← The Peter Attia Drive

#189 - COVID-19: Current state of affairs, Omicron, and a search for the end game

Jan 3, 2022 2h 45m 27 insights
<p>In this episode, Peter sits down with Drs. Marty Makary and Zubin Damania (aka ZDoggMD), both previous guests on <em>The Drive</em>. Marty is a Johns Hopkins professor and public health researcher and ZDoggMD is a UCSF/Stanford trained internist and the founder of Turntable Health. This episode, recorded on December 27, 2021, was in part inspired by some of the shoddy science and even worse messaging coming from top officials regarding COVID-19. In this discussion, Marty and ZDoggMD discuss what is known about the omicron variant, the risks and benefits of vaccines for all age groups, and the taboo subject of natural immunity and the protection it offers against infection and severe disease. Furthermore, they discuss at length the poor messaging coming from our public officials, the justification (and lack thereof) for certain mandates and policies in light of the current evidence, and the problems caused by the highly politicized and polarized nature of the subject. Themes throughout the conversation include the difference between science and advocacy, the messaging which is sowing mistrust in science despite major progress, and a search for what a possible "end" to this situation might look like. </p> <p>NOTE: Since this episode was recorded over the holiday and published ASAP, this is an audio-only episode with limited show notes. </p> <p>We discuss:</p> <ul> <li>Comparing omicron to delta and other variants [4:15];</li> <li>Measuring immunity and protection from severe disease—circulating antibodies, B cells, and T cells [13:15];</li> <li>Policy questions: what is the end game and how does the world go back to 2019? [18:45];</li> <li>A policy-minded framework for viewing COVID and the problem of groupthink [24:00];</li> <li>The difference between science and advocacy [39:00];</li> <li>Natural immunity from COVID after infection [46:00];</li> <li>The unfortunate erosion of trust in science despite impressive progress [57:15];</li> <li>Do the current mandates and policies make sense in light of existing data? [1:02:30];</li> <li>Risks associated with vaccines, and the risk of being labeled an anti-vaxxer when questioning them [1:18:15];</li> <li>Data on incidence of myocarditis after vaccination with the Pfizer and Moderna vaccines [1:26:15];</li> <li>Outstanding questions about myocarditis as a side effect of mRNA vaccination and the benefit of boosters [1:35:00];</li> <li>The risk-reward of boosters and recommendations being ignored by policy makers in the US [1:40:30];</li> <li>Sowing distrust: lack of honesty and humility from top officials and policy makers [1:43:30];</li> <li>Thoughts on testing: does it make sense to push widespread testing for COVID? [1:52:15];</li> <li>What is the endpoint to all of this? [1:58:45];</li> <li>Downstream consequences of lockdowns and draconian policy measures [2:05:30];</li> <li>The polarized nature of COVID—tribalism, skeptics, and demonization of ideas [2:10:30];</li> <li>Looking back at past pandemics for perspective and the potential for another pandemic in the future [2:20:00];</li> <li>What parents can do if their kids are subject to unreasonable policies [2:25:00];</li> <li>Voices of reason in this space [2:28:45];</li> <li>Strong convictions, loosely held: the value in questioning your own beliefs [2:32:15];</li> <li>More.</li> </ul> <p> </p> <p><a href="https://peterattiamd.com/covid-19-current-state-omicron/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=220103-pod-covid&amp;utm_content=220103-pod-covid-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=220103-pod-covid&amp;utm_content=220103-pod-covid-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=220103-pod-covid&amp;utm_content=220103-pod-covid-podfeed"> Learn More About Peter Attia</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=220103-pod-covid&amp;utm_content=220103-pod-covid-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> & <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights

1. Prioritize Self-Awareness and Inner Peace

Focus energy on self-awareness and managing your internal state, recognizing that external frustrations often reflect internal conflicts. Limit exposure to negative influences like social media (e.g., Twitter) that hack dopamine drives and contribute to discomfort, as this can improve personal well-being and longevity.

2. Practice Humility and Honesty

In interactions, particularly when errors occur, prioritize humility and honesty by acknowledging mistakes and explaining what could be done differently. This approach builds trust and can prevent negative outcomes, even more so than the severity of the error itself.

3. Value Adaptability in Beliefs

Trust individuals who demonstrate an ability to change their opinions and adapt their beliefs in the face of new information, rather than those who rigidly adhere to the same stance regardless of evolving data. Embrace the mantra of ‘strong convictions loosely held.’

4. Differentiate Science and Advocacy

Understand that science is a messy, uncertain, probabilistic process that evolves with new information, whereas advocacy often communicates with complete certainty. Recognizing this distinction is crucial for interpreting public health messages and avoiding the blurring of these lines.

5. Combat Tribalism with Openness

Actively combat tribalism by being a role model: listen to others, admit when you are wrong, and avoid echo chambers that reinforce extreme views. Foster open discussion and diverse opinions to navigate complex issues.

6. Assume Good Intent in Others

Cultivate the practice of assuming good intent in others, especially those with differing views. This approach can help overcome tribal tendencies to villainize out-groups, level the playing ground for constructive conversation, and reduce personal anger.

7. Evaluate Policy Holistically

When considering public health policies, evaluate them from a holistic, integral perspective, focusing on broader societal well-being (e.g., preventing deaths, avoiding hospital overwhelm, economic function, mental health) rather than a reductionist focus solely on preventing cases.

8. Seek Diverse, Independent Voices

To find reliable and rational information, seek out diverse, independent voices in the medical community (e.g., Monica Gandhi, Amish Adalja, Martin Kulldorff, John Mandrola, David Katz) and be wary of information from politically appointed physicians or those with strong political angles.

9. Acknowledge Natural Immunity

Recognize that naturally acquired immunity to COVID-19 is a real phenomenon that generates good protection against reinfection and severe disease, and individuals with natural immunity should feel confident in their immune protection.

10. Risk-Stratify COVID Treatment

Tailor COVID-19 treatment and prevention strategies based on individual risk factors, age, and health status, as a one-size-fits-all approach can lead to overuse of interventions in low-risk populations.

11. Explore COVID Therapeutics

If you contract COVID-19, discuss with your doctor evidence-based therapeutics like fluvoxamine (reduces mortality by 91%), budesonide (steroid inhaler, reduces hospitalization), and hypertonic saline (nasal rinse), as these are often underutilized. Note that supplemental Vitamin D has weaker correlative evidence.

12. Rethink Widespread Asymptomatic Testing

Question the utility of widespread asymptomatic testing for respiratory viruses, as there’s little precedent for tracking infection rates outside of morbidity and mortality. Only order a test if the result will directly change patient management.

13. Question Mandates for Low-Risk

Critically question mandates (e.g., boosters, quarantines) for low-risk populations like healthy college students, especially when their personal risk is low and professors/community members have access to their own protective measures.

14. Demand Policy Endpoints

If you are subject to public health restrictions, especially in schools, demand clear endpoints and criteria for their removal. Policies should not be implemented indefinitely without defined conditions for their cessation.

15. Manage Respiratory Pathogens Responsibly

Adopt reasonable strategies for living with respiratory pathogens: be careful around vulnerable individuals, wear a mask if you suspect exposure, and stay home if you have symptoms. This approach acknowledges their endemic nature without creating mass hysteria.

16. Prioritize Lifestyle for Health

Incorporate lifestyle modifications such as diet, exercise, and addressing metabolic syndrome as foundational strategies to improve overall health and potentially reduce vulnerability to infections.

17. Focus Beyond Antibody Titers

Understand that an intense fixation on only antibody titers for immune strength can be misleading, as antibodies naturally wane over months. Cellular immunity (memory B-cells and T-cells) is also crucial for preventing severe illness and should be considered for a more complete picture of immunity.

18. Rethink Frequent Boosters

Given that booster efficacy against symptomatic COVID can wane significantly within 10 weeks (e.g., to 35-45% for mRNA vaccines), and cellular immunity still protects against severe illness, constantly chasing high antibody titers with frequent boosters may not be an effective long-term strategy.

19. Space Out Vaccine Doses

Consider spacing out the first and second doses of mRNA vaccines as much as possible, as some immunologists suggest this could be more beneficial for immune response and potentially reduce the need for vigorous booster campaigns.

20. Evaluate Vaccine Risk for Young Males

Parents of young males (15-25) should be aware of the myocarditis risk associated with mRNA vaccines, particularly Moderna (potentially 3-5 times higher than Pfizer), with rates around 1 in 7,600 after the second dose. This warrants a nuanced discussion with pediatricians, especially given the ultra-rare death rate from COVID in healthy children.

21. Align with Global Health Guidance

Consider international health guidance, such as the WHO’s recommendation against universal booster programs (to avoid prolonging the pandemic and increasing inequities) and their advice against masking children under six, or the European CDC’s stance on primary school masking.

22. Question Perpetual Boosters

Be critical of the potential shift towards perpetual or annual booster recommendations, especially if the language changes to ‘up to date’ like software, and consider the long-term utility of frequent boosting for mild illnesses.

23. Beware Anecdotal Amplification

Be cautious of anecdotes, especially when amplified online, as they can distort data and influence fear and policy decisions. Prioritize well-designed scientific studies to understand true risks and probabilities.

24. Acquire Vitamin D Naturally

Instead of relying solely on supplemental Vitamin D, prioritize getting outside, exercising, and acquiring Vitamin D naturally through sun exposure, as the evidence for supplemental Vitamin D improving COVID outcomes is weaker and correlative.

25. Avoid Hospitalization When Possible

Recognize that hospitalization inherently carries risks due to medical errors, infections, and complications. Prioritize strategies to stay out of the hospital whenever safely possible.

26. Distinguish Fact from Opinion

When consuming information, especially on complex topics like health, actively differentiate between what is presented as fact or knowable data and what is personal opinion. This helps in critically evaluating the information received.

27. Deepen Health Knowledge

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