Episode 132: Don't Sweat the COVID Variants with Dr. Monica Gandhi
The Paradocs Podcast with Eric Larson
Release Date: 06/10/2021
Episode 154: Rethinking Vaccine Mandates and the Omicron Variant with Dr. Monica Gandhi
The Paradocs Podcast with Eric Larson
Vaccine mandates, mask mandates, boosters, and variants have been a constant source of debate and controversy with the pandemic. My guest today is Dr. Monica Gandhi, an expert in immunology and infectious disease who runs the HIV clinic at UCSF. She has been a fairly prominent voice in support of the mask and vaccine mandates in her home state of California and city of San Francisco. She returns from her visit in June for SARS-CoV-2 in which she guessed that it wouldn't evade the vaccine or prior infection (spoiler alert: she was right). Do Vaccine Mandates Make Sense? Dr. Gandhi is...
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Episode 153: Crowd Health is Go Fund Me for Health Care on Nitro with CEO Andy Schoonover
The Paradocs Podcast with Eric Larson
What happens when you take Go Fund Me and put it into an ecosystem of likeminded folks who want to build a community to care for each other's health care expenses? You get which draws upon some of the concepts of crowd funding for one time health care expenses within its community. By taking people from all over the country and putting them into a community where there are expectations of caring for others, Crowd Health offers a solution to paying for health care expenses without breaking the bank. Is Crowd Health Insurance? If you've been paying attention to the US health care...
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Episode 152: The COVID Drawdown
The Paradocs Podcast with Eric Larson
Today we are going to discuss the COVID drawdown. Essentially, this is what must inevitably happen for us to return to lives of normalcy where we have typical interactions with others at family gatherings, sporting events, concerts, and business meetings. Unless we are prepared to radically change the way we live our lives and choose isolation (which probably has far greater physical and mental health detriments) then we have to consider how the drawdown occurs and what conditions ned to be present for it to happen. What HaS TO HAPPEN FOR THE DRAWDOWN TO OCCUR? We've talked to...
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Episode 151: Health Care for Those Who Don't Earn High Wages with Dr. David Berg
The Paradocs Podcast with Eric Larson
One of the scariest times for many workers is being presented with a bill for medical services. Even if they have insurance "coverage", the deductible or co-pay might be more than they can afford. For hourly workers in entry level jobs or low skilled positions, medical bankruptcy is a real fear. While barely making ends meet an additional bill for an ER visit or doctor's office stop can send you to collections and destroy your credit. Unfortunately, a lot of Americans are in this exact spot as they earn a living working these low paying jobs but have little medical security even if...
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Episode 150: Make Sure Your Health Insurance Broker is Working for You and not the Insurance Company with David Contorno.
The Paradocs Podcast with Eric Larson
When you run a business, one person you usually meet and hire is a health insurance broker. In theory, these brokers work with the employers to secure the best deals for health insurance to meet the company's health care objectives. However, in practice, the brokers serve as a sales force for the insurance companies who lavish them with bonuses, trips, and gifts. The seedy underbelly of the health insurance broker industry is that they are really not working to save money or get deals for their clients - the checks are written by the insurance carriers and that's who they answer to. Who do...
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Episode 149: Is Asymptomatic Spread of SARS-CoV-2 a Thing? with Daniel Halperin, PhD
The Paradocs Podcast with Eric Larson
Not only has the COVID pandemic politicized our country - it has led to a lot of misinformation and a shutdown of communication. For instance, is there really asymptomatic spread of COVID? Or just pre-symptomatic and symptomatic spread? That might seem like splitting hairs but it can have a profound effect on policy for quarantining and testing. We've talked about this before on the show as well as general discussions on COVID policy which can be found , , and . 12 Myths and 12 Facts About COVID-19 If there is one certainty during this confusing pandemic it is that there are plenty of...
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Episode 148: Urgent Care as Primary Care with Dr. Juliet Breeze of Next Level Medical
The Paradocs Podcast with Eric Larson
There are a lot of urgent care clinics all over the country. But few of them, to my knowledge, also operate as regular primary care clinics. But that is exactly what is happening today in the Houston, Texas area with the emergence of Next Level Medical. If you think about it, it makes perfect sense to leverage all the facilities needed for a primary care clinic - exam rooms, physicians, etc. and use it to deliver regular and sometimes non-urgent care. We've discussed before that lower the cost of care with transparency so this seems like the next logical step with urgent care. We...
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Episode 147: Has the Pandemic Led to Infants Losing IQ? - with Sean Deoni, PhD
The Paradocs Podcast with Eric Larson
The COVID pandemic has brought on all sorts of changes to the way we live our lives. From wearing masks, working from home, stay at home orders, and restrictions on social interactions, the virus has caused untold disruption to the way our society functions. Although the changes COVID has brought to our schools and the lives of our school age children, it is perhaps less appreciated what changes have occurred for our infants. It is a well known fact that our environment and meaningful stimulation is necessary for normal intelligence and brain development. Infants are completely...
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Episode 146: Explaining COVID in 11 Minutes with Dr. Eric Larson
The Paradocs Podcast with Eric Larson
Imagine yourself in California at a clearing in a large forest. And it’s on fire. There are three groups of people standing before you. A large group is screaming and running around pointing at the fire. They’re yelling that we need to do something, anything we can to stop the fire. Meanwhile, there is another group (not as large) with their backs to the fire. They are mocking and ridiculing the group running around panicking. They tell them to calm down and to stop ordering people around. They insist there isn’t anything wrong at all. Of course, the largest group of people are...
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Episode 145: Surgery without Insurance with Dr. Keith Smith
The Paradocs Podcast with Eric Larson
A lot has happened since we last met with Dr. Keith Smith from the back in 2018. . We also spoke about how the system was rigged to enrich the hospital systems, insurance carriers, and PBMs (what's new right?). So what's happened since then and how has the center done with the pandemic? Is the Surgery Center of Oklahoma Thriving or Just Surviving? Not surprisingly, Dr. Smith says that the center is doing just fine and has increased its market share from other states. Additionally, the international community from Canada is now being allowed to come back into the US for their...
info_outline"Beware the variants!" scream the headlines all over the news. Now that the vaccine is available for SARS-CoV-2, we are pounded with an almost endless daily fear-filled stories about how the variants of COVID are coming and will continue to put people in the hospitals, ICUs, and funeral homes. But are the variants really that dangerous? Are there really wholesale mutations occurring in this virus that will make our natural immunity or vaccine immunity ineffective? According to my guest, Dr. Monica Gandhi of UC San Francisco medical school, the answer is a simple no.
How Does Immunity work?
Our discussion begins not with the variants but in talking about the basic units of our immune response - T cells and B cells. In short, B cells are the ones that make antibodies and persist for life (usually) in our lymph nodes waiting to get reactivated when the virus reappears later in our life. T cells function to clear the virus from our body and also persist long after the infection has gone. They too have life long memory to help us clear infections when the same viruses try and get us sick a second time.
An important point to consider is that we expect the presence of antibodies to wane over time. That is a perfectly normal process in our bodies. That's why we have B cells and T cells which are left to provide the memory or past infections and at the ready to ramp up a quick response if a virus returns. If the antibodies never left our blood would be too thick with proteins said Dr. Gandhi.
Will the Variants Evade our Immune Systems?
The concern a lot of doctors, public health authorities, and elected officials have expressed is that SARS-CoV-2 is mutating. They worry that its variants will not become more infectious or dangerous and they will make the immunity gained through natural infection and vaccination ineffective. This is not something we should worry about according to Dr. Gandhi.
Our immune system is designed to protect against just this very occurrence in nature. Viruses may evolve and change but SARS-CoV-2 is still the same virus. When we develop antibody defenses it is against around 100 sites on the spike protein so if a few of those change we will still have dozens of antibodies still that will work against the virus. This is why despite newer variants showing up they are turning out to be just as susceptible to our immune systems.
Did the Lockdowns Work? How About the Mask Mandates?
Dr. Gandhi also has an MPH in epidemiology and biostatistics and we briefly discussed the effectiveness of the various non-pharmacological interventions like the economic lockdowns and mask mandates. She takes a fairly sanguine view of these measures and feels that there isn't very good date showing that any of them were all that effective. Certainly, more research has to be done but it was clear that strict lockdowns or no lockdowns did not have a clear benefit when comparing various state policies. It that were the case, then California which has had the most stringent rules would have fared significantly better than other states instead of being right in the middle for cases, hospitalizations, and deaths.
Should Children get Vaccinated?
Dr. Gandhi is not sure what the best policy is for kids and getting vaccinated, however, she thinks we should all be glad that COVID rarely causes severe disease in children. What is more pressing, in her opinion, is moving the vaccines we are giving to our kids and distributing them throughout the world where the potential to prevent a lot more serious illnesses in the elderly is far greater. Equity in treatments should be near the top of our considerations right now since the benefit to children and the population at large is so small. Especially when there is an opportunity to do so much good elsewhere in the world.
Transparency is Key.
Finally, we spoke about the controversy with gain of function testing that has been occurring in laboratories around the world and whether that was a wise decision. The key for all these issues including public health is to be up front, honest, and transparent with the public. Every white lie or justification further erodes the public's trust with doctors and the government. One good example is that the push to get children vaccinated really has more to do with protecting adults that kids unlike a lot of childhood vaccines for viruses that affect children (whooping cough, mumps, measles, rubella, etc.).
Dr. Monica Gandhi is a professor of medicine at UC San Francisco medical school and an infectious disease specializing in HIV.
show notes
Episode 132: Today's show
@MonicaGandhi9: Dr.Gandhi's prolific twitter feed where she actively promotes T cells and provides a refreshing alternative voice to the echo chamber on COVID.
No, You Probably Won't Need a Booster Shot for COVID-19: An opinion piece by Dr. Gandhi in the SF Chronicle.
American Kids Can Wait: Dr. Gandhi and two other colleagues make the case for sending the vaccines we're using for our kids who are at low risk to other parts of the world where the elderly and vulnerable would have the most to gain.
Episode 128: If You've Had COVID-19, Don't Get Vaccinated
Episode 114: We're in the Transitional Phase of COVID-19 Now.
Episode 127: COVID Independence Day
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