It’s cold and flu … and RSV, and COVID season. But vaccinations are down this year — and we haven’t made critical investments in things like air purification and ventilation that we could have and should have to protect ourselves from airborne diseases. Abdul reflects on the opportunities missed and the consequences of missing them. Then he sits down with Dr. Katelyn Jetelina, author of the Your Local Epidemiologist newsletter to talk about what folks can do to protect themselves.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: New data shows abortions have increased since the fall of Roe v Wade. Covid cases are steadily climbing as temperatures drop. Global measles deaths are up 43%. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] As I read this, my throat is sore. I’ve been dealing with the same virus for seems like months now. Sore throat, the sniffles, a cough that gets particularly bad at night. It’s a hazard of having two kids in daycare or elementary school. They’re like walking [?] for disease. They spend all day up on the other walking [?] they go to school with only to come home and sneeze in my face. They bounce back within a few days, but me? No, I’m lucky to get a reprieve at all before the next one. That’s the story for millions of households across the country right now. Because let’s face it, it’s cold and flu season. Try as you might, you’re probably going to come down with something. For healthier folks, the annoyance of a cough or sneezing, runny nose or a sore throat is bad enough. But for infants, seniors or people with immune deficiencies, it can mean the difference between life and death. What makes that so frustrating, though, is that it doesn’t have to be. For all the [?] rising we do about the good old days. They just weren’t that good. People routinely died of diseases we’ve learned to control. We’ve had shots for Covid for almost four years now. We’ve had shots for the flu for more than a half a century. And as of this year, we’ve got shots for RSV for seniors. The people just aren’t taking them. Covid vaccine uptake is in the single digits. Flu vaccine coverage is lagging behind last years. People just aren’t getting their vaccines. [scoff sound] We literally just lived through a pandemic that took 1.1 million lives. People are well aware of how important vaccines are. But somehow the mis and disinformers, they’re winning. Make it make sense. Look, if I don’t say this again for the rest of this episode, get yourself vaccinated. But part of the problem is how hard it’s become to get your vaccines in the first place. Even if you want to take them. We should be putting these any and everywhere instead, particularly to get vaccines for kids. You’ve got to wait months. And all of this is the consequence of a set of policy choices our federal government made. Rather than making them readily available everywhere our government buys the profits of corporations that manufacture these vaccines, Even though you and I, the American taxpayer, paid for the R&D for them. This policy called quote, “commercialization” has been a complete and utter failure. But that’s not the only policy failure when it comes to protecting ourselves from preventable infectious diseases. The other is that we failed to take air quality seriously. Think about it. If the pandemic taught us anything. It’s that keeping our air pure should be the absolute number one priority when it comes to preventing infectious diseases. Lockdowns, masks, all the things we did in the first moments of the pandemic. They were about keeping people from breathing air into which someone else had breathed Covid just a few moments earlier. That simple. But there are more efficient ways to do that. Requiring air purification and ventilation standards in buildings where people congregate, whether workplaces or perhaps more importantly, schools and daycares. That should be the priority. Those kinds of standards are probably even more important than vaccination campaigns because they embody the best of what public health has to offer. They’re passive, altering the nature of the environment in which we operate. Protecting us from disease without requiring us to do a thing about it. In my home, we’re purified up, we’ve got air purifiers in every single bedroom and in the rooms where we congregate. It was an investment, sure, but one that I think is well worth it. The other benefit? Air purification and ventilation is way, way less controversial. Who doesn’t want to breathe clean air after all? But unfortunately, there just hasn’t been much effort to make that happen. You’d think that state and federal leaders would be clamoring to make these kinds of requirements. To provide funding for retrofit. Aside from pandemic era funds for schools, this hasn’t been a priority. So here we are facing another season of Covid, Flu, RSV and the annoying myriad of viruses that causes colds every year. To help me think more about what we can do to protect ourselves. I wanted to reach back out to a friend of the pod and a fellow epidemiologist. Dr. Katelyn Jetelina is a professor at the Texas Health Sciences Center and author of the Substack newsletter, Your Local Epidemiologist. She joined me to talk about why nearly four years in, our society still isn’t doing the basic things right and what all of us can do to protect our families. Here’s my conversation with Dr. Katelyn Jetelina. 

Dr. Abdul El-Sayed: Okay. Can you introduce yourself for the tape? 

Dr. Katelyn Jetelina: Yeah. Hi, everyone. My name is Dr. Katelyn Jetelina. I’m an epidemiologist and author of Your Local Epidemiologist. 

Dr. Abdul El-Sayed: I was going to say, uh Katelyn you’re our local epidemiologist. Okay like you’re [laughter] all of our local epidemiologist. Um. I uh I’m grateful to have a conversation with with my local epidemiologist uh as another local epidemiologist. And um, you know, we’re talking right now because we’re in this sort of weird moment in you know the pandemic/ uh infodemic/ um multi-demic of uh the winter. And you know I think I think for a lot of folks, the experience of Covid has given technical language to the thing that we have been experiencing for the winter for a very long time. Frankly, ever since um the early 1900s when the flu came roaring through. And then all of the you know other you name the diseases that that we tend to get because of human behavior when it gets cold outside and people like to come together and, um you know, the ones that we’re going to talk about specifically today are Covid, Flu, RSV, uh and then the common cold. But it is um you know it is something for us to be thinking about in the context of a uh Covid pandemic that that hasn’t really ended and um a set of dynamics that have been amplified and changed because of it. So I want to step start very local for you. How is your family faring in this moment of the holiday sniffles, sickness, you know, feel like crap? 

Dr. Katelyn Jetelina: Yeah. So I have two toddlers, a four year old and a three year old. And um hopefully you don’t hear them in the background because they are home right now with fevers. I mean, we had a lot of people get sick uh during Thanksgiving, unfortunately, um and we’ve been testing for Covid. It’s not Covid. So I’m thinking the flu or some other kind of crap that’s out there right now that’s circulating like you just highlighted. I don’t know who was patient zero, as an epidemiologist I want to uncover that. But, you know, I don’t think it one really matters. Um. My kids go to daycare. There’s a lot of stuff circulating at daycare. Cousins go to school. My husband was traveling for work. I mean, it could have been anywhere. 

Dr. Abdul El-Sayed: Yeah, I got to tell you. So in our family, my infant daughter was feverish and sick all last week. We think she got it from my older daughter, but it’s unclear because she goes to daycare. My daughter’s in kindergarten. Took me a month to get over some cold like uh post-viral um thing. And, you know, I think a lot of us are just sort of feeling uh that way this year. And then there are, you know, the more serious illnesses, the flus, the the Covids, the RSV’s. Sort of zooming out from, you know, our local epidemiology experience uh to a broader experience. What are the numbers telling us about this season writ large? 

Dr. Katelyn Jetelina: Yeah. So this was actually a really big question. As you know, we had among epidemiologists was like, how is this winter going to play out? Because we’ve not really seen I mean, last winter was the first time we had all three viruses back. It was a really weird year, so we were kind of waiting to see how things unfolded. Um. Right now today we are at above epidemic levels, which means that we are seeing a lot of viruses circulating that we typically see during flu um and fall and winter respiratory season. Um. And then all three of the big viruses, right, flu, RSV, Covid, they’re all increasing exponentially. RSV is really taking the cake right now, um but flu is quickly falling behind as well as Covid. Um. I think the biggest concern on a population level is what that means for our health care systems. Um. If all three of them are surging at the same time, can our health care systems take that? They didn’t really take it well last year, um and we’re not building capacity. Um. In fact, I would argue we have even more uh lower capacity because of burnout and people leaving the job. So I, I, I don’t know. [laugh] I was taught during the pandemic that I shouldn’t make predictions, but um we’ll see how things continue to weather uh in the next coming months. 

Dr. Abdul El-Sayed: Yeah. And and I think you’re really circling around the key point here, which is to say that we know we’re headed into a time of year that is notoriously bad for the spread of these illnesses. We know that there is the consequence that these illnesses have for our health care systems capacity to take, you know, all three hits at the same time. And then we know that these three diseases are deadly and they’re extremely serious. And the fourth thing we know is that there are things that we can do to protect ourselves. And unfortunately, when it comes to those things. We’re kind of not doing a great job of it. This has been an abysmally bad vaccine season. Why do you think that is? 

Dr. Katelyn Jetelina: Yeah, it is. It’s actually um really, really bad. Uh. There’s a couple of reasons. I mean, one, we’re seeing abysmal rates of uptake around Covid 19. Many reasons for that. People are just tired about hearing about it. Um. And then, two, there’s a lot of misinformation out there still. And then three, there’s a whole another layer of complexity with Covid vaccines this year because now they’re privatized. So access, cost, education, outreach, all of those have been um taken back. And I think we’re starting to see that in the numbers, particularly around vaccine disparities. Um flu vaccine is lower than normal. But I’m hoping that catches up soon. Um RSV vaccines for those over 60 is also just abysmally low. I think it was like 9% uptake among those over 60. And I think that is because of what we’re also seeing with Covid, that there’s just a newfound hesitancy around new vaccines um as well as just education and outreach. It’s public health 101  that um our funding is getting taken away. And so we’re going to continue to see that in uptake numbers. [music break]

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Dr. Abdul El-Sayed: I want to drill in on um a couple of these these points that you made and want to get to the notion that um they’re separate. But but they do interact with each other. But it is worth sort of thinking about how they operate independently for a moment. You know, when it comes to Covid, I think the operating hypothesis, many of us who do this work would have had would have been that after a deadly long pandemic moment, three years during which we really suffered and almost everybody knows somebody who passed that rather than walk away from this thing and pretending like it never happened, we would be thinking about how to protect ourselves moving forward. But that’s just actually quite the opposite. We have this like, impressive ability to want to shed the past and pretend like it actually didn’t happen to us. You’ve done some uh writing about this, this idea of pandemic revisionism. And I do think you know certainly the misinformation around Covid and the vaccines in particular have something to do with it, but it also tells us something pretty profound about human nature when it comes to risks that we face. Can you tell us why you think um there is this sort of willingness to almost ostrich about what we experienced over the last three years and this notion that somehow if you don’t acknowledge it, you don’t do the things around it, that somehow you can kind of get past it, even though, you know, the numbers are telling us that’s just decidedly not the case. 

Dr. Katelyn Jetelina: Yeah, I think that’s one of the most um sobering things, is, you know, after losing 1.1 million Americans to Covid 19, we’re kind of leaving it in the background. We have abysmal vaccine rates compared to, for example, the U.K., which is like 68% vaccinated at this point. I think that um I mean, I talked to a long time with a psychologist in San Francisco about this because I was so curious about the what we are seeing unfold in real time, this idea of revisionism. And there’s actually a lot of psychology that goes behind it. Um. Part of it is survival bias that, hey, we survived it actually, maybe because we survived it maybe isn’t as bad as I thought. And so we can kind of continue going forward. And that’s not the case um because we already lost a lot of people. Um. Our experiences and our biases very much craft our memory, and um we’ll continue to see that play out in a lot of different public health emergencies. We see that with mass shootings as well, that it didn’t impact me so it’s okay. We’ll just keep going forward. It’s um it’s really hard. You know, I think also there is this there is a study that came out a few weeks ago. You might have seen Abdul, but it was about um how those that were most stressed about the pandemic now remember the pandemic in worse terms than those that were not stressed during the pandemic and now they think it in better terms. And so it’s it’s very much not data in, data out. Our biases certainly craft how we remember and how we view things going forward. 

Dr. Abdul El-Sayed: Yeah. I mean, and you see it in the in the duality of the response. Obviously we count yeses or nos on things like vaccines, but oftentimes there is a almost extreme response to whether or not you believe that Covid is still a risk or it’s not. And there is a notion that because Covid is still about, the numbers are increasing, that we’re like, right back to the worst of the Omicron surge, which is which is not the case. Like decidedly not the case. And on the other side of it, like you said, there is this revisionism about whether or not Covid was ever real in the first place, like whether or not there was was actually a thing. Um. And it’s it’s impressive because the only way you can interpret that is that people are assessing their sense of what happened through the lens of their emotions about about how they felt about it while it happened. Right. And that’s what this this study is suggesting. But it also, you know, it also has real implications for behavior and our ability to to make common sense about an experience that we went through and then what we do about it moving forward. And that that really to me is the bigger risk, because it’s not just that individuals out there are choosing not to take their Covid vaccine. It’s that that the federal government uh responsible for ushering in those vaccines in the first place took a real gamble on whether or not for the sake of enabling the corporations that have profiteered off of that government investment. Whether or not it was worth fully commercializing them and uh interrupting the supply lines that we had spent years creating to make sure every single person could get them. And you know, in my day job I run a municipal health department and we’ve had to think about how do we vaccinate um incarcerated people, right? How do we uh advise the public about where to go? Because if you’re insured um in our county, you can’t come to our health department and get a Covid vaccine. You can get a flu shot. But you can’t get a Covid vaccine. Which just makes for some like really interrupted um messaging. Right. Uh. If you’re of this particular um uh insurance status, you can go here. And if not, you should go here. And at some point people are like, okay that just sounds real confusing and I you know, I maybe maybe I’ll think about this later. Um. And we all know that the more complicated you make a message, the lower the probability people are to follow it. And to me, I see this as a pretty serious abrogation of responsibility on the part of the federal government. You mentioned this um among the causes. How big of an issue is the disjunct uh Covid supply chain as a function of the commercialization of the vaccines? 

Dr. Katelyn Jetelina: Oh, it’s it’s terrible. I mean, it’s it’s terrible. It’s a it’s our pre-pandemic fragmented health care and public health system. Um. And that way is wide open during the pandemic. And we saw this through disparities. We saw this through access. And um I think a lot of it was ironed out um because of the one purchaser kind of model we created during the emergency. But we’re back to normal. Um. And actually, just this morning, right before this um recording, I was analyzing some data in California and on a hyper local level on whether disparities are widening because we are back in this privatized model and it looks like it is. Um. So that means that there’s a lot of people um hurting that there’s going to be these um disparities that are always going to be there until we make huge systemic changes. Um. And I hoped optimistically that an entire pandemic, more than one million people dead, would actually drive that change. And maybe it is slowly inching towards that, a change somewhere. But it’s just something um I’ve been disappointed to see. 

Dr. Abdul El-Sayed: Yeah, you and me both, and and you look at the the reason why, the only plausible reason why is so that the corporations that manufacture these vaccines, the research for which was paid for by the federal government can make more money by charging more. And the upshot of all this is that there are so few shots in arms that they’re just not making the same amount of money because because there’s just not that many people taking them. Um. And so, yes, the per unit cost is higher and their per unit profit in theory should be higher. But if you’re not getting shots in arms, you’re not selling your product. And I just think it demonstrates the way that our health care system shoots itself in the foot over this notion that a public good ought to be profitable in order to be publicly available. And it is such an indictment on, I think, everything we’ve learned and everything we are yet still learning uh because the lesson clearly hasn’t stuck. And then the last point here is just the misinformation ecosystem uh in which a lot of these decisions are being made. You know, on the one hand, obviously, the misinformers that went into hyperdrive during the pandemic have not stopped. They’ve somewhat moved on. Right. They like transmogrified the grift elsewhere, um but it has not stopped focusing on Covid. Um. I want to ask you, you know, what do you think as someone who spends a lot of your time communicating to the public about this, what do you think it’ll take um to insulate people’s minds from the impact of this persistent misinformation, or are we just doomed? Like at this point this is this is sort of baked in stone?

Dr. Katelyn Jetelina: No, I don’t think we’re doom and gloomed. Um. And I’ve actually been thinking about this a lot the past couple of months of what does this look like? Um. I think one is that, yeah, we can focus on misinformation and and sometimes there is a role in surveillance of misinformation, for example. It’s always going to be a game of whack a mole, though. And so I think as as well as surveilling and combating misinformation on the ground, you also need to build trust and do proactive communication, particularly from, again, trust and messengers, whether that’s your health department. The challenge though with public health is how do we increase capacity with very little funding um and where does something like this live? Maybe scientific communication, proactive communication isn’t doesn’t belong in the federal government because you’re going to lose half the people in the United States because they’re not going to trust that information. And so to me, the biggest question is how do we equip trust in messengers? How do we get them information as well as how do we listen to communities, how do we be responsive to the needs they’re faced with today rather than what we think that they’re interested in um and creating that bi directional relationship with communities. And so I think that all of this is gonna take a ridiculous amount of time. But I think it starts out with reimagining public health for the 21st century, that we can’t use our old 19th century public health tools in fighting this new information landscape. And we need to be a whole lot smarter with it and uh even leverage technology on um how to how to be better at it as well. 

Dr. Abdul El-Sayed: I really appreciate that. And I think part of that is also rethinking our messaging. You know, one of the things I got really frustrated about is because we tend to think empirically, because that’s the nature of public health training. We assume other people think empirically. And I think one of the numbers that we tend to lead with is that death number. And given what we talked about earlier about that survival bias, I think people almost come away, they’ll never say this, but they come away with this almost sense of invincibility that like, I’m not going to die of one of these diseases. That’s nuts. And look, I already lived through a pandemic for three years. Like, this this flu is not going to get me. And I think we lead with the wrong statistic because most people don’t have an experience well everyone by definition who’s alive has no experience of dying. Right. And most people don’t have a clear experience of having had a infectious disease that almost killed them or a loved one. Right. It’s not something that they saw uh in their faces. And I think the thing that we probably should lead with is it’s more like, hey, you probably just don’t want to get the sniffles. Like, you know, you don’t want to have a fever for three days. You don’t really– 

Dr. Katelyn Jetelina: It’s a disruption. 

Dr. Abdul El-Sayed: –want to be. Yeah, you don’t want to–

Dr. Katelyn Jetelina: Yeah. 

Dr. Abdul El-Sayed: –miss days of work or your kid’s missing days of school. This is a way to fix that. And I I think sometimes we think like, all right, lead with the most extreme, and then you’re going to get people to pay attention. And the problem with that is that the extreme sounds so extreme and people don’t have an emotional analog for it that they dismiss it out of hand. And I think we ought to be better about having just just simple conversations about experiences that people have had, for sure. Everybody who’s alive has had this experience of having a fever or a really bad cough or whatever. Right. And leading with that, um you talk about this idea of of passive positives, which I really like, which is it kind of highlights the gap between the number of people who would get vaccinated if there was a little nudge um from a health care provider or, you know, public health messaging, but but end up not getting it because we’re so focused on these like big, you know, the clash of of misinformation and truth. Right. Um. I want to ask you, like as you think about what actually is going to encourage people to get a flu shot um to like really do this basic thing of getting a Covid shot. If you’re over 60, getting a RSV shot, what is what is the right interaction, whether it’s with a health care provider, um as many of our listeners are, or um with a loved one. Right. Who uh, you know, who just cares about somebody in their life. What does that interaction look like and how can we in our own communication take advantage of this idea of passive positives? 

Dr. Katelyn Jetelina: Yeah. So passive positives is another lesson I learned from a fellow psychologist. Um. You know, I don’t think we leveraged uh behavioral science as much as we could during the pandemic, like we leveraged lab science. Um. But yeah, so passive positives I estimate is like 35% of the population. So it’s a big chunk of people, big chunk of Americans. 

Dr. Abdul El-Sayed: And just uh–

Dr. Katelyn Jetelina: Who are–

Dr. Abdul El-Sayed: Katelyn, if you can if you can just define that term, just so folks know exactly what you’re talking about. 

Dr. Katelyn Jetelina: Yeah, yeah. These are people that are um generally positive around vaccination, right? They got the first one, two, three, four Covid 19 vaccines but um have didn’t get their fall vaccine last year. Haven’t gotten their fall vaccine this year. Um. And the reason because of that is maybe they’re just want to tune out Covid all together. They’re just tired or they don’t know they’re eligible or it’s really hard for them to get the vaccine. Um. And so to me, I think public health needs to be and the health care providers need to be laser focused on passive positives. These are the low hanging fruit to get vaccinated. Um. And so, I mean, bottom line, we just need to make it as easy as frickin possible for them to get their vaccine. I went and got my um Covid and flu vaccine at Costco um a few weeks ago, and uh while I had to make an appointment, I showed up, um waited five minutes, got both vaccines. Great, I continued shopping. But when I was waiting, you know, in that five minutes after you get your vaccine just to make sure you’re good, there were I counted eight older adults probably over the age of 80 that came by the booth and was like, hey, I would like to get my Covid shot. And they were told they have to wait an hour and a half. And they just kept walking and it killed me. 

Dr. Abdul El-Sayed: That’s awful. 

Dr. Katelyn Jetelina: It killed me. And so and I don’t you know, that’s not the I don’t know it. I don’t think it’s the fault of the Costco employee. In fact, the Costco employee was doing amazing answering their questions. I was so proud of her on her answers. It’s it’s just that that how how do how what are the processes and we can make that better for them. Um. And so a lot about what passive positives is, is once they decide right then that they want a vaccine, they’re able to get the vaccine right then. Um. And so what that means, talking to your grandma about a vaccine, you drive them to CVS to go get it. Um. Or if you’re a health care provider, you have the vaccines available right there um for your patients. Uh. At the same time, I mean, my kids, my girls don’t have their Covid 19 vaccine this fall. It’s seven– the closest one to me is 75 miles away. I mean, it’s just. 

Dr. Abdul El-Sayed: Wow. 

Dr. Katelyn Jetelina: Access is abysmal and we can’t expect people, especially passive positives to get it if it’s that challenging to get. [music break]

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Dr. Abdul El-Sayed: What you’re speaking to is is ultimately a lack of investment. Right. It’s you know, it’s not necessarily Costco’s um fault as much as it is. We have not invested in getting these vaccines at the point of contact and incentivizing shots in arms in the way that we ought to, in the way that we know uh can save a lot of lives and prevent a lot of illness. And that that problem. Right. Is that we’ve like hook, line and sinker bought this idea that it’s like a commercial product like any other. Right. If you, you know, go by the store and decide that you want to buy that bag, like, okay, buy that bag. But if you don’t buy the bag, all good. Right? That’s just not how vaccines work. Like there is a incentive to get them in arms uh and we don’t do a very good job um promoting them and making it easy uh to take down the transaction cost. That um unfortunately, has been such a barrier. And you know, to the to the earlier point, we’ve made that transaction cost far worse. Right. And, you know, you obviously very, very few people could be more pro-vaccine than you or I, but I’m in the same boat. It’s like really hard to like we had to make a whole appointment for both of our kids to get their shots. And those appointments are like in a month. And I’m like, y’all like we’re missing the boat here. Like, you should be reaching out to us and saying, hey, have you scheduled your uh your vaccination appointment? Um. Rather than us reaching out, realizing that we’re not gonna able to get an appointment uh for a certain period of time and then um, you know, and then waiting. And so like we’ve like same situation. We’ve looked and looked and looked in particular for our infant. Um. It is very, very difficult to find a place to go. And so at this point, we’re like, okay, well I guess we have an appointment scheduled and like you and I are both people who do this for a living. Um. 

Dr. Katelyn Jetelina: Yeah. 

Dr. Abdul El-Sayed: And it, it ends up being like I, you know it, so it should not be this difficult. And I I highly doubt that um, you know, the average person has the time, uh energy or, or knowledge of the system to be able to game it the way that unfortunately you know, folks who really are motivated have had to. 

Dr. Katelyn Jetelina: They don’t they don’t. And we see that in the numbers. Right. And I think that, you know, I had this fascinating conversation with this epidemiologist in the U.K. um the other week um because she was wondering if the government provides reimbursement to pharmacies like CVS or Walgreens who administer the vaccine. Um. And I told her, you know, this is a it’s a very complicated question, actually, but typically no. That they’re paid through health insurance. And she was like, okay, so then a vax say a vaccine is recommended, do people with private health insurance then get invited by their doctor or pharmacy to go get that vaccine? And I was like, no, you have to go proactively find it. Um. And she was like, well, doesn’t that mean a lot of people don’t do it then? I’m like, yeah. I mean, this is the whole problem compared to national health systems like in the UK, it’s it’s really frustrating to watch. 

Dr. Abdul El-Sayed: Yeah. Um. And in that system, right, the whole of government is incentivized to get you vaccinated because that’s fewer people who are going to be in the hospitals. Unfortunately, in our system, like just to be clear, and this is I’m not saying that there’s a there’s any sort of effort um to do this, but in our system, the moments that money is made is when people consume health care. There’s a lot more money to be made when people get sick than there is on offering a vaccine. And, you know, when you just incentivize based on uh on medical care provided, you end up getting these really, really perverse emergent outcomes. Right. Where there’s just not that much effort put being put into getting shots in arms because there’s just not that much money to be made. And um and it really should force us to step back and ask like, how come we don’t do these very basic things well, and a lot of that ends up coming back to like how money moves in our system or doesn’t move. Um. I want to ask us, right, because one of the most important things that we could be doing that we’re really just failing at is addressing one of the central features of our lived space that we just take for granted, which is you’re inside right now. I’m inside right now. Both of us are breathing air. Uh. And that air um is a big reason why when someone has Covid, uh other people around them get Covid and we don’t do as much um to purify that air, particularly in crowded spaces, think schools or shopping malls uh or workplaces as as we should. And that’s a matter of public policy. There are choices that we could make about how we certify indoor spaces, about what kind of HVAC we require and what kind of purification we require in these spaces, that there hasn’t really been much movement on. How do you think about um indoor air purification and what’s needed now um so that we’re ready for the next time we end up having a very, very serious uh aerosolized uh virus that’s causing um hundreds of thousands of people to die. 

Dr. Katelyn Jetelina: Yeah. You know, um air filtration and ventilation is one of the most powerful public health tools we have uh because it works in the background. People, the individual doesn’t necessarily need to do anything. Um. It’s working in invisibly. Um. What it does require is kind of what you’re going getting at is institutional level action. And that institutional level action is just something we haven’t seen yet. Um. And for example, um schools were given funding to upgrade their air and ventilation systems, and only 50, 5-0 % of schools actually did it. Um. The money is still there. It’s still available for schools to use. It’s just not being done. Um. And, you know, I don’t know I don’t know why that is. But I do know that uh this doesn’t just need to happen because of pandemics. I mean, it happ– that would help with flu. It would help with other coronaviruses. It would help with RSV. It would help with uh climate related things that we’re seeing. For example, um uh the smoke uh that we saw in the Northeast last summer. Um. Upgrading AC would also help keep kids in schools. Um. For example, in DC when all the schools were closed because of the heat wave. Uh. And so I think that there’s and then there’s just these, what is it? Chronic healthy building syndrome. Chronic building syndrome, where you just feel like crap too, sometimes when you’re just breathing the same stuff. And we can actually be a whole lot more productive if we start cleaning our air. So I don’t know. I think that the pandemic did uh renew a sense of conversation around this. I will say this is the most I’ve ever really kind of seen it been talked about I there I know though that there’s a lot more that needs to be done um pretty quickly, I think. Uh. So we can be living our healthiest life. 

Dr. Abdul El-Sayed: Yeah, I really appreciate your point. I mean, this is this is the thing about it is that public health is best when we’re invested in institutional structural level change rather than individual level change. I think one of the unfortunate consequences of the pandemic is that it was the first time a lot of folks were introduced to public health and they were introduced to us in the most individualized way. We’re the folks telling you that you should get your vaccine or you should wear your mask. And that’s just unfortunately not what public health is at its best. It’s I think it’s what we’ve allowed public health to become, because in so many ways we’ve sterilized ourselves from taking on power. But it is not where we operate um most effectively. And I think in that respect, there’s a lot of opportunity I think we have to engage with um partners in in different industries, commercial real estate um and then certainly legislative partners to try and up the ante on what should be expected when you step into a building. And the consequences are not just Covid, right? The consequences are any um respiratory illness. And then uh, you know, any um air quality related illness. And given what we’re seeing with climate change, as you talked about uh in the bad air days, that that that we’re increasingly experiencing, this ought to be something that um we’re making a full steam invested in. And, you know, a lot of economists who study this and we’ve had a couple on the show talk about this moment um not just being about climate change mitigation, but about adaptation. And that means how are we changing the way we live vis a vis the reality of climate change uh is going to bear down upon us. As we um step out, right. A lot of the other things that that we can do to protect ourselves using uh testing, which is again, now freely available through the federal government uh and masking, uh you’re seeing a lot less use of these, um but they remain very effective. Um. I think part of that, of course, is is the conversation that we shared about you know our our instinct to run away from a bad experience that we’ve had and pretend like it never happened. But part of that also is that I think there’s there’s sort of um a peer pressure effect. Um. How are you thinking about this moment when it comes to masks, when you think when or when it comes to um testing around large indoor gatherings, etc.? 

Dr. Katelyn Jetelina: Yeah. I mean, mask that is one right one topic that just gets people’s blood boiling in the United States, which is, I think, unfortunate. It shows how much these became symbols of tribalism rather than tools of protection. And um yeah, I mean, it’s very we’re very social animals. And so it’s it’s peer pressure and social pressure is a very big thing. Um. I mean, I feel awkward, I’ll be honest, wearing a mask at the airport. Um. I don’t know if I necessarily care, but I do feel that. And so I guess I I’m not surprised that so many other people feel that. Uh. I will say, though, I just traveling over Thanksgiving, I was really happy to see many of those over 60 were wearing a mask and actually like a good mask an N95. So I think we did make progress there. We we wouldn’t have seen that pre-pandemic, um that’s for sure. Uh. And masks work. They mask, work on an individual level. I mean, that’s a physics question um that we cannot deny. Testing is interesting. And I even I have mixed feelings, at least now on asymptomatic testing um because it’s so there’s so many false negatives at the beginning of illnesses that given the cost for a family of four and doing cadence testing every other day, I mean it adds up. And so um but what tests are very good at is telling us, one, we’re not infectious anymore. So once you get that positive, when that positive turns negative, that’s a very good tool to say, hey, I’m not infectious anymore. I can go see great grandma at the nursing home, for example. So I don’t know. I mean, these are all tools. You and I have been talking about these tools nonstop for the past three and a half years. I think that um one, again, is access. And how do people access these tools um given their high expense? Another one is Paxlovid becoming $1,400 now that it’s privatized. I mean, it’s just we’re shooting ourselves in the foot. And it’s it’s hard to watch, given all we’ve been through these past couple of years. 

Dr. Abdul El-Sayed: And this is the [laugh] like this is where the rubber really hits the road. A lot of my um public health colleagues like to talk about public health and medicine as being these like two separate things. And, you know, at the end of the day, money is fungible, as all the crypto bros like to say. Um. And the choice that we make in this country to spend 19 to 20% of our whole GDP, like every dollar spent in America on health care, implies that we’re squeezing out on the back end what we could spend in public health. And then when you think about so many of these public health implements being uh juxtaposed to the same mechanisms uh and market incentives as all the rest of health care, it starts to explain a lot of the choices that are made or not made. And, you know, whether or not a test, which is a market product when it’s not subsidized by the federal government is available to you um and you can use it to make good decisions about protecting yourself and the family, right, that that is a that becomes an economic question pretty quick. Um. And uh and certainly when you like when you get sick and need the treatment to to to um to heal and it’s 1400 bucks. Right. And you may or may not know where to get it like that that is a real challenge. So um these things collide whether we want to pretend like they’re the same or they’re not the same. And in some respects, like, we’re all going to have to deal with the fact that the fundamental goal of the public health system is to keep people out of the health care system. And when you have a health care system that makes money when people go into it, there you set up a a really challenging macroeconomic incentive set. And um and we got to deal with with both sides of it. And, you know, we really appreciate you being on the right side of it. Doctor Jetelina, we appreciate reading your work and um we’re grateful for you joining us. Our guest today uh was Doctor Katelyn Jetelina. She is an epidemiologist and professor at the University of Texas Health Science Center. Uh. And she is the author of the fantastic substack, Your Local Epidemiologist. I highly recommend it. Uh Katelyn, thank you so much for taking the time. 

Dr. Katelyn Jetelina: Yeah, thank you for having me. [music break]

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. When anti-abortion extremists engineered the final end of Roe v Wade, I doubt they expected this. Abortions have increased since the fall of Roe v Wade and the restrictions on abortion rights in 21 states across the country that followed. To be sure, in those states that have banned abortion after six weeks, there were 115,000 fewer abortions. That includes nearly 37,000 fewer in Texas, 20,000 fewer in Georgia and 13,000 fewer in Tennessee. But they were more than made up for in states where abortions remain legal. Illinois alone saw an additional 21,000 abortions. Why? Think about where Illinois sits. It borders Indiana, Missouri and Kentucky, all states that banned abortions. And that should explain, in part what’s going on. People are traveling across state lines to get abortions. And because the option isn’t readily available in their home states, they’re not taking chances. The other explanation is the increase in medication abortion. Already more than half of all legal abortions are medication abortions, a form of abortion that is far harder to regulate. But that doesn’t mean that anti-abortion extremists aren’t going to try. A Trump appointed district court judge in Texas tried to make Mifepristone, an extremely safe, effective abortion medication cleared by the FDA back in the 1990s, illegal. And even the Supreme Court stayed the ruling, sending it back to an appeals court that tried to keep it legal, but vastly limited its use by restricting how it could be prescribed and transported. Given the fact that the fall of Roe has already backfired, I wouldn’t be surprised if we saw yet more back handed effort to limit abortion access. We’ll be watching this space. Covid cases, test positivity, hospitalizations. They’re all up. And the impact of the Thanksgiving holiday, where a large proportion of the country gathered indoors with loved ones won’t really be clear until next week. All of this reminds us that as much as the pandemic phase may be behind us, Covid is not yet over. As we just discussed with Dr. Jetelina. And the limited number and availability of vaccines isn’t helping. In case you’re wondering, we did finally get our kids vaccinated. If you’re still waiting, it shouldn’t be this hard to get vaccinated, but please do make the effort. In other vaccination news, global measles deaths have skyrocketed, up 43% year on year in 2022. That’s driven by about 33 million missed vaccines in 2021 alone. And more than half of those are accounted for by just ten countries, including India, Pakistan, Ethiopia and Nigeria. Let me just say this. Measles should no longer be a death sentence for any child. It is a vaccine preventable disease that we’ve long had the capacity to stop, but we just don’t. And that’s for two reasons. First, the pandemic had a displacement effect that we’ve talked a lot about, whether it’s kids who weren’t vaccinated for measles in Nigeria or pregnant folks who weren’t screened for syphilis here in the US as we talked about a couple of weeks ago. During the pandemic, limited public health resources were rightly focused on stopping Covid, but that meant that other critical public health interventions were missed. But look, the point isn’t that we shouldn’t have tried to stop Covid. It’s that we should have invested more in public health to be able to do both. Friends, we can walk and chew gum at the same time. The second issue, though, is in part what Katelyn and I discussed today. The role that mis and disinformation has had in the aftermath of Covid, that mis and disinformation has shaken trust in vaccines and not just Covid vaccines, but all vaccines, even the ones for diseases we’ve been vaccinating against for decades now. That’s meant that millions of kids who otherwise would have been vaccinated are not. And now nearly 40,000 more kids died of a vaccine preventable disease in 2022 than the year prior. That’s it for today. On your way out, don’t forget to rate and review. It really does go a long way. Also, if you love the show and want to rep us, drop by the Crooked store for some American Dissected merch. Don’t forget to follow us at Crooked Media and me at @AbdulElSayed on Instagram, TikTok and Twitter. [music break] America Dissected is a product of Crooked media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illick-Frank. Charlotte Landes mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer and me. Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.