The Review of Religions conducted a follow up interview with Dr Faheem Younus, who is Chief Quality Officer and Chief of Infectious Diseases at the University of Maryland UCH, about the current Covid-19 crisis. The views expressed in this interview are those personal to Dr. Faheem Younus. For up-to-date advice on the these fast changing conditions, Dr. Faheem Younus recommends visiting the WHO website. This interview was conducted 6 months after we last spoke to Dr Faheem Younus, and was conducted by Sarah Waseem, a clinical psychologist working for the National Health Service in the UK as well as Senior Editorial Board Member for The Review of Religions.
Below is a lightly edited transcript of the interview:
SW: Assalamo alaikum [peace be upon you] Dr. Younus.
FY: Walaikum assalam, thank you for having me.
SW: No, thank you so much for giving us your time once again. Six months ago, we spoke to you at the start of the COVID-19 pandemic and here we are six months on and certainly we here in the UK, like in other European countries, are in what seems to be a second wave of COVID-19. Death rates are rising across the world, is this what you were expecting six months ago?
FY: Yeah, I think it’s good and bad. The bad part is that much of the developed world, I’m specifically talking about Europe and the US, have not really controlled this virus as well. The US particularly, we have been extremely polarized because of the politics. We had the best scientists in the world, the best infrastructure, the best information, and yet we in the US have the largest number of cases. In Europe as you hinted, it is most likely now going through a resurgence, so that’s where some of the dismay lies. What’s good that I think it has brought a lot of common humanity in all of us out so far. The testing is now far more prevalent as compared to six months ago, our treatment protocols are much more established, and according to some British studies the intensive care mortality for coronavirus has gone down by over 30 percent. I can tell you some of the diseases that we’ve treated in 30, 25 years of my career their mortality hasn’t gone down by 30 percent. Sepsis for example, the sepsis mortality [rate] has not gone down by 30 percent in 25 years of my practice, and Covid’s mortality has gone down more than 30 percent in six months. So that is phenomenal; the fact that we’re likely to have a vaccine in record time is phenomenal. So that’s the good and bad of the pandemic so far.
SW: So, would you say we are in a better place this time round?
FY: It’s an interesting question. I think if God forbid, somebody had to pick and choose that they had to get Covid in 2020, I think they’re better off being a Covid positive patient now as compared to March and April. No question about it, we’re in a better place in terms of testing, hospital capacity, PPE, treatment, but nationally [is] our country in a better place? Geopolitically are we in a better place? I don’t think so. I think a lot of this is a thin veneer and there’s a lot of economic turmoil that is going under the surface and my fear is – in 2004 honestly, I did not even know what the word tsunami meant. When the tsunami came, and I was serving in Humanity First back then, and then we realized ok there’s an earthquake that actually happens under the ocean which can then impact the land so many minutes or hours later. My worry is, is there a silent tsunami with this pandemic that’s going come three years, four years, seven years down the road?
SW: Did you want to say bit more about that? I’m interested when you say you know, silent tsunami coming, are you thinking about the economic impact or you thinking about economics and health impacts?
FY: I think as people of faith you can’t help but connect everything, or try to connect whatever the Holy Quran has said, what Rassoollullah (saw) has said about the latter days, what our Caliphs have reminded us of, now imagine every word that the Caliph (aba) has been saying, and trust me I’m saying this is a scientist, I’m not trying to just over spiritualise something but the facts are facts; are we seeing new blocks being made or not? We are. We are seeing you know, Russia aligning one way, China aligning another way, we are seeing a very consequential election coming up in the US within a month, we’re seeing massive drop in GDP of large countries and at the same time, you’re seeing countries where sports are going on, where the pandemic is literally nonexistent; China, Taiwan, Hong Kong, South Korea, Vietnam, New Zealand, Germany is in a better place. So, when you look at all of that, and you look at the human suffering and the uncertainty, and how we have continued to politicize the virus, I mean that gives you a pause at the end of the day. It’s all one delicate balance; and here you are, you know the biggest, one of the safest things the world tried to do in the past 20 years is to de-nuclearize ourselves. You know we were all worried about nuclear weapons and we thought that they were a sense of security, and now no one can go and kill this virus with a nuclear weapon. It should give us a pause.
SW: Are you suggesting, perhaps since His Holiness (aba) has suggested on various occasions that we are heading, as a consequence of all of this, towards World War Three?
FY: Yeah, so there are certain words that only a father can say that a son dares not repeat. This is one of those. I will simply ask people to listen to what the Caliph (aba) has said, but I don’t have the courage or the spine to even repeat those words. You’re exactly in the same category, you know you’re hitting the right part of my brain with that question, but I can only do istighfar [seek forgiveness and protection from God] and it sends chills down my spine.
SW: Perhaps that’s something we can also return to a little later. I’m going to go back a little bit and just do a little bit of reflection now perhaps, because it’s so great to have you here six months on. You have been a great advocate for simple solutions to this pandemic; hand washing, social distancing, face masks, are these measures working do you think?
FY: Sure, you know first of all whatever I say I like to align myself with the herd. There is an African proverb that says if you want to go fast walk alone, if you want to go far walk with others. So scientifically I’ve always tried to walk with the scientific community. What I’ve said is precisely what the World Health Organization is saying, that’s precisely what the CDC is saying, and that’s precisely what other countries have done. You know just think about it, New Zealand does not have a secret vaccine in their basement that they’re not sharing with the world and they’re secretly giving it to their people, or China, or South Korea, or Taiwan, or Vietnam. Vietnam, I always say because nearly 100 million people in a relatively poor country, they don’t have some fantastic treatments that we don’t have access to. So how did they crush this pandemic? It is just by these simple measures. On a communal level from a policy standpoint it’s test, trace, and isolate. On a personal level it’s face masks, social distancing, and avoiding crowds, and I keep telling people don’t crave fancy solutions to simple problems; that’s proven, that’s good enough for us.
SW: That’s very interesting. Some might say though, or question, how do those measures – how can they work in countries where you do have really high levels of poverty, and gross poverty, and overcrowding with families living in very, you know, condensed situations where social distancing is almost impossible, what would you say to that?
FY: You’re absolutely right. First of all, I completely agree with that. I’m of the view that achievable is always better than desirable. In life we all, this is not just for pandemic; in poverty, in everything we prioritize don’t we? When we are healthy we fast, when we’re traveling the next best thing is not to fast and do it later on. If you have a lifelong illness the best thing is not to fast and just give your fidyah [monetary recompense for those unable to fast] . So, I think there are those conditions, and this is why faith is so practical for us that Islam teaches us, you just do the next best available thing, number one. Number two, when it comes to these countries where there is poverty, by the way before I forget, I’m never a big proponent of lockdowns and shutdowns. By social distancing, by these measures, I’m never saying countries should shut down because that will be economic suicide in many of those poverty-stricken countries. What I’m saying is you do the very best that you can. For example, social distancing is the only thing I can see where people may struggle with. Say India, Pakistan, Bangladesh, Sri Lanka, people have to get into a train or a bus to get to work, they have to go out every day to make a living. I get that but in that situation what I tell people is, invest in an N95 mask. Try to get the best, and I think the government’s responsibility should be to provide N95 medical level masks to people, number one. Number two, still wash hands don’t shake hands with people and number three, do the best you can. If there are two people standing in a train together at least don’t face each other. and none of this is the people’s problem; it’s about consistent public health messaging. I’ve seen nearly 25,000 patients in my career. I do this every day where people ask me these practical questions, and I’ll pull a chair sit next to them, and just walk them through. So, I think what you need is consistent, simple, messaging. So, if you cannot avoid as I gave a very specific example, if I’m standing in a crowded tube today in London, and I must do that there’s no way for me to avoid it, I’ll try to find a spot where at least I’m not facing someone, I’ll try to wear an N95 mask, keep a hand sanitizer in my pocket, and then I’ll just do durood shareef and run with it.
SW: Thank you that’s a very practical answer to that, thank you very much. Let’s move on a little bit now, again we’ve had six months of Covid, probably more actually, but are we any clearer do you think about the long term effects of COVID-19 on physical health and mental health? There are some people for example who have contracted COVID-19, not needed hospitalization, but are still experiencing multiple health problems having supposedly recovered and this is now being termed ‘long Covid’. I wonder if you could tell us a bit more about this.
FY: That’s a very difficult question. The short answer is we don’t know everything. And this is important because once I’m done with my long answer I’m going to remind you and come back to the short answer.
FY: I think there are too many unknowns here. First of all, how many of those symptoms are going to be objective versus subjective. By that I mean headache is a subjective symptom. If I say I have headache there’s no way for you to measure that. But if I say my joint is swollen or I have a fever that is an objective symptom. You can now measure my temperature and say, yeah it was 103. So number one, that is important because as physicians, as researchers we think that way. That’s not to doubt anyone’s intent, that’s not to say it’s in your head or you’re lying, that’s not to question the patient’s integrity, but that is how you assess population. So number one is when you read about ‘long Covid’ symptoms always ask these questions. Number one, how many of those symptoms are measurable? Number two, is it a correlation, is it happening more commonly among rich developed western countries verses the developing world? Number two. Number three, what is the incidence, is it one in a hundred patients who are coming down with those symptoms? Is it one in a thousand? One in a million? One in ten billion? Because that will be important. The incidence of a disease ultimately dictates how much worried we should be because if it’s one in a million, one can make an argument you know, that so many other things have a one in a million chance, so are we under or over reacting. And the last part for your listeners is important because this is nothing unique to Corona virus. I’ll give you an example of enterovirus. It’s another seasonal virus. There’s no treatment for it. People get a cough and cold and every year it happens. I would say probably millions of people, if we really did test it, we don’t test because there no treatment and 99% of the people get better by themselves. But, there are people who end up having heart failure because of enterovirus to the point where they need a heart transplant, or they die. It’s that bad.
FY: I’ve seen enteroviral meningitis every year I see patients who end up getting the spinal tap they have pounding headaches and they have objective measurable virus in their spinal fluid, so there are other viruses that can sometimes have prolonged symptoms but what I’m going to come back to it, I think today people should be worried about preventing the first infection, they should not worry about long Covid because they have no control over it. As researchers as governments we should not minimize it we should give it the due respect but my last point which I started we don’t know everything. It’s still evolving.
SW: it’s very interesting because certainly from a mental health perspective some people say that the recovery seems to be different from other post viral infections, there’s something about recovery here that is different and I guess also some people now, you know will be thinking about I seem to have symptoms of flu. Have I got Covid, and getting really anxious because you know the public mind-set is so alert to this killer you know disease. I wondered if you had any, you know, for, I’m thinking about people who have been listening into this who sort of think, you know I’ve got a sore throat or I got a cold I think I can feel a cough how would they know? Certainly here in the UK we are you know in flu season, what would you say to them?
FY: So clinically the symptoms can be very similar for both diseases, and I think if people really want to know the best thing is to get tested for flu and for Corona virus. That’s going to be the only sure way of telling one from the other and actually its very common that some people will have symptoms will have neither one of these viruses, they will be negative for both. And they may have a third virus because that’s what happens every winter. From a clinical standpoint we don’t know how much of influenza is truly asymptomatic, because we don’t do mass testing every year like we’re doing for Corona virus. To give you an idea, every, you know I’ve worked in two different hospitals, hundreds of patients get admitted. Every patient these days who gets admitted to a US hospital get tested. We never do that for influenza. If somebody, you know falls from a roof or a ladder and breaks their leg they come to our hospital, they came for a fracture in their leg we are going to test them for Covid.
FY: Ladies that are coming in for deliveries for children they’re getting tested for Covid. People who come in with a stroke for anything, and guess what every day we find three, four, five patients who are positive like that, so asymptomatic so I think flu versus Covid is going to be largely indistinguishable. It’s best for people to get tested for both, because their treatment is different. Unless you are planning on just isolating yourself, for ten, 14 days that’s fine then you probably don’t need a test you’ll just get over it, but if you’re planning on being out and about or if you’re over the age of 65 or if you have morbid obesity you have high blood pressure, diabetes or any of those other immune-compromised conditions, the treatment is very different, the prognosis can be different so I think people should get tested for both, and while we’re on that subject best to get a flu shot as soon as you can so at least you can mitigate the risk of one of those viruses, while that vaccine is available.
SW: I want to come back to the subject of vaccines in a minute, but just while were sort of on the subject of the kind of evolution of this disease, you know at the start, 6 months ago, it seemed that Covid 19 wasn’t affecting young people. Now we’re hearing about children and young people being affected. Here in the UK, and I’m referring to the UK because I’m not exactly sure what’s happening in the States but here in the UK students are in lockdown, they’ve gone back to university they’re actually in lockdown in many universities because, they’re all, you know, have contracted Covid. And I wonder how the thinking about the risk to young people changed in the medical community?
FY: So, so far, I think this is one area which we understand really well and this is where there is a direct correlation with the age, if you look at that graph that literally goes up like this, what I mean by that everyone is susceptible to Covid. But not everyone is likely to get hospitalized or have severe disease or death from Covid. So the susceptibility of hundred people are out there, some are five years old and some are 85 years old, I think by and large they all equally susceptible if everyone did the same activity your chance of exposure or attack rate as we say would probably be the same across the age. So children or youth are not immune from the disease, what is different though is the risk of hospitalization, the risk of developing severe disease or dying, there is no question it directly increases, there is a direct correlation with age. Now, I know sometimes there’s a 25-year-old young person who succumbs to Covid makes headline news and its very tragic. But I don’t know if that’s, you know again, its important it’s a right messaging, so everyone knows that no one is immune from it. But still the truth the scientific truth is that someone who is 25 their overall chances of bad disease are clearly less as compared to someone who is 65, the problem with this message is if people hear and they have selective hearing, many of us do, we just like to hear what favours our position and then they go to play sports and partying tomorrow, that’s the wrong action. I think this allows you to serve more on the frontlines for example, how can this information be positively used, I think young people should be serving on the front line, they should be protective of elders at their home. If I’m 25 and I’m going to college when I come home and if I have grandparents at home I better really take good care of my handwashing and myself for them because if I was asymptomatic, I gave it to them they have bad disease, so I think there’s a responsibility that comes with that but overall those are the numbers.
SW: Which is interesting because you know schools are opening up as well so I guess it’s also going to be putting adults at risk because children who contact with them and therefore spending a lot of time together are possibly going to be actually spread Covid 19.
FY: Yes, schools is a very difficult complex topic as well and the simple answer there is control your community spread, and open the schools, don’t look at these things as separate. We can’t look at demographics separately when people are all together when they come home. That’s a false narrative. I think it’s just a false sense of security. So again, look at Taiwan, look at Hong Kong, New Zealand they have schools open. Because their overall positivity is now less than one percent. They have a robust contact, test-trace-isolate system in place, so if we have a community and this will change from State to State sometimes in the same country, like in US, New York city right now has a percentage, 1% test positivity. If they want to open schools, by the way honestly this is how big this country is, I live three hours away from New York I really don’t know if New York schools are open or not. I think my wife will. She has better Covid situational awareness in the country than sometimes I have. But if New York state said ‘we wanna open schools’, I think that’s reasonable, because they have community control of the disease.
FY: And if a child were to be symptomatic, they can very quickly isolate, test, and there is a counter impact there is a harm of lockdown of keeping schools closed. If you look at the risk of anxiety, depression and mental illness particularly in US right now it’s gone up by 30% compared to the same time last year and that’s not just some hocus pocus number, it means there will be more suicides likely, there will be more hospitalisation, there will be more morbidity, I mean there is a suffering, so it’s a balancing act on both sides. But if you don’t have community control over the disease, then opening the schools is only going to add more fuel to the fire.
SW: That’s really interesting to hear that. Just again sort of, staying on this subject for a little bit longer, I wonder about what Covid 19 had taught us about health inequalities, and here in the West we’re hearing a lot about the relationship between contracting Covid and coming from an ethnic minority background. But it seems if we believe what the media is telling us and you know what we’re hearing is that the deaths from Covid 19 seem to be lower in the countries of origin of those people from ethnic minority backgrounds. I mean is that correct? How do we explain that?
FY: Yeah there are multiple no answers complexities, knowns, unknowns in the question. Let’s try to break them one by one. One is a question of ethnicity and one is a question of nationality; one is place of birth, one is colour of skin, right they’re different.
FY: So separate the two. In the US many are, in some states many almost up to 40%, 12% of US population is African American, while in some places 30-40% of Covid population is African American. They are getting the disease, African Americans and Hispanics, their incidence is higher, their mortality is higher. Now that’s not because their skin colour, that’s because of the inequity in the society because if 100 Hispanic people are all working in a meat factory in a huddled oppressive environment and they don’t have good access to healthcare remember in US healthcare is not a basic human right, people have to buy it like anything else and a lot of people skip buying healthcare because they can’t afford it. For a family of 4 sometimes it could be a thousand, fifteen hundred dollars a month. It could be that kind of an expense so people have to worry should I pay my rent, should I get health care for my family?
FY: Now, if you’re a meat factory worker, you’re Hispanic or African American, you get cold/cough, you’re likely going to get it because there’s no social distancing there you may be living in America, but you are operating like Sudan in that factory. And number two once you have cough and cold you’re likely not to seek medical help because you don’t have coverage, you don’t want to spend money so therefore there is more mortality morbidity that’s because of disparities in our system that’s tragic and I first read a study 20 years ago, it’s vividly etched in my memory, it was a new England journal of medicine, you could google it, about African Americans and whites coming to a hospital if both had chest pain it’s much more likely for a white person to get coria catheterization and be thought of as a heart attack versus an African American where we’ve tried you know according to that study they were not taken as seriously and they did not get the treatment for a heart attack as much as the white people would get. So, there’s this inherent disparity in our society there’s no two ways about it, it has been well researched, well published. The second story of the question is the death rate in some of the countries like India Pakistan and many other or Africa that’s a big unknown, the term I use for that is the data fog. As physicians it’s very hard for us to make decisions with incomplete data. Pakistan, has done, you know I think US has done 10, 20 percent testing as compared to Pakistan, US has done 6 percent not percent, times, six fold testing than India maybe ten or 15 fold as compared to Pakistan so what I mean by that is if you don’t test everyone you don’t know how many people are actually dying with the disease because somebody, you know somebody who’s 80 years old they had a heart attack and we said all right abbaji died of a heart attack. Well abbaji may have had Covid underneath and Covid may have caused a blood clot or stroke so there are many manifestations of this disease particularly in the elderly, and I know people in those countries they don’t like me saying that because they’re saying well or hospitals are all empty, they think we’re lying. Well, no we’re not questioning your integrity this is a good deep conversation about how we approach these complex problems, the fact that hospitals are empty is a very poor indicator. Because what happens in a disease like Covid earlier on there is mass hysteria there is fear of the unknown so everybody goes to the hospitals and hospitals are teaming with mildly ill patients and very ill patients, and capacity issues and relatives so this always happens with swine flu with Ebola, this happens with every big outbreak. But when 3 months, 6 months into it the hysteria fades away people are sick and tired and exhausted and only the sickest people are going to go to the hospital. It is an interesting anecdote. In the US about a thousand people, are dying of Covid every day, dying right, those are deaths, we know that this is still an undercount. That there could be many more deaths, which are unaccounted for. However, no hospitals are overloaded in US. If you come today in Wisconsin, which is one of the hot states for Covid, the hospitals are actually not overloaded. So, this is very interesting people need, its nuance but people need to think about to what I’m saying is, in some of the countries I believe unfortunately many more people are dying under the radar. However, knowing their complexities knowing their economics knowing their infrastructure, maybe that’s a blessing in disguise, maybe there’s nothing more you can do maybe that’s the tragic part of it, but I cannot with conviction tell you that the death rate in certain countries is low unless we have equivalent data, in both places which we don’t today, were living in a data fog.
SW: I get that, and you also said something actually quite interesting which is perhaps this correlation between ethnic minority status, and death and Covid is one that needs a lot more examining because perhaps underlying it are what we’ve talked about before which is health inequalities, rather than just because you seem to belong to that group and therefore for whatever reason are more susceptible, which is interesting. Having said that, the statistics in this country and I won’t go on about this for too long, but we have had quite a number of deaths of health professionals from ethnic minorities, of course our NHS is largely staffed by ethnic minorities but these are people who one wouldn’t consider to be in socially-deprived circumstances. So, interesting. I mean, it’s an interesting discussion, perhaps one we should return to, but it is fascinating and it means we need to question data quite a lot, in terms of what we see.
FY: We’re learning, there’s a lot going on and that’s the humbling part of medicine in general. The more we know, the more we don’t know, for example in that situation, it is possible the people who work in healthcare, they could be getting exposed to a whole lot more dose of the virus. Every virus has an infective dose, for simplicity purposes, let’s say if I’m going to catch measles and I must inhale 10 viruses of measles, I’m just making up these numbers, that if I must inhale 10 viruses of measles for me to give disease; if it’s 6 or 7, my immune system is going to kill it, but if I inhale a thousand measles viruses, I’m unlikely to die from it because I just had a big dose. So, there is a theory out there that sometimes if people who are on the frontline, if you get exposed to someone who has a massive amount of virus, and you were close to them for a long period of time and you got a massive inoculum, your outcome could be different, so that’s yet another twist in this whole story that so much we just simply don’t know, or do certain ethnicities add a genetic advantage? We don’t know if that’s possible because there are genetic determinants with every viral illness. Is exposure to BCG in the past or exposure to many other infections in the past is protected? We don’t know. So, when we don’t know, my theory is when you don’t know you never assume that you’re special you assume you’re ordinary, you assume the law of nature will work for you just like it’s working for everybody else and not be complacent.
SW: Thank you, that’s a really interesting response. Let’s move on vaccines. Vaccines are supposedly on the horizon. What are your thoughts about how safe they’re likely to be, because this is a question people ask? We’re rushing out there, producing vaccines, how safe are they going to be, do you think?
FY: We don’t know. It will depend once the vaccines are available, and we are able to study the phase 3 trial data but let me just break it down for everyone’s understanding. A vaccine typically goes through three trials: phase one trials is maybe 10 or 15 patients, different doses. We try to see if it causes any harm. Efficacy is less of a concern. Phase two, you may go to 100 or 200 patients and you repeat the same thing with a little bit more tightening of the system, and phase three, where you go to 10, 20, 30 thousands of patients and now you’re trying to discover if there are rare side effects. Something that happens in 1 and 1000 is not going to show up in a phase one trial or is less likely to show up in a phase one trial. These vaccines are about nine vaccines in the phase three trial right now which means these vaccines have gone through phase one and two. They were deemed safe in phases one and two. And now they’re going through tens of thousands of patients. No vaccine is going to be 100% safe, number one. I know recently the Oxford vaccine had a couple of patients with neurological complications, that does not surprise me at all. When you have 10 or 20,000 patients, you should expect some side effects. So, number one’s not going to be 100% safe. Will it be 90%+ safe? Very likely. Will it be close to 99%? Also likely. Usually these vaccines are very safe. Efficacy and safety is always measured in the backdrop of disease, right? Today 1,000 Americans are dying of Covid every day. I cannot imagine a vaccine that will be killing 1,000 people a day. That I can tell you right now. So, that’s how you want to compare it. That’s not to say that if a vaccine kills 500 people, we will take it, no, no. We want a very big differential. A 1,000 people with vs perhaps one, if that’s the kind of equation will be looking for. So, I think number one, people should know, that regulatory bodies are not likely to approve a vaccine that is not safe, number one. And I understand the politics and peoples’ mistrust will come to that subsequently. And number two is efficacy of a vaccine, how good it is. These vaccines are not designed to be 100% effective. There are typically designed to be 50 or 75% effective. Influenza vaccine we use every year. It’s in that range. There have been years when influenza vaccine was 30 or 40% effective. So, that’s the second part. And then the third thing is one thing we’re never going to know, which is long-term safety. If something happens in five years from now, we’re only going to find it five years from now. So, yes, they’re going to be unknowns with the vaccine, but I would say hang in there. Chances are more than one vaccine will get regulatory approval before the end of the year. I think the UK-based Oxford AstraZeneca vaccine will be one of them. I think Moderna’s vaccine from the US will be one of them. Pfizer or Johnson & Johnson could be one of them. Out of these there’s also a Chinese vaccine as well. So, these five…there’s a very good chance that three or four may get approval by the end of the year and then we will learn about it as to how safe or effective they are. But today we don’t have all the data, I try to just break it down for everyone to understand.
SW: So those people who say “I don’t trust vaccines, you know what, let the politicians get vaccinated before I’m going to do it. I don’t know what’s going on”, what would you say to them, say a vaccine comes out and they don’t want to do it? What would you say to them? What would be the consequences if, you know, there are a lot of people in the population who say “we don’t want to get vaccinated”?
FY: Yes I know. I think this is a philosophical argument which will never end. Anytime there can be two opinions about something, there will be two opinions, it’s one of those. I know some of my very close friends feel that way, they’re still my friends, I don’t hold it personally. But, how do you approach it? First of all, you don’t turn it into a must-win argument. This is not an argument, this is about “Let’s have a conversation, let’s hear each other out”. I’ll say this, we all know that the average age has gone up from 30 to 40 to 50 to now upwards of 80. Everybody celebrates that, correct?
SW: The average age of mortality you mean from Covid?
FY: No no, the average human age. You know our grandparents, 100 years ago an average person would live up to 30,40,45 years, today the average age is upward of 85. So, everybody celebrates that, it’s all over the world. What people don’t know, when you dissect that, that average age is gone up, there are two major determinants. Two things that have changed that whole equation. You take those two things away; the average age will fall down to 50 or less. You know what those two things are? One is infant mortality, and second is vaccines. These are the two game changers if you look at history of mankind. Because so many babies, you know children either died in the first six months, or they lived upto 80 years. And if you take out all those who died, you know you end up with 80, but if you add them in an average you end up with 40. So, vaccines have, I don’t know how someone can deny the impact, that’s a mathematical question. If anything, where we eradicated from the world it’s because of vaccine. Small pox, I don’t think anyone on this call has ever seen a patient with small pox. None of our children, thank God, have come down with small pox, and that’s because of a vaccine, that’s not just because the virus just went away. So, the good that vaccines have done is very hard to argue against, that’s number one. Number two- where did the fear actually start from? There was a land set study which was falsely linked with autism. Even though they retracted the study, even though there have been many, many studies subsequently. Then Hollywood gets on the bandwagon, then certain interest groups get on the bandwagon, and it’s, you know, there is general mistrust in profit driven materialistic societies. If we say that everything in our society is based on morality, that’s not true. The reality is there is a lot of money-making that goes on and unfortunately, we deplete the public’s trust when they are bitten- once bitten twice shy. So, people are bitten somewhere then they start losing confidence in everything. So, I do empathize with a lot of people who don’t have confidence in vaccines, but I take a vaccine myself, I have my children take it. And if a good COVID vaccine came out, I’ll take it, I have no problem.
SW: Do you think there is a certain number of people that will need to take it in order to eradicate?
FY: That is correct, yep. So typically, you would need 60-70% population vaccinated for this disease to go away. Now you can say, the natural disease has already caused some immunity, which is correct. But that number so far, when we do zero-surveys, that number is around 10% for most countries or less. If it’s 10%, the second question is will that immunity wain a wave? If somebody got infected in March, will they still be immune by next March? That’s a big if. I don’t know the answer, but I would not be surprised when these vaccines come out, that they are recommended even for people who have recovered from Covid. Because the antibody and protective effect of a vaccine typically outlasts that of natural infection, that’s an important point. Some infections give you, like if you got measles, you’re probably immune for the rest of your life. But as we know, if you get influenza, you’re still prone to influenza next year. So, I think 60 to 70% of a population would have to take that vaccine, but every number will help us slow down the pandemic. 35% will be better than 30%, 45% will be better than 40%, so we’ll try to push it as hard as we can.
SW: So, I mean, a kind of corollary to that is of course, issues about vaccine distribution and, you know we’ve heard about countries wanting to sort of hoard the vaccine. Do you feel that might be a problem that some of the poorer nations in the world won’t have access to that, and then there are lasting implications for this pandemic if that happens?
FY: I think unfortunately that’s true and unfortunately that’s exactly what we have. We have inflicted this wound on ourselves. If you look at the last 100 years, as a world we’ve become more materialistic. We know that there is a divide in front of us, children are dying of hunger, we didn’t, I don’t want to say we didn’t care about it, but we didn’t fix it, let’s put it this way. We have the rich and poor divide expanding in front of our eyes. We know what percentage of wealth belongs to just a handful of people. So that’s the background. With vaccine, yes it’s surely going to happen, because the countries that have invested billions of dollars in research, they didn’t just dish over the money, they have contracts in place that “when you make the vaccine, the first hundred million I will get or my country will get”. So, there is graph in Financial Times, I’m happy to share with you offline, that lists actually in a graphic form, they show you which country has bought how much vaccine. There are about 10-15 countries on that list, and guess what, the world is over 200 countries, so what’s going to happen to the rest of the 185 countries that are not on the list? Of course, they are going to wait, they may end up with an inferior product, they may end up with a product that is not as well-studied. We will wait and see but, the unequal distribution of vaccine to me is a given. Did we have equal distribution of PPE? Did we have equal distribution of testing for Covid? Did we have equal distribution for Remdesivir, the drug that we use? We don’t, so it’s a fact unfortunately.
SW: I think, the other extreme of all of this, here we’re talking about COVID, we’re talking about vaccines, we’re talking about treatment. Of course, there is another population out there that say “you know what, COVID-19 is all a big hoax, it’s a man-made virus, it’s actually just another form of flu that’s been misdiagnosed throughout, you know it exists but it’s been exaggerated”. And I wonder, as a doctor, what you would say to those people, because there is actually quite a substantial population who do think that?
FY: I think it goes back to ‘a man is known by the company he keeps’. So, there are so many, I don’t want to just throw religious references, but you know what I mean. Islam is all about ‘Qunuma Saadikin’[i]. So, these days, the media we consume is our company. That is our virtual company. And if the media that I consume is just telling me the same echo chamber message of why it’s a hoax, then that’s what I’m going to believe. Do people exaggerate? I do believe, I think that is true. One of the first articles I wrote about COVID in March when it came up, because I knew that was going to happen, that’s my experience, and I said back then that we should try to avoid the extremes of no-denial and no-panic. We need to remain in the middle, the beautiful place called preparedness. And unfortunately, now we are polarized in those extremes. There is one extreme that says it’s a hoax and there’s another extreme that says 90% of the people will develop long COVID. To me that is an exaggeration. We are not going to say that. We don’t know, and I think chances are a very small percentage will develop that. Don’t just say that “25 year old people are dying like flies”, that’s an exaggeration. Yes, there will be occasional deaths among young, but let’s just stay true to what the message is. The message is that we can crush this disease by taking these simple measures. So yes, there are extremes in the narrative, but I think we’ve got to stay in the middle, and people ultimately believe the echo chamber that they are in. And unfortunately, they don’t realize, nobody likes to hear this, but in the age of information, ignorance is a choice. We make the choice.
SW: This whole pandemic has actually enabled us to see both the best and the worst of humanity. We’ve seen tremendous acts of altruism. We’ve seen selfishness, you know the panic buying that happened at the beginning of the pandemic. As a medical professional, do you think that this pandemic has made people ask more questions about faith, the nature of existence? You were talking earlier about where this all may end up and you referred to the kind of tsunami that might be underlying this, but do you think this has made people ask those kind of more spiritual questions?
FY: That’s a great question. Honestly, I don’t know because, in a strange way, I also live in my own ecosystem here in the US, so I don’t know how people in India are thinking, how people in Pakistan are thinking, in Africa, in Peru, in Brazil. There have been so many deaths all over the world. So, I feel, my gut says, that this is much more greyer than what I see but, I have not seen much change here in the US, I’ll tell you that truthfully. I think the biggest change that people celebrate is that “oh my God we’re having Zoom and WebEx meetings”. To me that’s not a change. I mean that’s not a lesson, that’s an adaptation. You just adopted to a situation, that’s not a change. I go out in the rain and I opened up my umbrella, wow what a revolution! No that’s just nothing fancy about that. So, I think the kind of profound question that you are suggesting unfortunately, I have not seen people think that way. What this pandemic has done is, it has just squeezed us, so when you squeeze a fruit, whatever is inside of that fruit, whatever that juice is- sweet, salt, bitter- it comes out. So, it has just squeezed us. So, whatever we were hiding on the inside, is now coming out. If I was a bitter angry person before on the inside, I’m becoming more angry. If somebody was kindhearted, that kindness is outpouring. So, I think, and again may be a generalization, God knows best, that’s my incomplete humble view of the situation, I’ve just seen that this has squeezed all of us and I’m seeing the impact of that right and left.
SW: Thank you for that. I think you are one of those individuals that we know you’ve been responding and providing a really invaluable humane service. You’ve been responding across the world to people’s questions, via mainstream media, via social media. You’ve been responding to a lot of comments both in the US and abroad, and also particularly from the subcontinent, India and Pakistan. How did you get involved in that and how has that been for you?
FY: Two points, I think. In med school when I decided to come to US, one of our late professors, may Allah bless his soul, Dr Faisal Masood, he was a very smart man and left an amazing impact on our personality. And he used to either talk in Punjabi or in English. And I still remember he said, when he heard, and I was expecting a pat on the back, that “Wow, I’ve cleared my exam and I’m going to US”. He said in Punjabi, essentially meaning that “Oh son, light a lamp in darkness, where there is always so much light and millions of lamps, why are you trying to light another lamp there?”. So, he had an anguish in that, and of course I came here for whatever reasons and I did feel that, that I was just yet another lamp where there were millions of lamps. So, number one, this pandemic has allowed me, it was Allah’s plan and I can’t thank God enough, that I feel Dr Faisal Masood will be a little happy, because I truly feel I was able to put a light in areas of darkness. When people reach out to me from Paraguay, from Mexico, from Guatemala, from islands, places I never knew existed, and when they say “Well, thank you very much, that was a question that was bothering me, I appreciate it”. But here is the bigger point, along similar lines, as this started and I was getting approached by a lot of important people from around the world, I sought His Holiness, the Caliph’s (aba) guidance, that I’m trying to do this service, and you know I’m not a politician, I’m not a big policy guy, I want to stay away from areas that are not my expertise, and what should I do. the Caliph’s (aba) guidance that came back to me was very simple, “Look, don’t think about yourself and keep serving”. Essentially, don’t expect a pat on your back, don’t try to insert yourself in the equation, don’t try to become famous, this is not about you. Just think of humanity and then don’t worry about it. Just speak the truth. I cannot tell you that small little piece of advice, how helpful it has been to me. Because, if I were to say that Shaitaan (Satan) didn’t come in my brain during these six months, I’d be lying, I’m a human being and I’m as vulnerable to Shaitaan as the next guy. But those words of His Holiness (aba) have literally become a shield for me. Times came that I felt like Captain America, yes this is my shield. And by the way I’m not an Avenger’s guys, my little daughter she’s into these things, she’s still very young and pandemic is rough. Yes, I think this is the whole picture. I feel good about it; I feel very purposeful. I think it’s a time for us to get blessings and accumulate something for the hereafter by this service. I literally couldn’t care less about myself. If this ended tomorrow, I’ll go home, end of the story, I’m very happy playing with my children ball in the backyard. And I think people who don’t have the Caliphate of Islam Ahmadiyyat, I don’t know how they live, because if it was not for the Caliphate, there were so many forks in the road ahead of me that I’m pretty certain I could’ve taken the wrong fork. But those words of His Holiness (aba) and then when you listen to him every week or you ponder over it, it’s hard to express that bounty that Allah has given us and one just keeps saying “Rabbana la tul zigh quloobana”[ii] “O Allah, now that you’ve guided us, don’t turn our hearts”.
SW: JazakAllah [God bless you], that’s absolutely beautiful. I think you certainly have been a lantern to many people through your myth-busting tweets. I just wondered as a last note, have there been any kind of surprises when you’ve done those tweets. Was anything particularly surprising?
FY: I think you know the answer. Surprises, once again I’ve realized that there is a lot of hatred in the world. I’ve realized that there is a lot of judgment on there. I’m not a big social media guy, I’ve never made a Facebook page, I’m not on Pinterest or Snapchat or any of those. Twitter I thought was a more mature audience but still people say hurtful things, people judge your intention, I try to ignore all of that but I also find it’s important to do my piece there, so once in a while I’ll try to educate those people to try and clean up that environment while I’m there, wherever I am, I like to make sure, as the Hadith says, ‘to leave the place cleaner than I found’. So yes, I do feel it’s my social responsibility. There was a time Indians hated me for being a Pakistani, Pakistanis hated me for being an Ahmadi, Americans hated me for being a Muslim and the rest of the world hated me for being an American. So, there you go! But, by the grace of Allah, this is the beauty of Islam, “Wasbir ala ma yaquluna wahjurhum hajran jameela”[iii]. Allah Tala said to Rassulullah (saw) “Hear patiently whatever they say, and part from them in graceful manner”. So, these moments make you wonder, we are nothing, we’re not even the dust of his feet, but the kind of suffering that Allah’s Prophets go through, or even our Caliph right now, I cannot imagine the kind of hurtful things that His Holiness, the Caliph (aba) gets to hear but never even mentions to us. So, it gives you a little bit of that taste, so yes, it’s good.
SW: JazakAllah [God bless you], thank you so much. I know I’ve learnt an awful lot from reading your tweets and I really want to thank you for your time, you’ve given us so much time and I know that it’s been incredibly informative and I really appreciate this time that you have given us. JazakAllah, thank you so much. Asalamoalaikum wa rahmatullah wa barakathu [may the peace and blessings of Allah be upon you]
FY: My pleasure. Walaykumasalam.
[i] The Holy Qur’an, Chapter 9, Verse 119.
[ii] The Holy Qur’an, Chapter 3, Verse 9.
[iii] The Holy Qur’an, Chapter 73, Verse 11.