“Not the Doomsday Variant”: Dr. Eric Topol’s Concerns Around Omicron and America’s Low Fully Vaccinated Rate

Dr. Eric Topol

[Music]
Marianne O’Hare: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthcar e of the future.

This week , Mark and Margaret welcome Dr. Eric Topol, renowned
pioneer in personalized medicine , once dubbed the most influential
physician leader in America by Modern Healthcare . Dr. Topo l has
been using his team at the Scripps Translatio nal Institute to analyze
and drill down on all the data emerging around the pandemic. He
talks about concerns around the Omicron variant , how booster data is
showing this to be a 3 - dose vaccine and what holiday travel plans
should look like as th e Delta ca ses continue to rise.

Lori Robertson checks in, Managing Editor of FactCheck.org, looks at
misstatements spoken about health policy in the public domain,
separating the fake from the facts. We end with a bright idea that’s
improving health and well being in everyday lives.

If you have comments, please email us at [email protected] or find
us on Facebook, Twitter, or wherever you listen to podcast. You can also hear us by asking Alexa to play the program.

Now stay tuned for our interview with Dr. Eric Topol here on
Conversations on Health Care.

[Music]

Mark Masselli: We're speaking today with Dr. Eric Topol, Founder and Director of the
Scripps Research Translational Institute, renowned for his work in
advancing digi tal health in personalized medicine. He previously led
the Cleveland Clinic to the number one ranking for cardiac care .

Margaret Flinter: Dr. Topol continues to lend significant support to the National
Institute of Health ’s All of Us Precision Medicine Pro gram , program of
great national significance. He's the author of more than 1 , 200
papers, several books, including The Patient will See You Now and he
was once ranked by Modern Healthcare as the most influential
physician executive in the United States. Dr. Topol, w elcome back to
Conversations on Health Care today.

Dr. Eric Topol: Thanks very much, Margaret and Mark , to be with you again .

Mark Masselli: And Dr. Topol, Omicron is dominating the pandemic news right now ,
and there's a lots of unknowns. But last week, you said there were
lots of reasons for optimism that this is not some horrible situation
that we're in . We know the data will drive our perceptions. But what
do you say now?

Dr. Eric Topol

Dr. Eric Topol: Well, it's not the doomsday variant fortunately . I mean, w e do know
that there have been many people who've been vaccinated exposed ,
infected with Omicron, and they're holding up well . We don't know of
any yet actually, who have been very ill. That's good. But the fact that
it's getting into people who have been vaccinated even with a booster
third shot is, of course, disconcerting. I think the main property of
Omicron that is disturbing and very concerning is that it has marked
immune evasion that it gets – it works around our recognition from
the prior virus ver sions, and from our vaccine immunity to some
degree. Okay, and so that gives it an enhanced ability to spread , and
that's what we're seeing, of course, now we're seeing it with many
super spreader events in Norway, in the UK, and a lot more to come.
So it may well be on its way to becoming the dominant strain taking
over displacing Delta , we'll have to see over time, but you know, there
is good and bad here. We have a new very challenging variant. That's
mutation Leiden like we've not seen before. On the ot her hand, the
vaccines we have, for the most part, are holding up reasonably well ,
and that's a good sign.

Margaret Flinter: Well, you know, it's interesting, even in states with fairly robust
vaccination rates, we're seeing increases in hospitalization , i ncreases
in deaths associated with the Delta variant. And yet, you know, the
reports of Omicron seem to have spurred some more impetus on
people's part to go get vaccinated in the first place. Do you think
people are beginning to see that this is just some thing we're in for the
long haul, and maybe some of the resistors are moving a little bit
m ore towards accepting a vaccine?

Dr. Eric Topol: I hope so . We are dreadfully low in our vaccination rat e ranking
th
somewhere around 50 in the world as far as countr ies. Our 60% of
the total population vaccine is not going to get us very far. We've seen
the likes of countries like Czech Republic and Hungary, which are at
the same levels that are in desperate shape right now. We've left
ourselves terribly vulnerable. A lso, because of the waning we need to
get our boosters up much higher than they are . We are lagging in
many other countries. So we have a lot of work to do, and maybe the
good part of Omicron if there's any other good part would be to help
us get our immun ity well built more, number one, getting more
vaccinations , and number two, getting those who have been
vaccinated to maintain their full effectiveness.

Mark Masselli: And we're still waiting on Omicron data to come in over the next
couple of weeks to real ly sort of solidify scientists ’ view of this. Is this
a good time for Americans to be traveling internationally , and I'm
thinking about the holidays that are coming up. How should people
deal with this? And what safeguards might they take? I'm wondering,
w ould you – would you travel internationally right now? Or would you
wait this out until we get more information?

Dr. Eric Topol

Dr. Eric Topol: I wouldn't want to be in any long flights right now . You know, we
don't really have the systems in place to get maximize safety . Let me
just expand a little bit. First of all, Delta is out of control here . We
have about 100,000 cases a day , and we're on the way up – back up a
second Delta surge in the U . S. So in this country, we have a lot of
circulating Delta virus, which is, as you well know, hyper
transmissible, it's really been a formidable foe . You add to that we
don't have a rapid testing program, such that if you go on a plane, and
even if you knew everyone was fully vaccinated, which should be
three shots, if you're out by six months, you don't know at that
moment in time, whether they're a carrier, that is they're going to
have symptoms later in the flight or in the next day. So you don't , if
we had those things, that is the rapid testing that was done at the
airport, the r esults were done in five minutes, systematically , and we,
you know, had everybody who got on a plane that was vaccinated and
masked and all those, yeah, we could do it safely. But we just don't
have those systems in place. We know what to do. We just don't do it
repeatedly.

Margaret Flinter: Well, I'm hoping that we're beginning to as a country move closer to
that widespread availability of rapid testing, and certainly in the
Community Health Center world that seems to be happening
punished in the medicine just of people at home to test. But I want to
ask you about a tweet that you posted in August, it certainly caught
my attention , and I think I'm quoting this accurately when you say
there needs to be some truth telling about the reduced effectiveness
of th e messenger RNA vaccines versus symptomatic Delta infections.
What were you r meaning ? What was your message there?

Dr. Eric Topol: Well, it caught a lot of people off guard, and I got a lot of backlash
about it. But frankly, it was the denial , case of deni al. So by August,
we already had clear signs that the mRNA vaccines, particularly Pfizer,
but also some data with Moderna , we re losing their efficacy by four to
six months , and that was against not just infections, but symptomatic
infection, which is a bad sign, which you know, is going to turn out in
people who have increased risk like over age 60 as it turned out to be
over age 40, to have more hospitalizations and deaths . You knew it
was going to happen. But there was denial because of two reasons.
Numbe r one, there was the issue that, oh, we're trying to get our
vaccines up, vaccinations up. So keep quiet because this is going to
undermine the success of the campaign. Well, that's really stupid
because you can do both get the truth out saying, You know w hat you
need to get vaccinated, and you're probably going to need another
shot once you get beyond six months . Just tell the truth from the get
go. So you don't have to make stuff up later, and look like you didn't
tell the truth.

The second thing is abou t global equity. We all want the entire

Dr. Eric Topol

species, you know, near a billion people to get vaccinated. But we
don't have enough vaccines in low and middle income countries yet,
like we should, particularly the continent of Africa. That doesn't mean
we shouldn 't press on and get that up to scale. We need to do both.
But don't let the people who are protected become unprotected.
That's not going to help anyone , and that's not going to help get
control of the pandemic in the United States where we've
underutilize d vaccines grossly. So I laid it out there , turned out it was
true , the signal was obvious , and it took months for some of these
public health experts to now using Omicron as the excuse for why
they are now recommending boosters for all adults. But sorry, the
data was unequivocal. And we had a randomized trial by the way of
over 10,000 people who got the Pfizer vaccine with two shots and got
a Placebo versus two shots and a booster , and it showed very
substantial restoration of efficacy over 95%. That's fan tastic. But that
could have been predicted back in August. And by the way, that's why
President Biden made an announcement in August, okay , all adults
are going to be able to get a booster shot and should get a booster
shot.

Then he had to walk it back be cause all the infighting at the CDC and
FDA, with the r ogue scientists at the FDA and you know, this is crazy
stuff. We should all be looking at the data and we have a single voice ,
consistent voice and we haven't had that in this country. We've got
divisi veness even within our leadership.

Mark Masselli: Well, you're so right that data should be driving our policy and we
look forward to more transparency on the data that's out there and
it's great for you sharing that randomized clinical trial, those are re ally
the acid test for so much . You know, I want to focus a little bit about
the mRNA platform, the vaccine technology is being eva luated as a
way to treat cancer, auto immune diseases and other conditions. I'm
wondering if you're doing any research on this , and how do you see
the mRNA technology advancing healthcare, it obviously had a long
history of the last couple of decades and its development now it
seems to be really ripe , lots of investments going in . What are you
excited about this technology?

Dr. E ric Topol: Well, to be clear, it's been a work in progress for three decades, right ,
and CareCo and Weissman out of University of Pennsylvania deserve
really the credit for that persistent work there . They figured out what
needs to be done so it didn't evo ke inflammation, preventing the
mRNA from being able to be effective. So now, as you say, it opens up
lots of possibilities. Our group at Scripps Research is particularly
interested in of getting this for Pan - Sarbecovirus Vaccines . So we
won't have to worr y about each Greek letter as they come along , and
that we have a vaccine that works against all variants, all future
variants in this family . That would be ideal , and I believe we'll get

Dr. Eric Topol

there . We could have gotten there potentially by now had we had a
glo bal consortium that was given number one priority and the
resources that were necessary . We have lots of different labs around
the world that are working on this kind of in a redundant, isolated
fashion.

So as you say, though, other groups are working on it for heart
disease , for all sorts of other conditions, including suppressing the
immune system and autoimmune diseases, and in cancer. So we'll
see. I mean, there already is a triple vaccine, working to get RSV, flu,
and COVID, all in one with mRNA. Lots of diverse potential, but
obviously a lot of that excitement has to be validated in large clinical
trials , and we haven't seen those yet.

Mark Masselli: Now, just to follow up on that , the vaccines efficacy, as you said,
waned after a number of months . Ar e people working on just, I
assume on the modifications of the underlying structure of the
vaccine, so it will have longer effect . I assu me that that's going on as
well.

Dr. Eric Topol: Well, there are some things that can be done like the adjuvant and
oth er ways part of the package of the vaccine, but it's predominantly
the result of the virus itself . The fact that the virus when you are
getting exposed to such a hyper contagious virus like Delta , it really
was a combination of time plus Delta , and we were still dealing with
the ancestral stream, probably our vaccines were held up much
better, we didn't see her be any breakthroughs until we had time plus
Delta . So you know, what we're dealing with is, as the virus evolves, it
gets even more challenging. It' s this double hit of waning plus the
evolving virus.

Margaret Flinter: Dr. Topol, I think this is such an important point, I'm going to stay on it
for just a moment, if you don't mind . Are we really saying to people
that we're talking about a three part se ries like, if you have to get
Hepatitis B, or the D TaP that you give your kids , you just know, it's a
three part series standing up . And I think people kind of get one, two,
got it six months later, get that third one , and then I might be good. Is
that wha t you're saying? And who do we need to have come out with
this? Is it CDC that really needs to weigh in on this at this point?

Dr. Eric Topol: I do think that, you know, as I've posted fully vaccinated should be
three shots, three shots of all vaccines, ex cept we don't have any data
for J & J , whether a third shot will be useful. There aren't just our data.
And for people who have prior COVID, even one shot maybe enough,
certainly not three is necessary. But for the rest of the vaccines and
the rest of people who are relying on vaccination for their immunity,
three shots is fully vaccinated. Already we have I srael that's
recognized that fo r months, no less other countries that are coming to
that conclusion. We knew when the COVID vaccines were developed

Dr. Eric Topol

that t wo shots weren't going to be a lifetime vaccine. The only
question that was right from the get go was would it be one year, two
years, how much time can we eke out, especially remember that
these were done , the trials and the rollout with very short spacin g,
you know, three weeks for Pfizer , four weeks for Moderna because
we were in a crisis , and that's not ideal. I mean, everyone recognized
that if they were spaced longer, this would be better and we now
have data to substantiate that.

So the only thing t hat was a surprise was that we wound up at six
months rather than, you know, one or two years, but this is a three
shot vaccine. And the question what really is how durable that's that
package is going to be over the years ahead.

Mark Masselli: You know, I want to go back to your statement about this is a
worldwide pandemic, and we need to , we're Spaceship Earth, we're
all on the same plane, if you will, and thinking that we've gone
through a number of variants, but what's out there waiting. I mean, I,
you know, don't want to be a downer here in terms of this
conversation. But in a fairly short time, we've got to something called
Omicron that could be dangerous. But it was in part because we really
haven't done this effort of vaccinating the whole world , and it doesn't
look like if I look out the next 12 months, there's the political will or
united effort, what do we have to worry about out there? And are
there things that might be things that we can solve that arises in this
era of pandemics?

Dr. Eric Topol: Well, you know, I think we do need to get cohesive in our efforts. And,
you know, I m entioned, we could have had potentially a Pan -
Sarbecov irus Vaccine , done already in clinical trials had we had this
real coalescence of our work, but we don't, and in so many things that
we haven't yet gotten our act together. You know, I mentioned the
rapid test as another example, we just can do better. We've had two
years to get our act together, and we still don't do it and it's
frustrating, really, because by now, wha t we're seeing with Omicron is
like deja vu, you know, remember back in February 2020. It's been
found in this state. Oh, now it's found in that state. How many cases
in this? We have the same thing. We know it's in every state now ,
Omicron. But where's ou r contact tracing? Where's our quarantine
and isolation capabilities? No less our systematic sequencing for
breakthroughs, hospitalizations, people coming from international
who are coming in with an infection. There's so many things we could
do better. An d you wonder, you know, for at least the United States,
is this a bureau pathic issue of our country . You know, why can't we
move in the right direction, obviously, we have a plague of
misinfo rmation and disinformation that’s holding us back. But there
agai n, we haven't had an aggressive counter, to take that on and call
these bad actors in organizations, call them out and put them in the

Dr. Eric Topol

Hall of shame for the country to see, we've been letting them just run
amok , and that's really diminished our chance of g etting these very
high vaccination rates that we need .

Margaret Flinter: Well, Dr. Topol, in All of Us , there's a group of sufferers right now,
which is the folks who are really suffering with this long COVID
syndrome and suffering greatly. I think we all agree and I know that at
Scripps, you've got a new research initiative underway, looking at
whether wearable devices might make a contribution to improving
long term symptom management giving patie nts and other tool to
work with. Tell us a little bit about that. I think we all probably know
somebody that are suffering from long COVID.

Dr. Eric Topol: Well, thanks for bringing this out because I think long COVID is one
important area that's miss ed in the pandemic . It doesn't get nearly as
much attention , and it may be as many as 10% of people who get
infections are suffering in some way or other for some duration, some
now from the early times of the origin of the pandemic. And I've had
colleagues still today that are suffering with profound fatigue and lots
of other symptoms, of course, including difficulty of breathing or
exercising. So we are generally more vocal and our group is heading
up a trial to try to coach people, it is time to post oneself to, to have
using up energy in a way that's more efficient. That's one tool that the
various patient groups have found to be useful trying to get some
valid data. We also know things like that are out there, like whether
vaccination helps in people who had long COVID or to prevent long
COVID or other things that a re out there dangling, and we don't have
any therapies yet. We don't have anything that can help squash this
symptom complex , and of course, we know it's a mosaic of many
different symptoms, you know, different in any given individual. So
we have a lot of work to do for long COVID, and , you know,
fortunately, we're starting to see some trials prospective work getting
done, but we can't do enough because these people too many of
them are really substantially being affected adversely.

Mark Masselli: That's gr eat. You know, you talked about a sort of little reservation
about maybe traveling on a plane long distance. I'm just thinking
about the day to day work, that the effectiveness of mask , obviously
people should get vaccinated but what have we learned about
properly fitted mask indoors where somebody else may have had the
virus but you don't , what's the – what precautions should people be
taking and how important is just masking and washing your hands?

Dr. Eric Topol: Well, the mask story is really important , and what we haven't done is
getting medical grade masks to everybody, which we really helped a
lot. Obviously, you know, we might not be able to get N - 95 masks,
you know, for use throughout the pandemic to every American, but
we certainly could do far bet ter, we have never given out mas k s. In

Dr. Eric Topol

fact, I actually think that could help promote some unity by having,
you know, U.S.A. flag on the mask and it's a high grade high quality ,
but as you say, needs to be tight fitting . They have tremendous help
and prote ction, no less our other maneuvers, like physical distancing,
ventilation, air filtration, all these things that we don't necessarily do
but could do. And we may need to do more to help counter not just
the Delta surge that we're experiencing right now, wh o knows where
that's going to take us but also, when Omicron starts to get into the
exponential phase, which obviously is still in the very early days now.
So we have the tools to keep Omicron and any variant in check, we
have them. But ma sks are an import ant part. Again, we have the
people out there who are anti - science, anti - mas k s , anti - vaccines, you
know, trying to have mandates about not having mas k s , mandates
about not having vaccine, this is incredible stuff. You can't just – you
can't believe this is happening in a civilized countr y. You know, it's
amazing to me.
th
Mark Masselli: And just today is December 6 , when will we have the definitive word
on Omicron in terms of the work that has to be done by the scie ntist?

Dr. Eric Topol: Well, I think the tw o biggest questions are not just if it's more
immune, evasive, but how much more , you know, Beta was the
variant with the most before it's worse than Beta . We just don't know
how bad because when we see the la b test hopefully late this week or
early next w eek, there'll be coming from multiple labs , we will
quantify and that would give us an idea about whether how well our
vaccines are going to hold up for neutralizing antibodies , and soon
after that, we'll get the same kind of da ta for T cells. The other bi g
question is how contagious is it? How much more contagious is it than
Delta ? We don't know that yet. That's going to take epidemiologic
studies. We're going to know that in the weeks ahead as well. So we'll
get a much better readout on Omicron, you know, gradually over the
next few weeks. But you know, it certainly doesn't look encouraging
except for the fact that the vaccines are holding up reasonably well
against severe illness and that that's a very important sign.

Margaret Flinter: We've been speaking today with Dr. Eric Topol, Director of the Scripps
Research Translational Institute, follow his
[email protected]/translation or follow him on Twitter at Eric Topol.
Dr. Topol, we want to thank you again for your dedicated quest
to ge ther and share reliable data and insights on this pandemic and for
us again on Conversations on Health Care .

Dr. Eric Topol: Thanks so much for having me again, Margaret and Mark.

[Music]

Mark Masselli: At Conversations on Heal th Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and

Dr. Eric Topol

policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics.
Lori, what have you got for us this week?

Lori Robertson: With the release of its pediatric COVID - 19 vaccine, Pfizer switched the
buffer used in its formulation to increase the stability of the pr oduct
to remain at refrigerator temperatures for longer . The Food and Drug
Administration okayed the change and the change is also being made
to some doses for teens and adults. Social media posts however, have
misleadingly suggested that the ingredient sw ap is dangerous or was
added to prevent heart attacks in children. There's no evidence to
support that. The ingredient in question is Tris or Trimethylamine ,
which is used as a buffer in the children's vaccine and will soon be
available in some adult and t een formulations as well. A buffer keeps
doses at the correct pH , neither too acidic or too basic. The original
iteration of the Pfizer - BioNtech vaccine used phosphate buffered
saline or PBS . Pfizer and the FDA have said the switch was made to
improve the stability of its mRNA vaccine, which previously had to be
kept ultra cold for long term storage and lasted a month in a
refrigerator once thawed . The newer version can last in the fridge for
up to 10 weeks. Tris has safely been used in other vaccines and o ther
products. Less stringent cold chain requirements are especially helpful
for the pediatric vaccine, which is being administered more in doctors ’
offices. As for social media posts claims about Tris being dangerous or
a drug for heart attacks . In large quantities , Tris can be used as a drug,
but here as another vaccines and medicines, the compound is present
in only a very small amount as an inactive ingredi ent to keep the
vaccine stable.

Dr. Kawsar Talaat, an Infectious Disease Physician at the Johns
H opkins Bloomberg School of Public Health told us the in finitesimal
amount of Tris in vaccines has absolutely nothing to do with the much
larger volumes and higher concentrations of Tris being given to
people who are having heart attacks. The Pfizer - B io N tec h COVID - 19
vaccine is not known to increase the risk of a heart attack in any
population. That's my FactCheck for this week. I'm Lori Robertson ,
M anaging Editor of FactCheck.org.

Margaret Flinter: FactCheck .org is committed to factual accuracy from the cou ntry’s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you’ d
like check ed , email us at www.chcradio.com . We’ll have
FactCheck .org’s Lori Robertson check it out for you here on
Conversations on Health Care.

[Music]

Margaret Flinter: Each week , Conversations highlights a bright idea about how to make

Dr. Eric Topol

wellness a part of our communities and everyday lives. If Music
soothes the savag e beast, the question they want to answer at the
Sync Project is how exactly? There are lots of anecdotal studies
supporting music ’ s ability to trigger memory or boost endurance or
focus. But virtually nothing is known about how music truly impacts
our phy siological and neurological state. This is the question that
intrigued scientist Keta ki Karanam [PH] a systems biology PhD from
Harvard, who wondered how could music be scientifically harnessed
as a powerful precision medicine tool, they formed the Sync Pr oject
with a cross section of neuroscientists, biologists , audio engineers and
some rock stars like Peter Gabriel, and started by using Artificial
Intelligence systems to analyze existing playlists that purport to
promote relaxation and do sleep, enhance f ocus or athletic
performance.

Keta ki Karanam: And once we have this set of songs that Machine Learning algorithms
predict to be effective for a specific activity , we can then run studies
using these devices like your Heart Rate Monitors , your Smart
Watches , your Activity Trackers , and actually look at how effective
indeed is that song for that purpose.

Margaret Flinter: Karanam and her colleagues note that most of us self medicate with
music already. So why not harness this ubiquitous tool that's available
to all of us and develop strategies and systems that might replace
pharmacological interventions with musical ones. The Sync Project is
seeking a million volunteers to offer their music suggestions as well as
any information they can share on why these son gs seemed to work
for them.

Keta ki Karanam: So we’re literally walking around with, you know, 14 million songs in
our pocket every single day. So we saw a great opportunity on really
being able to understand how music was affecting us to measure how
differ ent types of music to fight both our psychological health as wel l
as our physiologies.

Margaret Flinter: Karanam and her team see vast potential for reducing reliance on
drugs by crafting personalized music interventions in the
management of a variety of c omplex conditions such as pain
management, PTSD, even Parkinson's diseas e.

Keta ki Karanam: In Parkinson's disease , patients have trouble coordinating
movements. So by playing them the right kind of music, it can be an
external auditory support they have th at's going to help them walk
more smoothly.

Margaret Flinter: The Sync Project, combining computer technology and neuroscience
physiology and musicology to harness the healing powers inherent in
music to help manage a variety of human ills. Now that is a b right
idea.

Dr. Eric Topol
[Music]
Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Peace and Health .
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