How To Stop Living In Fear of COVID (w/Dr. Monica Gandhi)

Dr. Z: Hey everyone, Dr. Z. I’m really excited to have Dr. Monica Gandhi, a professor of medicine at UCSF and an infectious disease doctor. She is well known for her work on masks during this pandemic. She was recently on our show. We’re just gonna continue the conversation. To join us, Monica.

Dr. Gandhi: Good to see you.

Dr. Z: So good to see you. Dude, your last interview got like million plus views, for like an hour.

Dr. Gandhi: Okay.

Dr. Gandhi: Well then let’s see what we can do today.

Dr. Z: Yeah, we’ll do some damage. Today, we’re gonna get ourselves canceled.

Dr. Gandhi: We’re gonna go deep, we’re gonna go deep. I hope we don’t make people mad.

Dr. Z: Now speaking of getting mad, what was remarkable is we talked about masks and your work that- And I’ll just summarize it quickly and you can correct me if I’m wrong. So the idea that masks are not necessarily gonna prevent you from getting virus in your system, but it will maybe lower the amount, the inoculum of the virus. Which means that the disease you get will be less severe, maybe asymptomatic, maybe won’t put you in the hospital, maybe won’t kill you, but may be enough to generate immunity that can then work towards some goal, ultimately, of herd immunity in combination with vaccine, distancing and the standard hygiene stuff of washing hands. Is that a fair summary of that?

Dr. Gandhi: That is a perfect summary of it. I mean, a lot of it is still hypothesis, but it seems that every study and every observational evidence we’re looking at keeps on showing this. We just did a big analysis with two MIT data scientists, big data scientists, who had contacted me and they said, “Could we show this at a global ecologic level?” And I said, “Okay.” And they got all this data together and we showed that mask mandates around over a thousand counties in the U.S. reduced hospitalizations, as we think as a marker of disease, from COVID, even if you control for age and testing and cases and everything else we’re trying to control for. Just that mask mandate in place, reduced the severity of disease, we think, as a marker which is hospitalizations. So we just put that together and submitted that.

Dr. Z: So that’s submitted, it hasn’t been published yet?

Dr. Gandhi: Yes.

Dr. Z: Okay, so this is interesting, So let me ask some question, because I think a lot of people have this question. So let’s say a bunch of cases in the community, big casedemic, people getting scared, mask mandate happens from government, then cases either decline or hospitalizations decline. Is that correlation or causation? And how do you separate those?

Dr. Gandhi: Well, that’s a very good question. And this is how I think of it. When I learned about science, like as a child. So when I was like 11, and then we went to the thirty, we were learning about basic tenants of science, hypothesis, theory, fact. When you do fact, when you do randomized controlled studies, or when you, for example, if you wanna prove that H. pylori causes ulcers, you drink H. pylori, you do your own endoscopy, and then you look down and you say, “Hey, I just got an ulcer.” That is proof, that is true. But there are some things that you cannot do direct experiments on. You can’t actually experiment on the human population. You can’t say mask half of you, unmasked half of you and spray COVID in your face, we cannot do that experiment. So because of that, we just have to gather more and more observational evidence. And then like evolution, it goes from a hypothesis to the word theory, because there’s so much observational evidence that evolution starts getting more and more play. And then you’ll never be able to say that we’ve experimentally proved evolution. You cannot actually do that. So all you can do is do more observational studies, show the association, it’s a correlation and it ultimately gets more and more meat behind it. But you cannot say- It’s never gonna, it’s not an experiment.

Dr. Z: So then let’s go put the meat on the bones of some of the background of this, just to remind people. And there’s a whole interview we did about it. But so mask mandate goes into effect, less hospitalizations. Now, the theory being that you have looked at animal studies, you’ve looked at some observational studies. So the animal studies with these Syrian hamsters, if you separate them with the mask membrane, they get less sick.

Dr. Gandhi: They get less sick. And now there’s just a new model in ferrets. So we have the little cute ferret and they have given them a lot more of a dose, they get more sick, less of a dose, they get less sick. So it’s a dose-response effect. So another animal model has come in since we last talked and then the observational evidence. Because that was what we call virologic evidence, where we do experiments or where animal models come into play. The next layer is observational evidence, epidemiologic studies, and we talked about some of them last time, which was settings in which mask mandates are in or where everyone had to mask like a cruise ship where no one was different in age, by the way, the two cruise ships, one 40% asymptomatic infection, one 80% asymptomatic infection. They weren’t different, they were the same populations. Who go on cruises? They’re older. Like it is a certain population.

Dr. Z: It’s like my parents.

Dr. Gandhi: Yes, it’s not like, young, healthy, strapping will never get sick from anything people are going on the cruises. Like, this is the same age range, but those who masked in Argentinian cruise ship, when they had the masks on, there was an 80% rate of asymptomatic infection. And then more and more observational evidence. There was a CDC study last week from Arizona that when mask mandates went in, because Arizona was surging over the summer, that 75% reduction in transmission. And then our study is not looking at transmission, it’s specifically looking at severity of disease because we’re really interested in this viral inoculum. And when mask mandates went into play, then there was reduced severity of disease as represented by going to the doctor. So we also looked at outpatient visits for COVID and hospitalizations from COVID, they actually went down very, very significantly after mask mandate, even if the cases were the same. So this is more of that case hospitalization rate, how sick you get on the basis of how many cases you have.

Dr. Z: Right, and this is age adjusted. So, in other words- Because there’s a lot of talk now where we have a lot of cases, but it’s a younger population there’s less hospitalizations, but adjusting for that, the same old person gets the disease before and after and mask mandate, they’re less likely, observationally, to be hospitalized in the second experience after mask mandate.

Dr. Gandhi: Correct. And you’re right, that I actually think there’s five reasons why the mortality of this infection is going down and it is going down. I mean the first surge, first wave, whatever you wanna call it because we can call the other one the continuation, the second wave. But we’ve had less mortality around the world, but especially in the United States and Europe. And I think the five reasons are indeed yes, people are being diagnosed when they’re younger because we’ve expanded testing. So we don’t just test older people or symptomatic people. Second is that I do think that better treatments, once you get to the hospital. So we actually have treatments now, but that stops after hospitalization. We were looking just at hospitalization, but true. When you’re in the hospital, we have better treatments and better hospital preparedness. I think the third reason is staying away from each other and masking. I do think that social distancing and masking reduces the viral inoculum and we’re getting less sick. I think the fourth reason is that there is a certain degree of immunity in the population. So even if you get reinfected, you’ll never know it because you get asymptomatic infection. And then the fifth reason I had it, but it’s not coming to me at the moment, but I’ll come to it.

Dr. Z: It’ll pop back.

Dr. Gandhi: Yes.

Dr. Z: So a couple of things on those reasons are interesting. So this idea of distancing and masking, so you look at Australia’s flu season, it was nonexistent.

Dr. Gandhi: Right, exactly.

Dr. Z: What else are we doing? I mean, that’s not Remdesivir, that’s not Regeneron. You’re gonna get everyone, it’s not that.

Dr. Gandhi: That was quite an advertisement, yes, yes, yes.

Dr. Z: So there’s some observational evidence, then, that these things do have an effect. But the question is in talking about masking. So mandates are always like, even I’m just like, “A mandate? Why? “Why do you wanna force people to do something?” What are your thoughts around that?

Dr. Gandhi: So, it’s a great question. So I think of it in three ways. So I’m an HIV doctor, so I actually don’t believe in yelling at people and making them do certain things. So condoms are a good example. That condom use actually would have stilled the HIV pandemic and we wouldn’t have HIV. You can’t tell people to wear a condom. There are actually aspects of the intimate relationship that people make their own decisions about wearing a condom. And beyond that, actually, like heterosexual spread of HIV, women can’t advocate their own condom use. There’s multiple reasons why saying, “Wear a condom and I’m gonna make you wear a condom,” doesn’t work.

Dr. Z: Right, that’s called penile lockdown.

Dr. Gandhi: Oh, okay.

Dr. Z: I’ve been advocating it and it’s been really pushed back.

Dr. Gandhi: It doesn’t go very far.

Dr. Z: It doesn’t go very well.

Dr. Gandhi: So that is, in a way it’s different, because it’s an intimate act and it’s an intimate moment, but in a way it’s similar. Because there were many people at the beginning of the HIV epidemic who just yelled and stigmatized and yelled at people and said, “Why can’t you wear an F condom?” Just like they say, “Why can’t you wear an F mask?”, right now Or how stupid you are that you don’t wear a mask or how stupid you are that you won’t wear condoms. So it is this absolute same thing and it gives me-

Dr. Z: Heartburn.

Dr. Gandhi: Like heartburn. I can’t stand it that people yell because that is not a way to do good public health messaging. Yelling, calling people stupid, all of this is unbelievably unhelpful. What you wanna do is give good messages for why it would protect you. And then even if you put a mask mandate and by mandate, I mean, actually the guidelines, it’s a guideline. You actually don’t need 100% of the population to mask.

Dr. Z: We talked about 80%.

Dr. Gandhi: 80% of the population should mask to get to zero deaths, 50% to get to even low deaths by this model. So some people don’t wanna mask and it is a personal choice, then they don’t have to mask. Because actually if your mask protects you, I can be right next to them and I’m okay. So I think it is that kind of not messaging in that way, but a mandate means guidelines. Like we mandated seat belts and we put in guidelines and we said, the police can stop you and you have to wear your seatbelt, but there are people who still don’t wear seat belts.

Dr. Z: Right, so it’s a kind of a soft enforcement type of thing. And what I’ve seen is it’s led to so much division so that the maskers and the people who don’t wanna wear masks, and they’ll walk into a store where really masks are required, and they’ll start shouting and screaming obscenities at the owner of the store, who’s elderly, who’s saying, “Can you please wear a mask?” And the opposite in certain parts of the country where you walk in with a mask and they’re like, “You can’t come in there with that garbage on your face.” And it’s become so polarized. And I think getting to the core of this, because we talked about this for quite a while last time, masking. I’m very much aligned with your observational evidence and your thinking on masks. And I think the overall generation of data that we’ve seen. Now, we could be wrong, but the harm of being wrong is tiny. It means that, okay, we’re causing people to wear diapers on their face. All right, that’s not the worst thing in the world, there are worse things. But it’s allowing us to open up, it’s allowing us to be comfortable with each other. And then the concern that people have though, that they push back and say, “What’s the end point? “Are we wearing masks forever? “What about the deaf who can’t see? “What about little kids who need facial expressions?” I mean, how do you think about that?

Dr. Gandhi: Yes, okay. So overall I think that I’m convinced enough by the evidence of masking, I don’t care about physical science studies where you spray things into animals faces. Again. I think what you wanna look at the epidemiology and I’m comfortable enough with the epidemiology of this infection that in places that masks we’ve seen reduce transmission, reduce severity of disease that I feel like it’s a very strong argument to wear a mask. I think that people can help get through this pandemic and be around each other by wearing masks. And I think they could be in hospitals and be in schools and be around each other by wearing masks. And I think there’s gonna be an end point. The end point will be when enough of us have either immunity from natural infection because it’s occurring, there’s nothing we can do about that, it absolutely happens that natural infections are happening. Plus a vaccine that will get to a state where the virus just fundamentally stops and retracts. Because it has no one else to infect. So we will have an endpoint, we won’t have to mask forever just like we didn’t have to wear condoms forever, actually, for HIV prevention. There were other strategies like prep and so forth and now people can do whatever they want, but there are other strategies. We’re gonna have vaccines, there’s gonna be other strategies, promise we don’t have to mask forever. So, people do write me actually. And one person keeps on saying, “When can we stop?” And I said, “Okay, maybe a year and a half, “I don’t know, maybe a year.” I’m not sure exactly, but I promise we won’t wear a mask forever. I promise, because fundamentally there’s no need for it. So, okay, so that’s comforting. Then the second thing is that I think that people who can’t hear, or I think that people have medical reasons to not mask, they should not wear masks. Because again, there is a certain proportion of the population that has to mask and it’s not everyone and schools for disabled children, for example, who can’t hear, can open up with more social distancing. because they do require the mouth. There are transparent masks that still could be harder. And there are ways to get around, we don’t have to keep on saying like, “Are there ways not to get around it?” There are ways to get around things where people truly have limitations for doing things. And then the final thing is that it does give me this comfort that I feel safe when I’m out and I’m really in a crowded place to wear that mask because I feel like it protects me. And it does give you more comfort and sitting in your home all day and not having interactions and not being able to go to work for those of us who can go to work is also causing its own host of problems. Loneliness, and depression, and not interacting with each other and not having that incredible rich dialogue that we can have. So I go to work every day with a mask, because I’m a doctor. And I see my colleagues in the hallway every day and we say, we have interactions with each other with our masks and I get so much more out of that than I do by being at home.

Dr. Z: I couldn’t agree more about the interaction thing. Look, put a piece of thing on your face, it’s still an interaction. Zoom, okay, I’m gonna hierarchize them. I would say Zoom is here, masked interaction is here, unmasked interaction is here. Like there’s diminishing benefits, but the main thing is get off Zoom, get in person like you and I in the studio, so joyous for me. Love and joy. I mean, totally different. And people are like, “I wanna be on your show “and I wanna do it by Zoom because I don’t-” Well then you don’t come on my show. And first of all, if you asked to be on my show, you’re probably not worth interviewing. Because you’re busy, you ought to be busy doing your thing like you. Now this is an interesting thing. So about you, and by the way, since the show went live, I had a bunch of people reach out to me like, “Oh, she was my resident at UCSF, she was the best. “Oh my gosh, Monica is lovely.” My mom was like, “Oh, you know, Monica. “you guys are sisters from other misters.” I’m like, “Are you reassigning my gender, mom?” But the idea that-

Dr. Gandhi: That’s so sweet, I wanna meet Auntie. Auntie, I very much want to meet now.

Dr. Z: She’ll come only now. So she’s of course living in fear, in her house, in the central Valley with my 80-year-old dad and their lives have been upended by fear. Now, when we did the thing, since then you have been directly attacked by say Michael Osterholm. Michael Osterholm is known as kind of the prophet of doom and fear. From the very beginning, he goes on Rogan and he’s an epidemiologist, PhD, not a doctor, right? And doesn’t touch patients, but has basically said, well, this is what’s gonna happen, tons of people are gonna die, We need to lock everything down, we need to distance. Don’t say social distance because that has a bad connotation, physical distance and this and this and this and this. And then you did your thing about masks and have been talking about it as a way to get us out in the world. And he said something to this effect, this is dangerous, it’s wrong, she’s misunderstanding science, her and her co-author. It’s gonna cost lives because people are gonna be overconfident and they’re gonna not be protecting this idea of inoculum is BS. It’s not that people have different disease states because there’s different doses of virus, it’s because they’re all different people and they have different susceptibilities that we don’t understand. And I remember seeing that and going, “Wow, that’s a rather unscientific way “to attack somebody I know personally, “who’s a lovely person.” But also you’re not attacking the ideas directly, you’re throwing out ad hominems and it sounded like, what? And people were coming at you on Twitter and all of it just this nasty thing. Just tell me how you’ve experienced this and what you think about this.

Dr. Gandhi: Well, it’s been really interesting because I’ve never had anything, necessarily, ever controversial thrown at me because I’m just kind of this doctor and I’m Indian and I’m boring. And like you said, I’ve done nothing wrong, I did whatever my parents wanted to.

Dr. Z: Clicked all the boxes.

Dr. Gandhi: Like I just became a doctor, I did what they said. But I think that it reminds me of what I and my co-authors because the people who were doing the masks mandate article with were looking at history and I was just talking to them on my way down here. And we were talking about the polemics of when there’s a new pandemic. So we were talking about 1832, Paris. And here we have a Cholera pandemic. And we have people who are saying that they were divided into camps of contagionists and hygienists. And contagionists were saying, “Lock everything down, this must be in the air, my asthma “lock everything down, stop everything. “It doesn’t matter if other things will go by the wayside “like mental health or people’s ability to work “or the poor can’t work “or rich people can stay in their house and be served “but only the poor can’t work, “but let’s just do that.” And then hygienists were like, “Let’s just work on the poor “because it isn’t spread that way, it’s spread fecal oral “and it’s about sanitation.” And both sides actually completely hurt the poor. Why? Because anything that shuts down society completely will have so many other effects and they will not be on the PhD or MD epidemiologist actually sitting in their house. It will be on the poor, it will be on the working class and what you have to do is try to figure out ways to keep people safe, but you still allow work to be done. Because unless, like we talked about last time, unless, this government, which is not going to do, is going to say, “Guess what? “We’re gonna do lockdown “But you get every single person in this country “gets $2,000 every week or $1,000 every week “or whatever the amount is to keep you going “and there’s no reason for you to have businesses open “and to have your store open and to have your- “Where we’re all socially distanced and masked. “But anyway, no reason to have that store open. “We’re just gonna keep everything down, “but I’m gonna give you money.” Well, we would never do that, we haven’t done that. We’re still arguing about the next stimulus check in San Francisco. I told you about this Right to Recover Program, the Immigration Right to Recover Program. Which that if you got tested and you were positive, they’d give $1,200 every two weeks. It dried up, it dried up. We don’t have that, San Francisco doesn’t have it anymore and it’s not being made much of, but they need to talk about, “Then why would I test “if I’m gonna have to stay away from my workplace “to go and deliver food “for all of you who are sitting in your house “and saying this.” “Why am I not gonna work? “I have to work, I have to feed my family. So my point, going back to the contagionists versus hygienist in the Cholera pandemic is that hurt the poor and it hurt the poor to stigmatize them and say that they’re the Typhoid Marys of Cholera. Just like we’re saying, “Oh, it’s the essential workers, “It’s black and brown people, they’re the Typhoid Mary.” The point is everything is in a complete- It’s not in a vacuum, this is not one disease, this is one thing that’s going on in the world right now so is poverty, so is mental illness, so is depression, so is people dying in nursing homes without seeing their families. There’s a lot of other things that’s going on right now. So how do we put together all the science to the best of our ability to allow people to still see each other, to still be together, to children to have in-person learning with all of these elements in play like masking, keeping the- We used to be very close up, okay, keeping the six feet apart, hand hygiene, ventilation, masking, contact tracing if someone gets sick, INQ, isolation and quarantine of someone gets sick and selective testing. With all those seven things, we can open up society and it is fair to do that. Being doom and gloom is gonna get us nowhere, it is a terrible thing to say. It’s like saying that humans are lab rats and that we have to control them. They can’t be controlled, they have to work. They have to work, they have to make money for their families to actually have food so that you can have nutrition to fight off illness so that you’re not malnourished and you don’t get COVID. I mean, really, that’s an isolated way of thinking, It doesn’t make sense in the context of the real world.

Dr. Z: It seems like every conversation I have nowadays with very smart people leads to the same exact conclusion that this is almost a suburban zoomocracy elite that is saying to poor people, “Shh, stay home. “No, you can’t have school, which is also childcare for you, “which is also food for you, which is also a future for you, “which is also breaking the cycle of poverty. “You can’t have that because we, in the zoomocracy, “in this elite class that can live like this “are afraid for the safety “of whoever, whoever and whatever.” And in a way, I don’t think they overtly do this, but I think this is an unconscious way to control people that frighten them. Because the same people that are saying these things would never venture into the parts of the city that are most affected by this. And they’re the same ones who will sit at home and I think Osterholm is one of these guys, you can’t say this, I can say this, I’ve watched him several times. He is becoming, in a way, famous by sitting here and saying, “Okay, I’m this PhD, I’ve run these numbers, “my numbers say this and this and this “and tsk, tsk, tsk and ta, ta, ta.” Okay, yeah, we have to touch the poor, the people, everyone who comes to our clinic who’s suffering because of the tsk, tsk, tsking in your projections, which actually are as abstract as the most tenuous observation trial that he would criticize.

Dr. Gandhi: I think that’s a fair point that maybe being a doctor does change your view of things. Because my patient population at San Francisco General, which is a vulnerable population, Medical or Medicare or uninsured altogether, so it is a poor population. And I also only serve people living with HIV, who’s been through one stigmatizing pandemic, and now they’re going through another and they are miserable, my patients are miserable. They’re because they can’t work, they’re miserable because they had low income jobs and they don’t have that anymore, they’re miserable because they can’t go anywhere. And I think you know, that there’ve been 500 deaths of overdoses in San Francisco, this was just data from two days ago, in the same time that there’s been 100 from COVID-19, over the same time period.

Dr. Z: 500 versus 100.

Dr. Gandhi: Right. So the effects of lockdown and the effects of this miserable time will lead to relapse, will lead to trying to get something that makes you feel better and will lead to overdoses and has led to it, the data is clear in San Francisco. So I think that to isolate, and this is actually the argument that was coming out in France at that time, because 1832 is not that far after 1789, so there was after the French Revolution. And there was those discussions, the bourgeoisie get to do whatever they want and maybe versailles, you can sit in your house and do zoom versailles, I don’t know what that is.

Dr. Z: The equivalent, right.

Dr. Gandhi: But actually, guess what? Like there are people who would go have to go work and actually be the servants for the rich people, because it was not like we equalized society by the French Revolution. So these same arguments were going on. And the interesting thing is the polemics and yelling at each other as scientists. Because I’ve never been yelled at by a scientist, in my entire life. Maybe I’ve been yelled at, by people on Twitter who are saying, “I would wanna reduce their oxygenation by masking,” which we talked about last time, it doesn’t reduce oxygenation, so please feel safe about that. It’s not gonna reduce your level of breathing. But I can understand that yelling more than being yelled at by fellow scientists, because I’ve never been yelled at by a fellow scientist before this. And it’s the polemic aspect, right? We can disagree, I can point to this study because I want to point to this study because that’s how science works, right? I’m gonna look at things that work with this hypothesis. And then this person who has decided in their mind that it’s this way and this way only will look at these set of studies. Science is never, ever free from your complete-

Dr. Z: Confirmation bias.

Dr. Gandhi: Confirmation bias. And my confirmation bias is someone who has worked with this population and has seen the effects of this every week as I see patients every week, is that this is terrible, this is really hard, this is really difficult. We have to get back so that people can work unless we wanna just send those checks, which we’re not gonna do, so let’s go back to- We haven’t done that, we’re not going to do that, even in the liberal city of San Francisco, we have not provided for those who test and can’t work. We’ve only done that for a short period and we didn’t continue it. So if we’re not going to do that, then we have to make things safe to allow people to do the way that they get money in this society, which is to work.

Dr. Z: Yeah. And you know this idea that we all come with our own biases, right? The problem is when a scientist who generates credibility, doesn’t put their bias on the table. You just did it. You said, “Hey, this is my bias, I work with poor people. “They are getting screwed.”

Dr. Gandhi: Yeah, they’re getting screwed.

Dr. Z: I’m like your anger translator.

Dr. Gandhi: Yeah okay great, great, thanks for interpreting it in that light.

Dr. Z: I know in your mind, I know what it’s like taking care of this population. You are angry, but you are also a professional. But I just get angry, I’m quite volatile. And when I hear this, I see deep injustice. And what I see worse than that is the very people who purport to wanna help these populations are the ones that are the loudest in support of fear l- Because what do you think is really driving this? The core was that induction of fear in the early days of this pandemic, when we were infected with the social contagion of we’re all gonna die, millions of people are gonna die. The Imperial College of London says so. If have you heard what’s happening, lungs are filled with these membranes and they’re long haul people and people are just dropping dead of clots and this and that. And okay, look, some of that is true, you do can have that. But if you look at the actual statistics and the risk, your very chance of dying of COVID is like that, depending on what risk factor-

Dr. Gandhi: Yes, so that is true. I think, okay going back to- So I think that’s a very good point. So it is an interplay between host and pathogen, that’s very true. And so my 86-year-old father is more at risk because he’s older. And I think the age is always coming out. However, I feel very safe with them when you just said your mother has been fearful. I desperately want my parents to socialize with their really old friends, like old Indian friends. So I tell them to wear a mask and be outside as much as they can until it gets cold and they are doing that now, they’re listening to me.

Dr. Z: Wait your parents are listening to you?

Dr. Gandhi: My parents are listening to me.

Dr. Z: Man I gotta get what you’re-

Dr. Gandhi: And they are so much happier since they’ve listened, right? Because it’s painfully lonely to be really old and not have your children and other people visit you. And so I think it’s an interplay between host and pathogen And I think there are elements of the host and there are elements of the pathogen. What we can control about the pathogen is I think it’s mutating maybe, but I don’t think it’s mutating to become more severe and there’s no evidence for that. Or less severe and there’s no evidence for that. I think the mortality, the viral pathogen aspect that you can control is having less of a dose and that you can do by wearing the facial mask and the social distancing. So there’ll be more and more data on this, I think from our group, from other groups, there’s already more data on this. We’re putting together this big review article on all the pathogens that we can find in the world and how their inoculum relate, a fellow’s doing this with me and two other very excellent collaborators with me. But we’re putting together any data that shows that a dose affects severity of disease, sometimes it does, sometimes it doesn’t. Salmonella does, influenza does, measles does, I think SARS-CoV-2 does, I think some diseases don’t. I think they shorten the incubation period, so you get sick faster, maybe not more, but faster. And then some may not do this at all But I think the diseases where it does work is where the immune system has to play a role in viral pathogenesis like COVID-19. So I think what happens here is you get too much of a dose, your innate immune system goes crazy, it throws out all these cytokines and goes crazy and it hurts your lungs and it puts inflammation in your lungs. And if you have less of a dose, your innate immune system doesn’t go as crazy and you can manage it better and you can have more mild disease and that’s why we use steroids in severe COVID-19 disease. We wouldn’t use steroids, if the immune system wasn’t inter playing with the severity of disease. We would never try to suppress the immune system, but we’re actually trying to suppress the immune system. So I think diseases where the viral inoculum matters, the immune system has a lot to do with how sick you get.

Dr. Z: So does that relate, it’s a really fascinating. Does that relate to the so called long haul COVID cases where even younger people, maybe who didn’t have so much severe disease, although we don’t have good data on this, having cardiac effects longterm, the brain fog, the almost the myalgic encephalopathy, the chronic fatigue syndrome that people are complaining of. Do you think that’s different in SARS-CoV-2 relative to other viral and what’s going on with that?

Dr. Gandhi: I think there are and you’re right the data-

Dr. Z: Because there’s fear.

Dr. Gandhi: Yeah, there’s a lot of fear, the data’s not great there either. So I think there’s two questions to ask about the long hauling question. One is it patients with more severe disease that are more likely to get longer term symptoms? And that seems to be true. There is a cohort study going on at UCSF and I’m not involved in the study, I just help, I watch it very fascinatedly. But that this study will show whether mild, moderate, and severe disease do people with longer term symptoms, they had severe disease and that’s what they’re telling me, but we need better data on that. So then you wanna avoid severe disease at all costs, which masks help you, yay. Then the second one is yes, I think that inflammation has a great role to play in how sick you get in the immediate term and maybe how sick you get later. Because the virus doesn’t stay in your system, unlike HIV that actually intercalates into your very DNA. It’s a retrovirus, so it goes from outside the world, into your very body and you can’t get rid of it, which is why we have to take lifelong therapy for HIV. With SARS-CoV-2 the thing’s gonna leave, because it’s an RNA virus, it’s gonna leave your body, but it’s the lasting effects of maybe you had a very severe inflammatory response or your particular system is more inflamed. And I think it will ultimately get better as the inflammation goes down. And we need to think about treatments to make that better that will all be in the anti-inflammatory class. But to me, it doesn’t mean that anything that reduces possible severity of infection should be wiped away. What I mean is people are leaving their houses because they have to work, people are going to go to school when schools open with safety protocols, people will be out in society unless you’re a very, very, either lucky or person who is okay not being in society. It is part and parcel of human interaction. And in that setting, anything we can do to reduce the severity of disease will help us, even with the long hauler question. And the other aspect, the final piece I wanna say about this answer is that vaccine studies are not only studying if you can stop transmission, they’re studying, can we reduce the severity of disease with vaccines? So vaccine studies are not assuming that people aren’t gonna be around each other because by definition they are. India tell, like people in the slums of Mumbai, you can’t be around each other, it’s, by definition, impossible. But the vaccine is also looking at, can we do something to reduce the severity of disease? That’s why anything that’s along this hypothesis, we should put out more and more evidence for it, because I think it’s true, but we have to put out more evidence to convince people.

Dr. Z: I mean, it would be a wonderful aspect of this that you can have a sense of control that doesn’t involve draconian, all the people say, “Well, masks are draconian.” The truth is we live in America and this is the thing, our strengths can become our weaknesses during a pandemic We’re individual, we celebrate liberty, we do what we want. That’s why people come here. That’s probably why our parents came here, right? But in a pandemic, those same strengths can become weaknesses in terms of just absolute mortality, because you can’t do what China did and shut everything down and you wouldn’t want to in this country. And so the question is, so let me ask a question that’s related to that. Why do we have so many deaths in this country?

Dr. Gandhi: Because I think lots of reasons. I mean, I think that we didn’t have- I think it’s true that if we had shut down appropriately for a short period of time and then reopened when the community prevalence was low, would have been better strategy. We didn’t do that, we like shut down, kind of, and then opened in some places and we have porous borders. And so we never did anything that was nationally regulated or federally regulated and definitive. We just been in a twilight zone for months and months and months. Then we didn’t have appropriate testing at the beginning, we didn’t have enough testing then, which is isolation and quarantine that allows you to know how to isolate and quarantine. Then our masking guidance was poorly delivered, the president didn’t deliver it well and he doesn’t believe in it so much, himself. And because of that, he has questioned it to this day. And I think that’s been a big problem because I do think masks are effective and I think modeling of mask behavior by public leaders would be super helpful. Then we had cities and states and the country saying different with totally mixed messaging. Even these scientists are totally giving mixed messaging, shut down completely, never see anyone that you ever care about again, is one message. And the other one is, completely open up and do nothing and we’re past it now. This is so confusing. We just didn’t do things in a regulated, clean, sort of centrally mediated way and we’re just in a mess.

Dr. Z: And I don’t think the U.S. was structured to do that, or at least with the current administration, isn’t structured to do that. And so you look at Europe, they are more structured to do that, but they’re still having large second waves, but those second waves aren’t as fatal.

Dr. Gandhi: They are just not. So Spain, Italy, UK, Germany to name four countries, they are absolutely seeing cases go up, but they are not having the severity of disease. And I wouldn’t say any of those four places are having as complicated a relationship with masking for example. They are doing things like spaces that you can’t mask effectively, which would be indoor restaurants that are closing. And I think that’s probably a fair thing. If we were in a surge and our indoor restaurants were open, which they aren’t, at least in this city. In this city, they’re gonna open them because we’re not in a surge, just at 25% capacity. But if you’re inside crowded together and you have to take off your mask, that’s a place where transmission can occur more. So they’re selectively looking at that places to close down and that’s what they’re doing in the UK and Germany and Spain and Italy. Then there always, we always knew that we needed to do a better job with nursing care facilities and they’re doing that. They are doing that way better than we did at the beginning, than any of us did at the beginning. So those two strategies, I think, are helping to keep these death rates low and then everyone’s masking.

Dr. Z: Do you think we have more chronic disease, more obesity, particularly in minority populations due to socioeconomic determinants of health?

Dr. Gandhi: That has been said. I mean, I think that that could be true, but then it’s of course the social determinants of health that would lead to poor diabetes control or poor hypertension or poor obesity. But you’ve already just circular argument that we haven’t given people better access to healthcare that that would minimize the effects of these comorbidities. But I also think if our inoculum has a role, that it was just being out in black and brown populations working, being the people who are like out there and we really didn’t mask at the beginning because we just didn’t know and it was confusing and anyway, lots and lots of reasons, not having shortages, all of that. So I wouldn’t say that masks went into play as a real strategy until mid April, like April 3rd was when the CDC put out their guidelines. So that whole March period, a lot of people were just out. And then you have crowded lived environments where if you have it, you’re not masking at home that hasn’t been part of our guidelines and then there’s more exposure to people inside the home. So I think it was a lot of reasons and it all speaks to social vulnerabilities of minorities. All these reasons that you can implicate for black and brown populations is essentially nothing that’s any of their fault, that’s the main thing. And the stigmatizing concern is where I get very concerned about how you stigmatize people like, “Oh, well, you know, there’s just too much obesity there, “hypertension, diabetes.” That sounds stigmatizing, that sounds like someone had something to do with it. They didn’t have anything to do it.

Dr. Z: It’s the Cholera epidemic all over again.

Dr. Gandhi: Yes, it is. It’s a cholera epidemic or the beginning of the HIV epidemic. Well, the dirty gay men, they’re getting it.

Dr. Z: The Gay Related Immune Disease

Dr. Gandhi: Yes, exactly. Yeah, exactly. If you’re gonna behave immorally, you’re gonna get it. This was such a part of the dialogue of HIV at the beginning.

Dr. Z: It’s still can be occasionally.

Dr. Gandhi: It still is, unfortunately, it still is. Now we know it’s more spread heterosexually in the world, 36.9 million people infected, it’s really a heterosexual pandemic worldwide because Subsaharan Africa. But we’re still doing that stigmatizing. It’s always easy to gay bash, right? Like this country has not gotten past the LGBTQ issue and so they’re still gonna put HIV in that population. But this is a respiratory disease, but they wanna put it somewhere, okay, black and brown, let’s do it that. There’s the I can stay safe. And that’s not right, it’s blaming the victim for social conditions where there’ll be more exposed to SARS-CoV-2, where there’ll be more exposed to not having good health care to control the diabetes, to control hypertension. It’s putting people in conditions that you’ve just allowed more contagion to occur or more poor healthcare outcomes to occur and then blaming the population.

Dr. Z: So it sounds to me like we’re seeing almost a class distinction here. It’s a economic inequity distinction that’s leading to a health inequity, which when Jay Bhattacharya was on the show, who’s getting a ton of crap now from like Buzzfeed, which I never knew was a legitimate media organization, but they’re crapping on him saying he’s advocating herd immunity and this and that, which he’s not. He’s actually, in a way, he’s giving a variant of what we’re saying with less emphasis on masking. So we’re all kind of on a spectrum of we need to protect the poor by opening up and that wealth is correlated to health more than anything. And by depriving poor people of both wealth and health, because I mean, they’re gonna get COVID because they’re stuck and they’re essential workers. What are we doing?

Dr. Gandhi: Yeah, it’s so unfair.

Dr. Z: It’s really unfair. And it’s easy for us to sit back if you’re not cognizant of that. I got to say this real quick and this is very controversial. So Bill Burr, comedian, was on Saturday Night Live last night. And he directly tried to get himself canceled on Twitter by saying truth, which is that, somehow the affluent and he labeled them as white women who drive SUVs with heated seats are now talking about how woke they are and how they need social justice and this and that. When in fact they’re so detached from that, that it’s a kind of a projection and really we have to focus on introspection and well, what is it that I’m doing to contribute to the inequity? And that’s the hard discussion to have.

Dr. Z: That’s a very hard decision.

Dr. Z: Twitter blew up, right? And I’m like, “Yeah!” I was like, share. But I have my own confirmation bias because I think there’s a lot of projection we do when we talk about injustice and instead of actually addressing the root cause, which is often within us, right? And the fear that’s driving this pandemic has been heartbreaking to see, because it has caused us to rend society in a way, and in further codify this inequity in a way that you brought up with this Cholera pandemic of 1832 did the same thing. New century, same story. What is it about humans that we behave this way? I mean, it’s very tough.

Dr. Gandhi: Well, it’s really interesting what you just said because there’s two things I think in humans that make us behave this way. One is, in some level, a desire to control and a desire to control without recognizing other people’s lived experiences. And their lived experiences, you can put as many dictums as you want, but you have just told someone that they can’t make a living. And so instead, what you have to do, is figure out how to keep people safe within the context of a respiratory spread pathogen that goes out of the nose and mouth and gets imbibed in the nose and mouth, thus my emphasis on facial masking and still allow that. So there is this control element. Then the second is fear, when you said the word fear. So I think that fundamentally, people are lesser or greater in harmony with their fear of mortality. And I think that, unfortunately, what many people have held at bay is that their mortality is 100% for everyone. And your fear of mortality can lead you to lash out at others from your positions of power, like being an epidemiologist or not, your fear of mortality-

Dr. Z: Osterholm, I’m looking at you buddy.

Dr. Gandhi: No, I’m not saying anything against him.

Dr. Z: She’s not, I am.

Dr. Gandhi: I’m not, I’m not doing it.

Dr. Z: Monica’s a sweetheart, I’m not, okay? Come on my show, physically, none of this Zoom stuff, come on my show and tell me what’s wrong with her hypothesis with some science, seriously.

Dr. Gandhi: But, what I mean is this fear of mortality that we all have, right? Everyone has that, but they have it to greater or lesser degrees. So at the beginning of the pandemic we shut down because it was the right thing to do because we had no idea what was going on. We didn’t know if it was surfaces, fomites is it radioactive, what’s going on? And so this was the right thing to do. Then as we got more of the work done and people figured out it was spread from the nose and mouth, even when you feel well. So asymptomatic transmission has a big role in spread. When we figured the fomites and surfaces really don’t make a difference and that’s not a big deal. Okay, clean up and wash your hands, great, definitely wash your hands, it’s a good thing to do anyway. But that’s not the role, that’s not the big way and it’s definitely not radioactive, that should’ve never been in anyone’s mind. Then we realized the blunt instrument of lockdown is causing so many other health problems that how do we then open with safety principles at play like masks and hygiene and social distance and testing when we need to and isolation and quarantine and contact tracing. So those seven things we can open. So how do we do that without fear? Well, people are fearful, they’re actually truly fearful of their own mortality. And now I have a new theory that I can only hang out with people that don’t have profound fear about COVID. And my new statement is strata, I actually had a friend helped me think of this, strata-of-fear. I can only hang out with people in my same stratas”fear” who have my same level of fear, because if I try to hang out with too many fearful people, then we don’t actually connect in the same way that like I like books and I like museums and I don’t actually connect with someone who wants to camp all the time. It’s just not who I am, I don’t camp, I don’t go outside that often. So this is something that now, I think, has become in our equations of social dynamics is that we hang out with the people who are in our strata-of-fear. And so the super scared people can hang out on Zoom all the time, and that’s great and they’ll do it for maybe so long. And I would like to, in a safe way, see my friends and family. So I have this little group that now is in my same stratas”fear” and thank God, once a week, I now have social interaction, it’s excellent.

Dr. Z: I tell you, if you guys don’t get anything out of this interview, but this strata-of-fear, stratas”fear”, is so amazing because I feel it as a lived experience to be true. I’m hanging out with you right now in my studio. I looked forward to it all week. Last time we hung out, it was a joy, it was one of the first live studio experiences. And both of us live in a certain strata-of-fear, which is we respect this virus, we’ve seen what it can do, we take necessary protocol, we’re well over six feet apart, we do this, we have ventilation, all of that. We wear masks if we’re not, great. And I have a circle of friends that share my strata-of-fear.

Dr. Gandhi: And it’ll become a new determinant.

Dr. Z: It is.

Dr. Gandhi: Yeah.

Dr. Z: It’s the fearful determinant of socialness. Like now I’m only gonna hang out with people that just kind of get it. Now, people who are terrified, like my parents, like if I said to them, “Look, we’re gonna mask up, “we’re gonna come visit you.” I bet they would say, “Well, yeah, hold on, hold on now, “we’re still scared.”

Dr. Gandhi: Auntie’s not listening to you enough because my parents, I have said, “I’m going to come and see you.” And they have, let me see them because I have brought them a little differently into my strata.

Dr. Z: Yeah, now one thing I’ll say, Auntie is probably watching the show, because she watches it. I have told her, I’m like, “You guys need to stay safe because you are the high risk.” So I have fear by proxy for my parents because they are, my dad has some lung disease. I mean, my dad has COPD just from being in the Central Valley of California.

Dr. Gandhi: You see, another determinant of health. All he did was just live in a place where we didn’t keep people safe from the environment.

Dr. Z: Yeah, we’re getting LA smog, the agricultural dust, the smoke from fires and so now he’s at high risk. So it’s like, well, you have to kind of weigh that. But again, the loneliness risk, the isolation risk. So we put them on Zoom with the kids and that’s been nice. My daughter will play ukulele for them and this kind of thing. A lot of WhatsApp, you got to put the WhatsApp.

Dr. Gandhi: It’s always WhatsApp somehow.

Dr. Z: It’s an Indian thing because then they’re like-

Dr. Gandhi: You could do text but they are going to the WhatsApp it’s Indian.

Dr. Z: You know, I went viral in India on WhatsApp? So early on in the pandemic, I did a rant where I talked about how our healthcare organizations have fundamentally failed frontline healthcare workers in not providing PPE, not being prepared for this. They had one job, administrators had one job, which is get your ish together and to keep us safe and they failed. And I said, we will never forget this, when this is done, we will have your heads. Like I went on this crazy rant.

Dr. Gandhi: But you’re right, though. And as soon as that was provided, healthcare worker illness plummeted. We have not seen the severe illness thing thank God for the healthcare workers.

Dr. Z: Masking, masking, masking.

Dr. Gandhi: Masking, mask, mask, mask.

Dr. Z: And so for some reason it went viral in India on WhatsApp. Like all the Indian doctors were like, “Look at him, I think he’s Indian, I can’t tell.” I’m like, “Yeah, I am, I am.”

Dr. Gandhi: It’s.

Dr. Z: Yeah, pretty much. So let me ask a question before I forget, because I think when we were talking about the other countries. So how do you fit Sweden into your theory? Because Sweden is such an interesting outlier in terms of masking, shut down. They have a very undense household.\

Dr. Gandhi: Yeah, that’s the thing is that it’s hard to say about Sweden, that they didn’t socially distance by definition, right? Because not only did they ask their populace to social distance, they just didn’t say it was less stringent. They sort of trusted their population to not have large crowds. So they put it out as a very gentle guidance and people would adhere to it. And then beyond that, there is less of a social density, apparently some statistic like half of the people in Sweden live alone.

Dr. Z: Single, yeah.

Dr. Gandhi: So it is a very different situation in these built, lived in environments where people are in crowded housing and that’s what we’ve done in our non sort of-

Dr. Z: Bougie areas.

Dr. Gandhi: Bougie, fix it. Like when you said these white women in the suburbs, we don’t have the projects in the suburbs that have put people together in very crowded environments, right? And so it’s not something that actually directly looking at. But yet that’s how our housing, even if we provide housing for the poor, which we don’t, a lot of times it’s very overcrowded housing. And so Sweden then, they told their populace to stay away, they not have large crowds, they did close things and some things, and people did stay away from each other. And then what they’ll be criticized for, which I think is fair is that when we got the asymptomatic transmission knowledge that in the nursing homes and where the elderly live, that’s where we had to do mass testing. I don’t think we actually can mass test every single human, every day. I really am against that because I think actually, in a way, President Trump showed us that mass testing is not the only way to get out of a pandemic. By the time you test you’re positive, right? Like by definition. So all he did in the White House was use a testing strategy, but these other strategies of masking and not having large crowds work and he didn’t employ those. So testing of everyone, it can’t be done. But testing of inpatient hospitalized patients, of nursing homes-

Dr. Gandhi: And their staff.

Dr. Gandhi: And their staff. Of jails and their staff, these places needed to do mass testing campaigns so that if someone’s asymptomatic but still have it, then they can be kept away and then you do contact tracing of them. And Sweden didn’t do that and there was a high initial spike of death. And there’s much made of, how it was higher than their neighboring countries, not all of them, actually, but their neighboring countries at the time. But then now they’re in a very good place, they don’t have the deaths, they just don’t. They even have some cases, but they don’t have deaths.

Dr. Z: People have been getting tattoos of Anders Tegnell.

Dr. Gandhi: He was the epidemiologist. And then it became very controversial because then he sometimes said that I’m pursuing a herd immunity strategy. And then he sometimes said, I didn’t. This is that issue again, where herd immunity becomes a bad word. Herd immunity is not a bad word. Herd immunity was absolutely a strategy by which you want the population to become immune, as much as you can, by combination of natural infection and vaccine which is what happened with smallpox. We don’t want people to get naturally infected with smallpox it was terrible, but there was no vaccine. So between natural infection and then the vaccine happened and then it went away and it got eradicated. Only one we’ve truly eradicated. So it’s not a bad word, but he got very criticized. But I don’t know if he was pursuing that, exactly because there were things that they enacted.

Dr. Z: That’s right. And in fact, I did a show talking about the super-spreader, overdispersed characteristic of this virus. And the idea that there is a stochastic element, in other words, there’s a randomness and there’s a super-spreader component. So what Sweden did was actually kind of, ideally, I don’t know if they did it intentionally, but kind of ideally targeted to that phenomenon. Big groups are bad ideas so they banned 50 and over groups. Now that ban stayed in place even as other European countries relaxed their larger bans.

Dr. Gandhi: So they still have this ban?

Dr. Z: They still have this ban. The second thing they did was they asked upper schools like kids older than 16 to do distance learning, But kids under than 16, they left open. Thinking that really the super-spreader characteristics are more in the adult population. So they never closed their elementary schools and so they didn’t destroy that fabric. And then the third thing was that they asked their people to distance, which they actually did do, innately because of household size and partially because they actually trust their government.

Dr. Gandhi: Trusting, that’s a very good point.

Dr. Z: And so the fear component was ameliorated by the fact that our guys know what they’re doing. Whereas here it was fear with our guys don’t know what they’re doing because they’re telling us mixed things and doing the opposite, like quarantining everybody for a long time, but then only partially. And then having it just be opening up things like bars and stuff.

Dr. Z: And not schools.

Dr. Gandhi: And not schools.

Dr. Gandhi: Where children have to learn. And like you said, the essential workers, where are you supposed to put your children? And then also they need social development, is terribly important for schools.

Dr. Z: It’s key. And again, it’s hurting poor people, specifically- Talk about control. Okay, let me just rant for a second. As someone of reasonable affluence, I can put my children in a private boarding school, that’s in-person and get them tested all the time and if they get sick, they isolate on the premises. And that’s what people are doing, they’re leaving the city of New York and they’re going up to Connecticut, to their second homes where they’re then putting their kids-

Dr. Gandhi: I have a theory you can never say second house, you have to say second home. Because by saying home, it makes you seem less that you would be of such affluence that you have to have two houses.

Dr. Z: That’s right, that’s right, that’s right, that’s right. Winters in Rangoon, we made meat helmets. And again, I’m not trying to generate class hatred here. I’m saying I’m part of this upper class. So I could easily do this and people are doing it. And then they lose the lived experience of the horror that is this.

Dr. Gandhi: That is the horror that is not having your children in school. Because it is horrific and it is not right for their development.

Dr. Z: My children are both in public school in the Bay Area and they’ve been on Zoom, they both really don’t like it. The youngest one is getting really crappy teaching because there’s no feedback. And so as a result, they gave a survey, “Hey, if you guys could come back to school, “would you do it in person? “And would you, even if you had to lose the teacher “that you have now and this and that-” They’re were like, yeah, yeah, yeah. “What can we go back? “When can we go back?”

Dr. Gandhi: And there are ways to keep the teachers and everyone safe. So we have all those protocols in play. And in this state, the governor has even given the green light to go ahead. But every county is now doing their own thing with their own level of decision making and it’s taking a long time. And it would be really helpful for children to be in school because it has been now since March.

Dr. Z: It’s scary. And everybody has an opinion on this and they all come from their own place of being. But I think, again, to tie it back to something you said, strata-fear and what’s the cause of strata-fear. Okay, this is something that gets tricky. I gravitate to people at a low level of strata-fear, meaning they get the risk, they understand their place in it and they’re willing to behave in a way that’s concordant with their risk. That requires a certain understanding that there is a tiny chance that you could get sick and die, but you’re not so afraid of mortality to outdo your fear of not living your life, this iteration that we’re given. And that, for me, I can only be with people who are that way because we connect on an almost trans-personal level.

Dr. Gandhi: It is. It’s not that you just become stratified by your fear level of COVID. It is actually a fundamental way to live, right? Which is that, actually, you have a chance of dying at all times and ultimately that chance will become 100%. But we live as if we are never gonna die. And yet, what kind of life do you have where you don’t see anyone, where you don’t hug your children, where you have so much fear that you’re not actually living, right? And there are people who are truly not actually living right now. And then the question is what’s their quality of life, if you have that much fear? Because it’s miserable to feel that anxious. And I’m so sorry that they feel that anxious, because I think there’s things to be done with this non-radioactive respiratory virus that we can do to keep ourselves safe. And I feel really sad for people who are that anxious. I have a friend whose husband is very anxious and it makes me sad that he feels so sad. And it has led to tension between the friend and me. And we have come to a resolution now. I have other friends that their level of fear has made it difficult for me to interact with them and now we won’t interact for the time being. But I think it’s a place where you have enough spiritual, in a way, and I’m gonna use the word spiritual, because I think you have enough feeling that you understand you’re gonna die, fundamentally, actually. And you have come to some level of understanding about that, that you’re able to move around and interact in the world. And if you’ve come and it is spiritual to come to the fundamental understanding that you’re gonna die. And if you’ve never come to that understanding that you’re gonna die, your fear will rule everything.

Dr. Z: Always, absolutely. And in fact, right before we did the show, I told you I did a live a show about meditation. Because every day I try to meditate and I had an experience this morning I’m like, “I wanna do a show about it.” And I meant to only go live to my subscribers, the people who pay $4.99 a month which by the way you should do, because it’s a small group. And it’s a wonderful group where we have a give and take, right? But then I realized I was live to the whole page, so I couldn’t take comments, but instead just was telling people, “We live in this now moment that is so colored by anxiety, “fear of mortality, fear of other, fear of everything. “And that’s all a coloration of what we actually are, “which is beyond death and life.” And it has nothing to do with religion, this is purely an experience you can have through meditation. And once you have that experience, your fear of death, and in fact, in many ways, when you really have an experience like that, and you can have it through prayer, you can have it through meditation, you can have it looking at the stars as an atheist, the ego dies, transiently, you experience death. And what you’re left with is this still, ever-present awareness. And you go, “Hey, that’s not so bad.”

Dr. Gandhi: It’s not that bad. Like universal loving consciousness where there is some still awareness forever, not that bad.

Dr. Z: Not a bad thing.

Dr. Gandhi: But yes, but this physical body will die.

Dr. Z: It will, it has to.

Dr. Gandhi: For everyone.

Dr. Z: Everything is transient, everything is transient, including this pandemic, which is why people say is this the new normal? Now one thing I do worry about as we’re approaching an hour, I got to say this because it’s important. I worry that the anxious stratas”fear”, and again, I’m not blaming people for being anxious, it’s somewhat hardwired into us, especially people who suffer from a lot of anxiety. And they’re a lot of them are my fans, like they’ll message me and go, “The only reason I watch you, I’m new to this.” Since, COVID started, talk about benefiting from the zoomocracy. Since COVID started, our audience on Facebook alone has grown by 600,000 people.

Dr. Gandhi: Wow.

Dr. Z: Yeah, from 1.4 to 2 million people. And a lot of them are people who come because they’re anxious and they saw in me, someone at a level of stratas”fear” that wasn’t in sync.

Dr. Gandhi: It’s comforting to talk to someone who isn’t that anxious because there isn’t- You can keep yourself safe from this particular virus, SARS-CoV-2, you can. You can still see your friends and family while keeping yourself safe, and you’re not gonna die of this. And we have to keep everyone safe so they won’t die of it. And I’m sorry that people are so fearful because I think it feels terrible.

Dr. Z: Yeah, it really does. And the idea, too, that there’s a culture of safety-ism where we think that bad things don’t happen, we can prevent them all. Well, that’s not necessarily true, sometimes bad things happen. But you have to live your life and you have to ameliorate risk in a way that’s comfortable to you and to society. And we’ve gotten that balance kind of wrong, I think, in this country, we’ve really screwed it up, but it’s not too late and we can screw it up more.

Dr. Gandhi: We can, I’ll tell you one thing to end, is that something really bad happened to me, which is my husband died of cancer and he was the love of my life and he was everything and have two children. And I realized that bad things can happen even if you do whatever possible, that it isn’t gonna happen. And this is where I realized that he never lived his life with fear, he lived it with courage and openness and never allowed fear to control anything. And if he were here right now, whether he had cancer or not, he’d be loving and seeing people and lovingly being around people because that’s just who he was. And so I think I learned a lot about fear through this experience of mortality. And all we should be doing right now is being loving to each other because that actually makes this life worth living. And that if it’s worth living, whatever the consciousness when this body dissolves will have been after a life of love and it’s worth living, if you’re around other people, there’s nothing else that’s better than being around the people that you love. So try to not message meanly and try to see some someone this week, with a mask, who you love. That’s how I’ll end.

Dr. Z: I cannot say anything to be more meaningful or powerful than what you just said. And would you ever be willing to come back and talk more about this stuff?

Dr. Gandhi: I will come back, we’re distanced and we are safe and we’re in the same stratas”fear”, I’ll come back and hang out with you.

Dr. Z: We’re in the same stratas”fear.” Guys, I think she had the call to action, I can’t do better than that. My only call to action is share this video, please, with your friends, love each other, live at a level of stratas”fear” where you think you’re being authentic to you and the people you wanna be with and modeling for people you care about, that’s important. All right, guys? I love you, I love you, Monica.

Dr. Gandhi: I love you too.

Dr. Z: You’re so lovely and we are out, peace.