Lose the Mask. Eat the Turkey. And Other Sane Advice For This Thanksgiving.

If your family is anything like mine, Thanksgiving is an opportunity to take a break from work, to bask in the presence of loved ones, and to fight savagely over the most contentious political issues of the day. 

This year, as always, there is plenty to argue about. But nothing can clear a room faster than a debate about Covid.

Should we be gathering outside or in? Should we insist on boosters for everyone gathered? What about negative test results for good measure? And what should we do about unvaccinated kids? Should we, as a recent New York Times op-ed suggested, encourage them to “eat quickly and stay away from the older adults when eating”? Or would that, perhaps, result in some emergency Heimlich maneuvers?

To answer those questions and many more, I called up Dr. Marty Makary, who has been a professor at Johns Hopkins School for nearly 20 years. Dr. Makary is also a member of the National Academy of Medicine; he has published more than 250 scientific articles; and he is the author, most recently, of “The Price We Pay: What Broke American Health Care and How to Fix It.” He offers a no-nonsense approach to the two pandemics he sees plaguing the country: the coronavirus and the “pandemic of lunacy.” 

For the full conversation, I’d urge you to listen to our here:

Veteran Honestly listeners will notice that this episode may sound a bit different. We’re piloting a new format, which we’re calling Quick Question, and we hope you love it. Feel free to email your burning questions—even if they’re not quick—to tips@honestlypod.com. Please include “QQ” in the subject line. 

For the anti-podcasters among us — and we love you almost the same — below, condensed for clarity and length, is my interview with Dr. Makary. I hope will help prepare for this year’s over-the-charcuterie-board brouhahas. — BW

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The End of Covid

BW: Is Covid over? 

MM: Covid is definitely moving to the endemic phase. That is the phase where we're going to have to just learn to live with it. That official transition is probably going to be when we get these new therapeutics, as soon as a couple of weeks from now. They're pretty remarkable, and cut Covid deaths to zero. Still, the only Thanksgiving I would approve of is if it's at the International Space Station after people have ten boosters and are tested every hour.  

BW: Are you talking about the pill when you talk about new therapeutics? 

MM: Yes. Merck’s drug Molnupiravir and Pfizer’s drug are both simple outpatient pills. You pick them up at the pharmacy. We’ve got a ton that are in storage. Honestly, we should be using it on a compassionate-use basis right now. But the FDA and the pharma companies don’t want to collaborate to make it available.

So that’ll mark the end of the pandemic phase. Officially, it'll be in December, and then in the next year, you’re going to see a lot of pushback on these restrictions because historically our government is very slow to remove restrictions.

BW: What is the actual risk of ending up in the hospital with Covid?

MM: I love that you're asking this. No one is asking this question. We’ve got to quantify the risk and present the data to people. We have such a paternal attitude right now in public health. For all Americans, if you’re fully vaccinated, the risk of being hospitalized is one in 20,000 on a weekly basis when Covid levels are high. When they’re low, it's much lower. For the one in 20,000, that’s heavily skewed toward older, overweight people. Those are the people that get into trouble. It’s not your young, healthy Olympiad or Aaron Rodgers. 

There are people dying today in high numbers. The vast majority are adults with a comorbid condition. They’re older, they do not have vaccinated immunity and have not had Covid in the past. That is a very surgically precise group, and those are the people at risk right now. And I don’t think it's fair to hold the entire society hostage because they’ve made a personal choice — which is not a wise choice, in my opinion — to put themselves at risk by not getting vaccinated.  

BW: If you are a vaccinated person who is not at high risk because you lack the comorbidities that you’ve outlined — age, weight and so on — is it okay to take off the mask? 

MM: I don’t wear a mask. I don’t wear a mask in public or with friends unless I'm at a bingo night at the local geriatric gathering where there’s a lot of people that have organ transplants. I wear a mask out of courtesy, but look at the farce of what's happening. Not only do you have to wear a mask for the nine steps to walk to your table at a restaurant, but when you go to a gathering the workers are wearing a mask and no one else is. We're imposing a new form of an oligarchy and exercising a power imbalance that would, in any other setting, be seen as disgusting. 

Just look and see who is wearing a mask. These are people from minority communities. They’re low income people. They have to work in the pandemic and those of us that are enjoying cocktails, we’re told, you are dignified enough, you are noble enough where your transmission is somehow sanctioned. It’s OK. But for other people, it’s not.

Kids and Covid

BW: Should kids be wearing masks, especially kids in schools?

MM: First of all, I don't think masks are a binary thing. It’s not “mask” or “don't mask.” It’s universal masking versus selective masking, and we should use selective masking in perpetuity. That is, if you have symptoms or if you're at high risk or you want to, you choose on your individual volition to go ahead and wear a mask. If you use universal masking as a heavy hand beyond its utility, you alienate the authority of public health and you discredit the ability of those of us in medicine to say, “Hey, we need you to run because there’s a fire” in the future. You can only cry wolf so many times. And we have to remove restrictions as aggressively as we put them on, or else we lose credibility altogether. 

Now, do the masks work? Cloth masks barely work. The cluster randomized trial was in adults, and we know kids are less efficient transmitters, so we’re fooling ourselves. Also, kids with learning disabilities are now showing up to speech pathologists because they can’t speak well because they’re not visualizing the foundation of words. We’re hearing guidance counselors talk about an influx of kids with all kinds of disconnect problems. Five percent of school-aged kids wear glasses. When they wear a mask, they’re fogging up their glasses. One kid told me he took off his glasses in class just because he can’t see with them on in the mask. 

What are we doing? We've lost our sense of being reasonable. If there is an active outbreak maybe a surgical mask makes sense. But what we’re doing now is using an indiscriminate mask policy at times when it may not even be working, and we don’t have any data that it is.

BW: Since masks presumably reduce the risk of getting other viruses, is it bad for children's immune systems to be less exposed to germs and not just because of masks but because of the sanitizing that's happening constantly?

MM: You’ll hear different things about this, and the reality is that if you can avoid getting an infection, overall, it's good. But what we are going to see — and this is inevitable — is we’re bracing for a big influenza season at some point in the future. Now we’ve already seen it with another infection called RSV, respiratory syncytial virus. Do you know there were as many kids with RSV in the hospital this year as there were with Covid? It didn’t get any attention. It’s not getting the headlines, but RSV was basically suppressed the prior year and it came back with a vengeance. So there is something to what you’re saying. 

BW: The FDA just approved Pfizer for emergency use for kids as young as five. Should kids be getting the vaccine given how low the risk is?

MM: I’m going to be very honest with you. And by the way, a lot of pediatricians have shared this sentiment with me, and they’re afraid to say it publicly. It’s not a one size fits all strategy. It’s not a binary categorization that you’re either pro-child vaccinations or anti-vaccinations. I don't think kids should be getting the anthrax vaccine, but that doesn’t make me an anti-vaxxer. The risk benefit analysis is unique, and it changes by whether or not the kid’s had Covid. If the kid had Covid, which is half of kids in that age group, they don’t need a vaccine. They can get one dose, and some pediatricians may recommend that. If the kid has comorbidity — and we think that’s the composition of the 94 kids who have died of Covid in that age group out of 28 million — I would recommend it.

Natural Immunity

BW: Will natural immunity protect you against Covid?

MM: It protects you better than vaccinated immunity. It’s not perfect, but where are the cases of those who had Covid in the past and recovered and now come back and they're intubated in the ICU or died? Where are those patients? They’re exceptionally rare, and when they occur, they’re immunosuppressed or patients with unique medical conditions. Plus, natural immunity works for other diseases. SARS and MERS have been studied long term and the natural immunity is effective and durable. But 16 studies show that natural immunity protects you better than vaccinated immunity.  The largest study worldwide, the Israeli study, showed that natural immunity was 27 times more effective than vaccinated immunity in preventing recurring Covid illness. The only two studies to the contrary are from the CDC. They were sham, jerry-rigged studies that were so embarrassing they would get disqualified in a seventh grade science fair project. That’s how horrible these studies were.

BW: Marty, do you trust the CDC?

MM: I sometimes think we would have done better in the pandemic if we didn’t have a CDC because the CDC has consistently put out unreliable recommendations, and we can’t have a group of disconnected people adjudicating on every aspect of American life. When they try to do it, they get it wrong, like when they shut out kids from school for over a year. I was very upset with the CDC for the original sin of the entire U.S. Covid response, when the CDC blocked any lab from doing Covid testing. Testing is the absolute foundation of dealing with any pandemic. And so they told the country, they told the White House, we don’t have evidence of community transmission. They were using these terrible sampling systems that were non-representative and they were banning anyone from running tests. 

Mandates (Nationally and for Thanksgiving Dinner)

BW: Vaccine mandates, yay or nay?

MM: We don’t do mandates well when we do them as a society. I don’t have a problem with hospitals saying ‘If you're going to interface with the vulnerable we need to require that you’re immune.’ And we’ve done that with influenza year to year. But there are nurses that are saying ‘I already got Covid. I jumped on the grenade when Covid hit this country. I sacrificed my life. I’ve got circulating antibodies.’ Why are we not accepting those circulating antibodies that are effective against Covid? Because they have not been approved by Dr. Fauci? That is absurd. It’s complete insanity that we’re going to require you to be immunized against a virus for which you're already immune to.  

BW: My mom just texted yesterday to say that my wife and I should get the booster shot before we come home. We both have the first two shots, of course. But should we get a third?

MM: So there’s no data to support boosters in younger people right now, which is why the FDA and CDC experts voted down the boosters for all. If somebody is high risk or over age 65, I say, yeah, they need a booster. 

BW: Marty, how are you celebrating Thanksgiving and what are the Makary family rules for the road going into the holiday?

MM: We’re fully vaccinated, except for my niece and nephew who are in that 5 to 11 category.  They will not be getting vaccinated since they both had asymptomatic Covid cases. Everyone else in the Makary family has gotten the vaccine, and we got the doses three months apart to get durable immunity, probably equivalent to being boosted as a young person, and that’s the way everyone should get vaccinated. My parents are boosted because they’re in that risk group now.  

We’re feeling good about our immunity and we're going to live our lives and we're going to have a great time. And after Thanksgiving, I’ll be meeting friends and family down in Delray Beach, Florida, where I like to spend my holidays and enjoy the warm weather. I’ll be on the beach. If I have my N95 mask, it'll be in my back pocket in case somebody requires it. But that doesn't happen in Florida.