--:-- Sean Rameswaram: Welcome to Today Explained. I'm Sean Rameswaram.
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--:-- Sean Rameswaram: Umair Irfan, Science Vox. We got FDA approvals. We got President Biden boosters. We got a lot to talk about with the COVID-19 vaccines.
--:-- Sean Rameswaram: Let's start with approvals. The FDA fully approved the Pfizer vaccine on Monday. What does it mean? It's the fastest any vaccine has ever achieved full approval in history. And they did this basically in just under two years.
--:-- Sean Rameswaram: I guess the big question then is, were they cutting corners, taking shortcuts? That's the big question. And the regulators insist that they have not.
--:-- Sean Rameswaram: That the main reason that they were able to do this so quickly is the urgency of dealing with the COVID-19 pandemic. And in fact, the FDA has been criticized for taking so long to actually get to full approval at this point.
--:-- Sean Rameswaram: But they say that, you know, in order to actually hit this benchmark, they need to have six months of follow-up data for the people that are in the clinical trials.
--:-- Sean Rameswaram: For the emergency use authorization that they got back in December, they only needed two months worth of follow-up data. So they needed about three times as long.
--:-- Sean Rameswaram: And also they need to look at things like the manufacturing lines, like the assembly plans for these vaccines they need to investigate.
--:-- Sean Rameswaram: Also, some of these super rare side effects as well. And then they also need to look at this in a broader public health context and see if there is a vaccine that's better suited to one group of people than another, and then come up with recommendations basically to minimize risks and maximize effectiveness.
--:-- Sean Rameswaram: All the same, how do they crunch this, what, usually 10-year process into two-ish years?
--:-- Sean Rameswaram: Well, one of the big things that they did was, first of all, they overlapped a lot of the clinical trial phases.
--:-- Sean Rameswaram: So they were concurrently running phase one and phase two trials. Usually those are done sequentially and they're spaced out months apart.
--:-- Sean Rameswaram: And, you know, there's a lot of lag time in between these different phases as well, just doing paperwork and bureaucracy.
--:-- Sean Rameswaram: But, you know, the regulators and the companies, they devoted a lot of like human power to actually doing a lot of the data analytics and whatnot, more than you would typically see with any other kind of drug.
--:-- Sean Rameswaram: And finally, like, you know, with the phase three trials, they recruited a lot of people very quickly.
--:-- Sean Rameswaram: You know, we're talking 30,000 to 40,000 people in each one of these clinical trials.
--:-- Sean Rameswaram: And so when you have a large group of people in those clinical trials, you can get results faster.
--:-- Sean Rameswaram: What has it changed, this FDA approval, this formal approval, not emergency approval, but real deal record-breaking approval?
--:-- Sean Rameswaram: In practical terms, for most people, they're not going to see a lot of changes in terms of how the vaccines are being distributed.
--:-- Sean Rameswaram: But on the regulatory side, there are some things that might actually happen.
--:-- Sean Rameswaram: So one is mandates. For instance, there are already companies that are starting to require their employees to get vaccinated.
--:-- Sean Rameswaram: Disney joins a growing list of employers who are mandating vaccines in order to return to work.
--:-- Sean Rameswaram: Tech giants like Facebook, Twitter, Google, they're taking a stance on vaccines.
--:-- Sean Rameswaram: And beyond that, though, there might be some companies that are a little bit on the fence or worried about having some sort of legal cover.
--:-- Sean Rameswaram: And now that they have a fully approved, FDA approved vaccine, they can be more aggressive about trying to get their employees vaccinated.
--:-- Sean Rameswaram: Companies can now very comfortably move to mandate the vaccine.
--:-- Sean Rameswaram: Similarly, like public institutions like, you know, the military and, you know, other kinds of like local governments, they may be more inclined to now start enforcing these mandates.
--:-- Sean Rameswaram: A new mandate for all active duty U.S. service members to get vaccinated. They've been waiting on full approval of the vaccine at the FDA to do that.
--:-- Sean Rameswaram: That full approval has been granted. The DOD is now moving ahead.
--:-- Sean Rameswaram: And we'll also see a bunch of these mandates going into schools and universities, as we already have almost immediately after this has passed, right?
--:-- Sean Rameswaram: Right. You're going to probably see universities starting to mandate this, probably for their students.
--:-- Sean Rameswaram: Mandatory vaccinations for all New York City school teachers and employees was Mayor de Blasio's announcement today.
--:-- Sean Rameswaram: That'll likely continue propagating outward.
--:-- Sean Rameswaram: Another big change from this is that with full authorization, doctors can use this off-label.
--:-- Sean Rameswaram: What that means is that doctors can, using their own discretion, prescribe vaccines to people that they think may need it beyond the scope of what's authorized here.
--:-- Sean Rameswaram: So, for instance, right now with the full approval for the Pfizer vaccine, that's for ages 16 and up.
--:-- Sean Rameswaram: But if a doctor has a patient who is, you know, under the age of 16 and may have you being immunocompromised, maybe getting treated for cancer or some other high risk factor, they can at their own discretion choose to prescribe it to them if they're in high risk scenarios.
--:-- Sean Rameswaram: And right now we still don't have full emergency authorization for children.
--:-- Sean Rameswaram: But doctors could make that decision on behalf of individual children.
--:-- Sean Rameswaram: And also for some of the older adults that they think are at high risk, they can also decide individually to, you know, prescribe a booster ahead of the schedule, ahead of what the FDA and CDC might want.
--:-- Sean Rameswaram: Okay, so big changes here. We're going to see lots of mandates.
--:-- Sean Rameswaram: You're going to see doctors able to recommend these to people who might not otherwise get them.
--:-- Sean Rameswaram: Anything else?
--:-- Sean Rameswaram: Well, as far as Pfizer and BioNTech are concerned, one big thing for them is they can now start marketing this drug.
--:-- Sean Rameswaram: Huh. You would think these things don't need any marketing. They're like marketing themselves, no?
--:-- Sean Rameswaram: Right. I mean, imagine with a deadly pandemic and an easy-to-get cure, you'd think you wouldn't need to sell this.
--:-- Sean Rameswaram: But in the United States, we still have holdouts. We still have parts of the country where fewer than half of all adults are vaccinated.
--:-- Sean Rameswaram: And the unvaccinated continue to dominate the majority of new hospitalizations and deaths.
--:-- Sean Rameswaram: And of course, you know, they have a financial interest in trying to get as many people vaccinated as possible.
--:-- Sean Rameswaram: So we may soon see commercials for what Pfizer and BioNTech are calling Comirnaty which is the brand name they came up with Comirnaty Comirnaty What That the Pfizer vaccine It like I don know somebody trying to say community with like a really bad Southern accent
--:-- Sean Rameswaram: But yeah, like imagine the team that marketed Viagra turning their muscle and attention to a vaccine.
--:-- Sean Rameswaram: Are you suffering from shortness of breath, lack of taste, and crippling fear of a deadly virus rapidly spreading throughout the country?
--:-- Sean Rameswaram: Have you lost touch with friends and acquaintances? Haven't seen your grandma in over a year?
--:-- Sean Rameswaram: Or are you suffering from maskne?
--:-- Sean Rameswarm: Try Comirnaty, a new vaccine from Pfizer and BioNTech.
--:-- Sean Rameswaram: I'm helping cut community transmission. I'm no longer wracked with virus anxiety.
--:-- Sean Rameswaram: My immune system says, take that, COVID.
--:-- Sean Rameswaram: Thanks, Comirnaty.
--:-- Sean Rameswaram: It's much worse than the Moderna vaccine brand name, which they're calling SpikeVax. Spike Vax? Spike Vax!
--:-- Sean Rameswaram: Leave your apartment with Spike Vax! Screw wearing a mask with Spike Vax!
--:-- Sean Rameswaram: Went to Lollapalooza on Spike Vax! Everyone's hooking up on Spike Vax! Spike Vax!
--:-- Sean Rameswaram: Okay, that covers the Pfizer vaccine approval. Historic moment. Just happened this week.
--:-- Sean Rameswaram: What about the boosters that were announced last week, Umair?
--:-- Sean Rameswaram: What's going on there?
--:-- Umair Irfan: Well, the Biden administration said that they will start the process for evaluating boosters, and they expect that the first batch will start rolling out in mid or late September, around September 20th.
--:-- Sean Rameswaram: You know, this will boost your immune response. It will increase your protection from COVID-19.
--:-- Sean Rameswaram: And it's the best way to protect ourselves from new variants that could arise.
--:-- Sean Rameswaram: And this has been bandied back and forth for a while now.
--:-- Sean Rameswaram: Initially, we didn't need boosters. Then it was immunocompromised. People need boosters.
--:-- Sean Rameswaram: And now everyone needs boosters. What's the deal?
--:-- Sean Rameswaram: Right. It was kind of strange.
--:-- Sean Rameswaram: Back in early July, Pfizer and BioNTech said that they were going to apply for a license for boosters.
--:-- Sean Rameswaram: And then the FDA and the CDC put out a joint statement basically criticizing that decision.
--:-- Sean Rameswaram: And they pretty explicitly said Americans who have been fully vaccinated do not need a booster shot at this time.
--:-- Sean Rameswaram: They were pretty categorical about that.
--:-- Sean Rameswaram: And now, you know, with the progress of the Delta variant and also some of the things that we've learned about the decline in immune protection, particularly for high risk people, they're a little bit more concerned about this.
--:-- Sean Rameswaram: And now they think that actually there is some merit to the idea of giving a booster shot.
--:-- Sean Rameswaram: And what exactly is the booster shot? Is it a different composition cocktail than a lot of us had injected into ourselves earlier this year?
--:-- Sean Rameswaram: Yeah, pretty much.
--:-- Sean Rameswaram: This is going to be basically an identical dose to the first two that we received.
--:-- Sean Rameswaram: And functionally for the companies, it's not going to make much of a difference.
--:-- Sean Rameswaram: It's just more of the same thing.
--:-- Sean Rameswaram: And so when you say two shots, you mean Pfizer and Moderna, the two mRNA vaccines.
--:-- Sean Rameswaram: What about the Johnson & Johnson, for example?
--:-- Sean Rameswaram: Right, that's the one-dose adenovirus vector vaccine that was approved earlier this year.
--:-- Sean Rameswaram: Since it came out a little bit later than the other two, it's going to take a little bit more time for regulators to look at the first batch of people that got the vaccine and see if there has been a significant decline in whether a booster is warranted there.
--:-- Sean Rameswaram: But people are talking about it too.
--:-- Sean Rameswaram: So just so I have this straight here, if you got Pfizer shot one and then got Pfizer shot two, was there any difference between those shots?
--:-- Sean Rameswaram: No, they were identical.
--:-- Sean Rameswaram: The exact same thing?
--:-- Sean Rameswaram: Yeah.
--:-- Sean Rameswaram: And this third shot, this booster shot, will also be the exact same thing?
--:-- Sean Rameswaram: That's the plan, yes.
--:-- Sean Rameswaram: So Pfizer one, Pfizer two, potentially Pfizer three, all the same shot, Moderna one, Moderna two, Moderna three, all the same shot from Moderna.
--:-- Sean Rameswaram: Correct.
--:-- Sean Rameswaram: Couldn't you just go to like CVS right now with how easy we've tried to make it in this country to get these shots and just walk in and not tell them you've been vaccinated and get a booster shot?
--:-- Sean Rameswaram: People have been doing exactly that.
--:-- Sean Rameswaram: Oh, yeah?
--:-- Sean Rameswaram: And health officials are trying to warn people not to.
--:-- Sean Rameswaram: Yeah, there's this whole situation of people just wildcatting these vaccines.
--:-- Sean Rameswaram: Wildcats. You know, just running around and trying to get whichever one they can and, you know, making their own risk assessments and trying to figure out, you know, if I'm at risk and I think that I need a booster, Where can I get one?
--:-- Sean Rameswaram: One man who got the Johnson & Johnson vaccine told you it's like you're in a hurricane and someone gave you a garbage bag to put over your head.
--:-- Sean Rameswaram: It's not the same as the Gore-Tex bodysuit that Pfizer and Moderna people are wearing in the same storm.
--:-- Sean Rameswaram: Now, the CDC says a booster shot is not necessary right now, and it's not clear.
--:-- Sean Rameswaram: And why are they warning against it?
--:-- Sean Rameswaram: Well, again, because, you know, this hasn't really been studied.
--:-- Sean Rameswaram: You know, there's a difference between making a categorical judgment when we're talking about hundreds of thousands, if not millions of people versus individuals.
--:-- Sean Rameswaram: And certainly health officials, public health officials are concerned about the large groups of people.
--:-- Sean Rameswaram: I feel like this also gets into an ethical question, although it seems like there are more vaccines than we need in this country.
--:-- Sean Rameswaram: There are still a ton of people who haven't gotten it in this country for more complicated reasons, but also all around the world.
--:-- Sean Rameswaram: I believe the head of the WHO came out and said something like giving people booster shots in the United States at this point is like giving people who are already wearing a life jacket an additional life jacket while essentially people around them are drowning.
--:-- Sean Rameswaram: Is there a real ethical problem with giving everyone in the U.S. who already has the first two shots a third?
--:-- Sean Rameswaram: Yes.
--:-- Sean Rameswaram: And there are health officials and health researchers in this country making that same point, too.
--:-- Sean Rameswaram: I do think the administration is moving a bit too fast.
--:-- Sean Rameswaram: We vaccinate to save lives. The purpose here is not to prevent mild cough, cold, flu symptoms or even something that leaves you laid up in bed.
--:-- Sean Rameswaram: The point here is to prevent severe disease, hospitalizations and death.
--:-- Sean Rameswaram: One thing to remember is this virus got here from overseas.
--:-- Sean Rameswaram: You know, it crossed borders. It went across airplanes.
--:-- Sean Rameswaram: You know, they didn't respect any of the boundaries that we're trying to draw between countries and between people.
--:-- Sean Rameswaram: And as long as the virus is circulating somewhere, it poses a threat to all of us.
--:-- Sean Rameswaram: Right now, there are countries where their vaccination rates are in the single-digit percentage points.
--:-- Sean Rameswaram: Like health workers are not even vaccinated.
--:-- Sean Rameswaram: And, you know, what we saw with the Delta variant, the more spread we have of this virus, the more likely it is to mutate in a dangerous way.
--:-- Sean Rameswaram: So a lot of health officials have argued that, you know, we should – it would behoove the United States for our own self-interest, not just out of charity, to try to ensure that health workers, frontline workers at least are being vaccinated around the world.
--:-- Sean Rameswaram: You know, there was actually an international program to do this called COVAX where the idea was that everybody would chip in, donate money and resources, and the first batch of vaccines would go around the world equally to health workers on the front lines.
--:-- Sean Rameswaram: And that kind of fell apart because a lot of the wealthier countries decided to keep the vaccines for themselves and vaccinate their own populations
--:-- Sean Rameswaram: And the ones that were actually supposed to go to the other countries you know the many of the poor and developing countries that are still dealing with an acute crisis with very low vaccination rates you know they been scrounging for resources and they really haven't been getting the shots that they need.
--:-- Sean Rameswaram: All the same, this is going to happen. Ethical quandaries aside, the booster shots will be rolling out officially in the United States come September. That's the plan.
--:-- Sean Rameswaram: You know, it will probably roll out in the same way that the vaccines initially rolled out because, again, they want an eight-month gap between your second dose and your first booster.
--:-- Sean Rameswaram: So the first people to get the boosters are going to be the people who first got the vaccine.
--:-- Sean Rameswaram: So it's going to be health workers and very high-risk adults, older adults, people who are being treated for cancer or people who are otherwise immunocompromised.
--:-- Sean Rameswaram: Those will likely be the first folks to get boosters.
--:-- Sean Rameswaram: And the large wave of people we saw getting vaccinated back in April and May, you know, they're not going to be eligible until probably early next year.
--:-- Sean Rameswaram: Though, as we established, you could probably just sneak into CVS like a wildcat and go get one.
--:-- Sean Rameswaram: I mean, you could and you shouldn't.
--:-- Sean Rameswaram: You could, but you shouldn't for a lot of good reasons.
--:-- Sean Rameswaram: Sure, sure.
--:-- Sean Rameswaram: Listen, I haven't done it. Don't do it.
--:-- Sean Rameswaram: Umair Irfan, thank you.
--:-- Sean Rameswaram: My pleasure.
--:-- Sean Rameswaram: We gotta do that one thing, and after that, what comes after the booster shots?
--:-- Sean Rameswaram: It's Today Explained.
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--:-- Sean Rameswaram: Sarah Zhang, you're a staff writer for The Atlantic.
--:-- Sean Rameswaram: You recently wrote an article titled The Coronavirus is Here Forever.
--:-- Sean Rameswaram: This is how we live with it.
--:-- Sarah Zhang: Did that title of your article bum people out or were they ready for it, you think?
--:-- Sarah Zhang: You know, I think when I was writing this article, I thought I was being the bearer of bad news and it's going to be a huge rumor.
--:-- Sarah Zhang: But I actually have had a lot of people come up to me or message me and say, hey, I actually found your article kind of encouraging and it made me feel better.
--:-- Sarah Zhang: I think because, you know, like, yes, like we're not going back to 2019 where there was zero COVID.
--:-- Sarah Zhang: Right.
--:-- Sarah Zhang: But, you know, this current like terrible pandemic phase, it's also not going to last forever.
--:-- Sarah Zhang: I, too, was one of the people who actually found it encouraging.
--:-- Sarah Zhang: We'll see how people feel by the end of this conversation.
--:-- Sarah Zhang: What exactly was the thesis of your article?
--:-- Sarah Zhang: Yeah, well, I think it's been pretty clear for a while now that this virus is not going to be eradicated or eliminated.
--:-- Sarah Zhang: So it's not going to be like smallpox. It's not going to be like polio or measles.
--:-- Sarah Zhang: We're going to be living with this virus for a really long time.
--:-- Sarah Zhang: So this virus is going to be what people call endemic, which means it's going to keep circulating.
--:-- Sarah Zhang: It might be another seasonal virus.
--:-- Sarah Zhang: So it might look something like the flu or the cold.
--:-- Sarah Zhang: It's probably going to be something that we hear about every year, but it's not necessarily something that's going to be like big news the way it is right now.
--:-- Sarah Zhang: So for the people who that might be news to, that this isn't going away, it's sticking around forever, let's dig into why exactly and what that might look like.
--:-- Sarah Zhang: So you say it could be the cold or the flu.
--:-- Sarah Zhang: What's the difference there?
--:-- Sarah Zhang: Let's start with the cold.
--:-- Sarah Zhang: How might this end up looking like the cold?
--:-- Sarah Zhang: Yes, I think the most optimistic scenario is that this ends up something like the cold.
--:-- Sarah Zhang: And we actually have maybe some precedent for this.
--:-- Sarah Zhang: So coronaviruses are actually a whole family of viruses.
--:-- Sarah Zhang: And there are four really common coronaviruses.
--:-- Sarah Zhang: They have names like OC43, HKU1.
--:-- Sarah Zhang: You've never heard of them because they are not very severe.
--:-- Sarah Zhang: What they do is they cause common colds.
--:-- Sarah Zhang: And we've actually probably all had these viruses before.
--:-- Sarah Zhang: I mean, probably first had them as children where the disease was pretty mild.
--:-- Sarah Zhang: And we've actually probably had it more than once because we see that the immunity to infection from these coronaviruses actually wanes pretty quickly.
--:-- Sarah Zhang: We, you know, have some immunity to it.
--:-- Sarah Zhang: And the second time you have it, it's not going to be as severe.
--:-- Sarah Zhang: It's going to be mild.
--:-- Sarah Zhang: It might even be symptomatic.
--:-- Sarah Zhang: So we don't really have to worry that much about it.
--:-- Sarah Zhang: And a slightly worse scenario is this becomes something like the annual flu?
--:-- Sarah Zhang: Yeah, it's basically we have a second flu, though, you know, not quite the same thing as the flu.
--:-- Sarah Zhang: Flu we sort of just live with it right
--:-- Sarah Zhang: But it does kill something like tens of thousands of Americans every year
--:-- Sarah Zhang: I don't want to say like we agree that like we okay with the risk of flu because it's not like we sat down on a table and all agreed to this but we kind of lived as if we were okay with the risk of flu, right?
--:-- Sarah Zhang: And most American adults don't get flu shots, even though it's, you know, it's free and it's right there.
--:-- Sarah Zhang: So I think we sort of like as a society had agreed to live with a certain amount of risk to flu, even though it does kill a lot of people every year.
--:-- Sarah Zhang: And in really bad flu seasons, hospitals do get pretty stressed.
--:-- Sarah Zhang: So you can imagine, like, you know, if you have a bad flu season, plus, you know, a coronavirus that looks like the flu, that's still going to be pretty bad in hospitals in the winter.
--:-- Sarah Zhang: If this ends up being just like the annual flu, does that mean all those people who are constantly saying coronavirus is just the flu would have been kind of right?
--:-- Sarah Zhang: They would have been right if they changed their tents, if they said the coronavirus will eventually be like the flu, not is.
--:-- Sarah Zhang: So, right, the reason that we're having a pandemic right now is that we have a new virus that is meeting a lot of naive immune systems that have never seen this virus before.
--:-- Sarah Zhang: And that's why we're seeing so many deaths and so many people who need to be hospitalized.
--:-- Sarah Zhang: You know, but with flu, we've all had the flu at some point in our lives, right?
--:-- Sarah Zhang: Or we had a flu shot. We all have some immunity to the flu.
--:-- Sarah Zhang: So when we get the flu, it's not going to be as bad as like encountering it like completely blank slate for the first time.
--:-- Sarah Zhang: What's happening with the coronavirus is that we are doing that.
--:-- Sarah Zhang: But in the future, when it's endemic, when we've all had some immunity to the virus because we've been vaccinated or maybe because you've been infected and you've been recovered, it will probably look a little bit more like the flu than it is right now.
--:-- Sarah Zhang: What would it take to get there to the point where this ends up just being the cold or the flu?
--:-- Sarah Zhang: We get there with this coronavirus when everyone has some immunity to this coronavirus, either because they've been infected and they've recovered or because they've been vaccinated, hopefully vaccinated, because the consequences of getting vaccinated are not as nearly as possibly deadly as getting the virus itself.
--:-- Sarah Zhang: So either the cold or the flu scenario seems like a potentially ideal scenario.
--:-- Sarah Zhang: Is that fair?
--:-- Sarah Zhang: There must be something that looks worse.
--:-- Sarah Zhang: Yeah. Well, so I think there are still some unknowns, right?
--:-- Sarah Zhang: This is a new virus.
--:-- Sarah Zhang: We don't know exactly how it's going to behave.
--:-- Sarah Zhang: We don't know exactly how it's going to keep changing.
--:-- Sarah Zhang: And the one thing we can say is it's almost certainly going to keep changing because viruses do that.
--:-- Sarah Zhang: The flu virus keeps changing every year as well.
--:-- Sarah Zhang: So it could also end up maybe somewhere a little bit worse than the flu, you know, depending on how quickly this virus changes and how quickly our vaccines are able to catch up.
--:-- Sarah Zhang: It's possible we may need boosters every year, and it's possible that we're kind of in this arms race against with the virus every year with our boosters.
--:-- Sarah Zhang: On the like more optimistic side, you know, we had pretty good vaccines, but it's possible we may have better vaccines.
--:-- Sarah Zhang: One of the things about respiratory infections is that it's pretty hard to make a vaccine that completely protects you from infection because the virus kind of affects your nose first, but vaccines are better at inducing immunity in your lungs.
--:-- Sarah Zhang: So they don't protect against infection, but they do still protect your lungs and protect you from getting severely sick.
--:-- Sarah Zhang: Like the flu shot, for example, tends to be like 10 or maybe as high as 60% effective, which is not very good, right?
--:-- Sarah Zhang: Like 10% is pretty bad for a flu shot.
--:-- Sarah Zhang: But we might have better vaccines for what, for example, ones that get sprayed in the nose are better at preventing infection.
--:-- Sarah Zhang: And we might have better treatments in the future.
--:-- Sarah Zhang: So, you know, we're exactly this far as UNSEP is up in the air for a lot of different reasons.
--:-- Sarah Zhang: And do we have any sense which one of these three-ish scenarios we might get?
--:-- Sarah Zhang: The cold scenario, the flu scenario, the something much worse scenario?
--:-- Sarah Zhang: I mean, I wish I knew.
--:-- Sarah Zhang: I feel cautiously optimistic because we are, you know, we are seeing breakthrough infections in people who are vaccinated.
--:-- Sarah Zhang: But for the most part, they tend to be really mild, if not asymptomatic.
--:-- Sarah Zhang: So it certainly seems like if this is something like the flu, we get a booster every year, we can probably keep up with this virus.
--:-- Sarah Zhang: The other thing is that the virus is spreading so much right now.
--:-- Sarah Zhang: It's having so many, so many opportunities to infect people and to replicate.
--:-- Sarah Zhang: And every time it replicates, it's kind of like firing a lottery ticket where it can chance upon a certain number of mutations.
--:-- Sarah Zhang: And some of these mutations might be the mutation jackpot that makes it really good at spreading.
--:-- Sarah Zhang: I think that in a world where everyone has some immunity, that adaptation is going to slow down a little bit.
--:-- Sarah Zhang: So we won't be trying to run quite as fast to keep up with the virus.
--:-- Sarah Zhang: So sort of like it always has, this sort of just depends on us.
--:-- Sean Rameswaram: Yes, as it always has, which is also maybe not encouraging because it's happened for the past year.
--:-- Sarah Zhang: Is any of this affected by the fact that we just seem to be heading towards a place, at least in the United States, where we have a ton of people who are like hyper-vaccinated, two shots plus a booster plus who knows what comes down the road, and then this other segment of the population that just won't be vaccinated at all?
--:-- Sarah Zhang: Yeah, right.
--:-- Sarah Zhang: That seems to be what the next few months, maybe a year, maybe more than a year looks like.
--:-- Sarah Zhang: I think the unfortunate thing is, is that Delta is so transmissible that anyone who's unvaccinated is going to be infected at some point.
--:-- Sarah Zhang: It's really a matter of time.
--:-- Sarah Zhang: So, yes, we're going to have like vaccinated, unvaccinated people.
--:-- Sarah Zhang: But eventually, almost everyone will have some immunity because you've been vaccinated, preferably or because you've had COVID.
--:-- Sarah Zhang: And this is a reason to feel somewhat optimistic about this pandemic endemic that will never, ever end?
--:-- Sarah Zhang: Well, in that scenario, right, like when everyone has some immunity, the pandemic has ended.
--:-- Sarah Zhang: That's when we're in the endemic scenario.
--:-- Sarah Zhang: The unfortunate thing is, is that a lot of people get sick rather than get vaccinated.
--:-- Sarah Zhang: You're going to have a lot more death on our way to getting to endemic coronavirus.
--:-- Sarah Zhang: So, again, we kind of get to choose the path we take to get there.
--:-- Sarah Zhang: It depends on us.
--:-- Sean Rameswaram: Sarah Zhang.
--:-- Sean Rameswaram: She's a staff writer at The Atlantic.
--:-- Sean Rameswaram: Today's episode was produced by Will Reed.
--:-- Sean Rameswaram: I'm Sean Rameswaram from, and I got comirnerty.
--:-- Sean Rameswaram: Side effects of comirnerty may include meeting people, seeing your family.
--:-- Sean Rameswaram: Oh, my. People have legs.
--:-- Sean Rameswaram: Commuting with nature.
--:-- Sean Rameswaram: Making out with strangers.
--:-- Sean Rameswaram: Having plans. Canceling plans.
--:-- Sean Rameswaram: In-flight entertainment. Live music.
--:-- Sean Rameswaram: FOMO. Catching all the other viruses you missed out on?
--:-- Sean Rameswaram: Fine, I guess I'll give you a hug.
--:-- Sean Rameswaram: What do I do with my hands?
--:-- Sean Rameswaram: Dining in restaurants without fearing for my life.
--:-- Sean Rameswaram: It's not cool.
--:-- Sean Rameswaram: I miss my dog.
