We're going to do. And I know you've had a sleepless moment. But you and I are going to do the math. Myocarditis off second
shot. The number I'm working with needs scientific notation one point four six times turned to the minus three. Okay fine. The
percentage numbers here. Does the public understand how small the likelihood is of a frightening myocarditis off the
second dose. It's unclear. I do think that sometimes when we talk with numbers like that the general public goes over their
head or they don't really concretely see it because what they think about is they heard some anecdote from somebody who had a
kid that had myocarditis and that's there to them. That's one hundred percent. So sometimes it's very hard to teach people how
to risk calculate because they're not able to and they're very swayed by anecdote. It shows how rare it is. I mean
Jon this is critical and this has to do with social media. I'm sorry. Social media doesn't do the math. Well some even want to
hear from health officials though directly. I'm still confused as to what I need to do. Let's talk about
that now Doctor. I was fully vaccinated in and around some time in May. Let's say I'm trying to work out how protected I still
am from this virus. Do we have any idea. Does it vary from person to person.
Do these vaccines only last six months. Doctor what are we learning about that.
Well it does vary from person to person but you have to take a step back and ask what do you want the vaccine to protect you
from. Do you want it to protect you from serious disease hospitalization and death. Or do you want it to protect you from
every breakthrough infection even if it's mild and doesn't even require a doctor's visit. But when it comes to the letter to the
former serious disease hospitalization and death unless you are above the age of 65 immunocompromised have some high risk
condition. Your vaccine is working really really well for you for breakthrough infections. I don't think that these first
generation vaccines should be used to kind of chase breakthrough vaccine vaccine breakthrough breakthrough infections and kind of
kick them down the road because we don't know how durable that response is and we might be doing this again in another six
months. So I don't think that's a good use of the boosters. But for those above the age of 65 those with high risk conditions
and those without the JNJ vaccine those individuals should get an additional dose. Dr. Adalja are the implication here is
significant that you don't think that it is worth trying to prevent breakthrough infections for people who are vaccinated
who do not have pre-existing health conditions. Is that what you're saying even though those people could potentially
transmit the virus in a social setting. This is not something that should even be tracked if they're not going to get
hospitalized if they're not going to die from it. It's unclear how well it actually prevents against breakthrough
infection. We have some limited data that shows yes for some period of time after that vaccination you may be less likely to
get a breakthrough. However we don't know how durable it is. And other individuals
including Paul Offit who's on the FDA committee said this is like akin to kind of rolling a boulder up the hill. It only
happened to roll back down again. So I don't think that's the best strategy because the virus
isn't going anywhere. Everybody is going to get Covid-19. Hopefully it's a breakthrough infection and not an mild for
them. And I think that's what we have to do with these first generation vaccines. There may be vaccines down the line that
induce more immunity in your nose which may be more beneficial for it for preventing breakthrough infections. But I don't think
that these vaccines are really going to be good for chasing breakthroughs in mile people. We don't actually know how
contagious these individuals are. And clearly if you've got symptoms you should be tested and you should isolate and not
expose yourself to others. But I don't think that this is something that's driving cases across the country. This isn't
what's causing the problem. Seventy something thousand cases we have every day in the United States now are not being driven by
breakthrough infections are being driven by unvaccinated individuals. Dr. Adalja you've come on this show repeatedly over
the past few weeks and frankly even a couple of months and said it is time to transition to a new reality where Covid is just
present and we have to live with it. And I wonder how controversial this is how much pushback you get from colleagues
how heated your conversations are. As many people whether it's China looking for a zero Covid policy or even here in the U.S.
it still is a really trying to adhere to pandemic era policies. I came out and said that this was going to be the fifth seasonal
corona virus back in February of 2020 and that we had to start thinking about it. And then I had a lot of pushback early on.
But now I think people are coming to the conclusion that really was something that wasn't even questionable based on the fact
that this is a respiratory virus with an animal host that spreads efficiently that this is going to be endemic. So that
pushback is lessening. But there are people that are having a hard time adjusting to a
new world where Covid-19 is always going to be there that there's going to be Covid-19 cases 50 years from now. And I
think that's because people weren't told that ahead of time. And public health really went on this abstinence only approach
where it never do this. Don't do this. This is always going to be risky and didn't teach people how to risk calculate to adjust
their lives or recalibrate their lives with the fact that Covid-19 is going to be a respiratory virus that we deal with
year in and year out. And you've got to learn how to cope with it. You've got to learn how to make good choices. And the best
way to do that is to be vaccinated. So Covid-19 is not a. Problem for you. Doctor did you think you mentioned public
health policy and I'd like to finish here with you. Do you think there has been a risk particularly over the last year that a lot
of public health officials now are conflating the science with what they'd like to see in social science behavioral psychology.
Do you think that's where there's some confusion at the moment. I definitely think that people sort of took their values
whatever they might have been and kind of applied them to Covid-19 policy. And and that's I think what caused all the
acrimony over masks over vaccines. People protesting all of that really has to do with the way
society kind of viewed Covid-19 in how they viewed it through the lens of whatever tribe they were in. And that was how they
viewed it not looking at the science but what did their tribe think whether that was the tribe on the right or the tribe on
the left. And nobody was actually saying what's the actual data show here. How can we do this safely. We all have to kind of
live with this virus. What's the best way to do it. But I think we live in an increasingly tribal society and people kind of
want to know what their collective thinks and that's what they think. And then it becomes difficult for anybody trying to
actually break through those bubbles. We expect politicians in Washington to be politicians. DR Was this a failure of
institutions groups like the CDC. I do think that when you look at what happened with Covid-19
this is a failure of government at the federal level the state level the local level even the school district level. And I do
think that the CDC had a lot of failures and you can't really blame them because they've been captive to politicians they were
captive to the Trump administration where we saw lots of political meddling going on where the CDC director was basically
bound and gagged and put into a trunk. And the same thing I think is happening to a lesser degree but still happening during
the Biden administration where we're always wondering you know did the CDC director overrule that that advisory group because
she herself believed the science was a certain way against what her advisory committee said. Or did she try to make Biden's
promise to give justice to everybody whole. So those are questions that we have. And I do think the CDC has
been damaged by this thing.