Biden COVID Advisor Urges Greater Paxlovid Use: ‘People Have Died Unnecessarily’

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Speaker 1: Welcome to Conversations on Healthcare. This week we welcome Dr. Michael
Osterholm, renowned pandemic expert and director of the Center for Infectious Disease
Research and Policy at the University of Minnesota. Now here are your hosts, Mark
Masselli and Margaret Flinter.

Mark: The clock is ticking as President Biden prepares to officially end the COVID Public Health
Emergency, and our guest has been in meetings at the White House in recent days to
sort [00:00:30] out what this will mean in re al terms, and you're about to hear his
answers.

Margaret: Michael Osterholm earned his PhD from the University of Minnesota, where he now
leads the Center for Infectious Disease Research and Policy.

Mark: Michael, welcome back to Conversations on Healthcar e.

Michael: Thank you. Good to be with you.

Mark: Yeah, it's good to see you. And as you know, you served on President Biden's COVID
Advisory Board, and the administration has really made a big decision to end the Public
Health Emergency, probably about [0 0:01:00] three months out. And your White House
meeting included a focus in on testing, and we know you think ending the Public Health
Emergency is troublesome. What has been your advice to the president's team?

Michael: Mark, I think one of the things tha t's important to understand is there's a whole series
of different actions that have been taken over the course of the pandemic, to either
enhance our public health response or make resources available. So it's not just the
Public Health Emergency, but the re's actually a federal emergency. [00:01:30] There's
the PREP Act, there was actually the Stafford Act, and even FDA had its own authorities
on emergency use of various drugs and vaccines. And so all of these are somewhat
overlapping, and I think what we' re talking about is the Public Health Emergency going
away in May. And actually that one may not be as onerous as many people think in
terms of what it means.

The one that actually I think has attracted a lot of attention has been the one that we
may be t aking a number of people off [00:02:00] the Medicaid rolls that were kept on
during the pandemic. As you know, Medicaid's operations go through and continuously
check for eligibility for people to be on Medicaid, and if they shouldn't be, then they're
move d off. And there's been wide - ranging estimates how many people have stayed on
through the pandemic that shouldn't be on, that will fall off. The point about that one
though is that the omnibus bill that was passed in December already de - linked those
two be fore the Public Health Emergency [00:02:30] action were even to be taken. So
this is not a new action by the Public Health Emergency.

If you look at the tools we have, the antigen test and so forth, the big challenge there
really is not so much about the emergency, but it's about whether Congress will
continue to fund making these available. Remember that at this point companies are
not just going to make a lot of antigen tests that's not already purchased, because of the

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outdating of these and the loss th at they would have of revenue if they don't make
[00:03:00] it. So we're trying to still work it out. But right now the U.S. [inaudible
00:03:03] Service program for testing still has a substantial amount of antigen testing
there, but it'll eventually run out, and whether Congress comes back and deals with that
or not, that's a challenge.

Same thing is true with vaccines. Right now we have quite a bit of vaccine, but we'll
need resources in the future. So the emergency in and of itself doesn't change that. If
Congress is not going to support purchasing more, then it will go to the private sector.
The private sector [00:03:30] then will have its choice of how they want to sell it. We've
already heard companies like Pfizer will charge up to $130 a dose. On th e other hand,
healthcare coverage for about 92% of the country will require as part of standard
benefits that you have to get the vaccine and pay for it as an insurance issue. So we'll
have about 8% of the public that won't be eligible.

And then the final piece is the drugs, the Paxlovid. Right now we have lots of Paxlovid.
We should be fine [00:04:00] for some time dispensing that. The challenge again is we
need to develop new and better drug. We need to continue to fill in behind Paxlovid.
Comes back to Congress so they appropriate the money. So I think that this May date
for relieving the Public Health Emergency is not quite what people think, as if it's a light
switch on and off. There's a lot of other complexities among [inaudible 00:04:22] the
FDA aut horities over emergency use authorization will stay at FDA, all the issues around
the PREP Act we've dealt with will [00:04:30] stay, all the Stafford Act and how FEMA
funds and doesn't fund will stay. So it really is more limited impact than I think most
people realize.

Mark: Margaret, I think Michael hits the right note of concern that we have is certainly on the
Medicaid redetermination, which could be 10 or 15 million people, and also that 8% of
the population for whom many of those who are listening to day are part of a network
that serves that population. I think both of those are big concerns for us.

Michael: [00:05:00] And they are for me too. And they are for me.

Margaret: Yeah. I think you're absolutely right. And the good news is we've seen it comi ng and
there's plans in place, but we know that that 8%, as you say, is concentrated in
community health centers and in public health clinics, so we need to have all the
resources we've had around Paxlovid, around vaccines, around testing, to care for
peop le. And as always, Michael, I really appreciate the broad 360 view you take of these
issues when responding [00:05:30] to questions.

But I was thinking, listening to one of the World Health Organization leaders, how much
words matter, and the comment was that the acute phase of the pandemic is ending.
Now, maybe everybody doesn't listen to these the same way. I think, if acute is ending,
then it's not like we're in end of pandemic, we're in a chronic endemic phase. I think
most experts like yourself hedge their bets on predicting COVID's [00:06:00] future path.
What does it mean in practical terms when the World Health Organization says the
acute phase is ending?

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Michael: Margaret, let me just say that I found myself in the very uncomfortable position sever al
months ago in a New York Times story, several lines below the president having
declared the pandemic is over, and me saying it's not. You never want to be in that
position. It's not a good place to be. But what I did do is reinforce that what the
presid ent was saying is that, for most of the public, the pandemic is over. They see it as
such. [00:06:30] And so that's a concern. But if you look, for the last 10 months, we have
been somewhere between 380, often 400 to 550 deaths a day, and it just hasn't
ch anged. Look at it today, we're at 460 deaths again today. And so we've been in this
High Plains plateau of cases for the past year. If you want to get some sense of the
importance of that number, just remember that the number one cause of cancer deaths
eve ry day in this country is lung cancer, and [00:07:00] that's about 350 a day. So this is
still a very significant impact issue, and yet the public is done with it.

When we look at the fact that we have clear and compelling data, in fact the CDC has
just r eleased new data this week, supporting how effective the bivalent vaccine is
among those over age 65 in preventing serious illness, hospitalizations, and deaths. You
have a 14 times higher risk of dying from COVID if you're not vaccinated versus having
the bivalent, and even [00:07:30] five times higher risk if you've been vaccinated but
didn't get the bivalent. And yet only 40% of the U.S. population over age 65 have gotten
the bivalent booster. That is different than getting the vaccine to the people. It' s getting
that last inch, getting the vaccine in the arm. And so I think we have a huge challenge
yet, to say that we're not at the level we might want to be, and we surely don't know
what the virus is going to throw at us next. And so I think from that st andpoint, I would
like [00:08:00] to think maybe we're in close to an end of a pandemic kind of time, but I
don't think that we can say that at all yet.

Mark: The numbers are so discouraging, and [inaudible 00:08:10] asking me a question about
the public h ealth community, and whether or not they're tone deaf in terms of the type
of information we need to provide people, or they have been so politicalized that
Americans have turned a deaf ear to them, and all of that is problematic. But I do want
to [00:08:3 0] talk about, speaking of ears, you and others have the administration's
ears, and publicly warned a few months ago that we've not done enough to prepare for
the next pandemic. And your piece in the New York Times even called for mandating a
national indo or air quality standard. Margaret, we had maybe six months ago Dr. Joseph
Allen from Harvard on, who's really the guru in this area, somebody we really enjoyed
having a conversation, really talking about the importance, so Michael, I'm so [00:09:00]
glad y ou stressed that.

There's a new chief of staff at the White House, somebody you're probably familiar with
to President Biden, Jeff Zients. If there was anybody who would have a receptive ear
about making the case for these air quality standards, I think i t would be Jeff Zients, but
I know there are a lot of priorities. But what's your take on the message you have for
the chief of staff, or [00:09:30] is he pretty well informed at this point? Talk a little bit
about this air quality, because I do think, in this whole notion of moving people back to
work, this air quality standard is really going to be high on their mind.

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Michael: Mark, I think this is a incredibly important point, not just for now, but for moving to the
future. And let me just say I have had the wonderful gift of having Ron Klain as a dear
friend, and Jeff, and having worked closely with Jeff [00:10:00] on the days of the
transition team, and I think very highly of both of them. Very highly.

Let me just put into context what we're talking ab out. Most people might think that we
want to talk about indoor air standards for the current pandemic, and I think we're
beyond that. What I mean by that is, any real efforts to deal with indoor air and
changing and improving ventilation is an infrastructu re concept, and we've already
learned just how far behind we are in infrastructure in this country [00:10:30] in roads,
bridges, et cetera. Indoor air is one of them that has not really been addressed. And
what we need to do is address it for the future. L et me just put this in context. I know
people never want to hear this, and they surely might label me as an alarmist, but what
we're doing right now with this pandemic, this is not the big one. This isn't. The big one
is a coronavirus pandemic that has the transmission potential of SARS - CoV - 2, very high,
and has the ability to kill like MERS and SARS, where anywhere [00:11:00] from 15% to
35% of the people died, not less than 1%.

Or think about again, influenza, which we're going to have more influenza pan demic.
Remember in 1918, influenza killed 100 million people in two years from this country, at
a time when the population was one fourth what it is today. And modern medicine
wouldn't necessarily save a lot of these people, as they died acutely with this
fulminating illness. And so we have to understand that, as bad as this has been, we have
to better prepared for the future. And [00:11:30] so clearly air quality and how we can
reduce the transmission by having better air exchanges, abilities to inactivate viruses for
example in the air, is an investment that is so, so important.

This is one of those ones... When I was a young kid growing up, there was an old
commercial on TV, an oil FRAM commercial, that said, "You can pay me now or you pay
me later." And we're going to experience that. So we have to keep pushing this. And I
know the administration is obviously very sensitive [00:12:00] to the infrastructure.
They have been. But now how, do we help buildings be healthier? How do we help
transportation be h ealthier that way? And we have a lot of work yet to do around that.

Margaret: We couldn't agree with you more. And I think even in the setting of healthcare from the
perspective of primary care, the standards and the requirements for facilities, they're
ju st not strong enough. You have a negative air pressure room in a facility. What good
does that do if you end up in the wrong room and find out what the patient's issues are?
So thank you so much for shedding [00:12:30] light on that.

I want to talk to an issue that's part promising and part concerning. Promising, a new
interferon drug in development that is reported to cut in half a COVID patient's odds of
hospitalization. But you've already sounded the alarm, and you noted this I think a few
minutes ago, that we're not even getting Paxlovid to enough patients who need it, and
still have, as you said, somewhere around 450 Americans dying each day from COVID. So
even [00:13:00] if the FDA approves new drug treatments, we're going to have this issue
of making sure they get to the patients who need them. And I guess my question to you

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is, from talking to all of your colleagues, is it prescribers not really being serious about
the recommendation and the prescribing? Or is it patients saying, "No, don't believe i t,
don't want it"? What are you hearing?

Michael: Margaret, again, you've framed a very, very important issue, not just for this pandemic,
but going forward. [00:13:30] Let me use an analogy that... I did a podcast on my weekly
podcast back in November of 2020 as the vaccines were beginning to roll out. And the
title of the podcast was The Last Mile, The Last Inch. The last mile was actually getting,
in this case, vaccines. You could just substitute the word drug. And then the last inch
was getting it in th eir arm, or in this case, how do you get the consumer to actually take
the drug?

Let's [00:14:00] take the big picture first. I'm extremely concerned that we are now
watching investments in any kind of aspects somehow related to the pandemic drying
up qui ckly. People want to move on. It's as much a psychological issue as an economic
issue. And we're watching companies right now that have potentially very, very
important new products to bring to market that are shelving them, because there's no
financial mo del for them. If the government doesn't buy it and give you a guaranteed
[00:14:30] price on it, financially it just isn't worth their while to do it, because you have
to wait till the next pandemic, or will the consumer use it? We're missing golden
opport unities there to bring forward new technologies, and we need to have that and
we don't. And that's not just true in the U.S., that's around the world.

The second thing is, even if you have that technology, the question is, how does it get
used? Just as yo u pointed out. The Paxlovid experience has been frankly a disaster from
my perspective. Look at the VA study that showed only 4% [00:15:00] of eligible patients
there were actually prescribed Paxlovid, when in fact they knew that they should get it. I
was actually involved in a situation where several of my friends and colleagues who
were VA patients who developed COVID, who had in fact all the risk factors for needing
the drug, and who were within the timeframe of getting the drug, but were turned
down. An d it turned out that the VA had sent out a statement that was used by the
nurse [00:15:30] line to say, "You only need Paxlovid if you're in the hospital and
severely ill." Which is already way too late and you're not eligible any more. It was a
mistake.

And we have seen so much misinformation. There's the information about Paxlovid
rebounds. There's been several studies now that show rebounds are common, whether
they're Paxlovid related or not. And so here we are now having this misinformation. You
don't want to get this drug because you'll have a rebound with it. Well, that's not true.
And so I think that we have challenges [00:16:00] about information systems to
physicians, so that they can have a better sense of what they can do, and that data are
clear and compelling. Paxlovid will reduce serious illness, hospitalizations, and deaths,
and Paxlovid has even been able to demonstrate a reduction in long COVID
development. So I think we have to go back and look at, how do we communicate this
information? Ho w does every practitioner out there know and understand?

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And finally, I just have to tell you [inaudible 00:16:27] story that involved me that I
thought was telling. So [00:16:30] I led a delegation last summer to Cuba, to look at
their COVID vaccines. Th ey actually have a unique technology, conjugated vaccine, that
is really quite exciting. And so I have not yet had COVID, and I wear faithfully with my
N95, but I contacted my primary care doctor's office and said, "Could I get a script for
Paxlovid now? I won't take it unless I actually have a lateral flow positive test while I'm
in Cuba." And they said, "No, we can't. But if you send [00:17:00] us a picture online of
your test result while you're in Cuba, we'll email you a script." And I said, "That's goi ng
to do no good. There is no Paxlovid in Cuba." "That's all we can do."

I finally had to go through the healthcare system myself, knowing who I am, and actually
was able to get through to the person who could say, "I'll write you one." But the
average ci tizen would've been [inaudible 00:17:22] from getting that. And that's what
we have to address. That's just wrong, and people have died unnecessarily because
they're unable to get Paxlovid, [00:17:30] when they could have and should have gotten
it.

Mark: A s you know, you've been working on a roadmap for a better coronavirus. So important.
I was just thinking over the last 20 years, SARS, MERS, COVID - 19. I'm wondering, as you
think about the vaccine, will we get a vaccine that prevents infection? Where do we
stand on all of that? And maybe give us a preview of what we can expect from the
report that you're about to release [00:18:00] soon.

Michael: Thank you, Mark. And in fact, yes, this report's coming out in just a little over two
weeks, and it is a year lo ng project which involved more than 60 of the world's leading
experts in all aspects of coronaviruses, vaccines, immunology, et cetera. And this
roadmap, like the one we did for influenza, is extremely detailed. It's over 70 pages long,
and it gets down to measurable outcomes, when we should have achieved these
outcomes, by [00:18:30] what date, and everything from something as simple as what is
correlate of protection for a coronavirus vaccine, to what do we know or not know?

And what my concern is here, again, is when we look at funding, I don't see any major
initiatives right now that have identified funds that will say, "This is going to take a
while, but we got to stay on it." And even if the pandemic "goes away," it's not time to
say we're done, becau se we don't know if we're going to have that big [00:19:00] one I
just talked about a moment ago, where in fact it is a SARS, MERS, SARS - CoV - 2 mixture
that could be much worse than we have now.

And so I think this roadmap will be very instructive. It will provide us with granular detail
about what needs to be done in sequence and how we do it. The challenge is going to
be, who's going to support it? If you look at the federal government right now, the
resources just aren't there. If you look at Europe, Asi a, we just don't see it. So this is not
the [00:19:30] time to have pandemic amnesia. This is the time to have pandemic
planning front and center.

Mark: Michael, you've got the Gates Foundation, Rockefeller along with that, but what's the
bread box or elep hant size that's needed for this type of investment?

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Michael: I think the challenge we have right now is, we're not really part of that other than just
keeping track of it. We plan on being air traffic control to understand, just as we do
again with influe nza, who's investing what, when, and where, so that we know if we
have underinvested [00:20:00] areas. The challenge is going to be likely in the billions of
dollars ultimately, to bring a new vaccine like this to fruition. But the bottom line is that
that billions could save trillions and trillions of dollars and many millions of lives. And so
I think one of the things we've learned, if nothing else in this pandemic and both of you
know this, I talked about this in my 2017 book Deadliest Enemy, that the co st of a
pandemic is not just in [00:20:30] human lives, it's economic too. And when you look at
the global economic crisis of the last several years and the inflation issues, this was all
caused by the pandemic. And the one thing that added, of course, was the war that
we've seen in Ukraine, but that has a late - comer and minimal.

Now, when you look at the cost globally, what this pandemic has done to us, and you
look at what the investment could be to take that off the table, [00:21:00] talk about
high qua lity insurance, this is it. And so we've got to help the world understand, don't let
up now. Help us get the kind of vaccines, that next time that one of these viruses
emerges, we will be able to act quickly, effectively, and then we cannot have just a
vac cine that reduces severe illness, hospitalization, and death, but a vaccine that also
prevents infection and transmission. Wow. What a gift to the world that would be.

Margaret: Right. And [00:21:30] I have to make the point as well that, as important as i t is to have
that vaccine on the shelves, there was a level of training, recruitment, deployment, of
frontline staff to manage that vaccine train, the refrigeration chain, get it out to where
people are, give the vaccines, that we can't let that workforce tone down their readiness
and preparedness, because it was not easy to stand it up around the country, and we
need to make sure we keep those skills really crisp.

Michael: I couldn't agree more, Margaret. And [00:22:00] I use the analogy, imagine if every year
Major League Baseball teams fired everybody after the World Series, and then tried to
go hire them again in March if they could. [inaudible 00:22:09]

Mark: You must be talking about the Brooklyn Nets. Sorry.

Michael: There you go. I'll leave that expe rtise to you, Mark.

Margaret: Yeah. Me as well, I don't do sports analogies. But Michael, we talked about using this
time now wisely, the report, the implementation, [00:22:30] being ready. I'm just not
sure we're going to have a long lead time. There's so much going on. And I wonder if you
could just speak to this outbreak at a Spanish mink farm, and bird flu, that's proven to
be so deadly in the past. You've just told us, do not take this for granted. What's the
current status of that? I know people are o verwhelmed sometime with this news, but
it's important for people to understand. So current status of that threat, and what can
people do to protect ourselves?

Michael: Let me just take a step back and [00:23:00] tell you, I've been dealing with this H5N1
issue since 1997 and its emergence in Hong Kong, and I've been very involved with it.

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I've been in Indonesia, Thailand, and Vietnam working on H5N1. I was on the National
Science Advisory Board in 2012 when researchers brought to the board the f act that we
were probably only one mutation away from H5N1 becoming the next pandemic virus. I
was part of a major effort to lead an investigation [00:23:30] in 2015 with the major bird
die - off in North America. So I've been eating, sleeping, and living H5 N1 literally since
1997.

Having said that, this virus has continued to make us concerned and then make us
unconcerned. And when I say make us unconcerned, I don't mean it's gone away, but
every day we are not on the precipice of a new pandemic. When you l ook at what's
happened, there's been 868 cases [00:24:00] of confirmed H5N1 globally since basically
the 1997 time period. Of those, over half have died. It's a very, very serious disease. But
if you look at it, countries like Indonesia and Egypt had major increases in cases over the
course of this time period, most of them five to seven years ago. At one time we had
over 105 cases in a year in the Nile River Valley in Egypt. Everybody said, "It's ready to
go. It's going to happen."

And so [00:24:30] I thi nk we have to be very careful here. I've seen a lot of hype, for lack
of a better way to describe it, over the past several weeks around H5N1, because of this
mink farm infection in Spain. And I don't want to suggest that that's not important, or all
of th e other animals that are now becoming infected outside of avian species. And
surely we've had another bad year here in North America with 58 million birds dying or
being culled out this year, versus what we saw in 2015 [00:25:00] with 52 million.

And so I want to add though a sense of, we've been here before with this virus multiple
times, and for some reason it has not just made the jump where it could be transmitted
human to human. That doesn't mean it couldn't happen tomorrow, but like some, I
don't thi nk it means it's absolutely going to happen tomorrow. And I think we have to be
careful. But it's a reminder that it could happen tomorrow. And therefore all of this
work we're talking about that needs to be done really is [00:25:30] very, very timely.
And we could have another 1918 - like influenza pandemic that would be so much more
severe than anything we've experienced with this current pandemic.

Mark: Those lethality numbers are so high, 46% or whatever I think I read. I wonder how it
really spreads, wha t the point is in terms of the spread on that. But I do want hear from
you on why vaccine development for avian flu is more challenging than what we've seen
[00:26:00] with the development of the mRNA vaccines for COVID. Maybe you could
enlighten us on tha t particular.

Michael: Yeah. If you look at the human vaccines, let's [inaudible 00:26:10] and then I'll talk about
the animal vaccines for a moment. When you look at human vaccines, just take a step
back and go to 2009. Remember when we were already livin g in a world with H1N1 as
seasonal flu, and then along comes this new pandemic H1N1 from Mexico. And we
learned very quickly that the [00:26:30] old vaccine that we currently were using
seasonally had virtually no protection against the new H1N1, even thou gh they're the
very same. They come from that same H - N combination. And one of the challenges we
have is that, even if we make H5N1 vaccines now, which there's not much appetite

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surely to do that or stockpile them, that we'd have no guarantee that when H5N 1
emerged that in fact the vaccines we had [00:27:00] already made would be protective
against it. They might provide some protection, but they won't necessarily provide that
much. And 2009 makes that point.

I think the other thing is that, when you have a vaccine like this, it has an outdating
problem where it's only good for so long, and how long can you keep it? And so buying
five, ten million doses of the vaccine may seem like a wise idea for at least the early part
of the pandemic, [00:27:30] but five to ten million doesn't get you very far in a
population of eight billion. And the cost of trying to supply a much larger volume of
vaccine is so, so high that I don't think it's going to be done.

So for me, the real answer is, how can you scale up quickl y a scalable vaccine program
that, as Margaret you talked about, getting it out there and having that infrastructure in
place, allows you to do that? And that's not necessarily easy to do, because remember
right now we primarily grow all [00:28:00] of our influenza vaccine in eggs, chicken eggs,
which one of the things we have to be worried about [inaudible 00:28:06] we have
those chickens around, or will they too be, if there's an avian influenza situation, what'll
happen to them? So that's a concern.

The second issue around the birds. We've heard a lot about vaccination of birds
themselves, particularly the poultry in many parts of the world, but these vaccines are
very, very difficult. Unlike standard vaccines we use in poultry production today, such
[00 :28:30] as Newcastle and so forth, they're stable vaccines that can be given in water
or in the air. Here, basically you have to individually inoculate each bird with an unstable
vaccine that needs to likely be changed every year. And there are 9 billion b roilers, the
chickens we eat, produced in the United States every year. You know what that means,
to try to hand - vaccinate each one of those? And so it's not as practical as some of the
recent media reports suggest, let's just vaccinate the animals. And so again, another
challenge [00:29:00] that we have to deal with, but it's one that, as I said earlier, pay me
now or pay me later.

Mark: Michael, let me just get one last question in before we close, about masks, because
there've been some flawed studies ab out a mask, and I want to know the efficacy of
wearing a KN95 or a respirator, and then maybe just tell us, is the 15 minute rule still
something that's operative? Take the mask first.

Michael: I just have to say, and [00:29:30] you may want to cut this, I hope you don't, but you
know what? One of the reasons I love coming on this program is, I never deal with two
more informed interviewers than the two of you. You are always current,
comprehensive, and authoritative. And in this case, you're absolutely rig ht about the
issue around respiratory protection. Studies that have recently come out, including the
Cochrane reviews, are seriously flawed in their understanding of how to evaluate
respiratory protection. Suffice it to say, for in the occupational area, t here is [00:30:00]
no question that we've already answered the question about, do you need to have that
fit and filtration combination to keep out aerosols? And we've learned, unfortunately

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through this pandemic, the absolute importance of aerosol transmis sion with this virus.
So yes, you do need to have that.

And one of the ideals is to have everybody face fitted, but we don't even need to do
that. We can get quite good protection with fit. Remember, procedure masks leak all
over [00:30:30] because there' s nothing that's tight around the face. Also, again, to
breathe air in a tight environment like that, you have to have a material that air can
move through relatively easily. Why does that work with an N95? Because they have an
electrostatic charge in the material, so that air can move and the virus gets trapped, not
because it's plugged up or stopped, but because it gets trapped by the electrostatic
charge. If you put any other kind of mask on, that won't work.

And so I think it's so important to [00:31:0 0] understand that a lot of people are wearing
what they think is adequate respiratory protection and procedure mask, cloth mask, and
they're just simply not. And I find it really very challenging, because they think they're
doing the right thing, and yet they're still just as vulnerable.

The 15 minute issue, Mark, that worked earlier with the previous strains or variants of
the virus, but as we've got these much more highly infectious variants, what we've just
seen in China in the last two months has been [00:31:30] transmission that puts us on
the upper end of measles transmission. That is aerosol, aerosol, aerosol. And it's clear
that we have to have that kind of respiratory protection, or it's basically more cosmetic
what you're doing.

Margaret: Michael , you just gave us a whole lot to think about, and perhaps get you back for
another visits soon with those last comments.

Michael: Thank you.

Margaret: But we want to thank you so much for this return visit to our program. We always
appreciate your insight s and your information, and thank you to our audience [00:32:00]
for being here. There's more online about Conversations on Healthcare, including a way
to sign up for email updates. The web address is chcradio.com. Michael, thank you so
much for your incre dibly important work and being with us today again.

Michael: Thank you.

Mark: Absolutely.

Transcript by Rev.com