Ep 86 Epidemiologist Dr. George Rutherford

Automatic TRANSCRIPT

It's you know it's unfortunate but this is a moment in time this time next year this problem will hopefully be solved. Welcome to midlife mic statement. The podcast. I'm nancy davis co and we're here to talk about the years between being him and breaking one. We do Buluan filming by taking slung. Aim keenum who listeners. This year's thanksgiving celebrations may be the strangest on record between the hardships of twenty twenty and the fear of covid spread. It's unlikely we're going to be celebrating the holiday as usual. But that doesn't mean there aren't reasons to be grateful or ways to find more thankfulness in our lives and to make it easier. I'm giving away ten signed copies of my book. The thank you project. Cultivating happiness one letter of gratitude at a time over at good reads just head over to good reads dot com and search for the book or for my name. And you'll find the page that lets you enter to win. Of course you can also find the book in bookstores online and for audio download. All the details are davis co dot com. That's dav is k. h. o. dot com and. Hey the holidays are coming. How about writing a thank you letter to someone tucking it inside my very pretty little blue book. It's a double whammy. Science shows that you and the letter recipient will feel better with that gratitude letter in place between the two of you and then you can just sit back and talk yourself into some eggnog and sugar. Cookies it's thaad. Hey people were back. I'm nancy davis co. And i wanna thank you for tuning in house your stress level. I'm recording this episode on the fourth day of november third three days after the election swollen up about the outcome of the presidential race and hoping not to be dropping an episode during a civil war. I have to assume could happen. In which case may your toilet. Paper supplies be robust. Your reflexes sharp. Your battle hymns at the ready now. Let's gaels humor. But i don't know what we're supposed to be thinking or doing right now and i'm really looking forward to the day that i can go. Twenty four hours in a row without thinking about who the president is. Today's is a bit different than normal but given the circumstances. I figured you wouldn't mind. The deal is that i know an epidemiologist and in twenty twenty. That's quite useful connection to have so. I asked if he would come on the show not to talk about midlife but about cova where we're going what we need to know right now and yes of course. I asked him about his first concert. Burien you guys sent him some questions. I had some of my own and the result is today's interview with dr. George rutherford md. Dr roth avert is the salvatore pablo lucia professor of epidemiology preventive medicine pediatrics and history. And he's head of the division of infectious disease and global epidemiology apartment of epidemiology and biostatistics at university of california san francisco dr efforts expertise in the epidemiology and control of communicable diseases of public health significance with a focus on hiv ebola virus and zika virus infection in low and middle income countries. Dr weatherford service as an advisor to the centers for disease control and prevention and the world health organization. He's been involved in public health response to covid since the earliest days of the pandemic. So i'm telling you we got the right guy on the line. I'm going to be up front with you because this is not a fiction. Podcast you are not going to hear. That is great so climb off now. If you're waiting for a bedtime story that's gonna make you feel better however because i respect you and believe in your ability to remain common plan accordingly. I'm hoping this interview will help you take steps to safeguard yourselves your families and your communities and to finally finally put this stuff behind us so let's hop up on the exam table and have the doctor give it to a straight a. So i'm here today with dr. george rutherford george. Thank you so much for coming on the program today. Of course my pleasure. Now i don't know if you know this but regardless of what the situation is with the pandemic outside the larger world we always start the midlife. Mix tape podcast with the most important question. Which is what was your first concert in. What were the circumstances trying to remember. The name of the band was either is like alternate spinach or fresh spinach. Or some some stoner thing. This was in nineteen sixty eight. So where wasn't cal western which is up now called point loma nazarene college. It was in san diego. Fresh garbage was one of their snow. Totta dada dada. But i'll look it up after you know if i can find video for fresh spinach song. Fresh garbage will put that with the episode. Have that furniture. Something i i can remember. My father asked me. What band writes in the rolling. His eyes then it worked. That's the whole point. I feel like we have to make the former ask. is it. Okay if we ask you to be the midlife mix tape official epidemiologist and in return for you agreeing to do that. I was gonna offer to make you a mix tape. Sounds great. I hey do you. Do you have favorite songs about medicine. Are there any that really. Speak to you of medicine. Yeah or doctors Bad case of loving or or or the doctor john rosetta. I was feeling so bad. I asked by family doctor just what i had. So we'll put that in there listeners. If you've got any songs about doctors or medicine or health sending your suggestions to me because you know. I love nothing more than a themed. Mix tape challenge so george. I'm gonna put something together. That you know hopefully will will crowd source and give something something new to listen to in in gratitude for the service. You're providing us today. Wizard about kind of you. Thank you well. Every time i opened the san francisco chronicle and look at an article about cova and the pandemic. you're one of the experts who has cited. So i really am grateful to have your expertise here on the show and listeners. Most of the listeners to the show are what i call in the years between being hip and breaking one or you know in midlife which means we're not just thinking about kkob as it relates to ourselves which is plenty worrisome but also were worried about aging parents and younger people in our lives. And you know we can be worried and seventy different directions over stuff. We can't control before we ever get out of bed in the morning. So i'm going to start casting the question. Net wide with some really general stuff and then we'll narrow into question sent in by midlife mix tape listeners. So you and. I are talking in the the end of october. What's the state of play in the end of october. Can you talk about trends that you're seeing that are concerning and are there any better hopeful of where where are we. Let's get a level set of where we are with covert right now and you obviously are in the bay area but you have worked globally and you know we can be brought in this as you would like to be so there's very little that's encouraging me be frank. Europe is in the midst of a second wave of the pandemic. that's much worse than their first wave although it spread fairly broadly across the continent. So that you're not seeing the very localized outbreaks like in milano and parts of spain. It's much more generalized. So that the hospitals aren't getting killed yet in the united states. We've clearly entered. The third wave of an epidemic of our of our epidemic cases are increasing across the country. Although on a per capita basis there are astoundingly. Bad in places. Like north dakota south dakota montana wyoming utah zero missouri iowa nebraska places like that sort of upper midwest in terms of total cases. Texas now dominates the largest amount of all cases than illinois which really is kind of part of this upper midwest cluster and california's because our population so large. So that's what's going on in the in california however the signs as of like right now today is that we were in a plateau We're still at the tail end of the second wave of the epidemic without a lot of new evidence of a third wave. Starting although there have been some worrisome spikes and a few places but we'll have to see how those shakeout over the next couple of days whether those are just artifacts of people showing up all showing up at the same time to get diagnosed or whether they really are the start of a large Upsurge california's done really quite well. Compared to the other states for sure in terms of being able to stabilize Infection rates stabilized hospitalization rates and stabilize the test positively. It's a big complex thing trying to understand what's going on in california. What goes on in imperial county and what goes on del norte. County could not be more diametrically opposed. So it's it's it's big it's complicated. There's infinite amount of detail i mean. We obviously closed down really early. And there's other states that did as well we're just seeing those policies. Play out now. Is that. that's what i'm here with. The upper midwest steph. Those are states. that didn't have masking. Didn't have the kind of shutdowns that we have gone through. It was the wisconsin. Supreme court said. It was unconstitutional invoice in one one evening in may there now just being slammed like So our our early shutdown That's kind of long ago and far away at this point in time there's essentially no residual from it except economic in terms of disease transmission long on the second phase the second wave of the epidemic was quite generalized. It involved disproportionately Latino population of the state both in urban areas like the fruitvale district and oakland and the mission san francisco but also in agricultural areas. And we're still seeing high rates in cinema monterey imperial riverside counties which i think are probably kind of the tail end of the agricultural harvesting season Where we're still seeing the farm workers who are being disproportionately affected but beyond that in. That's kind of coming down. But that's coming down is a natural phenomenon because people are going to go back to their regular houses and not be living in. You know marginal housing in your the fields. I would hope that that dissipates over time. Now the other thing that's going on school reopening in school reopening as is a real thing that's going on and much of the state a slowly our opening the elementary schools i Which is the prudent thing to do. And we have not seen any school outbreaks yet. We've seen college outbreaks and but most of the colleges are pretty much sure shutdown right down. So that's ms unfortunately if you're your college student it's fortunate for disease control standpoint right. And how are you feeling about the vaccine research where we are with development of a vaccine. I mean the pictures loud and clear. We're not nearly to the end the road here and we've got some rough months ahead of us but obviously you know i keep thinking that if there's a vaccine this is when things are really going to change i don't know if that's even true so how are you feeling about the state of accede research and what does it look like when that is available. So i'm feeling quite confident about the state of vaccine research. Although there was a problem today in brazil needs to be figured out but the to Marin vaccines the moderna in the pfizer vaccines. I think we're going. We're going to start seeing data from those very quickly and we'll be able to move ahead with them They're not going to be very many doses to start within. These are all those vaccine schedules. So you need to get one dose and then a second dose either twenty one or twenty eight days later. There should be something like one hundred million doses available nationwide say by the end of december round guessing. At one hundred million doses. Translate to fifty million people to get vaccinated in california as fifteen percent of the popular of the of the population of the country. That's seven and a half million here now and happen. They're gonna try and distribute it a little bit more evenly across the states but in california. I think we're going to have enough to vaccinate some healthcare workers the ones who are regain. Icu's and emergency departments in a really forward-facing are ones that are going to see patients. If i had my way the first people i vaccinate or nursing home attendance and and congregate living facility attendance. Those are the people who can experience said can be big amplifiers often because they're not the world's greatest jobs and so people often work at more than one facility and so there can be a real kind of crossbreeding of oven of outbreaks. Um we've not having nursing home outbreak in quite a while except for one in santa cruz about four weeks ago when one recently in shasta county but early on fifty percent of the mortality was a nursing home. So that's one thing we're trying to. I mean those groups. I would give precedence to federal government's gonna break it off the top for its own purposes. You can well imagine that. The navy at who has had big outbreaks on big ships. Big important ships like nuclear aircraft. Carriers doesn't wanna be screwing around with us any more than they have to be right. I think that that's gonna come off the top. Then you have people people who actually live in nursing homes. You know how well their immune systems can respond to this. We're not quite sure. But hopefully the day. There will be a sufficient data on the immunization of older people as as his trial data. Come up they may well be at the top of the list and then we have this sort of amorphous. Category of essential workers. Whatever that means I think the guys picking the fruit in the fields are essential workers. That's that's my. That's my list of essential workers bazaar the ones with all the infection. Right now you know but there will be pressure that it's gotta be the the prison guards or it's gotta be the police or it's gotta be the fire department or it's got to be. The empty is probably get it right off the bat and who gets to make those decisions the governor. Cdc is making it as there's a. There's a committee that preceded trying to make recommendations for the nation of for the first round. But then it's gonna come down to the states in the states are going to have to decide what they're going to so it's going to be different in all fifty states of corporates. How we've done all this sure because it's been so effective. I hadn't even factored in that. It's a does vaccine so when you hear people saying they're going to be x number of doses available. You need to cut that number in half right exactly a guy you can imagine. The data the data complications that engenders as well. You're gonna have to really keep track of who's gotten vaccinated right and that doesn't even touch on the question of how many people are skeptical of a vaccine whether it's because they're antibac- sers or because trump said it was okay so they don't want to get his vaccine so i don't know if you've seen this governor newsom appointed up of people who've been on basically the big cdc immunizations committees in the past two independent review of the data. Before offering the vaccine in california. I did see that. California is putting in the second level of security basically to make sure that the vaccine does what what we hope it will do. And i guess other states will or will not depending on. Who's in charge new york. Did it already new yorker broke the ice on this one in. But i think if it gives people greater confidence that the vaccine's effective and more importantly safe we can put vaccine coverage from forty percent to sixty percent or even higher. I think it's an effort well-spent right. So what's a realistic time line. Do you think before. Joe you know joe blow on the street is going to be able to get a vaccine or nancy coast sitting in her podcast studios. Forget joe blow. I just want to know when my my kids can go. Get there's ally july okay and give it to kids by the way mine are grown up so there but okay. So they're not gonna. They're not going to be for kids. It'll be early. May not they may not give it to them right away because they may because younger kids are not they do get infected. They do get complications. They can die but it happens in so much less frequently than an older people or even adolescence. There's a vaccine sparing mode. You might. there's some suggestion about sprint kids about not activating kids right off the bat. Well in hopeful that has a vaccine gets more widespread spread the the risks kids will get even lower. just because i'm less likely to be infected. Yeah right you know. I heard you tell a story just wanted to ask you to share for this audience. I heard you talking about the impact of the motorcycle. Rally in sturgis. Can you tell that story again. Plays cr- i couldn't believe it. So sturgis south. Dakota's little town in western south dakota that has a big motorcycle rally every year and by big. I mean four hundred and sixty thousand. People come into sturgis south dakota for a ten day event so there was you know not you know i. I've i've seen all the pictures i've seen. Maybe one or two masks out of this whole crowd and it's cheek by jowl smack bars everywhere it just you know. It's like a perfect incubation model. In early september secured from august when say six to fifteen. But it's something like that. By early september there had been an there was an estimate that there had been two hundred and sixty six thousand secondary cases from sturgis. Either people who got infected there or people who got infected there in the came back and infected other people in their home counties that accounted for a nineteen percent of all cases in the us between august second and september. Second the estimated cost of medical care for this population of infected. People was twelve point. Two billion dollars which meant you could have paid everybody. Twenty six thousand dollars not to come. And that's i'm hearing it a second time. And i'm still just as stunned. Four hundred sixty thousand people. 'cause two hundred sixty six thousand cases so that was as of the beginning of september right so gotten now right which leads to my next question. Given the lack of cohesive national response and with colder months looming. What are the most important things that people can do in the coming weeks to keep themselves in their communities safe and i guess the short answer is. Don't don't pull a sturgis. Well the big ten's coming back with football games this this saturday. Now they're not. I don't forget people in the stands. And if they do that it's going to be at minimal capacity but those are the big crowd events that you worry about right or we get to the rose parade and stuff. Yeah you don't wanna pull any kind of mask thing but the real question is about smaller family gatherings as you know. We have everything from halloween to deal with. Those two thanksgiving to christmas and new year's coming up and there are all sorts of opportunities for small family gatherings which dr redfield at cdc has specifically started to warn people about. And i think those could potentially be large amplifying events. And you know i for one am eyeing the sort of fat tapan instead of turkey. My wife and i can split the thanksgiving. Have everybody else on zoom. Is that what you're gonna do i have. I haven't told her this bit of news yet. So i'm not breaking it to her. Yeah i mean. I think that's possible to do so. I mean we're gonna get to listener questions but that absolutely was one of the questions that came in from ellen said basically. She's got college kids coming home. Her kids were able to go live on campus. Although it's not the kind of semester that any of us have ever had on campus or envisioned for our children. But they're going to be coming back home. They go see the grandmother. It two states away to drive the grandmothers been by herself for months and months and months. You're saying collar on zoom. Everybody stay home. Yep that's i'm saying. I mean this is this is exactly the sort of stuff. I'm talking about exactly. Yeah and it's you know it's unfortunate but this is a moment in time this time next year. This problem will hopefully be solved yet. I mean i'm totally with you. I was trying to figure out if there's another family because all we're all here not mixing with anybody really. And i was trying to think if there's another family that we could invite over just so we're looking at somebody. Besides the four of us. And i had a friend who said you know what let's make a turkey sandwich and meet out somewhere for a hike and i'm like that. Sounds like a great thanksgiving to me for twenty twenty. Why even bother pretending that it's going to be the same holiday and like you said it's a moment in time it's one year and you know if you if you insist on having another family over have to tables and have m- outside. Yeah and and you know. Stay away from each other. Yeah we've got more questions for midlife mix tape listeners. But we're gonna take a quick break to hear from our sponsor the presenting sponsor of the midlife mix tape. Podcast is the amateur music network on this podcast and in my life i try really try to accentuate the positive as the song goes but sometimes just get a little bummed out of thinking about all the things we're missing out on because of the covid pandemic like singing. Maybe used to sing in a church choir or community chorus or just along with the crowd at a concert which was my main. That was my main venue. But that's not happening now. There's no rehearsals new group practice. Needless to say there's no performances unless you count singing in the shower. Which if you're in my house don't that's why i was happy to learn about amateur music network. A bay area that connects dedicated amateur musicians with professional mentors. And i'm especially happy to tell you about amateur music. Networks new series singing saturday's with ragnar bohlin. Which is over six saturdays. 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Makers even while we're apart sign up for singing saturdays by going to amateur music dot org slash workshops. That's amateur music dot org slash workshops and if you don't sing but do play a musical instrument checkout amateur music. Networks other online workshops. There's something there for everyone who loves making music all right. We're back with george rufford and we had some questions. Come in from you guys that. I'm hoping george you will answer for us Chris wrote in to say. What care should we be taking with stuff coming into our house like groceries and packages. Nothing now often. Unless it's glistening. There's not gonna be fun like they have to put it that way glistening so basically we don't need to be using the clorox wipes on the packages anymore. The foam transmissions pretty low pretty low. Might so word. I learned in two thousand twenty. That's one positive. I guess okay. Okay so for the new york city subway and there's a pole and somebody's been hanging on. It has been sneezing into their. And you know. yeah you can. You can get my transmission from that but aside from stainless steel and glass services. It's pretty pretty unlikely. It's funny because if he were to ask me what is a service that might actually be glistening. Thanks to a stranger. New york city subway pole would be my first response so that lines up. Chris also wondered whether he needs to wear a mask all the time when he walks outside or only when he's near other people in that is i have that question too. 'cause i take a mask with me to walk. I put it on when i see people coming but do i have to have it on all the time. Should you should people come up from behind jones stuff. I at some level. It's easier just put it on. Keep it on the not okay. Well my daughter pointed out to me that it's actually helpful for building lung capacity because you have to work harder to breathe if that's true but could use it at least to rationalize that answer that question. Yeah the answer. No doesn't increase the work of ruth okay. Increase smells breathing. Not the word. Capri them all right. Well keep the keep the mask on and put it on outside the front door and don't take it off until you get back inside. We're gonna easier all right. Jennifer wrote in and said. Are you able to estimate. Average immunity conferred from covid infection She had cova back in april and she's wondering if she still has any protection now. Don't don't probably about somewhere. Between eighty five and ninety percent of people develop measurable antibody but only about fifteen percent of people develop high levels of measurable antibody and these are the right kinds of antibodies neutralizing antibodies that are directed to the protein on the sars. Cov two virus that actually binds to the cell wall basically. It's the key that goes into the Those antibodies wayne overtime but all antibodies wayne overtime. And the question is if you get re challenged. Will you have an immune response where you can recall this immunity and start making antibodies so fast that you don't get sick. The other there are a number of other corona viruses. We deal with there are four that are of a different lineage the alpha krahn for you virologist out there and they are the ones cost common. Colds upper respiratory infections immunity to them. Way wayne's over about four months so the concern is that maybe this is really not long lasting immunity plus we now have about a half dozen cases of clearly documented. Reinfection sec action. But that's out of forty million cases worldwide so homages six make you nauseous like Who cares but it's you know the the concern is is that this may not be naturally acquired. Immunity may not be as long live as As we would hope that it is so does that just mean we get our double kovic shots every year along with our flu shots or is it the actually the way the shots will work is it will set up a little protein workshop in your cells that will spit out these spike proteins. So you'll be continuously exposed and you lab continuous high levels of of antibody. So that's the plan the issue that's come up here. Recently is the whole notion of herd immunity and if we just let everybody get infected which also means leading tens of thousand people get dead we would have naturally acquired immunity and everything it'd be hunky dory and then have to wait for a vaccine which by the way is coming in about three weeks you know land of short attention span theater a but you know there's no guarantee that that's gonna happen right there we're gonna actually that's actually going to be able to protect people so sweden went down this path to have You know pretty much open economy which crashed anyway and basically ended up with ten times. The mortality of norway and five times the mortality of denmark and managed to get maybe seven and a half percent of its population with an measurable antibody levels. Now they're having a second wave of infection just as bad as the rest of europe i. I don't think there's any real merit to displaying that. Oh yeah i had it. I have antibodies. therefore i'm immune. Although somebody said this last week was that. I cannot recall while. I don't think i if i were in your shoes i'd get vaccinated for sure. Yeah well it's funny. Bring up sweden murray had written and asked about how how was it. Sweden's positive cases per capita. Where only a little bit more than a third of ours when they never wore masks or did a shutdown but it sounds like we may not be looking at that the right way. Yeah well. They haven't looked recently. You know trump turns of numbers of cases and they had exceptionally high mortality Okay tim wondered what you think. Some of the long term ramifications will be for those who recover from covert and and whether there is data on the percentage of cases that will have those long term consequences. The long haulers. That's a great question. Unfortunately were The studies are just getting put together now to try and understand. What the risk is this longer term risk. And what's it's associated with. And what its manifestations are for right. Now i what i can tell you is yes. There is a risk of of long term complications. There are a whole variety of them that have been described. Everything from myocarditis through the heart muscle to blood clots to neurologic disease without have without following a cohort of one hundred thousand patients. Forward over time. You know we're not going to know. What percentage is this. And what percentage is that and what may be what may contribute to this or what may contribute to that. Those studies are being put together. Now it's not risk-free once you get it you don't walk away us off your knees and get up and go right back to where you were Sarel that's the thing that's so crazy about this herd immunity theory is you don't know which category urine before you get it. I mean i've a friend whose daughter is along holler and she's twelve years old and it's bad it's it's a really it's a really challenging situation to be in and you don't wanna mess around with it. There's one bit of information to walk away with today. It's don't get infected okay. And the way to not get infected is to wear your masks and do your social distancing and don't have company over for thanksgiving and christmas sorry not sorry and especially voiding. Crowds endorse okay. Because that was my question that i sent into myself george. When will it be safe to go to a concert again. Out indoors or outdoors indoors at the fox theater in oakland specifically that broken down. Yet the name of the fox out of your mouth. Don't talk about my favorite theater that way. Well it all depends on what state of the air handling units can do. We've been we've been trying to deal. Help the opera in san francisco was from. Ucsf and we're dealing with one thousand nine hundred state of the art nineteen thirties ventilation systems. Crank it up a little bit more What i fear will happen is that there will be a lot of hesitancy about vaccination and there'll be a lot of outright resistance about vaccination and only a certain proportion of the population we'll get vaccinated like half and those people will have some magic button on their on their cell phone that says they've been vaccinated and therefore they can go to the fox theater or they can go into a restaurant for dinner or they can go to a basketball game or they can do this or they can do that right. That's what i'm worried about. That's why i'm worried. We're going to have a tiered less will really you know get vaccinated in to a level where you can achieve artificial herd immunity which is probably on the order of seventy percent. We're gonna end up with a society that's going to be segregated by whether your phone as green bar on it or a red bar. That's a terrifying dystopia future. Yeah but that's what public health workers in the cdc if you let them do their job that's the kind of stuff they can work on. You can avoid if you just get vaccinated right while i've been. I know we're coming to the end of my time with you but I will ask you the question. That diane senton. If you could get everyone in the world to cooperate what could we do to eradicate the disease. And how long would it take. This is a disease that occurs in nature and so it will likely crossover again. So we're not going to be able to eradicate it so to put that out of your mind what to control it though what we need to be able to do in the absence of vaccine what we need to be able to do is to have aggressive screening and aggressive quarantine in isolation by aggressive isolation. I mean making it worth people's while to be isolated for ten days after they're diagnosed and that means if you're a guy standing in front of home depot looking for day labor. Somebody's gotta be paying your wages. Have a place for you to live improve. Give your family food okay. That's what that's what happens in san francisco and that's not what's happening in other places. That's what makes successful isolation and quarantine. There's no point in testing people unless you're going to isolate them being the isolation people who are infectious until they are no longer infectious now. This is a fairly crude way of doing this. But that's what that's what testing is all about it's for the purposes of isolation or if you've been exposed in are not infectious yet quarantine and societies. That have done a good job of this taiwan. Do this very aggressively. And don't screw around with it. I i would also say that the This is a bit of a theoretical discussion or extract attention span theater. I mean this what we've been doing. Obviously but you know when vaccine comes people get vaccinated right. Hopefully abba convincing solid vaccine with that has very low levels of side effects and is highly effective. But you know no vaccine is one hundred percent so we're gonna end up with a ninety percent effective vaccine to get to a seventy percent or admitting means we're gonna have to vaccinate seventy seven percent of people. That's a huge tall order right and the other thing is about these vaccines is that they have to be started minus seventy degrees so centigrade. So there's a huge logistical challenge with these things as well okay did not didn't know that either. Divide the number of vaccines by two and stick them in your freezer. Your coldest the universes called his coldest. Razor marigot griego. Is there a question that people should ask you. And don't i mean. I get asked two thousand questions today. I don't. I don't think so. I mean i think that you know. Basically all the knowledge was out there. It's a question of synthesizing it you know. I think we have to really see how the vaccine plays. How the The trials look like what the data looked like. And then we'll be able to really kind of entered this next phase of disease control. But i mean make no mistake about it. There were a hundred mistakes made by the federal government specifically in january february and march and they continue to go on and the one thing i would like to be able to come away from this with is a really clear plan with clear lines of authority and the right kinds of warning systems to catch the next one of these before they part goes down. I don't know if people know this. But usa id had an early warning system. Specifically for these things will branch of which was specifically in wuhan in china and it was closed down in october because usa. I decided it wasn't worth it. Okay that's the kinda nonsense just absolutely has to stop. Amanda that all right. Dr george roth aford were so grateful. You shared your expertise today now. We always like to wrap up our reflections on the years between being hip and breaking one by asking this final question. What one piece of advice do you have for people younger than you or do you wish you could go back and tell yourself. Oh that's an interesting question. I didn't see a great t-shirt the other day. I tell you this and said you know you're old when happy hour means naptime. I'm old i'm old. I love them so anyway. So you want you want a real answer. I mean that's a good one to if you go back and tell younger george roth aford or somebody younger than you. What would your piece of advice be you know. I think that you have to find something you like. Do get well trained and do it. I think that we're citizens of the world. And i think we should act that way and be responsible on a worldwide stage. I actually do business in five languages. So i would. I would encourage people to learn languages. It's good for your memory. You know yeah you can learn the piano. Yeah yeah yeah but unless it's close encounters of the third kind that doesn't really count as a foreign language. You and i guess my advice is don't be insular if you're going to pick large kind of overriding themes you know. Don't be insular There's lots of parts of the world and if we're gonna be able to survive as a species for more than a few hundred few thousand years more we're gonna have to take much better care of the earth and that means finding solutions and being able to cooperate with people and not go alone. That's very good. Advice is is one of your language. Is german i was gonna say feeling dunk fit. Your site does a I'm not gonna embarrassments up with my french. I didn't tell the story on the radio when i have to look. I was in paris day. My daughter who was gone over from wanted throughout like a long weekend at bought me tickets to the french open to the french tennis open and we go on a wednesday afternoon. And it's like the most complicated gotta show your passport twice and they got the you know the paramilitary police there in. It's is also french school children's day so it is this guy behind me who's pushing in line those long lines and he's like my age i finally said to infringe yourself. You're so important. Go ahead was poisoned. A course he goes ahead of me again. Of course he turns are anti turns around and looks to me. It looks at me says you canadians. Think you're so perfect. And then i wanted to say if it weren't press canadian jacques. You'd be speaking german shnell and a subjunctive and i would never get it right in a million years. Oh that's awesome. That is an excellent story. We're going to close on that. Thank you so much for being on the show. george. I really appreciate your time at dot. We'll talk to you soon. Okay thanks okay hope. That conversation was useful to you listeners. Love to hear what you thought of it. Thanks to everyone who sent in a question and apologies. I didn't have time to get to all of them but there was a lot to discuss. I seriously want to make dr at the verte medically famed mix tapes. So please be sure to semi song ideas. I wanna be sedated. Feels right to me about now but maybe there will be better news by the time. The episode airs. Email your suggestions of songs to dj at midlife mix tape dot com or send me a message via instagram facebook or twitter at midlife. Mix tape when i couldn't find any fresh garbage songs about spinach but i found one about spirit so check out the show notes for a taste of the band. That may dr rutherford's father roll his eyes. I wanted to mention that. I'm still adding transcripts to every episode in case you prefer to read rather than listen. And now i've started the project to go back and add transcripts to older episodes. So let me know if you're finding that to be helpful. It's a big job. I hope it's adding some value. I think. I think it's a good thing to do but this week i have to say i was kind of cry laughing because i was cleaning up the transcript for episodes seventy one the fantastic listener shenanigans episode. Which is so funny but it was from back in late march twenty twenty when we were baby hunkered downers and i was making jokes about having to be inside for a whole week. Oh my gosh. that's a long time ago. Anyway join me next time. When i interview fairy godmother joanna bloor. That's all. I'm saying about joanna. I know you're intrigued. Come back all right. Take good care. All of you don't stumbling down three would have be stolidly that baranov. I'm only three had the me would have you want from me. B b b. He won't be.

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