Dr. Z: Hey, everyone. Dr. Z, welcome to the show. Monica Gandhi, infectious disease doctor and professor at UCF. Welcome back to the show.
Dr. Gandhi: Nice to see you.
Dr. Z: You need minimal introduction. You’ve been on twice, but there is somebody here who needs an introduction, and that is Frodo. Can we see Frodo?
Dr. Gandhi: Frodo is a little dog that is named after a hobbit ’cause he has hairy feet. He has a tie on for you today and he is really upset by COVID. And he’s just about to throw the Ring in, ’cause we’re almost done with COVID.
Dr. Z: You know what?
Dr. Gandhi: With these vaccines.
Dr. Z: I would follow him into Mordor. I would wear seven masks and I would follow him to Mordor, mostly ’cause of the fumes, you know?
Dr. Gandhi: He is kinda smelly too.
Dr. Z: Oh, he’s so adorable. So Monica, like we wanted to hang out again because you are one of the few voices of reason that is actually also a physician. So we have tons of PhD epidemiologists who are painting gloom and doom pictures everywhere. Well, you know, first it was this. And then, you know, okay, now we have a vaccine but you know what, the variants are coming. So we’re probably gonna have to wear seven masks and stay shut down. And by the way, don’t even think about opening schools. Why are you thinking about opening schools? Oh, by the way it’s your bad behavior that caused all this death, and so we’re gonna shame you. And on top of that, it’s never gonna get better. So expect 2023, before we get back to a semblance of what will be a new normal, which will be we’ll all be in bubbles. So get those guys out of the picture and go with actual physicians who touch patients. What’s your thinking right now? Where are we in this mess?
Dr. Gandhi: We are just facing like complete dawn of hope and light and love. Like it’s gonna be so great. It is getting so great. So what happened, right? Like March 11th was the day that the WHO declared this a worldwide pandemic. November 9th, we got the first press release from the first vaccine. Phase three clinical trial, that fast. And then we’ve had seven phase three clinical trials. So we have seven vaccines in circulation around the globe that work. And they work exactly using the same protein in different ways using that protein, and they work beautifully, and they all work beautifully against preventing what even made us notice on January 31st, 2019 or December 31st, 2019 that something terrible was happening, which is severe disease. They all work almost 100% to prevent… 100% for hospitalizations. And then like in the 90s to prevent you not even feeling well at home. So they’re amazing.
Dr. Z: And this accomplishment was against even our better judgment, right? ’cause I mean, we’ve all been talking, I’ve been talking with Offit, I’ve been talking with you… Is this gonna happen? Like there’s so many hurdles that have to be overcome in order for these vaccines to work. And we’ve never had a vaccine against coronavirus and so on. And there’s all the red tape and everything. Well, they got rid of the red tape. They did the science, they didn’t cut any corners. They actually just did the science right.
Dr. Gandhi: Yeah, these are peer reviewed fully, like pages and pages of text. They did it all right.
Dr. Z: And you’ve been vaccinated.
Dr. Gandhi: Yes.
Dr. Z: As have I.
Dr. Gandhi: Yes.
Dr. Z: Yeah. So and how is your 5G reception now? Must be really good.
Dr. Gandhi: It is so good, but I also just wanna like rub my… Be really close to people-
Dr. Z: No, but if you read the press, that animal could give you COVID right back, Monica.
Dr. Gandhi: Yeah, and I could give him COVID, but yeah.
Dr. Z: Put a mask on him.
Dr. Gandhi: So we have to understand that two vaccinated people should be, I mean… It’d be nice to crawl over this table and be closer. But this is like, what, three feet?
Dr. Z: It’s three feet.
Dr. Gandhi: So we’re fully vaccinated. We cannot get sick and we should be close. Vaccinated people should be close and they should spend time together. They should see each other as we get to all people being close to that.
Dr. Z: So Monica, I gonna tell something publicly that I have not said. This table is new, right? The last time you were here, I had a six-foot round table. We were six feet apart. This table is now about three feet. And the reason I’m doing that is, I believe with a 95% efficacy that two vaccinated people can hang out.
Dr. Gandhi: They could totally hang out. And remember, it’s not 95% efficacy against severe disease. It’s 100% against severe disease. And then yeah, maybe one person who got the vaccine will not feel well for a few days, because it was mild disease. So that’s the amazing thing. Keep on focusing on preventing what got us into trouble to begin with.
Dr. Z: And even with variants, you know, if they’re gonna be setting against… ’cause the variance of the new bugaboo, right? Like, oh, we always knew there was mutations. That’s what coronaviruses do, all viruses do that. But the thing is if the vaccines are effective against severe disease, which they are, even against the Brazilian variant.
Dr. Gandhi: Yes. I really need to say something. I need to say variants shmariants. Okay, I’m sorry. I don’t know what kind of trouble that’s gonna get me in,
Dr. Z: Hopefully, a lot.
Dr. Gandhi: But let me explain.
Dr. Gandhi: Okay, I hope so. Let me explain why. So actually the best one is the Johnson & Johnson as an example. So, okay. So the Johnson & Johnson vaccine, one dose, was studied in three settings. South Africa, Latin America and the US. And in those three settings, because this vaccine trial was done later than the others, the variants were circulating. So in South Africa, the B1351 accounted for 95% of the circulating virus at the time. And then yes, P1, so-called Brazil variant was very much there in Latin America. Okay, so then you look at the Johnson & Johnson one dose. So we’ll get more data this coming Friday when we get more data from the FDA hearing, ’cause it’s February 26, but what we get from the press release is this. 100% prevention of hospitalizations and deaths. 100%, whether you’re in South Africa with the B1351 or with the Brazil in P1, or there’s B117, anything. 100% against hospitalizations and death. Then 85% in the US, South Africa and Latin America equally even with those variants circulating against severe disease. And what that included was the subset of hospitalizations and deaths, but then also people who just didn’t feel well at home but were classified as really not feeling well at home feeling quite severe, like they had a severe illness. So it’s the difference in the illness across the variant types was in mild disease. And there was 50% efficacy in South Africa and then 72% in the US. And that’s one dose with the immunogenicity of the Johnson & Johnson vaccine showing us from the phase I, II trials that keeps on going, and they of course stopped… They looked at 14 to 28 days after they gave the first dose. Probably after 28 days, it’s gonna be even better because that’s what the immunogenicity showed us with the Johnson & Johnson adenovirus DNA vector. So it’s just gonna get better and better, but it’s very important to say that that is the trial for me. Novavax did the same thing, but that was more complicated. That is the trial for me that showed me that the variants, that severe illness is completely taken away.
Dr. Z: Which is all we care about.
Dr. Gandhi: That’s what we care about, because it’s what, otherwise, we never would have noticed this virus.
Dr. Z: We wouldn’t have cared. It would have been another cold or a mild flu. Instead, people die, they get hospitalized. They fill up our units with prone patients who need ECMO. Well, that’s a problem.
Dr. Gandhi: Terrible, yes.
Dr. Z: And of course, it preferentially seems to affect our most disenfranchised, which we never talk about on the news. It’s always like, well, everybody is like, well, no, actually, this is hurting the same people you’re hurting by closing the schools. It’s the same people…
Dr. Gandhi: So they got it on both sides. People who are racial and ethnic minorities, essential workers, you get both things. You get more COVID ’cause you’re working. And then you close the schools and you do all the economic shutdowns and you don’t chisel your lock downs, and then you also hurt them economically. What a terrible response for the poor
Dr. Z: You, from the beginning have been an advocate for masking as a way of lowering inoculum so that people get exposures at a lower level. In other words, preventing severe disease. Has there actually been evidence that masking does that, or is it still kinda hard to get that evidence?
Dr. Gandhi: So we have a paper coming out tomorrow. It’s in Lancet Infectious Disease, where we try to gather more evidence. How do we gather it? This is how we gather it. We looked back at all the viruses like known to mankind and went through the literature and did a very thorough review on how much inoculum gives you infection for other viruses. And also the relationship between other viral inoculum and severity of disease. We did that for rhinovirus, for influenza virus, for RSV virus. So it was a thorough sort of systematic review. And this holds true for many viruses. Not all the viruses where it holds true is where your immune system seems to have a lot to do the pathogenesis of the virus. Where your immune system hurts you, like the innate immune response. If you get too much virus, you get really sick and we have to give dexamethazone to make you less sick. It seems that where there’s immunopathology at play with viral pathogenesis is where the inoculum matters so much. Can we prove it? We can’t prove it. There will be challenge studies. They just opened it up in the UK. Let’s see if it happens. I hope they give just little to healthy people and then we’ll be able to prove it.
Dr. Z: So you give a small dose to a healthy person. They got it through the ethics committee over there and they’re gonna do it in the UK. They’re like, “‘ello, guv’nor. Here’s a little COVID.” I don’t know what kind of accent that was, but it had nothing to… Could you imagine like My Fair COVID, like a full musical?
Dr. Gandhi: I like the governor. I think that was really good, but it wasn’t governor. You took away a syllable.
Dr. Z: I did.
Dr. Gandhi: That was very good.
Dr. Z: Guv’nor.
Dr. Gandhi: It was very good, yeah.
Dr. Z: ‘ello’ guv’nah. But it’s an interesting idea that even they’re willing to do that, says that they must subscribe partially to this inoculum theory.
Dr. Gandhi: Yes, they will give little bits in the hope that people won’t get too sick. So by definition, a challenge trial will show us that for sure, like they did with influenza. So we’ll get that data. I thought a challenge trial wasn’t gonna be done, but it is. It’s been approved and it’s starting. So now we’ll get that data definitively, ’cause the only way to know would be to give human beings various doses and see if they get more sick. So we’ll know that soon. And then the second thing is, there was some other research by the NIH that masks may humidify the virus.
Dr. Z: I saw that.
Dr. Gandhi: Yeah. And then the virus hates being wet. It hates humid conditions. It’s seasonal, it likes cold, it likes dry. And so that humidity created by that seal of the mask and the face may prevent it from actually going down into lower respiratory tract and getting more sick. I thought that was an interesting hypothesis. We won’t know until the challenge trials for sure, but there’s more and more evidence. But you’re right. The whole point was to stop severe disease. That’s what you care about.
Dr. Z: That’s what you care about. And we were talking off camera a bit, because one of the things that comes out now, there’s a feeling in the public, because the officials and the way they communicate has not been the best. And some of that is just central, like lack of coordination. And some of it is just, I think a bunch of nerds trying to teach stuff and be trying to figure out where, you know, like, what should we be saying based on what’s gonna get people to do what they need to do? And then they do exactly the opposite of what’s correct. Like shame people about masks or keep moving the bar. Well, you can get vaccinated but you still have to wear seven masks. And now, but one of the things that did come up is…
Dr. Gandhi: And mask Frodo.
Dr. Z: Look at Frodo. Would you mask?
Dr. Gandhi: He doesn’t deserve a bad look. That’s not right. That’s just not right.
Dr. Z: It’s not right. You know, for one who has seen the Eye of Sauron, who’s a Bearer of the Ring, he deserves better.
Dr. Gandhi: Exactly, he deserves better.
Dr. Z: He deserves better. But the thing that I think a lot of people who are more on the spectrum of, hey, give me Liberty or give me death, are saying, now they’re saying, “I need to wear two masks.” ’cause you’re kind of the expert on this. How do you think about the multimasking question?
Dr. Gandhi: So I wrote a paper with Linsey Marr, who is a physical scientist in November, and this was starting with our third surge. And at that time, it actually goes back to that first paper about masks like cloth and surgical not blocking everything, because no one ever said that they blocked all viral particles. And so if you block more, if you block some, could you viral inoculum be less? Okay, that was the theory before, but it’s true. They don’t block all. And so there are ways to increase the fit and filtration of a mask. It’s not double masking exactly. It can be double masking. It could be a surgical plus cloth mask or it can be a filter inside two pieces of cloth, but increasing fit and filtration will block more. And then going back to tiered… So we wrote that article, then the surge was happening. Now, going back to tiered messaging as the surge is… the cases and hospitalizations are going down everywhere, going back to tiered messaging, where would you want to have more fit and filtration? If you’re medically vulnerable and if you’re inside, period. This wouldn’t be outside. This wouldn’t be for children. This wouldn’t be for people who are not medically vulnerable and it wouldn’t be if you’re vaccinated. So while you’re waiting to get vaccinated, if you’re more medically vulnerable, or if you are around people at less distance for example, in schools, because there’s a commentary now that schools may not be able to open until there’s a very exact measurement, which is of course not based on any science.
Dr. Z: Any science at all.
Dr. Gandhi: In fact, well, I will go back to this, but the WHO says one meter, and I heard a rumor that someone miscalculated and thought that one meter meant six feet, ’cause you know how we’re just terrible at metric and like calculating-
Dr. Z: We crashed a Mars probe because we got that wrong.
Dr. Gandhi: Okay, we did? Oh, I didn’t know that. That’s awful. So I literally, I think apparently, and I’d like to hear it. Someone told me this, that we just miscalculated and that’s why we said six. So the whole world has signs up. Like India, they have signs up that say one meter. And that’s 3.28 feet, I think. So it’s not six feet. But at any rate, the six feet has come into play here in this country around schools. And so if you can’t get that six feet ’cause that may be an issue with some more crowded environments, then you can increase your mask, the teachers while they’re waiting to be vaccinated, since they’re adults and thus by definition more medically vulnerable than children, they can wear a more fit and filtered mask to feel more safe, which is absolutely appropriate. And I think that’s a great idea.
Dr. Z: Well, there’s nothing wrong with using your own determination of risk to decide what you’re gonna do. And like, you know, like when I go in a grocery store, I wear a mask because first of all, it’s the rules. But second of all, it makes me feel better. Even though I’m vaccinated, I don’t wanna be re-challenged with a coronavirus exposure and have the symptoms of that potentially if that’s something that happens, right?
Dr. Gandhi: Yeah.
Dr. Z: Yeah. ’cause that second dose sucked.
Dr. Gandhi: Yes. Yes. Oh yes.
Dr. Z: Right.
Dr. Gandhi: It did not feel well.
Dr. Z: I was like, damn! Immunity hurts, yeah.
Dr. Gandhi: Yeah, immunity is so great though. I mean, I was kind of reveling in it. I was like, yay. I feel awful, I was so happy
Dr. Z: Women don’t get man flu. Man flu is not so much a symptom complex as it is a whining complex of complaining to a woman about yourself, ’cause that’s what I did. And Mrs. Dogg was not thrilled with me. I was like, “My arm and oh, I have to do a show today with Vinay Prasad, and he’s so smart, so my head’s gonna hurt.” Like, are you listening to yourself? Just shut up. But yeah, so-
Dr. Gandhi: I was very happy.
Dr. Z: Yeah, the positivity though, that you’re exuding now, like let’s contrast with how we were, before we were like, God, the amount of fear that’s being generated is out of proportion to the actual response to the threat. And actually, our response may be damaging. But now, the vibe is, oh my God, the end is here.
Dr. Gandhi: Yes. It’s so… See, it’s so great. And this is what I’m worried about, is that you can encourage hesitancy to take a vaccine or to do anything. Like, if I said to someone, take this blood pressure pill and nothing good will happen to you and your blood pressure won’t come down and your headaches won’t go away, and you won’t reduce your chance of cardiovascular disease. Then they should not take that blood pressure pill. So in this case, we should not say that nothing will change. It will absolutely change. I mean, it always has with mass vaccination and it always has, and this is an unprecedented pandemic because we’re having the vaccine rollout at the same time that the infection is still with us, which, you know, the influenza pandemic of 1918, it took 30 years to make an influenza vaccine. So this is the first time that it’s happening at the exact same time. So I think that’s why there’s so much confused messaging because people are still scared. And I mean, by people, scientists, they still are fearful. They’re not buying into how great the vaccines are and they themselves are conveying their own fear, I think, to people, but it will encourage hesitancy if you don’t think things are gonna change. They’re absolutely gonna change. Masks are gonna go away. Distances are gonna go away. People are gonna hang out. People are gonna go to the theater. People are gonna go to movies. People are going to go to large crowds. People are going to hug. Patients and doctors are going to be… Doctors will be close to their patients and they will bring them back in person, which is a right way to do medical care, I believe. People will come and see people in the hospital who are ill. All of this, all of this will change. And actually, I think pretty soon.
Dr. Z: I agree 1000%. And I think the smart money is on that, but it’s not the public money. It’s not what the press says. It’s not what the media says. It’s not what a lot of the experts would say. And I think some of them are rightfully concerned that they don’t wanna give messages that’ll allow people to just open up before they even get vaccinated. But I disagree.
Dr. Gandhi: Yeah, I disagree, that doesn’t trust the public.
Dr. Z: You got it… You know, it’s like, look, you work in HIV. You have always understood the idea that shaming people into wearing condoms doesn’t work. Shaming people into abstinence will not work. You give them information, you hear where they’re coming from and you let them decide based on the information.
Dr. Gandhi: Yes, see, that’s the weird thing is the same people… Remember how we didn’t like the abstinence only people? Like, remember it was like Reagan.
Dr. Z: Yeah, everybody was like, ooh!
Dr. Gandhi: Like, yeah, ’cause those were the people who were saying abstinence only. And now the people who used to message that you need nuanced, trustful messaging, where you trust the public and they trust you, they’re the same ones that are saying, “Stay away from each other. And if you’re lonely and miserable and wanna kill yourself, that’s okay. That’s okay.” And that’s not right. That’s not appropriate, because health, and I mean, public health, includes hunger, includes homelessness, includes loneliness, overweight, mental illness, depression, anxiety and COVID. It includes all of that.
Dr. Z: Domestic abuse.
Dr. Gandhi: Yeah.
Dr. Z: Exactly.
Dr. Gandhi: And children.
Dr. Z: Like you said, the very people who were so rankled that like Nancy Reagan would have a, Just Say No campaign, are the same ones who are saying, who’re putting “wear your damn mask” in their Twitter handle or “STAY HOME” in their… You know, it’s like…
Dr. Gandhi: The phrase, stay at home is the most non-nuanced message. It is exactly like, just say no. And people would make fun of just say no, because it was so insulting to the…
Dr. Z: It’s condescending.
Dr. Gandhi: Yeah, condescending to the life circumstances that would mean that it was difficult to just say no. And so stay at home, I find a very stigmatizing statement because you have to go to work. You are essential worker. You have to put food on your table. You’re lonely, you’re a widow, you’re single. You don’t live with anyone else. You have to see others. And that’s part of your ability to go on. So I find that message, you’re right. It’s almost like the same people are saying that message used to insult people for using non-nuanced messages before. I don’t get it. I don’t know what’s going on.
Dr. Z: I think it’s a tribal… It’s become so political everything that it’s a tribal identity badge. That I’m either with this… It’s the same thing that says, you know, “Follow the science.” Okay, this is dumb. That’s a dumb statement.
Dr. Gandhi: That’s true.
Dr. Z: Because the science is not a thing. It’s not something that you follow. No, you should be saying “follow science.” In other words, follow science. Use this method to inquire and discover what’s the truth, and it may be, but when they say follow the science, they’re saying follow what this one guy is saying, his interpretation of the science, which is this and this and this-
Dr. Gandhi: Which is informed by his own biases.
Dr. Z: Always.
Dr. Gandhi: He’s scared. He doesn’t wanna go outside. He’s older. He’s a PhD epidemiologist who’s older and hasn’t been touching, hasn’t been seeing patients. I mean, I do think being out and being human during this pandemic and then having infectious disease knowledge is helpful, because it allows you to realize what patients are going through and what other humans are going through right now. My patients have, I think I said this last time. I have seen people pretty miserable who have had HIV. I’ve never seen a group of people more miserable than now. And I mean, even when they first got HIV, right now, this misery of loneliness, depression and shaming is a terrible combination.
Dr. Z: But you know, “follow the science” and “stay home.” And I’m ZDogg ‘wear a mask’ MD. And again, and you can agree like, “Hey, masks could be good.” Staying out of unnecessary travel in the height of the pandemic, probably a good idea. Avoiding large indoor gatherings at the height of the pandemic, probably a good idea. So what do we do as a policy? We close schools, we force kids back home. We then close playgrounds and as Vinay said on the show, Vinay Prasad, he’s like, they actually took out every other swing so that kids could distance like some kind of electron valence shell repulsion theory. And close outdoor dining, outdoor dining in California-
Dr. Gandhi: Great, which is so safe.
Dr. Z: Yeah.
Dr. Z: Yeah. And let’s force everybody indoors. So it’s like the opposite of what you want. And instead of messaging with love, respect and understanding, we message with shame and a political badging. I think it really is… Just like the Right messages, oh, this thing is a hoax and let’s go out and party and go to spring break. And again, I’m simplifying it. Not everybody’s like this. The Left will badge as: Stay home, mask up, listen to this, follow the science.
Dr. Gandhi: Yeah, and don’t see anyone, another human being for a year, otherwise, you’re a very weak person that you would want to have human contact.
Dr. Z: Oh, heaven forbid!
Dr. Gandhi: It’s very strange. It’s very strange. So you’re right that the two things that happened is that we’re not incorporating. I use the word biology instead of science, because I think science, you know, Thomas Kuhn wrote about the philosophy of science, and that how everything is informed by that person who interprets the data and speaks it, it’s informed by their own personal biases. And so I actually don’t even use the word science because I know the biology of this virus. So, so much has changed from what we knew from the beginning. We know that outdoor is very safe, actually, not even 20 times less likely, ’cause I looked quite deeply into that metaanalysis that said outdoor transmission is 19 times less likely to occur than indoor transmission. And even that was informed by one study and a few data points. So if you take this out, it’s likely like much even, way less than 20 times safer to be outside. So we should be encouraging outdoor activities. And then the second is masks, of course, don’t have to be worn outside when you’re not around anyone. That would be so strange. That’s like a tree falling in the forest. No one can hear it, but also if you distance-
Dr. Z: Schrodinger’s cat. Schrodinger’s mask. He’s masked, Frodo is masked.
Dr. Gandhi: Schrodinger’s Frodo.
Dr. Z: Oh!
Dr. Gandhi: Schrodinger’s Frodo.
Dr. Z: Schrodinger’s Frodo.
Dr. Gandhi: So, if you can stay away from people, I think of this paper also that we have coming out tomorrow talks about this. Complimentary non-pharmaceutical interventional triangle, which is masks in one side, distancing on one side, ventilation on one side. So if you have a lot of ventilation, you don’t need to mask, meaning you don’t need to mask outside if you’re distanced from each other. These two components are already taken care of. So you don’t need to mask. And then if you can’t distance and ventilate, then that’s where you need the stronger masks. So they all inform each other. So we know so much more science, right? We know so much more biology about the virus since the beginning. So blunt lock downs wouldn’t make sense, like closing out our playgrounds, like this latest surge, closing outdoor dining because that gives people an ability to be around each other. It was right during the holidays too.
Dr. Z: That was the worst.
Dr. Gandhi: Like I remember like when they first announced it, and there was a public health official who said, “Consider your social bubble burst.” And I thought that was a very incredibly harsh thing to say on December 4th.
Dr. Z: Are they sick?
Dr. Gandhi: Right before December-
Dr. Z: What is wrong with these people?
Dr. Gandhi: Like all the things that were gonna happen, which were the holidays. Instead, create spaces that people can be together safely. Tell people how to be outside. Tell people how to, if you’re gonna do two families over the holidays, then the two nuclear families can be in separate rooms when they’re eating. There were many things that we could have done to chisel our approach. So because we know so much more about the biology. So to keep on the same messaging because we think that people are gonna be bad, so we wanna take an extreme approach is not trusting of the public. And I can’t trust a public health official that says something if they don’t trust me. So it is two-way street because we know that from doctor-patient. A patient can’t trust me unless I expose my own knowledge base and vulnerabilities and tell them, “Yeah, I totally get why this is hard. And let me explain why and what you can do to keep safe.” So keep that in the macrocosm is that public health officials and the public have to trust each other. So then, the public didn’t trust the public health officials that said, “Stay away from each other completely and lock yourself in your house.” So then people did see each other, and then there was more, without the proper messaging how to do it safely, there could be more transmission. And that occurred over the holidays.
Dr. Z: I think you’re right. And I think, you know, you throw into the mix though, unique dynamics of COVID, which is the vast majority of people either have minimal symptoms, mild symptoms or nothing.
Dr. Gandhi: So weird. It’s such a weird virus. It causes such protean clinical manifestations. It’s so strange. And we have to take that into account that 40% of people are asymptomatic when we message.
Dr. Z: Right. And the idea that then their neighbors or they had COVID, they did fine. How are you going to instill any respect for a virus that you’re probably thinking statistically is not gonna hurt you or your loved ones? Well, then it’s tough. And then you have the opposite. You have people, and I see this all the time. And this honestly is a pet peeve of mine because it causes suffering. Young person, otherwise healthy, terrified of this thing. Like, because they’ve been watching the news they have the social contagion of someone sneezing, some anchor person sneezing on their mind and infecting them with fear, when they are in the prime of their life, they need to be interacting with people. They need to be out doing their thing. Instead, they’re hiding behind two face shields. I recently was on a flight. There were two young people in their 20s. You never know, they could have had diabetes. Who knows? They were thin, healthy. Doesn’t mean they don’t have something. So I can’t really say, but there were a couple, they had hiking gears, you know, they’re active. They were wearing two masks, a full goggles, like they’re flying a plane and they had gloves on to get on this flight.
Dr. Gandhi: Ocular transmission doesn’t occur. So I think that’s gotta go. That whole-
Dr. Z: The whole face shield-
Dr. Gandhi: The face shield and that, goggles, because there’s not been a convincing case. Same with the surfaces and fomites. We got to change messages, more data comes up.
Dr. Z: People keep asking me, should I be disinfecting my groceries? And I’m like, no.
Dr. Gandhi: No.
Dr. Z: You should be eating your groceries.
Dr. Gandhi: And you can eat them right away. The USDA finally said it. I think sometimes people only trust governmental organizations, and that’s fine.
Dr. Z: That’s fine.
Dr. Gandhi: But the USDA said this just two days ago, that groceries, food and the food packaging cannot spread COVID, so please eat your food.
Dr. Z: Yeah, eat your food.
Dr. Gandhi: Yeah, eat your food.
Dr. Z: You don’t have to leave it in the garage for a week-
Dr. Gandhi: Before you eat it.
Dr. Z: And then it goes bad.
Dr. Gandhi: First test it first and make sure it’s been good.
Dr. Z: Everyone’s getting like staph aureus toxin syndrome from letting their meat sit out.
Dr. Gandhi: Yeah, don’t let it sit.
Dr. Z: Right, oh my God, yeah.
Dr. Gandhi: But yeah, that fear… Okay, so I actually think, I do think that fear is gonna go away pretty quickly though. And so, you’re right. That we have infected people with a lot of fear and it was the hope of infecting people with fear. I think that was a very good example that you said it, anchor sneezing into people’s minds, but the hope was to keep people away from other human beings. And then instead of just presenting biology and keeping people safe within the context of what we know about the virus and the non-pharmaceutical interventions at work. But instead, it was this tremendous fear so that we hope that people stay away from each other completely against their better instincts ’cause they’re human beings and they’re primates. But they thought that would be effective. People thought that would be effective. In some cases, it has caused people such severe anxiety that I am really worried that that will last a while. And it has led to depression and it has led to anxiety, but I think human beings are resilient. And what will happen is, and I’m gonna use a phrase that I’ve been thinking about recently that someone said to me, which is that, I think when the hospitalizations go down and when there are very few severe illnesses from COVID, society will fly open. And I’m using that phrase, fly open, deliberately, because you cannot keep people, people cannot be fearful of something that doesn’t cause severe illness. They cannot because they were never fearful of mild respiratory illnesses. And so it will naturally go away. And so, even though many people would get very mad at me about masks because I researched masks and they do say some angry things at me, but they won’t have to wear a mask and they’ll stop being mad at me, because also the masks will go away.
Dr. Z: Right, yeah. And, for Monica Gandhi, who’s been a proponent of viral inoculum effects of masks to say, masks will go away…
Dr. Gandhi: They will go away. They’ll go away.
Dr. Z: You need to listen to that. And I agree. I actually am with you-
Dr. Gandhi: Get out your lipstick. Sorry, there’s like, all these lipsticks and they’re sitting there and people haven’t been able to use them. And really, I like lipstick and you want people to be able to have their different colors.
Dr. Z: Am I gonna have to admit to you that I have a collection of lipstick myself?
Dr. Gandhi: I’ve just never heard anyone say the lipstick thing and we’re all thinking it. Many of us are thinking it and I wanna get out my…
Dr. Z: The lipsticks-
Dr. Gandhi: Yeah, lipsticks.
Dr. Z: You know, I want people to see my emotions. Part of the reason I like doing this show, is it’s my, I get to express myself without a mask. It’s really been great. Otherwise, it’s just .
Dr. Gandhi: It’s very hard in the patient-doctor interaction as well. It is not how it is having the masks. So all of this will go away, why? Because things will melt away naturally. Like, you know how we keep and say, “Children are resilient,” which is this awful statement that we’re using to keep-
Dr. Z: To excuse abuse, yeah.
Dr. Gandhi: Yeah, excusing not having in-person learning and not working harder on that. ’cause we had to have worked harder on that, to have where we are right now in February is just terrible for school openings. And so we used to say, “Children are resilient.” Well, adults, and I actually think adults are resilient. They are only fear… They’re only scared of this virus because it can cause severe illness. They are right to be scared. That’s very evolutionarily right. If the vaccines take it, make, de-fangs the virus. I use that phrase because it takes its teeth away. And it makes it into a cold virus. Then people will naturally, the fear will fall off like scales.
Dr. Z: I’m with you 1000%. I actually was telling my wife just today that I think that, if you’re gonna do a vacation, do it now, do it soon, because-
Dr. Gandhi: It’s gonna get crowded.
Dr. Z: It’s gonna get crazy. There’s gonna be an opening and a release of tension. And the thing is the press and the media and the entrenched interests that actually really are generating a lot of revenue from the coverage of this, it’s kinda like, well, Trump’s gone. We’ve got nothing to talk about. Well, what about variants? Well, what about this? What about, but did you hear about the one dose Johnson & Johnson vaccine? It’s only 60% effective against mild disease in a variant population, but it’s 85% against severe and like 100 against hospital and death.
Dr. Gandhi: Yeah. Amazing.
Dr. Z: It’s like, they don’t know.
Dr. Gandhi: Yeah, no, you’re… I mean, that’s very interesting that you say that thing about Trump, because I thought that the narrative had to be kept extreme. The extreme of the narrative was because people really wanted Trump to not win the reelection. So after he didn’t win the reelection…
Dr. Z: You’d think the narrative would soften.
Dr. Gandhi: Yeah, soften.
Dr. Z: But the opposite.
Dr. Gandhi: Yeah, and and I’m wondering it’s addictive to have fear and it’s addictive for people to wanna call up the people who speak of fear and get them on TV. And then maybe the people who like to be on TV ’cause they weren’t on TV when they were super geeky and in a lab. So maybe they like being on TV. But they will get off TV because it will melt away with taking away the virus.
Dr. Z: I was just talking to Vinay about this. Look, I have benefited tremendously from the existence of the COVID epidemic, because suddenly my platform is something people wanna watch. Whereas before it’s like-
Dr. Gandhi: Yes, health is everything right now?
Dr. Z: Health is everything right now. Health is everything. I would shut it down tomorrow if I could get this thing to stop. But there are people on Twitter, particularly, doctors who are, I’m gonna… Can I go off for a second? You don’t have to endorse any of this. In fact, you can sit there politely with the beautiful Frodo and just nod uncomfortably. There are people on Twitter who are not great doctors, have never done much academically, aren’t even great communicators, who have been empowered like the Nazgul, the ringwraiths in “Lord of the Rings” that by the darkness that’s happened to go up and suddenly, yes, Frodo. Throw it into the fire, “Cast it into the fire, Boromir.” No, not Boromir. Elendil? No. Who was the guy? I forget now. Anyway, so-
Dr. Gandhi: I just know Samwise really helped Frodo, really get his courage. They were such good friends.
Dr. Z: He said, “Mr. Frodo, I’d follow you to Mount Doom, and I mean to. I told Mr. Gandalf, I-“
Dr. Gandhi: Merry and Pippin. I mean, just those four were so close, and they were maybe vaccinated or something ’cause they were so close.
Dr. Z: One might say they were VERY close. Like quite close, but that’s another thing. And I respect that and encourage, you know, joy in all aspects. But I would say, so to the… To the Twitterati, you know, like it is empowering to get likes and shares and feel important. And by saying things like stay home and, oh, here’s all the negatives and… It’s easy, easy, easy social juice and dopamine. And it’s addictive.
Dr. Gandhi: Yeah, it’s addictive.
Dr. Z: It’s addictive, and the thing is, when it dries up, they will scratch for it because it’s, and they’re humans. It’s very hard to not. And then they go back to the day, oh, Frodo. Frodo took a fall.
Dr. Gandhi: Frodo fell off the chair.
Dr. Z: Yeah, Frodo, don’t fall into the fire.
Dr. Gandhi: That really upset him, the word Twitterati.
Dr. Z: You know what? It should. That is a smart dog. That’s a dog with two Gs.
Dr. Gandhi: That’s a good one.
Dr. Z: But you know, and so, I think we need to keep speaking truth authentically no matter what the cost and you’ve suffered a bit about this.
Dr. Gandhi: A lot, actually I have to say, I’ve never, never, ever been controversial. I’m just like good Indian girl, did what I was supposed to do. I became a doctor. I just did everything they told me to. I went to medical school…
Dr. Z: Everything…
Dr. Gandhi: Like, every, yeah. And so I just, I didn’t understand. So this is the first time that I’ve ever had people yell at me ever in my whole life, because I sort of research things. So I don’t say things until I feel sure of that biology behind it. And so, people yell at me about mask research and then, so I get a lot of people yelling at me from that side. And then I got a lot of people yelling at me about optimism about the vaccines. And that yelling is particularly painful, ’cause I just know that they know in their heart that they’re wrong about doom messaging right now and that it can hurt our vaccine cause, because there is anti-vaccination sentiment and there is distrust issues with vaccines. And so, I know they know better, but they just wanna, I think, wanna keep people with this fear messaging, because for so many complex reasons and I’m not sure all why, you said some of them. And so they will also yell at me if I’m too sanguine. And I don’t understand how I can be like yelled at by that many people, but it’s really okay because when I think about looking at myself in the mirror, I never thought schools should be closed from the beginning. Because I knew the effects on children, that this is not a bi-modal infection like influenza is. It hurts the young and the old. This was more that affected adults. And so once you figure it out, how to keep adults safe, and that was probably by April, we could have had schools be open with the safety precautions for adults. And so I never advocated, I never changed my mind on schools like people change their mind. I never actually changed my mind on masks, I never thought that they blocked transmission completely. I wanted that inoculum effect. So there are many things I didn’t change my mind on. And then I didn’t know what was gonna happen with vaccines. I knew I’d be really excited if it was 60 to 70%, because we were all jumping up and down when we thought it’d even be… ’cause herd immunity means you don’t need 100% of all those herd to be 100% protected. You need like some to be like 60% protected. So that’s what we wanted from a vaccine, 60 to 70% effective. Then when this 95% number came out, I couldn’t, like I could not stop being joyful. And I have not changed my position on that. I can’t not be happy about it. And so these are amazing. I think the spike protein was the right…
Dr. Z: Right target.
Dr. Gandhi: Was the right target, because all seven of them do this for severe disease. I just know that if I don’t talk about mental health impacts and other impacts when you can keep people safe and know the biology of the virus and still keep adults safe but still help children and help them have in-person learning, which is mandatory. I wouldn’t be able to look myself in the eye. So I’m just gonna keep myself like this but I promise I’m gonna be off Twitter and you’re never gonna hear from me again once this COVID thing is over, ’cause I have no desire to be yelled at after this.
Dr. Z: So this is a problem.
Dr. Gandhi: I will close down that account.
Dr. Z: You have a serious problem, and it’s called integrity. And that’s a problem with media people, because if you have integrity, then you will do exactly what you said. You will believe something, you’ll know, you’ll test, and then you’ll worry about, oh, is a vaccine. Oh, it came back. Ha, joy, express it authentically, tell people you’re worried about school. You’re worried about that. You say it, regardless of the fact that you’re generating hate, hate, hate, hate, hate from people that ought to know better but they’re not incentivized to know better. They’re incentivized to generate hate because it generates love online for them, which is a shot of dopamine, which by the way is as ephemeral as a line of cocaine or any kind of drug you can imagine. It’s that ephemeral and yet we chase it and chase it and chase it. And so it took me a minute to realize that I needed to stop chasing that. And now, I’m just, like I said, I would just shut this whole enterprise down tomorrow if I thought I wasn’t doing any good or I couldn’t say what I wanted to say. And that’s why I think you need to keep doing what you’re doing until like you said, you realize, okay, I did, I said what I needed to say, I can sleep. We’ve woken up, we’re back in business. Turn the Twitter off, you’ll be vastly happier.
Dr. Gandhi: Yeah, I can’t wait. I started in April, 2020 and I hope I can stop it in April, 2021. I think that may be a little soon, but we will get to herd immunity and it will all fall away. It will all fall away. All this anguish, all this yelling at each other, all this politicization, all this depression, it will fall away. Thank God for the human body that knows how to mount immunity to things it hasn’t seen before. Both natural infection that is truly a very terrible immune response, and/or to favorably to the vaccine.
Dr. Z: And natural immunity gets a lot of hate from the same people. “But you’re not really, re-infections though.”
Dr. Gandhi: Yeah, so rare.
Dr. Z: Severe disease? Severe disease re-infection?
Dr. Gandhi: And when it’s not only so rare but when you get infected, right. Because of the T cell response. I’m in love with the T cell and I talk about it a lot, but that’s because I work on an infection mainly that hurts T cells, which is HIV. So I think about the T cells, both CD4 and CD8s a lot.
Dr. Z: Do you know that’s why T-Pain called himself T-Pain? The rapper T-Pain because, ♪ He’s in love with a T cell ♪
Dr. Gandhi: No, is that true?
Dr. Z: I made that up right now, but it feels real, doesn’t it?
Dr. Gandhi: Sometimes, I really believe everything you say.
Dr. Z: You know what? You should, ’cause I’m always right. You’re right, and that T cell response and memory response. Marty Makary recently did a Wall Street Journal piece, where he’s like, “We’re gonna have some semblance of herd immunity very soon.”
Dr. Gandhi: By April, he said.
Dr. Z: By April. And you know, he was recently on the show and we have people from the 1918 pandemic who still have a durable T cell response with neutralizing antibodies 100 years later or something.
Dr. Gandhi: Yeah. That was this Nature article. That is actually very impressive. So they were three. They were three when they got it, ’cause these are people from 1915, and then this study was done 90 years later. So they’re now in their 90s, and they stimulated their B cells, their memory B cells, and they could produce neutralizing antibodies, readily, happily and immediately against that strain of the 1918 influenza pandemic. That’s how durable immunity is to viruses. The reason that influenza… Like, the influence shot that I got four years ago, I’m still very strongly immune against that particular virus. It’s just that it has two spike proteins and it changes a lot. And so I have to get it every year, ’cause it has two and it has a very leaky polymerase. It’s not a very… It doesn’t proofread very strongly, but SARS-Cov-2 is quite tight with its proofreading. We’re seeing some mutations in the spike protein. Cause like you said, that’s what RNA viruses do, but it’s much less, has a much lower mutational frequency than influenza. So there won’t be yearly shots. And then if you really need to lie awake about variant shmariant, then you can later say to yourself, and they’re doing this already is they’re changing the mRNA to be ready if there’s a variant that can evade the immune response. Hasn’t happened yet though with severe disease. So that’s why that will be for the future if something happens. But the reason I don’t think that will happen, to be honest is that T cell immunity even against other coronaviruses protects you from getting severe disease to this coronavirus. So T cell immunity, there’s quite a breadth of response. And I don’t think you can mutate yourself out of T cell immunity. And that’s why I don’t think we’re gonna need it. And then the final thing I’d say about T cell immunity is that, or boosting yourself out of the variants, this thing is gonna stop transmitting by definition as well, because now we’re getting, I mean, we always knew it was gonna stop transmission, but now we’re getting all the real-world data that shows us. So it’s not gonna be able to mutate that fast, because it’s not gonna be replicating. So, and one more thing I wanna say is that, a virus can’t mutate too much because it will mutate itself out of existence. That’s what HIV does. It mutates to try to evade the antiretrovirals and then it becomes less virulent, less fit, and then we can get it.
Dr. Z: Then it’s a chronic disease.
Dr. Gandhi: There’s not this mysterious thing where it will mutate to grow more teeth that we can’t evade, it won’t.
Dr. Z: Right, right. I’m blinded by the positivity.
Dr. Gandhi: I know, you must be so…
Dr. Z: I need sunglasses. It’s hurting my eyes.
Dr. Gandhi: It’s the truth though. It’s biology, it’s the truth.
Dr. Z: I know. I’ve been in the shadows for so long. I’m like Gollum from “Lord of the Rings.” I’ve just two big eyes. Where’s Frodo?
Dr. Gandhi: Let’s bring him out one more time. So you were in the shadows ’cause 2020 was so awful and I’m so sorry that COVID happened. And then suddenly, poom, he just threw it. He threw the ring into Mordor, like poom.
Dr. Z: Toss the ring. I actually bit it off his finger. I bit it off his little paw and I fell into the fires of Mount Doom, which is the basically, Twitter.
Dr. Gandhi: And he’s just looking up from here.
Dr. Z: Look at him, look at him. Frodo, you sir, are a hobbit among hobbits. And I gotta say, you know, there was an old “Lord of the Rings” cartoon, and there was Glenn Yarborough who did the soundtrack, and he was like, ♪ Frodo of the nine fingers and the ring of doom ♪
Dr. Gandhi: “No more doom,” says Frodo.
Dr. Z: No more doom, hey.
Dr. Gandhi: There’s no point in it now.
Dr. Z: Monica, will you come back and talk to us again?
Dr. Gandhi: Yes.
Dr. Z: I’m super excited. This was a joy.
Dr. Gandhi: It was great to talk to you.
Dr. Z: This was a joy. And I gotta say this. Before we did this show, this is a recorded show, on Sunday 2/21 at about 7:00 p.m. Pacific, we’re for getting nasty that way, my supporters who pay the five bucks a month to be a part of our Tribe across Locals, YouTube, Facebook, whatever platform you like. You just go to zdoggmd.com/supporters, and you can sign up there. Got a live conversation with Dr. Gandhi who walked in and I was like, “Hey, Monica, I’m live right now. You wanna be…” And she was like, “Sure.” She sat down with the dog and we talked some smack. So if you wanna be with the cool kids, I’m talking about Frodo, join the Tribe. If not, just leave a comment on this video. Tell us what your experience is. Tell us how cute Frodo is or how cute your animal is, and whether you put seven masks on your dog ’cause you’re crazy. And let’s get over this contagion of panic and fear.
Dr. Gandhi: Yeah, it’s time to look up. It’s great. These vaccines are amazing, I’m so happy.
Dr. Z: I am with you 1000% and my wife is texting me, “What’s your status?” Which means it’s time to wrap up. Fam, love you, hit share, and we out. Thanks, Monica.
Dr. Gandhi: Thank you.