You were one of those people with four doses.

That’s right, and I was also able to get a prophylactic monoclonal antibody. That’s probably why I think I got a relatively mild disease. But it persisted for 17 days, and I had to have two courses of Paxlovid.

By the way, I don’t think we should call this a rebound. A better way to say it is that we don’t have the dosing schedule correct. It’s possible that Paxlovid probably requires a course of seven or 10 days.

So if I get Covid, I can ask my doctor to give me seven or 10 day’s worth of Paxlovid instead of five? [Note: The official guidance is that Paxlovid should be administered for five days, though some physicians have spoken out about the need for clearer guidance.]

Not yet. When people say they’re following the science, what they should be saying is they’re following the published science, which is always based on a study done on something that happened before. You’re always behind.

Sometimes it seems like politics, not science, is determining policy. Biden said that he’d remain in isolation longer than the recommended five days if he kept testing positive. Who’s right?

Biden is modeling very good behavior. That’s really refreshing since the last president modeled the worst.

Sure, but it’s strange that the president has to disregard his own agency to do the right thing. [Note: After this interview, Biden ended up leaving isolation after five days when he tested negative, then reentering isolation after experiencing a rebound case.]

In part, this is because when Trump was president, he attacked the CDC. There was so much political interference that there was an exodus of the CDC’s top people and a loss of its institutional memory. But there’s also been a failure of the CDC to communicate well and update their recommendations.

Also, the CDC is slow. In some ways, you’d like that to be the case—you like your doctor to be deliberative. But not too slow. Even though their advice may have been perfect a year ago, it’s not perfect now. So now the administration is talking about shifting pandemic preparedness to what used to be a small agency—ASPR [Administration for Strategic Preparedness & Response].

Why does that make sense?

The CDC’s mandate is much more than pandemics. It works on health promotion, prevention. It’s responsible for looking at heart disease and diabetes, international relations with other countries doing all health programs—all the public health units of all the different counties. But of course right now we’re necessarily focused on the pandemic and infectious diseases, and we’re really dealing with Covid and monkeypox.

I was going to mention monkeypox. What’s going on there?

Let’s go back to 1967. The WHO had the idea that the whole world should work together to eradicate smallpox. But what about other poxes? The smallpox vaccine protects against monkeypox, too. If you eradicate smallpox, and subsequently you stopped vaccinating, what happens to the other poxes that were held in check by continuing to vaccinate? We could have kept vaccinating. But we didn’t, and now no one under the age of 40 has a vaccination scar.

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