What a Year! A Look Back At COVID’s Grip on 2021

Year in Review

[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 healthcar e of the future.

This week, Mark and Margaret, take a look at the second tumultuous
year of the pandemic. If 2020 was the year of COVID - 19 , 2021 was the
year of the vaccine, a dramatic achievement of its development and
deployment of first sense that thing s might be rounding a corner ,
t hen the arrival of D elta and the Omicron variants and how that has
dramatically changed the landscape.

We revisit some of our memorable guests from the past year from
renowned Virologist and V accine E xpert Dr. Paul Offit, to
E pidemiologist Michael Osterholm , to CDC D irector Rochelle
Walensky , NIH D irector Francis Collins. The pandemic wasn't the only
story to tell , climate change moved to the front burner, and women's
reproductive health fell under serious threat , a nd still th e pandemic
rages on.

If you have comments, please e - mail us at [email protected] , o r
find us on Facebook, Twitter, or wherever you listen to podcasts. Now, stay tuned to our look back at 2021 h ere on C onversations o n
H ealth C are.

Mark Masselli: Welcome to Conversations on H ealth C are I'm Mark Mas s elli .

Margaret Flinter: An d I am Margaret Flinter.

Mark Masselli: Well, Margaret, another pandemic year and what a year it was , still
we are far done from this experience. C OVID - 19 really has shocked
the world into submission in 2020 . 2021 taught us the meaning of
perseverance and patience and trust in our scientific community. The year began with the promise of a remarkable vaccine for the C oronavirus.

Margaret Flinter: Well , that's right, Mark 2021. Even the last weeks of 2020 were a
hopeful note . W e had the rapid development and now deployment of
the mRNA vaccine. It felt like the first real sign that there might be an end game for this pandemic. But the science needed some explaining
back then and the country needed that . W e had vaccine expert Dr.
Paul Offit join us just to do that. There are a lot of rumors circulating
around the new vaccine. Y ou'll remember there were concerns that
would alter people's DNA , and he came on the show and clearly
dispelled that myth.

Dr. Paul Offit: The M essenger RNA is in this little lipid droplet which is then taken up
into the cell in the cytoplasm. In order for it to enter the nucleus, it

Year in Review

needs to get past the nuclear membrane, which means it needs an
access signal which it doesn't have. Therefore, it actually cannot
possibly enter the nucleus. Even if it entered the nucleus , i t's RNA, it's
not DNA, it would have to be reverse transcribed to be RNA. Even if it
was reverse transcribed to DNA , it would have to be integrated into
the DNA which requires an enzyme called integrase, which it also
doesn't have. It's not like the chances that it could affect our DNA are
small, the chances that it could affect our DNA is zero . Y ou are more
likely to develop x - ray vision after getting this vaccine and having your
DNA a ltered.

Mark Masselli: T hat early excitement around the vaccine , I think it's fair to say we
experienced it ourselves h ere at the health center. We had our whole
team of folks working at four mass vaccination sites serving the whole
state of Connecticut , more than half a million vaccines into people's
arms. W e were , I think , driven by the same passion that we have that
health care should be available to everyone and our real focus in on
tr ying to bring this pandemic to an end. But we're also motivated by
what scientist were telling us b ack in February renowned virus
scientist Dr. William Haseltine warned that COVID was a shapeshifter
t hat Coronavirus mutates, and that variants were a real t hreat.

Dr. William Haseltine: Now that we know we're starting to look , and the more we look the
more we find. I t isn't the same kind of changes in one part of the
world or another. We're starting to find new variants that don't look
very much like any othe r variants . The California variant that just
popped up is not like the South Africa a n d the UK. People say it's
going to be a race between vaccine, public health measures, tamp this
down, put it in a bottle, but you asked me a re these good escaped
vaccines ? The answer is UK virus does so weakly , South African and
Brazilian viruses do it pretty well w ith a caveat . I'm going to predict
that as the antibody concentrations wane , t hose differences between
the ability that protect the variant is going to become greater and
greater and greater to the point where you'll have no protection at
all. I think that because these variants are reinfecting the same people
that were already infected, where 76% of people that already been
infected, there's a brand new wave of infection.

Margaret Flinter: We had another amazing epidemiologists join us on the show in
March , Dr. Michael Osterholm, who I think the country gets to know
very well during the pandemic as a reliable expert , spoke often on the
media , also served done Pr esident Biden's COVID A dvisory T eam. He
warned us that another surge was coming , a nd it was coming due to
the new variants, even though vaccinations were rolling out and we’re
having a good response around the country. O f course, it turned out
that he was absolutely right.

Dr. Osterholm : If you want to find out what is likely to happen here in the United

Year in Review

States, just look at Europe . Germany just put in place a new major
lockdown initiative just because of the challenges there. I could go
through country by country . Where this B 117 variant has taken off ,
the case numbers have surged substantially. Remember, in the United
States, even with everyone who has been previously infected, and
with even the amount of vaccine we've rolled out, we still have
roughly 50 to 55% of the population unprotected. F or all the pain,
suffering , deaths and cases we've had in the past year, we still have at
least an equal amount, if not more of people who are still vulnerable
to this virus , s o we have to take it very seriously.

Mar k Masselli: Well, one thing that happened in the new year, Margaret , was we had
a new administration, the Biden A dministration took the task of
vaccinating all Americans very seriously , m obilizing enormous . Y ou
might well say a h erculean effort. His White House V accination C hief
B echara Choucair joined us in April talking about the dramatic uptick
in vaccine rates under the Biden team i n just a few weeks from when
they took over

Bechara Choucair: 11 weeks ago the US was averaging less than one million vacci nations
per day. Our current seven day average is over three million
vaccinations per day. T his weekend, we've reported for the very first
time ever, four million shots reported administered in one day. F or
people 65 a nd older where we know 80% of the deat hs from COVID is
happening , m ore than 75% of people as 65 and older have had at
least one shot of the vaccine. That's up from 8% 11 weeks ago.

Margaret Flinter: I n the middle of all that effort , Mark , United States the place where
much of the basic science and R & D for these vaccines have been
done, had a new epidemic brewing . I t's really different than anything I
have seen in my long career a nd that was an epidemic of
disinformation. T hat epidemic led to a lot of resistance to the vaccine
in pockets across the country .

We had former CDC D irector, Dr. Tom Frieden join ed us in May . H e
t alked about his work at the Global Health E ntity V ital S trategies.
They're actually researching not just basic science, but an in - depth
analysis into what was leading to so much resistance. I t did appear to
be particularly among conservative voters.

Dr. Tom Frieden: But with the group of Trump voters that Frank Luntz and the Obama
Foundation put together, it was really interesting to hear the extent
to which they feel so alienate d from the health --- the political system .
T hey didn't want to hear about vaccines from any politician, not even
from President Trump of whom they think very highly. They want to
hear about it from doctors . T here were certain messages that really
resonate d with them.

There's a lot of concern about vaccines, people think I'm putting this

Year in Review

foreign substance into my body , a nd why was it developed so quickly ?
There were some messages that really did make a difference. One of
them was that if you get the virus, it's going to spread all over your
body in billions of copies for a week or 10 days. If you get the vaccine,
it'll be in your body for a day or so a nd then it'll be gone. It will save
your body t he trouble of getting infected to learn how to fight the
viru s. We also had to clarify that the mRNA vaccines were not rushed
to the market, they moved quickly, but not rushed. This is 20 years of
research. It's also really important to make the point that nearly every
doctor who gets offered the vaccine takes it. T his made a big impact
on them because they trust their doctors.

Mark Masselli: Margaret, we've had so many CDC directors on and they really
informed us and our listeners over the years and we have the new
CDC director joining us j ust a few weeks later, Dr. Rochelle Walensky.
She shared her thoughts on the effectiveness of the vaccine against
the first wave of COVID, as well as the next wave that was being
driven by the variants. E ven then in early spring, they were laying the
groundwork for the possible nee d for a booster.

Dr. Walensky: A mong the things that we're looking at, not just in the trial, but really
in the real world studies as well is what happens to our immunity ,
does it wane over time ? I want to be very clear to people , when we
talk about booste rs that doesn't mean you're not protected now
because that has caused some confusion. The question is not do we
need a third today , you are --- if you get your two doses, you're
protected. W hat we want to see is if in a year from now you will
continue to b e protected.

W e're looking at those data, not just in the trial, but in clinical studies
as well. Where we're worried most about that to start is among the
population that got vaccinated first, of course, and that's our long
term care facilities where peop le might not have had a robust
immune response to start. W e really want to make sure that they're
going to maintain protection.

Margaret Flinter: A t the same time, and I'm going to go back to 2020 f or a moment . T he
country was really gripped by , once again , the revealing of just what
tremendous health disparities exist in our country and w hen it comes
to really caring in an equitable and quality way for racial and ethnic
minority groups. W e saw this as the mortality and morbidity rates
made obvious that min ority groups people of color were more likely
to get sick from COVID, they were more likely to die from COVID. W e
had our guest, Dr. Elena Rios, P resident of the National Hispanic
Medical Association on . S he said, you know, this pandemic just
exposed what was already there challenges that these communities
have historically faced, and were continuing to face during the COVID
pandemic, very powerful.

Year in Review

Dr. Elena Rios: Overall, Hispanics and other vulnerable communities have really had
twice as many deaths than the white population. A lot of that is
because of the underlying conditions that Hispanics who are mostly
lower income working class people, known as essential workers , have
lots of underlying conditions like diabetes and obesity and heart
disease and can cers and also our living in multigenerational housing
w ith --- in small --- working in small business es or in the service
industry or in the agriculture business are meatpacking plants, etc,
where they've lost jobs and are really feeling the impact, the
ec onomic impact of COVID - 19 as well as the physical and emotional
impact of this horrible pandemic.

Mark Masselli: Yeah, she really was a powerful voice and really shined a light on the
health disparities inequities that exist out there. W e were fortunate
to have former Congressman Patrick Kennedy on , who is a renowned
mental health advocate told us about the isolation and fear and
quarantines . Margaret , we saw this in our own settings , our school
based health centers, the impact that COVID t he isolation that it was
creating, not only on the mental health, but addiction and increased
overdoses, and suicides. Patrick told us this was just the kind of
glaring spotlight needed to spur change in how we treat mental illness
and addiction in this country. H opefully, that will be an impetus for
the type of change that's needed.

Patrick Kennedy: We as a nation have just really never wrapped our arms around how
much of an elephant t his is in our nation's living room. I think that
both on a personal level and on a societ al level we're ready to have
that conversation. T o your point, the indicators are off the charts. I
mean, we're losing twice as many people as we lost during the height
of the HIV / AIDS crisis , a nd we're spending one fifth t he amount of
money as we dedicate d to fight HIV / AIDS. W e may think, because of
all the headlines that we're actually tackling mental health and
addiction, and I can tell you as a member of many who are on the
frontlines, we haven’t barely scratched the surface of tackling this
illness. It ’s all seen through the prism of the money.

If you really want to know where someone's priority is, follow the
money. T he money has not come into th e space . W e still treat mental
health and addiction as a as a grant. SAM H SA is the leading agency.
But it re flects the fact that insurance still does not reimburse for
mental illness and addiction in the same way that it reimburses for
medical and surgical care as is required under federal law. I mean, if
this were any other illness, we would have been doing a l ot more by
now.

Margaret Flinter: We also welcome back Dr. Anthony Fauci to the show. Now there's
somebody who a country got to know very well. He also endured
quite a bit of political pushback from certain circles, but he always

Year in Review

stays focused on the messa ge and getting clear information out to
people , and his message was we need to vaccinate the people of the
United States, and we need to vaccinate the people of the world.

Dr. Anthony Fuci: Getting back to the issue is that a global pandemic requires a glo bal
response is really important, because as you are correctly saying, if we
get the level of infection very low and we get the overwhelming
majority of the population vaccinated in the United States, and a large
proportion of the rest of the world, partic ularly in the lower and
middle income countries are not vaccinated, that is a surefire way t o
generate additional new variants . W e may not be so lucky t he next
time around that the variant that emerges is one that our vaccine is
able to cover. It may be th at it eludes the protection of the vaccine,
which means we've got to get the rest of the world vaccinated .

Mark Masselli: J ust as we seem to be turning the corner with increased vaccinations,
at least in the United States , w e saw the second wave, the Delta
variant rolled over our shores in 2021. I t swiftly became the dominant
strain filling up hospitals and really putting unbelievable pressure on
state leaders across the country. We are fortunate to have Kentucky
Governor Andy Beshear with us. We had his da d with us when he was
governor and who I think we all know here in the country , a nd our
thoughts and prayers are with his entire state as they're dealing in
grappling with this the after effects of that devastating tornado hit by
a storm of another kind th is summer , killer surge in COVID cases a nd
the harsh political opposition to vaccines and masking requirements. I
think Kentucky is one of those b ellwether states in terms of the
challenges that the country faces in educating people. I think
Governor Beshe ar is a great voice and advocate .

Andy Beshear: O ur state and the s outh will be the entire United States is on fire with
the Delta variant . Now more than ever, we've got to make the right
decisions guided by public health to save lives. I 'll also say and w e can
talk about it, our hospitals are bursting at the seams . W e have one
that has a disaster plan, in effect, the disaster plan, people are being
treated in their cars outside of them. W e're calling in the National
Guard to help where we're trying to take over testing for some of
them to free up staff. W e've asked FEMA for help. T his is a time when
we need strong leadership and I hope the legislature will step up and
make the right decisions.

Margaret Flinter: One of the highlights of the past year in term s of our guests for me,
Mark, i s when we had NIH Director, Dr. Francis Collins, certainly a
legend i n his time , one of our eminent senior people, such a
compassionate scientist joined us to make a case shedding a little
bright light on the remarkable scien ce that's been achieved during
this crisis. As he pointed out that that's historically been true for big
advances in science and technology being precipitated by a crisis , a nd

Year in Review

it will pave the way for many potential breakthroughs that will help
humanity. B ut he was really worried as he was coming to the end of
his tenure about how divided our country was in this ongoing war on
science, which got in the way of everything from testing, to
precautionary measures, to really getting the vaccine into all
communit ies around the country .

Dr. Francis Collins: The current polarization of our country about almost everything has
played out in a circumstance where it really has been destructive .
Y our political party really shouldn't be the main reason for you to
have a v iew about vaccines or mask mandates. But that's turned out
to be the case. T hings that really should be based upon evidence and
the truth of what we actually know get colored over , a nd that is
further made complex by social media and the way in which
misin formation spreads oftentimes more quickly than the truth. I do
worry about that, not just about what it's done to COVID - 19, but
about the future of our country .

I f we're in a circumstance where truth has somehow stopped having
the same purchase that it sho uld on our decision making, and other
things like politics, conspiracies, and just random opinions seem
capable oftentimes of pushing truth aside . T hat is not a good place for
the most technological nation on the planet to be , because the
culture wars that are now so much affecting COVID - 19 are killing
people. We've lost 600,000 people, most would estimate that if we'd
had a better management of our public health circumstances based
on evidence tens of thousands, maybe hundreds of thousands of
those lives c ould have been spared. This is really serious.

Mark Masselli: Well, we are going to miss him Margaret, though I think he's going to
go back to his lab at the end of December.

Margaret Flinter: He’s not retiring, we’re sure of that.

Mark Masselli: He's not retiring. He's not . B ut , you know, I think having all of these
various scientists on , we really got to see a good --- we had a window
into the effectiveness of this mRNA platform. Now, of course, it's new
to us, but it's been around for 15 or 20 years. It' s something in our
toolkit that we might have other types of impact in cancers or
autoimmune diseases , i t's being tested.

F ormer FDA C ommissioner, Dr. Scott Gottlieb joined us to talk about
that platform, but also some areas of concern, warning that we're not
in enough stockpiles of the right kind of medicines including new
emerging therapeutics for COVID, some of which are really showing
some promise.

Dr. Scott Gottlieb: We've stockpiled somewhere between 50 to 80 million doses of flu
medicines in preparat ion for a feared pandemic flu. W e procured 1.7

Year in Review

million doses of this Coronavirus drug in the setting of a raging
Coronavirus pandemic , and we stockpiled upwards of 80 million doses
of a flu drug for, you know, flu pandemic that we fear but it hasn't
arrive d yet. I t's sort of a mismatch between what we need in the
setting of this pandemic and what we ultimately procured . T here's
probably things we could have done much earlier to ramp up
manufacturing of this drug to have more available now, but it's too
late .

It just sort of underscores the lack of preparation. This is another
point to get back to in the book , not having the reserve capacity to
scale the production of some of the therapeutics and
countermeasures you're going to need in the setting of pandemic . W e
just don't have available capacity in this country that's ready to go.

Margaret Flinter: L est we only focus on COVID and the pandemic at hand , t here are
other crises happening against the backdrop of the pandemic of
COVID , Mark. We had our longtime cl imat e change activist Bill
McKibben joined us to talk about the UN's Climate Summit in
Scotland , a nd the hopes that he had for the Biden A dministration's
Build Back Better legislation, which he said had the most aggressive
measures yet to address the clima te crisis.

Bill McKibben: E ven when we signed the Paris Climate Accords , we knew and
President Obama said at the time that it wasn't strong enough . E ven if
we met all the promises, the temperature would still rise about three
degrees Celsius, so five, six degrees Fahrenheit, which is too much, we
can't deal with that. T hat's why everybody is aimed at strengthening
the ambition of countries. T he crucial meeting is in November in
Glasgow, and most important climate meeting, at least since Paris .

John Kerry, t he F ormer Secretary of State is now our climate envoy,
demonstrating I think how seriously the Biden A dministration has
taken this . H e needs to be able to go to Glasgow to negotiate with
something in his pocket, that something is that $3.5 trillion bill be fore
the US Senate. If it passes, then he'll be able to say with a straight
face, the US has begun to commit serious resources to this fight.
China, India, we need you to move up yours. If he goes there with
nothing in his pocket, then that's not going to be a productive
meeting.

Mark Masselli: Well, it's so important th e work the international gathering that was
held was so important . As you said, Margaret, there are so many
problems that we're facing all at once and certainly a very important
one is women 's reproductive rights are undergoing really an
enormous threat. The greatest threat I think from the passage of Roe
versus Wade 50 years ago . T here are several restrictive abortion laws
landed before the Supreme Court. I think we saw recently the
Supreme Court sort of punted on that, but we got an opportunity to

Year in Review

sit down and hear from Planned Parenthood President Alexis Mc Gill
Johnson who joined us to talk about what was at stake.

Alexis Johnson: S B 8 is a six week blatantly unconstitutional ban against abo rtion.
Normally, when you have an unconstitutional law you are able to
appeal. This law sue the --- sue the state law makers who put it into
place. Instead, what Texas has done is created a provision where the
state actually cannot enforce the law that the y created, and instead
empowers average citizens , c itizens in any state even outside of Texas
to enforce the law with what's called --- been called a Bounty Hunting
Provision .

Margaret Flinter: Her concerns were not unwarranted. The High Court has already
failed to block the Texas law banning abortions after six weeks and
has allowed vigilante citizens to go after abortion providers. These are
troubling times indeed for women's health and reproductive
freedoms. W e also had a visit with Dr. Eric Topol has re ally become a
voice of reason throughout the pandemic, an d he helped us to
understand the threat that was posed by the new Omicron variant.

Dr. Eric Topol: I think the main property of Omicron that is disturbing and very
concerning is that it has marked im mune evasion that it gets --- it
works around our recognition from the prior virus versions and from
our vaccine immunity to some degree , okay , and so that gives it an
enhanced ability to spread. T hat's what we're seeing, of course, and a
lot more to come.

Mark Masselli: He is all about the future. I think as we look back at the past two
pandemic years, I'm reminded again and again of how many brilliant
minds are using their talents to improve health care. W e started off
with thanking the health care heroes , a nd we want to thank our staff,
we want to thank everybody who's on the front line. T he front lines
include the schools , include the folks who are serving us at
restaurants . R eally, amid all these challenging stories, there's a need
to really focus in on the positive and the opportunities that present
themselves even in this difficult time.

Margaret Flinter: Well, I'll count is one of those positives that the Affordable Care Act
has remained intact. We still remember the December day when that
passed Cong ress a nd what an exciting time that was more than 10
years ago . A lso much promise in the President's Build Back Better
initiative, which seeks to address challenges that impact America's
health and that have been on the progressive agenda for a long time
t o address child poverty, the cost of prescription medications and of
course, climate change.

The bill has stalled in Congress and action has been pushed into the
new year. But we are hopeful as we go into the new year that we'll
see some progress on this l egislation, which would do much to

Year in Review

address inequity in this country. We know that if we can address
inequity, we address some of the fundamental causes of poor health .

Mark Masselli: Y et we still have facing us right now t he third wave of Omicron rol ling
o ver our shores and it will really --- we'll be looking to the remarkable
science and scientists. There's a dramatic increase around the globe in
research . W e've had so many people who've been talking about this
global network, right? Dr. Gallo and Dr. Topo l and Dr. Haseltine and
others have been really talking about this collaboration that's going
around and how important it is. B ut I think people are realizing that
we need to be working together , and the opportunities the mRNA
vaccine technology will provi de . W e'll be watching as this story
continues to unfold in 2022. Y ou can expect to see some of the most
important people in health policy and innovation, technology and
global health. Join us here on C onversations o n H ealthcare, to talk
about it.

Margaret Flinter: W e look forward to as happy and healthy a conclusion to this year and
into the next as we can possibly have. But in the meantime, to all of
our listeners and viewers w e hope you stay healthy. Take care of
yourselves , get vaccinated and Happy New Y ear from all of us here at
C onversation on H ealth C are.

[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 .

Marianne O’Hare: Conversat ions on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
[email protected] or find us on Facebook or Twitter. We love
hearing from you. This show is brought to you by the Community Health Center .