It’s Cold & Flu Season. Here’s How to Protect Yourself.

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I'm your host, Dr. Abdul El-Sayed.

As I read this, my throat is sore.

I've been dealing with the same virus for it seems like months now.

The sore throat, the sniffles, a cough that gets particularly bad at night.

It's a hazard of having two kids in daycare or elementary school.

They're like walking niduses for disease.

They spend all day up on the other walking niduses they go to school with, only to come

home and sneeze in my face.

They bounce back within a few days.

But me?

No.

I'm lucky to get a reprieve at all before the next one.

That's the story for millions of households across the country right now.

Because let's face it, it's cold and flu season.

Try as you might, you're probably going to come down with something.

For healthier folks, the annoyance of a cough or sneezing, runny nose, or a sore throat

is bad enough.

But for infants, seniors, or people with immune deficiencies, it can mean the difference between

life and death.

What makes that so frustrating, though, is that it doesn't have to be.

For all the valorizing we do about the good old days, they just weren't that good.

People routinely died of diseases we've learned to control.

We've had shots for COVID for almost four years now.

We've had shots for the flu for more than half a century.

And as of this year, we've got shots for RSV for seniors.

But people just aren't taking them.

COVID vaccine uptake is in the single digits.

Flu vaccine coverage is lagging behind last year's.

People just aren't getting their vaccines.

What the F?

We literally just lived through a pandemic that took 1.1 million lives.

People are well aware of how important vaccines are.

But somehow, the myths and disinformers, they're winning.

Make it make sense.

Look, if I don't say this again for the rest of this episode, get yourself vaccinated.

But part of the problem is how hard it's become to get your vaccines in the first place,

even if you want to take them.

We should be putting these any and everywhere.

Instead, particularly to get vaccines for kids, we've got to wait months.

And all of this is the consequence of a set of policy choices our federal government made.

Rather than making them readily available everywhere,

our government biased the profits of corporations that manufacture these vaccines,

even though you and I, the American taxpayer, paid for the R&D for them.

This policy, called commercialization, has been a complete and utter failure.

But that's not the only policy failure when it comes to protecting ourselves

from preventable infectious diseases.

The other is that we failed to take air quality seriously.

Think about it.

The pandemic taught us anything.

It's that keeping our air pure should be the absolute number one priority

when it comes to preventing infectious diseases.

Lockdowns, masks, all the things we did in the first moments of the pandemic,

they were about keeping people from breathing air

into which someone else had breathed COVID just a few moments earlier.

That simple.

But there are more efficient ways to do that.

Requiring air purification and ventilation standards in buildings where people congregate,

whether workplaces or, perhaps more importantly, schools and daycares,

that should be the priority.

Those kinds of standards are probably even more important than vaccination campaigns

because they embody the best of what public health has to offer.

They're passive, altering the nature of the environment in which we operate,

protecting us from disease without requiring us to do a thing about it.

In my home, we're purified up.

We've got air purifiers in every single bedroom and in the rooms where we congregate.

It was an investment, sure, but one that I think is well worth it.

The other benefit?

Air purification and ventilation is way, way less controversial.

Who doesn't want to breathe cleaner air after all?

But unfortunately, there just hasn't been much effort to make that happen.

You'd think that state and federal leaders would be clamoring

to make these kinds of requirements, to provide funding for retrofit.

Aside from pandemic-era funds for schools, this hasn't been a priority.

So here we are, facing another season of COVID, flu, RSV,

and the annoying myriad of viruses that cause us colds every year.

So to help me think more about what we can do to protect ourselves,

I wanted to reach back out to a friend of the pod and a fellow epidemiologist.

Dr. Caitlyn Gentolina is a professor at the Texas Health Sciences Center

and author of the substack newsletter, Your Local Epidemiologist.

She joined me to talk about why, nearly four years in,

our society still isn't doing the basic things right

and what all of us can do to protect our families.

Here's my conversation with Dr. Caitlyn Gentolina.

Okay. Can you introduce yourself here at the tape?

I'm an epidemiologist and author of Your Local Epidemiologist.

Like you're all of our local epidemiologists.

I'm grateful to have a conversation with my local epidemiologist

as another local epidemiologist.

We're talking right now because we're in this sort of weird moment

in the pandemic slash infodemic slash multidemic of the winter.

I think for a lot of folks, the experience of COVID has given technical language

to the thing that we have been experiencing for the winter for a very long time, frankly,

ever since the early 1900s when the flu came roaring through.

Then all of the other, you name the diseases that we tend to get

because of human behavior when it gets cold outside and people like to come together.

The ones that we're going to talk about specifically today are COVID, flu, RSV,

and then the common cold.

But it is something for us to be thinking about in the context of a COVID pandemic

that hasn't really ended and a set of dynamics that have been amplified and changed because of it.

I want to start very local for you.

How is your family faring in this moment of the holiday sniffles, sickness, feel like crap?

Hopefully, you don't hear them in the background because they are home right now with fevers.

We had a lot of people get sick during Thanksgiving, unfortunately.

We've been testing COVID.

It's not COVID.

So I'm thinking the flu or some other kind of crap that's out there right now that's

circulating like you just highlighted.

I don't know who was patient zero.

As an epidemiologist, I want to uncover that.

But I don't think it one really matters.

My kids go to daycare.

There's a lot of stuff circulating at daycare.

Cousins go to school.

My husband was traveling for work.

It could have been anywhere.

So in our family, my infant daughter was feverish and sick all last week.

We think she got it from my older daughter, but it's unclear because she goes to daycare.

My daughter's in kindergarten.

It took me a month to get over some cold-like post-viral thing.

I think a lot of us are just sort of feeling that way this year.

And then there are the more serious illnesses, the flus, the COVIDs, the RSVs.

Sort of zooming out from our local epidemiology experience to a broader experience, what are

the numbers telling us about this season writ large?

So this was actually a really big question, as you know, we had among epidemiologists

was like, how is this winter going to play out?

Because we've not really seen, I mean, last winter was the first time we had all three

viruses back.

It was a really weird year.

So we were kind of waiting to see how things unfolded.

Right now, today, we are at above epidemic levels, which means that we are seeing a lot

of viruses circulating that we typically see during flu and fall and winter respiratory

season.

And all three of the big viruses, right, flu, RSV, COVID, they're all increasing exponentially.

RSV is really taking the cake right now.

But flu is quickly falling behind as well as COVID.

I think the biggest concern on a population level is what that means for our healthcare

systems.

If all three of them are surging at the same time, can our healthcare systems take that?

They didn't really take it well last year, and we're not building capacity.

In fact, I would argue we have even more lower capacity because of burnout and people leaving

the job.

So I don't know.

I was taught during the pandemic that I shouldn't make predictions, but we'll see how things

continue to weather in the next coming months.

know we're headed into a time of year that is notoriously bad for the spread of these

illnesses.

We know that there is the consequence that these illnesses have for our healthcare systems

capacity to take all three hits at the same time.

And we know that these three diseases are deadly and they're extremely serious.

And the fourth thing we know is that there are things that we can do to protect ourselves.

And unfortunately, when it comes to those things, we're kind of not doing a great job

of it.

This has been an abysmally bad vaccine season.

Why do you think that is?

It's actually really, really bad.

There's a couple of reasons.

I mean, one, we're seeing abysmal rates of uptake around COVID-19.

Many reasons for that.

People are just tired about hearing about it.

And then two, there's a lot of misinformation out there still.

And then three, there's a whole nother layer of complexity with COVID vaccines this year

because now they're privatized.

So access, cost, education, outreach, all of those have been taken back.

And I think we're starting to see that in the numbers, particularly around vaccine disparities.

And flu vaccine is lower than normal, but I'm hoping that catches up soon.

RSV vaccines for those over 60 is also just abysmally low.

I think it was like 9% uptake among those over 60.

And I think that is because of what we're also seeing with COVID, that there's just

a newfound hesitancy around new vaccines, as well as just education and outreach.

It's public health 101 that our funding is getting taken away.

And so we're going to continue to see that in uptake numbers.

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I want to drill in on a couple of these points that you made, and I want to get to the notion

that they're separate, but they do interact with each other.

But it is worth sort of thinking about how they operate independently for a moment.

When it comes to COVID, I think the operating hypothesis many of us who do this work would

have had would have been that after a deadly long pandemic moment, three years during which we

really suffered, and almost everybody knows somebody who passed, that rather than walk away

from this thing and pretending like it never happened, we would be thinking about how to

protect ourselves moving forward. But that's just actually quite the opposite.

We have this impressive ability to want to shed the past and pretend like it actually

didn't happen to us. You've done some writing about this idea of pandemic revisionism.

And I do think certainly the misinformation around COVID and the vaccines in particular

have something to do with it, but also tells us something pretty profound about human nature when

it comes to risks that we face. Can you tell us why you think there is this sort of willingness

to almost ostrich about what we experienced over the last three years and this notion that somehow

if you don't acknowledge it, you don't do the things around it, that somehow you can kind of

get past it, even though the numbers are telling us that's just decidedly not the case?

to COVID-19, we're kind of leaving it in the background. We have abysmal vaccine rates

compared to, for example, the UK, which is like 68% vaccinated at this point. I think that,

I mean, I talked a long time with a psychologist in San Francisco about this because I was so

curious about what we are seeing unfold in real time, this idea of revisionism. And there's

actually a lot of psychology that goes behind it. Part of it is survival bias that, hey,

we survived. Actually, maybe because we survived, it maybe isn't as bad as I thought. And so we can

kind of continue going forward. And that's not the case because we already lost a lot of people.

Our experiences and our biases very much craft our memory. And we'll continue to see that play out

in a lot of different public health emergencies. We see that with mass shootings as well,

that it didn't impact me, so it's okay, we'll just keep going forward. It's really hard. I think also

there's a study that came out a few weeks ago. You might have seen it, Abdul, but it was about

how those that were most stressed about the pandemic now remember the pandemic in worse terms

than those that were not stressed during the pandemic, and now they think it in better terms.

And so it's very much not data in, data out. Our biases certainly craft how we remember and how we

we count yeses or nos on things like vaccines, but oftentimes there is a almost extreme response

to whether or not you believe that COVID is still a risk or it's not. And there is a notion that

because COVID is still about, the numbers are increasing, that we're right back to the worst

of the Omicron surge, which is not the case, decidedly not the case. And on the other side of

it, like you said, there is this revisionism about whether or not COVID was ever real in the first

place, whether or not there was actually a thing. And it's impressive because the only way you can

interpret that is that people are assessing their sense of what happened through the lens of their

emotions about how they felt about it while it happened. And that's what this study is suggesting.

But it also has real implications for behavior and our ability to make common sense about an

experience that we went through, and then what we do about it moving forward. And that really,

to me, is the bigger risk. Because it's not just that individuals out there are choosing not to

take their COVID vaccine. It's that the federal government responsible for ushering in those

vaccines in the first place took a real gamble on whether or not, for the sake of enabling the

corporations that have profiteered off of that government investment, whether or not it was worth

fully commercializing them and interrupting the supply lines that we had spent years creating to

make sure every single person could get them. And in my day job, I run a municipal health department.

And we've had to think about how do we vaccinate incarcerated people? How do we advise the public

about where to go? Because if you're insured in our county, you can't come to our health department

and get a COVID vaccine. You can get a flu shot, but you can't get a COVID vaccine, which just

makes for some really interrupted messaging, right? If you're of this particular insurance

status, you can go here. And if not, you should go here. And at some point, people are like,

okay, that just sounds real confusing. And maybe I'll think about this later. And we all know that

the more complicated you make a message, the lower the probability people are to follow it.

And to me, I see this as a pretty serious abrogation of responsibility on the part

of the federal government. You mentioned this among the causes. How big of an issue is the

disjunct COVID supply chain as a function of the commercialization of the vaccines?

and public health system. And that was wide open during the pandemic. And we saw this through

disparities. We saw this through access. And I think a lot of it was ironed out because of the

one purchaser kind of model we created during the emergency, but we're back to normal.

And actually, just this morning, right before this recording, I was analyzing some data in

California and on a hyper local level on whether disparities are widening because we are back in

this privatized model. And it looks like it is. So that means that there's a lot of people

hurting that there's going to be these disparities that are always going to be there until we make

huge systemic changes. And I hoped optimistically that an entire pandemic, more than 1 million

people dead would actually drive that change. And maybe it is slowly inching towards a change

somewhere, but it's just something I've been disappointed to see.

is so that the corporations that manufacture these vaccines, the research for which was paid

for by the federal government can make more money by charging more. And the upshot of all this is

that there are so few shots in arms that they're just not making the same amount of money because

there's just not that many people taking them. And so, yes, their per unit cost is higher and

their per unit profit in theory should be higher. But if you're not getting shots in arms, you're

selling your product. And I just think it demonstrates the way that our healthcare

system shoots itself in the foot over this notion that a public good ought to be profitable in order

to be publicly available. And it is such an indictment on, I think, everything we've learned

and everything we are yet to still learning because the lesson clearly hasn't stuck.

And then the last point here is just the misinformation ecosystem in which a lot of

these decisions are being made. On the one hand, obviously, the misinformers that went into

hyperdrive during the pandemic have not stopped. They've somewhat moved on. They've transmogrified

the grift elsewhere, but it has not stopped focusing on COVID. I want to ask you, what do

you think as someone who spends a lot of your time communicating to the public about this,

what do you think it'll take to insulate people's minds from the impact of this

persistent misinformation? Or are we just doomed? At this point, this is sort of baked in stone.

past couple of months of what does this look like? I think one is that, yeah, we can focus

on misinformation. And sometimes there is a role in surveillance of misinformation, for example.

It's always going to be a game of whack-a-mole though. And so I think as well as surveilling

and combating misinformation on the ground, you also need to build trust and do proactive

communication, particularly from, again, trust in messengers, whether that's your health department.

The challenge though with public health is how do we increase capacity with very little funding?

And where does something like this live? Maybe scientific communication, proactive communication

doesn't belong in the federal government because you're going to lose half the people in the United

States because they're not going to trust that information. And so to me, the biggest question is

how do we equip trust in messengers? How do we get them information as well as how do we

listen to communities? How do we be responsive to the needs they're faced with today rather than

what we think that they're interested in? And creating that bi-directional relationship with

communities. And so I think that all of this is going to take a ridiculous amount of time,

but I think it starts out with re-imagining public health for the 21st century that we can't use our

old 19th century public health tools in fighting this new information landscape. And we need to

be a whole lot smarter with it and even leverage technology on how to be better at it as well.

the things I get real frustrated about is because we tend to think empirically because that's the

nature of public health training. We assume other people think empirically. And I think one of the

numbers that we tend to lead with is that death number. And given what we talked about earlier

about that survival bias, I think people almost come away, they'll never say this, but they come

away with this almost sense of invincibility. They're like, I'm not going to die of one of

these diseases. That's nuts. And look, I already lived through a pandemic for three years. This

flu is not going to get me. And I think we lead with the wrong statistic because most people don't

have an experience. Well, everyone by definition who's alive has no experience of dying. And most

people don't have a clear experience of having had a infectious disease that almost killed them or a

loved one. It's not something that they saw in their faces. And I think the thing that we probably

should lead with is more like, hey, you probably just don't want to get the sniffles. You don't

want to have a fever for three days. You don't really want to be, yeah, you don't want to miss

days of work or your kids missing days of school. This is a way to fix that. And I think sometimes

we think like, all right, lead with the most extreme, and then you're going to get people

to pay attention. And the problem with that is that the extreme sounds so extreme and people

don't have an emotional analog for it that they dismiss it out of hand. And I think we ought to

be better about having just simple conversations about experiences that people have had for sure.

Everybody who's alive has had this experience of having a fever or a really bad cough or whatever,

and leading with that. You talk about this idea of passive positives, which I really like,

which is it kind of highlights the gap between the number of people who would get vaccinated if

there was a little nudge from a healthcare provider or public health messaging, but end

up not getting it because we're so focused on these big, the clash of misinformation and truth.

I want to ask you, as you think about what actually is going to encourage people to get

a flu shot, to really do this basic thing of getting a COVID shot, if you're over 60,

getting a RSV shot, what is the right interaction, whether it's with a healthcare provider,

as many of our listeners are, or with a loved one who just cares about somebody in their life?

What does that interaction look like? And how can we, in our own communication,

learned from a fellow psychologist. I don't think we leveraged behavioral science as much as we

could during the pandemic. We leveraged lab science. Passive positives, I estimate is 35%

of the population, so it's a big chunk of people, big chunk of Americans-

three, four COVID-19 vaccines, but didn't get their fall vaccine last year, haven't gotten

their fall vaccine this year. And the reason because of that is maybe they just want to

tune out COVID altogether, they're just tired, or they don't know they're eligible, or it's really

hard for them to get the vaccine. And so to me, I think public health needs to be, and healthcare

providers need to be laser focused on passive positives. These are the low hanging fruit to get

vaccinated. And so, I mean, bottom line, we just need to make it as easy as fricking possible for

them to get their vaccine. I went and got my COVID and flu vaccine at Costco a few weeks ago, and

while I had to make an appointment, I showed up, waited five minutes, got both vaccines, great,

I continued shopping. But when I was waiting in that five minutes after you get your vaccine,

just to make sure you're good, there were, I counted, eight older adults, probably over the

age of 80 that came by the booth and was like, hey, I would like to get my COVID shot. And they

were told they have to wait an hour and a half, and they just kept walking. And it killed me,

it killed me. And so, and I don't, you know, that's not the, I don't know, I don't think it's

the fault of the Costco employee. In fact, the Costco employee was doing amazing answering their

questions. I was so proud of her on her answers. It's just that how do, what are the processes,

and we can make that better for them. And so, a lot about what Passive Positives is, is once

they decide right then that they want a vaccine, they are able to get the vaccine right then.

And so, what that means, talking to your grandma about a vaccine, you drive them to CVS to go get

it. Or if you're a healthcare provider, you have the vaccines available right there for your

patients at the same time. I mean, my kids, my girls don't have their COVID-19 vaccine this fall.

It's, the closest one to me is 75 miles away. I mean, it's just, it's, access is abysmal. And

we can't expect people, especially Passive Positives, to get it if it's that challenging to get.

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get your podcasts. What you're speaking to is ultimately a lack of investment. It's not

necessarily Costco's fault as much as it is we have not invested in getting these vaccines

at the point of contact and incentivizing shots in arms in the way that we ought to,

in the way that we know can save a lot of lives and prevent a lot of illness.

That problem is that we've hook, line, and sinker bought this idea that it's a commercial product

like any other. If you go by the store and decide that you want to buy that bag, okay,

buy that bag. But if you don't buy that bag, oh, good. It's just not how vaccines work.

There is a incentive to get them in arms, and we don't do a very good job promoting them

and making it easy to take down the transaction cost that unfortunately has been such a barrier.

To the earlier point, we've made that transaction cost far worse. You obviously, very, very few

people could be more pro-vaccine than you or I, but I'm in the same boat. It's really hard.

We had to make a whole appointment for both of our kids to get their shots, and those appointments

are in a month. I'm like, y'all, we're missing the boat here. You should be reaching out to us

and saying, hey, have you scheduled your vaccination appointment? Rather than us

reaching out, realizing that we're not going to be able to get an appointment

for a certain period of time and then waiting. Same situation. We've looked and looked and

looked. It is very, very difficult to find a place to go. At this point, we're like, okay,

well, I guess we have an appointment scheduled. You and I are both people who do this for a living.

It ends up being like... It should not be this difficult. I highly doubt that the average person

has the time, energy, or knowledge of the system to be able to game it the way that unfortunately,

folks who really are motivated have had to. They don't.

epidemiologist in the UK the other week. She was wondering if the government provides reimbursement

to pharmacies like CVS or Walgreens to administer the vaccine. I told her, this is a very complicated

question actually, but typically, no, that they're paid through health insurance. She was like,

so then say a vaccine is recommended, do people with private health insurance then get invited

by their doctor or pharmacy to go get that vaccine? I was like, no, you have to go proactively find it.

She's like, well, doesn't that mean a lot of people don't do it then? I'm like, yeah. This

is the whole problem compared to national health systems like in the UK. It's really frustrating

because that's fewer people who are going to be in the hospitals. Unfortunately, in our system,

just to be clear, and I'm not saying that there's any effort to do this, but in our system,

the moments that money is made is when people consume healthcare. There's a lot more money to

be made when people get sick than there is on offering a vaccine. When you just incentivize

based on medical care provided, you end up getting these really, really perverse emergent outcomes

where there's just not that much effort being put into getting shots in arms because there's just

not that much money to be made. It really should force us to step back and ask, how come we don't

do these very basic things well? A lot of that ends up coming back to how money moves in our

system or doesn't move. I want to ask us, because one of the most important things that we could be

doing that we're really just failing at is addressing one of the central features of our

lived space that we just take for granted, which is you're inside right now, I'm inside right now,

both of us are breathing air. That air is a big reason why when someone has COVID,

other people around them get COVID. We don't do as much to purify that air, particularly in crowded

spaces, think schools or shopping malls or workplaces as we should. That's a matter of

public policy. There are choices that we could make about how we certify indoor spaces, about

what kind of HVAC we require and what kind of purification we require in these spaces that

there hasn't really been much movement on. How do you think about indoor air purification and

what's needed now so that we're ready for the next time we end up having a very, very serious

aerosolized virus that's causing hundreds of thousands of people to die?

because it works in the background. The individual doesn't necessarily need to do anything.

It's working invisibly. What it does require is kind of what you're getting at is institutional

level action. That institutional level action is just something we haven't seen yet.

And for example, schools were given funding to upgrade their air and ventilation systems and

only 50% of schools actually did it. The money is still there. It's still available for schools to

use. It's just not being done. I don't know why that is, but I do know that this doesn't just

need to happen because of pandemics. That would help with flu. It would help with other

coronaviruses. It would help with RSV. It would help with climate-related things that we're

seeing. For example, the smoke that we saw in the Northeast last summer. Upgrading AC would also

help keep kids in schools. For example, in DC, when all the schools were closed because of the

heat wave. And then there's just this chronic healthy building syndrome where you just feel

like crap too sometimes when you're just breathing the same stuff. We can actually be a whole lot

more productive if we start cleaning our air. I don't know. I think that the pandemic did

I renew a sense of conversation around this. I will say this is the most I've ever really

kind of seen it been talked about. I know though that there's a lot more that needs to be done

pretty quickly, I think, so we can be living our healthiest life.

best when we're invested in institutional structural level change rather than individual

level change. And I think one of the unfortunate consequences of the pandemic is that it was the

first time a lot of folks were introduced to public health and they were introduced to us

in the most individualized way, where the folks telling you that you should get your vaccine or

you should wear your mask. And that's just unfortunately not what public health is at

its best. I think it's what we've allowed public health to become because in so many ways we've

sterilized ourselves from taking on power, but it is not where we operate most effectively.

And I think in that respect, there's a lot of opportunity I think we have to engage with

partners in different industries, commercial real estate, and then certainly legislative

partners to try and up the ante on what should be expected when you step into a building. And

the consequences are not just COVID. The consequences are any respiratory illness and

then any air quality related illness. And given what we're seeing with climate change, as you

talked about in the bad air days that we're increasingly experiencing, this ought to be

something that we're making a full steam invested in. And a lot of economists who study this,

and we've had a couple on the show, talk about this moment, not just being about climate change

mitigation, but about adaptation. And that means how are we changing the way we live vis-a-vis

the reality of climate change is going to bear down upon us. As we step out, a lot of the other

things that we can do to protect ourselves using testing, which is again now freely available

through the federal government, and masking. You're seeing a lot less use of these,

but they remain very effective. I think part of that of course is the conversation that we shared

about our instinct to run away from a bad experience that we've had and pretend like it

never happened. But part of that also is that I think there's a peer pressure effect. How are you

thinking about this moment when it comes to masks or when it comes to testing around large indoor

the United States, which is I think unfortunate. It shows how much these became symbols of tribalism

rather than tools of protection. We're very social animals, and so peer pressure and social pressure

is a very big thing. I feel awkward, I'll be honest, wearing a mask at the airport. I don't

know if I necessarily care, but I do feel that. I guess I'm not surprised that so many other people

feel that. I will say though, just traveling over Thanksgiving, I was really happy to see many of

those over 60 were wearing a mask and actually a good mask, an N95. I think we did make progress

there. We wouldn't have seen that pre-pandemic, that's for sure. Masks work. They work on an

individual level. That's a physics question that we cannot deny. Testing is interesting. Even I have

mixed feelings, at least now on asymptomatic testing, because there are so many false

negatives at the beginning of illnesses that given the cost for a family of four and doing

cadence testing every other day, that adds up. What tests are very good at is telling us when

we're not infectious anymore. Once you get that positive, when that positive turns negative,