Hi, welcome to Conversations. I'm Bill Crystal and I'm very pleased to be joined again today by Dr. Ashish Shah, Dean of the School of Public Health at Brown and a guest on Conversations in December and February, where you were uncannily

correct, I would say, about the course of the pandemic and what was about to happen, and especially in February, which I

and I recommend both conversations, but they both are models of how to think about public health issues, I think, in addition to being a very sharp analysis of the moment we were in.

But in February, you said you thought we would be up for fairly normal summer, I think you might have even said, and you were ahead of the curve in that prediction, and I think vindicated.

Anyway, thank you for joining me again today on July 27th, let me just get the date down so people know when we're speaking, and where are we?

Where are we and where are we going and what are the options ahead and so forth?

Yeah, Bill, so I've really enjoyed both of our conversations before and I was delighted to get back together, and partly because when I was sitting here with you in February and looking out at the next few months,

I could see a pretty clear path to where things were going, and applying what we knew about the virus, what we knew about the vaccines.

One could make some pretty reasonable predictions about how infection numbers were going to plummet as we got through the spring and summer, and we could feel pretty confident that we were going to have a normal summer.

And I feel like that largely worked until it didn't, and all of a sudden, here we are, I would say about three, four weeks ago, so right in the beginning of July, I started feeling nervous that things were heading in the wrong direction.

And here we are on July 27th, and it's very clear that we have some challenges in front of us.

So let's just be very explicit about what those challenges are and what they may be.

I think there are three things that have surprised me, or let's just say weren't part of my mental model in February, whether they're surprising or not we can talk about actually.

One is the Delta variant, didn't exist as far as we know in February, and it certainly did not become prominent in the United States until June or July.

And the biggest thing about the Delta variant that I think has been a bit of a surprise is just how contagious it is.

It is way more contagious than any variant of this virus, and that really changes things.

And it changes things in terms of how much population immunity you need, it changes things in terms of what the breakthrough infections are for vaccinated, and that wasn't really part of our mental model, a super, super contagious version of the virus.

That's number one.

Number two is I did not expect that a large minority of the American population would not be interested in taking a vaccine that was as good as these vaccines are, and that came at the end of what was a horrible year.

I thought everybody's just like done, let's move on, and that my assumption was everybody was going to get vaccinated, you know, five, ten percent of people might refuse.

But if we got to 90 plus percent, I thought it's fine, we're going to have this pandemic largely dealt with.

And then the third part where I will say that it's still a bit preliminary, but we are starting to see some data around the durability of the vaccines.

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