Abdul salutes the frontline healthcare providers. Then he talks to Jenny Gold, Senior Correspondent at Kaiser Health News, and Dr. Paloma Marin-Nevarez, Emergency Medicine Resident at UCSF Fresno about the challenges of being a new doctor in a pandemic.

Transcript

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Abdul El-Sayed: Before we jump into today’s episode, Crooked would like to remind listeners about a high-stakes issue hitting the Senate floor. Right now, Senate Democrats have the power to stop the wave of voter suppression laws sweeping the country by passing the For The People Act. But first, they have to come together and eliminate the filibuster. To do your part to end the filibuster, head over to votesaveamerica.com/forthepeople, and use our new whip count to find out where your senator stands. If they’re on the fence, give them a call using our call tool. Together, we can un-break the Senate and save our democracy. Check out votessaveamerica.com/forthepeople today.

Abdul El-Sayed: Cases continue to climb in a majority of states, with deaths increasing in 11 of them, and variants of concern, including B117, increasing as a proportion of overall cases. The FDA and CDC called for a pause on the Johnson & Johnson vaccine, citing six cases of a rare form of blood clot, out of nearly seven million vaccinations. Pfizer and Moderna a hint that recipients will likely need a third booster shot in 6 to 12 months. In good news: 50% of American adults have now received at least one COVID-19 shot. This is America Dissected. I’m your host: Dr. Abdul El-Sayed.

Abdul El-Sayed: I don’t have to tell you this, this pandemic sucks. It’s robbed 560,000 people of their lives and millions more of their livelihoods. It’s taking away the big joys that mark our lives, like weddings and holidays, concerts and vacations—and the small ones that mark our days like a good meal at a restaurant or the joy of walking in a crowded place. Throughout this season of America Dissected, we’ve brought you perspectives from across the country, from Black and brown communities hit hardest by this pandemic, to businesses forced to shut down and folks who’ve lost loved ones or continue to live with the long-term consequences of COVID-19. This is our second to last episode of season two. Don’t worry, though, America Dissected isn’t going anywhere. We’re just shifting frame. We’ll be zooming out from the pandemic, to talk about all of the other major health stories we’ve missed, while we’ve been laser focused on this one. And don’t worry, we’ll still be talking about this one. Next episode, our last, I’ll be sharing a few different vaccine experiences, as well as my own. But today, I thought it was worth going back to the folks who’ve been holding down the front line on this pandemic from the jump: the brave nurses and hospital employees and doctors who’ve been fighting to save lives and defeat this pandemic. Indeed, in 2020 alone, more than 2,900 health care providers passed away, according to Kaiser Health News. For millions of others, though, this has been the most harrowing year of their lives. One of my friends, an anesthesiologist, told me about how he made sure he had his will sorted, and moved his family into his parent’s house through the worst moments of the pandemic. His days were spent intubating dying patient after dying patient, only to watch many of them pass away. He’d go home to an empty house, stuck face timing his family, who were only a couple of miles away, for moral support. The worst days, thankfully, are behind us, but they’re going to stay with us. That’s particularly true for those for whom this was their first experience in health care. Every July, new doctors are inducted into the practice of medicine as interns. First year residents—bright eyed and bushy tailed—they’re thrown into the deep end, working 80 hours a week and often caring for the sickest patients in the bowels of the hospital. Residency encapsulates some of the worst ways our health care system is broken. Fresh medical school graduates with hundreds of thousands of dollars in debt are paid peanuts to do some of the hardest work in the hospital with no recourse. Indeed, physician burnout and mental illness are an epidemic, and it starts with residency. Nearly a third of residents have symptoms of depression. This indentured servitude is the path that every doctor has to take to practice medicine in America. Hospitals profiting handsomely off of resident labor. Residency is bad enough as it is, I can’t imagine starting it in the middle of the worst pandemic in over a century. Today, I wanted to talk to some voices that have gone through just that, faced this pandemic head on in their first year of practicing medicine. So I reached out to Dr. Paloma Marin-Nevarez. She started her emergency medicine internship at UCSF Fresno in July of 2020, in the middle of this pandemic. With her will be Jenny Gold, a senior correspondent at Kaiser Health News, who documented Dr. Marin-Nevarez’s experience, and that of several other residents. They join us to talk about their experience and the lasting consequences, after the break.

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Abdul El-Sayed: Our guests today are Jenny Gold, she is a senior correspondent at Kaiser Health News, and Dr. Paloma Marin-Nevarez, who is a first-year emergency medicine resident at UCSF Fresno. Thank you both for joining us today.

Jenny Gold: Thanks for having us.

Dr. Paloma Marin-Nevarez: Thank you so much.

Abdul El-Sayed: Jenny, you wrote a fantastic piece, really talking about the broader consequences that this pandemic may have for a whole generation of new doctors. And Paloma, I want to start with you: tell us what it’s like to be an emergency medicine doctor, especially a first year resident.

Dr. Paloma Marin-Nevarez: I thought a lot about this. I’ve just been giving so much thought about, you know, what is the best way to encompass the intern year and the emergency medicine experience? And it’s just, does it feel like the first day of school over and over? It’s just, it’s really hard to describe. I would say every single day, especially in emergency medicine, it’s all about the unexpected. Being as comfortable as possible with not knowing what’s going to come through the door. And, you know, you could have a patient who comes in because they have an infected ingrown toenail or somebody else coming in because they have a perforation in their intestine. So you pretty much have to be ready for absolutely anything that could come through the door, and realizing that not everything—you know, patients aren’t just going to show up with their diagnosis on their forehead and you’re going to know exactly what to do. And specifically, being an intern, the intern year is a special place where you are transitioning from being a medical student into being a resident or being a doctor. And when you are a medical student, you are very book smart. You know, a lot of lists, you know a lot of facts. But then you don’t actually know how to synthesize everything into being a doctor. And then also, what does it actually mean to practice medicine in a hospital with real people, with real staff? So it’s, you know, again, the drinking water from a fire hose just all over again, except now there’s six fire hoses all firing in the same direction.

Abdul El-Sayed: Why did you choose emergency medicine? I know the choice of what residency to pursue is a really personal choice, and it’s a choice that profoundly affects the rest of your life. Why did you choose emergency medicine? What were you looking for in your career?

Dr. Paloma Marin-Nevarez: Yeah, so in a nutshell, I love working with my hands. I thought at some point that I wanted to be a surgeon, but I realized I also want to be able to diagnose and, you know, put together pieces of people’s story. Also, I think emergency medicine, we see a lot of the people who have nowhere else to go. And that’s a very near and dear to my heart about why I went into medicine in the first place, is to take care of people who do not have anywhere else to turn to. Also being an emergency medicine, there’s a lot of flexibility. I eventually want to be involved in medical education, and specifically work in academics, to help improve the education of younger doctors—you know, just procedures, being able to do diagnostics, also taking care of all patients that come through the door. And then the flexibility of doing other things besides patient care, is why I went into emergency medicine.

Abdul El-Sayed: I love that. You’re one of the doctors who went into it for the right reasons. And God bless you. Thank you.

Dr. Paloma Marin-Nevarez: Yeah. Absolutely.

Abdul El-Sayed: Jenny, I want to ask you what got you thinking about what the long term impact of this pandemic might be on this generation of doctors? What was that moment for you that sparked this interest that got you moving down in this direction?

Jenny Gold: You know, the idea actually originated with our Editor in Chief at KHN, Elisabeth Rosenthal, who was an emergency room physician before she was a journalist. And she actually trained at the height of the HIV/AIDS epidemic in the 90s. And she was saying that that experience really shaped her as a physician, and was sort of wondering whether this experience might have a similar effect on this generation of doctors. And, you know, as I thought about it more and more, you know, we thought about it originally maybe as a smaller story, but we realized there was just so much to dig into here. This is a generation who basically graduated from medical school and went straight to the front lines of, you know, a pandemic of the century. It’s a pretty unbelievable experience. And it’s amazing to think that this will be this generation’s, you know, first steps into medicine, their first experience. And I think inevitably it’s going to change who they are—and we, we hope for the better, but I think, it was an ambitious project because it’s hard to project forward what this impact might be in the long term. We’re a little bit guessing at that, but we are able to see already, you know, what people like Paloma Marin-Nevarez are thinking about. And I started this project following five different doctors, and sort of whittled that down again and again, so I really got a pretty broad picture from quite a few people across the country of what they were going through and dealing with in their first months on this pretty wild job.

Abdul El-Sayed: So for folks who don’t know, residents start on July 1st and there is this sort of changing of the guard, and this sort of walking into the hospital, these new interns. That meant that people like Dr. Marin-Nevarez were walking into the hospital for the first time as doctor about four months into the beginning of this pandemic. Paloma, can you walk us through what it was like to even mentally prepare for that? And then what did you see?

Dr. Paloma Marin-Nevarez: So I think mental preparation is ambitious. I don’t know if there was such a thing. But for all of us, the last few months of our medical school were completely changed because of a pandemic. So that allowed us, I mean, we were kind of getting the idea that, hey, something big is happening. There’s going to be, medicine is not going to look the way that it did before the pandemic. There’s going to be a lot of changes that we’re going to have to adapt to. At that time, though, we were really focused on the fact that we were losing a lot of stuff, at the end of being—you know, medical schools very, very long. We give up a lot. We are the masters of delayed gratification. And towards the end of fourth year, there’s, you know, people take vacation or, you know, they’re getting ready to move to a different place or, you know, they say goodbye to their friends, or they have match day—and all of those things that we had, like, all med students kind of look forward to, that was all gone. And so there was a lot of sadness and disappointment. But then also this kind of creeping fear about: what is our intern year going to look like? Because we were pretty much just abducted from med school, ripped out of our med school community and then just thrown into our residencies. And because of COVID, we didn’t have a lot of the like, there’s usually like orientation and like getting to know people—and we didn’t have those things because everything got to be socially distanced. And so it was an isolating time. And then once we actually got into the wards or in the ICU, for example, there was just death everywhere. To put it bluntly. There’s just patients coming in by incredibly high numbers, you know, we’re, as I mentioned earlier, we’re barely learning how to actually operate and practice and do medicine in a hospital, but we’re watching it, you know, with people scrambling and doing their absolute best because we’re in a crisis. Right? So all of those things that usually, intern year is supposed to be kind of settling in and learning all these things—we had to learn it 20 times faster in order to adapt. And we had to kind of learn to be on top of our mental health as much as possible because of all the death that we were seeing, all of the end of life discussions that we were seeing, just stuff that we were just not prepared for in med school.

Abdul El-Sayed: Mm hmm. And, you know, for folks who don’t appreciate this, I just want to lay out that already being a medical intern is like drinking from a fire hose. And what Paloma’s describing is like going from drinking from a fire hose, to drinking from a a large power washer. Right? There’s just no, there is no way to sort of describe it, because most folks who walk into internship already say that the learning curve is huge. And so we’re talking about a learning curve in a pandemic.

Abdul El-Sayed: We’ll be back with more of my conversation with Jenny and Dr. Marine-Nevarez after this break.

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Abdul El-Sayed: We’re back with Jenny and Dr. Marin-Nevarez.

Abdul El-Sayed: Jenny, from folks that you’ve spoken with, how generalized is the experience that Paloma is describing, and what do you think are some of the long-term consequences that may come from this experience?

Jenny Gold: I think it depends a little bit on where the people are doing their residencies. In some places like Fresno, where Paloma is practicing, you know that, that’s a community that’s just been devastated by COVID. It was a hot spot in California, and she really experienced so much of the virus and so much death in her experience. I spoke with other people who joined in July, say, in New York, who actually just didn’t have as much of a COVID-intensive experience. Their internship year has still been shaped by the virus. For example, there are fewer elective surgeries. People are avoiding hospitals and therefore, often necessary care. So you might not get the same experience, of the same breadth of experience, as you might get in another year. But they’re not necessarily experiencing the volume of death. So I think there has been some variation across the country. But, you know, I think that element of sort of personal safety and fear, especially before the vaccinations were available to health care workers—I mean, that was really real and added a whole dimension of fear for people who are just starting their training. And also this idea of isolation was really real for everybody. You know, you watch sort of Gray’s Anatomy—I kind of hate to bring that up—but you sort of know what medical residency looks like those first years. You are thrown into the deep end, but you do it as a group, as a cohort, and you have this community around you. You go out to drinks after a long day, to brunch after an overnight shift. You know, you have people around you supporting you. And these are young people often moving to a new place where they really don’t know anybody. So, you know, the other folks I spoke with as well, for them, that was sort of a universal experience: they did not have that. It’s really hard to make friends over Zoom. And, you know, they got to these brand new places and they were doing this, you know, kind of really difficult, grueling year, pretty much alone and pretty much isolated. And, you know, there’s real mental health consequences of that. When you don’t have that supportive community around you, you sort of feel like you’re you’re on your own. And, you know, speaking with Paloma, you know, I learned, for example, that in all of that PPE, in your mask and your hairnet and the gown and the goggles—she’s walking around the hospital and the people she’s working with day after day, they might not even recognize her sometimes. And, you know, that adds a whole other layer of isolation. I think that was a really sort of a universal experience of the pandemic with the interns that I spoke with.

Abdul El-Sayed: Paloma, how did some of these things show up for you? What was the most jarring part? And can you maybe share with us what you know, an experience in your day-to-day might have felt like?

Dr. Paloma Marin-Nevarez: Yeah, so, I mean, in terms of the isolation, I was going to share kind of something that Jenny had alluded to, which was that, you know, some people didn’t even know who I was. And it took them like, there’s three people in my residency who we all kept being confused for each other and we kept on being called for each other. But then at some point, you know, given that the pandemic is so heavy, being confused for one another and being called, you know, like I got called Dr. Kozer or Dr. Picart, and at some point just, we started laughing at that. Right? Because that’s, what else can you do. And we took pictures together in our PPE and we were like: hey, guess which one is which. So you try to find the little moments there. I think the hardest, most jarring moments for me were, so you learn to do a death exam when you become a resident. And there’s just, I actually, the first death exam that I observed was with other interns at my medical school. And so here in COVID time where I’ve trained, I got to do a lot of them. But there is something about being, first of all, often the only person in the room because, you know, like family couldn’t be there, or having to do with PPE, right, like just something that is so immensely personal and intense, such as, you know, declaring the death of a human being, having to do that, wearing—I mean, you’ve probably seen, you look like a duck sometimes with those masks—like you’re wearing the mask and the PPE and like the gown and you have the gloves, and there’s very, very few things that make a dead body toxic and to have to wear these gloves and to kind of treat the body as if they were a toxic thing, was very difficult. And then sometimes seeing the families, I mean, and the policy in some hospitals is that only two people could come in, right? Where it used to be that multiple people would be able to come in and say goodbye. But like it was this whole putting together the hazmat suit and the isolation and I mean, well, yeah, I’ve felt pretty isolated myself with residency. It’s even worse to think about the isolation of somebody who is dying, and for somebody who whose family members couldn’t touch them with their hands, they had to touch them with those blue gloves. Right? Or they couldn’t see into their eyes. They had to see them, couldn’t see their full face. They were wearing those masks. And so just seeing death in PPE was really just something that has stuck with me for a long time.

Abdul El-Sayed: Mm hmm. And how did you cope with all this?

Dr. Paloma Marin-Nevarez: I have a therapist. I was very lucky to have found a really wonderful therapist here in Fresno who happens to have availability when I have availability. For me, it’s very important to talk about my feelings and to process. I know that not everybody has the luxury to do so, but that’s one of the things that I’ve had to prioritize. It’s really important for me to build community and to, as best as I can, given the circumstances, but also asking my co-interns like: hey, how are you coping? And things like that. I mean, there’s only so much that I can do. But I think also just remembering that I have to take care of myself if I have to, if I’m going to be able to take care of my patients.

Abdul El-Sayed: Yeah. And thank you for talking about that. I think it’s so important for us to talk about the ways that we process the challenging parts of our lives, particularly something as extreme and challenging as you were facing. And Jenny, what are we learning about the long-term mental health consequences of being an intern in the midst of a one hundred-year epidemic?

Jenny Gold: One thing I was going to mention is that a lot of programs across the country have tried to create mental health programs for their interns and other residents. Sometimes they’ve made it opt-out instead of opt-in to have some meetings with therapists. But it’s really hard and there’s shortages. And, you know, in the case of Paloma’s program, I remember you telling me they were offering this service, but then the therapist that they had hired was out on maternity leave. And so, you know, even some of the best intentions, people still have been unable to access really needed mental health care. And programs have also done things like try to make fun Zoom activities and create community. But, you know, again, there’s really only so much you can do in this situation. In terms of the long-term mental health consequences for interns, you know, I don’t think we know, and I think it’s going to depend somewhat on these resources that are made available to them. Are people able to talk about what is likely a traumatic experience? You know, the volume of death that Paloma is describing and that a lot of interns experienced this year, is just it’s, it’s really difficult and painful. And interns experience, let’s say residents experience, death of a patient usually at some point in their training. But it’s not like this. It’s not the same experience of just being completely surrounded by death. And I think one of the things that would be positive that might come out of this pandemic, is trying to change medical education, to focus more on teaching young doctors how to deal with death, how to process the death of their patients, and really how to walk their patients and their patient’s family through the experience, and talking about, you know, when it might be time to think about stopping some of the life-extending interventions that they’re doing, and focus more on comfort, towards the end of life. And that’s something that med schools, you know, they just don’t tend to do it much. You might get a one-hour seminar, but it’s not something like molecular biology that’s really a focus. And I think this pandemic has taught us, that is a really important missing skill for people, and that if they don’t know how to have those conversations in a positive way, I mean, it seems that that would be a moment when trauma was more likely, and not only trauma, but we talk a lot about burnout for young doctors. You know, we want these doctors to be caring, compassionate people, and also to stay in the field and to keep practicing. And there’s definitely been a fair amount of physician drop-out over the last year.

Abdul El-Sayed: Jenny, you’re raising a really important point, right? Because I think, you know, when I was in medical school, we had these perfunctory conversations about death and dying but it was pretty clear that death itself was the pathology. It was the ultimate pathology that we were against. And that then puts you in a losing battle every single time. And that’s particularly bad when you’re in the middle of a pandemic, and you’re seeing this happen over and over and over and over and over again, frankly, as a function of public policy, that that is being made at levels well above your control, and it’s showing up in your hospitals, in your ERs, on your wards. I imagine that this experience will have changed you as a doctor, Paloma. I, I don’t know if you know how, but if you had to guess, what will have been the impact of having started your residency, your journey as a doctor in the midst of this pandemic?

Dr. Paloma Marin-Nevarez: I think there is like two main things that I feel like that I’ve taken away from my experience in the pandemic. I think, first of all, I feel like I had to take several steps farther and faster to learn—I learned so much faster than I would otherwise. And in terms of going into a room and making sure that things get done, advocating for my patients, pushing myself to be the best physician that I can possibly be, that, you know, when things are really, really busy, you have to rely on yourself and your own knowledge and your own confidence. And having been in, worked in situations where things were just so busy and I had to have that confidence and had to, like, push myself to figure out: OK, what am I going to do? How am I going to do this plan? You know, support was almost always available, but sometimes things were just really busy. And so that’s number one. I think number two, I also want to be a lot more involved in advocating for like the wellness of residents, of trainee’s, of medical students, and residents. I hear this a lot from especially like older physicians that they say: like, oh, you guys have it so easy, like we used to do like 48-hour call. And you know what I—respect. Respect where respect is do. Like they did used to work ridiculously long hours, and I know that things were very different, but nowadays, you know, first of all, like the breadth of knowledge that we are expected to have—I mean, I’ve looked at like, for example, the First Aid is one of the most popular books that we use to review for our board exams—I’ve seen it go through the decades and it’s just getting fatter and fatter. So like we are, we’re expected to know a lot more. And then we also have the immense pressure of an electronic medical record that is constantly asking us to be documenting all of the time. I mean, like 60%, 70% of my time as a doctor is just writing notes and documenting. And this is not good for patients, and it is not good for us. And I think, you know, the pandemic and how quickly, how easy it was to ask people to possibly give up their life, to go take care of other people, without hospitals and people with power, with economic power or political power being there to protect them, tells me, hey, like I mean—if you think about who tends to go into medicine, it’s people who care. It’s people who are going into this because they want to help other people, and they often do it at their own expense and they don’t advocate for themselves. Right? But then this pandemic has taught me, like, we cannot take care of other people if we can’t take care of ourselves, if we aren’t advocating for our own needs, if we aren’t figuring out how do we get the many, many unmatched residents to join the profession so we have more doctors. How do we get creative so that we can use the EMR to our advantage and not use it to burn us out? You know, how do we, you know, incentivize people to, I mean, there’s just so much that I mean, I could go on forever. But, you know, to keep it brief, it’s just, I do think that people who have economic and political power take advantage of residents, of doctors, because they know that we are in this profession because we care and so it makes it easier for us to be—I mean, I don’t want to use the word exploit, right? Because it’s hard to argue that physicians are exploited, but I mean, we are, we’re burnt out. Young doctors are burnt out. Older doctors are burnt out. And it’s because we have a lot to reform.

Abdul El-Sayed: Yeah. Well, I really, really appreciate your perspective. And, you know, Paloma, as someone who graduated medical school and decided not to match because I was so frustrated with the health care system I was about to walk into, I really appreciate the points that you’re making is that in a lot of ways we have to work on the system even as we work in the system. Because, you know, the truth is, is that residents are exploited and, you know, residents make $60, $65,000 a year and most of the time they’re being asked to pay down their medical school loans, hundreds of thousands of dollars a year, to work 80+ hours in shifts that will destroy any semblance of a regular life, all the while being asked to bear the biggest burdens in the hospital and, you know, right alongside with nurses and other hospital professionals who are doing the work. And meanwhile, we’re watching our health care system make more and more money for the folks at the top, whether they’re the hospital CEOs, or the insurance CEOs, or the pharmaceutical CEOs, and the manufacturers. Right? All of them are making a ton of money off of your labor and your time, to the detriment of both patients and providers. And so I really appreciate you sharing your story. Really grateful for your leadership, and the work that you’ve done on the front lines, and I know that even as I think a physician does work for every single patient at a time, one has to remember that if it were not for your efforts, so many others would have been affected by it. And Jenny, we really appreciate you highlighting the story and telling Paloma’s story, and giving her and others a platform to really highlight some of the ways that the structural brokenness of our system falls on some of the most disempowered people in that system.

Jenny Gold: And not only the interns, but also, as we spoke about again and again over the eight months that I interviewed Paloma, was just the racial disparities that she was seeing in the hospital. The fact that this pandemic has disproportionately affected Latinos and other people of color. And that’s a reality that, you know, it’s: yes, there’s the exploitation of the medical residents and others in the medical profession, AND also just these these vast disparities that we saw playing out in real time this year.

Abdul El-Sayed: Yeah, I really appreciate you bringing it always back to the people. Right? In the end, the system is intended to support, protect, empower patients, and when providers are not cared for in the ways that they ought to be, it ends up hurting patients most of all. And certainly because of structural racism, that means that the people that we are, we are leaving out, we are excluding from our systems, tend to be Black and brown, tend to be poor, and tend to have little other recourse, particularly when it comes to a pandemic. I really, really appreciate you all joining us today. And that was Dr. Paloma Marin-Nevarez. She is a emergency medicine intern at UCSF Fresno. And Jenny Gold, Senior Correspondent at Kaiser Health News. Thank you both so much.

Dr. Paloma Marin-Nevarez: Thank you.

Jenny Gold: Thank you so much.

Abdul El-Sayed: As usual, here’s what I’m watching right now. Last Tuesday, the FDA and CDC issued a joint statement calling for a pause on the use of the Johnson & Johnson one-shot vaccine after six patients of the nearly seven million who have had the vaccine, were diagnosed with a rare form of brain clotting. There are a few things people should know. First, though, the clot was rare, it put regulators in a bit of an ethical quandary. The particular kind of clot that was observed shouldn’t be treated the usual way. In fact, the usual treatment makes it worse. So it was critical that they alerted doctors to the risk of treating these clots the wrong way and possibly worsening the clots in their patients. Second, it’s clear that the J&J vaccine is safe and effective. The only question now is for whom? Though, as far as we know, these events occurred in women aged 18 to 49 within a few weeks of receiving the vaccine, it’s critical to investigate if these six were really the only people who experienced it, and if there’s a causal link between the vaccine and the clots. Understanding the biology of these clots will be important to making sure to prevent any future events. The broader question, of course, is beyond science. How will this information shape attitudes among people who are already vaccine hesitant? Many people on Twitter especially, have called this pause a disaster, claiming that this pause would do more harm for vaccination rates than benefits for the lives it may possibly have saved. But let me offer an alternative perspective. Transparency is always the best policy. Knowing that the safety system built around these vaccines caught a possible side effect that was so minute to be one in a million, it should reassure people about the safety of these vaccines overall. That said, there’s another wrinkle here: J&J was the shot of choice for harder to reach populations because it’s only one shot, and it’s easier to store and ship. These communities may also be the most vaccine hesitant, though. And this may interfere with our ability to ensure vaccine equity. Meanwhile, COVID-19 cases are starting to jump in many states around the country. It should remind us that the vaccines are still just on the way. We need a lot more vaccine coverage to achieve the kind of herd immunity we need to render all the things we want to get back to truly safe. We’re almost there. Can we please hold on a little longer?

Abdul El-Sayed: That’s it for today. Next week, our last episode of Season two, I’ll share my experience of getting the vaccine, and I’ll be joined by a few special guests. If you like our pod, I hope you’ll also check out The Incision, my Substack newsletter. I wrote more about the Johnson & Johnson vaccine pause, and why Michigan needs a lockdown, last week. Incision.substack.com. Also, if you like our pod, please make sure to rate and review. It actually helps our discoverability on the podcast apps.

Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra and Lyra Smith. The theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, and me: Dr. Abdul El-Sayed, your host. Thanks for listening.