Long COVID: The Experts Were Wrong

Episode One.

Could you have Long COVID and not know it? Possibly, according to Dr. Ziyad Al-Aly, a leading Long COVID physician-epidemiologist who explains what the condition is and how it has impacted hundreds of millions of people around the world. We also meet Hazie Thompson, a former cook living with Long COVID, who shares what the experience has been like for them.

More than 400 million people (and counting) are affected by Long COVID around the world. Dr. Ziyad Al-Aly is a physician-epidemiologist and TIME 100 Health awardee in St. Louis. He is one of the world’s leading Long COVID researchers.

As we approach the grim 5th anniversary of the COVID pandemic, he joins Daniella on Public Health is Dead to outline a major public health challenge of our time: If we don't die, what happens to many of us after we survive a COVID infection? Especially if we keep getting reinfected?

Dr. Al-Aly explains what listening to patients allows the best researchers to do, addresses some of the common rebuttals to his team’s study data, and shares his recommendations to help turn this public health failure around.

We also get to know Hazie Thompson, a former cook who has been living with Long COVID in Toronto since 2020 – they share how the condition has affected them and what they would like healthcare providers to know.  

The stakes of ignoring Long COVID are high.

People with Long COVID have been dismissed and ignored to everyone’s disadvantage because more people keep joining the ranks. There’s a lot of research. There are a lot of reports. But our public health leaders are pretty quiet about what Long COVID can do to us. Something’s getting lost in translation. And you deserve to know.

Dr. Ziyad Al-Aly | Image from University of Washington at St. Louis

Hazie Thompson | Image provided by Hazie Thompson

RESOURCES

Experiences of Canadians with long-term symptoms following COVID-19 - Statistics Canada

BIRCH Project (founded by Hazie Thompson)

New York Times op-ed by Fiona Lowenstein and Hannah Davis

Long COVID science, research, and policy by Dr. Ziyad Al-Aly et. al. (2024)

The Sick Times & Long COVID Justice Resource Sheets

Find your nearest Maskbloc on the Worldwide Maskbloc Directory

• Transcript

  HAZIE: The science that you knew when you finished school has changed.  The science wasn't finished just because you finished. Science is still doing stuff all the time, even when we don't want it to…
  
  DANIELLA: A lot of people’s reactions when they hear COVID is: their eyes glaze over, they turn away and stick their heads in the sand. 

  Ignorance is bliss, amirite?

  If someone sent you this episode and that is what you’re about to do then I’m specifically talking to you right now. 
  
  *tap on glass sound*

  whisper Don’t do it. 

  I’ve got a challenge for you before you turn this off. 

  Here it is: all you have to do is listen. 

  There is about an hour of this. I’m sure you have laundry to do or dishes to tackle. 
  
  And I’ll even go further – listening to this episode about COVID doesn’t mean you have to change anything about how you act. 

  Maybe you will, maybe you won’t. But my challenge to you? Just. Listen. 
  There’s a lot of stuff in here that might help you or help a loved one now or in the future. And you deserve to know.

  DANIELLA: We haven’t been told much about it from public health organizations but it’s very possible you, someone you know or even your kid is experiencing long lasting impacts from a COVID infection. Especially if they’ve gotten it more than once.
  
  These long-lasting symptoms are often called post-COVID symptoms or as patients have named it: Long COVID
  A lot of times we hear things like “I don’t know anyone with Long COVID”. But if you live in Canada and you know 9 people, you do, probably -- it’ll be one of those 9. And sometimes people don’t even realize they have it themselves because there’s so little public health information. So if they don’t know, they’re not gonna tell you.
  
  Hi I’m Daniella - I’m a lifelong public health advocate with a background in epidemiology, and health science. I also have a track record of troublemaki Mainly about anti-Black racism and queer issues but everything is connected to public health.

  I’ve made podcasts for big nonprofits and little indie projects. So lucky for you, I’m putting it all together for the first time in Public Health is Dead, which I’m calling your anti-establishment field guide to surviving in the age of pandemics. 

  Why? Because institutional public health is failing us. Our leaders are failing us. And I guess we’re going to have to do this ourselves.

  I’m gathering a bunch of people who know things to help guide us through a world where capitalism fuels climate change fuels pandemics fuels public health disaster.  

  But before we get too deep into it today, there’s someone else I want you to meet.

  HAZIE: My initial, um, symptoms, March 15th was the first one. It wasn't until mid April that I lost my sense of taste and smell. I was literally eating  and I had a bite of food and then the next bite of food I couldn't smell or taste anything. It was like a light switch turned off. But I had absolutely no congestion whatsoever. The connection from my mouth to my brain had gone out.   

  This is Hazie Thompson, they’re the founder of the Birch Project, Black Indigenous Racialized COVID health. They’re also a Black person living in Toronto who developed Long COVID after first getting COVID in March 2020 

  I didn't know what was happening. I was really scared. I didn't, and I, before that, um, now it's really funny because the next thing that people usually say is like, I was a long distance runner, I was a mountain climber and it's like, no, I was a cook.

   I have a great palate. I'm not going to lie. I have a great palate. Laughs. There's a machismo that comes with working in the kitchen. It is not a self care environment, you know, I put an oyster knife through my hand and wrapped it up in saran wrap and finished my shift because that's the ethic, right? That's the ethos of the place. And if you don't do that, you're not a team player.  I had been in sort of denial. It can’t be COVID I don't want it to be COVID. The connection between my mouth and my brain went out. 

  So, um,  yeah, that was scary.  You know, it's very scary because  it's something I really enjoy. It could no longer recognize what taste and smell were. Then that's when I knew it was neurological. I was like, Oh, that's  a neurological event that just happened to me.  Who knew? 

  DANIELLA: So Hazie tried to inform people by starting the Birch project. They were making posters in bright, interesting colours. Not in public health blue. 

  HAZIE: I wanted to make some images that were really, you know, straightforward  that could be at a bus stop. If you're, you know, a regular auntie, that's going out to do grocery shopping.  As far as you know, everything is fine.  All of the messaging from all of the magazines and your government and your doctors is telling you that everything's okay.

  DANIELLA: Dear listener, if you’ve found this podcast and somehow made it this far without recognizing this… to be clear, everything is NOT okay. Hazie is one of those 1 in 9 people in Canada who has Long COVID.

  The more times we get COVID, the more likely it is that we’ll experience some of these conditions that Hazie just mentioned. Maybe you’ve experienced them yourself. According to Statistics Canada data and various peer-reviewed studies. After the third infection, if it didn’t happen earlier, 40% of people develop long COVID symptoms. That’s 2 out of 5 people. 
  
  Even if you’ve had COVID once, twice, three times and you think you feel okay, that doesn’t guarantee you’ll still be okay after more infections. 

  Black people were more likely to report multiple infections - probably because a lot of us are under systemic pressure to work in face to face essential roles with more precarity and less agency. Like being a cook in a restaurant with no sick days.
   

  You might say, but Daniella, if Long COVID was really that bad… wouldn’t we be told about it? Wouldn’t it be on the news?

  If it’s as big a deal as you’re saying, how come public health isn’t sharing this information?

  Well my friend, that is the point of this podcast: sharing this critical information because you’re right, you should be told about this stuff. Even if it’s not easy to hear. And I have the same question. Why isn’t public health sharing information about peer reviewed study after stud after study after study showing that there are huge costs to every COVID infection.

  Instead, we hear public health officials tell us infections are good? Here’s Dr. Bonnie Henry, British Columbia’s Provincial Health Officer.

  clip of DR. BONNIE HENRY:  If you've had COVID recently. Um, you've had a boost to your immunity, so that's, that's a good thing. Um, I know many people have, uh, I know many people that have had COVID recently.

  DANIELLA: If you're confused,  I'm confused, because at each infection, pretty bad things can happen. Including dying. 

  And any immunity doesn’t seem to last very long. Our risk of strokes, heart attacks, diabetes and many other things goes up and can stay up for months to years afterwards. And when studies measure “years” that’s just how long the study went on for. 
  A significant number of people get long COVID after each infection. COVID affects our immune systems, damaging the cells that work hard to keep us free of other infections. And, I’m surprised this hasn’t gotten more attention, but since COVID is a vascular virus and it hurts the tiny blood vessels all over our bodies, it can also cause erectile dysfunction. The list goes on.

  And the damage can add up. 

  What we hear from public health officials doesn’t always add up. So this episode, we’re going right to the source. 

  We’re going to learn a lot more about what Long COVID is and what it means for you from one of the world’s leading physician-scientist, Dr. Ziyad Al-Aly. 
  
  Dr Al-Aly is delightful and talks a little fast sometimes He's going to outline a few important things for you in this episode, interspersed with some of Hazie's experience.

  DANIELLA: I'm so happy to have you on the podcast, Dr. Al Ali. Thank you for agreeing to spend some time with me. So this show is pretty informal. We're all sick of this mess.  Listeners really want to know your perspective and thoughts about how we get out of this…

  DR AL-ALY: First of all, really, thank you for having me. I'm delighted to be with you. Really, uh, sort of, uh, thank you and Congratulations on the, on the, on the podcast, on launching it. It's really important, especially in this time, in the juncture of our history. Kudos to you for, for doing that. Thinking about it, conceptualizing it and, and, and launching this. It’s really a difficult time. The reality is that that covid is actually still here and, and  you know, covid, you know, leads to all sort of problems and, and, and, and really most importantly, that we can actually do something about it!

  DANIELLA:  My first question is a very serious question that requires a very serious answer, you know, the trope at the beginning of the horror movie, where the scientist is waving papers, trying to share their data, but nobody will listen. Do you ever feel like that? 

  DR AL-ALY: Yes. And no, yes, in the sense that sort of, I sort of feel that, you know, we just said, like, you know, the world moved on and people are sort of tuning out, you know, the, the, the story of COVID and, and, and, and, and long COVID, but, but no, in the sense, I'm really heartened and, and really feel strengthened by The strength and the resolve of the patient community and the community of people that, that, that really come together. Actually, your show is one example that people sort of are “no, this is not correct. We need to make sure that we're spreading the message that we're amplifying the message”. And, and I, and I see that a lot. I see that on, on, on Twitter and other places that, that, that, you know, people are, you know, there's a lot of people actually, you know, still take this seriously and, and, and want to do the right thing. So the answer to that is yes and no, yes. I'm definitely cognizant of the fact that some people are sort of tuning this and tuning this out and, and, and don't want to  face reality. And this is reality. And just, I don't like this. I don't like the idea that, you know, we, you know, COVID is still around. I prefer a world without COVID, right. But, but the reality is it's actually still. Affecting people and harming people and leading to long COVID So sort of a mixed answer there. Yes and no. 

  DANIELLA:  Is there one sort of billboard sized thing that you want people to know from your research? Like if people turn this episode off 10 seconds from now, what's the one thing you want people to leave with?

  DR AL-ALY: That there's no, there's no long COVID without COVID. Right. I mean, there is no long COVID without COVID. So, so, uh, and, and that really gets to the heart of the, the, the issue. And I told senators, like, have you heard of long COVID in 2016 2018? No. And I. You know, ask the question rhetorically and answered it myself while testifying: No, you didn't, you didn't, you know, hear about that in 2016 or 2017, 2018, because it didn't exist. It didn't exist before COVID. So there's no long COVID without COVID. If you take one thing from this episode, take, take this. And, and, and really two is really very important.

  And I hope that your listeners will appreciate this long COVID is a serious issue. It can affect nearly everyone and can have devastating consequences on people's lives and their ability to maintain relationships, marriages, social ties, friendships, work, you know, And, and, and, and, and, and in some instances, you know, leave them bedridden, in bed for months or, or, or, or, or more. 

  DANIELLA: In one of your recent papers, you estimate that more than 400 million people globally have long COVID. And I think some of the misconception is maybe people think it's just, “oh, feel a bit tired with brain fog”, but you've described it as a constellation of possible symptoms and mechanisms that can cause severe outcomes. How would you describe long COVID to someone who's unfamiliar? 

  DR AL-ALY: So, that's exactly right. There are about, we estimate there are about 400 million lives that have been affected with long COVID around the world. So that's not a small number. It's really 400 million individuals across the globe have been impacted by, by long COVID. And long COVID is not one thing. It's sort of a, it's sort of almost hardwired in the, in the public consciousness or public narrative that, you know, off of it is brain fog and fatigue. But it's really so much more than that. It's, you know, certainly, certainly people, you know, present to clinics with brain fog and fatigue, but there is, you know, this, this whole entity called POTS or, Postural orthostatic tachycardia syndrome.

  There are some people who manifest with post exertional malaise, which is a really crushing form of fatigue after even mild exercise or a mild exertion in some instances could be as simple as walking the dog or doing some simple activity in the kitchen, preparing a meal. It can leave people profoundly exhausted and wiped out with depleted energy, cannot do anything sometimes for hours or days or, or, or even longer.   

  DANIELLA: Ok I’m going to interject here to bring you a little clip from my conversation with Hazie about how they experience this. 

  HAZIE: And I know that I'm not alone in this. Um,  I got COVID and then it slowly chipped away at my health over a long period of time. So there were definitely days of like acute illness, um, the fatigue, which people talk about, which is  impossible to convey. At one point I couldn't lift up a glass of water. I was too weak. Nobody just can't pick up a glass of water overnight. That's not a thing that happens, you know?  

  DANIELLA: This part we’ll keep breaking up with some examples 

  DR AL-ALY: And while we also know about long COVID, it can also affect, you know, organ systems. It can affect the heart. You know, some people have, you know,  some heart problems, either arrhythmias, you know, either fast heart rate or slow heart rate and other conditions of the heart, including heart failure. 

  HAZIE: I developed a cardiac condition, I couldn’t get any help for that. Um so I had myocarditis but I didn’t have any proof of that til later. It took months for me to get an MRI. then I developed POTS.  postural orthostatic tachycardia syndrome

  DR AL-ALY: Some people have kidney problems.Some people actually have metabolic consequences from long COVID in the form of new onset diabetes and other and cholesterol. So it's really, it's a condition that can impact nearly every organ system. And while we, you know, hear a lot about brain fog and fatigue, and those are actually quite important, long COVID is really much, much more than that. And certainly, you know, is the scale of it, you know, is not small. We estimated impacts around 400 million individuals around the world. 

  DANIELLA: It’s not small at all. Hazie says:

  HAZIE: it's more like, it's more like rolling a snowball, like things accumulate  as opposed to like, Oh, you get. Sick, and then maybe you might get better. It just keeps going. And so you just don't know,  you don't know when it's going to bottom out or  what the next thing to sort of go wrong is going to be. And it's like, it's a little like living in that very tentative state. It’s like I don’t know if my heart is going to blow out tomorrow. I don’t think about it. I’m not fixated on it. But there’s no way it’s not in the back of my head. 

  DANIELLA: Ok now we are back in my conversation with Dr. Al Aly
  
  DANIELLA: like you've mentioned, there are all of these, like, multiple organ system issues, like, just pulling from the papers of yours that I've read, people were at increased risk of having strokes, people were increased risk of having eye problems, hearing issues. And repeat infections, increasing the risk of long COVID, especially without vaccination… these are all really stunning findings.

  I know in the research that I've done when my statistics come back and I see effect sizes way bigger than I expected. It definitely leaves an impact, especially when you think about these are real people really suffering. What was it like to see those results for the first time?

  DR AL-ALY: When I first read those results, it was like, it was, it was almost like a, it's a, it's a, it's a, it was a jarring experience for me because it just, uh,  it dawned on me that this is really not a, you know, the patients were right. Um, but, but B, this is not a, this is not a small thing. This is a really, uh, a significant virus that, that can impact nearly every organ system. And then when we started digging into diabetes, I was in disbelief because I, I couldn't really, you know,  Wrap my head around the idea that the respiratory virus and I used to think, you know, because they told us as a SARS is a severe acute respiratory virus.

  The R in SARS is for respiratory. So they told us that. So I started, you know, in my brain was thinking, like, this is a respiratory virus. I couldn't wrap my head around the idea that this, this is a respiratory virus that's causing. You know, people don't have diabetes when, when I first saw the results, I said to my team, you guys made a mistake.

  This is cannot be true. This is all wrong. You have to redo this whole thing. And I said, okay, let's do it. The whole thing. So we rebuilt the cohort. We re-ran the code, rewrote the code from scratch. We ran the whole thing and the same thing. It's like. No, there must be a mistake. Let's do it again. So we kept doing the same, you know, kept doing it again and again, coming up with the same results.

  So, and now it has been reproduced in more than 20 studies from the UK Biobank, Germany, you know, and elsewhere in the world in 20 studies, you know, saying pretty much the same thing that COVID increases the risk of diabetes.  So  it's true. Now, it's easy for me to accept it now, but I was, I was a heavy skeptic because I, again, I sort of I couldn't wrap my head around the idea that this is a respiratory virus.

  What is it doing , in people's pancreas or other organs to sort of lead to diabetes,but you live, you learn. And I think also the biggest lesson that I learned here is that. You know, the prescience of the patient community, they, they knew things before we knew them. And, and, and I, that's really a lesson that we'll never forget . That's really they knew things before we knew them. And, and, and, and I think  having lived experiences is enormously important. And I think if public health practitioners or public health scientists or other scientists listening to this, if you want to take one thing that really will be the north star, would be your guiding star, listen to the patient community because this is really exactly where the where where you could help orient your research enterprise.

  DANIELLA: That's actually my next question is  what's really stood out for me in listening to you speak has been that you make a point to listen to patients and patient advocacy groups, and a lot of doctors and researchers don't. My question was, what have you learned from listening that maybe you would have missed otherwise? 

  DR AL-ALY: That they were right! And the so called experts were wrong with the so called expert called SARS severe acute respiratory, you know, like, and it's not, it's nothing, but it's not, it's not, not that that is certainly a vascular virus. It attacks the vasculature. It attacks nearly every organ system.

  We already know that. We found SARS CoV 2 in the gut. We find it in the brain. We find it in the heart, in the liver, in the kidneys. So it's not, you know, the last place you find it is in the respiratory. I mean, you still obviously find it in the respiratory, in the lungs. But, but, uh. Or on the respiratory system, but it, but it's certainly it's a, it's a, it's a systemic virus. It's a vascular virus that attacks the vasculature. 

  And that's very, very clear. I think, like, the major lesson here is that the patients were right. And the so called experts were wrong. 

  So if you want, if you want to get it right, if you're listening to this and you want to get it right, you’d listen to the patient community to the people who have lived experiences with the disease. And I, I really cannot stress this enough. This is sort of a. You know, the number number one of the major lessons that we've learned in this pandemic that this is really, it's important and and also helping orient the research enterprise to really address questions and concerns that patients really care about.

  DANIELLA: Like many people, Hazie has had some experiences of not being listened to by doctors as well

  HAZIE: It happens over and over again, where you're a patient, you've been in your body your whole life, and you say, this is not right, this feels bad in this particular way, and you go to a doctor and they go, no,  that's not happening to you.

  DANIELLA: Hmm.  Yeah. You're like, hmm, actually, it is.

  HAZIE: It is. I know,  I've been here the whole time, like I've been in this the whole time. I know how it usually goes.  It's a really strange dynamic that we've set up.  

  They were like, Oh, it's probably just a panic attack. 

  Um, one doctor, my favorite one was he just kind of went, huh,  menopause?  I was like, no, no. So it was almost impossible to get anyone to take me seriously 

  DANIELLA: Ok, back to Dr. Al Aly
  
  DANIELLA: Do you think there are a lot of people kind of going about their lives kind of  don't know they have long COVID? 

  DR AL-ALY: Oh, that's for sure. I mean, we see a lot of people in clinic and they and they say when you started interviewing them and they have these subtle things with brain fog or subtle things with fatigue or subtle things that they are functional impairment that they used to do. X, Y, Z used to walk the dogs. You know, two or three blocks and now they can only do half a block after COVID and they've never really fully recovered. They don't think, they don't know that they have long COVID. They don't think they have long COVID. When you probe it and flesh it out very, very clearly, they were, you know, they were at a hundred percent before COVID and now they're not at a hundred percent and they just, they, they just adjusted their lives to the new, to the new baseline, to the new 80 percent or, or 70 percent.

  Whether, whether, whether they were. About 100 percent before COVID. So that's very, that's very clearly happening. A lot of patients, but I think they, you know, a  lot of patients may not realize that this is really long COVID and a lot of patients also may be subtle in them. It doesn't really impair the ability to really work, you know, like it's still walk the dog, but it's half a block. So the dog can still do, you know, their business so they can still manage their lives.  But it's different than before. So, so clearly  this is a form of, of, of long COVID that's sort of subtle and actually pervasive in the population, ti’is under recognized, you know, A lot of times , it's news to them that they don't really think of themselves as like having, having a long COVID condition and, it's really important that people recognize that, of people actually got affected by COVID 19 and are left with, with some, some, some repercussions or consequences from, from COVID 19, especially those people who have really repeated infections.

  DANIELLA: I asked Hazie if there was a way they wanted to describe their experience of Long COVID to people… people who maybe haven't had this experience.  or haven't had this experience yet.

  
  HAZIE:  I think that there are things that happen to people that you can't, um,  prepare people for, but you can't explain, right. I can do the best I can. Everybody with long COVID can say, look, this is my experience.  And you'll look at it and be like, Oh  yeah, that sounds awful.  But I think unless, It happens to you, you're not going to get it. I don't think it's possible to relate. Like, I didn't know  how,  this is like me,  this is like me Misquoting Sassy Crass  when she was… about a year before she died when she was like, I don't think people understand how sick you can get before you die  and like, and sustainably ill.  Like the type of,  the type of, the type of ill that I am on bad days is, um… it's unbelievable how much your body  can go through and still  keep going.  It is unreal.  And I am, you know, I'm not like,  I'm not a young person. I've been through a couple of things that were, you know, unpleasant health wise and it was nothing compared to this obliterating illness    

  There is no safety net.   

  There is no, uh, place in Geneva where if you have enough money you can go and get fixed. 

  There's no cure.  Um, no one will come and help you and the people that told you not to worry about it will be gone

  DANIELLA: If that lands heavy.  Let's take a minute.  

  What Hazie  just shared is echoed by a lot of people who public health has failed and keeps failing.  This is why people need to know about long COVID.  

  Many of us are always closer to death because of capitalism, systemic racism, colonialism, all the things that make it so that some people are cast as disposable. And we're failing them. Disabled people know this well. Indigenous people, Black people. Migrant workers, trans people, drug users, all these different groups of people. Who sometimes overlap. All know this well.  
  And the person Hazie was quoting. Was a long time Black activist organizer. Um, and anti COVID advocate  Named “Sassy crass”. Their tweets are still up.  Unfortunately, they passed away in February, 2024 after a struggle with lung COVID. They had another tweet, that I think is  really relevant to this topic:

  “I'm gonna say again, that when long COVID effects kill me,  sooner than later,  I need y'all to recognize and say loudly what it was. Just tell them I fought and tried.” 

  
  If you want to learn more about Long COVID, the independent news site, The Sick Times, has put together some info sheets in collaboration with an organization called Long COVID Justice, and I'll link to them in the show notes. They also have a podcast called Still Here that you should listen to. if you like this one. Unlike many other outlets, The Sick Times continues to report on the impact of the ongoing COVID 19 pandemic, the Long COVID crisis, and infection associated illness. No denial, minimizing, our gaslighting here. Please check them out at thesicktimes.org. 

  DANIELLA: Let's get back into our chat with Dr. Al-Aly. If you hang on till the end, there is a whole roadmap of potential solutions and ways that we can help dig ourselves out of this.

  DANIELLA: Yeah. So you were working with the Veterans Affairs data, initially looking at air pollution and diabetes, which is very interesting.  Can you tell me the story about what sparked your specific research interest in long COVID, which seems on the surface to be quite different?

  DR AL-ALY: Yeah. So I think before the pandemic, we prided ourselves as a team here with, with, uh, wanting to identify questions that are really, really important for public health. And I think that's really relevant to your podcast. It's like  public health is dead. So we wanted to understand.  Before the pandemic. To identify questions that are relevant to the people okay. If we find the answer to these questions, we can actually help move the ball forward. And then we, we were working a lot on air pollution and, and the health effects of air pollution because it's affected all of us breathe air, you know, like, maybe not all of us eat chocolate, not all of us smoke, but all of us breathe air. That's really true for, for all humans. And and we wanted to understand the really, like, the effects of that, that air pollution on on on on people's lives

  So so we we tended you know before the pandemic to really focus on  You know, questions that the public cares about and address them rigorously using our data and methods.

  And then the pandemic hit. And I do remember having sort of these brainstorming sessions,  on the very early days of the pandemic, figuring out what do we do? What do we, as a group, you know, here, like, we are, we're a bunch of doctors, but also clinical epidemiologists,  we have this ability to to, you know, analyze data.

  What do we do? And at that time, we, we literally sort of. So the country or the house on, on fire, so to speak, and we decided that we, yes, you know, air pollution is important. Yes. You know, pharmaco epidemiology and proton pump inhibitors or heartburn medications are important, but, you know, now the house is on fire.

  Like, you pitch in you go and get a bucket of water or the fire extinguisher and then you you pitch in to to to help address the crisis at hand so we decided to switch to COVID at that time and then the very early phase of the pandemic and there's a lot of talks about 

  Is COVID worse than than than than the flu or the flu worse than COVID? So we've done some of the early early results on COVID versus flu. 
   

  The patient community. They started telling us that, you know, well, the doctors and you're telling us if uh, you are young and healthy and, and you get COVID-19, you'll bounce back as if nothing had happened.

  But that's not my experience. You guys are not telling us the truth. That's not my experience. I was young and healthy. I did not have any medical problems. And, and then, I got COVID-19 and weeks later I still having ha having these problems. And then very, very early on there was an op-ed piece that caught my attention read in New York Times by Fiona Lowenstein. And, and she was saying that.  We need to talk about what coronavirus recoveries look like because you guys were telling us that if you're young and healthy you bounce back. But that's not happened to me. Like, something is off here. Like, that's not my experience. So, so that and, and kudos to her and to the patient community that they rallied around that op ed and they, you know, started sort of promoting awareness of, of at that time it didn't even have a name but awareness of non recovery from, from COVID 19 on, on social media, kudos to them for, for, you know, Coining the term Long COVID in, in May of 2020, and then starting referring to themselves as Long Haulers in May of 2020.
   

  So that caught our attention. That's sort of a, you know, again, like if you wanted to take one thing from this podcast, like listen to the patient community at that time, we started asking ourselves here, like , you know, these patients are saying Long COVID and it's like, What is that? What is, what is long COVID? And then starting referring to themselves as long haulers. So what, what is, what is this? So we simply at that time asked the question, what are these people talking about? Oh, we want to understand it. We want to understand what they're suffering from. And that launched us on a, on a trajectory to, to  understand and characterize what long COVID is. And, and one thing led to another and, and yeah.
   

  DANIELLA: I’ve seen a few other researchers posting that they’re having a hard time finding controls for their studies. Um, some long COVID researchers get people who think that they're fully recovered from COVID, but then when they go through the eligibility questions, they find, you know, actually people are experiencing long COVID symptoms. Are you finding it hard to have enough controls or people who truly don't have long COVID in your work?

  DR AL-ALY: Yeah, I think, I think even the harder control to find is people have never had any infection, right? Because most of us, you know, even the COVID, even the COVID conscious people have may have may have had an infection, you know, at least once now, there are some people who are lucky and really very careful and have done an amazing job and excellent job.Kudos to them. But the majority of people that we see in clinic and data have had at least COVID once. And so there is really, um, yeah. So,  finding control, contemporary control is, is near impossible these days. And I think the, the best way to, to address that is really, you know, if you're doing the kind of work that we're doing in clinical epidemiology, rely on historical control, because there was an era where COVID did not exist, you know, it's called before 2020. You know, where, where COVID did not exist and long COVID did not exist. And those people's data still exist. And, you know, those peoples lives were, you know, people lived beautiful and wonderful lives and, and did not have long COVID because COVID did not exist in the data before 2020. And that's really, we, we think one of the solutions to to, to, to, to identify control historical control. Now, the drawback is that historical control like that, they're not, you know, living and breathing today's air. And they're not like, you know, uh, sort of, uh, you know, uh, they're, they're not contemporary. They're not like the, in the clinic today and say, on September 2024, et cetera, et cetera. So that's really a drawback. But, but, uh, again, um, you know, I think your point is absolutely well taken. It's really, really hard in 2024 to, to find proper controls whether COVID or long COVID. 

  DANIELLA: One of the critiques that I often hear about your studies, where people try to dismiss long COVID and say, oh, it can't be that bad. The VA database is just full of older white men, so your findings can't be generalized to the wider population. Do you think that's a valid critique? What's your response to it? 

  DR. AL-ALY: No, I mean,  it's sort of a, you know, an unoriginal refrain that we keep hearing, you know, all the time. And if you don't have anything intelligent to say, you sort of resort to the unoriginal  refrain, but, but, uh, but, uh, it’s true on the face of it.

  That that the average age in the VA population is about 60 and then about, you know, 88 percent are male, but, but the VA population is more than 10 million people.  And then when we say there are 12 percent female in our cohort, that's more than, that's more than 1.2 million individuals. I once told a reporter that, you know, you know, we could literally fill 10 or 12 Taylor Swift stadiums with our, with our cohort of women alone. So, these are not small numbers and, and yes, yes, the majority, if you want to regress the experience of about 11 million people or 12 million people to just one number, you say, Oh my God, this is like 88 percent men, but then you're reducing the. This, this richness and diversity of 12 million people to one number.

  And then you're like, you know, because women in this score would happen to be the minority happen to be only 12%,  you're still like eliminating the contribution of literally 1.2 million women. So it's, it's, it's a bit baloney to sort of, uh, You Summarize the experience of millions of people into one number. A lot of these people don't really think, about what they're saying, or sometimes actually they use these oversimplification on purpose to dismiss the science, you know, instead of like instead of really tackling it and having substantive debate or substantive discussion about long COVID and the merit of the science and then how can we, you know, address, you know, questions and, and better understand it altogether.  You know, instead of having those substantive discussions or dialogue, you know, they resort to sort of a dismissive attitude: “this is really in old folks.”
  So, I've asked people to go through all the VA studies that the VA has done. The VA has been doing studies and clinical epidemiology for the past , 30 years before I joined the VA. And like, I wanted to find a single study. That didn't pan out. A single study that was like only in veterans, like smoking is bad for you. Air pollution is bad for you. PPIs can hurt your kidneys Proton Pump [Inhibitors]... Like we wanted to find one single study that, that didn't that didn't pan out in the general population.

  And we couldn't. If people are listening to this, if they can find something, please email because I would want to know. I would want to know if there was ever, ever in the history of science at the VA, more than 10, 000 studies have been published now so far, more than 10, 000. That is one single one. That didn't pan out, you know, like the va you know, had dumb studies that smoking is bad for you. Is that contest, I mean, is that, is that contested? No So a lot of these findings  have been reproduced.

  And, and I think the other thing that these naysayers or these minimizers or you know, critics, say, or ignore is really reproducibility. like, Yes, we tend to be the 1st because we're sort of like at the leading edge of things. So we come up with these studies like 1st before anybody else. But, you know, let's say when we came up with diabetes study, well, it was the 1st, but now there have been 20 of them saying the same thing. 

  DANIELLA: With different data

  DR. AL-ALY: With different data! From different countries, not only the U. S. from Germany from the United Kingdom from elsewhere in Europe from multiple different cohorts throughout the globe, you know, saying exactly the same thing.

  In science, what you want is really reproducibility. To really know whether this finding really replicate. And, and all the work on Long Covid has been, has been reproduced to, to the t actually to the t And it's true that we, we, we, we tend to get most of the heat, not others because we, we come up with these things first.

  You know, like we, we, we, we sort of pride ourselves that we, you know, are able to, to, to do these analysis and put them out to help inform the public discussion. About long covid and the patient community and clinical care. So we take a lot of the heat because we come up with these things first, but, but, but they get Reproduced and I see these papers like, oh, they're saying the same thing that we did. They're saying the same thing that we did. So, So,yeah,

  DANIELLA: One of the manifestations that I find quite concerning, I mean, it's all quite concerning.. is your research into like how our brains take a hit with COVID infections. So a lot of knowledge translation requires putting research findings into a frame or analogy, like you've said, that the public can easily grasp, easily understand.

  And yeah, some of your research about the cognitive decline of people who have COVID or have had COVID, , whether it was a mild infection or not, we now know that doesn't really matter. Um, essentially it shows that your research, essentially research shows that our brains do take this hit with every infection.

  Can you tell us a bit more about this and does this worry you on a population scale? 

  DR. AL-ALY: Clearly. So, so we, we definitely know that, uh, you know, COVID or SARS-CoV-2 has neurotropic. And what does that mean by that? Has an affinity to it. It You know, interestingly, and actually in a peculiar way, it sort of has an affinity to attack the, the, the, the brain.   certainly can attack multiple organ systems, but, but, but. Very clearly there's lots of data now from our work and other works that, you know, CoV 2 can induce inflammation in the brain, can activate glial cells, those like small cells that are immune cells of the brain, but actually, that actually are responsible to make sure that the brain remain, healthy, can actually, you know, And use activation in those cells and, and making them, you know, hyperactive or, or, or dysfunctional, it can impair the blood brain barrier.

  You know, brains are actually evolved throughout literally, you know, hundreds of thousands of years to. To to be protected and they're protected not only by the skull, the sort of bony structure, the skull that protects them physically, but also protected by a layer, a membrane called the blood brain barrier that protects them from noxious stimuli or noxious or bad substances from entering the brain and affecting it adversely. You know what COVID does? COVID impairs that blood brain barrier and uses inflammation in the brain. and uses vascular dysfunction. SARS CoV 2 or the virus actually also attacks the blood vessels. And guess what? Blood vessels are also in the brain, induces endothelial inflammation, micro clotting or, or fibrin aggregation, platelet aggregation in a way that, that,  you know, patients would develop these small clots in their brain that may explain that many people have, you know, brain fog or strokes or some other manifestations. 

  So, very, very clearly, SARS-CoV-2 affects the brain. And we also see that one of the cardinal manifestations  of long COVID is brain fog very, very clearly.  And we see it, we see it, you know, and in the clinic, and we also see it in studies  and in some instances that can be, you know, significantly disabling to the point that affecting people's ability to work and continue on with their jobs etc.

  So overall, I sort of know that that certainly has a has a neurologic component or affects the brain  in many ways and and and and can lead to multiple manifestations. Brain fog is one of many, it can also lead to stroke. Some people complain of headaches. Some people have sleep problems. They cannot really sleep very well or. You know, so multiple neurologic manifestations and rare instances, people develop seizure disorders or epilepsy or seizure disorder after, after a SARS COV2 infection. It’s rare, but certainly, certainly, certainly present. 

  DANIELLA: And so in translating this kind of knowledge to the public, a lot of the media articles that I saw about it, use the framing of IQ that, COVID  damage to the brain was causing a drop in IQ, and I'm sure you're aware there's a history of the use of IQ as a way to sort of disenfranchise certain groups, was there a reason for choosing IQ as a framing or  the media did, was your team concerned that people just wouldn't take cognitive damage seriously enough?

  DR. AL-ALY: So I think quantitating it is important. So definitely aware of the, of this, the history, you know, , on this and, and definitely sensitive to it. And we definitely don't want to, you know, give bad actors more ammunition. That's not the intent.

  But, I think that there is a… quantitating that cognitive dysfunction after SARS CoV2 is actually important. And it doesn't have to be necessarily with IQ points. If there are other tools to quantitate, it is really important to sort of understand, you know, the impact on individuals and also impact across, across populations.So I think the key there is to try to, to help us quantitate it  to better understand the impact and the scale of the problem. And I think that's really why some of the media sort of emphasized these points. I think, I think you're, you're referring to a paper that, that, that initially came out in the New England Journal of medicine and then subsequently got a lot of media uptake. I wrote an editorial about it and then, and then something we got a lot of media uptake and in that paper, sort of, they  translate some of their findings into IQ scores or loss of IQ to help the public understand what are the implications of this? It's really not a nothingburger. This is, this is a virus that can actually leave. You know, it's, mark on your brain and affects cognitive health. And as a matter of fact, actually can reduce your cognitive performance by several points after infection. And that's really not not a small thing 

  Daniella: That's the key. And I think, yeah, I mean, they did pick up on it. People were talking about it. So maybe even if the framing isn't the greatest, I think it was also  a way that people could  understand. 

  DR. AL-ALY: Yeah, yes, but I think you are, you're making a very important point. We definitely need to also understand the history of this and, and, you know, if there are better framings out there, I think that that also should be explored. And that's very important. 

  DANIELLA: Yeah, people say “the IQ test is just a measure of how good you are at taking IQ tests” 

  DR. AL-ALY: Well, that's, that's,  that's definitely truth to that. There's definitely truth to that.

  DANIELLA: Okay, I have, this one's maybe a spicy question. Um, and maybe I'll lead with my own story and then I'll ask you. So I had the opportunity and I chose to go to this very fancy event.  In LA, because my partner works in the film industry. And it's hard because you want to celebrate people's accomplishments. You want to support them. And a lot of people act like COVID is over, even though it's not. So we wore respirators indoors to that event. And I was really fascinated actually by the optics of it, because even though there weren't many people at all wearing respirators, I saw two of the biggest HEPA filters I've ever seen in my life inside that, uh, theater.

  Uh, there were a lot of venue workers who were wearing respirators. I didn't notice far UV, but I don't know if I would know what that looks like, but the film industry for a long time was taking some of, like, the most stringent COVID protections. They would do tests every day, even when the general public couldn't get them. but now all of that seems to be out the window. 

  And I'm wondering kind of what you think about the way that these big Hollywood events don't talk about precautions that they may be taking,  or maybe they're not, but how it contributes to this pretense that COVID is over. And do you think it would help if they talked about it? 

  DR. AL-ALY: I think it would certainly help. And I definitely am aware that a lot of these big fancy, schmancy events have a lot of protection, embedded in place, but people don't really see it. They sort of see the red carpet picture, but they don't really see the HEPA filters and all the other things. That people do to try to reduce the risk, of course, you know, uh,  When these people are going unmasked on, on, on, on camera and all that, there's, there's certainly a risk, but, but, you know, if, if in an environment where, where, you know, there is, you know, other mitigators in place,  the risk could also , be managed and, reduce, and I think we don't talk about it enough.

  And I think it tends to be almost like an elitist thing. I think there was something going on, on, on social media about, you know, You know, uh, people at Davos that they, they, they know how to protect themselves and they have filters all over the place. And actually the best filters that money can buy and they have all the others and they go unmasked as well.

  Like all these air spaces are, are super filtered , and, and that's not really available to the, to the average person. Right. So that's sort of a,  almost like a divide between the haves and have nots scissors, people at Davos that can afford these fancy schmancy filters and, and all the other technology to really reduce the risk.

   But that does not really it translate to the average person, right? So I think I think talking about it is really important because, you know, the optics, you know, that people see, like, oh, these events are are. And nobody is wearing a mask, but you don't really you don't see all the other  layers and layers of mitigation that are in place that are not visible on camera. 

  You don't see them on camera, but they're there. But but at the end of the day to the end of the day, even with all these mitigators, um,  you know, if you choose to go on the mask and I'm, I'm also, you know, have done that and, and, and, and, you know, like, I, I, I, I don't mask all, all, all, all the time, but if you choose to go on mask, I think that you're, you're taking a risk and that's really, that's really what people need to understand. You're certainly taking a risk

  DANIELLA: I saw a lot of people kind of talking. They saw some photos, uh, that were posted of you, I think it was like a red carpet event as well, maybe it was a Time 100, and people were quite upset they were feeling, like, sad that someone who's usually in a mask and who researches the dangers of COVID was not wearing a mask. Did you see those comments? Were there precautions at the event? What did you think? 

  DR. AL-ALY: Yeah, so there was actually quite a bit of precautions at the event. And, and yes I did see those comments and, and, and the truth is that I, I, I try my best to mask most of the time, but I don't mask all the time. And, and I, and I sort of feel that, uh, you know, that's sort of that, that that's my reality. We track, uh, those wastewater surveillance systems. quite religiously to try to understand the level of of code in the community. That was literally the lowest point it has ever been in those waste water surveillance systems and in the, in the time and the location where the event happened. So at that time, the risk of getting, you know exposed to COVID is very, very, very low in a venue that has really ample air filtration and, and ventilation and, and, and other mitigators among, among people that I also knew that they were careful. So I chose to do it, uh, to go unmasked, but I I definitely understand that some people may feel differently about that choice.

  DANIELLA: A lot of people do see it differently. It’s a hard thing because individuals make choices every day and decide what they think is worth it and what’s not. But you literally cannot do a risk assessment if you don’t have good information. A lot of people are making decisions based on vibes, wishful thinking, and peer pressure. That’s not a risk assessment. Some people wear respirators in public at all times because their risk assessment, based on what they know and what they want for their own health, lines up with that. We now know cloth and surgical masks don’t provide adequate protection against airborne transmission of viruses like SARS-CoV-2. There will be more episodes about respirators in the future so hang tight. Wearing a mask can provide a really high level of protection for you and others around you if it is designed to block aerosols and only if it’s worn properly and consistently. There’s this idea of the Swiss cheese model, in an ideal world we’d have many layers of protections including people actually being able to stay home when they’re sick, plenty of data on wastewater and test positivity, good air ventilation and filtration in addition to proper use of personal protective equipment like masks. But we know many of those layers are not in place anymore or were never there. While we try to get these precautions in place, and have very little information shared by public health to make decisions about actual risk, masking does become the best line of defense against viral infection. There are mask blocs in different parts of the world that will make sure you can get free respirator masks - if you’re in Vancouver, check out masks4eastvan or maskbloc BC and if you’re anywhere else I will add a link to a site where you can find your closest mask bloc there will be links in the show notes. 

  DANIELLA: Speaking of online issues, I also was really sorry to see you were threatened on Twitter recently about your work.  In Canada, we had that whole anti-science trucker convoy and they sort of threatened public health officials. And I personally think it had something to do with how weak our protections became because they were scared about upsetting these very loud, very wrong groups. Can you speak on the sort of threats of violence and the impact on science? 
  And is that going to affect how you do or communicate your work? 

  DR. AL-ALY: It's not gonna affect me or how I do in my work. Like I'm, I'm  unmoved by this.  It's going to take a lot so they're going to have to do much more than that.  I'm not, I'm not sort of trying to irritate them or anything like that, but, uh, you know,   I've had my share of things over the years. I think we need to continue to do what we need to do. We're on the right side of history and we are doing good science to inform public health and inform public health decisions.

  You know, when, when detractors or the opposite side start going after the messenger, that's really when you know, that they're failing when, you know, like, when they start using language like this, like, threatening and again, like, they, they don't. They don't have any substantive criticism of the actual work. They go after the messenger and, because they cannot critique the message they have literally like that.  And at the end of the day, I think the, The more serious discussion here, the core purpose of things like is distraction, you know, like they actually want to distract us from having the real conversation from having the real discussions from actually  moving the ball for from actually devoting much of our energy and time and effort to. To moving the conversation forward to discovering a new science and advancing the, our understanding of long COVID. So I think, I think that's really what they, that's really the core purpose of all of these shenanigans is distraction as they want to get you off your game and distract you and have you be distracted with something else  when I'm distracted, rebutting this or or paying attention to this, I'm not doing Long COVID science. I'm not writing. I'm not  doing more research. I'm not doing more advocacy and then you give them a win by, by not doing that and engaging. You know, with these, with these individuals, uh, your you’re effectively distracted and you give them a win and that's what people should resist. You should resist going down that road where you're distracted by these individuals and giving them credence and giving them oxygen and And we're like really we need to continue we have we have a job to do I mean, this is a big problem we need to solve and we cannot solve by being distracted We need to continue to work work diligently to solve it.  

  DANIELLA: My last question for you is now what? I know you've mentioned in previous interviews that  we don't need any more observational studies. We know long COVID shows up in all of these different ways. You recently published this research and policy roadmap, which I will link to in the show notes so people can read it, but it has excellent recommendations about what we should do next. What are maybe the top three things you would do right now to turn this public health failure around?

  DR. AL-ALY: I think from a policy perspective, the most important thing is really more emphasis on prevention, figuring out how to better prevent more COVID and long COVID and treat it seriously as it should be treated. Prevention is serious. And when I testified in Congress, I told them that we spend literally billions of dollars every year to make sure that our buildings withstand earthquakes.  That happened once every 500 years. We actually spent a lot of, a lot of money for this building that I'm in lots of money just to make sure that it's actually, you know, earthquake proof, so to speak. And we know we got hit now with a, with this huge pandemic and the pandemics are going to happen out of fact of life. We're going to have another one  we just don't know when it's going to be. It's going to be 2030 or 2040 2050. It's very, very important to invest in prevention. 
  Now, I really think also that there is a lot of opportunity to try to improve vaccine technologies and improve uptake of vaccines. What we've seen is that, you know,  vaccine uptake is really, really minimal. And,  the current vaccines that we have don't really block the infection very well. So there's really opportunities in improving that. 
  And, and three really. You know, more emphasis on clinical trials. And I think that should actually honestly be first because for the people who are listening to this. And if they are the people who are affected by brain fog or post exertion malaise or POTS and have been hurting and suffering for several years now, some of them since 2020. Since 2020, that's really, you know, four, four plus years been suffering with the disease and they want, they want to get help. They want to feel better yesterday. And, doing more observational research or doing other things  are not going to make them, you know, feel better. What's going to make them feel better is really a drug that is going to cure or manage the conditions. You know, you know, to treat the conditions that can actually feel better. So there area lot of key, key things that need to happen. But I think you emphasize that, that, you know, there is a lot that needs to happen. 

  So the three key things that need to happen, but there's a lot that needs to happen assessment of the economic impact of long COVID needs to happen, the societal impact we, we need to understand the societal impact of , how does really impacting, you know, marriages and friendships and, you know, how is it impacting the, the, you know, the, the ability of kids to socialize, to form friends, to develop in school, educational attainment, to do well in school or not do well in the schools. I worry about a lot of kids with long COVID. So there's a lot that needs to be done. A lot of needs to be done.The best way to, to continue to, to, to prevent more growth and the number of people with long COVID is to. Is to put mitigators in place. You know, for example, better  vaccines that block infections, you know, air filtration and ventilation systems. So for those of you,  who are interested as you, as you mentioned, we actually have put out a review recently. We outlined a resource roadmap, what needs to happen over the next several years to really help us tackle long COVID. And a policy roadmap  for policymakers to help us  tackle the crisis of the global crisis of long COVID. This is again, not a US problem, not a Canadian problem, not a North American problem. This is a global problem, you know, across the world and needs to be tackled globally.

  DANIELLA: I followed up with Dr. Al Aly after this interview about the change in administration in the United States.  He said that institutional public health has failed and needs reform. And public health agencies have clearly failed to address this crisis. The pandemic was a huge stress test he said, and they failed miserably. To paraphrase, he said we have no choice but to work with whoever is in office because we can’t achieve progress if we sit on the sidelines. While he doesn’t agree with RFK Jr on many things there is universal agreement that we’re sicker than before.

  DANIELLA: Okay. I think this is, we have come to the end. Dr. Al Aly, I really appreciate your time.  My last thing, uh, is a very quick game that I want, I hope to do with all of my guests. Have you ever heard of the game Two Truths and a Lie?

  
  DR. AL-ALY: No. But you tell me!
  
  DANIELLA: Well, this game is a direct ripoff. It's just one truth and one lie because I don't want to take up your whole day. Basically, the point is to determine which statement was said verbatim by a real public health official and which one is completely made up. So, listeners can play along too. This game, I think, is harder than maybe people will think. So, I'll give you the two and then you can tell me which one you think is real from someone's actual mouth and which one is made up.

  So, quote one, “what we are not seeing is what we call traditional airborne transmission, which colloquially we say transmission around corners.”  Quote two,”Children just don't get sick with COVID. Their immune systems can fight it better.”  
  Which one is a real direct quote from a public health leader? And bonus points if you can tell me who said it. 

  DR. AL-ALY: I think the second one is a direct quote because I've heard that before and I don't, I don't, I don't think I've heard the first one before exactly verbatim as you, as you, as you mentioned it. That's what I think, but that's my answer laughs

  DANIELLA: it's the other way. It's the other way around! It's the other way around.
  
  DR. AL-ALY: Oh! Okay! laughs

  DANIELLA: Dr. Bonnie Henry said the first one that they're not seeing airborne transmission around corners.  So, uh,

  DR. AL-ALY: Okay! 

  DANIELLA: But, uh, you would be, you would be very correct to say that people have said things like that children don't get sick in their immune system. So it was, it was tricky.

  DR. AL-ALY:: Yeah, I've heard that a lot and I get challenged a lot. Like, when I talk about long COVID and I say kids have long COVID, it's like, oh, no, kids don't get long COVID. It's like, what do you mean? We actually have tons of kids with long COVID. So, so,uh, Yeah. So, but, but yeah, that's fun! That's fun to, to, to play that game!

  DANIELLA: LAUGHS Well, thank you for participating. I really appreciate you being here and spending some time with me on this little podcast. The world owes you so much, you and your team, science owes you and your team so much. Thank you for all the work that you're doing. And, uh, again, just really appreciate the opportunity to speak with you today.

  DR. AL-ALY: Well, thank you. Thank you. Thank you. Thank you for having me. I'm really delighted to be with you and congratulations again on putting together this podcast. Very, very important.

  DANIELLA: If you live in BC like me, you probably got the answer to that. But we're not quite done here.  Um, I asked Hazie what they'd say to a doctor about treating people and engaging with people who are living with Long COVID. Because there are going to be more and more, the less we do about mitigation and prevention on a public health level. 

  HAZIE:  If you're lucky, if you find a very, very curious doctor, I would say,  yeah, try to keep your curiosity up and just, you know, and just  remember that the science that you knew when you finished school has changed.  The science wasn't finished just because you finished. 

  Science is still doing stuff all the time, even when  we don't want it to.  Um, medicine is not finished. We are not at the apex of what we know.  And so you need to behave as though you know that, that you understand that there's stuff that you don't know,
  
  That's not a failing  on the part of a doctor. It's not a failing on the part of a  researcher. There's only so much,  like all of my favorite doctors are the doctors that were like, I have no idea how to help you. And I'm like, Perfect.  That's a good starting point.
  
  Public Health is Dead is hosted, produced, written, and edited by me, Daniella Barreto
  Thank you to Lauren M for additional content editing support and Loida M for thoughtful feedback

  And because I couldn’t say this in the trailer, thank you to Alexandria Maillot for music production on the amazing trailer. You may have heard it before this episode came out. They are incredible. Thank you thank you thank you. 

  Thank you to Hazie Thompson for being so willing to talk to me after being Twitter mutuals.
  And to Dr. Al-Aly for enthusiastically jumping on board to support this project. 
   

  If you liked this episode, and you’d like me to make more of Public Health is Dead, please consider supporting production by visiting publichealthisdead.com and following the donation link on the site. 

  This is an entirely indie project self-funded off the side of my desk. Thank you to everyone who has already supported the idea of this project, show unheard, I appreciate the vote of confidence! 
  These incredible people are Ian, Claire, Serisha, Maria, Joey, Selin, Victoria, Lynette, Raymond, Mark, Madison, Hamzah, Jenn, Michelle, Josh, Teagan, Marlee, and Rachel. Thank you so much.

  
  If you’re not in a position to donate that is a-ok, you can still help the show out by sending this episode to a friend! Until next time, public health is dead but we’re not dead yet!

  
  I’m Daniella, and I’ll catch you on the next one. Thanks for listening!

EPISODE CREDITS
Public Health is Dead is created, hosted, produced, written and edited by Daniella Barreto. 
Content editing by Lauren M. 

Public Health is Dead runs on listener support! If you liked this episode or learned something from it, please share it with a friend. And if you’d like to contribute to ongoing production of Public Health is Dead, please support the show!