India’s Crisis, Masks Off In The USA: The COVID Paradox (w/Dr. Monica Gandhi)

Dr. Z: Hey guys, Dr. Z. Dr. Monica Gandhi from UCSF back with a special friend. ♪ Frodo of the nine fingers and the ring of doom ♪ Welcome Frodo. How are you buddy? Welcome back to the show. You look like you are chill. Look how chill he is, he’s like, bro, Let’s talk about masking. Let’s talk about India. Let’s talk about this phase of the pandemic. So let’s start with India because both of us have a vested interest in this as does the world because, as India goes, I think it affects all of us.

Dr. Monica Gandhi: It does.

Dr. Z: So you and I’ve been talking a little bit about India here and there for the months. What’s going on? Why are their infections not booming yet? What’s happening? So walk me through what’s going on. What happened and why are we where we are?

Dr. Monica Gandhi: Yeah. I mean, you’re right. It was almost a miracle to think that such a densely populated country, so 1.36 billion people wasn’t being hit before this with this terrible virus, and there were several reasons I think. Number one, anyone who could just like in any society could stay at home, shelter in place, and then who was getting hit? Even before this of course the poor were getting hit. So Mumbai slums, there was a Lancet, June 2020 article, 60% of people in the Mumbai slums had been exposed to coronavirus, had gotten coronavirus; about 11% of the general population. So just shows you the discrepancy, if you can’t shelter versus like you have people come to your house and you can just stay in your house, which is a lot of what rich people can do.

Dr. Z: So I imagine these were seroprevalence studies looking at anybodies and they said, Okay, like 60% of the people. But then the question was, people were wondering, Why was the fatality rates so low? Were they mostly elders getting infected in the early days or young people or what was your understanding?

Dr. Monica Gandhi: The fatality rates I think were lower because more younger people were infected and so they could get through it. I also think possibly, I still going back to our first conversation that we had about masks, that even the simplest thing you can do is just put a cloth over your face, and I think people were masking and if they got more mild infection because of that. I still have my viral inoculant theory going on So then what happened is it seemed like it what was getting so much better and suddenly there was like hardly any COVID and it was an amazing time and so there was, I think an assumption, which I was wrong about, many people are wrong about that there was more immunity in the population than there was.

Dr. Z: I thought that too.

Dr. Monica Gandhi: And there wasn’t because then naturally people completely opened up and there was some political stuff about Modi letting big Hindu festivals go on when he’d closed Muslim festivals a year ago, but of course, Kumbh Mela got moved up early. In India, it’s not like thousands, like millions of people are next to each other, lots of mingling, huge events, and maybe this B.1.6.1.7 is more transmissible.

Dr. Z: The Indian variant.

Dr. Monica Gandhi: The Indian variant. and it went crazy. And this going crazy, now this was the dreaded thing that we thought we weren’t going to see in India but now we’re seeing, kind of like New York at the beginning except that let’s take New York and multiply it by 20 fold because 1.36 billion people. So now it’s so prevalent, there’s so many people getting infected and even if it has whatever fatality rate it has in India right now if you’re multiplying it by many, many cases, people are dying and getting sick.

Dr. Z: And that’s what I was talking to my dad about because he’s like, I don’t understand, India was doing well. He’s worried about our family in Pune, which is a very hard hit area, they’re isolated, but they can do that because they’re upper middle class, the poor cannot do that. And talking about Modi, like in the early days they did it pretty aggressive lockdown and it preferentially destroyed the poor and they realized they couldn’t sustain it.

Dr. Monica Gandhi: You’re so right. Like, remember how he said you have three hours and then we’re on lockdown. It wasn’t like, Oh, we’ll do it on Tuesday. It was like three hours and we’re on lockdown, severe lockdown, you may not leave your house. So many people don’t have a house. And so people started walking back to their villages literally because they had no way to make money and the way that you made money was not like month to month, day to day. So you had no way to make money day to day. It was decimating. And so those kinds of severe lockdowns, I mean, they are the privilege of the rich, no doubt, and very fairly that was not a strategy that could be used thus mask, distancing as much as you couldn’t being outside.

Dr. Z: Because it was interesting to say that it actually worked for a long time, and India is not one country, it is a series of states that are very very diverse, different, different climates, et cetera and end getting from one to the other is not entirely easy, but there is a lot of migration, migrant workers, et cetera. And so it almost seems like you have a perfect storm, like may be there was some degree of natural immunity, natural behavior change with distancing and covering and so on, no vaccination at that time, and climate warm in the summer and then winter cools down a little, I don’t know how their monsoon was and what happened there but then-

Dr. Monica Gandhi: Very hot now.

Dr. Z: Very hot now. Now coming back, like you said, with the super spreader events mixed with a variant that maybe is not more deadly but it’s more higher viral load, higher inoculum-

Dr. Monica Gandhi: Transmissible, high inoculum. Exactly. And so then like if you’re standing next to someone which you inevitably are in India, then you’re more likely to spread it, and then this is right, the perfect storm. And I think our immunity… the bizarre part, not bizarre, this actually happened in Michigan, places that surged and had high levels of infection are not surging right now, like slums in Mumbai, is happening Michigan, by the way, counties that had been hard hit, minority counties, racial ethnic minorities did not have this latest surge in cases, but Michigan in general had not been hard hit. And it’s a whole other thing, you have to think about natural immunity plus vaccinations as you go forward. And India, like you say is right now only at 9.7 first vaccination, right?

Dr. Z: Yeah, very, very, very small. One interesting thing, I read an article in the Atlantic by someone from Bhopal India who was making parallels to the gas tragedy, Union Carbide. And basically saying in the early phases it was the poor that were infected, probably underreported, probably orders of magnitudes more people sick and maybe even dying and we don’t even see it, it happens in areas where they’re not even getting attention. And now what’s happening, and the rich kind of are like, Well, we were okay, we did this.

Dr. Monica Gandhi: Please bring me my food.

Dr. Z: Please bring me my food, from my servants, et cetera, and my driver and so on. And now what’s happening is you’re seeing the rich, and he used a line in in that piece saying, clutching their pearls as their loved ones are not having beds and not having oxygen, not having ambulances. It’s a real divide in India that people don’t really… In the USA, we think we’re polarized

Dr. Monica Gandhi: Discrepancy between rich and poor.

Dr. Z: It’s a chasm.

Dr. Monica Gandhi: It’s painful to watch.

Dr. Z: Yeah, it’s hard when you go back because you’re just like . You feel like you’re 1800s America in the South or something.

Dr. Monica Gandhi: Or 1854 London, which was the time when cholera was spreading and the rich people could stay in their homes and they thought it was miasma, evil humors as opposed to a fecal oral, and so they wouldn’t leave their homes but the poor we had to go out and get all their stuff and they were the ones who got sick and then later it came to them too.

Dr. Z: It seems to, history seems to repeat itself traditionally and consistently. And so in this now, like you said it’s not necessarily that there’s something magical going on in India that we should all go, Oh, this is a new thing that’s brand new. It’s that you have what we had in Wuhan basically, the same virus with some modifications that make it a little higher viral load. Now in a population that has primed through these stochastic events, semi-random events where you have the super spreader event here, super spreader event here, and then everybody disburses. And then you have a country of 1.4 billion people that suddenly is exploding logarithmically in infections with an infrastructure of healthcare that is not designed for that.

Dr. Monica Gandhi: Yes, exactly. And so we very much know that people wouldn’t be dying at this rate clearly, obviously if there was health systems that were different than this. I hope this makes people think differently about how unfair things are around the world but it is unfair that people are dying from lack of oxygen.

Dr. Z: So let’s talk about this lack of fairness because you and I both have this weird thing about fairness. It’s really interesting because the United States really was hit hard, and actually, this was interesting because Indian friends of my parents were calling them, it’s not gloating, but kind of going, “Look at America, you guys are supposed to be the bomb. I thought you were going to have the best CDC, the best vaccine, the best everything but now everybody’s dying, and look at us.” I mean, that’s what it was like. And so my mom was mad because she’s very patriotic, having come here and struggled and as an immigrant and she’s like, “Hey, don’t talk to me. You watch out because they’re just under-reporting in India what’s going on.” And now to see the…it’s just heartbreak.

Dr. Monica Gandhi: Tragic and heartbreak.

Dr. Z: It’s really bad. And so the question is coming to fairness, I think you’ve talked a bit about the U.S and patents around drugs and therapeutics and things like that and how it affects countries like India. Help us understand how we might help India by modifying some of this stuff.

Dr. Monica Gandhi: Actually, I think there’s actually something to be done immediately, there’s two things to be done and I would do it tomorrow in my authority if I were in charge of the world. I would wave patents for COVID-19 vaccines that pharmaceutical companies are holding, and I would also donate our very extensive access supply of, not AstraZeneca, 60 million they already did, that’s not enough. We bought 700 million doses. Remember all that like, Trump said it, and then Biden said it, we bought 600 million doses of Moderna and Pfizer together. And then because things weren’t going fast enough, bought additional a 100 million of Johnson & Johnson. We have 700 million doses of not the 60 million AstraZeneca that they’ve already released which I’m grateful for but that’s a drop in the bucket for India. We have many, many more doses that we can release right now because if we think of the needs of our population it’s only adults who qualify for vaccine and we’re at a third of our population fully vaccinated, we have the vaccine supply to immediately give India more vaccine doses. So that would be the first thing I do, and that seems really easy to me. We can’t hoard vaccines when this is happening somewhere else. But one thing I want to say, Why would vaccines help immediately? They would help immediately because fundamentally like we said before, even the shutdown right now which is quite shut down is very devastating for not only the poor, but actually for like my… I have in-laws there who are dentists or who are doctors and they can make no money, and so it is going to be devastating lockdown. So immediate vaccinations and why do vaccinations bring down cases. They do. We’ve seen it here. We’ve seen it in Israel. We’ve seen it everywhere. Fundamentally they block transmission.

Dr. Z: It’s controvertible.

Dr. Monica Gandhi: At this point, anyone who says vaccines don’t block transmission really do need to go back to like October 2020, and then they can just sit there. But right now we are very clear that we have study after study that showed that vaccines, maybe up to 94%, maybe even more, block transmission. I haven’t seen a single case yet as someone who’s asymptomatic vaccinated got some COVID in their nose and can pass it on. So the point is it would bring down cases and we saw this in Israel, we saw this in Michigan, we saw this everywhere where cases were going up, you get enough vaccination, they go down. So that’s why vaccines are, I consider it, an immediate strategy.

Dr. Z: So would you actually even go further and say maybe the U.S should delay second dose and try to vaccinate part of India?

Dr. Monica Gandhi: I would, I would. I’ve always been pushing for that actually because we know from the UK experience that there was no harm in delaying the second dose or many people in the UK that haven’t gotten their second dose because they delayed it by three months. And there are 1,900 cases right now out of 66.65 million people. They had seven deaths in their country yesterday from COVID, in a country that large, that’s at a 51% first dose rate, that’s what first dose does for you.

Dr. Z: And you have natural immunity already from people who’ve already been infected.

Dr. Monica Gandhi: Yes, exactly. So we could actually delay anyone who’s been infected before, wait on their doses, delay second doses, we could get a lot more to India. that would be an amazingly collaborative strategy that we could do right now.

Dr. Z: But why would we do that? Who cares about India? Why should we care?

Dr. Monica Gandhi: Number one, beyond the like obvious moral and ethical implications of not caring about one seventh of the planet or one sixth, actually, beyond if you just let that aside, anything going on over there affects us, any infectious disease until we’ve gotten it in control everywhere still is happening here. We’re not safe from HIV until people in Sub-Saharan Africa are safe from HIV. If there’s a variant that I hope I don’t actually think can evade the immune system but if it’s very transmissible it can come over here-

Dr. Z: If we’re not fully vaccinated-

Dr. Monica Gandhi: If we’re not fully vaccinated then we can get more and more cases here. There’s umpteen reasons why we’re all interconnected, we are interconnected economically, tech industry. I just saw this New York Times article: the five big tech companies made so much money this last year. And I was thinking, how many Indians are-

Dr. Z: Are driving those companies success.

Dr. Monica Gandhi: All the work going on in India for those companies for people are up in the middle of the night doing the work.

Dr. Z: I said recently on the show, people like to think of India as other, like these are other, they’re not other, I mean, you and I know this because they aren’t other to us cause it’s family. But I’m telling you, having been there, you’ve been there, these are not other, these are our doctors and our lawyers and our engineers, they come here and do that work too.

Dr. Monica Gandhi: They do.

Dr. Z: They work in rural communities. We’re all one civilization, all of us. So that in itself and all the reasons you said, one thing I want to make sure people understand, what you and I have said before variant schmariant. We say that because when you’re vaccinated, it’s variant schmariant. until you’re vaccinated-

Dr. Monica Gandhi: Until you’re vaccinated, of course more highly transmissible variant could spread more quickly so there’s no doubt. I think that’s the only thing variants do, is that there may be more transmissible but not more deadly and not, can’t evade the immune system. So going back to this patent question because you asked me about patents. So the reason that I think about this constantly is it has to do with HIV, I can’t wait to go back to being an HIV doctor ’cause even though I’m in infectious disease, really my passion is in HIV and I’ve been in it for so many years. And what happened is I watched in 1996, I was an intern then, and I watched like we all dead people rise from the dead because of highly active antiretroviral therapies. We all watched the mortality plummet from highly active antiretroviral therapies in this country. It was so amazing. And yet at the same time, for years and years and years people were dying in Sub-Saharan Africa, India and everywhere else, Brazil, everywhere else, except Europe and the U.S because they could not get access to these highly effective antiretroviral therapies because of patent loss, because of big pharmaceutical companies saying, “I won’t make as much money if India, for example, can make cheaper version of the drug with my formula. And so I am not going to give you the formula. We’re not going to go off patent.” And pharmaceutical companies have big ties to government, to our US-based government. So in the year 2000, for example, they spent 176 million in lobbying fees as people were dying in Sub-Saharan Africa of AIDS that they didn’t have to die with, because they wanted the election to go the way they wanted to go. So they absolutely defied and said, No, owe cannot release our patents even though there’s life-threatening emergency, we have an easy formula and people are dying everywhere else except the U.S and Europe from AIDS. And there was so much international pressure that in 2001 finally Cipla in India, so speaking of India, Cipla pharmaceuticals in India said, you know what? I’m going to do it. I’m going to make a cocktail of antiretroviral therapy for instead of 10,000 a year or 26,000 a year that you’re charging for $350 a year. I’m going to leave it less than a dollar a day for triple cocktail to give to Sub-Saharan Africa and to Brazil and to ourselves and I’m just going to do it. And of course, pharmaceutical companies actually sued South Africa ’cause South Africa were buying these drugs and the Treatment Advocacy Coalition sued back, fought big pharma back. And it looked so unpalatable that they were suing South Africa who wanted drugs to save their people from AIDS that finally the big pharma drop their lawsuit. And there was so much international pressure from all of us, from activists, but for just from anyone sitting in around who was like happen to look at the news and saw that people were dying of AIDS when they didn’t have to. And finally patent laws were dropped, of course only 26 million people out of 38 million people still who have AIDS worldwide, HIV worldwide are on antiretroviral therapy. So the fancy good drugs come here and then patent laws have been dropped for some of the drugs that are more toxic or harder to use and that’s what Sub-Saharan Africans get. But at least there was so much international pressure, he were waived, I should say, but it was so many years in so many deaths. So the way you think of what happened then is they had years that they fought it. We have days, we have days right now, the Biden administration is considering waiving patents. The second they do this, they have days to do it, they can make things happen faster for India. India can make COVID-19 vaccines for their people. Other people can make it for them and they could get more vaccines.

Dr. Z: So, isn’t India already a big vaccine producer, why can’t they but they were producing it for these companies, they can’t release sell it locally.

Dr. Monica Gandhi: No, actually they are making two types of vaccines: AstraZeneca vaccine which they called Covishield there, and then their own vaccine, which is called Covaxin, and they were making it for other countries but then, of course, as soon as this happened they’ve turned it towards their own population. They do not have enough vaccine. And if we waved patents, for example other countries could make vaccines for India. And we could even say Pfizer, I know you just made a billion dollar just since the beginning of this year, the profits they just estimated are going to be very enormous from the COVID-19 vaccine market. Pfizer themselves, they could philanthropically give doses to India, but even if they didn’t, if we waived the patent, they could give them, they would just give it to them. I don’t know why we’re not doing this, there’s a big debate going on, actually Dr. Fauci supports waiving the patents Biden is on the fence and they’re all thinking about it. And I keep on thinking, Don’t think too long, please.

Dr. Z: We’re just gonna have to do some internal lobbying you and I, are we?

Dr. Monica Gandhi: Yes, if you know people who are very close, I think you do, please talk to them.

Dr. Z: And what’s interesting is, what’s fascinating is it doesn’t matter who is in office, there’s lobbying and there’s politics no matter what, it doesn’t matter. Everyone’s like, Oh, Trump. Oh, Biden. It doesn’t matter.

Dr. Monica Gandhi: It seems that way, it’s amazing.

Dr. Z: It seems that way. As we finish up on India here, a couple of questions, so what can on the ground Indians do? They don’t have hospital beds, there are shortages of Remdesivir and those kinds of things which I’m not sure Remdesivir helps a whole heck of a lot, have you found it to be very-?

Dr. Monica Gandhi: I think it could, anything that would help, like meaning this would also be helpful if Gilead waived the patent on Remdesivir. I’m actually been wondering about Tenofovir which is an oral drug, there’s some data that shows that that will help, which is kind of a relative of Remdesivir. Anything can help, but those I call tools, the ultimate solution is vaccines. But yes, oxygen, waiving the patent for Remdesivir, getting more steroids like for dexamethazone, anything that we can do financially to raise for India and get more supplies. The problem is we are people and we should definitely raise money, actually people like Priyanka Chopra, people have a big platform are raising a lot of money, but I think of it still as the U.S government’s responsibility, as we’re like all kind of sitting here happily talking about normal and when can we get back to normal and when can we take off our masks, and I think those are important conversations. We’ll talk about them, but it’s almost paradoxical that we’re thinking like, When can we all go to baseball games or when can we be super normal, and this is a conflagration. And so I think that the U.S government would have more ability with their pockets and their donations and oxygen to help and then we will help the U.S government by telling them to please do this.

Dr. Z: Exactly. And you brought up something which is a good pivot to what we’re going to talk about the U.S now, is this idea of holding paradox which humans have a lot of trouble doing and yet life is full of paradoxes that we hold, for example, how can we talk about what we’re about to talk about, which is taking off our masks outside and maybe even beyond that, vaccinated people going back to some semblance of normal, in an aggressive way that I don’t think CDC has done, I don’t think people have talked about, we’re talking about that while half the planet is burning with COVID. And the reason is that two things can be simultaneously true.

Dr. Monica Gandhi: Okay, this is where Frodo comes in from as you mentioned- The simultaneous of Frodo that your audience doesn’t know is he’s adorable but he’s actually really smelly and he needs a bath. So right now, as I hold Frodo up, he looks adorable and I’m like So these are simultaneous paradox that is being hold true right now.

Dr. Z: Right now, beautiful and filthier at the same time.

Dr. Monica Gandhi: Yeah, this really needs a bath.

Dr. Z: This is true. Spiritual people talk about this holding paradox all the time, Zen masters talk about paradox. Paradox is important, but in this case you can hold it without cognitive dissonance if you understand that all these angles are true but partial. So in the United States we’ve been through this conflagration, the PTSD is still fresh. You can say what you will about Trump and people have all kinds of opinions about Trump, but, Hey, Operation Warp Speed kind of worked. We have these amazing vaccines and Biden is spinning them up. Let’s use them. Now, we’re seeing uptake start to peter out as that initial phase comes up, and now in Oregon, they’re getting overwhelmed again because young people are infected because they weren’t vaccinated in the first round and so we see the effect of the UK variant in Oregon. We need to get vaccinated and then we can get on with it. So what’s your take on masks now ’cause you are the mask maven?

Dr. Monica Gandhi: Yeah, I was. I was the mask Maven.

Dr. Z: You’re like Danerys, “The Mother of masks.”

Dr. Monica Gandhi: People are mad at me about that but I actually did think they reduced transmission, I really do believe in that hypothesis the viral inoculum. However, because I am a thinker that does sort of moves with science, I hope, when I think about vaccination we should be actively discussing when masks come off. You can be like really sad about India and be Indian, you can be someone who wrote five papers on masks which I did, including one of the first papers in this country, maybe the first that said, “Universal Facial Masking for the Public,” with my division chief, and you can also actively scientifically think when it’s time to take off masks. Doesn’t mean that people who are nervous have to take off their mask, they can certainly keep them on, but nervous and also like for years there may be people who will still mask, but mandates are for public health emergencies and they have to be based on science, otherwise in any country, not just ours who’s politicized around masks, any country you cannot put a public health mandate unless it is indicated by a public health emergency. And so it is time to discuss when to remove outside mask and inside masks.

Dr. Z: What we’re seeing is now this is going to bleed into the next school year where we’re slapping masks on kids in schools when case rates are very low in the community, when the majority of adults will be vaccinated or naturally immune, does it make sense to do that?

Dr. Monica Gandhi: No, actually I think it’s really clear that sometimes people forget that your risk of getting infected right is very clearly a two factors. One is if you’re vaccinated, you’re great, it’s very rare for you to get infected, breakthrough infections are very extremely rare. I actually keep on remembering that it’s three zeros and then a 5%, so 0.0005% rate of breakthrough infections in the real world even when cases are still circulating, it’s very hard to get symptomatic COVID after being vaccinated.

Dr. Z: So talking about symptomatic?

Dr. Monica Gandhi: Symptomatic. So your rate of getting COVID-19 as a vaccinated person is very rare. However, the other thing that prevents you from getting COVID-19 is not having COVID-19 around in the community. So having low case rates which is exactly what will happen, is happening, we had 21 cases in a city of 896,000 people in San Francisco yesterday with lots of testing going on, it’s not like testing has stopped. So it’s so hard to get COVID-19 even if you’re unvaccinated right in the city of San Francisco. Why? Because our first vaccination rate is 62%, we’re the fastest vaccinating city in the U.S. So the cases are so low that when we go back to school in the fall this will be true everywhere. And to put a mask on a child when the only way we’d even know there were any cases is because we’re asymptomatically swabbing people which we never did for any other infection. And your cases are so low in a population, they’re much, much below a 100,000 right now, I just calculated this morning, in the UK they’re at 0.9 per 100,000. I don’t know if people can even, but it’s very hard to to look around and see COVID in the UK right now. And so to put masks on children when this Israeli study and even just real wildlife epidemiology showed us that with every 20 point increase in vaccination rates in adults that halves the risk of transmission in children because by definition they block cases, they block transmission, they block children being exposed to the virus, then it wouldn’t make sense for children to be masked in the fall when those case rates are low and we have achieved everyone who wants to get a vaccine in this country, getting it.

Dr. Z: Do you hear about the federal teacher’s union or something lobbying CDC for language in their restrictions in schools?

Dr. Monica Gandhi: I did, it made me sad and the reason it made me sad was this, is that when the CDC guidelines came out for school reopening they seemed to not totally make sense. There was two parts of it that didn’t make sense. The six feet versus three feet confused a lot of people because the whole standard worldwide is three feet. 3.28 feet by the WHO, and anywhere a lot of studies that have shown three feet was safe. But beyond that, the thing that was the most surprising that they released the guidelines on a Friday and Jake Tapper on CNN that Sunday interviewed the director of the CDC and he said, “Why did you say that we can only open schools at a certain transmission rate in the community because you said that opening schools was linked to transmission rates in the community but your study, the Wisconsin study showed that wasn’t true you could still open safely if you use all the mitigation procedures. So why did you link it to that? And then he actually showed a map of the United States, he said, no schools could open even though Biden administration said that he wants schools open. And there was no clear explanation of that and then actually it was revealed that the American Teachers Federation did insert language. And it’s actually very fine, of course to interview stakeholders like when you’re making guidelines you should absolutely interview stakeholders, but if stakeholders can change language in like kind of verbatim and text in opening guidelines of our public health organization when that wasn’t based on the studies the CDC had published in their journal so the science said that you could open them during high rates of community transmission, that looks like tampering. So I think is political, actually it made me realize anew ’cause it’s not like this is that surprising, I shouldn’t have been so surprised but it made me realize anew that every administration is going to have politics in their science, and it is actually up to us as scientists, as academicians, as scientists, you with your big platform, you with your platform of just being a doctor who really informs the public. It is up to us to pull people back and say, no it should be based on your scientific studies, it should be based on epidemiology. We should do things that way because school closures have been very problematic. I know that some people think it’s okay but it’s so not fair that the rich all have their kids in private school because they saw this coming and they pulled them out of public and put them in private and those have all been open and the public schools to this day are not open.

Dr. Z: I think it’s interesting cause you, me, Vinay Prasad, Jay Bhattacharya we’re all Bay area people and we’re furious about this because-

Dr. Monica Gandhi: Because California is one of the lowest.

Dr. Z: We are the worst. Now, if you look at nationally I think 47% odd of schools are fully open, another 40 odd percent are on a hybrid and then only like three or 4% are only remote.

Dr. Monica Gandhi: It’s hard to be in California being the worst state. We are 50 out of 50 in terms of children being back in school, normal kind of full-time learning K-12. San Francisco, I told you, 21 out of 896,000, still middle school and high schoolers are not back at school, still online.

Dr. Z: So back to holding paradox. So you have a very progressive area like San Francisco that’s really good at getting vaccinated, I mean, one of the best in the country, case rates plummeting but that same progressivism may be empowers a sort of a pushback on opening schools even though the same progressivism would say, the fairness and equity of school openings mean poor people get educated, get meals, get structure, and we’re not doing it. So again, holding that paradox.

Dr. Monica Gandhi: San Francisco has been a paradox throughout this entire time.

Dr. Z: Yeah, it has. It has good and bad, good and bad. I’m still glad we’re here but it’s challenging. Sometimes you’re right, we need to be the loud voice, we have been but I think it sometimes-

Dr. Monica Gandhi: It behooves though, that’s why , but I’m on Twitter until this is over because I actually behooves to do this work.

Dr. Z: To keep shouting about it. And also listen, listen and update when things change. Like you said, you and I were both wrong about innate Indian immunity to COVID.

Dr. Monica Gandhi: We’re wrong, I apologize actively for that.

Dr. Z: And it’s tough because I think there was only a minority of Indian scientists that were saying, ‘You know what? This is not true, things are going to get crazy. We need to do something.”

Dr. Monica Gandhi: It seems so good for awhile and it really had us fooled.

Dr. Z: Because if you think such a dense country. So masks outside, is there any reason to be wearing them now vaccinated or unvaccinated?

Dr. Monica Gandhi: No, I would probably only wear them in India in densely populated places where you have high case rates and you’re in a densely populated situation. We are getting down from any of those high case rates in the United States, as you know, native 26% drop in the last 14 days of cases in the United States including those places of concern, Michigan and Minnesota and Pennsylvania, New Jersey, and New York, everything coming down. And even the case rates, like you said, in Oregon are actually not that high, it’s more that they haven’t had a chance to vaccinate the younger and they need to. So those are the places that I mask outside. I want to distinguish outside masking from vaccination rates in a way because there’s a whole body of science that actually has been there the whole time and I wish I’d pushed on earlier that outside transmission is very low. And in fact, the best study, let’s just say, Wuhan China, they know how to do contact tracing. And so this was published in September 2020, out of 7,324 cases that they assiduously contact traced, one linked outside transmission. That’s a pretty good odds that 7,000 times the rate inside than outside, that’s the best on study but there’s study after study, University of Canterbury very extensive review said it’s so rare to get a COVID-19 outside, it hates ventilation it disburses in the outside air, that we should be pushing people outside.

Dr. Z: Humidity, ultraviolet, infinite ventilation, and natural spacing.

Dr. Monica Gandhi: Exactly. All of those made it so hard to get it outside. The WHO never said, even before the vaccines, their guidelines say you don’t have to mask outside, only if you can’t distance do you have to mask outside? So that was always true, the WHO guidelines which, by the way, if you look at their mask guidelines are very well done, they really review the evidence, and our guidelines, they didn’t get into the outdoor transmission so we kind of just said, “Wear mask, save lives.” This is our way to do things in the country-

Dr. Z: A single answer.

Dr. Monica Gandhi: No nuance.

Dr. Z: Don’t hold paradox-

Dr. Monica Gandhi: Don’t hold, and wear masks; save lives, and then you’re like, “Wait, in the car when I’m alone? There’s all that non nuance, we do this here, just say no- This is our way. So it was non nuanced to even say that we had to wear them outside before. But now with these incredibly high rates of vaccination, I would say even the unvaccinated, of course based on the outdoor transmission don’t have to wear masks outside unless you’re in a dense crowd, in a high prevalence region, but unvaccinated should be exercising, going around without outside, and I’ve been seeing more people doing it. Vaccinated, the CDC even last week they said, Okay, if your vaccinated you don’t have to wear a mask outside. They could have included the unvaccinated because of the outdoor science.

Dr. Z: I agree. And this is not without harm, that’s the thing. Because if you think twice, I have to bring a mask to go outside walking. I see people biking with mask, dads biking with their kid, three-year-old wearing a mask on a bike and you’re just like, but this is not a child-

Dr. Monica Gandhi: It’s not, and it’s also not scientific.

Dr. Z: So in a way, what it is is it’s actually doubly harmful. Number one, it impinges on the liberty of having your face exposed outside where we were evolved to be out. It’s one thing inside here, and in fact, even the Indians in the Pune zoom call that they did with Stanford that I was on, they were saying, It’s ripping through families. So whole families are coming in sick and they’re all inside. But here it’s saying, not only is this, since it’s unscientific, we’re encouraging a kind of a fear mindset that’s not based in reality. So people seem to think that now everybody else is poison, like I see someone walk on a trail this way, I’m walking on a trail this way and suddenly everyone’s like this and they’re distancing and it’s like, Dude, we’re human beings. Like we’re not going to get sick this way, the science says we’re not, and it’s harmful to our minds, it’s harmful to our psyche.

Dr. Monica Gandhi: I’m worried about this thing where… I wrote a paper or I wrote an op-ed in Wall Street Journal about take off your mask outside. Of course I have to model scientific behavior, so I started taking off my mask outside in San Francisco and people will like-

Dr. Z: They’ll walk around.

Dr. Monica Gandhi: They’re glaring, some and then some just were like I was something scary, and I thought, wow, that does a jolt to a human being because you’re like, I am totally scientific, I’m thinking scientifically and I also write about masks, but it was, they don’t know who I am but it’s amazing to think that we’ve gotten into this conditioning where we think people are infected just by being human, I mean, we did this whole time, it was not like everyone was infected and all of these masking, distancing, ventilation worked, we didn’t have to keep kids out of school, just like we went to work as doctors we could still be doctors. Anyway, we did this the whole time, this is a whole other topic but for right now not masking outdoors for anyone in the United States unless you’re in a dense crowd, in a high prevalence region which is getting very unlikely is indicated by the science.

Dr. Z: I think it’s hilarious that people are giving you wide birth when you’re like-

Dr. Monica Gandhi: Wrote that first paper, yeah.

Dr. Z: I believe I said, the mother of masks, and here you are saying, it’s okay, the science says this. But that’s what we’ve done is we’ve conditioned people. And I think it’s unfortunate because it’s anti-scientific and it’s going to lead to… Again if we don’t say, Get vaccinated, take your mask off we’re going to generate anti-vaccine sentiment ’cause people are gonna be like, so what’s the point?

Dr. Monica Gandhi: That’s what I’m worried about. As an HIV doctor, I think positive messaging has always gone far. You can have sex without a condom. I’m sorry, that’s positive messaging for people, and that was with pre-exposure prophylaxis, PReP and treatment as prevention, those are good things to say that people can be safe. And it’s positive messaging to say you don’t have to wear a mask, like if you get vaccinated, you don’t have to wear a mask. I think that’s positive. I think it’s negative to keep on wearing masks after you’ve been vaccinated, I’m sorry, but I do see president Biden in a room with a small group of people and I know not only do I know they’ve been vaccinated but like I saw it on TV, he like Kamala Harris vaccinated on TV, those guys could unmask, they can sit right next to each other and talk to each other face to face like you and I. I know they both been vaccinated but there is this kind of putting on the mask on TV. And I know what we’re trying to signal there, we’re trying to say, “We are not Trump,” but actually that isn’t signaling to me that you aren’t Trump, that’s signaling to me that you’re not being scientific-

Dr. Z: You’re not following science.

Dr. Monica Gandhi: And we are not in April, July, November even December, 2020, we are in May, 2021. And you’re both been vaccinated and it’s really okay to do it and your CDC guidelines say that you can be unmasked and undistance if you’re both vaccinated or you’re a small group that’s vaccinated. So take them off, show that you believe in that public health guidelines, mention it, I’ve gotten vaccinated that’s why I’m not wearing a mask with all my vaccinated people in this room. And that may make people who are still on the fence get vaccinated.

Dr. Z: Change your mind, I agree. And this idea of persuasion means when you talk you have to positive incentives, stop shaming people. we talk about this every show we’re on, it’s weird because I used to be pro-vax, absolutist before COVID when it was all about MMR and your kids dying of getting measles and stuff, it was very emotional for me and I felt like these people are really anti-scientific but I had it wrong. I absolutely had it wrong. That’s not how you talk to people. And all you’re doing is rallying your own tribe. And Oh, it gets a lot of views and a lot of likes and a lot of polarization which is exactly what social media thrives on but you have to say is, Hey I understand why you’re reluctant.

Dr. Monica Gandhi: I really agree with that ’cause compassionate messaging, which we could have done about mask too, never tell someone to wear a stupid mask, where’s your damn mask, but there was even the F word

Dr. Z: Oh, I like that.

Dr. Monica Gandhi: But that was such a terrible way, some public health messengers with platforms message that way saying that people were Covidiots, not wearing masks. So that was so uncompassionate, I couldn’t stand that behavior by public health people but this is how I see the vaccine hesitant, I kind of divide them in four groups. One is of course ethnic racial minorities, not all, but like many people who’ve had that history are distrustful of how quickly this went, that is fair to have distrust, this wasn’t a great nation on trust with the medical system and that really involves I think what is happening, maybe not enough is community-based messaging, working with communities, community doctors who look like the community talking, educating, that’s one approach.

Dr. Z: Community health

Dr. Monica Gandhi: Bringing vaccines to people so it’s convenient if you’re working all day.

Dr. Z: Showing by example

Dr. Monica Gandhi: and showing by example, like getting vaccinated. So I think that’s one group. Then the second group is young, they had a really hard year, like their colleges were shut down, they weren’t really at risk as much and they simply had a hard year. And they are working trying to do their thing, make it convenient for young like college campuses do it there, do it at night, during the weekends, give them vaccines where it’s easy and when they have time. And then I think that there are some people who really don’t trust them and I’m not sure we can get to them but at least be compassionate. And then the fourth is people who think these guys keep on doubling after vaccination and they’re double masking outside after vaccination, they’re never going to let the world change. And unless you take off your double mask health care messenger, I’m not getting vaccinated, and that’s positive motivation.

Dr. Z: I think you’re exactly right. I think end there, there’s some people that are just kind of a little delusional. That’s very rare. That’s actually unusual, but they are the outsize voice so they come up with the theories like, This causes sterility. And now you’re shedding spike protein and women are miscarrying around vaccinated people, and then you have this idiot school. And I said, idiot-

Dr. Monica Gandhi: We’re not going to do that.

Dr. Z: We’re not doing that. We have this private school that exercises first amendment rights to say, you cannot be an employee of our school if you’ve been vaccinated. The Centner Academy in Florida, and the reason they said, they cited misinformation online that vaccinated women’s shed spike protein that caused other women nearby to either become sterile or miscarry or have abnormal menses. So clearly crazy talk, and I did a show on it. There’s that and the thing is people are willing to believe that because they see people double masking while still being vaccinated saying it’s never gonna get better, because they’re being called Covidiots,

Dr. Monica Gandhi: We just didn’t do it right in this country, we’re so mean to each other.

Dr. Z: We were nasty.

Dr. Monica Gandhi: The politicization was so bad.

Dr. Z: Want to hear a funny story. So we talk about polarization a lot. You talk about how much you hate Twitter, I hate it too. The reason we hate it, again, you can’t hold paradox, you can’t hold nuance, you have to stake a claim and then just pound on it and assume the other person is evil, not even just a human, they’re just evil, they’re just wrong and there are Covidiots or they’re Vax Nazi, whatever it is.

Dr. Monica Gandhi: Next time when you think about your Twitter folks, they look like this, and you can’t be mean to Frodo.

Dr. Z: You can’t be mean.

Dr. Monica Gandhi: I never call them a Covidiot

Dr. Z: You shouldn’t end. There’s one interesting thing about Frodo. When you imagine, like when you have anger arise or you have some emotion, what we classically call negative emotions. There’s no emotion that’s negative, it’s just an energy pattern you feel. If you imagine that that energy pattern is a little Frodo, and he’s a rising to try to keep you safe, he’s like

Dr. Monica Gandhi: And he’s gonna throw that ring, he’s gonna get patents waived tomorrow by the Biden’s administration and throw that ring into Mordor.

Dr. Z: Suddenly your anger dissipates as something that is not other than you and it passes, you don’t hold onto it. The story I wanted to tell was this company called Basecamp which is a software company had to actually make a rule which became super controversial, a third of their employees quit. It said, Internal-like, Slack channel conversations among employees can not any more be about political topics because you guys are killing each other. You’re distracting from work. You’re hating each other. You polarized. At first I was like, Wait you can’t stifle free speech. And then I was like, Why is this happening? It’s happening because people treat Slack like social media. These people work together but when they’re on Slack, they’re non playable characters, they’re enemies and it’s like, well, you like Trump. Well, you like Biden. Well, you like it. Well, I’m a social justice. Well, you’re not a social justice. Black lives matter, all lives matter back and forth, back and forth, and suddenly they hate each other.

Dr. Monica Gandhi: That’s not a good work environment.

Dr. Z: I’m feeling assaulted.

Dr. Monica Gandhi: It’s not a collaborative work environment.

Dr. Z: And so the whole idea is that we’ve taken social media now, we brought it into the workplace where we can hurt each other in the workplace where it used to be… So here’s what one company did, which was I thought was remarkable. They said, okay, you guys can post anything you want but if you post a link about anything political or anything like that, any statement you have to first post a video of yourself saying why you think this video is important for you to watch and what it means to you. And then if you’re going to respond, you also have to respond with a video, because what does that do? It puts a face there, it puts a voice there reminds you that’s a human and then when you respond you’ve got to put your own face there. And suddenly they’re not non playable characters anymore they’re actually humans.

Dr. Monica Gandhi: That’s so interesting because this is why I think we do need to go back to work by the way.

Dr. Z: Yes, I agree.

Dr. Monica Gandhi: You know how this whole idea that like everyone’s going to be at home and we’ll do hybrid.

Dr. Z: Hybrid is fine.

Dr. Monica Gandhi: Maybe some hybrid, but I want people to see each other face to face when we get through the mass vaccination campaign in the United States because it does make people more like human. I hope people go back to work.

Dr. Z: Absolutely, I think we will. I think we’re hitting that tipping point. Now that reminds me, kids and vaccinations. What’s your thinking on the very young and give me an age cut off, where do you think we should not be necessarily focusing our vaccine efforts?

Dr. Monica Gandhi: This has not gotten published or anything but when we talked about these three places where we could still get that more vaccines out to other people, I also think that focusing on vaccinating 11 and younger in this country when so many people that we can see actively are dying in other countries from COVID-19 is a very uncharitable. So I do think we have to think about this stress on younger kids because they just haven’t been at risk for severe disease from COVID-19, just spare the young. However, what do I think that age should? I think that any parent should decide for themselves if they want to vaccinate their child when they’re young but right now those safety and studies have not been done. The safety and efficacy study for 12 to 15 has been done for Pfizer, EUA has been applied, the authorization have been applied for by the FDA

Dr. Z: 100% effective, right?

Dr. Monica Gandhi: Yeah, 100% effective cause kids don’t get cold that much but the 18 cases that occurred were all in in the placebo arm. So it was 100% effective and it was safe. And so to the 12 to 15 year old EUA will come out, before the fall semester and parents should decide for themselves I’ll likely get my children vaccinated because I love vaccines and they’re in that age range. But 11 to younger, they can’t do an efficacy study because there’s so few symptomatic COVID cases in that population so it’s only going to be safety and immunogenicity. So make sure it’s safe and then see if their antibodies go up and hopefully T-cells, they’ll measure too. So see if that happens but it can’t be efficacy and it’s not going to be efficacy. If it’s safe, it’s not powered to detect rare events, of course, like we saw with the Johnson & Johnson vaccine, that was very rare but you need lots of people to be powered to see that in the clinical trials. It’s not powered for rare events, but if it’s safe then I think every parent will decide for themselves. But the CDC can likely only mandate vaccinations in a school for vaccine preventable illnesses that harm children disproportionately. And right now those are measles, mumps, rubella, diptheria, and pertussis, and I don’t think COVID can join that list given that it spares the young more but there may be schools that will ask but I don’t think they can mandate it.

Dr. Z: It feels influenza ish for kids.

Dr. Monica Gandhi: Well, it is. I know that’s hard for people to hear it because Trump said COVID is the same as a flu, which is inaccurate for adults. However, it is accurate for children in the sense that 11 children died of COVID in California in 2020 and 16 children had died of influenza in 2018. So it is similar to flu in children. I don’t know if we’ll be mandated, but I think that people can choose for themselves. I don’t think we’re going to need it though to get to herd immunity, and that’s the final point I want to make because you don’t actually have to look at some paper about measles, like some epidemiologic paper and be all geeky and stuff to think about herd immunity, just look at the world stage, it’s like playing out in front of your very eyes, places that don’t have high rates of vaccination tragedy multifold, India, places that have high rates of vaccination that are faster than we, look at Israel and the UK, it’s playing out, it’s showing us what happens, at 62% first dose in Israel, they had something like 50 cases yesterday I was looking, so that’s out of a country of 9 million people, they had zero deaths and they’ve had zero deaths for a number of days now, they have no one in their hospitals with COVID, that’s what 62% first dose does for you. 62%, they’re still going to give more to over 60’s. So I think the fact that in this country, 14.5% of our population is 11 and younger. And that means 84.5% of us, by that I mean we don’t need to get to 84.5% to get to herd immunity, probably much less, so it won’t be required.

Dr. Z: That’s the important piece because I think a lot of moms have reached out to me saying, some will say, my kid has medical issues and I’m worried and when is it going to be approved? Because they want to protect their child who’s at higher risk and that makes plenty of sense.

Dr. Monica Gandhi: Any parent can choose for vaccine for their children.

Dr. Z: Joe Rogan, I don’t know if you know him at all.

Dr. Monica Gandhi: I heard some rumors but I didn’t see.

Dr. Z: I didn’t watch the full thing, but basically he said, “If I’m a guy in my twenties and I’m healthy and I eat right and exercise, I don’t think I need the vaccine.” He got a lot of crap for saying that because Biden and everybody was like, “Hey, you’re not a doctor, you shut up?” Well, he has a platform and he’s expressing what a lot of young people feel. So instead of like, pillorying him and shaming him, maybe go, Oh, Hey, I’ll go on Joe’s show and talk about maybe why it is and isn’t important. Like why you would make a decision for a 20 year old

Dr. Monica Gandhi: See, that’s like compassionate based how we talk to each other. So what I would say is actually you’re right, like young people are much less likely to get ill and yet we are sort of saying please herd immunity is tremendously important to reach because then we can stop testing and going wild and going crazy and it just would be really helpful. And so we’re actually appealing to the young because we know these vaccines are safe and effective, please get vaccinated to protect others. And actually we have done that. We have done that throughout history, H. flu after it stopped being serious in children we vaccinate to protect older people. We have vaccinated younger people to protect older people throughout history. So it would be just say but it’s saying it compassionately instead… you should never say, No it’s inaccurate that younger people are less likely to get ill than older people. That epidemiology is out there, it’s very obvious the CDC website you just have to look every day.

Dr. Z: If you want a sure fire way to alienate Joe Rogan’s audience which is young males predominantly, go and attack him like that. Instead of saying, Hey, you know what, how about you get Vivek Murthy or someone to come on a show? I don’t care who it is, and say, Well here’s the pros and cons and hit me up, Joe, you’re a curious guy ask some questions, is the thing safe? What do you think about it? mrna? And he’s done shows like that. Again, there’s a heterodox aversion in this country where you cannot say the wrong thing without getting the Scarlet letter on you. Instead of just saying, You know what? I strongly disagree with that, let’s talk about this.

Dr. Monica Gandhi: Let’s talk about this because herd immunity will actually help young people because they won’t even have to think about it for testing or everything else that comes along with that with the terror of a virus. If we could get to herd immunity where it’s so contained we would really need the young people’s help.

Dr. Z: Yeah, I concur. So let’s see now, what else is kind of crazy in the news right now about vaccines?

Dr. Monica Gandhi: They don’t cause infertility, they don’t make vaccines. They don’t make the virus hypermutate to be-

Dr. Z: So this is a Geert Vanden Bossche thing. So I did a show about this guy. So he’s a virologist in Europe and he’s saying it puts selective pressure on causes to hypermutate, there’s early imprinting so that your immune response is just to one type and then when it mutates you can’t fight it. And none of that has really been shown to be the case.

Dr. Monica Gandhi: And inf act the one good thing to remember about any human being or a virus is you can’t actually mutate indefinitely because it comes at a fitness cost. And so the way it’s is like if we grew a hand out of our head, we couldn’t wear a hat. Wouldn’t that be a huge fitness cost?

Dr. Z: It’d be a fitness cost but you’d be able to slap people. So you might be right. You might be a little more deadly in the short run, PAP! but you’re not going to get laid so you’re not going to reproduce so it comes at a fitness cost like who’s going to marry or have sex with someone with the hand on their head, I mean, some people have a fetish, but I’m just saying.

Dr. Monica Gandhi: I’m just trying to make the point, you can’t mutate indefinitely. And a virus, it can mutate, for example to become more transmissible, that’s actually the smartest thing it could do and I think variants have done that, but it can’t at the same time also become hypervirulent and evade the immune system all of a sudden, is just literally a function of biology-

Dr. Z: And there’s only so many spots on that spike protein you can change The variant/schmariant thing, I’m very sympathetic to, it’s like, no, no, no, you can talk about variants in a sense of this, it’s pressure to get vaccinated and all the more pressure to get

Dr. Monica Gandhi: Yes, that’s the reason to get vaccinated but please don’t tell me that 52 T-cells across a spike protein, that was the NIH article that they showed that you form CD8 cells, this was NIAID actually and Dr. Fauci talked about it in our program, but you form CD8 cells across 52 different pieces of the spike protein.

Dr. Z: That’s a lot.

Dr. Monica Gandhi: A couple of mutations, it brings down one of the epitopes and they showed that, the South Africa variant, couple of the variants may bring down 51s so now you have 51 epitopes that you’re fighting with CD8 cells. So you can’t evade the immune system not the T-cell mediated immunity to vaccine.

Dr. Z: The fact that young people are more affected in these second waves, I think that happened in 1918 as well in the Spanish flu pandemic. Is that function of the virus actually changing it’s viral load/transmissibility?

Dr. Monica Gandhi: We would never have known that but that’s a good question. The thought was that they were just like gathering more and World War I and coming here we’re gathering-

Dr. Z: Kind of what happened in India. That’s interesting. Even with this, we’re seeing second wave almost assuredly as usual, bigger than first wave. Of course we’re on what our fourth wave or something, I don’t know, I’ve lost track of the waves.

Dr. Monica Gandhi: We’re done with waves.

Dr. Z:  We’re done. We’re on the ebbing.

Dr. Monica Gandhi: It will keep on ebbing and the only way to get out of a pandemic, pure and simple, is not through mask, distancing, contact tracing, testing, and ventilation, those are tools, the solution is vaccine.

Dr. Z: Vaccination.

Dr. Monica Gandhi: The only way to get through a pandemic is to become immune to the pathogen.

Dr. Z: And Frodo, you my dahling are so immune. Ah look at you. I feel like he has a German accent. I feel like he does, put him up against the mic. Hello everyone. My name is Frodo. There are several things we will talk about today. Number one, T-cells; number two, B cells; number three, C cells. What’s a C cell? I don’t know, you tell me. My name is Frodo and I’ve got a license to ill. Now suddenly I’m Russian. I’m Russian Frodo, no, that doesn’t fit so he’s more German.

Dr. Monica Gandhi: I have wondered if he’s German sometimes.

Dr. Z: He’s so German. ACHTUNG FRODO! SCHNELL! He’s so adorable, I just wanna squeeze him

Dr. Monica Gandhi: He’s smelly.

Dr. Z: I know.

Dr. Monica Gandhi: Paradox.

Dr. Z: You said he was, but I can’t stop- He’s so cute.

Dr. Monica Gandhi: I can hold the paradox.

Dr. Z: I love that you just bring a smelly animal into my OCD studio and I want to hug him.

Dr. Monica Gandhi: But it just means we can hold these things all at once.

Dr. Z: We can hold paradox.

Dr. Monica Gandhi: We can hold paradox.

Dr. Z: My hermetically sealed studio can co-exist with lovely Frodo and his smells miasma. Monica every time you come I’m filled with a sense of radiant joy.

Dr. Monica Gandhi: Thank you so much. Every time I come I’m filled with how delightful you are but I had no idea that you could do accents that well, now I will come all the time. You’re amazing.

Dr. Z: I’m not sure I can do them well and I’m sure I’m going to get a 13 comments. That was not German. That was more Dutch. I don’t know what you’re doing. Last thing we got to end on a spiritual note here. Humans need to go back to human stuff and part of being human is helping our fellow humans, conscious entities.

Dr. Monica Gandhi: If you’re thinking about India all the time right now that is what you should be doing.

Dr. Z: I like it. Even the energy is probably a good thing. And I think even India is going to get better but it’s going to come at a high cost.

Dr. Monica Gandhi: And it means that we have to do our part to make it better.

Dr. Z: So patents, we talked about-

Dr. Monica Gandhi: Waive the patents and give doses, give multiple doses ’cause they’re readily available, they’re there. You don’t have to make it, give it to them.

Dr. Z: And the scarcity in the U.S is much better now. So people who want to get vaccinated probably get back vaccinated. A politician actually kept a promise. Both of them did actually.

Dr. Monica Gandhi: Yes, they did. Vaccines were the solution and they both did it.

Dr. Z: Nailed it. Science for the win. I love it. Everything else apocalypse.

Dr. Monica Gandhi: Science, don’t wear a mask outside. That’s our final message.

Dr. Z: You know what? That’s my new t-shirt. I’m going to get that shirt.

Dr. Monica Gandhi: Science: Don’t wear a mask outside.

Dr. Z: “Don’t wear mask outside ‘cuz SCIENCE” Don’t follow THE science ’cause that’s dogma, follow science ’cause that’s a process. Monica, thank you.

Dr. Monica Gandhi: Thank you very much.

Dr. Z: So, Frodo, thank you.

Dr. Monica Gandhi: Thank you, bye, says Frodo.

Dr. Z: Z-Pac, share the video, become a Supporter, Yada yada yada, links, my website, zdoggmd.com. You + me = us. All right, we out. Peace.