Episode 154: Rethinking Vaccine Mandates and the Omicron Variant with Dr. Monica Gandhi

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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 where we discussed the delta variant 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 the first to point out how she has been very supportive of mandating vaccines in the general population and specifically for health care workers. She has written extensively in many local and national outlets about the case for vaccines to reduce transmission of SARS-CoV-2 and hospitalizations. However, she has begun to rethink her support for these draconian measures because of a number of reasons:

  1. It can cause a problem with mental health in those who are restricted from interacting normally with society.
  2. It erodes the public trust in public health officials and well established measures.
  3. Even when vaccinated and boosted, those individuals can still become infected and infect others limiting its value as a way to stop transmission in its tracks.
  4. The political payback for politicians who support these measures may be significant at the ballot box.

Are there Good Therapeutics Coming Out?

One of the more exciting developments out of the pandemic is the emergence of designer drugs for this coronavirus. The newest therapeutic drugs are protease inhibitors which can be developed with a specific virus in mind. These drugs work by blocking the ability of the virus to successfully hijack your cell’s ribosomes to create more viruses. Molnupiravir has been approved by the FDA but hasn’t been shown to be all that effective because it was not designed with this specific virus. However, the new drug Paxlovid has show extremely high efficacy approaching levels seen with the vaccine around 90%. The advantage of these drugs is obviously that as soon as you show signs of symptoms it can arrest the extent of the infection and prevent hospitalizations and worse outcomes.

Is Omicron Worth Worrying About?

Finally, the question of whether the new SARS-CoV-2 variant, Omicron, is one that should concern us was posed to Dr. Gandhi. Much like the Delta variant, she is very confident that those who have gotten an adequate immune response from vaccination or prior native infection should be well protected from serious harm. Additionally, reports out of South Africa and elsewhere have seemed to show that this variant causes a much more benign infection. She believes it is possible that this variant – if it is truly more infectious but benign – might be the world’s ticket out of this awful pandemic.

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