Will the pandemic change how we live and work forever?

- Hello and welcome everyone. I am Chris Hyams, CEO of Indeed. Welcome to the next episode of Here to Help. This is our look at how Indeed has been navigating the global impact of COVID-19. Today is August 20th. We are on day 535 of Global Work from Home. Today, we'll be talking specifically about the pandemic and its impact on all of us and the world of work. That delta variant has challenged everything we thought we knew about COVID-19. In the words of the CDC, "the war has changed." So how exactly has it changed, for whom, and what lies ahead? What level of risk will we tolerate? These are some of the questions we'll get to with my guest today. Dr. Mike Tuggy. Dr. Tuggy has been Indeed's medical advisor throughout the pandemic. I've been asked to add a short disclaimer here. Indeed does not provide medical advice to employees. Employees should seek their own medical advice if they have personal medical questions and should not rely on any content they hear or see in this program for personal advice. So, as I said, Dr. Tuggy has been Indeed's medical advisor throughout the pandemic. I am so happy to have him here to talk through everything that we've been through and where we might be heading. Dr. Tuggy, thanks so much joining me.

- Yeah, it's great to be with you.

- Let's start off. We always start these discussions off with, just to check in, how are you doing today?

- Well, it's been a very busy month. There's been a lot of new changes, again, that keep on happening. And so it just feels like the work pace around this pandemic has really been accelerated. So it's nice to be home on a Friday, but I think it's going to be a busy day no matter what I try to do around the work site, yeah.

- Great, well, before we get into bigger questions about the pandemic, I'd love to talk a little bit about your career and what led you to working as a medical advisor to companies like Indeed.

- Yeah, well, my first foremost kind of position is I'm a family doctor and I've been doing this now for over 30 years and I was fortunate enough to train in the military where they had really great training for family physicians. And then I spent seven years on active duty, was over in Europe and served in the first Gulf war, and then came back and then moved into education and training myself and I trained physicians for about 20 years in Seattle. And then from there, I moved to a rural practice because I wanted to cut back on work, I thought. And then I was also involved in a number of projects nationally with primary care and also internationally with training family physicians in Africa. And I had a chance when I was there to work with patients with HIV and AIDS and learning to manage that and train people around that pan or that epidemic was really kind of my foundation for learning more about global health in epidemics and pandemics. One of my colleagues I worked with for 20 years in Seattle was already working as a corporate medical advisor and asked me to come on as soon as the pandemic started, because they really needed some more support. And so it's been a really, really interesting last 18 months. It would be nice if it was done, but we're not. And so it's been a really great experience learning how to work with corporations better and really understanding the passion that people have around taking care of their own people have been really impressive for me to see. It's really lifted my spirits in seeing how well companies are taking care of their people.

- Well, you've been at an incredible help to Indeed. We first got the chance to start working with you back in the beginning of 2020. Indeed was at the time we were one of the first companies in the world to be faced with a possible outbreak of COVID and by March 3rd of last year, made the difficult decision to send 10,000 employees home. In retrospect, clearly it was the right decision. You were a big part of helping us through that decision and pretty much everything that we've done since then. Can you talk a little bit about how you've helped advise us to think about protecting our employees during the pandemic and the role that you have played in helping us navigate through this?

- Yeah, in the first phase, it was first of all, trying to figure out how do we get people out of the workplace? And obviously your company had to decide how work could be done remotely, but then there's always essential workers and people who need to be on a work site. And so look at all the different evidence and track the progress of understanding how this disease was spreading and making sure your team was informed about that. And then once that was a bit more clarified and still evolved over the first six months, then it was really looking at, how do we look at protecting people, even when they're at home? What information can we do we provide to your employees to make sure that they stay safe in their home environment when they're working? And then that continued to progress, kind of getting ready for the vaccine to come out, to kind of prep the groundwork for the vaccination's arrival and looking at other mitigation measures that may or may not be helpful to try to get the workplace ready. And of course, what we've seen in the last eight months now has been the release of the vaccines. And then also trying to build the preparations for work sites to start. So it's been just this evolution of moving back into normal life, but it's been really delayed by a number of different factors, which we'll talk more about throughout the session.

- Yeah, so, and we'll get back, in just a few minutes, to the impact on work and how we think about creating an environment that is safe as possible for employees. But let's talk a little bit about the delta variant, which is clearly the I think top of everyone's mind right now, and there's more than one variant, but that's the one that we have been hearing the most about. And so we've seen surges everywhere. Schools are now opening up and there's new vectors. Can you talk a little bit about, just for folks that might have heard this word being tossed around but don't don't know everything about it, how is the delta variant different from the COVID infection that started this pandemic and what do we need to know about it now?

- Yeah, that's a great question. It's really important for people to understand what variants really are. I mean, variants are normal type of mutation cycle that viruses go through. We haven't had the technology in the past with other outbreaks to do as good of tracking and rapid assessment, as we've been able to do with this pandemic. And so what we've seen is this evolution of the first native strain of COVID-19 to the alpha variant and the beta variant, and then eventually there's a lambda variant, and then the delta variant came around at the same time. And what naturally happens in the ecology of viral infections is the most infectious agent wins, the one that has the easiest way of transmitting. And so the delta variant has erupted. It started basically in India and because it was so contagious, it basically has dominated the whole global scene around the pandemic now. In the United States, we had about 6% of our infections in May or June were, actually end of June were delta variant and it went from 6% to 93% in just six weeks. And so it shows you how incredibly contagious this is. So the delta variant requires far less viral load to infect somebody. And then once somebody gets infected, it starts replicating faster than the other variants. And so that person starts to shed virus more quickly, oftentimes within 24 hours of getting the virus, you're shedding the virus already. And that's one of the reasons why it cycles so quickly 'cause it occurs before people get symptoms, and then they're spreading the virus and don't know it. It's changed its outer coat. The spike proteins have changed a bit. And that change in the spike protein is making our antibodies have to work harder to get the virus under control if you're immunized or if you're previously infected and have antibodies to COVID from a prior infection. So this has created another challenge. And then the other part of it is that it is creating more severe disease because people are having a higher viral load. The virus is replicating so fast, there's many more particles in your system, and that creates more damage basically to the infected host. So it's more contagious, it is more lethal and it's definitely effecting younger people in a more severe way than we saw with other strains.

- And just to put some numbers to it, so the news stories that we've seen all say a thousand times the viral load of the original COVID-19 strain. What exactly does that mean, does the a thousand times the viral load?

- Yeah, and what that means is what they've been able to document in several different case studies, looking back at where the virus got transmitted. And one of the better studies have been two different cases in Australia where people were on quarantine in one hotel, and two people across the hall from each other went out to get their meals off of a tray that was placed outside their doors. Neither of them had masks on. They said, "hello" to each other for about three seconds and that was enough for one person to transfer the virus to the other. So that's how fast it can move. And then another case in Australia, two men were standing outside at a bus stop, about two or three feet apart, not talking to each other, but the one person must have exhaled, the virus and the other person picked it up. And that was caught on CCTV to know how short that 10-second interaction was. So that's what viral load does. It creates a very infectious vapor around you that you can spread to other people.

- And so how is the variant actually getting people who are vaccinated sick? Is it that it is working around the immune defenses? Is that it just is doing something that was not targeted by the vaccine, but the vaccines do work some against this. So can you explain that, for someone who's vaccinated, what is happening here?

- Yeah, so the main reason why the vaccines are kind of slow to respond to vaccinated immune system is because of the viral replication being so rapid. So when you have this rapid eruption of virus, so those first couple days that a vaccinated person, their immune system sees the virus in their system, it starts to gear up antibody and cells to kill off the virus, but the virus replicates so fast that it kind of gets ahead of them, initially. And then after three to five days, our immune system then fully turns on and catches it and eradicates the virus, usually within five to seven days completely in that setting, if you have an infection. So that's how it overwhelms the system, but it's transient. Now, the good news is, is what we're seeing with the vaccine is that serious illness is very rare. And we'll talk a bit more about what that means, why that's happening for some people, but the antibodies that you develop from, especially the Pfizer, Moderna vaccines, those antibodies, you're making multiple antibodies to the spike protein, not just one antibody type. And so we know the delta variant's spike protein is mutated in some locations, but other locations are not, and that's what your spike antibodies are going to go after. They're going to knock out the virus because it can attach to parts of the spike protein and then take it down.

- So. there's a lot to be worried about, there's a lot to be scared of right now. Let's talk about, any positive news with the vaccines? What do you think the state of vaccination is globally and in the U.S. right now?

- Yeah, so vaccinations are definitely being amplified and spread really rapidly in many countries and some countries are really getting a very high rate of vaccination. And what we're seeing that... I mean, the good news is the vaccinations really are really reducing the mortality among those people who are vaccinated. The number of deaths like in Israel is single digits most days. And at one point it was down to zero for quite some time before the delta variant really hit the Israeli population, same thing in the UK. I mean, it's a dramatic drop in the number of fatalities from COVID because they vaccinated the right age group, which is the older age groups initially. And so that's the good news. People are not dying at all at the same rate if they're vaccinated from COVID. So that's been very positive news. So we know the vaccine is working to protect people's lives and protect them from getting hospitalized. And so that's been very positive news, and I think the uptake in vaccines this last several days in the United States has been up to a million doses a day again. So we've almost quintupled the amount of doses being taken for the vaccine in the last two weeks and that's also very positive news.

- Explain from your perspective about the safety of vaccinations and what we know about that.

- Yeah, so every vaccination has side effects. So we've always have known that. And the question is, what is the rate of the side effects and how severe are those side effects? And what we're seeing is the rate of significant side effects is in the order of 1 in 100,000 where somebody has a life changing event from the vaccine, and it's based on their immune response. I mean, it's the way their immune system responds to the spike protein. And the reality is, is that if they were to get COVID instead, they would have millions more particles that they would be responding to. And these are the people who would probably would be sick and die if they were to get COVID, but the vaccine gives them another side effect that may be serious, sometimes it's a neurologic side effect that's really difficult to manage, but it's far, far better than getting COVID. I have two patients in my practice who've had significant side effects from the COVID vaccine, but they... I mean, one of them is very analytical and she said, "I'm so glad I didn't get COVID because this is bad that I have right now, I'm dealing with this neurologic problem, but I know I'd be dead if I got COVID." And so I think that's the reality of it. It's far safer by far than getting the infection and that's what kind of people's choices are: am I going to get infected or am I going to get the vaccine?

- There's been a lot of discussion, and I know the CDC has just started to make some recommendations for people who happen to be at high, high risk, what is the best understanding of the medical community right now about boosters, how they'll work and will this just be a standard part of what we're doing?

- Yeah, so definitely people who are immune compromised are going to need a booster. It's just like, we know that they're in that category of people who did not take with the first vaccine very well, and they need a second shot or a third shot in order to really make that happen. The question is, is whether or not people who have a good immune response really need a booster. And the CDC has decided to lean on the side of going ahead and giving the boosters out in order to reduce that transmission risk. That's really the purpose of that booster is to stop the transmission cycle by giving people a more robust response if they get exposed to the virus. We haven't really answered the question, what if you've been vaccinated and you got COVID, you got delta variant, do you really need a booster? 'Cause you already had a booster when you got your delta variant. So that question needs to be really clarified with the public that we, and I'm hoping that CDC will clarify that, that if you got delta variant and you're immunized, you probably don't need a booster. Save that booster for somebody else. But I think it is going to help reduce the risk of transmission in the long run by having people immunized at a higher level.

- As the vaccines were first getting rolled out, I think... I guess I'll put it this way. I think the story that most people thought they were hearing was that this was going to protect them against death, it was going to protect them against hospitalization, protect them against infection. Some of the counter narratives now are, well, with these variants, people are still getting sick. Has anything changed in terms of the message that was intended to be delivered versus what was heard and what do we think about vaccines right now?

- Yeah, I think initially we were thinking and hoping that the vaccine was going to prevent spread so that if you were vaccinated, you would be unable to spread the virus. And it definitely looked like it was that way with the beta variant, which is the UK variant that was really widespread prior to the delta variant. We were definitely seeing far fewer spreading cases in people who were vaccinated. Once the delta variant hit the scene, because of this rapid replication cycle that it has, we've now are seeing that if you're vaccinated, you still can spread it. So that's been probably the biggest shift in thinking around how the vaccines are working. The other part of it, though, the reduction in fatalities and hospitalizations really has kind of held true despite the fact that people can spread it. It's really just the timing of our immune systems turning on fast enough to knock out the virus before it replicates. And it definitely happens in some people. There's a lot of people who get delta virus or get exposed to delta virus who never shed the virus. That's about seven out of eight. It's actually quite high if you're vaccinated. So most people who are vaccinated are not going to actually shed the virus, but there's enough of us who get the virus that could spread it still, that we have to be really careful.

- So that careful includes now the general recommendation that people who are vaccinated wear masks. And can you talk a little bit about mask wearing and in particular, the goal of it being to protect others versus protecting ourselves?

- Yeah, especially, yeah, especially for people who are vaccinated. If you're wearing a mask and you're vaccinated, you are really protecting other people. That's the main thing you're doing because the risk to you of the actual infection is quite low. And the other people, you're protecting, not only your coworkers, but anybody at home who's not vaccinated. And if you're lucky enough to live in a household that's fully vaccinated, then if you happen to bring the virus home from work or the store or wherever you've been, it's not going to be a crisis situation 99.99% of the time because people's vaccines are working. So that's really the value of wearing masks, and masks we know are not perfect, just like seat belts aren't perfect. I mean, people who wear seat belts, sometimes they get injured, but most of the time they're injured far less than not having a seatbelt on. And the same analogy applies to vaccines. It really does work well to reduce those series injuries.

- So one of the other terms that we've been hearing is this idea of a breakthrough infection. Can you explain what a breakthrough infection is?

- Yeah, I think it's helpful to think of breakthroughs in two different types. The first type is somebody who gets the vaccine and gets these mild symptoms or no symptoms, handles the virus, and then clears it out. The other type of breakthrough infection is a person who gets the vaccine, but their immune system just doesn't see it. It doesn't recognize it, it doesn't respond. They don't build any antibody at all. And those are the ones we are seeing in the hospital. And they're oftentimes people who are quite a bit older, or they have an immune system problem of some sort, or they were on immune suppressant medications or cancer chemotherapy. So in those categories of folks, there's a higher risk that the vaccine doesn't take. And so when they get COVID, it's like they had no vaccine at all and they end up having the same complications that somebody was unvaccinated, but those cases are quite rare. There are the 1 in 2,000 to 1 in 10,000 range. So it's a really a small percentage of people who are in that category.

- All right, so let's talk a little bit about COVID and work, which is obviously something that impacts Indeed as an employer with 10,000 people all over the world, but also because our business is helping people get jobs and we spend a lot of time thinking about the world of work and our job seekers and our customers. So we started this podcast back in April of last year, because we had been navigating some of this a little bit before some other companies and wanted to share our approach and how we were thinking about making decisions and what we were doing. Now, when we look ahead, so you have been advising us, we've been following a set of what we think are pretty conservative protocols. We've opened a handful of offices. And with these surges, given where we had set levels, we've now closed all of those offices. So we don't have any, as of today, Friday, August 20th, we don't have any offices open right now. We certainly plan to come back to work. A lot of other companies have already been back at work and many will. What are we doing... So let's talk a little bit first about Indeed. What are we doing right now in terms of how you're helping us think about how to return to the office as safely as possible?

- Yeah, I think the primary consideration right now is, who can come back safely, which category of employees can do it based on their immune status and are they immune enough to come back to work and not contract the infection there? And then also are they immune enough that they're not going to be shedding virus multiple times when they're around other people that they're working with. So that's looking at that thought process around what makes you safe. And then what are the mitigation measures that we can do if you have people back at work, even if they're vaccinated, or if they're unvaccinated. All of these different questions come up about what's the mitigation things you can do to prevent the spread of the virus in that setting? The challenge, like I said before, was that, before the delta variant, we thought we could get people back quite safely 'cause they weren't going to be spreading the virus. But now that we know that we can spread the virus, it really is kind of constricting the safety margin about going back to the work site in this phase of the pandemic. As we see community spread diminish in the future, as vaccination rates get higher, which we presume they still will and/or everybody else gets infected. I mean, once everybody's been infected with the delta variant, if they haven't been immunized, we're going to see very low case rates. And that's going to really change the dynamic of when the office gets safer, because if you have a highly vaccinated office, and everybody else has had delta variant, then your infection risk is extremely low, and you're going to be able to go much back to normal again. But what we want to do is avoid the high cost of high infection rates. That's the thing we want to avoid is those unvaccinated people getting infected.

- So one of the things that has clearly been in the news, there are a lot of businesses that have now made the decision to require vaccinations for people to come back to work. And there's a couple different parts of it that we can explore separately in terms of... Well, let's just talk a little more broadly first. So our Indeed Hiring Lab, which is our team of economists that look at what we're seeing on Indeed, in terms of job postings, one of the things that they reported, they've been tracking job postings requiring vaccination. And as of August 7th, that's now... I mean, things are moving so quickly, two weeks ago is probably old news, but even then the share of job postings per million that require vaccinations was up 90% compared to a month earlier. And that's in a wide range of sectors, software development, marketing education companies, not just the Googles and the Twitters that we'd heard about, but older companies like IBM and then even Fox News requiring employees to get vaccines, and there's more and more kind of every week. How do you think companies should think about the options to require vaccinations for their employees?

- Yeah, it's an interesting problem because everybody's very careful about respecting individual rights. The challenge of course, is with a pandemic and a work site and workplace settings is that we all interact together in community. And so when you think about protecting a community, then the best protection that we have available right now, since treatments are not at all 100% for this virus, fact, they're more like 30%, that we have to do things to protect each other. And so that's what most companies have settled in on is that when you look at all the options, the safest option is to vaccinate everybody that's at the workplace. And it's kind of the only thing we know that's going to reduce that risk long-term. And in that setting, in the future, what we envision happening is that if you have COVID enter a work site, or somebody gets COVID from home and brings it to work, if everybody's vaccinated, it's going to be like potentially spreading a cold virus, like any other normal cold virus. And so that's very tolerable. I mean, we can't stop, that for other cold viruses either, from those interactions. I think people are going to be a lot smarter about not coming to work when they're sick after this pandemic, but I think that's going to be what the end state's going to look like. It's going to be a cold virus for those people who are vaccinated. And so most companies, when we've tried to look at doing mixed office openings, it's been so complicated to try to have the right space and environment that's actually safe, knowing how fast this virus spreads. It's almost, there's no way to build a safe internal, indoor work environment if you have people who are unvaccinated.

- So one of the questions and options that comes up a lot is what about testing for people who are not vaccinated? Can you talk about the efficacy of testing and what that would look like for a business like ours?

- Yeah. So a couple things is if we use testing and somebody comes to the work site and they come in and they get a rapid test and that test is positive and they were at the work site the day before, then all their close contacts or all their exposures they had from the day before have to be evaluated, tested, potentially go home on quarantine or go home, leave the office, and you have this incredible cycle of shutting down over and over again, different either floors or different work sites because of all the positive tests that are coming up. So testing is going to trigger actually more shutdowns of offices, but you have to. If you're going to have people coming into the office and they are being tested, it does provide you with... Like, if they're negative, they're probably going to be negative the whole day. There's a high probability that person won't be shedding virus later in the day. So you can get people onsite for a short period of time, like one day at a time, pretty safely with testing, but you have to test every day. That's the problem, and that gets to be pretty costly to try to do that. And so testing once a week or twice a week is a little bit, it will give you a false sense of security about how safe your work environment is. And so testing is not a great answer for day-to-day getting people back to work. I mean, the real answer obviously is getting vaccinated, but for some events, there's certainly some value in can considering testing. If you're having a strategic planning retreat and you wouldn't need everybody there and there's somebody who can't, for instance, can't get the vaccine for a medical reason, that person getting tested negative would be what allow them to come much more safely, especially if they're around mostly unvaccinated, I mean, mostly vaccinated people.

- One of the things, the last time we had a chance to speak, we talked about, immunization versus vaccination. And so there are a set of companies that are looking at requiring a proof of immunization, which is not just vaccination, but also it could be having had a positive COVID test. Can you talk about what's the difference between one versus that broader definition and is there any difference in terms of the safety that provides?

- Yeah, so yeah, we've definitely looked at the whole question of, if you're COVID immune, so if you've previously had COVID, you've had a positive test, you may or may not have had symptoms, but you at least had a positive PCR test, is that good enough immunity to get you back to the workplace? And have you mixed with vaccinated people? Prior to delta, the answer was pretty close to, yes, that would have been enough. Unfortunately, the delta variant, because of its rapid replication and how different it is from the alpha and beta variants that were out there, those people do shed virus more. They do get sick more often. They have higher rates of breakthrough infections, I mean, quite a bit higher rates of breakthrough infections compared to people who are vaccinated against the spike protein. So that's why the CDC recommendation has never gone away, that if you had COVID, you should go ahead and get vaccinated too. That they're getting a booster basically with the vaccination really does amplify your protection quite a bit. We can't really use COVID immunity alone as the gold standard. It really is COVID immunity plus vaccination that really gets people very well-protected.

- Let's talk a little bit now about where we go from here and what we think the future of all this will look like. So I guess the first thing is we're having all these conversations about what it's like to get people together and work, but people get together in a whole host of other settings. So how should people be acting right now when they're out and about?

- Yeah, so because of all the downstream effects of continuing to spread the virus, it does make most sense now to be in a mask when you're out in an indoor setting, grocery store. If you're at an office that's open, wearing a mask just to help reduce that spread. I mean, the more replications this virus does, the more risk of a new mutation. We want to just shut that down. So wearing a mask cuts that at least in half. And so that is probably the thing that's going to be the most common thing you're going to see at the work site. And then if you are in an office that's open in a lower risk area, when things have improved, being mindful of that spacing, being mindful of any symptoms you might have. I've had so many cases where somebody had mild symptoms and went to work. I mean, they just shouldn't have gone to work. And that triggers a whole downstream effect of infecting other people and have people go home and things like that. So being really mindful about, if you're having any symptoms at all, just stay home and get tested. So the masking and being incredibly mindful of any potential symptoms and have a low threshold for testing is really key.

- So one of the things that is probably the source of the greatest fear for some set of people is that they have children who are below the age where vaccinations have been approved. What do you think will happen over the coming sort of months in terms of where those age recommendations will eventually get to? And will there still always be some group of people who we're going to have to worry with children that just can't get any protection?

- Yeah, yeah, so the pediatric trials are going on right now, still, and they had to be extended because the FDA really wanted more children in the trials than what they had initially. So instead of having the data in October, it looks like we'll probably have the data in November or early December. And we can anticipate the FDA to approve the vaccine for pediatrics around that timeframe. Late November probably would be the approval time. So if that happens, then we have to roll it all out to the children who are going to get vaccinated whose parents are willing to do that, which hopefully they will be, and that will protect probably... It may go from age two on up or four on up. So under that age, there really is probably a low chance we'll have vaccine available for quite some time for under age two or four, depending on what the FDA decides, but the risk of serious illness in that age group is incredibly low. I mean, most kids who get COVID at that age either have no symptoms or the sniffles, just like somebody who's vaccinated. And then the other category is the newborns. I can't emphasize enough that for moms who are pregnant, getting vaccinated is really important for two reasons. One, if you get sick while you're pregnant with COVID, the pregnancy hormones can trigger a very significant inflammatory response, which is what COVID loves to kill people with, and your risk of getting seriously ill is quite high. The second thing is is that if you do get COVID or if you get vaccinated when you're pregnant, you will pass antibody onto your child and that baby's protected for usually the first six months of life from getting COVID when they're very young. So vaccination helps protect you and the baby, and it does it much more safely than getting the COVID infection.

- So one of the things that we heard from early on was COVID is not going away and we're just going to learn to co-exist and cohabitate with it. So when it comes to something practical, like wearing masks, do you think that we're going to get to a point where we're done with masks or are we going to be done with masks and then there'll be a COVID season and we'll put them back on and we'll always have drawer with seven or eight masks that we'll carry around with us?

- Yeah, that's a good question. I think there will be a point, and it may be sooner than we think, where the masks will come back off again, because a couple of things is that I think we are going to reach some sort of herd immunity one way or the other, with this virus being so infectious, probably later in the year, we'll have enough people, either infected or vaccinated to reach herd immunity. We're going to see the cases really drop off. We've already seen that in many parts of India, where they had a huge eruption of COVID cases and they didn't have the capacity to test everybody they should have tested, but we think that the rates may have been two million cases a day when they were in the middle of their pandemic flare they had this last few months. So we're going to get there at some point, and then the masks probably will come off at that point. And then it's only people who are unvaccinated are the ones who really are going to have to be worrying. If you have the vaccine and then you get COVID delta variant, then you'll be immune to the delta variant very strongly, as well as having the additional boost of the vaccine. And if you see another form of coronavirus, you probably won't have any symptoms at all with that type of immunity. And so we're going to have a high degree of immunity for everybody who's had the vaccine and had the infection, and then everybody who didn't get the infection will still be quite immune. So I think the mask will be coming off at some point later, either this year or early next year. And then the thing is we will have that drawer of masks because we're going to be smarter about not infecting each other when we have a cold and you go to the grocery store where I'm asking if you have a cold and things like that, or the flu. What we saw happen with the flu cycle last year, it shows you how effective the masks are against the flu, because we had like less than 2% of the normal cases of influenza last year because of the people wearing masks. So they clearly work for many of these infections.

- One question that that I've had is, just to try to put COVID-19 in context with other pandemics that we've seen. Obviously in many people's lifetime, this is the first thing like it, certainly at this scale, I heard so many stories growing up from my mother about growing up in the era of polio. When you think about some of these other, where does COVID fit in them, and is it worse? Is it not as bad? How will we think about it 100 years from now?

- Yeah, I think it's going to be probably one of those intermediate range infections, because the mortality of it. I mean, it could have been way worse, like MERS and SARS, those two infections, which were also coronaviruses had higher mortality rates initially when they first erupted and the virus mutated down to a milder form, fortunately for us, but polio has significant long-term lifetime effects and we've nearly eradicated polio with vaccination. I mean, there's a few countries that have had political reasons why their leadership hasn't allowed vaccination programs to occur. And if they had done that 10 years ago, we would have no more polio left on the planet, just like smallpox. So it's possible to eradicate some of these infections and strains completely. We could eradicate COVID-19 if everybody got vaccinated. I mean, it would have nowhere to go and who would eventually die off. So it's possible to eradicate these infections, and COVID mutates, but it doesn't seem to be mutating so much that the vaccinations don't work at all. It's just a matter of reducing the spread. Influenza is really interesting, the flu. There's a new vaccine coming for the flu that's under trials right now that may provide lifetime immunity to the flu where you get one shot and then you're done. If that occurs, first of all, healthcare workers will be really happy 'cause we've stopped getting annual flu shots then, but it would be another potential virus that we could potentially eradicate if we were able to have a single shot for the lifetime.

- There are a whole host of reasons and people have done a lot of thinking and talking into why the vaccination rates are so low in many parts of the world, the U.S. being one of them. In addition to people making decisions because they might not have the right information, there are some people that have health reasons that they can't get vaccinated or a different set of objections that are not based on a lack of understanding of the science. What does that mean in terms of, are we headed towards a two-tiered society where there are just going to be some people who are not going to have the same kind of protection and the people who can and what should we be doing to think about that?

- Yeah. So I think... Well, first of all, the medical contraindications to getting vaccinated for COVID are incredibly narrow and incredibly small. And I think we're going to find that... I mean, even people who had serious reactions to the first vaccine, anaphylactic reactions, there are ways of giving them the second vaccine shot and keeping them safe and protected, and that has happened. We have done that with many. Many people have gotten their second vaccine, but a lot of people had their first vaccine and they still get some immunity from that enough to keep them from getting very sick from COVID. So eventually what's going to probably is that everybody will either have the vaccine, or have the infection, or both. And I think that's going to be the end state of COVID is it's only going to be the children who didn't get vaccinated, didn't get exposed and finally get exposed as a young adult. Or as a child in daycare, they'll get COVID at that point, just like they have with other coronaviruses, which we never cared about 'cause it wasn't causing serious infection.

- What, and I'm sure as someone who's been a PR practitioner, as long as you have, you've done a lot of thinking about what have we learned about our healthcare system and the role of healthcare professionals through this and what should people who are not in that field maybe understand and think about?

- Yeah, I think what we need to be really thoughtful of is the cost that this has laid on the healthcare working system, I mean, the actual workers in the system. Getting in and out of protective gear and everything else, which I used to do in the hospital for my patients with infectious disease, that is a nuisance to do, but if you get to wear it all day long and you'd have to wear it day in, day out, and then you're having people die regularly in front of you, which happens... I saw a photo of a nurse who had 153 patients die under his care and he was just devastated. I mean, this is not like a normal disease process where you have somebody who has cancer and they fight it for several years and then they pass away. It's been devastating for many, many of our health workers. And I think that part of it, we need to understand and respect and show some compassion for those parts of our team that have done that. One of my partners I work with very closely, he went and volunteered in New York last year and he texted me one day and he said, "I had 20 people die on me today." I mean, that just doesn't happen in routine practice. So it's a something that we have to be really conscious of. And then the second piece we've learned that our healthcare system has a lot of holes in it. There are a lot of people don't have access. There's not good equity in the healthcare system. We need to work on that piece of it to make sure we have healthcare for all, provide good basic care for everybody so that we can get them educated on the health literacy, make sure that they understand what their health conditions are. And then we need to really work on the trust piece. I mean, there's a lot of distrust of the healthcare system. And we've known that, especially at the primary care level, we have a lot of patients who we've have great relationships with, but if people don't have a good primary care team that takes care of them, they often don't trust the system at all 'cause there's no connection there. So we need to work on building that connection to make sure everybody understands that there are great people in the healthcare who care about them, and we just need to get them connected together so they can build that relationship.

- Well, there's a whole host of other things we could talk about here, but as we're nearing the end of time, a question I'd like to ask at the end is, throughout all of this and in particular from your experience, which has been really on the front lines, a lot of this, is there anything in the past year and a half that you have seen or that's happened to you that has left you with some optimism for the future?

- Yeah, I think it's interesting, watching how people responded to this in the positive ways, stepping up and initiating vaccine campaigns in your community. I mean, we've had community groups getting really involved and being very outspoken for the truth around the science around what's happened, about what we've learned about this, and pushing back against misinformation. There's just been a lot of individuals in the communities that I've been engaged with who have stood up and really taken a stand for what was the right thing to do for people and thinking and promoting the message of let's protect each other. I mean, that's really the essence of what we're trying to do during a pandemic, and that is a really positive thing. And I have to say too, that many of the healthcare workers that I've engaged with, some of our nursing staff in the intensive care units and places like that, where you really see the sacrifice and the risk that they take to go to work. I mean, it actually reminds me when I had this feeling one day of, when I was in the war, you would go and grab your wounded people and take care of them and sometimes that was in a place that was pretty uncomfortable, like you're being shot at, but you do that because you care about those people more than you care about yourself. And that's really the essence of what we've seen in a lot of the pandemic, 'cause there's people who've gotten vaccinated despite the risk that they were worried about, despite their fears, because they cared about their neighbor more than themselves, and that's really a positive thing to see.

- Well, thank you. Thank you for sharing that and thank you so much for joining me today, but really thank you so much for helping guide us through what has been an extraordinarily difficult period, certainly for the world. It's the most challenging thing I think most of us have ever faced in our professional careers and the one thing I can say is that I feel like we have been able to really put the health and safety of our employees and their families and their communities first and your guidance has really helped us to feel like we were taking the right steps along the way. So on behalf of everyone at Indeed, thank you so much.

- It's been my privilege.