Didn't want anybody. This astounding and unprecedented story continues to evolve. We are dealing with a challenge and a crisis that we have never seen in our lifetimes. We know the hospital surge is coming and it has only just begun. COVID nineteen can beat as a pandemic. Hi everyone, I'm Katie Kuric, and this is next question. This week, we're recognizing a sobering anniversary the coronavirus pandemic one year later. One year ago mid March, I actually genuinely felt almost almost panic, almost real genuine worry, which for an e R doctor like me is extremely unusual. I could recognize right away that a US epademic and a global pandemic was just going to be in all hands on deck kind of a thing. For the first time, I really felt like I was entering ad no idea would come next. In retrospect, I feel sort of lucky that I got sick when I did. I think I would have been much more distraught if I knew then what I knew now. On March eleven, the World Health Organization declared the coronavirus a pandemic after watching the slow tidal wave of infections, deaths, and fear consume most of Asia and Europe. Americans finally felt COVID's impact at home. This totally unknown novel virus took root and completely up ended our lives. Remember when we were wiping down groceries like milk and even bags of potato chips and leaving packages outside for forty eight hours. We've come a long way from those panics stricken early months. So on this episode, we're exploring all that we've learned about COVID nineteen, about our healthcare system, about science, and maybe even about ourselves. I got sick with COVID pretty early on. In kind of the trajectory of the pandemic hitting the United States, we'll be hearing firsthand accounts from three Americans intimately involved with COVID nineteen. An emergency room doctor, an epidemiologist, but first a patient. My name is Fiona Lowenstein and I'm an independent journalist, UM speaker, and consultant based in New York City. A friend of mine came over for dinner on March tenth. She got sick before my eyes, like literally got pale, said I don't feel well. Of course, we were both like, is this COVID. I mean, it was so new at that point, nothing had even shut down in the city. Um. She went home right away, and then three days later, UM, I developed a fever and a headache. You know, I'm young. I was twenty six at the time I got sick, and I don't have any pre existing conditions. Um, I'm very healthy otherwise, I like exercised six times a week. I used to teach UGA classes. UM. So I assumed that, you know, if it was the worst case scenario and it was COVID, I would get better relatively quickly. I would be able to write it out at home. That was very much kind of the public health messaging that we were getting at the time. But by day five, Fiona started having trouble breathing. It started as kind of like, oh, I feel, you know, winded, or I'm having trouble catching my breath when I get up to go to the bathroom. And then by the end of the day it was like I couldn't talk, I couldn't eat even really because just the exertion was was winding me. I could barely walk to the bathroom. I was communicating with my partner like writing on a right on white off board and my partner actually had to call the e R on my behalf and explain my symptoms and they were like, you have to come in right away. Fiona went to the e R and after a night of treatment and oxygen, she was admitted to the hospital. They wheeled me, you know, from the ear into the into the hospital. I was just sobbing the entire way there um and the nurse said to me, Oh, now I'm gonna get emotional when I When I got there, the nurse said to me, you've been through a lot, and I know it's really scary and it's gonna be okay, Like you're with us now and we're going to take care of you. And just the validation that, like what had happened actually was very scary, and also that you know, in the e ER everyone was very stressed out and they were very helpful, but they were also like, we have no idea what's going on, and we don't know if you'll be able to get tested and that sort of thing. But to have someone really likes affirmed that I was going to be taken care of and going to be looked after, it calmed me down and it made me feel better, and I feel I mean, those people who took care of me while I was there, I feel so indebted to them. Luckily, Fiona's hospital stay was brief, and after one more night and some tests, she was able to go home. When I was discharged from the hospital, they all cheered for me and clapped and we're like, yeah, Fiona, like you can do it. You're gonna get better. Um, you know, And unfortunately wasn't that simple. But yeah, one year ago was the strangest time in my life. The outbreak of COVID nineteen wasn't only scary for patients. Doctors were scrambling to make sense of it too. We were just waiting to find out what was happening in New York and it was sort of like, Okay, boss's next, right, it's coming to Boston. So it was sort of this moment of Okay, here we go. Are we ready? We'll hear from Dr Jeremy fast right after this. Dr Jeremy Faust is an emergency physician at Brigham and Women's Hospital in Boston. He is for the most part unflappable an occupational hazard, but this time last year, he felt a very uncomfortable feeling panic. I'm working an overnight shift in my e R and I have a patient with pneumonia and I look at the X ray and I just my eyes go, WHOA, that's a nasty pneumonia. That's all over the lungs. That's wow, Okay, that's kind of an older person. And so I occasionally will see that, but pretty unusual. But I was pretty impressed. Two hours later, pneumonia, younger patient, middle aged, same X ray. Oh my god, Like, look at that X ray, like that is just nasty. I was just like, check this out to my colleague, like, look at that thing. Third patient overnight in one night, same X ray, Like, nasty pneumonia. Now it's like, now we would call this classic COVID pneumonia. Like now I could like, look at that x raam be like COVID. But at the time I just never seen it. So I said to my colleagues or whatever, I said, we need to test these patients for coronavirus. And we got the little list out and it said, well, do they have the criteria that the testing requirements? No, no they don't. I was like, well I don't care. Look at this, look at this, Look at these X rays. There's three of them, you know, one night, we need to test everybody, so and we didn't. We didn't have the tests. We weren't able to do it. And so I had this that panic where I was where I was thinking, oh gosh, these people are everywhere, They're going to be everywhere, and we're not even able to detect it. And so until it's too late, until they have X rays that looked like this, And when when that happened, I just completely realized like, yeah, Houston, we have a problem. This is we have a major crisis right here, and we don't even know it yet. We don't even we can't even detect it. You couldn't test people for quite a while. Why did it take so long to be able to test these people? The tests weren't available. You just simply didn't have the tests. The CDC had a major fiasco about this. They didn't develop a test and time, they had quality problems on the inside. It's one of the great, um, you know, mistakes of how that was managed. Um you know, when you think about that what do you need to make a test? You need to understand the genetics of the virus or the bacteria you need to understand some you need to have something, some molecular understanding of what's tests for. We had that information in January. When you look at the people who made the vaccine, they had this thing sequenced in days. In a matter of weeks, the protein structures were available. So we actually, interestingly enough, the the prototypes for the vaccines were already being developed in February, and we didn't have a test that was functional in the United States. So it just took time to ramp up and catch up. So to me, it's like some of that infrastructure exists right now for you know, quote unquote cod like make the swabs, make the viral media, make sure you have the system set up, and then the last second swapping whatever molecule you needed to be. But we didn't do any of that. What was that like as a physician who is trained and is passionate about taking care of other people to have to do it, uh at arm's length or more. Yeah, it's really hard, um to connect with people through a shield and an eyemask and if you know, a ninety five mask and a big gown, because you just look, it doesn't it doesn't matter how you look. But you look like yourself, and so when someone can't see that you are you, it's just really hard to connect with them. And what it does is it sort of made the medicine I feel really impersonal, which maybe was an okay thing, sort of almost like a defense mechanism, like a distance thing. I don't think we spent nearly as much time in those patient rooms as UM we usually do. I know we didn't. We went in less often. I was trying to minimize trips, so if we could go in and do something for the nurses, or they could go and do something for us, like you know, we're trying not to you know, go into too much. I think the harder piece UM actually was trying to talk patients through it, to reassure them without downplaying, as physicians were so used to being able to say to our patients, Okay, I've seen this before, here's what's going, here's what here's let me tell you what's gonna happen, or let me let me give you a range of possibilities based on your condition. And so we give our patients. I like to give my patients like a really frank and honest assessment of where they're at so I don't sugarcoat, but I don't I'm not a doomsday or either. I say, look, here's some things that could that could go down, and I want you to understand that, so you, you know, just know what to expect with. What I found so difficult with this disease was we didn't know. So how can I look at someone and say, oh, yeah, I've seen this tons of times and you know, here's how long it's gonna take you to feel better. I didn't know any of that. So it was it felt like you were sort of, um, you know, driving blind in a way. We and we also had very little to offer patients other than oxygen, other than intubation if they needed to want to ventilator, and eventually we started giving steroids and all those others, a few other things that may help a little. But that was the hard part was the sense of not just powerlessness, but a sense of I can't even tell you what I think really because we are an uncharted territory. We watch this in real time, and doctors and nurses had to learn like almost just trying it, you know, wing it in some ways. So what do we now know? What is the standard of care? For COVID patients. Okay, so it really depends on your severity of disease. And what I will say is that if you do not have what we call hypoxy a low oxygen, hypoxy just literally means auctions too low. If if your oction levels are normal, there's really not a ton that I think makes a huge difference. I think that you know, some of these monoclonal antibodies have been talked about the there's a very narrow of people who that might help. Um. But for the most part, if you have normal oxygen, in my mind, you don't. There's not much we can offer you at this time. If you do have hypoxeall oxygen, then the things that we know to give you our oxygen and we don't know if that saves your life or anything. But the theory is that you get your muscles just get less tired sooner, you crap out soon, and your body has more energy to fight the virus. Right. Yeah, Ostensibly that everything is better when you're oxygen needd right. So we'll never be able to test that because it's just we give the oxygen okay um, and then the steroids, the dex and methos on steroid has really been shown to have a what we call immortality benefit. It saves lives of people who need oxygen, a little bit among people who just need any kind of oxygen, and a ton uh tenor among people who need to be on ventilators. And when I saw that data, my eyes just bugged out because it was almost too good to be true. But it's it's it's so far, you know, because I think it's probably mostly true. In other words, I think that it's the ballpark. You know, we'll never really know. But um so that's a huge, huge thing, is that we give steroids to people who have low oxygen and that has a mortality benefit. This virus has really laid bare the health disparities that exist in this country. And I know that you realized it almost immediately when you saw some patients in the Brigham e Er, didn't you. Oh yeah, I mean it was just uncanny. And I give credit to my colleagues, um black positions, persons of color in the medical community who I work with, who pointed this out, you know, you know, they say, look, have you noticed something here? And um, I always understood. I thought I understood this before I really thought I did right, Um, But I didn't. I did. I did not. Um. I hate to admit it, like I just never really never really landed as much as it landed this year. It's not just that black and Hispanic people were just proportionately affected by coronavirus among adults. Four is that black and Hispanic people were the majority of deaths among a mathematical majority among death in this country of coronavirus and young adults. And that to me is just unbelievable. Um. It's it's an unbelievable um indictment of the system failing people, and that we need to really shake it up and and and rebuild. I'll say one thing with a little bit of like sort of um. One piece of good news is about the time that when adjusted for disease severity and and everything else, once the patients are in the hospital, the outcomes were appropriately sort of distribute distributed. So in other words, the hospital care has been has been equal um in terms of outcomes. That made that was that gave me a side of relief to see that. But what what we have not seen we have seen, I should say, is that the disproportionate numbers who show up on our doorstep, so and and so you have to reach the community because if you do have a patient who is showing up far sicker than you know, white populations, for example, we need to understand why. We want to understand, like why where is the messaging that we can reach them? Why where? How are we failing? How are we not able to do that m messaging and outreach and care so that by the time people come to the hospital, the disparities are already playing out in front of my eyes. What's interesting is that we have seen in the black population, UM a little bit of a comeback story there. The early on the black population just devastating numbers. I mean again, as I said, like I thought I got it, but I didn't get it until I saw it, you know. And but then over the summer and number the fall, the numbers fall and fall, and at this point later in the in the crisis, UM, there still is access mortality among lack Americans, but it's actually pretty similar to white Americans, which is really interesting. I think that some of my colleagues who have been out there making the case about about access and disparities have actually had measurable success and they're saving lives, but we haven't seen the drops we want to see in every every ethnicity and race, and so we still have a lot of work to do. So it's unclear whether it's you know, physiological considerations you know that are making certain populations uh more likely to to get sicker and die, or its access to care you know, basically income inequality uh that results in people living in cramped quarters, people not having healthy diets, uh, you know, all the things that go hand in hand with poverty in this country. So yeah, I would actually I would not even put it as an either or So what I would say is, I don't think that these massive disparities have anything to do with genetics. So in other words, that the disparities in terms of access, it really has to do with whether a patient or a person arrives at the moment of infection with a series of conditions that are preventable that we're preventable um, that then render their risk factors like off the charts, right, So that to me is baked into that these social determinants of health, these these stomach factors of inequality racism that play out in a sort of magnified way. Um. Suddenly, so it's not that, um, you know, one community or another has genetics that's hurting them. That's not the situation at all. It's that the diabetes and the hypertension and the Kindian disease and all these other things that make a different smoking Actually even is that that's something that makes a difference we learned which is not equally distributed across race and income. All these things when you arrive at the moment of infection UM have have tremendous implications for your outcomes. So the social determinants of health really have an impact on the physical determinants of health. That's right. So social, the social factors are what deny people access to preventative care or to modulate diseases that all of us would get if it weren't for the correct medical interventions. So some of us are able to avoid it because we're privileged and we're plugged in, and others of us are not. And so then at the moment that you're infectively coronavirus, you know, you're punished or whatever because of society's choices. Are are are unfortunate? UM structure, do you think in five years will have a much better understanding of this virus, how and why it behaves the way it does, and what has happened in the last year plus. Yes, I think there are three things that we're gonna learn that are going to save lives going forward. So we've lost lives in this country and millions of over the world across. And one of the only things that like makes me like not just like collapse when I hear that number is to think, Um, Okay, maybe we can learn so much from this that in the long run, years from now, we will save lives in the aggregate. And when we cross that that threshold depends on two things. How much we learn and how many lives you save today. Right, So if we can keep that number low and our knowledge increasing, then we can get there sooner. And so one thing I think we're going to learn from this virus is about transmission dynamics of lots of viruses. We're gonna learn all kinds of things about transmission and mix and so we're gonna understand how better to control disease. The second thing I think we're gonna understand a lot better is how to leverage the MR and a vaccine technology. This technology is truly impressive. It didn't happen overnight. It was people said, oh, how do we get a vaccine ino one year? And the answer is we didn't. This vaccine um was the rubber met the road in one year. But this vaccine took twenty years to develop. It took two years to develop in some ways because of our understanding. And now people say, look, what are the things we can do now that we know this technology actually works? Um and I I think that the implications are huge. Might help people with cancer in some cases, might help malaria vaccine. Can there begin a bowl of vaccine? I don't know the answers to that, but I think that this, this success story is just huge. And also, um, what good can happen when we do trials correctly, when there's good regulation and there's good UM buy in. The last thing I think we might learn from this virus that could be applicable to not just this virus, but many other conditions is the long term consequences, the long code or long haul. I have no idea what we're gonna call this. There's gonna be different terminologies. UM. So I want to watch the way we say it. But we're just beginning to study this and there are people who have acute diseases like things that come and go right, like coronavirus, and they have long term effects. And it's really hard to study that for most diseases because and then I'm always diagnosed with the right disease, or there's just there's just a few of them. Now we have a cohort of people, unfortunately, who we can really look at and work with together to learn about what happens to the body when it responds to a major, major insult like this virus is. And my guess is that the sort of long haul, long term COVID syndrome that we're seeing is not particular to coronavirus it's self, but as much more something that could happen as rules of many many infections diseases, and if we can start to untangle how that is occurring and why and target that, it could be that we could help people avoid long term suffering from a variety of diseases. So I think that this is why studying long term symptoms of COVID is extremely important. I mean, patients really in a way discovered this. Doctors did not discovered this, so patients talking about it, and but I think that we're receptive to that, so we should study that because we can actually learn from this. When I was discharged from the hospital, they all cheered for me and collapsed and we're like, yeah, Fiona, like you can do it. You're gonna get better, um, you know, And unfortunately wasn't that simple. But yeah, Fiona Lowenstein, you might recall, is the twenty six year old New Yorker who was hospitalized last March for COVID. But after I got home, I remember that Wednesday night, I was like kind of trying to clean up my room a little bit and make it a nicer space, and I opened a bottle of essential oil, like a lavender essential oil, because I was like, oh, well, you know, diffuse it in the room and it'll feel good. Um. And I couldn't smell it, like I I literally thought someone had replaced the oil with water. So then there was this period of a few weeks where I was still quite sick um and developing different seemingly unrelated symptoms every day. I mean it was like, Okay, I can't smell, and now I'm having g I issues. And then I was having like these really intense headaches and these strange new symptoms was like having I paint and I was very light sensitive, lingered hives and rashes, um extreme sensitivity to temperature. Eventually it became clear, though she didn't know it at the time, Fiona was a COVID long hauler at that time, like there weren't many stories of young people dying, and there weren't any stories of long COVID or long haul COVID it, so I certainly wasn't thinking about that. Since her positive test in the hospital, Fiona had been sharing her COVID journey on Instagram and she was becoming a magnet for other patients desperate for information and guidance. As people were reaching out to me online, I was hearing these exact same symptoms. But what was more striking was that a lot of the people that I was connecting with were my age, and they had had a milder case than I had, but had gotten sick, you know, first second, third week of March, and they still weren't getting better. And that was what kind of was the red flag, because for me, I was like, Okay, my case was pretty bad. I was hospitalized, so you know, maybe it's going to take three to four weeks for me to feel like my normal self. But these people who like just had a mild grade fever of like a hundred degrees, why are they still feeling so sick? You know? Three or four weeks down the line. In late March, Fiona wrote an opted for The New York Times, a warning for young people to take this virus seriously. It was called I'm twenty six. Coronavirus sent me to the hospital. So that also helped connect me to a lot of other COVID patients because people saw the news and they and they kind of found me on email or social media. And it was really helpful to talk to these people because you know, they validated by experience and vice versa. But it was also very dreaming because I was communicating with each of them individually, and so I would wake up in the morning and be like, oh my gosh, I have like all of these dm s I have to respond to, and this person is in California and their boyfriend is on a ventilator, and this person is in Paris, And I realized I should just put them all in a chat together so that we can all talk to each other. And that was something my friend Sabrina and I had talked about as well. Was just there's no resources, there's no place to go to get information on this as a patient, and our doctors are so overwhelmed that they can't even you know, answer our emails or our calls. So we created this little mini support group. It was just in like an Instagram DM. It had maybe like what five thirty people on their UM and people were just sharing updates about their lives UM but also sharing like very tangible needs and questions like you know, what did they do for you when you were hospitalized? In Apriliana wrote another op ed for The New York Times called Coronavirus Recovery Isn't so quick or simple. In it, she linked to the ad hoc support group she'd started. Overnight, two thousand people joined. It was astounding and of course, like I felt both like, oh my god, I'm not alone, because people were writing in their sign up from like, oh my gosh, I've been sick for a month and I don't know why and I can't get better, and this is like the first that I've heard that this is happening to other people. But it was also very overwhelming because I was thinking, how am I going to support these people like it's it's it was me and you know my friend running this and we were doing it through Body Politics, which is a group that we ran prior to COVID that you know, did events in New York City and kind of focus on the intersections of health and social justice, but had a very small volunteer team. We had exceeded you know, Instagram's chat limit, we moved to WhatsApp, then we exceeded WhatsApps chat limit, and eventually we got on slack um and that's where we are today. This community is called the Body Politic COVID nineteen support group. More than twenty people have signed up since it started in April, with more than ten thousand active members today, it has a team of thirty to forty volunteers who moderate this virtual city of support. We have I think about seventy different channels on Slack and these channels are like little sub groups for different discussions based on either topic or community. So we have channels for almost every system of the body. We have UM, a couple of private channels that you join by messaging you know, the administrators of the group UM and that's the lgbt Q plus channel, the BIPOC channel, and the Medical Professionals Channel. We also have channels for people in you know, South America. We have channels for people in Europe. We have channels for people in New York City. You can go into the Victory's channel and just see the good dues, or you can go into you know, the mental health channel, or that we have a need to Vent channel, right, because sometimes we need that, but we don't all need to see it all the time. And another initiative I should mention that grew out of the group is UM, the Patient led Research Collaborative, which started in Body politic Um in April. There were some patients in the group who were scientists who worked in medicine, who had backgrounds in you know, survey design and research, and basically said, okay, we're seeing a lot of anecdotal evidence that is very contradictory to what we're seeing, you know, in the mainstream media and on the CDC's website. How can we actually find data to support what we think is going on here? And of course they were talking about you know, the wide variety of symptoms and the long term symptoms. UM. So they did their first survey in April, UM and just put out a second preprint on their i CANT survey, which focuses on some more issues facing long COVID patients and COVID patients, like sleep issues and mental health and some of the lesser known things. They've been hugely instrumental, I think UM in in helping people understand that long COVID is real, and I think they're also doing something really important in terms of helping people understand how communities that have been impacted by illnesses can be involved in the research processes to find treatments and cures for those illnesses. What's been most astounding has just been the way that everything that happened in those early months has affected such amazing change. Congress just announced that they were allocating I think this was in December January, that they're allocating one point one five billion dollars to the NIH to study long COVID and related post COVID sequel i UM and that's incredible, Like that is, you know, everything that we would have wanted months ago. Like so many other aspects of COVID, Supporting COVID patients and recovering from the virus has been something Fiona has had to learn on the job, but she says there are a lot of key takeaways that can extend well beyond this pandemic. I think when you're running a COVID support group, or really any patient support group, there's a few very important guiding lights to keep in mind, and the first is keeping it patient centered. The second is always providing context on recommendations and advice um, and the third is always acknowledging, you know, other aspects of politics and people's identities that might be intersecting with their experience of being sick. I didn't realize that at the time, but the thing that those nurses gave me that I needed so badly was just affirmation and validation. That was incredibly helpful. And so I think that's what we really lad with in the support group was You're not alone. What you're experiencing is not in your head, and you know there are thousands of other people who are here too, just walk with you through it. I've mostly recovered from COVID, I think. I say recovered. That doesn't mean I'm exactly the same person I was before, but I I've mostly recovered from COVID UM and now I really am passionate about trying to get other people who have survived COVID or who were part of the long COVID community, but have you know, recovered to still stay engaged with these issues because I don't know that this is the last pandemic we're going to see in our lifetime, and I know that the pandemic is not going to be over the day that everyone gets vaccinated. Coming up. What COVID has taught us about science, that's right after this. I started studying COVID when I realized that I had something to contribute as a person who has studied each TV for a long time and how people live with HIV for a long time, and so this infectious disease was very fascinating to me when coronavirus emerged, so I began studying it as soon as I could. Dr carry all Top is an associate professor of epidemiology at the Johns Hopkins School of Public Health. What we've learned is that we can do science faster with the right resources in place. And we've also learned that even with the right resources in place, science is still really hard and we and we've known that it is. It is baby step by baby step, one piece of evidence on top of the next in order to really make progress. And we've known that for a long time. I mean, every quote breakthrough that we have is built on a mountain of baby steps that we took in order to get to that to that peak where we have what we consider something to be a breakthrough. There are some amazing virologists out there that really pushed forward, you know, our understanding of MR and A vaccines and went from you know, a decade of research in in phase one two in three trials and then boom, here we go, brand new virus on the scene, and and they can create these vaccines and get them tested in large numbers of people safely and quickly. So I think we we definitely have learned a lot. We've learned a lot about hospital capacity, We've learned a lot about where to meet people because we understand and in public health, we always knew that your plan is as good as what you can get people to go along with, right, So if you have a community that takes a hard stand against masks, your plan can't just be masks for that community. So it is about that implementation of what we know from our scientific knowledge and how we roll that out, how we communicate, how we present the information so that people are ready to listen and accept or or question and ask great questions. And we build that partnership with all eyes on scientists and the research they're doing in real time about the virus. Sometimes the information we're so hungry for isn't actually ready for public consumption. The scientific information that's come out in the last year, it is most definitely drinking from a scientific fire hose. There is just so much information that has come out. We're thinking about science um in in faster terms, and putting our information out there more quickly, even if it isn't fully peer reviewed, and how you have to be careful of that um But you know, there's this balance of just needing information as a pandemic rages on, and then of course we can't talk about science without acknowledging it's strange bedfellow the federal government. Dr Altov says, what we've learned about that may prepare us for whatever comes next. One of my favorite lines is that public health is best working when you don't notice it, and and science is a little bit in that way too. Write when when we are progressing in science, then we have medications for your illness. And when public health is working then you don't notice. But your drinking water is safe and your road trip is safe, and all of those pieces come together and it just becomes you know, the air we breathe. And so I think what we've also learned through this pandemic is that science and public health are ongoing, and when they're not properly invested in, it only takes a pandemic to show show where the cracks are. And you know, our public health infrastructure has been a place where there has been under investment for for a while, and specifically in pandemic preparedness. But now we see different federal agencies looking at the reports that academics have put together about pandemic preparedness and they're picking them up and saying, we need to make some policy based on what this this science tells us. And that to me is so thrilling. It's it's just like this bright rainbow after you know, what has been a very lengthy storm. I think it's important to remember that pandemics end They always do. That this virus will become what we call endemic, so we will live with it and control it hopefully the way that we control measles for example. Um, what we will need to do in order to kind of get to that is we will need to have enough immuo logic control in the population so that we do not see vast numbers of people getting sick. And so what does that mean. It's vaccination. Really, That's that's where we're headed. We're not there yet, but I do think we will get there. And the most important lesson we are all connected. I mean, it's just that simple. We are all connected. And I don't know if we all had an awareness of how connected we are until you have something like an infectious disease that doesn't care who you are, it will infect you if given the chance. So I think that is a really important thing for us all to remember that we are connected and we need to help take care of each other. How wong it go? I love you and if Powhip, and a huge thank you to Dr Carrie all Top, Fiona Lowenstein and Dr Jeremy Faust, not just for peen on our podcast, but for the extraordinary work they have all done over this last year. Let's get away, Let's make a change. I want to see all of the Kurds, I've been looking at grave. If It's soon. Next Question with Katie Curic is a production of I Heart Media and Katie Kurk Media. The executive producers Army, Katie Curic, and Courtney Litz. The supervising producer is Lauren Hansen. Associate producers Derek Clements, Adrianna Fasio, and Emily Pinto. The show is edited and mixed by Derrek Clements. For more information about today's episode, or to sign up for my morning newsletter, wake Up Call, go to Katie correct dot com. You can also find me at Katie Curic on Instagram and all my social media channels. For more podcasts from my Heart Ray video, visit the I Heart Radio app, Apple Podcast, or wherever you listen to your favorite shows. I want to go some lovely

Didn't want anybody. This astounding and unprecedented story continues to evolve. We are dealing with a challenge and a crisis that we have never seen in our lifetimes. We know the hospital surge is coming and it has only just begun. COVID nineteen can beat as a pandemic. Hi everyone, I'm Katie Kuric, and this is next question. This week, we're recognizing a sobering anniversary the coronavirus pandemic one year later. One year ago mid March, I actually genuinely felt almost almost panic, almost real genuine worry, which for an e R doctor like me is extremely unusual. I could recognize right away that a US epademic and a global pandemic was just going to be in all hands on deck kind of a thing. For the first time, I really felt like I was entering ad no idea would come next. In retrospect, I feel sort of lucky that I got sick when I did. I think I would have been much more distraught if I knew then what I knew now. On March eleven, the World Health Organization declared the coronavirus a pandemic after watching the slow tidal wave of infections, deaths, and fear consume most of Asia and Europe. Americans finally felt COVID's impact at home. This totally unknown novel virus took root and completely up ended our lives. Remember when we were wiping down groceries like milk and even bags of potato chips and leaving packages outside for forty eight hours. We've come a long way from those panics stricken early months. So on this episode, we're exploring all that we've learned about COVID nineteen, about our healthcare system, about science, and maybe even about ourselves. I got sick with COVID pretty early on. In kind of the trajectory of the pandemic hitting the United States, we'll be hearing firsthand accounts from three Americans intimately involved with COVID nineteen. An emergency room doctor, an epidemiologist, but first a patient. My name is Fiona Lowenstein and I'm an independent journalist, UM speaker, and consultant based in New York City. A friend of mine came over for dinner on March tenth. She got sick before my eyes, like literally got pale, said I don't feel well. Of course, we were both like, is this COVID. I mean, it was so new at that point, nothing had even shut down in the city. Um. She went home right away, and then three days later, UM, I developed a fever and a headache. You know, I'm young. I was twenty six at the time I got sick, and I don't have any pre existing conditions. Um, I'm very healthy otherwise, I like exercised six times a week. I used to teach UGA classes. UM. So I assumed that, you know, if it was the worst case scenario and it was COVID, I would get better relatively quickly. I would be able to write it out at home. That was very much kind of the public health messaging that we were getting at the time. But by day five, Fiona started having trouble breathing. It started as kind of like, oh, I feel, you know, winded, or I'm having trouble catching my breath when I get up to go to the bathroom. And then by the end of the day it was like I couldn't talk, I couldn't eat even really because just the exertion was was winding me. I could barely walk to the bathroom. I was communicating with my partner like writing on a right on white off board and my partner actually had to call the e R on my behalf and explain my symptoms and they were like, you have to come in right away. Fiona went to the e R and after a night of treatment and oxygen, she was admitted to the hospital. They wheeled me, you know, from the ear into the into the hospital. I was just sobbing the entire way there um and the nurse said to me, Oh, now I'm gonna get emotional when I When I got there, the nurse said to me, you've been through a lot, and I know it's really scary and it's gonna be okay, Like you're with us now and we're going to take care of you. And just the validation that, like what had happened actually was very scary, and also that you know, in the e ER everyone was very stressed out and they were very helpful, but they were also like, we have no idea what's going on, and we don't know if you'll be able to get tested and that sort of thing. But to have someone really likes affirmed that I was going to be taken care of and going to be looked after, it calmed me down and it made me feel better, and I feel I mean, those people who took care of me while I was there, I feel so indebted to them. Luckily, Fiona's hospital stay was brief, and after one more night and some tests, she was able to go home. When I was discharged from the hospital, they all cheered for me and clapped and we're like, yeah, Fiona, like you can do it. You're gonna get better. Um, you know, And unfortunately wasn't that simple. But yeah, one year ago was the strangest time in my life. The outbreak of COVID nineteen wasn't only scary for patients. Doctors were scrambling to make sense of it too. We were just waiting to find out what was happening in New York and it was sort of like, Okay, boss's next, right, it's coming to Boston. So it was sort of this moment of Okay, here we go. Are we ready? We'll hear from Dr Jeremy fast right after this. Dr Jeremy Faust is an emergency physician at Brigham and Women's Hospital in Boston. He is for the most part unflappable an occupational hazard, but this time last year, he felt a very uncomfortable feeling panic. I'm working an overnight shift in my e R and I have a patient with pneumonia and I look at the X ray and I just my eyes go, WHOA, that's a nasty pneumonia. That's all over the lungs. That's wow, Okay, that's kind of an older person. And so I occasionally will see that, but pretty unusual. But I was pretty impressed. Two hours later, pneumonia, younger patient, middle aged, same X ray. Oh my god, Like, look at that X ray, like that is just nasty. I was just like, check this out to my colleague, like, look at that thing. Third patient overnight in one night, same X ray, Like, nasty pneumonia. Now it's like, now we would call this classic COVID pneumonia. Like now I could like, look at that x raam be like COVID. But at the time I just never seen it. So I said to my colleagues or whatever, I said, we need to test these patients for coronavirus. And we got the little list out and it said, well, do they have the criteria that the testing requirements? No, no they don't. I was like, well I don't care. Look at this, look at this, Look at these X rays. There's three of them, you know, one night, we need to test everybody, so and we didn't. We didn't have the tests. We weren't able to do it. And so I had this that panic where I was where I was thinking, oh gosh, these people are everywhere, They're going to be everywhere, and we're not even able to detect it. And so until it's too late, until they have X rays that looked like this, And when when that happened, I just completely realized like, yeah, Houston, we have a problem. This is we have a major crisis right here, and we don't even know it yet. We don't even we can't even detect it. You couldn't test people for quite a while. Why did it take so long to be able to test these people? The tests weren't available. You just simply didn't have the tests. The CDC had a major fiasco about this. They didn't develop a test and time, they had quality problems on the inside. It's one of the great, um, you know, mistakes of how that was managed. Um you know, when you think about that what do you need to make a test? You need to understand the genetics of the virus or the bacteria you need to understand some you need to have something, some molecular understanding of what's tests for. We had that information in January. When you look at the people who made the vaccine, they had this thing sequenced in days. In a matter of weeks, the protein structures were available. So we actually, interestingly enough, the the prototypes for the vaccines were already being developed in February, and we didn't have a test that was functional in the United States. So it just took time to ramp up and catch up. So to me, it's like some of that infrastructure exists right now for you know, quote unquote cod like make the swabs, make the viral media, make sure you have the system set up, and then the last second swapping whatever molecule you needed to be. But we didn't do any of that. What was that like as a physician who is trained and is passionate about taking care of other people to have to do it, uh at arm's length or more. Yeah, it's really hard, um to connect with people through a shield and an eyemask and if you know, a ninety five mask and a big gown, because you just look, it doesn't it doesn't matter how you look. But you look like yourself, and so when someone can't see that you are you, it's just really hard to connect with them. And what it does is it sort of made the medicine I feel really impersonal, which maybe was an okay thing, sort of almost like a defense mechanism, like a distance thing. I don't think we spent nearly as much time in those patient rooms as UM we usually do. I know we didn't. We went in less often. I was trying to minimize trips, so if we could go in and do something for the nurses, or they could go and do something for us, like you know, we're trying not to you know, go into too much. I think the harder piece UM actually was trying to talk patients through it, to reassure them without downplaying, as physicians were so used to being able to say to our patients, Okay, I've seen this before, here's what's going, here's what here's let me tell you what's gonna happen, or let me let me give you a range of possibilities based on your condition. And so we give our patients. I like to give my patients like a really frank and honest assessment of where they're at so I don't sugarcoat, but I don't I'm not a doomsday or either. I say, look, here's some things that could that could go down, and I want you to understand that, so you, you know, just know what to expect with. What I found so difficult with this disease was we didn't know. So how can I look at someone and say, oh, yeah, I've seen this tons of times and you know, here's how long it's gonna take you to feel better. I didn't know any of that. So it was it felt like you were sort of, um, you know, driving blind in a way. We and we also had very little to offer patients other than oxygen, other than intubation if they needed to want to ventilator, and eventually we started giving steroids and all those others, a few other things that may help a little. But that was the hard part was the sense of not just powerlessness, but a sense of I can't even tell you what I think really because we are an uncharted territory. We watch this in real time, and doctors and nurses had to learn like almost just trying it, you know, wing it in some ways. So what do we now know? What is the standard of care? For COVID patients. Okay, so it really depends on your severity of disease. And what I will say is that if you do not have what we call hypoxy a low oxygen, hypoxy just literally means auctions too low. If if your oction levels are normal, there's really not a ton that I think makes a huge difference. I think that you know, some of these monoclonal antibodies have been talked about the there's a very narrow of people who that might help. Um. But for the most part, if you have normal oxygen, in my mind, you don't. There's not much we can offer you at this time. If you do have hypoxeall oxygen, then the things that we know to give you our oxygen and we don't know if that saves your life or anything. But the theory is that you get your muscles just get less tired sooner, you crap out soon, and your body has more energy to fight the virus. Right. Yeah, Ostensibly that everything is better when you're oxygen needd right. So we'll never be able to test that because it's just we give the oxygen okay um, and then the steroids, the dex and methos on steroid has really been shown to have a what we call immortality benefit. It saves lives of people who need oxygen, a little bit among people who just need any kind of oxygen, and a ton uh tenor among people who need to be on ventilators. And when I saw that data, my eyes just bugged out because it was almost too good to be true. But it's it's it's so far, you know, because I think it's probably mostly true. In other words, I think that it's the ballpark. You know, we'll never really know. But um so that's a huge, huge thing, is that we give steroids to people who have low oxygen and that has a mortality benefit. This virus has really laid bare the health disparities that exist in this country. And I know that you realized it almost immediately when you saw some patients in the Brigham e Er, didn't you. Oh yeah, I mean it was just uncanny. And I give credit to my colleagues, um black positions, persons of color in the medical community who I work with, who pointed this out, you know, you know, they say, look, have you noticed something here? And um, I always understood. I thought I understood this before I really thought I did right, Um, But I didn't. I did. I did not. Um. I hate to admit it, like I just never really never really landed as much as it landed this year. It's not just that black and Hispanic people were just proportionately affected by coronavirus among adults. Four is that black and Hispanic people were the majority of deaths among a mathematical majority among death in this country of coronavirus and young adults. And that to me is just unbelievable. Um. It's it's an unbelievable um indictment of the system failing people, and that we need to really shake it up and and and rebuild. I'll say one thing with a little bit of like sort of um. One piece of good news is about the time that when adjusted for disease severity and and everything else, once the patients are in the hospital, the outcomes were appropriately sort of distribute distributed. So in other words, the hospital care has been has been equal um in terms of outcomes. That made that was that gave me a side of relief to see that. But what what we have not seen we have seen, I should say, is that the disproportionate numbers who show up on our doorstep, so and and so you have to reach the community because if you do have a patient who is showing up far sicker than you know, white populations, for example, we need to understand why. We want to understand, like why where is the messaging that we can reach them? Why where? How are we failing? How are we not able to do that m messaging and outreach and care so that by the time people come to the hospital, the disparities are already playing out in front of my eyes. What's interesting is that we have seen in the black population, UM a little bit of a comeback story there. The early on the black population just devastating numbers. I mean again, as I said, like I thought I got it, but I didn't get it until I saw it, you know. And but then over the summer and number the fall, the numbers fall and fall, and at this point later in the in the crisis, UM, there still is access mortality among lack Americans, but it's actually pretty similar to white Americans, which is really interesting. I think that some of my colleagues who have been out there making the case about about access and disparities have actually had measurable success and they're saving lives, but we haven't seen the drops we want to see in every every ethnicity and race, and so we still have a lot of work to do. So it's unclear whether it's you know, physiological considerations you know that are making certain populations uh more likely to to get sicker and die, or its access to care you know, basically income inequality uh that results in people living in cramped quarters, people not having healthy diets, uh, you know, all the things that go hand in hand with poverty in this country. So yeah, I would actually I would not even put it as an either or So what I would say is, I don't think that these massive disparities have anything to do with genetics. So in other words, that the disparities in terms of access, it really has to do with whether a patient or a person arrives at the moment of infection with a series of conditions that are preventable that we're preventable um, that then render their risk factors like off the charts, right, So that to me is baked into that these social determinants of health, these these stomach factors of inequality racism that play out in a sort of magnified way. Um. Suddenly, so it's not that, um, you know, one community or another has genetics that's hurting them. That's not the situation at all. It's that the diabetes and the hypertension and the Kindian disease and all these other things that make a different smoking Actually even is that that's something that makes a difference we learned which is not equally distributed across race and income. All these things when you arrive at the moment of infection UM have have tremendous implications for your outcomes. So the social determinants of health really have an impact on the physical determinants of health. That's right. So social, the social factors are what deny people access to preventative care or to modulate diseases that all of us would get if it weren't for the correct medical interventions. So some of us are able to avoid it because we're privileged and we're plugged in, and others of us are not. And so then at the moment that you're infectively coronavirus, you know, you're punished or whatever because of society's choices. Are are are unfortunate? UM structure, do you think in five years will have a much better understanding of this virus, how and why it behaves the way it does, and what has happened in the last year plus. Yes, I think there are three things that we're gonna learn that are going to save lives going forward. So we've lost lives in this country and millions of over the world across. And one of the only things that like makes me like not just like collapse when I hear that number is to think, Um, Okay, maybe we can learn so much from this that in the long run, years from now, we will save lives in the aggregate. And when we cross that that threshold depends on two things. How much we learn and how many lives you save today. Right, So if we can keep that number low and our knowledge increasing, then we can get there sooner. And so one thing I think we're going to learn from this virus is about transmission dynamics of lots of viruses. We're gonna learn all kinds of things about transmission and mix and so we're gonna understand how better to control disease. The second thing I think we're gonna understand a lot better is how to leverage the MR and a vaccine technology. This technology is truly impressive. It didn't happen overnight. It was people said, oh, how do we get a vaccine ino one year? And the answer is we didn't. This vaccine um was the rubber met the road in one year. But this vaccine took twenty years to develop. It took two years to develop in some ways because of our understanding. And now people say, look, what are the things we can do now that we know this technology actually works? Um and I I think that the implications are huge. Might help people with cancer in some cases, might help malaria vaccine. Can there begin a bowl of vaccine? I don't know the answers to that, but I think that this, this success story is just huge. And also, um, what good can happen when we do trials correctly, when there's good regulation and there's good UM buy in. The last thing I think we might learn from this virus that could be applicable to not just this virus, but many other conditions is the long term consequences, the long code or long haul. I have no idea what we're gonna call this. There's gonna be different terminologies. UM. So I want to watch the way we say it. But we're just beginning to study this and there are people who have acute diseases like things that come and go right, like coronavirus, and they have long term effects. And it's really hard to study that for most diseases because and then I'm always diagnosed with the right disease, or there's just there's just a few of them. Now we have a cohort of people, unfortunately, who we can really look at and work with together to learn about what happens to the body when it responds to a major, major insult like this virus is. And my guess is that the sort of long haul, long term COVID syndrome that we're seeing is not particular to coronavirus it's self, but as much more something that could happen as rules of many many infections diseases, and if we can start to untangle how that is occurring and why and target that, it could be that we could help people avoid long term suffering from a variety of diseases. So I think that this is why studying long term symptoms of COVID is extremely important. I mean, patients really in a way discovered this. Doctors did not discovered this, so patients talking about it, and but I think that we're receptive to that, so we should study that because we can actually learn from this. When I was discharged from the hospital, they all cheered for me and collapsed and we're like, yeah, Fiona, like you can do it. You're gonna get better, um, you know, And unfortunately wasn't that simple. But yeah, Fiona Lowenstein, you might recall, is the twenty six year old New Yorker who was hospitalized last March for COVID. But after I got home, I remember that Wednesday night, I was like kind of trying to clean up my room a little bit and make it a nicer space, and I opened a bottle of essential oil, like a lavender essential oil, because I was like, oh, well, you know, diffuse it in the room and it'll feel good. Um. And I couldn't smell it, like I I literally thought someone had replaced the oil with water. So then there was this period of a few weeks where I was still quite sick um and developing different seemingly unrelated symptoms every day. I mean it was like, Okay, I can't smell, and now I'm having g I issues. And then I was having like these really intense headaches and these strange new symptoms was like having I paint and I was very light sensitive, lingered hives and rashes, um extreme sensitivity to temperature. Eventually it became clear, though she didn't know it at the time, Fiona was a COVID long hauler at that time, like there weren't many stories of young people dying, and there weren't any stories of long COVID or long haul COVID it, so I certainly wasn't thinking about that. Since her positive test in the hospital, Fiona had been sharing her COVID journey on Instagram and she was becoming a magnet for other patients desperate for information and guidance. As people were reaching out to me online, I was hearing these exact same symptoms. But what was more striking was that a lot of the people that I was connecting with were my age, and they had had a milder case than I had, but had gotten sick, you know, first second, third week of March, and they still weren't getting better. And that was what kind of was the red flag, because for me, I was like, Okay, my case was pretty bad. I was hospitalized, so you know, maybe it's going to take three to four weeks for me to feel like my normal self. But these people who like just had a mild grade fever of like a hundred degrees, why are they still feeling so sick? You know? Three or four weeks down the line. In late March, Fiona wrote an opted for The New York Times, a warning for young people to take this virus seriously. It was called I'm twenty six. Coronavirus sent me to the hospital. So that also helped connect me to a lot of other COVID patients because people saw the news and they and they kind of found me on email or social media. And it was really helpful to talk to these people because you know, they validated by experience and vice versa. But it was also very dreaming because I was communicating with each of them individually, and so I would wake up in the morning and be like, oh my gosh, I have like all of these dm s I have to respond to, and this person is in California and their boyfriend is on a ventilator, and this person is in Paris, And I realized I should just put them all in a chat together so that we can all talk to each other. And that was something my friend Sabrina and I had talked about as well. Was just there's no resources, there's no place to go to get information on this as a patient, and our doctors are so overwhelmed that they can't even you know, answer our emails or our calls. So we created this little mini support group. It was just in like an Instagram DM. It had maybe like what five thirty people on their UM and people were just sharing updates about their lives UM but also sharing like very tangible needs and questions like you know, what did they do for you when you were hospitalized? In Apriliana wrote another op ed for The New York Times called Coronavirus Recovery Isn't so quick or simple. In it, she linked to the ad hoc support group she'd started. Overnight, two thousand people joined. It was astounding and of course, like I felt both like, oh my god, I'm not alone, because people were writing in their sign up from like, oh my gosh, I've been sick for a month and I don't know why and I can't get better, and this is like the first that I've heard that this is happening to other people. But it was also very overwhelming because I was thinking, how am I going to support these people like it's it's it was me and you know my friend running this and we were doing it through Body Politics, which is a group that we ran prior to COVID that you know, did events in New York City and kind of focus on the intersections of health and social justice, but had a very small volunteer team. We had exceeded you know, Instagram's chat limit, we moved to WhatsApp, then we exceeded WhatsApps chat limit, and eventually we got on slack um and that's where we are today. This community is called the Body Politic COVID nineteen support group. More than twenty people have signed up since it started in April, with more than ten thousand active members today, it has a team of thirty to forty volunteers who moderate this virtual city of support. We have I think about seventy different channels on Slack and these channels are like little sub groups for different discussions based on either topic or community. So we have channels for almost every system of the body. We have UM, a couple of private channels that you join by messaging you know, the administrators of the group UM and that's the lgbt Q plus channel, the BIPOC channel, and the Medical Professionals Channel. We also have channels for people in you know, South America. We have channels for people in Europe. We have channels for people in New York City. You can go into the Victory's channel and just see the good dues, or you can go into you know, the mental health channel, or that we have a need to Vent channel, right, because sometimes we need that, but we don't all need to see it all the time. And another initiative I should mention that grew out of the group is UM, the Patient led Research Collaborative, which started in Body politic Um in April. There were some patients in the group who were scientists who worked in medicine, who had backgrounds in you know, survey design and research, and basically said, okay, we're seeing a lot of anecdotal evidence that is very contradictory to what we're seeing, you know, in the mainstream media and on the CDC's website. How can we actually find data to support what we think is going on here? And of course they were talking about you know, the wide variety of symptoms and the long term symptoms. UM. So they did their first survey in April, UM and just put out a second preprint on their i CANT survey, which focuses on some more issues facing long COVID patients and COVID patients, like sleep issues and mental health and some of the lesser known things. They've been hugely instrumental, I think UM in in helping people understand that long COVID is real, and I think they're also doing something really important in terms of helping people understand how communities that have been impacted by illnesses can be involved in the research processes to find treatments and cures for those illnesses. What's been most astounding has just been the way that everything that happened in those early months has affected such amazing change. Congress just announced that they were allocating I think this was in December January, that they're allocating one point one five billion dollars to the NIH to study long COVID and related post COVID sequel i UM and that's incredible, Like that is, you know, everything that we would have wanted months ago. Like so many other aspects of COVID, Supporting COVID patients and recovering from the virus has been something Fiona has had to learn on the job, but she says there are a lot of key takeaways that can extend well beyond this pandemic. I think when you're running a COVID support group, or really any patient support group, there's a few very important guiding lights to keep in mind, and the first is keeping it patient centered. The second is always providing context on recommendations and advice um, and the third is always acknowledging, you know, other aspects of politics and people's identities that might be intersecting with their experience of being sick. I didn't realize that at the time, but the thing that those nurses gave me that I needed so badly was just affirmation and validation. That was incredibly helpful. And so I think that's what we really lad with in the support group was You're not alone. What you're experiencing is not in your head, and you know there are thousands of other people who are here too, just walk with you through it. I've mostly recovered from COVID, I think. I say recovered. That doesn't mean I'm exactly the same person I was before, but I I've mostly recovered from COVID UM and now I really am passionate about trying to get other people who have survived COVID or who were part of the long COVID community, but have you know, recovered to still stay engaged with these issues because I don't know that this is the last pandemic we're going to see in our lifetime, and I know that the pandemic is not going to be over the day that everyone gets vaccinated. Coming up. What COVID has taught us about science, that's right after this. I started studying COVID when I realized that I had something to contribute as a person who has studied each TV for a long time and how people live with HIV for a long time, and so this infectious disease was very fascinating to me when coronavirus emerged, so I began studying it as soon as I could. Dr carry all Top is an associate professor of epidemiology at the Johns Hopkins School of Public Health. What we've learned is that we can do science faster with the right resources in place. And we've also learned that even with the right resources in place, science is still really hard and we and we've known that it is. It is baby step by baby step, one piece of evidence on top of the next in order to really make progress. And we've known that for a long time. I mean, every quote breakthrough that we have is built on a mountain of baby steps that we took in order to get to that to that peak where we have what we consider something to be a breakthrough. There are some amazing virologists out there that really pushed forward, you know, our understanding of MR and A vaccines and went from you know, a decade of research in in phase one two in three trials and then boom, here we go, brand new virus on the scene, and and they can create these vaccines and get them tested in large numbers of people safely and quickly. So I think we we definitely have learned a lot. We've learned a lot about hospital capacity, We've learned a lot about where to meet people because we understand and in public health, we always knew that your plan is as good as what you can get people to go along with, right, So if you have a community that takes a hard stand against masks, your plan can't just be masks for that community. So it is about that implementation of what we know from our scientific knowledge and how we roll that out, how we communicate, how we present the information so that people are ready to listen and accept or or question and ask great questions. And we build that partnership with all eyes on scientists and the research they're doing in real time about the virus. Sometimes the information we're so hungry for isn't actually ready for public consumption. The scientific information that's come out in the last year, it is most definitely drinking from a scientific fire hose. There is just so much information that has come out. We're thinking about science um in in faster terms, and putting our information out there more quickly, even if it isn't fully peer reviewed, and how you have to be careful of that um But you know, there's this balance of just needing information as a pandemic rages on, and then of course we can't talk about science without acknowledging it's strange bedfellow the federal government. Dr Altov says, what we've learned about that may prepare us for whatever comes next. One of my favorite lines is that public health is best working when you don't notice it, and and science is a little bit in that way too. Write when when we are progressing in science, then we have medications for your illness. And when public health is working then you don't notice. But your drinking water is safe and your road trip is safe, and all of those pieces come together and it just becomes you know, the air we breathe. And so I think what we've also learned through this pandemic is that science and public health are ongoing, and when they're not properly invested in, it only takes a pandemic to show show where the cracks are. And you know, our public health infrastructure has been a place where there has been under investment for for a while, and specifically in pandemic preparedness. But now we see different federal agencies looking at the reports that academics have put together about pandemic preparedness and they're picking them up and saying, we need to make some policy based on what this this science tells us. And that to me is so thrilling. It's it's just like this bright rainbow after you know, what has been a very lengthy storm. I think it's important to remember that pandemics end They always do. That this virus will become what we call endemic, so we will live with it and control it hopefully the way that we control measles for example. Um, what we will need to do in order to kind of get to that is we will need to have enough immuo logic control in the population so that we do not see vast numbers of people getting sick. And so what does that mean. It's vaccination. Really, That's that's where we're headed. We're not there yet, but I do think we will get there. And the most important lesson we are all connected. I mean, it's just that simple. We are all connected. And I don't know if we all had an awareness of how connected we are until you have something like an infectious disease that doesn't care who you are, it will infect you if given the chance. So I think that is a really important thing for us all to remember that we are connected and we need to help take care of each other. How wong it go? I love you and if Powhip, and a huge thank you to Dr Carrie all Top, Fiona Lowenstein and Dr Jeremy Faust, not just for peen on our podcast, but for the extraordinary work they have all done over this last year. Let's get away, Let's make a change. I want to see all of the Kurds, I've been looking at grave. If It's soon. Next Question with Katie Curic is a production of I Heart Media and Katie Kurk Media. The executive producers Army, Katie Curic, and Courtney Litz. The supervising producer is Lauren Hansen. Associate producers Derek Clements, Adrianna Fasio, and Emily Pinto. The show is edited and mixed by Derrek Clements. For more information about today's episode, or to sign up for my morning newsletter, wake Up Call, go to Katie correct dot com. You can also find me at Katie Curic on Instagram and all my social media channels. For more podcasts from my Heart Ray video, visit the I Heart Radio app, Apple Podcast, or wherever you listen to your favorite shows. I want to go some lovely