ASM232 The Second Wave

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hello and welcome to ask science mike this is a weekly podcast where we believe that every sincere question deserves an honest and non-judgmental response i'm your host mike mccarg and this is one of those special episodes so the normal format for this program is people send in questions using the website asksciencemike.com and i respond to those questions with both empathy and evidence-based information and i love that show and uh sometimes we have requests from the listeners of this program to dig deep into one topic and that's the kind of show we're going to have today and if you notice the title of this episode in your podcast player you know what we're going to talk about this episode is titled the second wave and so this is going to be an episode about covid19 now for a little while i was doing a lot of covet 19 episodes and they were wildly popular there were hot lots and lots and downloads from folks because unfortunately in our media landscape and our cultural context it is difficult to get high quality information about this pandemic that we're all facing together and um you know people were basically just asking me to help provide some guidance with media literacy and what information we could trust and what might be happening and what science said and i did a lot of those episodes and honestly i got discouraged because you know it didn't seem to help the outcomes the responses especially in the united states to cover 19 uh did not seem improved or better because of those efforts i also thought people needed a break from covet 19 so i returned to my regular show format and um you know based on the data that i'm seeing and based on your messages your cards and letters which i do get and receive and read them all if you send me a card or letter in the mail i do read all of those um and i have heard your requests loud and clear to do another covet 19 episode so that's what we're going to do today uh especially because i keep hearing so much about this second wave uh way back when coveted 19 was beginning we wondered if we would defeat the first wave and then have kind of a more calm summer and then have a second wave a second period of rising infections or rapidly rising infections toward the fall of the year especially if that coincided with cold and flu season and now as cases are on a rapid ascent in the united states again i hear a lot of people talking about a second wave and i want to be really clear what's happening now in no way meets the epidemiological criteria for a second pandemic wave it's still the first wave other than key areas in the northeast new york new jersey those areas which have legitimately had a first wave and legitimately brought their caseload down the rest of the country just flattened the first wave out but never actually meaningfully uh ended that wave and so what we're what we're seeing now is the first wave for real for the first time in most parts of the country now the united states and brazil frankly uh and sweden are three countries that have just blown it with covet 19. just absolutely will be historical cases for what not to do in a pandemic why do i say that if you look at the cases per hundred thousand people new york brazil and sweden are in a completely different category than every other country in the world even when you think of places like italy and spain that were hit harder sooner their maximum caseload per hundred thousand people is much lower than what's happening in the united states sweden or brazil right now so we do have a second wave right now but that second wave is a psychological wave it's a wave of awareness a wave of concern it is not a second epidemiological wave we are still in the first and um this most of what i'm going to say today is very difficult it's very challenging so as always i'd like to invite you to listen to this episode at your own pace i'd like you to pause the audio when necessary for you to reflect or to de-escalate remember the kind of grounding exercises that are available to you anytime you can focus on your breath you can focus on tactile sensations or things that you can see hear and smell around you you can remind you that you are here and now and that here and now you are safe right you can go through grounding exercises anytime you want and that might be necessary as we look at the reality of what our collective actions um are bringing to our life experiences into our culture and here's the first really big scary thing i'm going to say today our utter failure to meaningfully respond to covet 19 means that this pandemic is going to be with us for a long time longer than it needed to be easily 2021 or even 2022 we're still going to be in the middle of managing this pandemic likely there's a couple of uh ways that might not happen but they're long shots at this point so it is very very conceivable that in july of 2022 we're still having the social distance we still have uh strain on the health care system we still regularly uh have people in our lives that we know and love that are impacted in the various ways covet 19 can impact people including death by the way and gosh this is why i've been so sad and why i've been so stressed out friends can i just tell you that this was completely avoidable how do i know that because most countries developed countries around the world have in fact contained covet 19 they did it it worked some countries have reopened schools without surges of infections they've been able to reopen most of their economies without waves of infections so it is possible to contain covet 19 it is possible to avoid a crushing strain on the health care system it is possible to avoid mass deaths and how do we know that because countries have done it i have to take a deep breath myself there because i have such a sense of sadness you see america's sense of rugged individualism has backfired our sense of self-sufficiency our sense of self-reliance and frankly our sense of self-importance over others is what's driving this problem i mean wearing a mask a common sense easy solution that slows the spread makes it easier to protect people who are more at risk from covid makes it easier to have more economic activity and in doing so protect people's livelihoods we have allowed wearing a mask to be turned into some kind of partisan culture war statement now you could say this is a trump thing or a conservative thing i'll get to that in a moment because we've also seen people especially young people and this includes people of all political orientations and ideologies are belligerent and defiant with contact tracers i read some reporting this morning where ex judo just completely exasperated contact tracers are saying that when they go and they ask young people who test positive for covet 19 where have you been and who have you been with the most fundamental part of contact tracing an essential part of containing a pandemic they are met with answers like that's none of your business that's that sense of individualism that's why our caseload in the united states is what it is so this is is trump a problem absolutely trump might be marshaling the most ineffectual response to a pandemic possible literally the most ineffectual but it's not just trump and it's not even just conservatives not by any means we have seen so many young people gathering together for close physically close dance parties at lakes and beaches and in homes home gatherings which become coveted super spreader events because people are in close proximity with no masks drinking spraying aerosol droplets into the air that's because young people have a sense of invincibility which we will completely dismantle in the course of this podcast by the way we have parents letting their children get together in pods that end up overlapping so if you if you have play dates with three other children but those children have play dates with three other children that aren't in that pod you create a branching network to spread covid19 folks and that is just as common among progressives as conservatives and the the most uniting factor in the united states right now is a wholesale embrace of conspiracy theories the absolute garbage that is getting sent to me both by the public and my personal friends is terrifying no 5g doesn't cause covet 19. no it's not youtube isn't censoring people who are telling the truth the anti-vaxx movement is becoming virulent in anticipation of covid 19 vaccines folks we are reaping what we have sown in an anti-science anti-intellectual culture in the united states and it is not just conservatives one of the most disappointing things in my life is the degree to which legitimate critiques of the sciences sciences whiteness problem for example or the way that science has been used to erase the nuance of perspectives of marginalized people in society legitimate critiques of things like post-modernism have led to a wholesale rejection of the notion that there are facts at all primarily by white people to feed a sense of epistemological entitlement epistemological entitlement a right to believe whatever i want to believe that makes me feel comfortable and the cost right now is human lives and human livelihood because some data just came out this morning and i i have so many links this week in the show notes and so i have a link to this so you can read it for yourself coven 19's impact is wildly racialized wildly racialized covet is impacting black and brown people so much more than white folks when we look at cases per 10 000 people the new york times sued the cdc to get this information among all people there are 38 coronavirus cases per 10 000 people among white people there are 23 cases for 10 000 people among black people there are 62 cases per 10 000 and among latinx people 73 cases per 10 000 people wildly racialized and so our sense of entitlement as white people to think we can believe whatever we want to believe because this is too hard and we've got to see friends and we've got to go to parties because we're young or our kids are driving us crazy so they get to go do what they want to do friends it is killing black and brown people and the future will judge your actions and listen to me i judge your actions this is ridiculous folks we talk about mass protests because black lives matter and resisting police brutality while we engage in actions that are killing black and brown people in the united states today through covid19 friends show up show up if you believe that black lives matter act like it and put on a damn mask and keep your physical distance from others other people and you'd say but for how long and i'm telling you this for as long as it takes are we committed to justice around race or are we not because for most people for most white people coven 19 will end up being an inconvenience meanwhile my dear friend mickey scott bae-jones has lost multiple family members including her mother and so i am patient and i strive to be non-judgmental but folks i'm done i am done if you want to talk to me about your business or you want to talk to me about conspiracy theories i'm going to talk to you about mickey scott bay jones and her mom the impact of coven 19 is wildly racialized and the fact that white people progressives and conservatives alike pitch a fit about having to make lifestyle changes to slow the spread of this pandemic is a tool of white supremacy stop being white supremacists quite a soapbox this morning but folks i believe this and i have the data to back me up if anybody would like to debate me you may try now here's the other thing we're learning this virus is likely wildly more contagious than we ever thought we started to get some sense that the infection may have begun earlier than we believed and that it may be more widespread than we believed and the cdc put out data they believe that more than 20 million people in the united states alone may have already been infected it's a lot bigger than the official case count by a factor of 10 [Music] for what it's worth i think that's that's very likely that cases are wildly undercounted and that covet is far more infectious and less deadly than we believed at first but still very deadly so i want to be really clear when we hear more infections and people go oh good so there's been more infections there's still been a lot of deaths folks those deaths are undercounted chronically when we do research and studies to look at that we find that just an absolute race is the absolute rates the death rates are skyrocketing all over the country right now far more than what's being reported to covet 19. uh so covet is still very deadly very contagious and very deadly and what we're looking at right now so that the problem with looking at a national caseload in the united states is that the us is so big it's so spread out and covet hasn't spread at the same rates in different places um it's taking a lot longer to get into rural america although my goodness it is getting there we're seeing some real super spreader events happening in rural communities now but it took a lot longer and so that meant we all saw what's happening in new york and everybody locked down and it was the right move by the way but because we were locking down at different points in localized infections right that lockdown was really early in wisconsin right so it did a good thing that when everyone locked down because new york had to new york's lockdown was late but for a lot of people that was actually an early appropriate lockdown if we would have combined that early lockdown with widespread taste widespread testing and contact tracing friends we would have been like containing the pandemic instead we did like a long lockdown with limited stimulus for people who are whose incomes are impacted by that creating a lot of fear a lot of confusion a lot of frustration a lot of desperation and so then people rocketed out of that extended shutdown and then what's happening our national curve is sloping right back up it was dropping for a while not because cases were dropping everywhere but because cases were dropping so fast in the new york area so you have to be careful looking at the national graph but if we look at the national graph right now cases are absolutely skyrocketing there won't be a simultaneous second wave so-called second wave in the united states the u.s is too big it'll happen county by county so cases are skyrocketing deaths are not skyrocketing yet this is likely because the infections seem to be happening mostly among young people right now among essential workers who tend to be young who have no choice but to be out and among people who are ignoring the restrictions in order to socialize that's where the spread is happening and because it's younger people younger people are much less likely to die from covet 19. we already know that the deaths are not skyrocketing yet hospitalizations are especially in key areas like texas and florida just like they did in new york the death rate though isn't going up yet it's possible that the virus is mutated to be both more contagious and less deadly and friends if that is true i'm going to be so happy if the death rate never goes back up you will not like it i'm not going to pout i'll be really happy but listen it is so unwise to plan on this being true because it's still possible that all that's happened is we just have a lot of young people infections that are now going to spread through their social graphs to people who are more susceptible to severe case presentation and death and then we will have a crushing death wave now that could start um i mean today's monday it could happen this week we see that just a little tick up in the death curve and then another seven days and the death graph is as steep as the infection graph is now so it's unwise to plan on the viruses less deadly so we don't have to change anything but listen this is important even if the virus is less deadly it is not less debilitating because death is not the only negative outcome that can come from govid19 i've got a link in the show notes about covet long haulers people who get coveted and then have severe symptoms not for weeks but for months we believe this is coming from tissue damage people's tissues get damaged from covet 19 especially if it ends up provoking autoimmune responses their lungs can be damaged their brain can be damaged their cardiovascular system can be damaged major body systems can be debilitated gastrointestines can happen there are people who've gotten covet 19 have had severe diarrhea for months it's terrible and then there's another related condition multi-symptom inflammatory syndrome covid where we believe a cytokine storm happens in the body and provokes an autoimmune response that can lead to brain fog severe emotional impairment gastrointestinal distress debilitating waves of symptoms that come and go and change for months or longer this is debilitating like you can't work you can't function condition it could be that for long haulers there's a mix of you know a severe covered presentation and misc but when we've studied mis before it happens with a family virus is known as epstein-barr viruses of which mononucleosis is one and uh for epstein-barr infections mis can happen for as many as 10 percent of patients and early indications are that 10 is not an unreasonable number to expect for mis cases for covid and young people are just as at risk here as other groups perhaps even more at risk children teenagers and people in their 20s may be the most at risk for misc i want you to think about that for a moment if you're young and you're out because you you're young and you feel invincible and you just want to dance millions of young people in this country could get a debilitating autoimmune condition that lasts months or years think about how that is going to reshape our society young people are not invincible with covid right now they seem less likely to die but death is not the only way that sars cov2 can impact your life or those you love let's take a moment just to take a deep breath take a moment to remember that right now we're here and we're safe i'm going to take a break right now to talk to you about a couple of sponsors and then after the break we'll come back and we'll talk about how to beat covet 19 together this program would be impossible without sponsorships and i have two long-running sponsors that i absolutely love that i'm a customer of both was a customer of both before they became sponsors um and the first of those companies is betterhelp.com betterhelp is an online counseling service with over 10 000 licensed therapists finding a therapist is hard better help makes it easier you go to betterhelp.com sciencemike and when you go there there's a little quiz you fill out a little questionnaire and that will let the experts at 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the mail these are sustainably made designed in california products that are centered around steam science technology engineering arts and math you pick a line there's lines centered around those different different disciplines for people of all ages from from infants all the way up to uh 104 as they say you pick a line and then they come to you automatically every month we look so forward to getting our kiwi crate of crates every month we get four as a family we do four different lines and then set them on the dining room table and decide who gets what we love it the adults love it my teens love it but children love it too i get so many pictures that you all send me of people putting together their kiwi crates it is an absolutely phenomenal service that makes learning fun so you can get started today by going to kiwico.com ask sciencemike they'll give you 60 off your first month on any line so you can get something fun to do while we are being safer at home okay it's not hopeless it feels hopeless it's not hopeless i said right at the top of the program other countries have beat covid19 they pushed the pandemic back they are containing it and their societies have returned to some sense of normal people are going to restaurants folks can you imagine just going to restaurants and they're safe people are going to school children are going to school how well by following the well understood guidelines that epidemiologists have created to contain pandemics so there's two things we should talk about number one is how we respond as individuals which is something we have a lot of control over and two how we respond is a society which requires us organizing together which is a little harder for individuals i like to tell people to think about the risk triangle how do you determine in any given situation how much risk you have of contracting coven 19 or if you already have it and don't know it spreading covet 19 to other people the risk triangle is made up of three things one distance two duration three environment i'll say that again one is distance two is duration three is environment one is the distance we are from other people you wanna be at least six feet apart from other people ideally if you're indoors more like ten feet from other people distance because we understand covet is spread by droplets of saliva the more distance you have the more likely it is the big heavy drops fall to the ground instead of striking you or your clothing so distance six feet to ten feet indoors i go for 10 feet not six but distance is just one factor number two is duration how long you are with a person or people okay uh if someone passes you on the sidewalk for a moment there's very little risk even if they're not wearing a mask frankly if you're outdoors they pass on the sidewalk the duration is very small so when once one experiment they found that sitting indoors with someone at a table and talking for five minutes people covered each other with more droplets than someone sneezed on someone else at a distance of two and a half feet outdoors what yeah the kinds of activities we need to think are no big deal and low risk eating drinking talking that is like the highest risk so the duration matters it means if we're gonna have a long duration with someone like we're talking to a friend it means we should increase the distance do you see what's happening if i'm having a conversation with a friend i need the farther apart i am from that friend the safer we are as the duration of our conversation continues but that's only two distance iteration number three is the environment what are we looking for in the environment well there's several things number one how many people are there more people equals more risk especially more family units okay so technically if you had you know two family units but it's 30 people the risk is still really low if that family is isolating correctly but that's that's an aside the number of people is a factor in the environment this is why we're saying avoid large gatherings right if the risk a gathering of 50 people is say 15 which is a reasonable number that's that's data driven in many counties in the united states right now if you have 50 people there's a 15 there's someone there 15 chance someone there is actively spreading covid if you have 100 people and i have a 30 chance right so getting together that way is risky this is why bars are a problem that's why restaurants are a problem you reach statistical certainty that someone is there as cova 19 they're spreading it in droplets indoors it's hanging in the air for hours oof now people are sick so the number of people in the environment is a factor the amount of protective equipment are people wearing masks are people wearing face shields that's a big factor is it indoors or is it outdoors outdoors is wildly safe for number one because of droplet dispersal there's lots of space for droplets to disperse outdoors there tends to be a lot more moving air outdoors and number two the outdoors has kind of a self-sterilizing effect with viruses the sun is no friend of covid or sarcia v2 if you're in a droplet the sun starts to evaporate that evaporate that droplet quickly and then burn off the lipid coating around the viral shell and now that viruses is dead it's inert so outdoors is just a lot safer than indoors and then sanitization of self and surfaces washing hands not touching your face sterilizing and sanitizing surfaces regularly all those factors play into the environment distance from others duration of encounters and then environmental protections how many people are there masks and other protective equipment are we indoors are we outdoors and are we sanitizing ourself and shared surfaces with that triangle you want to make the sides of the triangle as big as you reasonably can that means more distance from others less duration with others and the most environmental protections that you can get which means seeing fewer people gathering outdoors wherever possible and sanitizing yourself and surfaces when we follow the risk triangle guess what the risk of transmission is relatively low we have had friends over to our house on a limited basis you know one family unit at a time we hang out in our backyard we sterilize our outdoor furniture and i've gone through with a tape measure and set up you know seating that feels pretty normal but where there is proper distance enforced naturally and then while we're talking we wear masks and then if we you know have a drink or we get some food we spread out a little bit more to eat and drink because our maths are off outdoors i'm comfortable wearing a mask being six feet apart there's going to be eating or drinking that's got to be 10 feet now and again this is not a frequent thing it's like every other week we might have someone over someone who is taking similar precautions as ourselves we don't hug we don't shake hands uh we invite people through the side gate of our home to the backyard where the seeding is laid out and then you know we we bring people drinks we wash our hands we make sure everything is sterilized and sanitized i follow the cdc guidelines so you can see now why bars restaurants and social gatherings in people's homes are so risky this seems to be where most of the spread is happening today by the way you know we've seen the data now it doesn't look like the black lives matter protests are a significant spreading event they were outdoors and mass compliance was extremely high at those events and we're seeing in data now this could change but so far the data we're seeing is these spreader events they are not correlated to or related to uh the blm marches they are the the contact tracing we're seeing leads to what bars restaurants and social gatherings in people's homes where people are taking their masks off masks seem to be highly effective in a relatively inexpensive intervention so outdoor spaces with physical distancing and environmental precautions are relatively low risk we don't have to be hermits friends we don't have to say well i gotta see someone i just miss talking to people you can you can see a limited number of people outdoors wearing a mask it's summer it's hot i get it get together in the evening maybe sweat a little bit i don't know i'm just telling you indoor gathering is a terrible idea a house party you're get it's a very high chance you're leading to the death of a human person from that event so that's what we do as individuals we got you we guide our actions using the risk triangle of distance duration and environment now what about society the societies the cultures that have effectively flattened the curve and contain the pandemic what do they do well first they had a social safety net that was robust and they expanded it rapidly and immediately with an emphasis on protecting people's individual incomes and livelihoods people will not obey lockdown orders or stay at home orders when they are existentially afraid of their basic viability talk to this a little bit more at the very end but my inability to earn an income in the face of this pandemic was a crushing psychological blow for me crushing so i understand the sense of desperation people feel when they're locked in their home and have no prospects to provide for themselves and their families the societies that beat covid had programs and interventions to address that sense of crushing fear what we're seeing in the united states is an overspending on corporate rescue programs the fed is funneling trillions of dollars into corporations right now trillions of dollars which is not then getting redistributed out to the workers of those companies so the us is wildly overspending on corporate rescue while underspending where it will help the economy and society the most that's just people our my spending is your income and your spending is my income so the the the economic shock is so bad right now because what people have income they can't spend this is this is not complex stuff this is not controversial stuff so we're seeing a lot of resistance especially among conservative lawmakers but not exclusively at expanding the social safety net for ideological reasons i have no patience for it so that's one two consistent messaging and policies we have this patchwork culture war excuse just [ \_\_ ] right now it's ridiculous masks work so let's get consistent messaging do you know what good it could do if donald trump just wore a mask publicly we'd end this thing i mean it'd be an about-face people would change their behavior so quickly so we need consistent messaging on masks what the criteria is for reopening economies on a city by city and county-by-county basis and contact tracing and compliance to contact tracing if state federal and local governments were sharing the same messaging on the same policies we'd be in a lot better shape we do need lockdowns with high compliance as needed on a local basis we should be monitoring especially hospital admissions especially icu admissions and then guess what if you don't have a wildly exploded pandemic like we do a two-week lockdown is enough because if you keep the total number of cases small enough where the clusters are actually traceable you can go in and quarantine all the people who've been exposed stop the spread of disease it works they're doing it everywhere else friends they're they're just they're already doing this everywhere else but you that means there has to be actual compliance with the lockdowns we have anonymized cell phone data when we're locking down even in progressive cities people aren't locking down people's about about after about 11 days into the lockdown in los angeles people started moving around again we they've got people are wearing gps trackers all the time and call them cell phones advertisers can pull that data so so can researchers when we lock down people have to actually lock down local monitoring is essential if you want to know how your county in the us is doing i've got a link to an amazing tool in the show notes go look for that it's quite good we need contact tracing and widespread testing that's essential you have to when you have a positive infection if you're contained right now contact racing is not especially helpful in most places because the infection rates are so high only way to fix that it's going to be really severe lockdowns stern lockdowns maybe 21 days if people would comply for 21 days we could go back to this policy but contact tracing you know actually answering investigators when they ask who you've seen and when and widespread testing our testing capacity is not expanding the degree that it needs to to be effective and ample personal protective equipment both for hospital workers and the general public right we don't need n95 masks now this stuff about mass not being healthy is not true there are very very very few health conditions that mean you can't wear a mask and i mean very few now there are legitimate psychological challenges that make wearing a mask difficult we can have a kind of anxiety that leads to a particular type of claustrophobia makes us feel like we can't breathe i don't discount that that's significant but the very few physiological conditions that mean we can't wear a mask part of it is that the masks we're wearing um if i might make a recommendation here there's a company called adams it's a great shoe company they have made what i think is the perfect non-hospital worker everyday mask they're not a sponsor of the program they've never heard of me i just think this mask is exceptional i was having a hard time my family jenny and the girls i hate wearing masks they do it because me but they hate it um paper masks generate a lot of waste a lot of homemade solutions um you know are cumbersome or too thin or too thick adam's masks are perfect so i've got a link to the adams everyday mask in the show notes i highly suggest you check it out i'm gonna put mine on right now it takes that long it's already on it's very comfortable it doesn't fog my glasses it's the perfect thickness to be breathable but also to actually be effective at containing droplets it's a phenomenal mask it's hand washable i wash mine every day i've got i've got a couple of them they're they're affordable best of all but you know we're gonna need personal protective equipment manufactured at scale and that's all it takes and it would be better friends if we did these things as individuals and as society are we going to get back to normal no but we can find a new normal that's better than what we have now that lets us see people that lets us open schools back up which is really important not only for children's education but poor families rely on schools for basic nutrition we've got to get schools back open but here's the big thing and listen to me normal is never coming back i'm going to say that again normal the normal we had before covet 19 is never coming back and that's hard before this is over everyone is going to be touched by this pandemic even if it's mutated to be less lethal the number of people who will have severe case presentations the number of people who will be long haulers the number of people who deal with misc is going to be staggering the mental health effects and economic effects of this extended self-inflicted pain from this pandemic it is going to reshape us and that's hard the mental health landscape in my house has been so challenging so challenging friends my patterns of compulsive medicating got severe my daughter's eating disorder returned with a vengeance and both my wife jimmy and my other daughter macy had challenges of their own unique in severity and presentation of our in our entire lives and the financial devastation my income comes from selling tickets i am in the events business so don't hear me lecturing as some kind of outsider on the economic impact of coven 19. my business income dropped by 90 percent 90. acute absolute financial devastation i have wondered how we are going to pay rent and eat meals for months now and i'm fortunate because we've been able to and i you know i'm very fortunate that you know that last week i picked up some consulting clients again i used to do corporate consulting and i leaned back into that and signed a couple of contracts and we are out of the red zone for now that is a great feeling um but just think about how many people are in that situation right now it might be you but it might not be statistically most the people listening are not in ex personally experiencing that financial devastation but i want you if you like this program and you think fondly of me i want you to think how many people how many millions of people are in this situation i just described and what that's doing in their lives and in their homes sense of isolation sense of fear and stress we have maybe the largest mental health crisis in modern history an invisible enemy sweeping a claw across the globe epic in its utter indifference a lot of countries have done a good job a lot of countries should be lauded for the ways that they have banded together but not america friends so far we have failed and our failure the weight and magnitude of that failure is being felt in black and brown communities and as andre henry says it doesn't have to be this way we can begin to live our lives today using the risk triangle of distance duration and environment and then organized to make societal interventions of an expanded social safety net consistent messaging and policies lockdowns as needed with high compliance contact tracing and widespread testing and ample personal protective equipment and if we do those things life will not go back to normal but it will get better and we can make a new normal together as we wait for medical researchers to do what they do best and get us to a set of medical care interventions and vaccinations that permanently eradicate this pandemic i believe that we can do this even though we have not so far maybe this is a humiliation that we need and my hope is that as kovid stops being an abstract thing that's happening to those coastal elites in new york and starts being something happening in every city and county in america we will wake up and we will respond and we will save lives thank you for listening my friends i can't wait to talk with you next week take care