The ever-amazing Dr. Monica Gandhi returns to talk Flu/RSV/COVID, viral interference, China’s zero-COVID response, MPox, and public health lessons from HIV for the next pandemic—while searching for true meaning beyond our apparent divisions.

Here’s the paper summarizing Monica’s proposed pandemic playbook. More about Dr. Monica Gandhi here.

Find all our episodes with Dr. Gandhi here.

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Transcript Below!

Topics & Timecodes:

00:00 Intro

03:27 Influenza, RSV & COVID, “immune debt,” viral interference, population immunity, targeted boosting, pregnancy & immunity

12:30 Bivalent boosters, age stratified risk, flu shot uptake, public health’s vaccine messaging failures, China’s zero-COVID policy, mRNA vaccines & the immunocompromised

22:53 Mpox (formerly monkeypox) messaging, why at-risk population targeting is so important

28:17 Monica’s new book Endemic: A Post-Pandemic Playbook, HIV lessons learned but not applied to the COVID pandemic, harm reduction, school closures, global vaccine equity, planning for future pandemics

37:42 Social divisiveness & the moral matrix, societal harms due to the pandemic response, mental health, substance abuse & suicide, the Alt-Middle

44:15 Burnout, healing divisiveness, fostering compassion, searching for meaning through connection, waking up to what “is”

57:46 Final thoughts

The PayPal Tip Jar!

– Monica Gandhi, welcome back. We just launch right into it.

– Very happy to be here.

– You look beautiful as always.

– I went to India and I got all these Indian dresses, and I had my bindi, you know. I just really got Indian. It was great, it was five weeks in India.

– So you went, you spent five weeks.

– My, as we’ve talked about on this program before, my husband had passed right before the pandemic, and we were putting his ashes in the Ganges in Varanasi.

– Oh.

– It was a very beautiful experience, and then went all over India. It was, I think, through their BA.2.75 wave, but they were done with COVID, so everyone was sniffling around us, and it was a very beautiful experience.

– Oh, and did your kids come with you too?

– Yes, yes.

– So they all got that closure of being there.

– Closure and a, maybe we’ll talk about this at the end, a lot of kind of spiritual discussion. A lot of like being right in it. I mean, if you’re in Benares, that is.

– That’s the epicenter.

– That’s the heart of it.

– You know what’s funny? So when I was young, I was a hardcore atheist, and that’s when I went to India, is with my parents, and they took me in when I was a teenager, and something about India.

– You’re seeped in it.

– You’re seeped in it. It’s, I couldn’t describe it.

– God’s everywhere.

– It’s, God is everywhere, God is everywhere.

– You can’t get away from it. It’s just God-soaked.

– That’s what it is.

– So because of that, you come back.

– And you know what’s funny? I told my grandfather, my maternal grandfather at the time, I said, you know, I’m an atheist, I’m about science.

– Yeah.

– And he said, oh, yeah, I was too.

– Yeah.

– And that’ll change.

– Yeah.

– And I’m like, oh, but just because you’re getting old and you’re gonna die. No, it’s not that.

– Yeah.

– He goes, there’s no doubt.

– Yeah.

– He just looked at me at my 14 year old self. He says, there’s no doubt.

– There’s no doubt.

– And that’s what the experience of that spirituality is. It’s an experience. It’s not a belief, it’s a deep knowing, and India is steeped in it.

– Yeah.

– So, we’ll talk about that.

– Yeah, we’ll talk about that. My, just his one comment, my son, my 12 year old was in Varanasi after anarthi, and he looked up at the sky and he saw this thin crescent of the moon, and he saw the metaphor of that being the comb in Shiva’s hair, and just like the water stemming from that and falling, the Ganges falling from that, and he saw, he just burst into tears. He said, mommy, I saw God, and I said, I’m glad it was here. So yeah, it was very beautiful.

– That’s so beautiful. How old is he again?

– It was beautiful. He’s 12.

– Oh.

– And we went back to the hotel and he couldn’t stop crying. He said, it was beautiful. He truly saw that image and he, and it’s changed him. He’s a very nice little boy.

– Oh my gosh. Oh my gosh, oh my gosh. I can’t even do the interview now.

– Yeah. That’s so awesome.

– Now we have to talk about.

– Now we have to talk about the triple-demic. I know. We gotta move over.

– All right. So, okay, all right. Well, we’ll move. Okay, I’ll compose myself and we’ll move to what we’re gonna talk about. So I’ll just let the folks know we’re gonna hit RSV, flu, COVID. We’re gonna hit China’s response to COVID. We’re gonna hit ♪ MPox Pox Pox Mpox ♪ ♪ Yeah yeah yeah ♪ Nice name change. We’re gonna hit your new book that’s gonna be coming out.

– Yes.

– Called “The Pandemic Playbook.”

– Yes.

– And learning from what we’ve learned here and applying your HIV-AIDS experience.

– To it.

– Yeah.

– Could have done it before. I wish we had, but yeah, bringing HIV into the response to any pandemic.

– Absolutely. Absolutely, and then we’ll end with a little more spirituality.

– That sounds good.

– All right, so RSV, flu, COVID is all the news right now, this idea that there are three circulating respiratory viruses and then some rhinoviruses and enteroviruses that were at tail end of summer. What’s going on? We know hospitals are as busy as they’ve been in terms of those viruses. Let’s talk about this because there’s so much misunderstanding. People are talking about immune debt. We’ve somehow damaged our immune systems by not exposing ourselves to the normal pathogens, but what’s really going on here?

– I think it’s super simple. It’s just two things are going on. One is that no, immunity debt, maybe we shouldn’t use that word, because it, that sounds like by staying away from pathogens, we’re no longer able to respond to pathogens. That’s not true.

– Yeah.

– If you have not seen RSV for two years and we have no vaccine to RSV yet, we’re getting one, then your antibodies and your exposure to respiratory syncytial virus, RSV, go down. So children, especially neonates who are born of mothers who haven’t seen RSV for two years, and then children, older children, they haven’t seen RSV, which gives them the immunity to fight it better the next year, and so then they’re very susceptible to RSV as it comes roaring back for the second reason, which we’ll talk about, and so RS, we’re just less, we’re just more susceptible to it.

– Right.

– So we have more RSV in the hospital. We’re more prone to severe disease.

– More prone to it. It’s almost like we took something that normally happens.

– Yeah.

– Which isn’t great when it does happen in the sense that newborns in particular are quite susceptible to the.

– Yes, they can get very sick, yeah.

– Very sick, and so what we did is we just delayed that, but when, we delayed it in a way where when it comes back, it’s hitting with the delayed RSV. It’s also hitting with the delayed flu, and because of things we’re gonna talk about, viral interference.

– Yes, yes.

– And typical respiratory pathogens, and the fact that we’ve changed our behavior, so when schools were closed, people are masking, there’s distancing, that kind of thing.

– We stayed away from each other. Everyone keeps on marveling, oh I didn’t have a cold for two and a half years.

– That’s right.

– But they didn’t have RSV, they didn’t have influenza, they didn’t have adenovirus, they didn’t have coronavirus, human metapneumovirus, parainfluenza, all the usual respiratory pathogens, and then if you don’t see viruses that you don’t have vaccines to, then you have no way to fight it. Your immune system is not there to fight it, and so yeah. We’re seeing more severe RSV. Two good things happening is that one, is that the RSV has definitely peaked and coming down in this country.

– Yeah.

– And second is that we do have a monoclonal antibody for very susceptible children, and we have vaccines coming out next fall for pregnant women to protect neonates and older people, ’cause they, these extremes of age have always been more affected by respiratory pathogens.

– Right.

– Except for COVID, which really spared young children. It was a bizarre aspect of COVID.

– Blessedly, yeah.

– Yeah, blessedly.

– Yeah, yeah.

– And then influenza, same thing also coming back. Didn’t see it last season. Didn’t see it two seasons in a row. So we don’t have the immunity against it.

– Right.

– Our influenza rate, vaccination rates aren’t as high as usual because I think we need, do need to talk about trust in public health at some point when we get into the book.

– Absolutely, yep.

– And so people aren’t, we’re at 40% influenza vaccination rate right now, which isn’t great, and that we could try to do better with, and so because of that, you haven’t seen influenza, so you don’t have the antibodies or the T-cells or B-cells from last year to protect you, so more severe influenza. Good thing about that also coming down, reached our peak coming down. Now, viral interference is very important to talk about.

– Yeah.

– Because this isn’t just in COVID that we had papers on this for years. Essentially one virus, if it’s circulating at high levels and it’s one type of virus, like a respiratory pathogen, kicks the other P viruses out of the playground, and so essentially COVID’S been it for two and a half years. It’s been circulating at very high levels, and now we have such high degrees of population immunity to COVID. It can no longer dominate our world, and so nature abhors a vacuum and these other viruses are coming in. So we had a 95% spike antibody rate. This was advertised in March of 2022 by the CDC. I feel like no one noticed it, but they’d put out a seroprevalence survey that 95% of Americans have IgG to the spike protein. It means either we’ve gotten vaccinated or we’ve seen the virus.

– Right, but it’s immunity.

– 95 percent, it’s as good as you can get. We have such high rates of immunity.

– Yeah.

– It’s why since March of 2022 we’ve seen very little severe disease in the hospital.

– That’s right.

– The media’s obviously reporting this incorrectly because we swab everyone in the hospital. They have COVID in their nose. They’re there for another reason. Looks like hospitalizations are going up, and you could see this split in the media. Most, some media, CNN actually said the other day, this is because we’re swabbing too many people. The CDC told us to stop asymptomatic swabbing in the hospital on September 23rd, and we still haven’t stopped in 50% of our hospitalizations.

– Yeah.

– So CNN is reporting accurately. “New York Times” and “Washington Post” is not, and they’re saying hospitalizations are going up. So they’re not. So I have a piece with an ER doctor from Southern California coming out in “Time” on Monday where we call it COVID optimism, really talking about how little severe disease there is. COVID pneumonias, people in the ICUs.


– People who need, ARDS, dexamethasone, it’s so much lower. So such high levels of population immunity to COVID means these other viruses come to fill that vacuum. Viral interference and RSV and influenza really came in and so did adenovirus and other coronaviruses, the common cold causing ones.

– Right. They’re all back, and I think one of the speculations around, what is the mechanism of viral interference? We don’t fully know ’cause it’s complex, but maybe there’s an interferon component. So when you’re with one virus, your interferon release and that actually has a general protective effects against other viruses, but some media has spun it as, oh, but we’ve actually seen COVID suppresses immunity. So maybe it, so the recent COVID infections that have made us prone to RSV, and this kind of thought. Well what’s your thinking on that?

– That is really a very dangerous statement to make because coronavirus is an RNA virus, right. It’s not a retrovirus like HIV. HIV is a RNA virus that gets made into DNA in the body and then it stays in your body, and it’s why we can have chronic inflammation and we can’t cure HIV except in very rare cases, and that stays in the body, and then it happens to infect very cleverly, unfortunately, CD4 cells, which are our immune system. That’s why if you don’t get on treatment, you can really have opportunistic infections, severe infections. Coronavirus is a RNA virus. It doesn’t stay in the body long term, it doesn’t damage T-cell immunity, and there’s paper after paper showing that if you get exposed to COVID, you expand your T-cell repertoire, you expand your B-cells to fight the virus, and this is, we’ve known about RNA viruses forever, and then there’s six other coronaviruses. It’s not like COVID is this brand new virus. There’s four common circulating cold causing coronaviruses. There’s MERS, there’s SARS. So that’s six, and then there’s SARS‑CoV‑2. So it’s acting like any other coronavirus. Fundamentally, when you get enough immunity to it in the population, severe disease goes away, and we’re always gonna have COVID, but it will cause mild infections and will probably boost vulnerable people every winter to give them that increased immunity against SARS‑CoV‑2. So my 87 year old father should get a boost every winter.

– Now, and this is an important distinction. So a boost for the very fragile who even if they got an adenovirus, it could knock them over.

– Exactly. My 87, 88 year old father who went through B-cell lymphoma treatment, I wouldn’t want ’em to get an adenovirus either, but I’d have no way to control that meaning there’s no vaccine for that.

– No vaccine.

– But I’m very lucky in the world of coronavirus to give him a boost every winter and then he could get Paxlovid if he needed it. So we also don’t realize how much incredible progress we’ve made in coronavirus. Someone said, I was on NPR the other day talking about RSV. Someone called in and said, give me COVID any day over RSV. I was really flattened by RSV.

– Yeah, I know.

– And that’s the stage in the pandemic we are with COVID.

– That’s where we are, and again, vulnerable young people and old people get RSV as well.

– Yes.

– And we don’t have a great armamentarium, like you said, a monoclonal, a drug.

– Or a drug, a medication that we can give for RSV.

– Exactly.

– I hope COVID will make us have better treatments for other RNA viruses.

– For other, exactly. Now one thing I just wanna circle back quickly because you said it in in passing a couple times, is that pregnant women, when they are vaccinated for certain things or they’re exposed to RSV, et cetera, what they’re benefiting their newborn with is those breast milk past or placenta passed antibodies.

– Antibodies, yeah.

– So and that’s what, is roughly a six month duration of those.

– Exactly.

– So you’re protecting your very vulnerable newborn by, you know, vaccinating mom or mom being normally exposed to RSV.

– Exactly.

– Mom being in a position to handle RSV a lot better than say, a newborn.

– Yes.

– I’m not saying go out and get infected, but I’m saying that’s one of the explanations why we’re seeing so much, yeah.

– Because mothers were not exposed to RSV.

– Exactly.

– Over the last two and a half years, and so they don’t have antibodies to pass to their very vulnerable neonates now.

– Exactly right.

– And then that’s why the vaccine that’s coming out in September, I think, will, that vaccine was for pregnant women for RSV.

– Yeah.

– And they’ll take it to give immunity to their newborn.

– Now to circle back to the bivalent booster, say, we’re not talking about kids. We’re not talking about college students. We’re not talking about healthy middle-aged people. We’re talking about the extreme vulnerable elderly.

– Exactly. That’s what the WHO said. I know the US has given a different message. They actually just approved yesterday giving boosters to six months olds and onward. I doubt the uptake will be very high.

– It won’t be, yeah.

– Just like the uptake hasn’t been high in five to 11 year olds.

– Yeah.

– Even 12 year olds, I explain it very simply. I have a 12 and a 14 year old and I have an 88 and an 82 year old mother. My older parents got the bivalent. I didn’t because I don’t need it.

– Yep, me neither.

– And my 12 and 14 year old didn’t even need the third shot. So they got their two shots.

– That’s right.

– So you just, it’s called age-stratified risk, and it’s so profound in COVID, even more than any other virus that we need to make our booster recommendations very appropriate.

– Appropriate.

– WHO said that. They said, don’t boost everyone every winter. What a waste.

– Yeah.

– Just do vulnerable people every winter. We’re gonna do that from now on.

– And remember this boosting every winter. That’s distracting and confusing to people who aren’t even getting flu shots.

– Yes, trust. This is their trust.

– Which actually, right, and what’s your take on flu shot? We ought to be getting it, right?

– Yes, so in fact I got it, and of course we have to get it in healthcare and I got it for my children, but I think that flu, because we’re, we have such low immunity now.

– Yeah.

– To influenza over the last two and a half years, very safe vaccine six months and up. I think everyone should get the flu vaccine.

– Yeah.

– And it’s, but we’re not seeing people all get the flu vaccine. We even aren’t seeing people give their children measles or polio vaccine.

– All this reaction to our public health fiasco.

– This is public health trust, and that’s the other thing is that public health should look at themselves and say, okay, what did I do wrong with my one size fits all, my non-nuance messaging that got people to distrust me, as opposed to saying, oh, Americans are so anti-science, they’re so anti-vaccine, they’re so wrong. That’s not a very good way to kind of look at yourself and say what went wrong?

– Yeah.

– So when polio, you know, that case of paralytic polio in July in New York, and then the circulating polio in the wastewater and low rates of polio vaccination in New York and then the Ohio ongoing outbreak of measles, 95% among unvaccinated children, we should take a hard look at ourselves and say, okay, what, where do we go wrong with our one size fits all messaging? Your six month old needs a boost, no. The older people need a boost, and that’s where we have to go because also we could concentrate on that population.

– Yeah.

– And it’s kind of actually like mpox. If we concentrated on gay men, that’s appropriate.

– Yeah.

– To scare the entire population and say, when school’s open, you’re all gonna die. That was very inappropriate messaging by some public health people, people with loud voices on Twitter and also in mainstream media.

– Yeah, exactly.

– Instead of you, focusing on the populations at risk is good public health.

– So, yeah, and I think what’s interesting is there’s still so much confusion and heartache here in the Bay area especially. You know, I just got an email from a woman who’s a lawyer, parents are doctors, watched our show for a long time and their kid is in a theatrical group, and the theater company said, all kids in this group in order to perform need to be fully boosted up to current CDC recommendations.

– Oh wow. That could be up to five shots.

– Exactly, and this parent was like, that is insane. This kid had Omicron.

– And they know it. They know it.

– They know it, they all know it, and so this is unscientific and what it does, it creates a backlash. Now that same family is gonna start to be much more receptive to hearing ideas that maybe even the standard childhood vaccines are an overreach.

– Exactly.

– And they’re not, but this is what’s gonna happen, and we’re seeing it, and flu vaccine, forget about it. People are like, I’m not gonna do that.

– Exactly. 40% flu vaccine rate when we’re having a raging flu season.

– Yeah, like.

– Is very, very worrisome, and you have to take a hard look at yourself.

– Yeah.

– But mainstream media is still saying, oh, just as recently as yesterday, rethink your holiday gathering.

– Yeah.

– You know, like it’s amazing, like, we have a tool which is a flu vaccine. Talk about that, but after three years of keeping people apart, the mental health effects are so clear that also could be playing into this. People have mental health effects. It’s a very anxiety, depression.

– Oh, creating this social contagion and anxiety and people have been alone and it’s horrible.

– And being scared of people breathing.

– Right, which.

– You know, so amazing. That was so different than an HIV where you’d say, okay, if you’re at risk here, I’m gonna just tell you how to stay safe. Go ahead, do whatever you want. Here, I think you should use condoms. Go ahead and do whatever you want, harm reduction.

– Yeah.

– And then, oh wait, treatments came out. Do whatever you want. You don’t need a condom. Like, treatments came out that actually reduces your viral load to the point that you can’t pass it on. I love these treatments. I love the prevention and I keep on thinking mainstream media right now has not embraced the vaccines. They’re not extolling the vaccines as the key to normal life.

– Right, right.

– They’ve been, even though the vaccines have been out since January, 2021, we’re still seeing messages two years later, the only way to keep safe is stay away from each other or test before you go to the party.

– Yeah.

– Instead of, the vaccines unlock that key to normal life.

– Yeah.

– Two years later.

– And guess what, you’ve been saying that since the vaccines came out on my show.

– Yeah.

– And it’s just like we, oh, but then you see in the media, but there’s more cases and then there’s this. Okay, where are the deaths?

– Yeah.

– Yeah, where are the, where’s the severe disease? And we’ve been talking about it and there’s a wall.

– Focus on that population.

– Focus on that population.

– And it’s actually quite a low rate of severe disease now. We’re again conflating, miscategorizing hospitalizations by swabbing everyone.

– By swabbing everybody.

– But it’s actually very low. I’ve seen it. I’m, I work in a hospital.

– That’s right, and now speaking of things that have gone terribly wrong, China. So China had a policy that was touted as extremely effective. They basically said anytime there’s evidence of COVID positivity, shut the entire community down. Swab everybody, PCR everybody keep them locked in their houses literally, and they can do that ’cause they’re China.

– Unless there’s a fire, and they die.

– Unless there’s a fire, and they die, and then the people go, wait, we’ve been tortured for how many years, and it’s fine if the economy’s going, it’s fine if I can make a living, it’s fine if my mental health is intact, but it’s no longer. So they go into the streets and protest, which is unheard of.

– Mass protests, yes.

– Unheard of, but now they got what they wanted to some degree, and I’m reading that now they’re scared because they’ve been so conditioned that COVID is a terror.

– Instead of clean databased, age-stratified database messaging. it’s so clean, it could be so clean. You are very at risk if you’re 80 and above, actually less at risk even being 60 and above. 80 and above is the highest.

– Right.

– So I mean, I give you, make sure that you’re all vaccinated and boosted in the 80 and above first, then 70 and above, then 60 and above, and we’re gonna protect you with these vaccines, and you’re gonna be okay.

– So they got abysmal uptake in the elderly even for Sinovac, which is the Chinese vaccine, which is not, I understand as robust a protection.

– Maybe not as mRNA.

– Right.

– But it’s still better than nothing.

– Still better than nothing, yeah.

– I actually think it’s, the mRNA vaccines are profoundly important because they’re very good for immunocompromised ’cause they produce such high levels of protein.

– Right.

– That even if they’re immunocompromised, there’s this narrative in the news right now that immuno, we’re throwing immunocompromised under the bus.

– Right, right, right. So, so.

– And true, these vaccines work beautifully. I work with an immunocompromised population. They work beautifully in immunocompromised but older, but the whole virus vaccines that show you the whole virus, they’re okay, they’re good. Just give three doses.

– Right, right.

– For elderly.

– Right, right, and so that hasn’t really been done. So instead, China’s been just moving the football out and now they have this elderly population that’s at risk.

– Very little natural immunity.

– Very little natural immunity, and now the piper’s gonna have to be paid. So I mean, what would you recommend if you were advising the Chinese government.

– You know those, I don’t know if you’ve seen those pictures of those awful isolation bunks.

– Yeah.

– Like what, just miles and miles of little white barracks and they’ve just been kept alone in a barrack if you had a positive test. So, dismantle those and I would just definitely use these as vaccination sites.

– Ah.

– And start with over 80 and above who are the most at risk. So here, you know, here’s the vast vaccination campaign. Please come down here, we’ll give you the vaccine and then we’re gonna give you the booster so that you have three shots and we’re gonna do it in a stage fashion, then over 70, over 60. Then you’re really safe when you have your over 60 year olds all vaccinated and boosted because there was a piece in “Lancet” on March 11th, 2022 that showed that we’ve had 6.6 million deaths from COVID across the planet at the two year anniversary of the pandemic, and probably up to 12 million deaths from the collateral damage of lockdowns, the cardiovascular deaths, cancer deaths, HIV, malaria, tuberculosis, and so, but the, and that paper showed the strongest in any country, doesn’t matter if they masked, it doesn’t matter if they locked down, the strongest protector against lower COVID mortality is vaccinating and boosting your elderly.

– Yeah.

– That’s it, 60 and above. So then you’re free to go when you’ve really have the highest rates that you can in 60 and above, and then everyone else can mill and be around each other and then in time try to vaccinate others.

– Right.

– But you just know that you’ve saved the population that’s most at risk.

– And those individuals can determine risk for themselves.

– They can say, okay, my risk is this. I can vaccine.

– It’s my decision.

– I can wear a mask or not, I can do this or that.

– Yeah.

– But it can’t, it doesn’t need to be compelled and it doesn’t need to be shamed by the media or by public health officials.

– Yes.

– And it doesn’t need to be divided based on blue and red states, and it doesn’t, I mean, it’s all madness is how it played out.

– Yeah. We did it here in that polarized blue-red state way, and fundamentally I, they keep on thinking Sweden, Norway, Finland, Denmark, or as left as they get, right. They’re very left.

– Right.

– But they never had this response. They didn’t have the blue state response in our country. They said vaccines unlock the key of normal life. Once we give you guys the vaccine, you can wear a mask but you don’t have to. It’s totally up to you. Stopped mass mandates, stopped lockdown, stopped capacity limits. Denmark did that in very early on after the mass rollout of the vaccine, and they’ve been living normally for quite a long time now.

– Yeah.

– Since the time when we could have been living normally, which is around the beginning of 2022, after the BA.1 wave. That’s when we have so much immunity that people are very safe.

– Yeah, yeah, and okay, so what are the lessons then? Because then you have monkeypox, I’m sorry, mpox, and the messaging around this was equally sort of disadvantageous to actually having an outcome that you want, which is not so much fear. Yes, good outcomes for the targeted population at risk.

– Yes. I mean, I wrote a book on COVID and it’s called “Endemic,” and one of its big themes is, why did the media go to such fear-based messaging?

– Hmm.

– And I have three thoughts about that. One was for compliance, to help increase compliance with mask wearing, with vaccination, with whatever I think the media wanted. The second I think was anti-Trump.

– Yeah.

– So Trump said open schools. So the media said close schools ’cause they were very anti-Trump.

– Right.

– And then the third was clickbait, just people, you know, just will read your stories if you say something scary.

– Yeah.

– So the mpox outbreak worldwide, May second was the first report to the WHO occurring in the UK with a gay man that had not traveled to west and Central Africa and was very surprising, and then there was this relationship between these two big raves in Spain and Belgium, and then very quickly it was clear it was mostly among gay men, and I don’t mean mostly, I mean like 98%.

– Right, high.

– To 99%, mostly among men, and absolutely wasn’t gonna affect children in big ways. Even herpes or syphilis or molluscum contagiosum, if I have an active herpes lesion, I, if I cuddle or hug a child, I can, they can get it on their fingers. Remember herpetic whitlow?

– Whitlows, yeah.

– And then remember.

– That was a board question.

– Yes. If I touch a herpes lesion as a healthcare worker, I can get it on my finger.

– Right.

– Doesn’t mean that was sexually transmitted.

– Right.

– But it, some of these STDs can be spread to others, and then syphilis, we didn’t used to glove with genital exams and so a lot of healthcare workers had syphilitic lesions on their fingers when they were examining the genitals. So we always knew that there was rare spread of STDs through other means, but it didn’t mean that when schools were gonna open, we were gonna see big, you know, monkeypox outbreaks in September, but boy I don’t, I’m sure you saw the coverage that there was a lot of coverage that schools weren’t gonna be safe.

– Yeah.

– We needed a mask in schools, but masks.

– And masking to prevent.

– Doesn’t prevent sexually transmitted infections.

– Right.

– So it was very hyped up and I think that was because there was that same response in the COVID coverage that you wanted to increase fear to get more people to read your paper and to get people to be compliant, but what did they want people to be compliant with? We needed to vaccinate gay men, and that’s what happened, and now we’re pretty much on our way to eliminate this outbreak in Europe and U.S.

– Right.

– I haven’t seen a case or, we were really hit hard ’cause I direct an HIV clinic. Lots of mpox over the summer and we haven’t seen a case in four weeks.

– Yeah, so we’re starting to see the benefits of that targeting that population.

– Yeah, targeting is good public health.

– Do you think, and this is just speculation, do you think that the media was too slow to actually say, you know what, this is mostly gay men that this is happening to and that’s where we ought to focus, and do you think that was because they didn’t want to appear like they were stigmatizing the men who have sex with men community?

– I didn’t understand that. That was certainly said like, it’s stigmatizing to say that someone’s gay, but how is that stigmatizing? Like with HIV we always said, hey, you’re more at risk if you’re a gay man. So let me give you some PrEP. Let me give you some condoms, before PrEP. It was just very matter of fact, you know, to say if you’re more at risk, I’m gonna help you. Like, a obese child is more at risk for Type I, sorry, obese young adult is more at risk for like, Type II diabetes.

– Type II diabetes, yeah.

– So let me put my focus on this population for Type II diabetes.

– Right.

– Not like just saying everyone’s at risk for Type I or Type II diabetes. You always focus your efforts on those who are at risk. It’s just part of being a good public health practitioner. So it made sense to say this is the population more at risk. Actually I was very offended by that coverage in a way because I felt like there was very limited vaccine supplies.

– Yeah.

– And certainly a 10 year old shouldn’t get it. A gay man should get it.

– Yeah.

– So as someone who works with gay men as an HIV doctor, I felt like that was taken attention away from the population who needed the limited resource.

– Yeah.

– Same thing with the boosters. Like, older people need the boosters. Don’t take attention away and also don’t spend money, government money and boosters for tiny children when my 87 year old father needs it. That’s what I was saying.

– And you know what also, it’s just logistical stuff. Like, to get an appointment at CVS.

– Yeah.

– For a vaccine takes, it’s forever because, in the Bay area especially, everybody’s there getting boosters for their kids.

– Yeah, yeah, but the older people need that.

– The older people have to wait and they’re the ones who like, you know, they actually need it.

– Yes.

– Or would benefit from it, right.

– That’s how we used to, well I don’t know. Maybe, I think that’s how we used to do public health. Like, you’re more at risk for cholera if you were near the water pump that had cholera in 1851 London.

– It’s Jon Snow, yeah.

– So let me take you, yeah, so let me take away this cholera pump and give you clean water.

– Yeah.

– You’re more at risk. Actually, the affluent people in the suburbs who, their Uber drivers were driving them, you know, the equivalent was people would deliver food and they stayed in their homes.

– Yeah.

– They were never at risk.

– They were fine.

– So this, we, there’s been a lot of talk about this with COVID, the laptop class and the Zoom class. The people who were at risk were those who were out doing all the work.

– Yeah.

– So give them the protective equipment, give them the ways to stay safe until you get to a vaccine and give them the vaccine, and then we’re done with COVID because that’s what vaccines do and that, you know, is what this book is about.

– So that’s a good segue right into the book because it’s written, but it’s not coming out until.

– It’s coming out July 11th. It’s called “Endemic: A Post-Pandemic Playbook.” It’s published by Mayo Clinic Press and it’s kind of based on everything we’ve been talking about for the last, you and I for the last two and a half years, ’cause we started talking really early in 2020 in spring. I can’t remember, were we masked or we were distanced? I don’t know.

– No we weren’t.

– I remember we were further.

– We were further. We did keep social distance.

– Yeah.

– And we were not so huggy.

– Yeah, we weren’t as huggy as we are now.

– Yeah, now we’re like, oh my God.

– Yeah.

– Yeah, exactly.

– So it’s everything we’ve discussed. So like, it’s seven chapters but basically the first part really is an introduction to the book, and then the second one is how HIV could have informed the response because that’s, that for those of us who have done HIV their whole lives, that really could have informed the response more, specifically harm reduction, this idea that what you do to control a pathogen is you take the populations at risk, you protect them, but you also figure out how to minimize harm on society or individuals. So if I had said early on in the HIV epidemic, I was too young, I was only 12, but like if practitioners had said like Ronald Reagan said to gay men, you are diseased, something’s wrong with you, stay away from people.

– Right.

– That’s actually was the conservative message, and then the public health community went wild. They were like, that is a horrible way to message on public health that there’s something wrong with you ’cause you have a pathogen. It’s not their fault. People get pathogens, so we are gonna go away from that stigma-based, that shame-based that, you know, kind of terrible, everyone’s still equally at risk style of messaging, and we are going to kind of do tailored focus messaging, here’s how to stay safe, but please have your sexual intimacy, please have your normal lives and here’s how to, the tools to stay safe, and then when we got treatment and prevention, here, these are wonderful treatments and prevention. You’re, everyone’s free to go. Just have your life please and use these treatments, please, and what we did with COVID is, it was the opposite. The current administration was conservative and people really didn’t like Trump, the public health community, and so then they said, if he said open schools.

– We better close it. Yeah.

– We better close schools. If he says that it’s, there’s an age stratified risk, like children are much, much, much, much less risk for COVID, that’s not true. A child is just equally at risk as an older adult. That wasn’t true. That just wasn’t true, is never true. We knew that from data from Wuhan in February of 2020 that was covered by the “New York Times,” and that same “New York Times” reporter who covered saying children are really not at risk, this is such a blessing, went on to become the “New York Times” reporter later for two and a half years that scared people about children, and I’ll never understand it except that it was political.

– Yeah.

– And so it was really how HIV could have informed the COVID response harm reduction, and then the next chapter is just this kind of technical, hope not too technical, but just all the greatness about the vaccines, the therapeutics, how much progress we’ve made in COVID. Amazing, Denmark, when they made the progress, they said we’re done because these things work. So go please live your lives. Thank you for getting vaccinated, you’re awesome. Head up higher levels of vaccination.

– Right.

– ‘Cause they said if you get vaccinated, if you take these vaccines, we’re done, and everyone’s like, ah, we’re done, and then here we said, if you take the vaccines you’re gonna mask.

– Yep, yep.

– You’re gonna socially distance, and you’re gonna stay away from each other forever.

– That’s right.

– Wow, what a motivator.

– It’s a great motivator, and not only that, but we don’t know how many boosters you are going to need.

– Yeah, eternal masking, eternal boosting.

– Yes.

– Is I think the most, those were the two most negative anti-vax messages I could think of.

– They’re absolutely, they’re anti-vaccine messages, like you said, because they generate anti-vaccine sentiment.

– There is a meme that said the thing about people who don’t wanna vaccinate and who wanna keep boosting, is a vaccination is never enough.

– Yeah, yeah.

– Like, it’s the same principle. They meet in the middle.

– Yeah.

– Like, you don’t believe in T-cell and B-cell immunity and that you can stop and you’re gonna be okay.

– Yeah.

– You know, with your vaccines.

– You know what’s nuts? So, and and this goes right into, it’s not just the media, it’s not just the political leaders, it’s everything. Social media companies.

– Yeah.

– Censoring people like Jay Bhattacharya who was saying like, hey guys, and you know, sure, maybe Jay leans a little more politically right, I don’t know. I found him to be incredibly sincere, thoughtful, compassionate guy, very articulate about his position.

– We have to talk about immunity and he talked about immunity.

– He talked about immunity.

– I mean that’s actually my simplest message about this. If you know immunology, you didn’t have to have this hyperbolic response.

– Right.

– You just needed to get to a point where there was enough immune people and then everything was okay.

– That’s it, and what’s crazy.

– So like in 1918.

– You continue, like you continue to be on Twitter and say the most rational, balanced, and beautifully worded things that are so far from designed to incite division, and yet some of the responses are like wow, and it’s really about them, but what I think is interesting about it is like even like one of the big attacks on you is like, oh remember when Monica Gandhi said variants, shmariants on ZDoggMD Show?

– Yeah, yeah, yeah, that reporter who doesn’t know immunology really attacked me on that.

– I love that.

– He doesn’t know immunology.

– Not at all, and doesn’t understand what you were saying either, which was clear.

– Yeah.

– Which is, hey, we have a vaccine that prevents severe illness. It almost doesn’t matter what variants you get, even if they immune escape for infection, the severe disease protection’s still there ’cause of B and T-cell immunity.

– It’s just true. There’s paper after paper on it.

– Move on with your life.

– Yeah, yeah, yeah. T-cells will blanket that spike protein. From alpha to omicron, you are protected if you got vaccinated.

– For severe disease.

– Does it for severe disease, doesn’t matter what variant it is. That is just true.

– Yeah.

– It’s paper after paper. That is actually the fourth chapter of this book. It’s all on immunology, which I think that we really lost sight of. We thought it was only antibodies, not B- and T-cells.

– Right.

– The fifth chapter, I have to admit, is on schools, and what I mean by have to admit, was very painful to write, because any student of history, and I’m a student of ID history, it’s just like my geeky thing. I’ve loved ID since I was like, I loved worms. I love, I can’t explain to you, I love helminths, I love worms coming out of legs. I love ID, I’ve always loved it. I was always that weird, I knew I wanted to do ID before I, before anyone and I loved it.

– You’re wired for it, yeah.

– I just love it, and so if you’re a student of infectious disease history, you can really look back and see that schools were always the places that you would close the least amount of time because of the need for children in schools, and I think you know this, but in 1918 there were three cities that were the most progressive in our country, New York, Chicago, and New Haven, and they were told by the federal government, we’re having a pandemic, close schools, and they said, are you kidding? Nothing doing. These are 750,000 children. In New York City, we’re in low-income housing, tenements, and school’s a place to look for abuse, to give people food, to give children food, and we are not gonna close our schools and you can come and tell me whatever you want, but we are not gonna close our schools because we’re progressive, but you know, we went opposite ’cause Trump, but.

– Yeah.

– And so it is a, I think it’s quite devastating because now the harms of these prolonged school closures are so clear, especially, let’s forget about United States for a minute, especially in our, in India and the Philippines, Bangladesh, Uganda who drove up, you know, the sex trade in young girls, drove up HIV rates, drove up, Bangladeshi boys going and work for their family. They’ll never work, they’ll never go back to school again. There are now 250 million children that have entered intergenerational, multi-generational poverty because of this response of not being in school. School is the most fundamentally thing, important thing to get you out of poverty. So there’s no, we can’t sugarcoat this. So it’s all that data on schools, and then the sixth chapter is about global vaccine equity, which we’ve talked about on this show before that why did India have a 4% vaccination rate when delta hit? Because we’re selfish in the west with vaccines and we need to work on global equity. So it’s about global equity for therapeutics, and then the last one is a pandemic playbook for the future, using all these lessons of HIV, even the anti-lessons of COVID, kind of in a circular way. You get vaccines, you ease restrictions immediately. You never really focus on schools as a place to close, keep those open as much as you can, and then you de-emphasize like useless deep cleaning ’cause that decreases trust in public health. You reassess testing and what’s a true viral load, viral culture versus a PCR test that could stay positive for 100 days, and then you work on trust in public health and then you come back to the top of the pyramid where you wanna hopefully, you know, have more trust before we face the next pandemic.

– So I mean, this is brilliant. I can’t wait to see this.

– I hope people actually.

– I hope, yeah.

– Use it proactively, right.

– For the future, I hope so.

– For the future, yeah, because this, we blew this one like, severely.

– We really blew it.

– Especially in the United States.

– Yeah.

– I mean China’s blowing it in a different way.

– Yeah.

– But we’ll see in the end what all pans out. You’re pointing to the Nordic countries that actually generally did quite well.

– They did very well, and they’re left.

– Yeah.

– Please remember that, blue state of California, they. They did very well and they encouraged vaccines and they just lived, you know, after that.

– Yeah. They moved on the way that you were pointing in the beginning.

– Yeah.

– And the thing is, because it’s been so divisive that it is a moral palate thing like, oh, well if I, you know, if I have a moral matrix that kind of skews liberal, then Trump was so offensive and some of the stuff they did in that administration around COVID seemed so minimizing and so careless and thoughtless that my care versus harm moral taste bud is really triggered and my fairness versus cheating moral taste bud is really triggered, so I’m gonna go all in the opposite direction and it’s.

– So opposite that you didn’t think of societal impacts on kids.

– On the societal impact, and even like, you know, there’s stuff that you, there are second and third order effects of our response that are interesting and hard to quantify in advance. For example, do you remember the South Korean Halloween stampede crush where all those young people were killed?

– Yeah.

– Part of the reason there was such a big crowd is it was the first time in three years they were able to do that. So you’ve pent up young people who were safe from this thing.

– So blessedly, as you said.

– Blessedly.

– Such a weird, it has to do with IL-17 and interferon, apparently. I think the best work of this was out of Albert Einstein. I would encourage people to read a “Nature” article that says the kids’ immune systems mean they’re all right.

– Wow.

– That’s the title. We’re so lucky, that wasn’t true for measles or mumps or rubella or diphtheria or pertussis or influenza.

– Flu, yeah.

– Always worse in young children, but it was just a blessed aspect of COVID.

– And so what we did was we did a backwards response and now when they’re able to be young people again, you know, bad things can happen, and the mental health crisis around that.

– Yes, and adolescents.

– Substance abuse, the abuse at home that we weren’t catching ’cause of schools, all of that, like you said, probably made that chapter really difficult.

– Did you see that now suicide is the second leading cause of death in 10 to 18 year olds? That was just a report.

– That is just obscene.

– From the CDC last week, and even on Twitter you’ll see people denying it. They’ll say, well it’s okay. It was a pandemic. How is it okay? They wouldn’t have died of COVID.

– Really? They wouldn’t have died of COVID.

– I think that minimization of the harms on society is because of a justification of the response. You wanna keep on doubling down.

– That’s right, that’s right. Double down.

– So you don’t look like you’re wrong.

– That’s right.

– As opposed to apologizing.

– That’s right.

– And I think, you know, that’s the other thing about me writing this book as opposed to someone else. I’m pretty, I’ve always just been kind of really left of left in my politics. I’m really interested in poverty and social justice.

– Yeah, I saw, I, you know how I knew you were pulling up? I saw a Bernie sticker on your.

– Yeah, exactly. I can’t get it off, actually. He’s not running again, but there’s, I’m super left. So I think it’s helpful for a super left person because I write this line in there that I say, I’m left of left, but I’ll never understand the Democratic response to what happened with children.

– Yeah, yeah.

– ‘Cause you know you hurt the poor children the most.

– Right.

– You know you hurt Black and brown children the most. White children, their rich affluent families. They had tutors, they had people at home, they sent ’em to private school. We know that. This is now documented by Harvard and other, you know, major looks at this, that it was really African American and Latino children that got hurt the most. So you know that you did it. So don’t double down, apologize. You have to apologize.

– You know what you nailed is that you can be, you can have the moral matrix that would identify you as left in many ways, like caring about disenfranchised people, the things you’re pointing at, the old school progressive values, and the right actually applied those same values during COVID.

– They did.

– They said, you know, this is disequitable. This is a regressive tax on the poor. This is.

– Yeah, they did.

– You’re hurting small businesses that are not affluent and they’re trying to, they’re employing people at minimum wage and you’re putting them out of work and.

– They’d swear the Democrat party gets criticized for the coastal elite.

– Yeah.

– You know, that hurling that question. Are we, is this party representing the elite only? Because the poor, yeah.

– Yeah, the limousine liberals.

– Yeah, yeah.

– And I will really encourage everyone to watch, I don’t don’t know if we talked about this, but Michael Moore’s “11/9,” which explained how Trump got elected, and the reason is because what he’s explaining is that the Democrats at the time were not representing middle America poor, and so is not taking away, taking away schools and taking away small businesses, not actually representing the poor, and so you’re gonna rebel and vote for whoever’s trying to help you ’cause you’re poor.

– Exactly.

– So I hope that there’s a realignment of values ’cause the values are off.

– I sense there’s a shift actually. People are just in general waking up to a more, a view that’s like yours, which is pragmatic, compassionate, actually looks at all the different consequences. It’s a very nuanced view. I call it alt-middle. It’s not political.

– Yeah, yeah.

– It’s like, you can be on any of the spectrum and still have an alt-middle mindset, which is like, okay, all right, and first of all assume love for the other person, that they’re not an evil person.

– Yeah.

– But that doesn’t happen on Twitter because Twitter is, everybody’s a non playable character. They’re just like a.

– So mean.

– Tweets are super mean, yes.

– Yeah, but it, that word pragmatic that is, I love that word because that was what was happening with HIV after a while after we got over Reagan and all that, like the public health was very pragmatic.

– Right.

– And someone told me once about San Francisco, it’s progressive without being pragmatic, that you have to be pragmatic in your approach. How could you think that a highly transmissible respiratory virus that has 29 animal reservoirs and counting could ever be eradicated? How could that ever be thought of? That’s again, going back to student of infectious disease history, it’s not smallpox, which was the only virus that could be eradicated, and next stop I hope is polio once we get over the public health.

– No animal reservoir, and ’cause vaccine.

– Because it’s only in primates, yeah, and a good vaccine.

– Primates, I see.

– Primates only is the only animal reservoir, but COVID will never be eliminated or eradicated because it has animal reservoirs, it looks like other respiratory pathogens, you can spread it, right, before you’re sick, and our vaccines are great, but they’re not gonna prevent our reinfection. We don’t, and nasal vaccines aren’t there yet, and I’m not sure they’re gonna ever work. That’d be nice, but we haven’t gotten one for influenza. So no non-sterilizing vaccines. So four reasons we’re never gonna eradicate it, and China should have known that in February, and we should have known that in February of 2020, and then you minimize damage.

– Yeah.

– You first basically protect those who are most at risk. You can do masking. You can do masking, but it has to be those good masks. You could do distancing, you can do ventilation, you can do contact tracing, you can do testing. They weren’t very effective, any of them. Ventilation I think is the most effective non-pharmaceutical intervention, moving things outside.

– Right.

– Then you get the vaccines and that’s your way out. That’s your ticket out.

– Right.

– That’s your key.

– Right.

– And we didn’t make it our key in this country ’cause we were political.

– And so that’s a nice segue into the last topic we’re gonna discuss, which is our division and our sense of meanness and our sense of separation from each other, and our sense of in healthcare, especially, this idea of burnout, this moral injury, this idea that we’re not, we don’t have the resources to take care of the patients. The patients are adversarial, it feels like. There’s this sense that there’s violence at our doorstep, and you told me a story actually before we even started the interview of your experience with a patient in, was it residency?

– Yes.

– Can you tell that story?

– Yes. So I came to San Francisco cause I was really interested in HIV for my training, but I was also really interested in the county population and in really poor population.

– San Francisco General.

– So San Francisco General.

– I was a sub-I when you were there. It was like, that sub-internship at San Francisco General is like, it will make me cry.

– It is, it was all publicly insured patients or non-insured.

– And so much HIV, so many disenfranchised people.

– So poor and.

– And challenging population, but so rewarding, like you just felt like a sense of expansion. Yeah.

– I love that population and that is the population I’ve been privileged enough to be with my whole life. So in residency, I just hated being up in the middle of the night. So this was.

– I feel it.

– Night shifts for ER.

– Yeah.

– And I don’t know how people do it, but.

– The male ward at the general.

– Yeah, it was called the MISH.

– The MISH.

– At the time, remember it?

– Yep, I remember.

– And now they call it something else, but, and so I had to do the like 11 to seven, 11 o’clock to seven, and I dragged myself in ’cause I think I was on jeopardy and I had to go in at like in the middle of the night and someone was yelling at me, he was coming off methamphetamines and he was so angry and he was calling me so many names, you know.

– You can use the names if you want, but.

– Well, he said, F bitch. See, I’m not even a big swearer ’cause I come from Utah, and then I think there was something about my color of my skin, I’m sure.

– Yeah.

– He was so mad at me.

– Yeah.

– And at first I was looking at him and I don’t know what happened. I was really tired, but I also like was reading some Vedanta and Hinduism and his face shifted and I just, I saw him as God. I just did, I saw him as God and I was so privileged to be with him at that moment. Like, I was suddenly not tired. I was just privileged to be a doctor and I have been privileged to be a doctor, you know. In all the years that I’ve been a doctor, I can’t imagine a better job, and the privilege comes from, the privilege comes from illness and being and seeing the person across from you as God, and that’s where the privilege of being a doctor comes from, and I was on the other side and my husband died, and the privilege of being a patient and being a doctor and we’re all God, and I was very moved by that experience, and ever since then I have literally seen every, I have never been offended if someone calls me terrible names. I’m totally into it. It’s fine. It’s fine, it’s fine. It’s fine, it’s God, it’s God. We’re just talking to each other.

– I was so moved by that story because having recently been on all these retreats and all of that, when you experience the face, and the thing is, we all have different names for this. Like maybe the atheists are offended by the word God, but you could just say this.

– This.

– This, when you see that face that is not other than you, like the same thing looking through my eyes and experiencing what I see as you is looking through your eyes and experiencing itself, and when you know that, it’s one thing to talk about that and people go, that sounds like a Hallmark card. When you experience it like you did in that.

– Directly, yeah.

– Directly, you know it in your marrow, in your core, everything changes. Everything’s okay, everything’s okay.

– Everything’s okay.

– It’s all perfectly managed.

– I, to me, I read Alan Watts in India, like really hot. It, we went over the summer, so super hot. Try to distract myself from the heat reading Alan Watts, and he tells this story. There’s this one essay where he said he had a dream when he was nine, and in the dream he was strapped to a metal ball and the metal ball was, and he was, he couldn’t get out of this metal ball and it was hurdling around the earth and it was extremely miserable, like what an awful feeling, right. Dizzy, can’t get out of it.

– Claustrophobic.

– Claustrophobic, awful, and he suddenly got the sense that this is exactly as it should be, and the metal ball broke into a million pieces and he was on the sparkling beach and everything was exactly as it should be, and that, it doesn’t have to be God, like you said. It has to be that just that feeling of knowing.

– Yeah.

– That this compassion for your fellow person, and you know, Emily Oster wrote this piece on, right before the midterm elections on, she wrote it for “The Atlantic” saying, let’s have a pandemic amnesty. I’m sorry that, you know, she actually worked hard on school openings, but what she said is, we didn’t know enough. Maybe it’s okay we kept schools closed so long and it’s okay, let’s just all forgive each other. It was a nice article, but the anger on both sides was so polarizing.

– Oh.

– It didn’t look like there, like many people said, no amnesty for you, no amnesty for anyone in the pandemic response, and then many people, some people said we should have kept schools closed longer, but that’s increasingly a very, very tiny position.

– Tiny minority, yeah.

– That’s a very tiny extreme minority, and at this point, if we can’t heal this divisiveness, not just about COVID, but about this idea of like, looking at the other, looking at someone else and seeing them as you, or seeing them with compassion or love, we are, I’ve never seen such a polarized response. It’s very much on living in San Francisco, I see people so angry because they’re not finding common ground somehow with each other, and it, we need to work on this healing, divisiveness.

– So, okay. I think this is, if we talked about nothing else, this is all that matters because everything else will click when you know it’s all perfect, you naturally do the right thing.

– Yeah.

– And the way that, you know, the way that I think it’s manifesting in the world now is we have religion, but we don’t have God. We have meaning and belonging, but it’s not true meaning and belonging. It’s the meaning that’s ascribed by tribe and by clique and by party and by this. So that’s where we’re finding our belonging and our sense, because we no longer have a common mythology. We no longer have the hero’s journey as our common myth. So we have to find meaning by going, I’m a liberal who hates Trump and I’m gonna do this, or I’m a conservative who loves ivermectin because my tribe loves that, whatever it is.

– Yeah.

– And so we find this a solution to the meaning crisis in things that mean nothing, that are appearances.

– But we used to have meaning. I mean like, well number one, it’s, this is the main point is it’s fundamental to have meaning in life, right?

– Yes.

– Like you need some meaning, and so we told people to stay away from each other for three years, and there’s this kind of depression anxiety that came along with that, so then we weren’t able to find meaning in like our human connections.

– We stripped away that meaning, yeah.

– We took away probably the most meaningful thing of all.

– Right.

– Which is human interaction, primate interaction.

– Right.

– If you’re a primate, we need to be together. So we took that away and now we’re trying to come back together, I hope. I wish the mainstream media would let us come back together and stop saying, be scared.

– Yeah.

– To come back together. That’s very unreasonable to say that, but we have to come back. Maybe when we come back together, we’ll get more meaning, but we, whatever you get your meaning out of, we need, the meaning should not be gotten out of hating someone else, and we don’t, that’s kind of where we are right now, and I hope we can get our meaning back from the things that used to give life meaning, interactions, if you believe in God, God.

– Some spiritual practice.

– Some spiritual practice, quietness, nature, environment, whatever, it’s gonna give you meaning, but we gotta get back to it ’cause we’re so mean right now.

– Definitely. Absolutely.

– It’s just, I’m just amazed.

– And even that meanness, even that division is absolutely the perfect unfolding of this, but when you know that, the meanness goes away.

– Yeah.

– Because the motivator for the meanness evaporates into a sea of meaninglessness. Why would I do that? Why would I hurt myself? Why, you know, what’s to push and pull on? It’s all this.

– It’s all this.

– And you know what’s crazy? So I just, you know, I recently got back from 100 person, mostly medical people, silent retreat for five days in the hills of North Carolina, and a lot of these are doctors now. I’ve had the privilege of being able to connect with them afterwards. It was trans, it’s always transformative, these things, but this one was, there was something even different, and I talked to an anesthesiologist who used to hate being on call. Like, it was like suffering. Saw it as like, me versus others suffering, and texted me and said, I’m actually glad that my hospital is forcing me to wear a mask everywhere in the hospital, and I was like, why? And he said, because they won’t see how I’m grinning ear to ear about how amazing it is to be able to do what I do and have these connections with people and they’ll just think I’m crazy.

– That is amazing.

– And that’s the meaning, the connection with this moment, each other, you know? And I felt it in you from the first time we met. There’s something special about you. Other people feel it too, that you see that clearly, you’ve had to suffer through these terrible loss with your family, and the story you told at the beginning of your son looking up and seeing God, that is just it. That’s it, you don’t need to say anything else. We could have cut the interview right there.

– Yeah, we could have. It’s, one does get dragged back into the petty fights, and Twitter can be extremely petty and mean, but it isn’t actually about that because someone who’s yelling at me and saying, you know, I don’t like the vaccine, or then they yell at me, I like the vaccine, I mean, I like the, I don’t know. I can’t, I somehow can’t get it right. You know, like they all.

– Oh, they all hate us. They hate all of us, yeah.

– You could get, you don’t, you’re not telling me that the vaccine’s killing people, and then you’re not telling me that the vaccine, I don’t know exactly what they’re yelling about. Yeah, you need 20, but the issue is that that is also people suffering, and so they’re yelling at you because they’re suffering in some way, and if you can just see people with compassion in that same way that that person in the ER became this luminescent figure to me that day, that night, that two in the morning night, he was just yelling and he became luminescent because he was just someone that I actually had the privilege of being able to give him something to make him feel better ’cause I had medicines and I had like, I got to be a doctor, it was profound, and if you can try to keep on bringing yourself back to that, then the person on the street that you feel like being mean to or they’re being mean to you, you can see it as they’re suffering and you can view them with compassion and then you’re grinning ear to ear. I don’t wanna wear masks though anymore. So I’m not with your anesthesiologist ’cause I want people to see me smiling.

– I want people to see.

– I think we need to again, harm reduction. We need to understand that there are harms to covering most of your face. There are harms to not being able to see the light in people’s eyes and their smiles. So that’s, especially for children, they need to see each other smile.

– That’s right.

– So, I wrote a lot about masks at the beginning, but I was very clear if it reduces severe disease, boy there’s better part of reducing severe disease is getting the vaccine.

– Vaccine.

– That’s how most of the world responded.

– Or the people who’ve already been infected and are protected.

– Yeah, yeah, exactly, immunity.

– Immunity, immunity in general, which we talked about on previous shows.

– Totally works.

– That is absolutely beautiful, and you know, what I tell people too is, you know, when you’re, when you feel that sort of triggering from other people, we were talking about this before the show, like, it’s like how do you tolerate Twitter? Like, how do you manage that when people are attacking? You really have to realize that any response to the comments that we read about that are directed in any way is always us. It’s always something in here that’s responding or projecting or whatever, and when you see it for what it is, which is just this like, it is suffering in itself.

– Yeah.

– Or it’s the sense of, the mistaken sense of separation or the mistaking sense that any view is absolutely correct from the standpoint of reality, that reality’s perfect.

– Multivariegated and it’s not only one way and there’s not just one science and there’s not just one thing.

– Yes, yeah, exactly.

– Yeah, that’s exactly right.

– It’s very, very beautiful.

– Reality’s a magician.

– Yeah.

– It can do anything and it spins up a world that has these laws that it violates on a regular basis.

– Yeah.

– It’s just, it’s perfect.

– Yeah.

– So yes, so I’m hoping through your light that you bring to the world and this book and the way that you teach and talk from tolerance and from all the lessons you learned about HIV and AIDS and treating that group and the stigma that we initially created and then we learned how to manage better, that’s true public health.

– Yeah.

– And that brings people together and the conservatives that are listening and they’re like, well I’m not gonna listen to Monica anymore because she has a Bernie sticker on her car, I’m hoping.

– Actually, I can’t get it off. Only ’cause he’s not running again, and I’m, I’m I yeah, I mean I just wanna say.

– You wanna replace it with a Trump sticker.

– I wanna replace it with a like, love, you know, fellow man and don’t keep children outta a school sticker. Say that like, I like that.

– That’s, I dunno who.

– Represents, but.

– That’s what I want, please. There you go.

– But even they would say, wow, I see the light in you. That’s exactly, and we’re all coming from this beautiful place of love, and when we see that the winds shift and everybody wakes up a little more and you know, so anyway, so I told you, I promised you that we’re gonna do, like, we’re gonna try to set up a little mini retreat here.

– Yes, I wanna come so badly. I wanna meet that anesthesiologist.

– Yeah.

– He’s screeninng, like constantly smiling.

– Yes.

– I love that.

– Yes. Yes, yes, and and yes, and anything else you wanna say as we run out of time?

– I do wanna say that I think anyone who has moderate point of view, you know, in either way is gonna be in touch, but I hope that this book actually does become a playbook that we minimize the impact of society, of our responses. We try to make public health less political and we just think just as we do as doctors, who’s most at risk? Who can I help the most? How do we harness our amazing biomedical advances to help people? And when do we just say that like this is what we wanna to achieve and please have your life and please go back to what gave you pleasure and meaning. So I hope that this book could serve as that playbook and maybe it won’t, but I think it’s coming out at a time where there’ll be reception to it because now we have HIV, we have COVID, and we will have something else, and we have to have a clean, reasonable, compassionate way to deal with it.

– That was pretty well said. I don’t think I have anything else to say. Monica.

– Thank you for having me.

– Amazing to have you here.

– Thank you so much for having me.

– Guys and gals and non-binary pals, I just give, I do my usual end of show thing. Like we’re a podcast, subscribe, leave a review on your favorite platform, YouTube hit the notification bell, Facebook, iTunes, Stitcher, whatever you listen to and share the episode. That’s the main thing, and if you wanna support us, there’s ways in the show notes, for a onetime donation. I respond to all comments there, or join our supporter tribe I sound like an NPR person.

– No, but you say it so well ’cause you have such a mellifluous voice. I couldn’t say that.

– You say just remember like, like when George Takei, Sulu in a Star Trek episode where they went back in time to go to San Francisco and save the whale.

– Gosh, I can, yeah.

– He’s so sexy, and I’m not even gay.

– So like yeah.

– He’s like so good with controls.

– I wanna be good with controls.

– He’s so good with the control.

– I want him to marry.

– They’re flying into San Francisco, and he goes, “San Francisco. I was born there.”

– Okay, him and John Lennon were supposed to marry me. They just didn’t know it.

– They didn’t know it. I love it guys. We are out. Thank you Monica.

– Thank you.