Hi, I'm Bill Crystal. Welcome back to conversations. I'm very pleased to be joined again today back by popular demand and that's even true in this case.

Dr. Shisha, Dean of the Public Health School of Brown, very well-known public health expert and has consulted with everyone, federal governments, state governments, the public informed the public over this last year in very impressive ways, I think.

So thank you for being with us with me again. We talked just before Christmas, I think.

Yeah, Bill. So first, thanks for having me back. I'm excited. Yeah, I was, I think it was early December and mid December, I think, yeah, mid late December. Yeah, so, but that was two months ago.

And I think I look back quickly at the transcript and I think here your prognosis stands up pretty well. But let's, so let's talk about where we are, where we're going, vaccines, testing, what the new normal will look like the whole thing.

It's February, what is it? 18th, as we talk, I think, what, where do we stand? I mean, just generally in dealing with this pandemic and obviously vaccines is the focus of most people's attention.

Yeah, so generally, I would say things are looking pretty good. Case numbers are down, I mean, since we talk, but, you know, with a peak in early January, they're down 60, 70% hospitalizations are down 40, 45%.

Deaths are starting to move. They always lag. They're down maybe 10 or 20%. But look, that's going to continue going down. So, so on one hand, it's great. And if, if there were no clouds in the horizon, I would say it's more or less smooth sailing from here, but there are a couple of dark clouds in the horizon, the variants that you've been hearing about, the UK one, the South Africa.

Maybe some from the United States. And those are real clouds. And they're going to cause storms. And we've got a weather, though. But that said, overall, I feel like the outlook here is still very good. And those clouds and those storms are going to be passing.

And we're going to have to get through them. And then after that, things will get meaningfully better.

So you don't think it's likely at least that the variants fundamentally challenged the vaccines or the horror us achieve a reasonable new normal.

No, not, not based on everything we have so far, but here's the little asterisks in this, which is there is this sort of tail.

And kind of possibility this low likelihood event that we could get a new variant, not once that's out already, but a new one that is resistant to our vaccines. I don't think that's impossible.

Haven't seen it. Don't think it's likely, but we should be prepared for it because the consequences of that are pretty darn catastrophic. So we've got to at least get started getting ready thinking about that issue.

Am I right? And I fully understand this. I've got to say the epidemiology of this, but that the faster we would have or the faster we now get to vaccination into immunity, the less we have to worry about, even from a new variant within it, post new challenges with booster shots, I suppose, and so forth. But am I right that it makes speed all the more important.

Absolutely. So the way to think about it, let's just maybe take a minute to talk about some terminology.

There are mutations, there are variants, there are strains. So what are all these different things? These viruses, these SARS-CoV-2 viruses and RNA viruses, RNA viruses are notorious for making mistakes. They're just, they're sloppy viruses.

And 99.99% of the mistakes are irrelevant. They're little mutations that don't make any difference.

When a group of mutations come together and become dominant in some form, you start calling it a variant, and it says, yeah, this really looks a little different than the normal wild type.

When that variant takes on new characteristics, what do I mean? It's more infectious, it's more deadly, or it evades immune response, then we call it a new strain.

So I would say the UK variant can be called a new strain, because it's clearly more infectious, it might be a bit more deadly.

The African variant, South African variant, is probably a new strain as well.

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