Omicron infections, of course.

So to turn our backs on it, that's not right either. The other thing is you touched on it already, that what about the next variant? What about where are we headed here?

And the point about that is if we have millions of cases a day, what's the chances that we're going to basically cultivate a variant that's beyond Omicron? So these are things why we can't forget about each of these important data points. We could prioritize them, but we get no granularity on all the important outcomes.

What does the next year look like for us? And some people are taking a positive approach towards Omicron from the perspective of saying, hey, if we have a less lethal, more infectious variant take over from a more deadly variant, such as Delta, and a lot of people get it and develop now herd immunity or natural immunity, that could be the beginning of the end of the pandemic or make it more endemic. Do you agree with that? What do you think the year ahead looks like?

The first thing to say is that we will inevitably have a much better immunity wall from Omicron because so many people are getting infections. They're going to develop some immune response, not just antibodies, but also memory B and T cells.

So that's good and that actually cross reacts with all the prior variants. So maybe it will also take care of potentially future variants. That's a good thing. But what we don't know-- and this is why this inevitability thing is not acceptable to me-- is that what about the long COVID? What about when someone gets it that you know for sure you're going to have this non-severe mild case, or might you get so darn sick that you're at the brink of getting in the hospital and have to get monoclonal antibodies, which are in short supply that work against Omicron? Or these pills that are basically PAXLOVID that you can't even get a hold of right now.

So this is the problem is the unpredictable aspect of Omicron. And once we go through the current surge, which we will get to some point, it will come down, what about a second Omicron wave? We don't know.

So the best case scenario is the one you portrayed, which I love to be optimistic and hopeful, that we basically get through this, and we start to get into containment mode. But the unknowns are there could be more Omicron. There could be more of another Greek letter variant that hasn't yet been identified yet.

The lack of containment with millions of cases a day around the world and a lot of them coming from the US doesn't put us in good stead to say that we've reached the finale of the virus right now.

You know, let me put the caveat out that this has been the type of pandemic that occurs once a lifetime. How do you think the FDA has done in terms of managing this crisis?

Well, I think it did a really great job in the vaccine approval. They nailed it. That is, they did it as quickly as they could at getting the trials done. So that, I give a lot of credit.

They could have shortened that three week time from when the data was submitted to the first approval. But it's pretty good. Now, with respect to getting the pills approved, getting the vaccine and boosters, you know, they've done pretty well on keeping up with the data.

So the one disappointment I have in the current phase is the rapid tests. They've been very slow on that. And we need many more tests that are validated out there, inexpensive, ideally free.

And we're starting to see that later this month perhaps. But the number of tests that are going to be out there is still going to be scant.

Let's turn to the CDC and the importance of health communication. So for our listeners, FDA is a regulatory agency, has a lot of broad authorities. CDC functions a little differently, but really has the responsibility to communicate public health messaging.

And we all agree-- I know you and I have the same philosophy that it's a premier scientific agency. The folks there are extremely well-intentioned and hardworking. But I got to tell you, Dr. Topol, there are many people who have said over the past year that the messaging is just completely wrong. The science doesn't seem to always be there, or at least that's not how they're communicating.

And it's caused confusion, which can impact people's lives at this point. What's your assessment in terms of you've been communicating health information, you've been doing leading trialists, you know how to look through the data, how to communicate it, what's wrong over there?

The problem is not just the CDC. What we have is terrible infighting between the CDC and FDA and NIH and the White House. And they can't get unity of message. So whether it's about boosters, as we just discussed, or more recently about isolation and rapid testing need or previously about mass or the primacy of data.

We can't get a unified message. And the problem is that if you're going to lead us in a pandemic, you need one voice, one voice. And who's that going to be? And if it's going to be the CDC director, fine. But you can't have them fighting with each other, as we know has been happening.

And the latest one, Salvo, which was just over a week ago with this rapid test. So a week prior, they approve our recommendations for health care workers five days with a rapid test, go back to work.

They first said-- they originally said seven days.

Seven days. That's right seven days. Five days later, they say the public-- no, five days, and you don't need a rapid test.

And then there was if you want one and can find one. Like how is that science, though? That's not science driven.

No, the science was 0. And Dr. Fauci and Dr. Murthy are out there saying you should get a rapid test, and what are we doing here? So I don't put it all on the CDC because basically, they don't have a unified message.

Are we in a better place though somewhat, do you feel?

Somewhat, yeah. Oh yeah, but look, we have a CDC that, if anything, has moved to independent, whereas before it was subverted in the prior administration. So at least we have independent thinking.

But what we don't have is seen from the same hymn book. We don't have-- we're not on the same page. And when the leadership is mixed up and giving mixed messages, what do you think happens to the public?

They can't function as a university professor. I mean, they have a role in terms of the public health of the United States working within a department and working within an agency. What do you say to listeners, hey, Dr. Topol, what do I need to do over the next couple of months? What's your advice to them to stay safe and avoid getting COVID?

Yeah. Well, I think you want to hunker down as much as possible. When you go out, you definitely want to have either a KN95 or N95 mask, double mask. I mean, when I went out to the grocery store yesterday, I had a surgical mask, not to scare people, on top of my N95.

So you do that. You get a rapid test if you're going to be in a group setting. You make sure everyone who you are with in a group setting is triple vaccinated.

And you make sure your air quality, the windows are open, the doors are open, air filtration, HEPA filters, CO2 monitoring. You can do all this stuff if you pull out all the safeguards.

But short of that, you don't want to get Omicron, I mean, if you can avoid it.

When does this all become endemic that it's a level that we can live with? What's your best bet?

It could even be in the next couple of months if we don't see something in that bad scenario where either we get a repeat tour of Omicron through us, or we get the next Greek letter. But if we have this big immunity build up, our wall gets so much better, we might get to a level of containment, which is something we almost got to in May and June this past year.

By spring, by Easter, remember when we were all going to go to church for Easter? That's two years ago.

Remember July 4 was Independence Day from COVID.

[INAUDIBLE]

We almost were there.

2022 maybe.

If we had had 90% vaccinated, we would be in such great shape. But that's our biggest stumbling block in this country.

And trying to pin you down for some optimism. You hope by spring?

If we didn't have all the fighting against vaccines and boosters, but rather acceptance that this is how you help your fellow person--

But we're not going to move that needle much, Dr. Topol. We're not. I mean, we just have to be realistic where we are today, two years in. We're not going to convince people.

The Supreme Court is not going to help us here either, unfortunately. And who would want it mandated? Nobody thought we would want-- need mandates. But how do you have countries without mandates that have 90% of their population fully vaccinated and twice as many boosters percent as us?

And like Portugal as the model, but there are many others, they are-- like Omicron is a non-issue. Hospitalizations and deaths are flat, even though there's abundant number of new cases. So that's where we should be right now.

We can be. But we have a politicization of vaccines in this country and masks and science. And when we go down in history, the United States will look shameful because of this, unfortunately. And people won't understand someday, John. How did we screw it up this bad?

Are we going to be talking about this in January 2023.

I hope only with the realization that we got through it, that we prevailed. And even though we didn't do things optimally, that somehow we stumbled our way through it. I hope so.

I've had enough. You've had enough. Every one of people listening, watching WebMD has had enough. I know that.

We got to leave people with a positive note. So let's end on that.

OK, the positive note is we're lucky because our vaccines-- the original vaccine is holding out so incredibly well. Get boosted and you will not have to worry about being in the hospital. You have about 90%, 95% or so protection. You can't beat that.

So that's our biggest-- that's the message of hope today.

All right. Well, Dr. Topol, I want to thank you again for always taking the time. I encourage everyone to follow your Twitter feed for the latest information on what's happening with COVID. And thanks for all you're doing to communicate to the entire world, to researchers, to patients, to policymakers about what we should be doing and need to be doing to protect ourselves. So thank you.

If you have questions for Dr. Topol or myself, drop me a line. You can email me at [email protected]. Thanks for watching.