Anne Wyllie: The Latest on Omicron

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.

Howard Forman: And I’m Howie Forman. We are physicians and professors at Yale University who are trying to get closer to the truth about health and healthcare.

As we begin the new year and our fifteenth episode, we were going to forgo having a guest because we are well aware that Omicron remains one of the most pressing topics in the U.S. and globally today. We will do a deeper dive into what we know, what we still don’t know, and try to separate the signal from the noise, but we are also lucky enough to have Anne Wyllie, our former guest, to come in again, rejoin us in a few minutes to talk about some breaking news about testing Omicron and what that might mean for future policy. But first, as is our custom, we want to start to talk about a non-Omicron topic in the news today. Harlan, what has gotten your attention this week?

Harlan Krumholz: Well, I think one of the big things that came out this week was the Theranos trial. I mean, I think it riveted a lot of us, and it raises so many interesting issues. We know that Silicon Valley and a lot of startups exaggerate, of course. This was more than exaggeration. I mean, and the conviction was one of fraud, but it raised to me this question of due diligence and the degree to which people just accept what other people say rather than dig in for themselves to try to do the research, do the work. And I can remember back when people were making so many different claims about Theranos, that people seemed so willing to accept that they had really cracked the problem and fixed how to measure a whole wide range of blood tests with just a drop of blood. The idea was very attractive, but they had yet to have any real academic publications and any demonstration that what they were doing was really working. It was this proprietary secret thing, secret solution. And the trial and the conviction… I just wonder, by the way, she’s getting convicted, but how many others seem to get off the hook? Take a look at WeWork, for example, and Adam Neumann and others. Anyway, I thought that was an interesting thing for us to reflect on. Will it change anything? There’s an op-ed in The New York Times today suggests that it won’t, but I think it’s a cautionary tale about just accepting what other people say and not for yourself, trying to figure it out.

Howard Forman: There’s an aphorism that is attributed to Warren Buffett that says, “You only know who is swimming naked when the tide goes out.” And I think it appropriately describes the situation that there’s so much hidden beneath the surface that unless you’re looking for it, you’re not going to see it.

Harlan Krumholz: What’s on your mind this week? What’s caught your attention?

Howard Forman: Yeah. This is an anecdote really from my own family experience with buying prescription drugs and a family member has gone away for a few months and forgot their supply of atorvastatin, which is the old Lipitor, and therefore had to fill the prescription. But because the insurance company had already paid for the previous prescription, it wasn’t going to be covered by insurance, which shouldn’t be a big deal. Atorvastatin is a very inexpensive generic drug, and so when this family member went to their usual pharmacy to fill the prescription, they were very surprised to find out that it was going to be, I think about 350 or 360 dollars for a three-month supply. And I had had a similar experience to this myself with a prescription that was not covered by insurance. I quickly told this family member go to Costco, and in this case, they chose a different pharmacy and were able to fill the prescription with twice as many pills for less than 1/10th of the cost.

Harlan Krumholz: Yeah. I thought this was a four-dollar prescription from Walmart, when Walmart did all those four-dollar prescriptions.

Howard Forman: Exactly. Exactly what it is. So in this case got six months supply for about thirty dollars. Very close to the four dollars that you were describing. And it’s just a reminder, Sarah Kliff, Elisabeth Rosenthal, and others have done great work in the last few years uncovering all the ways in which consumers are exposed to prices that are vastly higher than what they should have to pay.

Harlan Krumholz: What’s the take-home for anyone who’s listening? If you’ve, if... What should they be doing if they’ve got to reduce their cost?

Howard Forman: I mean, the first thing I would do is if you get an egregious cost for your prescription drugs, look around, go on discussion boards, talk to people. I have a family member with type 1 diabetes who has to buy insulin, and we learned really quickly how and where you get insulin at the lowest cost. And it’s not easy. There’s so many different places where we need to increase transparency, but in the meantime, patients should know that there are communities out there that’ll help them find it.

Harlan Krumholz: That’s great. That’s great.

Howard Forman: There is a lot for us to unpack about Omicron. And it’s been a couple of weeks since you and I have talked about this, and we’ve been living with this variant now for, really, almost eight weeks since it was first, the outbreak started in South Africa. What are the big key findings that are sticking out for you right now?

Harlan Krumholz: Well, I think it’s really, it’s been quite a ride, and there are a couple take-homes that I have about it. Look, most people will have heard this from other places, but we know: highly transmissible on an individual basis. If you’ve been double-vaxxed and boosted, it’s not nearly as dangerous as what we’ve seen before. Has a predilection for the upper airway, not for the lungs, so it seems to be sparing some of that. We have no idea yet about long COVID; they’re still too early to have a sense of that. And that, even with the double vax and boosted, there’s a lot of people who are getting infected. It’s just that they’re being largely protected. Now, what I see this as is something that’s going to rage through society, is hard to stop, and the biggest issue about it is the disruptions.

It’s taking people out of the workforce, it’s putting them on the sideline with regard to the CDC recommendations, but some people are sick, some people asymptomatic, but it’s taken them out. That’s disrupting the airlines; it’s causing the hospitals to have quite a problem too, because the large number of people infected, even though it’s safer, is boosting up the number of people who are needing to be hospitalized. Fewer people in the ICU, fewer mechanically ventilated, but still more in the hospital, enough to create a crisis, especially when 10% of the nurses are out or 10% of the doctors are no longer available or other healthcare, other vital healthcare workers, not just nurses and doctors, all the healthcare professionals, handicaps their capacity in a moment in the winter where we’re usually seeing surges anyway. And so this ends up being a societal disruption. I think it’s going to be more akin to a bad flu season with regard to the individual damage, but because so many people are going to be infected, so many more than were ever infected with flu, many more people are going to be harmed as a result.

And then the final little coda for me is about the kids, is that there is talk about an increase in hospitalizations for kids. Best I can tell, most people are thinking that it’s not that this is more dangerous for kids, but there’s so many more kids infected that even though the small percentage get into trouble, the absolute number of kids who end up, are being hospitalized now is going up. That’s my capsule about this, which is, this may in the end be a blessing because, not blessing people are going to harmed, but what I mean is that Omicron infection less harmful for individuals who are vaxxed and boosted does seem like it provides protection against Delta. And maybe that means that as this burns through the country, that people will be left with immunity, that might be broad-based, and then we’ll see what happens with the next variant. Whether or not it protects us against that, but what do you think?

Howard Forman: No, no. As usual, we’re mostly in alignment. I just want to add a couple of, sort of, facts that I think are being understated and then just talk a little about my own narrative from the emergency room. Fact-wise, I think we’re still going to see a massive number of deaths from this, which I think surprises people, because we keep saying it’s mild or milder, but “milder” is not “mild.” And in South Africa it looks like it’s about 30% of the deaths from the Delta peak. In places like the UK, the United States, we’re seeing vastly more cases than we saw in the South Africa. And so 30% of a much, much higher number can still be a large number of deaths.

Harlan Krumholz: But the harm is mostly accruing to the unvaccinated, right? Or the partially vaccinated?

Howard Forman: I agree.

Harlan Krumholz: I don’t mean to suggest that that’s any less tragic, but just to say that people can control their destiny, they can control their risk. Do you agree with that?

Howard Forman: Totally. And so let me tell you about my experience because as you know, I love working in the emergency room, and I usually only work about two days a week, sometimes even less, but over the ten days of the holidays, I worked six evenings, which is a lot and it was a very, very high COVID time in our emergency room. I saw a lot of COVID pneumonia cases because as a radiologist, I’m not seeing people that are coming in to test positive, I’m seeing people who are coming in, shortness of breath, or have chest symptoms. And here’s some observations I’ve made. One is that if you are very elderly and not boosted at this point, you are at a much higher risk than you think. I’ve seen a fair number of vaccinated elderly people with severe COVID pneumonia.

Harlan Krumholz: Fully vaccinated? Two shots and the booster?

Howard Forman: Two shots and not the booster.

Harlan Krumholz: Not the booster.

Howard Forman: And not the booster. Right.

Harlan Krumholz: But by the way, we have a lot of scientific, basic science evidence, that those two shots without the booster puts you in a very difficult position with regard to Omicron, right?

Howard Forman: And particularly if you are older. And again, I can’t even tell you about all the cases I’ve seen, whether they’re Delta or Omicron, because at the time that I was in the ER, even though Omicron was vastly dominant, COVID pneumonia is a late finding. It’s ten days after you’re infected, it may even be more in some cases. I may be seeing Delta cases, but nonetheless, a lot of Omicron should have been there. I have seen one patient with a booster have a breakthrough severe COVID case that was an immunocompromised patient with a transplant. That makes sense to me, at least as an outlier. I’ve not seen any other severe booster breakthrough cases. And I just want all of our listeners and everybody I talk to to just keep that in mind, because what you said is 100% true. You control your destiny here, and we can dramatically hold down deaths and disability if people would be vaccinated and boosted on time.

Harlan Krumholz: And this is where we’re changing this definition of “vaccinated,” right? I mean vaccinated at this point, really, if you’re getting the mRNA, it needs to be three shots. Somebody asked me the question, “If I got the J&J and then I got an mRNA, do I need to still get another one?” And I said to them, “I think so.” The question is, how long between getting the mRNA after the J&J do you get a boost? There’s lots of different variations here.

Howard Forman: I’ve been asked that question many times, and I have a standard answer for it, which is, that makes a lot of sense, I think you should talk to your physician and the biggest issue is timing. Again, we agree with that. It is one of those things where people are expecting there to be some large trial to give answers to it. And those trials will possibly come out, but they’ll come out really too late to influence policy, which gets to the other issue that you and I talked about, which is the CDC making a bold move right around the time of the holidays, around what you should do for isolation and quarantine after you test positive or develop symptoms. And this is a great example also where we don’t have the perfect evidence we’d like, and the CDC made, I thought, a more nimble type move, showed that they were willing to be more flexible.

Harlan Krumholz: Well, but come on, Howie, this was a decision to spread the virus! I mean, it just was a decision to say “Look, we know that you’re, lots of people still shedding.” I mean, the study I saw was that, by some of the places that are doing sequential testing, is that even at ten days, 20% of people have a, and I’ll speak technically, a CT value, a cycle threshold value, less than 30. When we’re doing these PCR tests, we’re amplifying the genetic material. How many cycles you have to go through to amplify it toward detection tells you how much virus is being shed. If you don’t have to amplify it very many times, that suggests you’ve got a lot more virus on board. Less than 30 is kind of thought to be, you’re shedding a lot, you’ve got a lot of virus on board. And 20% of people at ten days are probably still infectious. To suggest that people can go back at five days without testing is to say that “Look, we’re throwing our hands up. We can’t paralyze the economy. Go out, go forth. In fact, it’s fine.” Right?

Howard Forman: But we also know that very few people were following the CDC guidance at all. One could argue that getting something that gets people to believe in it and complies with it might be better than something which is unapproachable for most workers in our country. I mean...

Harlan Krumholz: But why codify a policy that by its nature is going to accelerate the spread? I mean, you’ve got the NFL saying, “Great, five days, you’re back on the field.” We’re... And ask them, “Are you going to test anyone?” They’re going, “Heck no, we don’t want to know. We don’t want to know. We want to put people back on the field. We got to get the games played.” And so given this, it’s almost got to be a universal precautions. You’ve got to assume anybody you’re sitting with, anyone you’re with... And by the way, this, having Anne on, she’s going to bring on this issue that raises this to a whole nother level, which is about the antigen testing. And the fact that people are spreading the virus even before they’re positive on the antigen. We’re going to give out 500 million antigen tests, and Anne’s just said that these are worthless to stop the spread.

We’re learning in real time, the problem— and that’s why I’m to the point of saying, “Look, I think most people are going to be infected by the time we’re done with this.” What’s my plan? I mean, I’d rather not get infected, but the truth is, I think it’s futile. It’s a Star Trek, “Resistance is futile,” but I’m really looking forward to Anne explaining to us how she’s thinking about this now, because she’s introduced a paper, a pre-print, into circulation that’s going to rattle a lot of folks about the utility of the antigen tests, the 500 million antigen tests that are about to be distributed, and how they should be used to control the epidemic. Maybe we should transition now and talk to Anne. What do you think, Howie?

Howard Forman: I think that’s a great idea. I mean, I just want to say you’re the one who pointed this out to me this morning. I got to read the paper in advance. I’m so thankful for that, and it’s great to have Anne back. Why don’t you just reintroduce her to our audience, but thank you for joining us, Anne.

Harlan Krumholz: Well, Anne Wyllie’s one of the rock stars of Yale University and actually, now, of the world, who’s leading so much important research about how we can best identify and track and test for COVID. And we had her on the program before, and we’re so happy to have her back. She and a few colleagues have just posted a pre-print. Pre-prints are a way to circulate scientific information, but recognize that this hasn’t been through the peer review process yet. But when I get a great scientist like Anne who’s posted something, I generally have a lot of confidence that she’s done the right thing and in the right way. And Anne, welcome today. Let me just say welcome, so glad you were able in the last minute to join us.

Anne Wyllie:

Yeah, no problem. Thanks for having me again.

Harlan Krumholz: And we don’t want to take too much of your time, but I thought maybe you could tell the listeners a little bit about what you’ve just done and what you think it means, and then maybe just field a couple questions from us.

Anne Wyllie:

Yeah, sure. We were actually alerted to this data back in early December. I think, actually, last time you had me, we talked a little bit about the National Basketball Association and the role sports play. And again, they play a big role in this because of our weekly COVID-19 sports and society call. This sort of data really came to light where we could really start discussing it. And it has been, it’s actually, to be honest, been weighing very heavily on my mind the last three or four weeks, knowing that we had found this data that we were seeing. One of our fabulous collaborators, Blythe Adamson, who’s been running phenomenal testing programs, helping people to return to work safely, she was the one who really identified this very early on. And so what she actually found was that through a very rigorous testing program that she was running, she was working with individuals who are at high risk of transmission.

She was conducting both a saliva PCR test and right before these individuals were going to come together, they were also doing an antigen test because you really wanted to make sure that they were going to be negative for SARS-COV-2, that they weren’t posing a risk to each other. And she soon found that she had an outbreak on her hands where saliva PCR tests were coming back positive, but all of these antigen tests were remaining negative for days before turning positive. And we first learned about this sort of early December, mid-December, and we knew that the entire country was relying on these tests essentially to travel, to see friends, to see family, to go about their vacations and knowing that there was a risk that these tests weren’t actually correctly identifying these individuals, but knowing that it was very early days and really not knowing, was this an isolated incident, or was this going to be more widespread with more tests? It was really hard to... How do we discuss it, how do we bring it to light in the public forum when... How do you raise something like this when so many people are relying on these tests around the country?

Harlan Krumholz: One thing I wanted to ask you was, first of all, just so people know, so these are asymptomatic people at work who are part of a screening program. The idea is trying to pick up asymptomatic infection. This is different than a situation where people are actively symptomatic, but my two quick questions are, one is, you’ve got a relatively small number of people in the end in this study, to what degree do you think we can generalize what was going on in this group? Do we need a larger study, or is this enough for us to say “Look, there’s no reason to believe what’s going on in others is different than this group”? I mean, how do you think about that?

Anne Wyllie:

What gave me confidence to start discussing this a little bit more, firstly with colleagues, collaborators, even sort of sharing a few warning sort of tweets or retweeting a few things of other observations on Twitter was that the amount of the general public that was starting to see similar. I mean I first sort of saw it on an Instagram story as I was trying to wind down one night, then came all the tweets with people who were like, “I’ve clearly got symptoms. I’ve clearly had a high-risk exposure. But my antigen test is negative. And then hang on, I’ve gone off-label, and I’ve conducted a throat swab, and it’s positive.” And the more and more and more of these that came through from the general public on my timeline, and then the more, as I was sort of resharing these, the more people who are reaching out to me via email, via direct messaging, also reporting that they’d experienced the same, they’d seen the same, their families have been the same.

We certainly need more studies. I mean, I’m not sure if you saw it, but the South Africa study, there’s a pre-print as well. South Africa released a study showing that they had improved detection using saliva PCR versus a mid-turbinate swab, so also a nasal type swab PCR. Again, it was small numbers, but again, it’s this common thing that we’re seeing. And if we also think about what we are seeing with Omicron, we are seeing a shift in symptom profiles, less loss of smell being reported and many more sore throats. There have already been reports that you have much better replication of Omicron, 70 times more, in fact, in the bronchial tissue than Delta. And the rate that this is spreading, you can’t just simply, there’s been some comments of, “Wow, an antigen test. Is that’s how you’re supposed to detect someone’s infectious?” If it’s negative, maybe they’re not infectious, but you have such high viral loads that Blythe was seeing in these saliva samples for the, anyone who’s familiar with CT values, we’re talking 18 to 23 CTs. These are very high viral loads.

Harlan Krumholz: People were talking about Omicron when it first came out to say that this thing replicates so quickly and people go from asymptomatic to highly infectious in just hours, but there was a lot of talk about, in contrast to Delta, that there wasn’t going to be a large reservoir of asymptomatics. And this sort of blows that out of the water, too. I mean, it suggests that no, no, no, no, they’re— I get that the PCR is positive, but these people are very low CT value. So again, emphasizing, that means a lot of virus, likely a lot of infectivity. They’re feeling fine. They just happen to be in an occupational health program, but under normal circumstances wouldn’t even be tested. And if they were vigilant, might just test with an antigen test, not to go to the trouble of getting a PCR. I mean, are you, what’s your impression of the asymptomatic spread of this now, after looking at this study?

Anne Wyllie:

Well, I think this could also explain why we’re seeing such spread of it again, especially leading up to Christmas. How many Christmas events were there? How many family get-togethers? I mean, in the vast majority of settings, people are so concerned about passing infection onto their friends, family, so they have been tested. They would be a little bit concerned if they were presenting with symptoms, but just the number of people who continue to get together and what large outbreaks we saw from these events really show that there is a risk for these infectious loads of this virus to be able to spread through entire events in the course of an evening.

Howard Forman: I just want to emphasize something you brought up in the last podcast. It’s the non-science part of the science here is that you have embraced social media in a way that a lot of other people haven’t had the opportunity, and you’ve been a proponent of how Twitter and other formats have allowed you to communicate both with scientists as well as individuals out in the community. I just want, if you could expand a little bit, because I experienced this a little bit as well, just how meaningful individuals out there in our community, people who just want answers, how they contribute to your thinking, your questions, and how you come to answers about this pandemic.

Anne Wyllie:

I mean, it’s incredible. I just continue to learn so much through this pandemic through Twitter. It’s one of the things I do check regularly throughout the day. I mean, I even saw a post also comparing some other antigen tests the other day, which someone had collated, and they said, “This is going to be part of our pre-print.” They don’t even have the pre-print out yet, but they’ve made their table, it’s looking great, and they’re sharing it on Twitter. I mean, this is where we can really find out things very early. I mean, I remember very early on in the pandemic, one of our other fabulous colleagues, Nathan Grubaugh, they needed to develop a PCR test. He turned to Twitter and he said, “Does anyone out there have any SARS-COV-2 RNA for us?” And one of the first comments was, “You’re really asking Twitter for this?” And the next couple of tweets in reply were all, “Yeah, we have some, we have some.” And I believe he received them a day or two later. I mean, Twitter has brought so many of us so much more together. There’s so many of these other fabulous scientists around the world who they may not have been in touch with otherwise or talk with on a frequent basis, but it’s provided this platform where we can share ideas, share what other people are seeing, and just really, yeah, grow a really interesting knowledge base, I think.

Howard Forman: I just wanted to bring it up because I do think we oftentimes say how Twitter or Facebook or whatever is bad, it’s dividing us, it’s this... And I think there’s a lot of good that can be done, and it brings us closer together.

Harlan Krumholz: Well, I think it is a double-edged sword, but let me just get back to this particular pre-print, and you’ve been reflecting on this for a while. If you were going to be speaking to government officials, and you probably already have, what are you saying? They’re on the cusp of sending out all these kits. My own town’s distributing antigen tests for asymptomatic people. What do you think? What’s the recommendation?

Anne Wyllie:

I think one of the quickest things that could be done is for these companies to quickly validate, what is detection like using a throat swab? I mean, I just looked at the NHS test in the UK. I mean, they rely heavily on antigen tests across the country. Their antigen test includes a throat swab together with their nose swab. They’re doing it; it’s working for them. Again, clearly, Twitter is showing that there is potential for these BinaxNOW quick views to also accept a throat swab that I really think there should be pressure on these companies to validate whether this is acceptable. And this could be a way to include this as a way that these tests won’t go to you, it won’t go to waste, but also highlighting to individuals that they really need to listen to their symptoms. They really need to listen to their high-risk exposures, and if they’re getting a negative test and any sign of symptoms, that they should not ignore those because they might not be in the clear. Yeah.

Harlan Krumholz: And when you’re talking about throat swabs, are you speculating that if these had been done with a throat swab, they might have had a different result? Or do you know that if we, if they had been done a different way, they would’ve been, we would’ve seen much better performance?

Anne Wyllie:

Again, this is just what I’m learning from the general public on Twitter, which is again, insane.

Harlan Krumholz: Yeah.

Anne Wyllie:

But again, the number of people who have reported, “We included it. We did it. We see earlier detection.” I think if you’ve got a higher viral load in your saliva that it could be a, potentially you are going to pick it up earlier using a throat swab with an antigen test, then waiting for that infection to be detected a number of days later in the nasal cavity.

Harlan Krumholz: Well, like you said, we really need to see validation of exactly how good the test is and so forth.

Anne Wyllie:

Yeah, definitely.

Harlan Krumholz: Thank you so much. At a moment’s notice you joined us. I think you’ve provided so much clarifying information, and congratulations on the work you’re doing. I also think, Howie, there’s one piece about this that Anne said I think is so important, which is, she made an observation, but she recognized that it could cause harm if it wasn’t true. And so she had to figure out how to get confident enough that it was worth sharing rather than to come out prematurely and maybe cause harm without feeling confident about the result. And then she got to the point where she sees the results. She’s a great scientist. It’s really, also someone who’s weighing the public health implications of her work. I just... Anne, really great, really great what you’re doing.

Anne Wyllie:

Thank you.

Howard Forman: Thank you, Anne, very much for coming.

Harlan Krumholz: Well, that was really great. I’m glad that she took the time to speak with us. We’re just at the final segment where we often talk about what’s on our mind, what’s inspiring us, but Howie, look, I’ve heard you’re getting involved in TikTok, so I can’t resist. Tell me, what are you doing with TikTok, and what advice do you have for the rest of us who are trying to catch up to it?

Howard Forman: Yeah, so I’ve been shocked by this. I’ve watched my daughters with TikTok for several years now and, sort of familiar with what the app is about, but I never really opened it on my own. And then the School of Public Health asked me whether I would help them promote our TikTok account and whether I would tape some videos, giving updates about Omicron right before the Christmas holiday. And then more recently, and I was shocked by how fast you could get a message out to large numbers of individuals now.

Harlan Krumholz: Well, but tell me, who’s listening on TikTok to Howie Forman? I mean...

Howard Forman: I was, so I agree with you. At first I was like, “Okay.”

Harlan Krumholz: I’m not doubting you. I’m just wondering who’s...

Howard Forman: No, I know. I, too, I thought the same thing. And even when they said to me, “Oh my God, there are 50,000 people that have viewed it,” or 2,000 likes. I was like, “What does that really mean?”

Harlan Krumholz: Let me ask you a question. Do you guys, did you actually have 200,000 people who viewed your TikTok?

Howard Forman: Over that. And it still grows, but what’s more important and what really heartens me and makes me actually want to help them more with this is, there are so many comments of so many earnest people asking legitimate questions that they have about Omicron.

Harlan Krumholz: Are you answering all those questions?

Howard Forman: I was trying to answer a lot of them, then I did a short follow-up video, and now my intention, I’ll talk to the School of Public Health to see what they want to do, because it is the YSPH account for TikTok that I’ve been primarily using. My “the4man” account, I’ve not actually made a video from it, I just...

Harlan Krumholz: Why is it “the4man” instead of “thehowie”?

Howard Forman: I think “thehowie” was probably taken on TikTok at that time.

Harlan Krumholz: Oh, my. There’s another “thehowie”?

Howard Forman: There must be, but the questions were so good, and people are so scared so often, and they can’t call up their physician, and they don’t have friends like Harlan Krumholz who knows so much to ask questions of... This is a way that we can reach people, people asking, “Am I safe if I got a booster?” “Should I get a booster?” “I heard this, can you tell me if it’s true?”

Harlan Krumholz: Just imagine that. I mean, you’re a master teacher and you had a platform to reach 200,000 people. If I want to go look at your TikTok, what do I do? I go to TikTok and then go to the app and I just search Howie, or I search Yale School of Public Health?

Howard Forman: You can find me on TikTok at YaleSPH. That’s Y-A-L-E-S-P-H.

Harlan Krumholz: And did you wear a funny hat? Did you do anything, or what did you do?

Howard Forman: Nothing. Our really crack group at the School of Public Health did add in a few graphics that were available and appropriate for the image. In my opinion, it has changed the way I think about public health communications, particularly on social media.

Harlan Krumholz: What a great thing. And I’m so happy that you had the opportunity to reach so many people. And now you’re opening my mind to think about this as a tool, but let’s wrap up. You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.

Howard Forman: How did we do? To give us your feedback or to keep the conversation going, you can reach us at Twitter.

Harlan Krumholz: I’m @hmkyale. That’s H-M-K Yale.

Howard Forman: And I’m @thehowie. That’s @thehowie, T-H-E-H-O-W-I-E, and on TikTok I’m @ Y-A-L-E-S-P-H, YaleSPH.

Harlan Krumholz: Oh, my gosh. I’m going to get a TikTok account just so I can compete with you, because that’s just no fair. You got two ways people can reach you. We want to let everyone know Health & Veritas is produced with the Yale School of Management. Thanks to our researcher, Sherrie Wang, and to our producer Miranda Shafer. Talk to you soon, Howie, and see you on TikTok.

Howard Forman: Thanks, Harlan, talk to you soon, and Happy New Year to everybody.

Harlan Krumholz: Yeah. Happy New Year, everyone.