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All Podcasts A Year of COVID and Predictions for the Year Ahead (Part 3)

A Year of COVID and Predictions for the Year Ahead (Part 3)

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Description

Apoorva Mandavilli, science and global health reporter for The New York Times, joins Dr. Bob to close out our three-part series marking one year of the pandemic. They discuss how journalism had to adapt to cover COVID-19, what she’s hearing from experts about a possible fourth wave, and what lessons she’s taking with her for the next pandemic. Plus, an Andy update from Lana! Be sure to check out the other two episodes in this series with New Jersey Governor Phil Murphy and Ashish Jha, Dean of the Brown University School of Public Health.

 

Follow Dr. Bob on Twitter @Bob_Wachter and check out In the Bubble’s new Twitter account @inthebubblepod.

 

Apoorva Mandavilli is on Twitter @apoorva_nyc.

 

Keep up with Andy in D.C. on Twitter @ASlavitt and Instagram @andyslavitt.

 

In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask Andy questions, and get discounted merch at http://lemonadamedia.com/inthebubble/

 

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Check out these resources from today’s episode: 

 

 

To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.

Transcript

SPEAKERS

Lana Slavitt, Dr. Bob Wachter, Apoorva Mandavilli

Pres. Joe Biden  00:00

I promise I will do everything in my power. I will not relent until we beat this virus. But I need you, the American people, I need you. I need every American to do their part. That’s not hyperbole, I need you. I need you to get vaccinated when it’s your turn and when you can find an opportunity. And to help your family, your friends, your neighbors get vaccinated as well. Because here’s the point. If we do all this, if we do our part, we do this together. By July the fourth, there’s a good chance you, your families and friends will be able to get together in your backyard or in your neighborhood and have a cookout and a barbecue and celebrate Independence Day.

Pres. Joe Biden 

That doesn’t mean large events, with lots of people together. But it does mean small groups will be able to get together, after this long hard year, that will make this Independence Day, something truly special. Where we not only mark our independence as a nation, but we begin to mark our independence from this virus.

Dr. Bob Wachter

Welcome to IN THE BUBBLE. I’m Dr. Bob Wachter. You just heard President Joe Biden in his speech to the country last week, showing the kind of leadership that we were sorely lacking in 2020. Somehow, the president managed to mark the one-year anniversary of the pandemic, hitting the shores of the United States with the empathy and remembrances that befits this tragic milestone. But while doing that, he also infused his speech with optimism about the future, real tangible plans about vaccination, about the support package, and importantly, a call for action to all of us. This wasn’t passive, we’re not victims, we’re not just receiving information and instructions, he actually asked us to do our patriotic duty. And I thought that all was very impressive.

Dr. Bob Wachter  02:09

The optimism seems justified, we’re about to hit 100 million doses of vaccine being distributed in the United States, not quite at Israel level, but better than virtually every other developed nation. The president announced that not only will there be enough vaccine for everyone by the end of May, but that everyone will have an opportunity to have their name on the list by the end of April, which is extraordinary. I had dinner with my younger son last night, and he told me that he’s going to get his “Fauci Ouchy” in May, which was the first time I’d heard that apparently, young people, that’s what they’re calling the vaccine there, “Fauci Ouchy” and once I heard that I can’t think of calling it anything else.

Dr. Bob Wachter 

We’re also seeing the impact of vaccination, we’re starting to see the numbers fall and disproportionately fall in highly vaccinated populations, like older people and residents of nursing homes. So the vaccine is working. It’s getting out there. The vaccine news remains excellent. We’ve heard a few small concerns, particularly about the AstraZeneca vaccine, which is not available in the United States. But the vaccines that we’re using here appear to be incredibly effective and incredibly safe. And even the news about AstraZeneca, I think is going to turn out okay, I think you know, what we all know is you’re going to see, some people have health events after vaccination. The key is are you seeing more of it in people with vaccines than those who haven’t. The variant news is mixed with cases going up in some countries, including some countries in Europe, which is vivid illustrations, we have to be careful.

Dr. Bob Wachter 

But the good news is the cases are going down actually faster in the UK than they are in the US. And in the UK, most of the virus they have is the variant. We’ve also had some scientific news that the vaccines do appear to work reasonably well against the variance. So that’s less scary than it was a couple of weeks ago, we’re beginning to open up in most states prudently. In some states, in my judgment, not so much going a little bit too fast. But we have to watch this carefully and be sure that people are acting carefully. If you’ve made it a year and have not gotten infected, I don’t care if you live in Texas or Mississippi, this is a bad time to get infected, you’re a month or two away from getting vaccinated. So please, do everything you can to stay safe out there.

Dr. Bob Wachter  04:26

And importantly, the rates of vaccine acceptance seem to be going up in several surveys, particularly in communities of color. And as the vaccine has been out longer the acceptance of it, the willingness to get it the interest in getting it has gone up as well. The one group where it has gone down a little bit appears to be in Republicans and I’m hoping some of the political leaders in that party push and support the vaccination because it’s really important. It will save people’s lives. While we are a year into the pandemic, and we’ve chosen to do a 3-part series reflecting on the past year thinking about where we are today and helping us think about where we might be a year from now.

Dr. Bob Wachter

Hopefully you’ve had a chance to listen to the first two installments in the series. I thought they were both wonderful, one with New Jersey Governor Phil Murphy, and the other with Ashish Jha, Dean of Brown University School of Public Health. Today, it will be the third and last installment in that series. And we’ll be talking to Apoorva Mandavilli, the science and health correspondent for The New York Times. But before I bring on Apoorva, we also had a chance to check in with Lana Slavitt, to see how she and Andy are doing a year into the pandemic. So let us ring up Lana Slavitt.

Lana Slavitt 

Hi, there.

Dr. Bob Wachter 

Lana, welcome. I thought it was a nice chance to check in on how you’re doing and how Andy’s doing. Before we talk about Andy because we’re always talking about him. Let’s talk about you. It’s a year into this thing. How does it feel for you?

Lana Slavitt 

It was the it’s the longest fastest year I think I’ve ever experienced, you know, on some level, I can’t believe it’s been a year. And then there are other days where I can’t believe that we are still doing this. And it feels like a decade. So, but you know, I’m hanging in there. We know that we’re some of the lucky ones.

Dr. Bob Wachter  06:12

Yeah. So how’s Andy doing?

Lana Slavitt 

He’s working a lot. He’s sort of in the 18 to 24 hour a day mode. I think most of the time. You know, it’s a short-term role. And so every day matters. And I think he’s feeling a lot of pressure to get a lot done as quickly as possible and to really maximize his time in DC. But I can also tell that he’s feeling really hopeful. You know, at the beginning, I think it was, you know, peering into the abyss. And I think now, you know, they feel like they’re above ground, and they’re building up again. And it’s a good feeling to see all the statistics improving every day in terms of vaccination numbers, and who’s getting vaccinated. And, you know, you can always do better, but I really do feel like they’re feeling good about the progress made to date, and like, there’s light at the end of the tunnel.

Dr. Bob Wachter 

Wow, it’s actually unbelievable the amount that they’ve gotten accomplished in a couple of months, if you know, between taking the vaccination program, which was hobbling along to something that seems to be humming along now to the $1.9 trillion bill to hundred things in between, it just feels like they’ve been not only working really hard, but actually quite effective.

Lana Slavitt 

Yeah, and I think having a team that’s focused 100% on this was really essential to. So this isn’t a walk chew gum thing, you know, the President can do that. But like, you know, in terms of like, the response team, this is all they do, is you know, worry about getting more vaccinations to more people faster. And it really did take that kind of a focused effort.

Dr. Bob Wachter 

There’s so many talented people on the team. Was it a challenge for Andy to figure out what his precise lane would be, he probably had more experience with public and scientific communications than many other people that felt like an obvious thing, but sort of figuring out who does what, was that a challenge for him at all?

Lana Slavitt  08:07

You know, I think for like two days, and then he said it came together pretty quickly, it was pretty obvious, you know, that they wanted him to lead a lot of the communication stuff. And so, you know, he moved into that lane very fast in terms of the, you know, thrice weekly briefings and, you know, communications with the press and the media, and that, you know, he knows how to manage talking points, how to answer questions, how to be honest, when you don’t know and remember to circle back to somebody, and then I think on the distribution front, I think, you know, at the end of the day, he’s just very comfortable with ambiguity and uncertainty, and calling people and asking for help, like corporate leaders, and not necessarily knowing what exactly you’re going to be asking them, but letting them know what you need.

Lana Slavitt 

And then having a dialogue where they start talking about what they can do. And then being able to like bring in other people to, you know, hone that. So a lot of the work he’s done, has been around bringing in corporate leaders and, you know, corporate capabilities into helping on the distribution and vaccines sort of management front. But yeah, I’m actually I mean, I think even he was surprised at how quickly he was able to get up to speed and really, you know, start running.

Lana Slavitt 

And he hasn’t stopped since. People ask me all the time why didn’t you go to DC? And I’m like, so I’ve like been a work widow before. Like, it just would have been, like, you know, me hanging out, you know, taking care of errands and things like that. And, you know, I wanted to like sort of live my best life also. So, you know, we try to see each other at least once a month, but you know, it’s a short-term gig.

Dr. Bob Wachter 

Well, please give Andy our warmest regards, and I’m glad you’re doing okay. And I think we’re all feeling a little bit optimistic about how things are gonna be and Fourth of July sounds great.

Lana Slavitt 

I’ve been enjoying the show, Bob. It’s great. Yeah, you know, love your guests. And it was great to hear Phil Murphy on there the other day, that was like, nice to see some repeats and all that. So you know, thanks for doing what you’re doing. I know Andy feels a lot better having you on the podcast and you know, taking care of things.

Dr. Bob Wachter  10:09

Big shoes to fill. But it’s been a great privilege to do it. Thanks so much for being on today.

Lana Slavitt 

Great. All right. Thanks, guys.

Dr. Bob Wachter 

Thanks so much to Lana. And it’s wonderful to hear how well she and Andy are doing, not surprising that Andy is working 24 hours a day, because the amount of activity coming out of this White House is really very, very impressive. Well, there’s been a lot of attention paid appropriately to how well many health systems have done and performed in the pandemic, the miracles that were pulled off by some of the pharmaceutical companies and producing these vaccines in record time. A lot of kudos for essential workers in so many industries that have helped us but I think there’s been a little less attention to another set of individuals who’ve really made a big difference.

Dr. Bob Wachter

And that’s journalists, who have helped educate us over the past year about this incredibly confusing, ever changing virus and pandemic. My wife is a journalist, I have a great respect for what journalists do. And I think in the pandemic, they really have been essential to all of us, and keeping us informed and keeping us sane. One of my go to sources has been Apoorva Mandavilli, who covers science and health for the New York Times. Apoorva has not only done a terrific job in cutting through the complexity on issues relating to testing or vaccines or variants. But she’s also been particularly and I think, unusually good at looking around corners talking about where things are going, helping to work through some of the new findings.

Dr. Bob Wachter 

Sometimes before they’re fully ripe, which is a courageous thing to do when you’re writing for The New York Times The National paper of record. But she’s really helped us understand where we are, but also to an unusual degree where things are going. And so I felt really privileged to have an opportunity to sit down with Apoorva and talk to her about what it’s like covering a pandemic, and particularly doing it from the perch of the New York Times really, there’s nothing quite like it in our country. So I really enjoyed this opportunity to chat with Apoorva Mandavilli. Let us call her up.

Dr. Bob Wachter  12:21

Good morning, or afternoon or probably both. I don’t think we’ve met before. So I’m Bob Wachter, it’s nice to see you.

Apoorva Mandavilli 

On Twitter.

Dr. Bob Wachter 

Yes, we met on Twitter. Why don’t we start just tell us about your life a year ago, what were you doing? Before this thing became a thing.

Apoorva Mandavilli 

I think a year ago, I was just starting to really recognize how big this was going to be exactly a year ago, I was a little slow I will say to recognize that this would be a pandemic. So I wasn’t one of those people who, you know, in January, or even in early February, was convinced it was going to be a pandemic, it took me a little bit longer. So right around this time last year, I was thinking, oh my god, okay, this is the big one. And everything is going to change now.

Apoorva Mandavilli 

I remember being really scared. Talking to my parents warning them not to go outside too much talking to people on my team. I wasn’t working at the New York Times then I was at Spectrum, which is an autism news site that I founded. And, you know, talking to my team and telling them how to be careful and also but calming everyone down at the same time. But yeah, a lot changed very quickly.

Dr. Bob Wachter 

Yeah. Have you been a science correspondent, and health correspondent for a long time, is this been your field?

Apoorva Mandavilli

I have been a science journalist for 20 plus years. But most of that I’ve been an editor. And before I founded Spectrum, I was an infectious disease reporter and editor at Nature, The Journal, and this is sort of a return to that. And now I’m just a reporter. And I actually really love it. So going back to what I went into journalism for to begin with, you know, and I kind of lost track of how much I love reporting, being an editor for so many years.

Dr. Bob Wachter  14:15

And having covered infectious diseases and science, as you began to see this thing emerge in January and February. Were there examples that, you know, did you go back to the great Influenza and think about that, or were the things that you’d covered in the last 20 or 30 years? Not to say that you were at the great Influenza. I understand it was 1918. But how did you what was the kind of intellectual scaffolding you use to say, oh, this might be like x or y? What were those things?

Apoorva Mandavilli 

Well, obviously SARS that was the big one that I covered and because it was also a Coronavirus, and because it was more widespread or more cases than MERS and more on the sort of global consciousness than MERS. That was the first thing I thought about. I’d also covered Bird Flu. So those were sort of my reference points. And one of the first stories I wrote actually was based partly on what I’d learned about SARS, and MERS, which is that with both of those kids weren’t very affected.

Apoorva Mandavilli

And I started to notice that even with this, we weren’t really hearing much about children being affected. And there was a New England Journal of Medicine paper that came out very early on with some data from Wuhan. And I remember seeing that anybody under 15, it was like the number of cases was so low. So there was a clue that this was behaving much like those other two coronaviruses. So that was actually the first story I wrote, kids seem to be mostly spared by this virus.

Dr. Bob Wachter 

So let me ask you about that. One of the things that has struck me about your reporting over the past year has been that you have taken some risks. You’ve been out there with stories that could have proven to be not true, or things might have, you know, the ball might have bounced a little differently. How did you decide when to pull the trigger on a story, particularly after you came to New York Times where the impact of anything you write is going to be multiplied, you know? 10,000x?

Apoorva Mandavilli  16:06

Yeah, and pretty much all of the Coronavirus reporting I’ve done has been for the Times. So it’s from the beginning, the spotlight has been very big for this. I think I really rely on my conversations with scientists, you know, I’ve been what they call a Trade Journalist in science journalism, which is that I’ve written and edited mostly for scientists in my career. And I think that has really helped me understand when scientists are cautious and to read between the lines to hear their hesitations and caveats.

Apoorva Mandavilli

And I think I’ve also learned how to eavesdrop on their conversations, and start to notice when something is becoming a trend, and only among them hasn’t quite filtered out to the mainstream yet. So that may seem more like a real gamble from the outside. But I think for me, it’s pretty much rooted in some conversations that I have seen taking place, or that I’ve had myself with scientists, where I can see that this is where the science is headed.

Dr. Bob Wachter 

Did you appreciate that when you came to the Times that the spotlight would be on to the degree that it was particularly as COVID emerged as the dominant issue in the world, I’m just thinking about that first article, you write about emerging evidence that kids may not get hit quite as badly as adults, the implications of that for the schools and for everybody is so massive, did you appreciate that fully as you were writing that article?

Apoorva Mandavilli 

You know, I had some sense of what it can be like to write for the Times and have a really big reaction because I had written an article about Lyme disease about a year before. And I got so much email, and so much hate mail, and so many tweets. So I have some sense of how much things can blow up with that particular COVID kids story. I found out very quickly how many reads it got. And I think that was also a clue to all of us, that this was going to be huge, and people were just so interested in every aspect of this. But over the year, I have to say I am really surprised at the unrelenting nature of the interest, and the unrelenting nature of the spotlight. I’ve had been on the receiving end of some very, very nasty attacks, and I wasn’t quite expecting that.

Dr. Bob Wachter  18:38

Yeah, I noticed a couple of weeks ago on Twitter, you talked about how you know you say one thing, and then a white male journalist says something comparable, I think this was about the New York versus the California variants. And you get hammered in Twitter and white male journalists does not as, first of all maybe describe that to us. And second of all did that, how is that made you feel?

Apoorva Mandavilli

It’s not new, right? This happens all the time. But I think that was a very stark example, where it was like, you could almost compare them side by side. This was, you know, Carl Zimmer. And I don’t think he would mind me saying that, because he was quite open about it as well. So we both write for the New York Times. He wrote about the California variant. And that was almost all based on unpublished data and not even pre-print data. So it’s what we call pre-preprint now, right? So everything was just based on talking to the scientists and not actually having data that all the other scientists can see out there on […] archive or bio archive, and he didn’t get a lot of pushback. I think the few people who did engage with him did so very respectfully.

Apoorva Mandavilli 

You know, they asked questions, and then they heard his answers and they went away. And I did the exact same thing. If anything, I would say that mine was a little less questionable or, you know, tricky because I wrote about two different sets of data and one was a preprint. That was already out. And the other one came out within 12 hours of my writing the story. And yet, I was just raked over the coals, how irresponsible I was, and how dare I write about this when scientists haven’t had a chance to look at it. And it just started there. And it just went on and on. And I think the more I tried to actually defend myself, it was like this, the worst of God, it was like, I was just supposed to take it lying down and not even speak up for myself.

Dr. Bob Wachter  20:32

First of all, how does that feel? And second of all, how does that affect your journalism going forward?

Apoorva Mandavilli 

Well, it doesn’t feel great. But, you know, I’ve been, I think one of the ways I’ve coped during this pandemic, with these things with, you know, being treated, the way I have been, is to just call attention to it, because I think these things continue when they are in the dark, or when they continue without anyone calling them out, and the public eye on it. So I just called it out. And Carl, who’s a good friend, and you know, a great journalist, also wrote about it very publicly, and you know, in his tweets, and I think that was how I cope with all of these things is just by, first of all, being very confident that I’m doing my job. This is my job, is to bring information to light.

Apoorva Mandavilli 

Not everyone is going to like it, scientists may not like the pace at which it happens. But journalism doesn’t work at the pace of science. Sometimes it does. But often, it’s faster than science and it has to be, especially in a pandemic like this. So a lot of it is just being very clear about what my job is and what my job is not. And where my allegiance lies, it lies with my readers, it does not lie with my sources.

Dr. Bob Wachter 

Good for you. I have to say that one of the most instructive things for me this year has been exactly that, that I’ve been tweeting a lot. And I’ve been trying, I’ve been a little bit out there and trying to be ahead of the curve. And I have found the response has been wonderful and supportive and benign. And I’m going to visit my father who’s dying. And oh, I hope your dad’s okay. And then I hear from colleagues who are women, or particularly people of color, and their world on Twitter is completely different. And I would have been clueless about that, unless people told me that. It’s, it’s very sad. But yeah, I think shining light on is really important. And I appreciate you doing that.

Apoorva Mandavilli  22:26

Thank you. Yeah, I’ve gotten some incredibly horrific emails the last few weeks. So let’s see if we can take it all over time.

Dr. Bob Wachter 

Yeah, well, terrible. Maybe a couple more questions about the origins, you said, you might have underplayed it a little bit, what was the moment that told you this was going to be as huge as it became?

Apoorva Mandavilli 

No, there wasn’t one moment, I think it was a sort of slow realization on my part over a course of probably a couple of weeks, starting around early to mid-February, that this was going to be here. I think part of that was hearing about the cases on the west coast. And then hearing about cases in New York and knowing that there was community transmission already, because the people who are being identified had no travel history. And, you know, once you know that it’s in the communities here, and that it’s already spreading, you just realize okay this is here. And I think one particular thing that really struck me very early on is the possibility of asymptomatic transmission, because that was very different than SARS and MERS. And when people started talking about that, as a possibility with this virus, everything just changed.

Dr. Bob Wachter 

How so?

Apoorva Mandavilli

Well, it’s very hard to control something that you don’t know is being transmitted, I think, with SARS, and MERS, pretty much everyone who was infected had symptoms and had strong symptoms. And so you could see who they were, you could isolate them, it just you know, you see the enemy. Whereas with this virus, a lot of the transmission was happening before people knew they were sick. So you know, isolating people after the fact by the time they get sick, and then go get tested, and then they get the results. You know, it’s like locking the barn after the horses gone. So that really changed the picture. And in terms of how quickly we would be able to contain it.

Dr. Bob Wachter  24:12

Right, it made all the temperature checking sort of theater in a way, that usual things that we did weren’t going to work very well. Something already hinted at, but I think was really a mega trend for the year was the way science came out, and the pre-prints and the pre-preprints and the peer review on Twitter and all of that. So tell us a little bit about how that trend played out for you and how that has changed the nature of your work?

Apoorva Mandavilli 

Well before the pandemic, when I was at Spectrum for example, we had a rule that we would never cover preprints because it hadn’t been through peer review. We wanted it to sort of go through the review process and only cover things that had already been vetted to a certain extent. That just wasn’t going to be the case with this pandemic and it was obvious early on that the journals were just not able to process papers fast enough to accommodate the pace at which information was coming out. And more and more people, I think especially biologists and biomedical researchers, you know, traditionally been not very comfortable publishing preprints, having preprints.

Apoorva Mandavilli 

And they seem to be putting things out more and more on preprint servers. So in both ways, it became obvious that the preprint servers were where all of the science was going to be coming out. So I signed on to, you know, email alerts from both bio archive and my med archive. So that I would know when preprints went up, and the deluge of prints was just massive. And for a while, you know, we were just looking at preprints, or just looking at data that was coming out.

Apoorva Mandavilli

But I think that has slowed down quite a bit to now where I only cover a preprint if it’s really seems extremely important, extremely interesting, of some public relevance that’s quite strong. Otherwise, you know, it’s still try and sort of wait for the paper, or at least have multiple preprints that are showing the same trend before we write about it.

Dr. Bob Wachter  26:11

What do you think the impact of it has been on science and on science journalism? It strikes me It’s yet another form of disintermediation that people can sort of go directly to the public without trusted vetters. And you could see things about that that are good and things about that, that we’ve seen in the rest of our life that are pretty scary, and pretty bad. What do you think the net of it is?

Apoorva Mandavilli 

You know, I think science journalists dislike science by press release, just as much as scientists do. And we have pretty good […] detectors for the most part. So when we are approached to cover something, and, you know, we know that it hasn’t been through peer review, we have our alarms going off, too. And the key for me has always been to have sources that I trust that I can go to and say, hey, I’m hearing this, what do you think about this, so much depends too on who the person is, you know, if they have a history already of having published really good work, if it’s a good lab, if the finding makes sense.

Apoorva Mandavilli 

And it’s consistent with what we are hearing, rather than some completely crazy outlier of information, there are a lot of different ways that you can sort of let these things and I think beyond a certain point, if I wasn’t able to tell that something was good or not, I would go to my sources. And of course, every single thing that I’ve written, and I think that most science journalists, right, that you send out whatever that information is, whether that’s the pre-preprint, or the pre-print, or whatever it is, to a number of scientists who can look at the data. And so even if not every scientist out there can see the data, you’ve had a bunch of scientists look at it and say, yes, this looks solid, this looks legitimate.

Dr. Bob Wachter 

Got it. I’m gonna pull up to the present in a sec, maybe last question on the past year. You’re a science journalist, you’re not a political journalist, how did you deal with the politicization of everything that happened pretty early? You know, it has been said, When science meets politics, you get politics. And so I think a fair number of journalists who are covering science, wanted to steer clear of the politics, but then sort of had to recognize at some point, there was no, almost no way to do it. How did you manage that?

Apoorva Mandavilli  28:25

I think I tried to keep my eye really on the science to be honest with you. I mean, that’s the point, you just have to ignore what the politicians are saying. And I didn’t want to spend too much of my time spinning my wheels and countering the misinformation. Because first of all, we have an actual desk of people whose job it is at the times to find these kinds of misinformation and write articles to counter that. So that frees us up the science journalist to really just be writing about the science instead of spending all our time getting rid of the misinformation out there.

Apoorva Mandavilli

And also, I think the best way to counter misinformation, or even disinformation is to have good information out there. It’s to have good science and good clear messaging about what is actually happening. So that’s where I put my focus. And, you know, you said when science and politics made its politics, I tried to think of it as when science and politics mean, it’s still science, just because politicians are not talking about it doesn’t make it any less scientific.

Dr. Bob Wachter 

Yeah. All true. Did you feel like you had a special obligation, for example, on masks or on hydroxychloroquine? Or on any way? You know, once the issues became politicized? Did that cause you to redouble your efforts on the science?

Apoorva Mandavilli

Yeah, I would definitely say this time I think with the agencies, especially with the CDC and the FDA with not being able to more or less take what they said at face value, that made things really difficult. Not that you ever want to completely trust everything that agencies say because it’s always a little bit political, but the degree of obfuscation and misinformation and misdirection was really heavy this time. And as the pandemic went on, you know, in the fall, last year, for example, we did a lot of pieces about the ways in which the White House was actually actively distorting the information that was coming out of the CDC.

Apoorva Mandavilli  30:20

And so, you know, some of it was uncovering that and reporting on that. But the masks, you know, I think it was really a misstep on the part of the CDC and the WHO, to make decisions about whether to recommend masks based on availability or financial considerations. I think they should have trusted the public. And they should have been upfront about what was really the case.

Apoorva Mandavilli 

You know, one of the early conversations I had was with my mother saying to her, that she should cover her face when she goes out, you know, even if it’s just with the edge of her sorry, she lives in India. And she said all that they’re saying that masks aren’t important. What I said to her, Well, it’s a physical barrier, how could it not help? At the very worst, it’s not going to do anything, but you know, might as well. So the idea that the WHO and the CDC were telling us it does nothing, it’s just baffling.

Dr. Bob Wachter

Yeah, must be nice to have you as her child. Give her the cutting-edge science.

Dr. Bob Wachter 

Alright, let’s move to the present. As you survey the landscape now, there are a lot of cross cutting forces, vaccines, variants, Governor’s beginning to open, others not, it’s just give us your view of where we currently stand.

Apoorva Mandavilli 

we’re so close to the end, I really feel that we’re so close to the end, not the end, as in the virus will be gone forever. But just the end, as in the horrific deaths and hospitalizations, and these peaks of cases, I feel like we’re so close to that end. And it’s just really demoralizing to hear about all of these Governor’s lifting restrictions just a little too soon. I recently wrote a piece about what the next few months might look like. And I spoke to 21 experts, and almost all of them said there would be a fourth wave. And it just depends on how we act, how big that wave will be.

Apoorva Mandavilli  32:27

And one of the big factors in determining that is behavior is what politicians do, and what the average citizen does in the next few weeks, you know, we can hang on and continue to be cautious, that fourth wave may be very small. But if we lift restrictions too soon, it could be yet another wave of if not horrible deaths, at least a lot of cases and at least some hospitalizations, and people, perhaps long COVID. So it’s been frustrating to see that this close to the end we are still not willing to learn our lessons. It’s also been quite whiplash inducing to be hearing about variants.

Apoorva Mandavilli 

I think, at the end of the year, last year, I really thought okay, we now have vaccines, we kind of know what we’re fighting, we know how to fight it, it’s going to be okay. And then we started hearing about the variants, one after the other. And I wrote, I think the first variant story that was, you know, expense of look at it right around Christmas. And I remember talking to all those scientists and thinking, what is this? I thought we were done? That’s just so dispiriting

Dr. Bob Wachter

Exact the same feel like I remember November 8, when the Pfizer data came out, I said, alright, you know, you can see the end game here. And it’ll be a little bumpy. But we’ll get there. And I had spent the year talking to journalists, and they would say, what about this mutation and say, oh, you know, it’s just different fingerprints. It’s not it doesn’t mean anything, and then turned out well, that’s not quite right.

Dr. Bob Wachter  34:00

So where do you think we are on the variants? I mean, there are two competing narratives now, which is, one is we’re ahead of the curve. And yes, B117 will take over in the US. But if you look at the UK, they seem to have the curve is doing fine. And the second is some combination of that, or these more vaccine resistant variants actually are going to be major players and really get in the way of moving toward resolution. Where do you come down on that?

Apoorva Mandavilli

I think we will see one or the other of those variants really take off in the US. Maybe not quite to the extent that it did in the UK, but I think we will because you know, people love to talk about how the UK’s numbers came down despite the variance but that’s not where we are. Those numbers went up in September and they didn’t start coming down until after they impose some very strict lock downs. And I don’t think we are willing to do that here in the United States.

Apoorva Mandavilli

Also, you know, B117 is just one of them, right? we’ve now been hearing about the one in New York City and the one in Oregon. Probably many more that have the E484K mutation. The one that’s vaccine resistant, as you pointed out, and that, you know, keeps popping up. And there is now a version with, you know, B117 with that E484K and that’s sort of like the worst of all worlds, you know, it’s perhaps transmissible and immune resistant. Hopefully it won’t take off. But, you know, and hopefully, hopefully B117 will take off instead, it’s sort of weird to hope that..

Dr. Bob Wachter 

Rooting for B117, right.

Apoorva Mandavilli 

Right. to root for the more transmissible one over the vaccine resistant one. Yeah, I think we will probably see some, some surge of B117 cases. And but, you know, hopefully, it’ll be short lived, because we are making good progress with the vaccines. And any minute now we’re going to really start seeing those effects. And it’ll just be a question of getting to a point where the benefit from the vaccines is higher than the B117 surge.

Dr. Bob Wachter 

How do you think your readership has changed over the past year? I mean, it strikes me that you and others have thrown an awful lot of science at people, do you think people are more sophisticated than they were?

Apoorva Mandavilli  36:07

I think so. I think there is a lot more understanding of what are viruses, what variants are, I hear people talking about all of these terms that I would never have expected from the average person. And I have thrown some pretty technical stuff at people over this last year. And I don’t know people seem on phase, some of the most nerdy things I have written have been our biggest hits. So I don’t really understand what’s going on there. But people definitely seem hungry, to know what’s going on. Maybe that’s because everybody’s home, and we feel so out of control. And, you know, we just want some sense of control by learning everything about this virus. But yeah, certainly. I’ve been really blown away by the interest in some of the really geeky aspects of things I’ve written.

Dr. Bob Wachter 

Yeah, I mean, it seems like it’s a combination of existential dread meets a topic that actually is unbelievably interesting. I mean, almost hate to say that, because it’s so terrible. But if you just took a step back and said, We’re gonna do a college course, on all things COVID, whether it’s the hard science, virology, epidemiology, vaccinology immunology, to the softer sciences of sociology, and politics and behavioral change, and all that. It’s extraordinarily interesting in every dimension.

Apoorva Mandavilli 

I think so and I think, you know, immunology is extremely complicated, but people seemed very willing to learn it. They wanted to know, what are antibodies, what are T cells, you’ve got all kinds of people talking about these things. And I would like to think that, you know, maybe not for everybody, but that some proportion of people that come around to really understanding why science matters. And then science is important and interesting, and doesn’t have to be scary.

Dr. Bob Wachter 

Yeah, that might be a good thing that comes out of it. All right, where do you think we will be a year from now with COVID? What does the future hold for us?

Apoorva Mandavilli 

I think it will be back to somewhat of a normal-ish life. But I hesitate to say normal, because I don’t think we will ever fully go back to the way things were. I don’t think that people will be wearing masks, except maybe some subset of people that have discovered that they never get sick, because they wear masks. And I think some people will continue to do that. But on the whole, I think people will stop wearing masks. I think we’ll all go back to those, you know, movie theaters, and bowling alleys and all of the rest. But I think we’re all a little changed by what happened. And I think we will remember this time. And you know how quickly things changed for everyone. I would like to think that it will make us all more appreciative of the freedoms that we enjoy on a regular basis.

Dr. Bob Wachter  38:46

Do you think we all have booster shots in our future?

Apoorva Mandavilli 

Yeah, unfortunately, I do. Hopefully not too many. I think there are some good indications that, you know, they made a booster against the South African variant, for example, B1351, that would actually take care of all the other variants out there. So at least in the short run, maybe that’s the only one we would need. I think it’s a matter of how often we will need them. But at least as long as the rest of the world is not vaccinated, we can expect to see more variants coming out, we can expect to see more clusters even in countries where most people are vaccinated and there will be you know, the virus will still be around. So we will need boosters. I think some people would need them more often than others you know, older people, people who are immunocompromised and don’t put up a very strong immune response. They may need them more often. But yeah, I do see them.

Dr. Bob Wachter 

And how do you believe the world of journalism will have been changed a year from now? How will you be dealing with preprints and all the things that sort of took on an extra sense of urgency because of COVID?

Apoorva Mandavilli 

I do think that science journals will look at preprints a little differently. You know, so much is going to depend on whether scientists continue to publish on preprint servers and I think they will, and I don’t think that I’ll stop looking at them at least to see what the trends are, you know, if not to actively cover each one.

Dr. Bob Wachter  40:04

Yeah. My wife still freelances for the Times and wrote for the New York Times […] for many years. So I kind of have a sense of what it feels like. But the level of scrutiny, the level of celebrity that you had this year will probably not be replicated again in your career, you’ll still be reporting from New York Times, and people still gonna read you and you’ll get a lot of feedback, but nothing, probably not like this. Will you be happy for that to go away? If it does to some extent? Or will you be sad about that?

Apoorva Mandavilli 

I don’t know. I think I’ll have mixed feelings. I think it’s been lovely to feel like everything you write is important to people, and that people read it and cherish it and want to know the information. But on the other hand, you know, I’ve had so much negative reaction, so many negative reactions, so much hostility, and anger directed at me, that it’ll be really nice not to have to deal with that. So it’ll be a mixed bag. I’d like to think that, you know, even if people aren’t paying as much attention, because it’s not COVID they will still care about infectious diseases a little bit more than they did before. Because now they understand why it’s so important.

Dr. Bob Wachter

Yeah. And how will you calibrate your response to the inevitable next threat that, you know, there will be in a year or two or five, an emerging infection that you hear report of from somewhere. And how do we prevent the possibility that we’re now going to overreact because everything this might of course, this of course is going to be the new COVID every story. And as we know, from SARS, and MERS, and Swine Flu, and most things are not. You know, this the last time anything was like this, it was 102 years ago. So how are you going to get that right as the story emerges?

Apoorva Mandavilli

I’m a naturally cautious person. Honestly, I you know, even with this virus, I think the reason it took me so long to acknowledge that this was really going to be a pandemic is because I, I don’t like to panic people and talk about things until I can be somewhat sure that it’s going to happen, because I think it’s just it’s so frightening to think that your world is going to be taken over by a virus. So I, you know, I might be a little more scared on the inside, having lived through this once. But I think and I hope that in my writing, at least, I will continue to be cautious and want to see some real science before I start to, you know, beat the drums and get the information.

Dr. Bob Wachter  42:29

Yeah. Well, I want to thank you for all of your writing and your honesty. And as I have said, I think you have been someone who has taken the science and synthesize it extraordinarily well, and also not been afraid to kind of be a little bit out there from time to time, which I know is risky, when you know that many people are going to be scrutinizing every word you write, but your track record was unbelievably good. I think you tended to be right on almost everything. And it made a difference and helped a lot of people, including me understand this far better than we would have, so grateful for all of that.

Apoorva Mandavilli 

Thank you so much. That’s so nice to hear.

Dr. Bob Wachter 

That was terrific. I really love the way Apoorva thinks through complicated issues, you can see why she’s such a quality journalist. And I personally feel like I owe her a great debt of gratitude. And not only just to her, but there’s so many journalists this year, who have made a difference in our understanding of what’s going on and what’s coming at us. And it is a hard job, particularly as she mentioned, as a generalist, you’re constantly having to learn new things and talk to people too. And sift out wheat from chaff and if you’re at a place like the New York Times, my wife Katie wrote for the Times for many years, you’re being pitched constantly and trying to figure out what of which of those pitches are real, which of those pitches are not ready for primetime.

Dr. Bob Wachter  44:05

It’s a tough job. And she has done it very, very well. We have a number of other great episodes coming up here on IN THE BUBBLE. Next Monday, we’ll have a Tool Kit. And it’s a vaccine toolkit. And you may say Why haven’t you covered vaccines before? And the answer is yes. But A, it’s the most important issue in COVID and maybe in the world today. And the second is I think the question of vaccines has become more complicated in the last few weeks, particularly with the addition of the J&J vaccine to our armamentarium. And the variants and so a lots of questions came up on the part of our listeners about should you prefer one vaccine over another? Are the vaccines safe in different circumstances, pregnancy being one of them? How do the vaccines and the variants interact with each other and a ton more.

Dr. Bob Wachter 

So we had great questions and we will have that Tool Kit for you next Monday. The following week, we’ll have another Tool Kit. I’ve been saying for about a month that the hottest issue of the summer, I believe is going to be the question of vaccine or immunity passports. And when I say that I’m not talking necessarily about a passport, […] what you need to have in your pocket in order to fly to Europe, but evidence of vaccination, and whether or not you’ll be required to show such evidence when you get on an airplane, get on a train, go into a sports stadium, go into a theater, a lot of really interesting, challenging legal, ethical and practical questions around that issue. And we’re lucky to have Art Caplan, who is one of the top ethicists, medical ethicists in the world, and also uncommonly good at explaining ethically and morally charged issues in ways that are very, very accessible and very interesting.

Dr. Bob Wachter 

Finally, we talked to Gregg Gonsalves of Yale and Carlos Del Rio of Emory. And the episode will focus on what we learned, those of us who live through the early years of HIV-AIDS, what we learned about epidemics and pandemics about the public and political response, and how it’s relevant to what we’re now all learning collectively about COVID. I think you’ll find it really fascinating. I started my medical career just as HIV and AIDS were becoming a thing. And there are lots of parallels, although some really profound differences as well. It’s really an interesting topic. And both Gregg and Carlos were there at the time, and very thoughtful about the lessons from that to today. So I hope you’ll listen to that and a lot of other terrific episodes coming up here on in the bubble. It sounds like you will get your vaccine in the next couple of months. So please stay safe until then, and we’ll talk to you soon.

CREDITS

We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced our show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs executive produced the show. Our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @InTheBubblePod. Until next time, stay safe and stay sane. Thanks so much for listening.

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