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Most people think about their health when something goes wrong.
Next Phase Human is for everyone who wants to start thinking about it before that moment arrives.
Hosted by Dr. Sandhu — a cardiologist with a focus on prevention, longevity, and whole-body wellness — this podcast brings together physicians, researchers, and wellness professionals for honest, evidence-based conversations about the topics that actually move the needle on your long-term health.
Each episode covers the intersection of cardiovascular wellness, modern medicine, lifestyle optimization, and human performance — translated into practical, approachable conversations for professionals, business owners, and anyone serious about living better longer.Topics include heart health, metabolic health, sleep, stress, nutrition, longevity diagnostics, wearable technology, recovery, burnout, and the future of preventative care.
This is not clickbait wellness. This is a forward-thinking physician who believes the best healthcare happens before you need it.
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Have we become too comfortable prescribing antibiotics?
Yeah. Antibiotics
added about 23 years to people's lives.
Wow.
So that's the estimation.
Welcome to Next Phase Human,
where medicine meets performance and science meets longevity.
I'm your host, Dr Rasham Sandhu, and with me today is Dr Rasha
Quran,
infectious disease specialist at Kern Medical Center and at UCLA,
and director of Infectious Disease Fellowship Program.
We have lots to talk about, about antibiotics, the overuse,
the effect on gut microbiome on that, about
COVID-19 a little bit, how your nutrition will affect your
infection risk, and how your hormones affect your infection risk.
So lots of fun stuff to talk about. Let's dive in.
Thank you, Dr Quran, for joining.
Thank you for having me, Dr Sandhu.
So first of all, a lot of our viewers may not know what an
infectious disease specialist does day-to-day.
So what drove you to become an infectious disease specialist, and what does
your day look like on a day-to-day basis?
Yeah. Infectious diseases, the title of the specialty is a
bit of a misnomer, and it
implies that I treat infections that spread from one person to the other.
But the majority of the infections I treat are not
transmittable from one to the other, and that's why
they're not all communicable diseases.
Some happen when microbes move from where they belong to where they
don't belong from within the body.
So what got me into this was really an excellent role
model, and a career role model, and a mentor.
His name is Royce Johnson. He happened to be my chair
of Department of Medicine when I was a resident, and I fell in love
with the specialty since then, and he sponsored me and recommended me
to the fellowship programs that I wanted.
And
so I did my residency at UCI, and I never looked back
since then, and I fell in love with it.
Well, we are all lucky to have you. As I always say, you're one of the smartest
people I've known.
Oh, thank you. I'll pay you later.
So why should healthy people who are living
normally a good, clean, healthy life, should care about infectious
disease?
So infectious diseases do not necessarily only affect
people who do not eat healthy or live a healthy life
or
have good hygiene.
Some infections affect people based on genetics, believe it or
not, like valley fever, for example.
The likelihood of it spreading in someone's body and causing a severe
infection versus not is not all predicated on
the immunity itself. It has a lot to do with genetics.
So really, there is nobody who is completely immune from
infections.
So
we'll dive into it more, but just a quick follow-up on that.
You mentioned that the valley fever spreading into your body can be affected by
genetics.
Now,
is it likely that if your parents or your brother or sister had
bad valley fever, you're more likely to have bad valley fever?
Is that what that means?
That's a very good question.
So we are actively doing research to discover
the mutations or genetic susceptibilities right now at Kern
Medical in collaboration with our colleagues at
UCLA.
So it's not that much of a straightforward
relationship,
but that can happen and where it can cluster in certain
families.
But for the most part, you'll see someone who has a severe disease
and their family members are not, and it's not fully
elucidated yet.
But there may be a component-
Yes
... of what your genetics are like.
Yes. Genetics and ancestry
as well.
Got it.
So modern life.
Infectious disease used to be a big part of how people
died back 100 years ago.
Has modern life made us healthier
or more susceptible?
So it depends on what you mean by healthier.
If you look at the lifespan,
comparing what it is now compared with the turn
of the
20th century, it almost doubled. So it went from 50
to close to 80, I think, something like that.
So our lifespan increased.
Now, the quality of life,
one can argue, are we healthier or not?
Looking back at the mortality rates in the beginning of the
1900s,
it appears that most of the deaths were during childhood.
So really, whoever survived that early childhood
period would live a healthy, long life into their 60s
and 70s.
So they obviously had a healthy life, and with modern
times come
risk factors for infections,
such as the diseases of the time, like diabetes, which predisposes people for
infections. And so it's not a straightforward
question to answer, but I would say,
generally speaking,
I think we are healthy. Now, if you think about the
lifespan, and how much longer people live,
a lot of the times they didn't live long enough in the past to experience the
diseases that we're having when we age.
The lifestyle diseases.
Yes, the lifestyle diseases. So, I think it's complicated,
but certainly with modern
lifestyles comes more susceptibility to diseases.
We have to pay attention to them and
counteract that.
And a big part of that is, of course, antibiotics.
That journey has been
Pretty impressive, to say the least.
But we're at a point in medicine where,
have we become too comfortable prescribing antibiotics?
Yeah. Antibiotics
added about 23 years to people's lives.
Wow.
That's the estimation.
So
they are important, and they save a lot of lives, millions and hundreds of millions
of lives. But we do have a problem nowadays
with over-prescribing of antibiotics, and it's even worse in other
countries other than the United States.
We have some control here. But even with this
control, there's a lot of pressure on providers to prescribe
and issues within the medical system where antibiotics
do tend to be prescribed
more than they should be.
Does every cold need a Z-Pak?
That's one of the pet peeves now, huh?
Right.
No. Obviously most of upper respiratory tract infections are
caused by viruses, and antibiotics will not cure
viruses. So
that's one of the biggest issues.
So
most of people with upper respiratory tract symptoms, presuming they are
otherwise healthy, would not benefit from antibiotics.
Correct.
That's a fair statement?
Correct.
And in general, for viral illnesses, they don't really do anything,
correct?
Uh-
The antibiotics
... the antibiotics will not affect a viral infection.
Antibacterial antibiotics will not affect a viral
infection. Antivirals might, but not all viruses have treatment.
And
we talked a little bit about the overuse of antibiotics.
What are some of the issues we are facing with that?
So it starts with the expectations from
people when they get sick nowadays.
For the longest time, too, they would go to the doctor or the practitioner or the
provider expecting something to be done, and I think there's
pressure on the providers to prescribe something,
even though studies have shown that
education and reassurance can be satisfactory to the patient.
But a lot of people do feel that pressure, and I think it's not as bad as it used
to be in the community. And with the advent
of the
rapid testing that we have nowadays, where you can check someone for
influenza, group B streptococcal infection,
on the spot, that helped withhold antibiotic
prescriptions, especially in children.
So that's one of the issues, but there are many
others, and some of them have to do with the specific
situations like here with valley fever.
Valley fever
manifests like the flu initially, fever, chills,
and then cough, and then pneumonia. So it is a type of pneumonia.
And one third of community-acquired pneumonia in an
area like ours is valley fever. But it's
very rare that this gets diagnosed the first time
the person goes to the ED, because it's confusing, and it looks
exactly like bacterial pneumonia.
So patients with valley fever, on average, get two to
three courses of antibiotics before they actually get
diagnosed and
then take the antifungal medications that treat valley
fever. So that's another way where,
if we diagnose valley fever early, we would save all these antibiotic prescriptions
and treat the patient sooner.
And that's more common for the area that we live in, where valley fever is
endemic-
Yes
... in the Central Valley of California.
But my understanding is, with the changing climate patterns, we are seeing
it beyond Central Valley areas, too. Is that true?
Yes. It is. It's common in Arizona and
the Central Valley in California and some Central and South American countries.
And then the surrounding
states such as Texas,
New Mexico, Nevada, et cetera. But yes,
we are seeing more cases now outside the zone
due to the changing weather patterns.
And
just kind of pivoting back to when you mentioned for the common
cold check, the
test for strep and whatnot. So if, as a parent,
someone brings their kid, and most common scenario is either to primary care or
their urgent care, local urgent care, with cough, cold
symptoms, what are some of the things they would ask
or reasonably expect to be done
from an infectious disease standpoint?
Okay, do this, this, and this test, and this is what parents should be asking.
So a thorough history and physical examination, that's always the base.
Examine the patient. Look at them.
Look at their vital signs.
It is tough to distinguish viral from bacterial infection just by
examination, though. So that makes it challenging
to pinpoint whether it's a virus or not without testing, really.
So I would say if testing is available for the
strep throat tests or influenza
testing, COVID-19 testing, if it's available, I would
say yes, ask for it.
So those three would be the base that you would start with?
Yes.
Fair enough. And then generally, if all that is negative-
There's no need for antibiotic
... is it reasonable to hold off on antibiotic and see?
Yeah. There's no need for antibiotics.
Perfect. And
are we approaching a future where infections get more and more difficult to
treat?
Yes. They are getting more difficult to treat, in part because of
antibiotic resistance.
And another part is people are living longer
with more immune-compromising conditions like
transplantation and autoimmune disease
treatment and
cancer treatments are advancing, so
people's immune systems are not the same like before.
They're not homogenous as they used to be.
And so you can get really challenging infections.
They are more difficult to treat now.
There's almost subspecialties in infectious
disease now, where some people specialize in
solid organ transplantation
or hematologic
transplantation or orthopedic infections, et cetera,
because they're getting more complicated.
And in terms of those infections that you treat, what are some
of the organisms that you really, as an infectious disease specialist, worry about
in the hospital or in the community?
You
hear it all about patients talking about MRSA, and that's the
dreaded word. So what is that, actually, and why should
people in the community worry about?
MRSA,
it's a staph infection. Staphylococcus is a bacteria that we all
can carry on our skin. But there are strains that
happen to be more resistant to antibiotics when they do
cause an infection or get inside the body,
cause pneumonia or skin infection.
These new strains are more aggressive, and
so they cause infections more readily.
And also, they are more resistant to the antibiotics, and they require
special advanced antibiotics to treat them.
And so the original staph aureus or staph bacteria used to be called
methicillin-sensitive staph aureus, and then MRSA is methicillin-resistant
staph aureus.
That's one of the challenges. And even the antibiotics that we have been using
for that MRSA,
there's small
amounts of resistance that's building up in it.
Even the ones that you use now for that?
Yes.
And that's likely due to overuse of antibiotics?
That's likely due to the use of antibiotics and certain
host factors as well.
So it's the pressure of antibiotics
while the bacteria is replicating that produces resistance.
So someone who has an infection, and we're not able to surgically
clear the majority of it and giving antibiotics at the same time,
that's the most difficult and most conducive to resistance
occurring, is when the infection source is not removed,
but we're giving antibiotics.
So should a normal person going down the street worry about MRSA?
Yeah, you can get MRSA from the gym.
Okay.
From any
skin-on-skin contact with other people, or short period of time
between someone else touching the same item.
So in the gym, people sit on the same
seats,
and it touches their skin.
You really want to disinfect the seat before using it.
Doorknobs or taking care of people or touching someone.
So it doesn't live in the environment for too long.
Usually, four hours is the time we say, but
you can get MRSA from the community.
And that could cause a skin infection or worse?
Or worse. It can go to the lung, the brain, the blood.
It can go anywhere in the body.
So what can someone do to sterilize the surface in the community places like
gym that you use?
Yes. Surfaces where other people touch.
Mm-hmm.
Doorknobs, I think
I would hold the doorknob with a tissue paper or
wash my hands or use a sanitizer after touching
doorknobs or touching surfaces like this, or
the gym. Especially the gym, because the sweaty, moist environment is
conducive also for the bacteria to grow.
So it's primarily in pertaining to the gym-
Gyms are-
... or similar locker room kind of environment?
Yes.
Okay.
Now, there is a topic which gets a lot of talk, but at
the same time does not get enough. That is the antibiotic use in livestock
that we eat.
Mm-hmm.
And antibiotic use in cattle or chicken,
and how does that affect us?
What are some of the downsides that we see from that?
It does affect us. And I'm empathetic
to farmers who are raising
animals or cattle, and if they get sick, what do you do?
Of course, they need antibiotics to treat
the animals. I'm not an expert on animal health, but
the use of the same categories of antibiotics that we use in humans,
using those in livestock has led to significant
resistance in
antibiotics we call quinolones, for example.
And something called C. diff, that's a bacteria that causes
a potentially deadly diarrhea in humans.
If exposed to antibiotics, you can now get C.
diff even if you've never been to a hospital,
because animals get it, and that has to do with antibiotic
prescribing. So it's a complicated
problem, and I can't just simply say, "Oh, nobody should use
antibiotics for animals," but it should really be regulated
and studied more.
And in terms of
if someone does not eat that meat,
does even drinking the milk or coming in
close proximity with those animals, is that enough?
So if you're drinking the milk and the animal just took an antibiotic and it's
still in their system, that's one way.
You'll get the antibiotics
with the milk. But also, the colonization of these
resistant bacteria on the meat when you buy it.
When you buy meat from the supermarket, there's usually bacteria on it,
and that's killed when you cook it.
So they can be colonized with that resistant bacteria and the C.
diff bacteria.
But when you cook it, that should-
Yes, but cross-contamination is so easy to happen in the
kitchen.
So from meat to the vegetables you have in the kitchen-
Yes
... or something, the bacteria can come in close contact and-
Yes. This is the reason they say don't wash your chicken,
is because you
turn the faucet on and water splashes everywhere, and then it takes
the germs to the utensils on the side of the
sink that you're going to use later to cut your salad.
So it's even more subtle than that.
You don't have to use the same cutting board to-
Mm-hmm
... to transfer this bacteria. It could be just the splashes when you're washing
chicken. That's why CDC recommends against washing chicken.
So don't wash chicken?
That's what they say.
Okay.
And I-
Cook it straight up?
I'm not going to say what I do, but yeah.
Okay. What do you do?
I wash it.
I'm very careful about the stream and not splashing the water around.
But it's recommended not to wash it.
Okay.
Yeah. Mm-hmm.
But you wash it, just careful.
I'm very careful.
Got it. So someone got antibiotics, whether they consumed
it or they got it through the milk or whatnot from the
animals. What happens to your gut with that?
So our gut is an entire community of
microbes. So there's billions. I think most people know now, there are billions
of microbes living inside our body, inside our gut, and
on our skin, and those microbes help us with our
life. They manufacture vitamins for us.
It's tremendous what they do to us, and I don't think we scratch the
surface of what they do. We don't even understand exactly what the
microbes do to help our bodies.
And taking
one course or dose of antibiotics can disturb--
The antibiotic doesn't distinguish good bacteria or bad bacteria, so it just
kills bacteria that is susceptible to the
antibiotic, and that can really disturb the balance of
the microbiome, we call it.
And so it can take up to a year for the
microbiome to
be restored completely after taking-
After one course of antibiotic
... one course of antibiotics.
Wow.
Yeah. And babies born by C-section,
their microbiome is different than babies who are born naturally because
babies get also some microbiome from their mom as
they pass
with natural delivery.
And so this is a science that's now starting
to develop, and we're trying to understand, starting to understand
how immense the effect of the microbiome on our body.
It literally talks to our brain through the vagus nerve and sends
signals to our brain, affects mood and depression and
weight, and
I think we cannot live without our microbiome.
Yeah, no, I was reading certain bacteria are related to weight gain.
Yeah.
Obese people have more of that
in a sense.
So what happened is, there was an obese
person who donated fecal microbiota-
Fecal transplant is a thing
... yeah.
So that C. diff infection that I mentioned earlier, the best treatment for it
is to get a healthy stool from a person
who's healthy and give it to that person with the problem, and
that instantly
stops the problem. This is how powerful our microbiome is.
So they did that once, where the donor was an obese
person, and the recipient has never been obese.
And after the procedure was done, the recipient became obese.
Wow. So it's your bacteria which are telling you what to do-
Yes
... for most part.
So you wonder if we're there for them or are they
here for us, really.
Very interesting.
Yeah.
Yeah. This is a medical procedure. Don't do this at home.
Don't do this at home, no.
So
we live life, and if there's an infection, you have to take antibiotics
sometimes. And now that you told me, it takes a year for microbiome to recover, and
sometimes there's more than one course of antibiotics for a bad infection.
Now, what can I do to help my body?
Yes, there's a lot we can do. So this is actually one
of the interests that I have in my career.
I became fascinated with this early on when I started
practicing, where my office was like half
of my patients were
post-menopausal ladies with urinary tract infections.
And it was puzzling to me. Those ladies would have no infections
until
approximately 10 years after menopause, and then they start getting one after the
other, and they can die and can get admitted to the hospital.
So what is it about their bodies that
changed? So I started reading into this, and it wasn't that well-known
at the time,
and discovered that the skin in
the urinary tract,
the health of that skin is dependent on estrogen.
And so once we lose the estrogen, that skin becomes dry
and weakened. The immune cells go away, and
so a bacteria can get in and cause infection.
And so those ladies lived miserable lives.
They would be depressed and feeling shamed, and
all they got from their providers was prescriptions of antibiotics and
lectures on hygiene, and it was really tough.
And so there were some studies showing that if you replace the
hormone topically,
that can stop the problem, and I started prescribing it, and those
ladies were just calling me to say, "Dr.
Karan,
six years, no UTI." Or, "Five years," or, "Three years," and that
really was
tremendous. So this got me thinking.
So infections are caused Or happen when
there's an imbalance between our immune system and the
microbes. And so, what else is
there that
we can modify by non-pharmaceutical interventions,
or just being healthy,
or replacing something where we can prevent or treat infections?
And I have special interest in that topic.
So what more can we do? This is so impressive, just hormone replacement,
recurrent UTI is gone.
Yeah.
For an average person, gets antibiotics, what do you tell that
person, okay, do this, this, and this to help your gut or your body?
For the gut,
you want to rebuild your gut microbiome and keep it healthy.
So it's what you feed,
which germs do you feed
is what
type of microbiome you get.
So there are foods that feed the beneficial
bacteria, such as soluble fibers, for example.
So it all goes back to processing of the food.
There's been studies where the more processed food is,
the less soluble fiber and the less
nutrients there is in it. And as a matter of fact,
the more disease people get when they eat it.
So really it goes back to eating natural
food, and there's another study that showed that
people who cook food from scratch at home, even if
it's the same type of types of meals, are healthier than people who
buy their food cooked or eat out.
And so
keeping ourselves healthy and eating the right food,
that's what prebiotics are, and so it's the food that
feeds the good germs, and then those bacteria are the probiotic, what
we call probiotic.
So eating the right thing and not eating the bad
stuff such as processed food,
pure sugars, especially the high fructose-containing
beverages, those are straightforward.
The highest
bang for the buck if you want to stop something, it's
the high fructose-
The liquid sugar
... liquid sugar, yes. It mucks up the immune system and
causes fatty liver,
and
just really affect our health negatively.
Do fermented foods help?
They're good, yes. And you could see that our ancestors ate them regularly.
Right.
So there has to be an evolutionary
selection to it. So fermented food is good,
and the more
naturally fermented it is, so if you buy the olives in a
can,
I don't think there's much
live microbes in that, but if it's truly pickled
olives, for example, those are healthy.
And
how many servings of fermented food should a normal person have?
I read-- No, I've never looked into this.
I know that it's healthy to eat them-
Right
... probably on a daily-
There was a Stanford small study which recommended three to five servings-
Mm-hmm
... a day-
A day
... in general for health,
and that would include all fermented foods like sauerkraut, kimchi,
kombucha,
whatnot.
I believe it.
What's your favorite?
My husband would be happy. He eats olives with everything.
But there's more to fermented food than olives, obviously.
No, I personally,
I like to eat fermented food with every meal, but it's not everybody's
taste to-
It's a good addition if someone can.
Yes. Like in the sandwich, I put pickle,
olives with breakfast.
Our Middle Eastern food has more pickled food,
naturally.
So it's an essential part of any meal to have
pickled or fermented food.
And do you routinely recommend prebiotics or probiotics for
people who are on antibiotics?
Who are on antibiotics? Yes, I do. Now, the problem with
probiotics is
not all of them show benefit. So there's been many
studies, and there are many products out there on the market,
and not all of them have been shown to prevent the medical
problems that occur, at least very deadly problems such
as C. diff.
So there's one product that I would prescribe
and recommend to take while people
are taking antibiotics. Now, that doesn't mean that other products don't
benefit.
But I, as a physician, prescribe the ones that have
shown
benefit in randomized large clinical trials.
And what is that product for-
It's called Bio-K Plus, so this is not an endorsement of the product, but Bio-K
Plus is the one I prescribe when I prescribe antibiotics.
And
for someone who is not on antibiotics, has not been on it for six months, and I
see a lot of people, they do take probiotics.
Is there any role of that in health?
So for health maintenance, I think there are some studies here and there for
allergies or for inflammatory bowel disease.
I don't tend to study those as much as infectious diseases.
So I would imagine that there are some, but I haven't looked into them.
But there would be,
stands to reason, there would be different probiotics which can suit different
people. So not every probiotic may not be-
Yeah
... a viable one for every person, so to speak.
And not every probiotic that you take by mouth is guaranteed
to get to the stomach-
Right
... because stomach has acid, and that's designed to kill germs.
And yeah. And so does it really get to where it would
work, and then when it works, what is it going to do?
The only way you would find out is if you do
an actual study and look at the outcomes in large numbers, and
look at the statistical significance.
So you mentioned briefly on this,
the gut issues with it can have effect on other
diseases. So when we use antibiotics, it affects the gut
microbiome, it'll affect the lining that the gut is coated with.
And there's some suggestion that it may increase allergies
or autoimmune disease or whatnot.
Is there truth to it?
Yeah, there's been studies that showed an association.
I don't think it was exactly defined as a causation.
But there's an association with children who take more
antibiotics having more diseases such as asthma and
allergy,
and obesity.
So just pivoting a little bit, there's a lot of parents that watch
and
are kids receiving too many antibiotics today?
I think so. And you have people who don't give their kids
antibiotics, but then I see people who, out of love to
their kids,
people do this not with
bad intention, obviously, but because they're worried about their kids, and they
want to help them immediately.
They'll take him to the doctor and then,
that issue of pressure and prescribing practices
can contribute to more prescribing there.
And this early life exposure, obviously, they have much more of life's
runway ahead of them than adults. So this early
life exposure, what problems can this cause for the kids, like a lot of
antibiotic exposure early in life?
Yeah, that's been linked to more asthma, allergies, and
obesity in some studies.
And autoimmune disease.
And autoimmune disease.
And
in terms of
when should parents feel comfortable saying, "You know what?
Can we safely wait?" If someone is wanting to prescribe antibiotics,
when is it reasonable for a parent to just say, "You know what?
Can we wait?" And what should I look for if we need to change this?
If the child doesn't have a fever,
generally it's safe to wait.
And then if it's been a week and they're not getting better, yeah, that's when you
want to
check into it. But,
or going to the doctor and then checking that rapid tests and not
finding the Streptococcus bacteria.
That's the main dangerous one in children is
Streptococcus. It's a type of bacteria that
can cause problems.
If the test is negative,
I would wait.
So for the parents who prefer antibiotics for their kids
anytime they get sick, what advice would you give them? It's not an act of love.
I'm sure it's an act of love and I would never
doubt the intentions, but
just educating that there's really harms, because
I think the general public doesn't see that
there's harm in giving someone antibiotics.
So if there's an infection, if they benefit, they benefit, and if they
don't,
it's not bad. So, educating or
spreading the
data that we have on the effects of antibiotics, I think would make
people make a better choice and more balanced
choice.
So we overstate the benefits of antibiotics in our discourse
and likely understate
the adverse effects-
Correct
... for that, especially for kids.
Mm-hmm.
I'll switch gears a little bit, and we went through a
whole COVID epidemic, and looking
back as an infectious disease doctor,
what is the take home message for you now,
hindsight being 2020, what would you say
lesson learned?
Lesson learned is, well, I think it's not for me maybe, but
mixing politics and medicine is not a good idea.
It was a painful time on all of us
because we were truly having a hard time and
working hard and going through the difficult
treatments and developing protocols and moving fast.
And at the same time, there was a lot of politics going on, and
people trusting the medical community,
that changed. And so the lesson is, I
don't want to be involved in politics, and I'm just a doctor, and I want to
stay away from that.
We want to help people, that's all.
Just want to help people, and that's, yeah, based on what we know.
So if COVID first appeared today,
what would we do differently than what we did?
If it was up to me, again, regardless of how did it start or
where's it, it's here.
Mm-hmm.
So to protect ourselves,
and really those precautions have become very politically
charged. But
I would protect people from getting the infection by
the precautions that we use and-
Hand washing, masks.
Yes, yeah. And I know that-
For vulnerable population especially
... especially, and there's data now, people conflicting whether the
mask helps or not, does not help. It all depends on how the study
is done, and
what does the study look for is what the outcome shows.
So there are studies that show that wearing a mask does not
help, but the study was done in a way that
would not help. So,
yeah, masks do help, and especially if the person
who is sick is wearing them all the time, and that's the only way they would
work. So it's before they get symptoms, and that's why it's
confusing. People are infectious before their symptoms start.
So at that time, during a pandemic, is wearing masks
all the time around people, and that's hard, and it's not easy, and
it's
very difficult.
But implementing that early on,
and maybe
Utilizing that IV
immunoglobulin treatment
early on as well, it helped a little bit until the vaccines came out
and until the medications came out.
There's going to be pandemics in the future. That's not going to stop happening.
And the question is, how well prepared are we for them?
Because they are going to happen-
Why is that?
... whether we like it or not. Because viruses do
mutate and change and
hybridize, and they mutate in animal bodies and our
bodies.
So that's just a fact of nature. We cannot change it.
And
COVID has changed.
A lot of us have immunity, so the pandemic rules, of course, regarding the masks
don't apply now. It'll be difficult to assess
someone who has not had an infection.
But
in terms of infection, is it more like flu now that we
lived with for years?
Yeah, it's less severe now.
It's less severe now.
Yeah, because the majority of us have had some immunity against it,
so it's not as deadly or severe as it used to
be.
Who remains at highest risk?
So groups that are at high risk are at high risk from
influenza and COVID-19 and all viruses, including
RSV, and that's people above 65 years old
or very young, especially premature babies,
people who are taking immunosuppressive medications.
And the most commonly prescribed one is called prednisone or
steroids. Those are given commonly in the
community.
So immunocompromised,
and extremes of age.
Do you see a lot of long COVID?
I used to get those referrals, but because we are infectious disease
physicians, there's no antibiotic or something I can treat it with, so
they ended up being treated at certain centers that focus on them, and they have
research grants for them,
like in Stanford, for example.
But you hear people talk about it once in a while, and I know
people whose lungs changed after having had
the COVID infection. So it definitely
happens.
And so there is a lot, like you hear about either the breathing never went back to
normal or the brain fog that-
Mm-hmm
... is just there.
Mm-hmm.
So for those people, there are specific centers like UC Davis or Stanford
that have the programs to help them?
True. It's like a scar on the immune system.
It causes a change in the way the immune system operates
that is lasting, similar to valley fever, by the way.
And
how have COVID vaccines evolved since?
Do we have new vaccines, like flu vaccines every year?
For COVID?
Not every year. And they stopped being
recommended now as part of the
usual recommendation that we have for patients, and it's a choice
now to give them to the patients who agree to take them.
Or who are at higher risk-
Or want to take them
... they have the option.
Yeah.
But not everyone has to have them.
Yes. It's not recommended.
Flu vaccine.
Mm-hmm.
Do you recommend it for...?
I recommend it, and I take it,
and everybody I know takes it.
So
flu vaccines, do you see that changing?
Like we have mRNA vaccines for COVID.
Do you see that changing for flu vaccine also?
Is that an era that we are headed into?
It's up in the pipeline, yes. It's probably going to happen. Yeah.
And there's a lot of controversy about
vaccines.
If you had to pick subgroups of people who would benefit most from staying
up to date with vaccine, what would that population look like?
Not everyone would be in that, but who would that be if you had to pick certain
subset of people?
Children.
That's the group
where vaccines worked, and it saves the most lives
in children.
And young, healthy adults, is there any vaccines they
should kind of look into on a routine basis, or no?
There are. So vaccines, it's a matter of choice.
Now we have a vaccine, for example.
There are vaccines that protect from cancer,
and this is tremendous. So there's something called HPV,
and HPV is a virus that is sexually
transmitted and
causes cervical cancer, causes throat cancers,
causes other cancers, and there's a vaccine now for
the virus that causes the cancer. So you're preventing
cancer with a vaccine. That's already happening, and we're giving it to our
patients. That's recommended now in preteen
teenagers.
I would definitely recommend it
before they become sexually active.
A hepatitis B vaccination is a vaccine that
prevents cancer,
because hepatitis B can lead to liver cancer.
So all the recommended vaccines really,
they're recommended for a reason, and I would
use them.
Flu vaccine, who should take it in general public?
I take it every year, in part because
it would make the flu less severe on myself, but
also to protect people around and not spread it to the vulnerable around me.
So I think everybody
can, and in my opinion, should take the flu vaccine.
Is the immunity different from what you get from infection versus what you get from
vaccine?
It is different, and immunity from the infection is usually more
lasting or more intense, but again, you're gambling with
the actual infection possibly causing harmful outcomes.
So,
that's the choice that you have to take.
Is there a hybrid immunity that you've had infection and then vaccine?
Is there a benefit to-
Yeah
... that on top of what you had?
So our immune system, the way it works is it makes
antibodies against a virus, for example, and then
there's other viruses. It gets busy with fighting something else and then something
else. And then
making antibodies takes energy, so the body cannot focus on all
infections and make antibodies in the same levels for
all viruses, and so it prioritizes the most
recently exposed one. So
when you give a booster or a vaccine dose again, it
re-boosts the amount of antibodies in the body against that
infection.
Got it. So this is really intriguing conversation, and I think there's a
lot more that we have to talk about, including the valley fever and the hormones
and nutrition as pertains to your infection risk.
So we'll close out here today, and we'll come back for the second part of this
conversation-
All right
... which should be a lot of fun.
All right.
Thank you so much.
Thank you, Dr. Sandhu. It's been fun.
Thank you.
Thanks.