“Special 100th Episode: The COVID Vaccine – Everything you need to know” – with Emily Oster

For the 100th episode, Emily Oster returns to Healthful Woman to talk about the COVID vaccine. She explains how testing was done, how the vaccines work, whether they are safe for pregnant women, and more.

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Dr. Fox: Hey, welcome to the “Healthful Woman” podcast. Today’s Thursday, January 14th, 2021. And today I’m joined by Emily Oster to talk about the COVID vaccine. Anyone who’s a regular listener of this podcast knows how awesome Emily is. She was our first guest and today will be her fourth time on the podcast. We’re gonna discuss the vaccines in general, the COVID vaccine, how to decide whether to get an in pregnancy or not, and when life might actually return to normal. All of these are really hot topics and I’m sure you will appreciate her perspective. Okay. So today is our 100th podcast. Happy 100. 


When we started planning the podcast about a year ago, I had a small idea of what it might look like, but it was truly mostly a mystery. I had no experience in this space other than listening to a few podcasts about sports and movies. So I wasn’t really sure what to expect. I have to say, from the moment we dropped that first podcast in April until now, it has been amazing. First of all, I’m so touched by all of you who take the time to listen. Our listenership continues to grow and we surpassed 30,000 downloads a few weeks ago. I’m overwhelmed. The reason I do this is to get good, reliable information out there. And the fact that so many people find it interesting, or helpful, or both is really meaningful to me. I also appreciate all of the emails, and the comments, and suggestions, as well as the reviews on Apple. I read every single one of them. They’re really helpful, so please keep them coming. 


I wanna give a huge thanks to the entire team at DLM, Digital Limelight Media in the great town of Grand Rapids, Michigan for overseeing all of the technical aspects of the podcast as I am wholly incapable of doing that. Although they are a full team, I do wanna single out Emily O’Connor who is the person assigned to deal with me in all my shenanigans, yet manages to remain upbeat and positive and rarely reminds me that I’m an idiot. I’m so thankful to all the guests who take the time to either come to my office or get on the phone and let me pepper them with questions. Public speaking isn’t everyone’s cup of tea but all of the guests also know how important it is to get good information to you, so they volunteer. 


As for the next 100 podcasts, we have a lot to come. We already have a lot of awesome guests lined up for “Healthful Woman” podcast. And I’m really excited to announce that in the upcoming weeks, we plan to start a second podcast called High-risk Birth Stories. In this new podcast, I’m gonna be speaking with women about their own birth stories. Over the years as an OB, and especially in the past year doing this podcast, I’ve come to learn how meaningful and powerful these stories are and how much we can all learn from them about people, about ourselves, and about life. They’re also really fascinating and interesting. So be on the lookout for High-risk Birth Stories. We’re also gonna put a link on our own website for anyone to let us know that they’re interested in coming on the podcast to tell their story. Once again, from the bottom of my heart, thank you all very much. Enjoy today’s podcast. Have a great day and have a great weekend. 


Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right. Emily Oster, welcome back to the “Healthful Woman” podcast. You were our very first guest and now we’re having you back for our 100th podcast. How about that? 


Emily: I am impressed that you have done 100 podcasts, maybe. That’s pretty awesome. 


Dr. Fox: I am impressed that I could do anything 100 times. 


Emily: Yes, exactly. 


Dr. Fox: But yeah, I mean, listen, you started us off with a bang, and everybody really loved your podcast, the first one we did, and then obviously the second one we did together about pregnancy and now we’re back to COVID for the big 100. 


Emily: Sounds good to me. I mean, not good, but, you know, I’m excited to get to talk about it. 


Dr. Fox: Yes. The start with COVID and we’re back at COVID. And it’s been a long 9 to 10 months, but it’s really quite remarkable that we’re talking about a COVID vaccine today, literally like 9 months from we talked about the start of this. 


Emily: Yeah. I mean, it’s pretty amazing if you sort of think about how long it would typically take, how long it does typically take to make a new vaccine that we’ve somehow found ourselves not just talking realistically, but like actually people are being vaccinated, like as we speak. It’s a pretty impressive thing. I will say, like, there are many aspects of this that I think have been incredibly badly managed where we could have done better, but this feels like one where, you know, this is about as good as I could have expected the vaccine piece of this to go. 


Dr. Fox: Yeah. And the amazing thing is sort of the science and development part of it was really quick. I mean, they had the vaccine ready to roll in, you know, June, July, and the six months are really to test it to make sure it was safe and it’s gonna work and all these things, but the actual production of, you know, from getting COVID or, you know, seeing COVID to having a vaccine ready to inject into somebody was really amazingly fast. And I think that it’s great that we’ve had, you know, three, four, five, six months to actually test it before we start vaccinating people. 


Emily: Yeah. I mean, I think, you know, one, I’m sure we’ll get into this, but I think one of the things people had sort of said is like, “How could this be so fast? How could this be so fast?” And I think that there’s this fear that somehow the thing that we’ve cut corners on is that is the safety testing. But actually, the thing that was very fast was the development of the vaccine, which probably in part reflects this mRNA technology. But the testing piece, the kind of like how do we do the safety testing, that’s something which, you know, we’re doing the same way we would typically do with, you know, big samples and big trials and good amount of follow-up and all those things that should make us feel secure. 


Dr. Fox: Right. I think that’s the reason there was a lot of confusion during the sort of the four months and a lot of this came into play, you know, with the presidential campaign about “We’re gonna have a vaccine,” “We’re not gonna have a vaccine.” “It’s gonna be ready by a certain date.” “It’s not gonna be ready by a certain date.” People thought that sort of meant like the people in the lab with the white coats are like working to develop it during that time. And, you know, people weren’t sure, but no, it was already done. It’s just sort of, when are we gonna finish these trials to make sure that, A, it works and B, it’s safe, and that’s not as predictable and that’s why there could be a lot of people, you know, bending it one way versus another way or just not knowing and disagreeing. But it was done by that time, the vaccine was ready. I mean, it was made. 


Emily: Yeah. And they actually, I mean, I think that they ended up being even a bit faster than they thought because of the fall surge, which, of course, is like a double-edged sword there. But because so many people became infected in the fall, they were able to get to conclusions about efficacy much faster because that requires, you know, you being able to see a lot of infections. And had the virus been, you know, more under control, we wouldn’t have seen as many, it would have taken longer to get to a point where they could be confident about, you know, the amount of efficacy we were seeing in the vaccine. 


Dr. Fox: Right. I was reading an article in the wall street journal about it and it almost reminded me of the movie “Twister” where these people are, you know, chasing around the tornadoes to find them where, you know, they couldn’t really recruit people for the vaccine studies until they knew where there was a hotspot of COVID. And so they would sort of rush to that area and say, “Okay, there’s an outbreak here. Let’s do the vaccine.” You know, “Let’s recruit people in this place.” And then to go to another place. So it wasn’t as…you can’t predict it. And so that’s, like you said, they had a lot of hotspots in the fall so they were able to quickly get people there to enroll people in the studies, to see whether the vaccine is gonna work or not. 


Emily: Yeah. No, it was…the whole thing was a pretty impressive effort to, you know, get to where we find ourselves. 


Dr. Fox: Excellent. All right. Go humans. Good work. So I think it would be really helpful for our listeners, because there’s been so much talk about this vaccine, which has brought up talk about all vaccines and, you know, what is this? Should I get it? Should I not get it? Is it safe? Is it gonna work on? And there’s a lot of questions. There’s certainly a lot of misinformation out there that’s surrounding the actual information. And I wanted to talk about that, but obviously, I’m gonna plug, you know, you do have the website you’ve been running, explaincovid.org, which is, you know, you and your colleagues put a lot of really good evidence-based, understandable information about COVID there. Is that website still…are you still pouring stuff into there or is it just sort of like a standing repository, what you already put in, how is that working currently? 


Emily: Yeah. So we’re still updating the stuff we have in there and putting some new stuff in. And I think we’re looking at kind of a partnership, which I’ll know more about in the beginning of the year where I think we can get even more distribution for the content we have. But the content is still being updated and I think we have some updated stuff about vaccines in there. So hopefully people can take a look if they wanna go deeper than we can go on podcasts. 


Dr. Fox: That’s great. And also you have your newsletter that comes out. It just came out yesterday. We’re recording this towards the end of December, and you had your newsletter came out yesterday, which was about the COVID vaccine. And how do people sign up for your newsletters? 


Emily: I am on Substack. It’s emilyoster.substack.com. Or you can search the name in the newsletter as parent data. 


Dr. Fox: Awesome. And it was really good one yesterday, I highly recommend it. Let’s jump in. So essentially, I think the first thing that we need to cover is just, in general, how do vaccines work, like why do people take vaccines? How do they work to prevent disease? And essentially, the idea of a vaccine is really, you’re teaching the human body to fight a disease without actually giving the person the disease, right? Because if someone gets an infection that’s like a virus, like if you get measles, your body will see the measles, attack it, learn how to attack it, develop what’s called antibodies. But the problem is you’ve also just had measles, which itself can make you very sick. And so, the idea of a vaccine is to put something in someone’s body, usually by an injection or…vaccine’s pretty much always by an injection, that is similar or derived from the measles virus that doesn’t get you sick, but teaches your body to respond to the measles virus in the same way as if you’ve got it. That’s sort of like the concept behind a vaccine. Do you find that people have a hard time sort of grasping that, or is that something that everyone sort of gets, or why does there seem to be a lot of confusion about that? 


Emily: I think people sort of understand that. I think that the step that is hard is thinking about, well, what did you do to the virus that made it so I’m not getting it? And I think that for a lot of people, they sort of…somehow they end up thinking about it like the vaccine gives me a milder form of the virus. I’m not sure that’s a very helpful way to think about it. That’s not really right. And so it sort of… But then that generates some fear, like, “Well, what if I, you know, I don’t wanna get the virus at all. I don’t wanna get any virus.” But, of course, that’s not what vaccines, what vaccines do. And so, I think that’s part of the confusion and the kind of like fear that some people have. But, you know, the basic, I mean, as you said, like the basic idea is that somehow you’ve got to introduce a portion of the virus, a version of the virus, something closely related to the virus. It’s such that your body can recognize at least some piece of the virus and then figure out, you know, how to react to it, make some antibody so it’s ready if you, you know, did encounter the real virus out in the world. 


Dr. Fox: Right. And then sort of before this technology that we’re gonna talk about, this mRNA technology, generally we divided vaccines into what we called live vaccines versus sort of like dead vaccines. And the live vaccine was you weren’t getting the virus, it’s something called inactivated where the virus-like doesn’t work anymore. And there was always like the theory that someone can get infected from it and so you wouldn’t give those viruses to pregnant women or women who are…or people who are what you call immunocompromised, that they couldn’t mount a response. But the viruses that were not alive, the dead viruses, you would give to them…we give those in pregnancy, we give those, you know, because there is no risk of the virus because there is no live virus available in the vaccine. 


Emily: Yeah, exactly. So, you know, we sort of think about like, there just isn’t…you cannot get it from that. It’s dead. It’s not a live virus. I mean, it doesn’t mean that there aren’t other, you know, risks to vaccines or other things that, you know, sometimes people have allergic reactions. Like there are things that can happen, but the thing that cannot happen is getting the virus from the vaccine. 


Dr. Fox: Right. Exactly. So people do have reactions to vaccines sometimes and those reactions are generally just the body’s response of mounting an effect against it, but it’s not the actual virus itself. You’re not getting ill from the virus, you’re just… And again, in some ways, it’s showing that your body’s…it’s doing what it needs to do but it may just be uncomfortable while it’s happening. And then the allergic reaction is just like, you know, you take anything in your body, you could be allergic to it, you know, whether you eat it or inject it, and that’s always a risk. But again, these are things that we monitor for. And I think that what has thrown a loop into this is this mRNA technology that’s new. And so, I just wanted to…you know, so we can explain exactly what that is, why this vaccine is unique in terms of…because it’s not really a live virus and it’s not sort of a portion of the virus itself, but we’re using a portion of the mRNA. So how would you explain what mRNA is? 


Emily: M is for message. So it’s a messenger RNA. So people know normally what DNA is and RNA is a related compound or related biological methods messenger, in this case. I think the way we described it, in the COVID explained newsletter about this is it’s like a recipe card. It’s like a little, you know, fragment of biological information that your cell can read like they read a recipe card, and they can then…it’s a recipe to make a particular thing. And so when this is introduced, it goes to your cells, it tells your cells, “Make this thing.” And the thing it’s making is a particular spike protein from the virus. So it’s not making the whole COVID virus, obviously, it’s just making one particular protein. And then it encourages your cells to make that protein, your body will then recognize that as a foreign protein and it will create antibodies against it, and that is how the sort of vaccine works. The sort of key piece here is that this…the way that we’re introducing a piece of the virus is through this like messenger RNA recipe card that is introduced in the vaccine and then it goes into your cells and that your cells can read. 


Dr. Fox: Right. I mean, mRNA, you know, the way we sort of think about it in the cell is, you know, DNA’s the ultimate code, right, of our cells. But what actually happens is that DNA is made into, or not into, but mRNA is made off of the DNA sort of template and then proteins are made off the mRNA. So it’s sort of like a blueprint for proteins. And the interesting thing is, so in a typical virus, they would just inject the protein from the virus into the body, like use that protein as the vaccine. But, again, I’m not a molecular biologist, but I assume that the reason the mRNA is a much more effective way is you’re injecting that and it’s gonna get taken up into your cells, and then your cells are gonna start producing that protein. Again, they don’t produce the virus, right? You’re not getting any form of the virus. You can’t make the virus, it’s not gonna change your body to make any virus, but your cells will temporarily make that protein and it’s a much more efficient way to deliver the protein to your body because it’s gonna be everywhere essentially. And so it’s almost like it allows our bodies to actually produce this protein ourselves that we can learn to fight. And it’s a much more efficient way to be vaccinated than to try to like round-up the protein and inject it into people. 


Emily: Yeah. So I think one of the things that is very impressive about this technology is that is part of the speed of producing it, which we sort of talked about at the beginning, is that if you wanted to make the protein and inject people with the protein, you would have to actually make the protein and that would like…like in a lab, like in a factory. There has to be like a factory producing the spike protein, that would take a lot of time. Creating these mRNA things is much faster because your body is doing a lot of the work, your cells are doing a lot of the work that would be happening in the factory. And I think that the big technological innovation here was figuring out how to get the mRNA to be introduced to your cells so your cell is not just sitting around waiting for foreign, you know, messenger RNAs to like come around. That wouldn’t be very good to sort of…there’s a technological step to get the mRNA into the cell. And I think that was the thing they figured out. But having figured that out, it’s like a really efficient production technology for the vaccine. And then, and you know, an efficient biological process because your body’s making proteins all the time. That’s like the main thing that your cells are doing, is just making different protein. 


Dr. Fox: Right. I mean, it basically outsources the production of the vaccine to your own cells. Instead of having a bunch of factories trying to pump out protein for 300 million people, let the 300 million people make the protein in their own bodies because mRNA we can make easily, but the key is that’s one of the reasons why it’s a little more delicate and this business about how cold does it have to be and, you know, because proteins tend to survive… 


Emily: They denature. 


Dr. Fox: …travel better than mRNA does. 


Emily: Yes. Proteins are better, mRNA decays. Which of course is part of what, you know, it’s gonna decay pretty quickly once, you know, once it’s in your body. So some of these things people said, “Oh, is this gonna stick around?” You know, “Am I gonna have this foreign virus DNA in my body forever so it’ll merge with my other DNA?” No, actually this decays really fast that’s probably why it has to be, you know, stored in the world’s largest collection of dry ice. 


Dr. Fox: Yeah. It’s pretty cold but it has to be stored in. But again, it’s, you know, better to have some difficulty in the transport than difficulty in creating the production of this because otherwise, that would slow it down significantly. And so this is one way to really speed up production into millions, and millions, and millions of doses a lot quicker. So I think that’s cool. So now that we’ve sort of explained how vaccines work and the mRNAs sort of functions like a “typical vaccine,” but the unique aspect is it allows our bodies to sort of produce the protein instead of producing it in a lab. But again, it should have the same effect. And one of the really nice things about the studies is how high the efficacy seemed to be. It really seems to work. 


Emily: Yeah. It really does. So I mean, you know, and I think it’s important for people to kind of understand what… Some people say it’s 95% effective, like what do they mean by that? I think some of the messaging around that has been a little confusing. So basically what they do in these studies is they’ve got, you know, some people who get the vaccine and some people who don’t and then they follow them over time and they see, you know, how…they wait until some number of people, total of all of the people, have gotten COVID. So, you know, in this case, they waited until, I don’t know, like 150 people in all of the population had COVID and then they see how many of those are in the different groups. So I think in these things, it was something like, you know…you know, think about it like there’s a hundred cases in the control group that wasn’t vaccinated and like five cases in the group that was vaccinated. 


And then what that means is basically if you imagine what otherwise these groups are the same because they were chosen randomly, in the absence of the vaccine, you would expect 100 people in the treatment group to have gotten COVID. And, in fact, only five of them did. So that means kind of 95 of those infections were prevented. And so then we say it’s like 95% effective in the sense that it would have been 100, but instead, it was five. And that’s a really good efficacy number. I mean, that’s like, you know, that’s like up there with what we’re seeing in measles, it’s way, way, way outside of what we typically see for flu vaccines, you know. In a general year, a flu vaccine could be, you know, 30%, 40% effective, could be even less. So this is just a really, really, really effective vaccine. 


Dr. Fox: Right. I mean, vaccines are not 100% effective in any population, but when you get to the point that they’re 90% to 95% effective, that’s really when you start getting rid of the disease, if everyone takes the vaccine. Because even the few people for whom it did not work in their body, like for whatever reason they did not mount an antibody response or it wasn’t high enough, they’re not gonna run into people with the disease because, you know, if your chances are reduced of running into somebody with COVID, for example, because 95% of people are vaccinated, aren’t gonna get it, it just won’t spread quickly. And I think that that’s part of…that’s this concept of herd immunity that people talk about, that if enough people are immune to it, either because they got the disease or because they have the vaccine, even if there’s a few people in there who are susceptible to it and can get the virus, they’re not gonna run into the virus anywhere. And so, yeah, if they happen to run into it, they could get it, but those odds are so much reduced. It doesn’t spread quickly in the population. And that’s the idea of herd immunity. And it’s important because some people won’t react well, meaning they won’t be able to mount a response on the vaccine and they are susceptible, and there’s a lot of people who can’t get vaccines because they’re not well enough. And those people really, if we don’t have enough people vaccinated, they won’t be protected. 


Emily: Yeah. And I think that, you know, this is…you know, when we first started talking about vaccines for COVID, I think people were thinking, “Oh, you know, it’d be so great if we had a vaccine with a 60% efficacy, like even that, you know, that would really help.” And then to sort of have the realization be this kind of efficacy, I think that is just…it just really gives you a lot of buffer around, as you say, sort of people who can’t get the vaccine for some reason and against the fact that it’s gonna take a little time to vaccinate everyone, you know, like well, we’re gonna start getting some of that protection even as we sort of vaccinate portions of the population. 


Dr. Fox: When the COVID virus first came out, there was one of these thoughts, “Well, how is it gonna behave?” Right? And if you think of like a spectrum, on the one end of the spectrum, you have something like measles. The measles virus is basically the same now as it was 5 years ago, 10 years ago, the measles vaccine is basically the same. And so if you have a virus that’s not mutating, not changing, it’s basically what it is and you develop a vaccine, it has a much higher chance of working, right? As long as the vaccine is made correctly, because once someone’s immune, they’re basically immune. Now, immunity can wane with time and because of that, sometimes you need a booster to sort of get your immunity back up. And that’s true with most vaccines that, you know, every 5, 10, 15, whatever years, you maybe get a booster. 


But then on the other ends of the spectrum of something like the flu, and the flu changes every year. And the reason the flu vaccine is, number one, has to be injected every year, and number two, isn’t as effective is because the flu vaccine isn’t against one virus, it’s against multiple flu strains. And they sort of have to pick every year, which, you know, 5 to 10 flu strains, are they gonna put in the vaccine. And there’s no thought it’s gonna protect you from the other flus, but they’re just trying to do the math on this and, you know, figure out how we can do that. And so those are the two ends of the spectrum. You know, when you vaccine it’s, A, not gonna work so well, and B, you have to repeat every year versus something you get once and you’re pretty much done, or do you need it again 10 years later. And we didn’t know where COVID is gonna fall out and all of this is indicating that it’s really towards that measles side of the spectrum, which is much, much better in terms of how this is gonna play out in the future. 


Emily: Yeah, absolutely. I mean, I think that, you know, there’s still a question of kind of… I think we will still need to figure out, you know, to what extent do people need boosters, how frequently, you know, and you know, questions like that, and immunity, even from things like measles, you know, does feed somewhat overtime. Well, the measles is unusual in the sense of the immunity lasting a long time, but it certainly does not suggest that we’re in like a kind of every year, people are gonna have to be vaccinated, [inaudible 00:24:21], at least not now, which is good. 


Dr. Fox: Right. I mean, if that were the worst-case scenario, it is doable to get a COVID vaccine every year, but it doesn’t look like that’s gonna happen. It looks like if you’re gonna need a booster, it’ll be in that 3 to 5 to 10-year range, again, which is not different from your tetanus shot. Like this is something that we already do with other infections. And so, we know how to do this. It’s done, there’s a way to track it. It’s not that complicated. And I think that would be sort of a reassuring prediction if that’s how it’s gonna play out and not something like, “Oh, I’m gonna need to get a booster every 5 to 10 years.” Like, okay, like that’s how it works. Like that’s okay. 


Emily: That’s how it works. Yeah. 


Dr. Fox: Yeah. And so I think that that’s really good that they’ve seen that type of efficacy. And the other thing that’s interesting is in those studies you mentioned, one of the other important parts is since people didn’t know if they got the vaccine or the placebo, they didn’t have different behaviors. I was talking about this with my daughter the other day, where she goes, “Why did they have to know what they got?” I said, “Well, you can imagine a situation where let’s say everybody with the vaccine, you know, sort of behaved as they normally would have and everyone who got the placebo really hunkered down and sheltered and wore masks and did this, and then you would see very few infections in either group and you’d say it doesn’t work. It didn’t make it any better.” So you need everyone to have a similar exposure so you can find the true effect of the vaccine rather than the effect of people’s behaviors on the virus. And that was another way these studies that were done, were done, you know, very pristinely and the way they should be done. 


Emily: The sort of science of randomized trials for vaccines is something we’re pretty good at. And, you know, these were really good versions of that. 


Dr. Fox: [Inaudible 00:26:04] good they did it right other than just rolling it out and seeing what happens. That’s gonna be [inaudible 00:26:09] harder to prove. 


Emily: That’s more of the Russia, the Russia [inaudible 00:26:16]. 


Dr. Fox: Yeah. And then just to review, like we said, so someone who chooses to get a COVID vaccine cannot get COVID from the vaccine. It is not scientifically plausible that that could happen. It just can’t. 


Emily: Right. You cannot get COVID from the vaccine. I think one thing that we’re gonna see, that I think we’re just gonna have to keep pushing the messaging on, is actually the side effects of this vaccine are by all accounts, like typically slightly worse than, you know, the side effects you get from like a measles vaccine. And so, I’m a little worried that if people… And these side effects are like you’re tired. I mean, I think I’ve heard them describe it as like hangover, you know, for a day or two. And so I think we’re just gonna have to sort of manage that messaging a little bit to make sure that people understand that if you have, you know, you sort of have like have some fatigue the day after the vaccine, it’s not because you have COVID, or mild COVID, or a little bit of COVID or something else, that’s just because your body is like mapping up this immune response and, you know, that takes some energy. So in some ways, it’s sort of a good… Like when people were in these trials, I heard somebody will be like, “Oh, I’m hoping that I feel really tired so then I’ll know that I got the vaccine.” So I think, you know, we got to like repackage that as a good thing. 


Dr. Fox: Right. And this is true for all vaccines. I mean, people do get reactions. I don’t mean reactions like that’s like a bad thing, but they sometimes feel ill after getting a vaccine. And it’s the type of things that either they’re tired, or they feel a little feverish, they feel a little, what we call malaise. They’re just kind of weak or their muscles hurt. That’s a normal response to a vaccine. It’s not an illness, it’s not the virus. It’s your body’s response. The thought was that the COVID vaccine maybe was slightly higher percentage of people who would have that, I think they’re estimating like 15% or so of people will get that. And it may be a little bit worse, but it doesn’t seem to be markedly different. It’s not like everyone who gets a vaccine is gonna feel bad afterwards. Just an in of one…I got my vaccine on Friday and today is… 


Emily: I’m so jealous. I’m so jealous. 


Dr. Fox: Yeah. Today’s Tuesday or what? Today’s Tuesday and I felt fine. My shoulder was slightly sore the next day like any other time you get an injection, but I was fine. And my other friends who got it, or, you know, the doctors I know in this, they were fine. And so, a few people felt sick, but no one got violently ill from it. And I think that’s all been very reassuring. And so, yeah, you can get a reaction now, again, like we said before, an allergic reaction to a vaccine is different. It’s unique, and it can happen, you know, with any type of injection, or any medication, or any food that some people just get allergic reactions. They try to sort of screen for that based on other allergies and their sort of recommendation that after you get a vaccine someone should be like watching you for 10 to 15 minutes to make sure it doesn’t happen. They have to bend a drill available and an epi-pen. You know, there’s things that should be there when you get the vaccine, but again, that’s not specific to COVID, that’s just anytime you get an injection, there’s a chance of an allergic reaction, which is again, not common but possible. And then I think the other thing is the reason there’s two shots, two injections for this vaccine, again, very common for other vaccines. Flu is only one, but again, it’s really just a one-year thing. But when your children get, you know, measles shots or they get, you know, they’re teed up shots, it’s always a series because it takes a little bit of time to build up enough immunity. And if you only gave one shot, maybe some people will be protective and not everybody. So the fact that it’s a series of two injections is not unusual. That’s typical for vaccines. 


Emily: Yeah. I mean, it works. So if you think about like the MMR, which is like, I think people are pretty comfortable with for their kids, you know, you get one at a year and then you get one at four and it’s actually… The MMR pattern is in some ways kind of similar to this, which is that like there’s a fair amount of protection provided by one and even better protection provided by two. And that’s kind of what we’re seeing here that, you know, sort of like the protection seems to be pretty good from the first one, but, you know, it’s even better if you have to and I think that, you know, hopefully people will just kind of go through their two things, get their vaccination card and then we’ll be able to start moving on. 


Dr. Fox: Right. One of the things we don’t know yet is for people who got the disease, the virus sort of naturally, so to speak, A, will that protect them from getting it again and to what degree and for how long? And that’s really not known. So, for example, someone gets measles or chickenpox, the vast majority of them will have lifelong protection against getting it again. Not everybody. It is possible to get it again, but it’s very unusual, and these people don’t tend to need vaccination later in life. And it’s just unknown with COVID. Is it something that… You know, there’ve been a few reports of people getting it twice, but very unusual. And so we don’t know if the people who got it, if they’re sort of protected for life, if they’re protected for three months, for a year, for five years, and that’s just something we’re gonna have to learn with time and figure that out. There’s no way to know it yet, because not enough time has passed, but that it’s…it’s a possibility that they’re protected and it’s a possibility that they’re not, and we don’t really know those percentages. 


Emily: Yeah. And we’re just gonna have to… I mean, there are gonna be many unanswered questions that we’ll know in, you know, three or five years that we don’t know now. 


Dr. Fox: Right. Now, I think one of the things we should address is the safety of the vaccine, right? So we explained how it worked, we explained that it’s effective and sort of what’s typical. People have a lot of concerns that since it’s “a new vaccine,” that how do we know it’s safe? Like, what if, you know, we find out later, you know, something horrible is gonna happen to all of us. How do you reassure people, you know, your listeners, your readers, people in your family, that it’s safe? I guess I should ask you, do you think it’s safe? And then if you do… I know the answer to that, but if you do, how do you reassure people? 


Emily: Yes, I do think it’s safe. You know, I think that some of the reassurance comes in in the explaining. So sort of helping people understand that like, yeah, like this mRNA is new, but the idea is not new. You know, it’s not like a totally… It’s based on the theme ideas that vaccines have always been based on. So I think that by helping people understand, that’s kind of the first step into sort of helping people feel comfortable. But I think the other thing to say is like the safety trials are extremely rigorous, right? They did… If you sort of think about like they do safety trials first, you know, phase one, phase two trials, and then they did a very large phase three trial. Now, the goal of phase three, which is this sort of the last trials of the Madonna and the Pfizer vaccines, the goal of those is to, you know, to show efficacy, to figure out how effective it is. But on the way, obviously, they’re also monitoring for, you know, adverse events for bad things that that may happen. And, you know, they monitor really, really carefully and we just didn’t, you know, we didn’t see any of that. I think there were sort of no major vaccine-associated adverse events. They said that there were, you know, I think there were probably a couple of deaths from COVID among people in the non-vaccinated group. And so, you know, I think that like the safety profile, we already know a lot and we are gonna know more, and more, and more as time goes on, right? So it’s not like we just stopped paying attention to what happens. You know, when you are vaccinated, you will be monitored for, you know, serious adverse effects because the data that we keep collecting as people are getting vaccinated, we will know more, we’ll know more, we’ll know more. This is a place where like every day now, you know, thousands of people are being vaccinated. So I think all of those things together should help people feel more confident about the safety profile. 


Dr. Fox: Yeah. Like you said, I think there’s a lot of data that goes into the, you know, assuming or considering it a safe, number one is the actual raw data that we have a lot of people who’ve been injected with it. You know, tens of thousands of people have gotten this vaccine in the studies who were monitored very closely and they didn’t find anything. So could there be a rare complication that you would not have seen in a sample size “that small?” Sure. That’s a possibility, but it doesn’t seem to be like a common problem that would happen. And number two, this isn’t the first vaccine we’ve ever given, right? There’s been many vaccines produced and given, and in general, they tend to be very, very safe. I mean, every single year we produce a new flu vaccine and inject it into, you know, millions of people, and it’s safe pretty much every year. 


And so it’s sort of…the assumption would be that it’s gonna be safe because of the history. And then when you actually test it and it, you know, actually plays out that way, I think people should feel very reassured, you know, that it’s safe. Obviously, we don’t know everything from everything. There is always the theoretical possibility. But I think that, you know, when you look at safety, you have to look at the alternative, not getting the vaccine, right? If there was… Yeah. If there’s a third option, like get the vaccine, don’t get the vaccine, and the third option is wake up in the morning and COVID is gone, yeah. I would take the third option, but that’s not really on the table. Yes, but not get the vaccine. 


Emily: No. It is… I think this is the piece that is in some ways so different now than in all of the other places where we’re talking about this. So, you know, like even in childhood vaccinations, which I think everybody should get and I think are super, super important, you know, people still have this like, “Well, you know, I’m worried about the measles vaccine and like, you know, I don’t really know anybody who’s had measles.” And there’s a piece of that’s true. Like you should get your kid vaccinated, but the chance of them getting measles, if they’re not vaccinated remains fairly small. Whereas the chance of getting COVID, if you don’t get vaccinated is not small. A lot of people have COVID, hundreds of thousands of people are testing positive for COVID every single day. And so when we think about like, what is the alternative, I think sometimes we’re sort of stuck in this place where people are like, “Boy, wouldn’t it be great if there were no COVID?” Yes. That would be great. That would be the first best. But like right now your choice is between getting the vaccine and remaining, like, I have quite high risk of getting COVID, which we know is bad. So I think that’s just a kind of piece to… Sometimes these people are missing even though, of course, like how could you possibly miss it? But I think that because of the way we think about vaccines is sort of so often in the face of a kind of abstract threat, which like because we have good vaccinations, we don’t have that anymore, very much somehow this has been a sort of harder thing to kind of get your head around. 


Dr. Fox: Yeah. I find it so interesting because people, you know, I’m getting a lot of calls as you can imagine, “Should I take the vaccine? Should I take the vaccine?” And, you know, we talk about this and this and they say, “Well, how do you know that it’s safe?” And I’ll tell them, you know, why I think it’s safe. They say, “Well, are you 100% sure?” I’m like, “Well, no, I’m not 100% sure of anything really. I mean, there’s always a very small chance that there’s some risk with a vaccine.” I say, “But, you know, there’s risks with the virus.: I mean, like that’s the alternative, that you have, you know, whatever it is, 5%, 10%, 20% chance of getting the virus from somebody and, you know, the same thing, short-term problems, you know, severe problems. I mean, people die from this virus. 


Now, most people won’t, particularly young and healthy people. And I get that. I’m not really hugely afraid of the virus in the young, healthy population because I think most do fine, but it sucks to be out of work for two weeks or to even to be quarantined for two to three weeks and your whole family has to be quarantined for two to three weeks and people get hospitalized and even if they recover, it still is a really unpleasant experience. And then same thing like, well, what about long-term? Well, the virus people are worried maybe there’s long-term consequences. No one really knows, but we know, you know, just as little about the long-term consequences as COVID as we do about the vaccine, and that’s it like given the two options, like why would you choose the virus over the vaccine? It doesn’t make any sense. And so I think that, you know, people have to really think about, there are only two options here. One is to get the vaccine and one is to not get the vaccine. There’s no option to just not have COVID around. 


Emily: No. No. And I think, I mean, this is…for me, there’s like this exemplifies so many of the terrible choices in this space. Would you just like… Like I find myself a lot of times telling people, “Look, you’re gonna find yourself between two choices that neither of them you really like.” You know, it’s like when we think about seeing our families, it’s like you see your family and you remain nervous all the time that you might give them COVID or do you not see them and then you’re sad? And like, this is in some ways, a little bit like that although I would say actually, for me, the vaccine choice seems great. But even if you are nervous about that, it’s really between sort of maybe being a little nervous about the vaccine and otherwise, you know, remaining at risk and being nervous about getting the virus and needing to be isolated in various ways. And so, you know, I think that that there isn’t a choice to have, you know, snap your fingers and have COVID disappears so we kind of got to figure out what’s the second-best. 


Dr. Fox: Right. I mean, I think there are some people who just in general, they like to wait and see a little bit longer. And I think that’s okay if someone said, you know, “I’ll probably get it, but I don’t wanna be in the first wave.” Like fine. If you feel comfortable, you know, isolating sheltering, hunkering down for another, you know, two, three, four months until you, you know, see that the rest of us didn’t, you know, drop dead from the vaccine and then you get it, okay, fine. Like you wanna wait a couple of months and just let it play out first and then do it, I cannot. That’s not how I think about these things because I wouldn’t want the risk for the next couple of months, but okay. That’s not like insane, but pretty much people are gonna have to get it because again, unless 95% of the population’s vaccinated, it’s not gonna be situation where you can just walk around and say, “Oh, I’m fine because everyone else vaccinated.” Because it’s not gonna be that way. It’s just not gonna get to 95%, not in the near future. And I don’t think people wanna, you know, stay shelter down for the next three years. 


Emily: No. I mean, I think people are kind of recognizing like there is a lot of concern that we’re gonna have a lot of vaccine resistance, and that’s gonna be problematic, but I think I am less worried about that than some other people in part because I think a lot of the resistance that I hear is just sort of, “Well, I don’t wanna be first.” Good news. You’re not first. Unless you’re, you know, apparently you’re first. 


Dr. Fox: Yeah. I’m still here. 


Emily: But I assure you, I am not first. And, you know, by the time you get around to sort of people like, you know, in my kind of…in my set, which is kind of like, well, I think, you know, I’m a pretty low-risk person. Like maybe I wouldn’t wanna take, by the time we get to be, millions, and millions. and millions of people, tens of millions of people are going to have already been vaccinated. And so if what you’re looking for reassurance is like millions of people have already been vaccinated and everything is fine, you’re gonna have that by the time we get to most people who are in, you know, whatever is the tier. And I’m probably in tier, you know, 11B or something, whatever tier I’m in. So by the time you get to that space, there’s gonna be a lot more information. And so I think, you know, more complicated questions I think have come up for people who are saying, you know, frontline healthcare workers where it’s like, “Okay, actually I’m being offered it like this week.” And you know, “Do I take that?” And I think, you know, part of the value of doing healthcare workers first is that this is a group which is probably, you know, on average, more comfortable with, you know, with vaccination and has, you know, has a better understanding maybe because they’re professional, you know, life into kind of what it is and what the sciences and so on. 


Dr. Fox: Yeah. I think also it’s… I mean, a lot of things you’ve said are great. I mean, I agree with you. I think that people are gonna get on board and do it. I don’t think it doesn’t need a ton of resistance. I tell it’s like the iPhone. You know, there’s a 10% of people who are gonna, you know, camp out overnight to be the first ones to buy the new iPhone then there’s the next like 30% to 40% who sort of just like get it cause it’s new and then there’s like the next 40% who like, they just get beaten down so much by the iPhone that ends up getting it even though they never even wanted it. And ultimately all of us have iPhones. And it’s gonna sort of be there with the vaccine. There’s gonna be some people are like, “Oh, my God, I’m dying to get it. I want the vaccine.” And get the vaccine. And then the rest are like, “I’ll get it when I get it.” And then the people who I think initially hesitant, will see you all, “All my friends got it and they seem okay and I really don’t want all of us to be wearing masks forever.” And they’re like, “All right.” And then they sort of do it. And I think we’ll end up getting to high numbers. And I think that’s also one of the reasons it may take six months to get everyone vaccinated or almost everyone to vaccinate, not just the logistics of it, but just… I think there’ll be stragglers, but I don’t think it’s gonna be a huge percentage who put their foot down and don’t get it. I just don’t think that’s gonna happen. 


Emily: Yeah. And I think we’ll eventually, you know, to get, you know, to get over the last hump, we will probably need to say things like, you know, there will be…employers will be able to say, you know, “You can’t come back to work unless you’re vaccinated and schools will be able to say you can’t come to school unless you’re vaccinated.” And, you know, those last things, but I don’t think there’s a huge share of the population that’s gonna need those, you know, last nudges to do it. 


Dr. Fox: I agree. And then one of the unique categories in that, you know, I work with all the time are pregnant women. And I think that’s a little bit more difficult because they didn’t study the pregnant women. So when they did those big studies that we spoke about in the summer and the fall, they intentionally excluded women who were pregnant or knew they were pregnant. Obviously, they inadvertently vaccinated people who probably were pregnant, but they didn’t mean to. And there’s a lot of debate whether they should specifically be excluding them or they should specifically be including them in these trials and people disagree about that, but ultimately they weren’t included. And so when pregnant women asked them what they should do, it’s sort of the same conversation, and where I say that I don’t believe there’s gonna be risk. And I do believe there’s benefit. But the idea of risk is less known because it wasn’t really given to tens and thousands, tens of thousands of pregnant women. So there’s some theoretical possibility, but again, with other vaccines in pregnancy, unless it’s a live virus, we give them and we don’t really hesitate. We recommend the flu vaccine every year, we do a teed up vaccine in every pregnancy. And so we haven’t seen problems. And so the risks, I would say, are theoretical. And again, I tell pregnant women like, “Do you wanna have COVID when you’re pregnant?” Because people are really scared about that too. Again, fortunately, they usually do well, but people are really afraid of that. And it’s the same two options. Would you rather be at risk for COVID when you’re pregnant or take a vaccine with the potential for a theoretical risk that we didn’t think of? And it’s not a great choice to be in, obviously, but that’s where we are. That’s it. That’s your choice. And I’m not recommending people delay pregnancy till we figure this out. I think that’s probably a little bit much, people can do what they want. Obviously, that’s their business, but I sort of present it in the same way, I am in I’m in favor of it. I do encourage it. But I do sort of temper my knowledge about the lack of risk because it wasn’t really tested in the same way that it was a non-pregnant adult. 


Emily: Yeah. And I mean, I think this is like, in some ways it’s not so unique, like they explicitly excluded pregnant women, but there’s people with other conditions that were just like, are not, you know, are not exactly included. So it’s not, you know, it’s not that we know everything about everybody with every other preexisting condition except for pregnancy. And so, you know, what we do tend to treat pregnancy with some caution. And I think that, you know, I saw, and I put in yesterday’s newsletter, what I thought was a really good decision tool out of someplace in California, just sort of walking through like, you know, what are the circumstances that would sort of cause you to think, like how can you think about this as a pregnant person? You know, how do you sort of think about the benefits versus the risks that there’s sort of really what you have to come down to is like, there is no reason to think that this would pose a particular risk in pregnancy and it’s not unique. We give other, you know, other vaccines in pregnancy, as you said, but, you know, we also don’t have that explicit data, you know, right now. 


I do think again, not dissimilar from our earlier discussion about, you know, what like the fact that most of us have to have to wait. There is a study out of…there’s a registry, there are a couple of different registries the CDC is collecting information on pregnant, particularly, you know, frontline healthcare workers who are kind of first in line, collecting information on their vaccination status so they can follow up with them. So, you know, we will know, even as the drug companies are also doing their own, you know, doing their own safety trials, we will just know from the kind of the world, some things about how this is doing in pregnancy from the fact that a lot of healthcare workers are pregnant and will get the vaccine. So I think we will know more and, you know, like you, very, very, I’m very optimistic that what we will learn is this is safe in pregnancy, as it is in other times. 


Dr. Fox: Yeah. I mean, and what you’re saying about the frontline, the healthcare workers, whoever are getting vaccinated first, it’s an interesting thing. First of all, it’s interesting that they couldn’t figure out what the better numbering system, because it’s like the craziest thing, it’s like the craziest outline. Like I’m in group 1A, 2B, or something. It’s like just… it’s like that’s the [Crosstalk 00:47:16] thing… 


Emily: Yeah. I think they’re adding more numbers. 


Dr. Fox: It’s like, does it make it groups 1 through 40? Like, I don’t know, whatever fine. So that’s interesting, but the healthcare workers, for example, it’s an interesting group because, number one, like the thought, is how do you prioritize who gets the vaccine first? And there’s two ways to think about it. One is what is the individual’s risk of getting COVID? And the thought is, okay, if you’re a healthcare worker, you’re gonna be seeing sick people who come into the emergency room, going to the labor floor, you know, whatever it might be. And so I personally, as a healthcare worker, am at risk. Now, on the flip side, most healthcare workers, if you look at the entire population are on the younger, healthier side. Obviously, it’s not universally true, so it’s sort of odd. But the other way to think about is we’re the ones most likely to spread it. Right? So part of the issue, you know, someone saying, “I work in an emergency room, should I get the vaccine?” And I say, “Well, number one, you’re higher risk to get it from somebody. But even if that doesn’t worry you, you don’t wanna pass it on to some poor patient who comes in, you know, who has, you know, some other, you know, diabetic, hypertension, and a heart attack. You don’t wanna give them COVID. 


And so it’s sort of both ways and it’s sort of the reason the hospitals really either push or mandate or whatever that everyone gets a flu vaccine. It’s not to protect the workers, it’s to protect patients from the workers, spreading it or spreading it from patient to patient. And so I think that it’s almost…it’s not just a sense of like, “Oh, since we’re at risk, we get the vaccine first.” It’s like, “We have a duty to protect these people. And if I’m spreading COVID from one person to another or from me to somebody, like that’s bad. And so, you feel like a sense of responsibility to get vaccinated for just that reason. And so I think a lot of the pregnant healthcare workers, when making their decisions, it’s not… I mean, it’s hard for them. This is a very difficult position to be, and it’s not just about their health, their baby’s health, but it’s all their patients’ health. And so I think that probably many of them are gonna end up getting vaccinated for all of those reasons. And we should have data on it. 


Emily: Yeah. I mean, I think by the logic you give, I think the most important groups to be vaccinated are people who work in nursing homes and live in nursing homes because those are, you know, those are people who are basically…the people who live in the nursing home are very, very, very, very high risk for serious complications. And then the people who work there are, you know, probably much more even than doctors at risk of the spread because they look kind of like PPE, the sort of generalized PPE situation is just way more, like way less serious. And so I think that, you know, putting those guys in the sort of tier 1A, 1A, whatever it is… 


Dr. Fox: 1A, 1A, A1. 


Emily: … Higher better than you. Better tier than you seems like a good but, you know, there’s been so much variation in how this is dealt with. You know, the UK has gone with almost an entirely like age-based ranking system where you’re just like start at the top and go down more or less whereas the U.S. has this sort of like essential worker business and all this other stuff. 


Dr. Fox: And it’s also state by state. Every state does it a little bit differently. 


Emily: Exactly. Everybody decides their own, everybody’s rolling their own. That’s worked so great so far. [Inaudible 00:50:18] 


Dr. Fox: I sense the sarcasm. Yeah. 


Emily: I mean, I really like, I feel like they sort of… I mean, immune… This is a total another topic, but I feel like the fact, you know, the kind of like the states have had so much responsibility in the pandemic in the U.S. and the approaches they’ve taken are so variable and it’s sort of partly just the like total like melt data,[SP] federal leadership around every everything that’s kind of been part of the problem, but it’s generated quite a lot of random-seeming variation in behaviors. 


Dr. Fox: It’s really interesting because, you know, we’re learning about all this on the vaccine, so number one, it was distributed to each state and each state can decide how they prioritize it. But then within the States, they would send it to each hospital and each hospital could decide for themselves how to prioritize it. So it’s like, you know, it’s an exponential equation for how many possible ways this is gonna be done and it’s gonna be done in every way. So maybe we’ll learn the best way on the 4 million permutations. 


Emily: Maybe. Yeah. Just in time for the next [Inaudible 00:51:20] 


Dr. Fox: Just to review, where we’re both pro the vaccine and the benefits very much likely outweigh the risks. There are obviously some exceptions, but, you know, this whole thing, like talk to your doctor. I mean, this is what the doctor’s gonna talk to you about. There isn’t usually that much nuance in this, you know, it’s a crazy thing. And like, “What’s the recommendation?” “Talk to your doctor.” I’m like, “Well, okay, what does the doctor know?” I mean, like, again, this is what we’re dealing with. So, I mean, if everyone’s educated, it’s really a decision people can make for themselves about which risks are they less comfortable with. You know, would you rather have the risk of taking a vaccine or rather have the risk of getting the virus and go from there? Those are really the two choices. So we’ve been talking for a while about risks and benefits and choices, but I know that many of our listeners wanna know my own recommendation as a doctor, and specifically as a doctor who takes care of pregnant women. So here it goes. For the general public, I recommend getting the COVID vaccine unless there is a specific reason you can’t. I recommend it whether you are high-risk or low-risk. Whenever it is your turn, you should get it. 


It is the best way to protect yourself and the best way to protect others. Also, from a practical perspective, it’s the best way to start lifting all of these restrictions. I got the vaccine myself without any hesitation. For pregnant women, as of now, there are less data on safety, simply because it wasn’t studied on pregnant women, specifically. For that reason, it’s hard to give a firm recommendation on getting it like I do for everyone else, but for pregnant women who want it, they should get it. The risk is likely very low and the same benefits should apply. It’s not known yet if getting the vaccine in pregnancy will give the baby some protection against COVID but it’s certainly possible as that is the case with several other vaccines. For women who feel uneasy about getting the vaccine in pregnancy and prefer to shelter and distance until after they deliver, that’s fine too, but definitely discuss that with your OB first, because it means you will continue to be at risk for getting COVID and COVID and pregnancy has risks. 


Also, if you or your family members have high-risk conditions, that may tip the scale in favor of getting the vaccine. I know that’s a long answer to a short question about the vaccine and pregnancy. For those of you looking for a short answer, here it is. If I were pregnant right now, I would get the vaccine. For breastfeeding women, all the recommendations are to get it, and there’s no thought that the vaccine could be harmful to you or your baby in any way. I do think we should talk a little bit about, now that this is happening. I’m curious what your thoughts are about the “return to normal.” Number one, like how was that gonna happen? Sort of either ideally versus actually, I mean, ideally it’s gonna be one way and actually, it’ll probably be a total mess, and when? I think people sort of curious like, “Well, is this gonna…we’re just gonna be done with this in three months, or is it gonna linger for five years?” What are your thoughts on it? 


Emily: I’m sort of like go back and forth. I think it will be a long time before things return to like normal, normal, normal. You know, there’ll be some lasting effects of this, but that’s not quite what you’re asking. You know, I think by this, my instinct is that by the summer enough people will be vaccinated that we will sort of start…things will start feeling a little more, you know, a little more, more regular and maybe we’ll see a little bit less masking and so on. But I actually think we may be focused too much on the vaccine almost as like a kind of like the vaccine is gonna save us and like let’s just wait until that’s done and then it’ll be just like regular, because, of course, like, I mean, we’re seeing this in the UK variant, which my guess is it’s not as big a deal as people are talking about, but anyway, like it’s sort of come up as a thing. You know, I think we’re gonna need to keep pushing on things like testing, rapid testing, antigen testing, like, you know, like doing some kinds of prevention type things. I think that, you know, requiring people to wear masks forever is not gonna happen, but things like testing, we could make more, you know, more palatable for longer. So, you know, my guess is it will be that, you know, in six months things will look a lot different than they do now, but not the way they looked in, you know, June of 20, you know, June of 2019 say. But I don’t know. What do you think? 


Dr. Fox: Yeah. I mean, I think that… I predict similar to how you predict. I think it’ll just end up being that way by the summer it’ll probably be. Again, not exactly like it was, but I think it will be much more…it’ll appear more normal. I think there’s gonna be a lot of lingering anxiety and sort of like PTSD type of stuff from this. A lot of people are still gonna be freaked out. And so I do think that on a human behavior level, there will be a lot of differences. There’s gonna be a lot fewer people shaking hands. And, you know, I just think people are gonna be very, you know, when, when you do it a certain way for a year, and then I think people are just gonna be hesitant about, you know, sort of going back to normal life. 


But I think that sort of, in a bigger picture, I think there won’t be as many sick people. I think there won’t be as many hospitalized people. I think the numbers will actually be better. And I was wondering like, how would everyone sort of track it to ensure that we’re doing the right thing? Meaning it would seem to me that the smartest way to do this is to start doing some form of systematic randomized testing, you know, just go around random testing and you say, “Okay, if a random test, you know, when this all started, you know, 8% of people tested positive. And then, you know, in March, it’s now 4% of people and then it’s 3% of people.” And you start loosening restrictions and the percent stays low and doesn’t bump, that’s really the way to prove that this is working. And the way they’ve been testing until now was so ridiculous. This idea of positivity rate. 


Emily: Doesn’t make any sense at all… 


[Crosstalk 00:56:58] 


Dr. Fox: It’s the craziest thing in the world that people use these numbers to make massive decisions when it’s so easy to go out and do random testing. It’s like literally the easiest thing in the world from an epidemiologic perspective. Just, you know, go out and just test people randomly and get a percentage. And it’s so much more valuable than the percentage of tests that are done that come up positive because that’s so dependent on who’s going to get tested and how available is testing. It’s crazy. So if they did that, I think we would get, number one, we would sort of see how the vaccine is working and number two, it would be data we can use to continue to release a lot of these restrictions in a hashtag science in a real way that makes sense. 


Emily: I would just like to see a whole different, like take on how we test and monitor and all this other stuff. I mean, I think for testing, I think that we need people to be antigen testing in their houses all the time like every day. I think we need to be testing everybody at school twice a week. Like we need to sort of figure out a way to do just a lot of testing all the time and then, you know, that will sort of naturally lead into some kinds of, you know, some kinds of report outs that depicts that make more sense than the ridiculous stuff they’re reporting now, which obviously is like doesn’t, you know, the case counts in the positive. I mean, this is just like a crazy way to do this. And I cannot believe like 10 months in that is still how we’re reporting things. It’s really bizarre. 


Dr. Fox: Right. And for people just to understand that the reason, you know, Emily and I are so flabbergasted by this is if you just look at total cases, sure that could go up or down based on how, you know, the virus is spreading within a community, but it could also go up and down based on if someone opens up a new testing site, right? If someone says, “All right, we’re gonna test 10,000 more people,” yeah. You’re gonna get a lot more positive tests because a bit people are getting tested or like, for example, earlier in the disease, people, when they were sick, were told to just stay home and not get tested. So they wouldn’t show up at a positive test rate. And so that made no sense. So then they said, “Okay, we’re gonna say of the people get tested, what percentage are positive?” 


And it’s the same idea. Well, okay. Well, if, you know, for example, when they were doing that in New York State and New York City was using that number in order to determine if the schools should stay open and it went above I think 3% or 4% and they closed all the schools and everyone realized, “Oh, oh.” And on the same day, the same day that that happened, the leader’s saying, “We want everyone to go out and get tested every week.” So I would imagine it’s probably because they know that’s gonna lower the positive test rate because all these healthy people are getting tested. It’s like you can gain the system. 


Emily: No. You’re just crazy. You can gain the system in either direction. You can do whatever you want. 


Dr. Fox: You either have to test everybody all the time and get a real percentage, or at least like statistically, if you do a random sampling of a big population, as long as your numbers are big enough, you’ll get a very precise estimate of what it is in the whole population like they do with, you know, polling, which is never wrong, but, you know, conceptually. So, yeah, and I hope they figure this out for the next six months and then also for the next time something like this happens because the way… Like I agree, 10 months later and they’re still doing this, it makes no sense. 


Emily: It’s totally crazy. 


Dr. Fox: Excellent. Well, Emily, thank you so much for coming on. I love talking to you. Obviously, I’m your biggest fan and I read everything you write and I encourage all my patients and my listeners to follow you and learn from you and keep doing what you’re doing. Hopefully, we could see other face to face one day in the next millennium and… 


Emily: I hope so. That would be amazing. That would be so awesome. We can do our next… Maybe at the 200th episode, we can do in a face-to-face manner. 


Dr. Fox: That’d be awesome. All right. Take care. Thanks a lot. 


Emily: All right. Thanks, Nate. Take care. Bye. 


Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s H-E-A-L -T-H-F-U-L W-OM-A-N.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@helpfulwoman.com. Have a great day. 


The information discussed in “Health Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.