Pandemic: Coronavirus Edition

Second wave or slow burn? The question almost seems romantic...almost.

June 17, 2020 Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger Season 1 Episode 30
Pandemic: Coronavirus Edition
Second wave or slow burn? The question almost seems romantic...almost.
Chapters
Pandemic: Coronavirus Edition
Second wave or slow burn? The question almost seems romantic...almost.
Jun 17, 2020 Season 1 Episode 30
Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger

Stephen, Mark and Matt are back with a fun episode comprising discussions from cow's blood to ethics.  Listen now!

We offer transcription now! Caution, it is AI transcription so please excuse AI errors.

  • Download here - https://bit.ly/2AJ7DHq
  • See it on the podcast website here - https://bit.ly/3eQO8uW

Can you Rate and Give us a Review in Apple Podcasts?

Please consider supporting us to help upgrade our equipment and offload our editing responsibilities:

  • Give monthly (as little as $5 a month) on our Patreon Page -https://www.patreon.com/pandemicpodcast
  • Give a one time gift through Venmo at @mattboettger
  • Give a one time gift through PayPal here: https://paypal.me/mattboettger

Matt Started a New Podcast:

  • Check out a new episode of Living the Real that Matt just dropped. He has a conversation with Kim Winter who talks about her struggles with divorce and how meditation saved her life and changed her law firm. 
    • Living the Real Podcast: https://bit.ly/3fyPIlx
    • Sign Up to be notified about his free mini-course coming out soon. https://www.livingthereal.com
    • Learn more about Matt's 3-M framework here: https://bit.ly/2UQIi59

Things Discussed on Episode:

Support the show (https://www.patreon.com/pandemicpodcast)

Show Notes Transcript

Stephen, Mark and Matt are back with a fun episode comprising discussions from cow's blood to ethics.  Listen now!

We offer transcription now! Caution, it is AI transcription so please excuse AI errors.

  • Download here - https://bit.ly/2AJ7DHq
  • See it on the podcast website here - https://bit.ly/3eQO8uW

Can you Rate and Give us a Review in Apple Podcasts?

Please consider supporting us to help upgrade our equipment and offload our editing responsibilities:

  • Give monthly (as little as $5 a month) on our Patreon Page -https://www.patreon.com/pandemicpodcast
  • Give a one time gift through Venmo at @mattboettger
  • Give a one time gift through PayPal here: https://paypal.me/mattboettger

Matt Started a New Podcast:

  • Check out a new episode of Living the Real that Matt just dropped. He has a conversation with Kim Winter who talks about her struggles with divorce and how meditation saved her life and changed her law firm. 
    • Living the Real Podcast: https://bit.ly/3fyPIlx
    • Sign Up to be notified about his free mini-course coming out soon. https://www.livingthereal.com
    • Learn more about Matt's 3-M framework here: https://bit.ly/2UQIi59

Things Discussed on Episode:

Support the show (https://www.patreon.com/pandemicpodcast)

[00:00:00] Matt: [00:00:00] You're listening to the pandemic podcast, where we equip you to live the most real life possible in the face of today's crises. My name is Matt  and I'm with two of my good friends, dr. Steven Kissler and epidemiologist at the Harvard school of public health. And dr. Mark Kissler was doctor with university of Colorado hospital, my friends, and I think officially we've been now episode number 30 huge success.

[00:00:21] I think I can say, it's your friends to listeners. It's your friends group because we're all friends here now. It's the 30th. I feel like, you know, usually after like the third date, you feel like maybe you're kind of rubbing up. This is 30 dates. I mean, this is like, this is, this is an exclusive relationship.

[00:00:34] Mark: [00:00:34] Right. Yeah, I guess so.

[00:00:39] Wow. 

[00:00:40] Matt: [00:00:40] Maybe should have prepped you guys on this one. Cause you guys are speechless. You guys 

[00:00:43] Mark: [00:00:43] are blushing, lots of friendly feelings towards all of our listeners. 

[00:00:47] Stephen: [00:00:47] Me too. 

[00:00:48] Matt: [00:00:48] We do have incredible feelings, Bruce. Just email me back. I haven't got a chance to show you when to give it to you guys from Australia.

[00:00:54]just giving us a thumbs up and excited for what is going on for us. And he gave us an update on what's going on in Australia. [00:01:00] Sounds like it's going really, really well for the most part. Good. So I'll read that. And then maybe another time I forgot to put it in here. So, Bruce, I apologize. Thanks for the email.

[00:01:07] I read it and I will send it to Mark and Steven as well. but we've been having good responses, great connections. And of course we always need reviews. It's helpful. It's really just helped for us to kind of rise. And we're not trying to be like the best of the best. We just want to get this information to more people.

[00:01:21]and so the best way of doing this is as we get reviews and even comments, that kind of allows us to be more exposed on Apple podcasts and people can check us out. And listen to us and hopefully enjoy our, Are our intellectual inquiry and then, our, our, our humor and our banter. So, that's, I hope it's greatly appreciated.

[00:01:39] So I have another one here, a review just recently came in, S Mohs. Thank you so much. he or she writes a writing in here to support. I listened to a lot of COVID related news. One of my favorite is COVID-19 fact versus fiction. I like that one. This one now is my next favorite great experts with great voices, truly that matters in a podcast.

[00:01:59] Thanks. [00:02:00] I appreciate the voice, voice comment, always good, and just 

[00:02:04] Stephen: [00:02:04] totally, 

[00:02:07] Matt: [00:02:07] and just enough in depth discussion on a topic before moving on to next current topic. Great again. Also, if you can, if you can help, any way financially, it just helps us to get us our equipment to pay it off so we can keep this going, help offset some of this stuff, to, to make my life a little bit less burdensome on the editing.

[00:02:25] Thank you for all those who have supported. Ready, you can do that. patrion.com. Slash pandemic podcast, Pat reon.com/benjamin podcast, or just a onetime gift, at PayPal or Venmo all in the show notes. Also one last plug shameless plug. My living, the real podcast just dropped a new episode. Kin winter was on an old friend of mine.

[00:02:43] And my sister's talking about a really dark time in her own life. went through a really struggle of a divorce and how meditation really changed her whole life in that dark moment. So it was a really of discussion. I think you'll find it. And official as well. If you want to go into living the real.com, you can subscribe [00:03:00] there as well as San Fran newsletter.

[00:03:01] And I'll be putting up a mini course soon. That will be free. Okay. Let's get in. We have lots of news it's once a week stuff is Cray Cray, because I just, just totally check the news once or twice a day and keep copying and pasting. And then by the end of the week, I had like 50 articles that I have to cipher through and figure out which ones might be interesting to talk about.

[00:03:20] So I wanna start with you Mark first, because you were gone last week. When I hear your voice come up to the surface here. antiviral updates. So a couple of things. So the one thing I saw in here was a very moving article. It was good. So human trials expected to start next month for COVID-19 treatment derived from cows, blood, get it, people moving cows.

[00:03:43] That was a dad joke. Total dad joke. I thought it was awesome. I thought about it last night. So, Mark, do you know anything about 

[00:03:49] Mark: [00:03:49] this? Just this, one of the secret marks of a dad joke is that often, often at forums. And you just wait and you wait for the right moment to dislike, drop it. [00:04:00] And it seems like it's you, you want to make it seem spontaneous.

[00:04:04] But most of these jokes are they've been, they've been baking in the back. 

[00:04:08] Matt: [00:04:08] My life has completely scripted Martin and it all forms around dad jokes. So what, what is the deal with this cow's blood stuff? 

[00:04:17] Mark: [00:04:17] That's kind of interesting. I mean, it's, it looks like what they're doing. I hadn't heard about this until you brought this to my attention.

[00:04:23]essentially you can, in a laboratory swap some genes from animal cells, and make them more. Human. Like, so humanizing cells, they've done this with mice for a long time. and essentially there's certain characteristics of some animal cells. for instance, cows seem to have a really robust immune response.

[00:04:43] And so when you humanize them so that they can make human antibodies, and then, indeed induce immunity too. The coronavirus, then pull that plasma out and take the components that are compatible to go back into the human body. It's one, it's sort of a link [00:05:00] between, the science and kind of the mass production of some of these things.

[00:05:05] And so, you know, it's definitely a process that's been used for a while and it involves some genetic manipulation of these cells. and so it's interesting, you know, it's in another way, it looks like they're using it to, try and get more. Plasma, you know, we, we, right now we have convalescent plasma from individuals who have recovered from coven under who are donating it because it's full of the antibodies against the coronavirus.

[00:05:26] And this looks like it's a way of trying to upscale that a little bit. okay. So interesting. That's an interesting next step. 

[00:05:33]Matt: [00:05:33] I'm curious, Mark has, I haven't had an update on the plasma stuff. Has there been any more hopeful or is it kind of just reaching a plateau or has there been, I think a sign that it's gonna fit?

[00:05:42] Mark: [00:05:42] I, I think that throughout, we've kind of thought that there is, there is a good, you know, there's benefit to it and, yeah, it's not a miracle drug necessarily, but it's a really good. Possible treatment, particularly for individuals who are really sick. And so, you know, we've been using it consistently as, from when it [00:06:00] came online.

[00:06:00]and it's still available at our hospital. Okay, 

[00:06:03] Matt: [00:06:03] great. Another thing that came up, promising. Now this is confusing steroids. I've heard mixed reviews on steroids, but this article says, you know, show me the data. U S doctor is skeptical of reported COVID breakthrough. That initial science seemed like, I don't know, like 30%, you know, a betterment or whatever that means, any response to this part.

[00:06:20] Mark: [00:06:20] I think those are exactly the right questions. It's like, You know, what's the sample size, what is the primary outcome? These are all the things we've been talking about over and over again. This is a study about dexamethazone, and dexamethazone is commonly used. As a steroid, we use it in asthma exacerbations.

[00:06:36] We use it in treatment of certain types of cancers. It's and one of the things that people have mentioned that they're excited about is the dexamethazone is relatively cheap. and so we had talked a couple of weeks ago about sort of the different prongs in terms of. Treatment and one of those being, so you talked about kind of direct antiviral stuff.

[00:06:55]you talked about inducing our own host immunity. and, we talked about [00:07:00] anti-inflammatories being another one of the big hats, you know, that you can, work in. And so dexamethazone kind of works. Okay, paradoxically by tamping down the immune response. and this is one of the things that we see in, in infectious diseases, is that your immune response is helpful for a while, until it's not.

[00:07:17] And sometimes you tip over in your homeostasis where you get too much of an immune response, too much cell damage because of your own immune system's robust response. And there's really a sweet spot that we want to stay on, where our bodies are fighting the infection. But not doing harm to our native tissues.

[00:07:34]and so that's one of the reasons that the, these anti-inflammatories and there's been others, you know, is it through my son, as an antibiotic, it works against bacteria, but it also, interestingly has some anti-inflammatory properties and we use it that way, in, COPD, for instance, or chronic obstructive pulmonary disease to reduce the amount of baseline lung inflammation.

[00:07:51]and so similarly dexamethazone is kind of working on that same. theoretical pathway of reducing inflammation. And downstream [00:08:00] damage to cells from the infection 

[00:08:01]and 

[00:08:01] Matt: [00:08:01] Mark, do you do like cocktail things when you're at the hospital where you don't just do one of these, I'm curious, so you all do one at a time or can you like, we'll do some of this and we'll do something viral and maybe the plasma or do he's like, no, we kind of just, 

[00:08:11] Mark: [00:08:11] you know, there's different paradigms for how we treat and, and.

[00:08:14] So the ideal case scenario is when we have a disease process that we've characterized and we've done randomized controlled trials, and we have a standard of care that we use that. And sometimes that means a cocktail. So sometimes that means that we've studied multiple drugs in combination and. Found them to be safe and effective and better than any of the alternatives.

[00:08:35] And sometimes that means one therapy. This has been a different, this has been really interesting and very different because we don't have the standard of care yet. Or, you know, in particularly early in the pandemic, didn't have a standard of care for. COVID-19 we have all of these potentials and most of the time, what has, what I've been seeing happening is we try to use these, new drugs in a study context because [00:09:00] the fastest way to create a real good actionable data is to make sure that we're paying a lot of attention to what we're giving.

[00:09:07] Patients and the effects and making sure that they're enrolled and properly consented and things like that, so that we can make the differentiation that, you know, is it hydroxychloroquine, that's working, you know, as it REM does for this working. and so you can, there are statistical ways, you know, factorial design and Steven, Kentucky, you know, so you can test multiple interventions at once, and using statistics, try and tease out what, which of the things that you're doing.

[00:09:35]where it had actually the biggest effect size. So that's something that can be done. and, but all of that is couched in, you know, essentially big picture wise. We've been doing a lot of, one thing at a time. We've been doing a lot of trial enrollment. and there are individual cases in which, we have been using multiple things at once, but it's very patient to patient.

[00:09:55]you know, case by 

[00:09:56] Matt: [00:09:56] case. And I'm curious, I mean, maybe you can't say too much on this without leading a [00:10:00] jury, but with your experience, have you, have you witnessed with your own trials, one thing working a little bit more than another in your own experience, what have you seen? Like, Oh, I like this one.

[00:10:09] Mark: [00:10:09] Yeah. It's hard to say. I don't think. and of course the, What the question behind the question there is, you know, what's the anecdotal experience in the hospital. and as we've talked about, that's not as robust of a, you know, basis for evidence by any means. And there's also this, you know, this interesting thing where like, if I'm choosing to use.

[00:10:27]you know, is it because of a certain patient characteristic, you know, are they sicker? Are we using these interventions on the sicker patients? That's why randomization is so, so important, to make sure that, and, and blinding, we call it so that we're not using interventions on patients that might have characteristics that may actually affect our results.

[00:10:44]I would say anecdotally, I haven't, it's been, it's been a little tough to tell what, which has helped the most. and largely because I think what we need is that bigger picture. Data. and, so the, the most important things to my practice pattern have been things like the, you know, the [00:11:00] big rim does severe study and, and things like that that have aggregated information from multiple sites.

[00:11:05] And given us, even if it's not a huge signal, you know, not a huge positive effect, at least given us some trends in that direction. That's the most valuable thing for me. 

[00:11:14] Matt: [00:11:14] And one more freebie for hint. The Steven, this is the, I read this a few weeks ago and you were, you weren't able to be with us last week.

[00:11:20] How long does a coronavirus last inside the body? The reason I asked you this question, because I saw this Reddit started talking to friends about it and I was confusing them. So the gun may be worth talking about because they were saying, Oh, it can maybe last months and then they're questioning. Wait a minute.

[00:11:32] So now we're saying that it could spread and transmit over a month. We know there's a difference between how long it's in the body and then how long it's transmissible. So question is, you know, what does this mean? What did the difference between the two? And is there any value to this when it comes to immunity?

[00:11:47] Is that what they're trying to get at? 

[00:11:48] Mark: [00:11:48] Yeah, I mean, I think that's precisely the question. So there are viruses, and you'd mentioned it before a varicella or chickenpox being an example. So they're viruses that can persist in the body. Yeah, varicella goes into the nerve [00:12:00] ganglia and can just live there.

[00:12:01] Not cause disease not be contagious and it can be reactivated later in time. and you know, things like shingles, for instance, you know, down the road. So that's an example of a virus that persists in the body, over a long period of time, but it's only infectious when, at certain periods, and for coronavirus, you know, we don't.

[00:12:20] Suspect that it, it doesn't have the same pattern. It doesn't go into the nerve cells. You know, it seems to affect other cells of the body. Maybe it does persist for, for a while, but I don't think that that changes our clinical sense of when are you most contagious? When are you most susceptible to. No bad effects from the disease and that sort of thing.

[00:12:40] And so this helps us to further characterize the pathogen, but it doesn't necessarily change the way that we think about, what's going on, 

[00:12:47] Matt: [00:12:47] Steven now to you, I want to kind of talk to you briefly about there's a bunch of things I have listed here. I think we can lump them into this. Well, there's a rise of transmission and hospitalizations and a handful of States.

[00:12:59] And this leads to [00:13:00] this website that I wanted to ask you about this, effective reproduction number. The are not, I've been looking for them like this. And so I found it this morning. I'm like, Kay, Steven, is this a legit? Does it come from legit data? And it shows, you know, Colorado's fairing well, not, not at the best, but pretty on the better side of things, but other States are not faring so well.

[00:13:18] So, you know, first of all, is this, is this website a reputable place to find information. And what are you thinking about, the States kind of, the number of steps increasing their numbers. Is it a second wave? Is this a slow burn? What are you perceiving right now of what's going on at this particular state?

[00:13:33] Stephen: [00:13:33] Yeah. So maybe I'll start with the, I'm talking about the website that you just mentioned. So I think, you know, we'd have to dig into it a little bit more deeply to know. For sure. how reputable it is and where their data are coming from. But maybe, maybe I can talk through a little bit about like what my thought process would be to try to evaluate this sort of thing, because you know, there's, there's, there's been this explosion of online dashboards where you can track your projections or what's going on in your state or your County or what the, our number is and that sort of thing.

[00:13:59]So 

[00:13:59] Matt: [00:13:59] by [00:14:00] the way, it's, it's really, it's really difficult. Cause it makes it feel like coronavirus is a video game sometimes and not real. And so I got to check myself, I'm like, okay, this is, this is not just a video game. So this is a real deal. 

[00:14:10] Stephen: [00:14:10] No, that's for sure. It's, there's, there's a lot of really pretty graphics and it can be hard to, you can lose sight of what's actually going on because of sure.

[00:14:19]yeah, so, I mean, At its at its most basic level. If cases are increasing, the, our number is greater than one. And if they're decreasing, the, our number is less than one and the, the how much greater or less than one is important, because that gives you a sense of the speed and how, how robust those trends are.

[00:14:36]But on the whole, that can be a very difficult thing to estimate. And so, what I'm happy about is that this, this website that you've mentioned, it seems like they've done their due diligence where they've posted their code. they've made clear who has contributed to it, how they've contributed to it, where the data are coming from.

[00:14:51]and so those are all really good signs because, if it's difficult to see. Who made it, how they made it, where the data are coming from, then, then that's an immediate red [00:15:00] flag that, that probably something that shouldn't be trusted. but as it stands, I mean, there's estimating the R number can be, basically as simple or as complex of a, of a calculation as you want it to be.

[00:15:10]I had a quick look through the code just in the last few minutes of, of what's going on here and it looks like they've taken some. What seemed to be pretty standard approaches to do it. So, so I'd be cautiously, cautiously trusting of this. one of the other things you see on here is that it has this, this list of different States, and this is kind of a segue into the second thing that you mentioned is, you know, what are, what are we seeing now between States between regions, where we're starting to see cases rise again.

[00:15:32]and the very first graphic on this, this website that you've mentioned is, is. Sort of this ordered list of us States where, there there's that lion at one and you can see which States are below one and at one and a little bit above one, And, you know, like up on the right hand side, which is where the States that are above one seem to be sitting, are places that we have started to hear about in the news a little bit more recently.

[00:15:54] So there's, interestingly their estimate for Texas and North Carolina, are right around one, even though cases seem [00:16:00] to be increasing, they're pretty substantially, but again, that might be partially due to increase testing as well as actual increased transmission. it was the Arizona, which is sort of one of the big spots that's been hitting the news a lot lately and, Florida, Oklahoma, as well as Oregon and Vermont.

[00:16:12] So, all of these places to varying degrees have been seeing rises in case counts lately. and the question is just sort of what what's going on here. So. You know, a while ago we were talking about how the transmission of the Corona viruses, you know, we want to be able to attribute it directly to the actions that we've taken and, and almost like, Oh, if we're seeing cases rise, that's a punishment for something that we did in the past.

[00:16:34] And if they're staying steady, then that means we're doing the right thing and everything is okay. Right. And to a certain extent, that can be true. But, but the fact is that there's. you know, there there's a lot of difference in timing, especially so some of these places are just seeing coronavirus in a big way for the first time.

[00:16:48] So they're, they're seeing their first wave right now. So whereas here in Massachusetts, we've seen a big spike and have come down a lot. some places are really just seeing transmission for the first time and that's just because it just. Didn't get there yet. and so [00:17:00] I think that's part of what we were saying and, is, is sort of this extension of the first wave.

[00:17:04]some places are seeing second spikes as well. And I think that that can probably be partially attributed to reopening, you know, things that have happened just three or four weeks ago, which are leading to cases being detected. Now that's probably what we're beginning to see now in some places as well.

[00:17:18]So I think it's a mixed bag, but you know, you made this distinction between like a second way of, but also the slow burn. And I think that as far as I can tell, it seems like we are sort of in this, locally, we're starting to see different sorts of epidemics, but it really is the bigger picture. It does seem to be sort of the slow burn sort of thing, where different places are rising at different times, but.

[00:17:37] You know, then other places maintain control. And so on the whole, we sort of get this picture of almost a steady epidemic, decreasing a little bit at the national level. And so, you know, it's, it would be great to have very few cases, but it also seems like most healthcare systems across the country are.

[00:17:52] Handling things at the moment. And that was really the biggest concern in the first point. Anyway, it's like, you know, the goal was not necessarily to, you know, [00:18:00] squash the bug out of existence because I don't think that that was really a realistic goal from the outset, but we really wanted to make sure that our healthcare system didn't collapse.

[00:18:07] And it seems like at least at the moment, there's not an acute danger of that happening. Yep. 

[00:18:12] Matt: [00:18:12] Great. You know, I'll put this in the show notes and I think it came in after our last episode, Steven with you. But I really love this article is straight answers from top epidemiologists who predicted the pandemic.

[00:18:23] It's the blue zone article. And you know, for those of us who are thinking, Oh my gosh, a slow burn. It's not going to end. He proposes two options of like either we're going to have these, these peaks and waves, or we're going to have a slow burn. And his preference was the slow burn. Would that'd be a similar preference for you, Steven.

[00:18:38] Stephen: [00:18:38] Yeah. And the idea behind that is that, you know, essentially if cases are accumulating very slowly, then that means that, you know, ideally infection leads to immunity. I w we think that that's probably the case. And if you do that, then, then you slowly accumulate immunity in the population. The problem with big epidemics is first of all, you know, overwhelming the healthcare system that I mentioned, but you also get, What we call [00:19:00] an epidemiology, this, this overshoot, where you actually infect more people than you need to achieve, sort of that herd immunity in the population.

[00:19:07] You have this big spike, and then, you know, the people who are infected during that spike go on to infect lots of other people. And you end up with a lot more infections than you would have had if you would have just had this very slow bubbling along transmission. So I think that, that's why I would say a lot of epidemiologists prefer that slow burn sort of, sort of thing, you know, if.

[00:19:26]Again, the best thing would be to sort of push off transmission as much as we can into the future, because then we can develop treatments and vaccines, but in the absence of any of those things, if we assume that no treatments or vaccines are really going to be available for a very long time, then that slogan is, is really the best, the best way to keep the total number of cases at a minimum.

[00:19:42] Mark: [00:19:42] Yeah. I keep going back to that article, Stephen, that you had published with the graphics. I think there's one that's. Pretty evocative in terms of this, where it showed that the lower transmission, the bigger, the slump and transmission over the summer, the higher, the fall peak seemed to be. Is that a [00:20:00] correct characterization of those, those graphs?

[00:20:02] Whereas if the transmission kind of stabilized over the summer, but didn't drop all the way down. that actually we had less of a peak in the fall when we started to retransmit and go back inside and schools open and things like that. Right, right. 

[00:20:16]Matt: [00:20:16] I think it's good to qualify that I'm and correct me if I'm wrong, Steven Mark, then we say slow burn.

[00:20:21] It's not the Corona virus has slow burning because I think it's, it, it, it, it, by, it seems like by itself, it loves it just to be a raging fire. That's what it wants to do. The slow burn is because of our actions to help keep it a slow burn. So I want to make a distinction between what the coronavirus is.

[00:20:37] And what it's doing and the kind of, I dunno, anthropomorphic our, our, our, our, our application to the Corona virus that actually is not inherit to itself. It's our response. So all the more important. To do our due diligence. If we wanna continue this slow burn. And as Mark, you just said, yeah, it's, it's better to have this.

[00:20:53] If we can keep this going, then having a peak and then maybe having a huge peak in the fall, which just can really cause problems [00:21:00] that leads to another. Then a question here of the slow burn in this article, before we get into our deep dive, let me see if I can find it. It was the two hairstylists. This is from a couple weeks ago who had coronavirus saw 140 clients.

[00:21:12] And they both had coronavirus and no new infections have been linked to this land. I don't know if that's still the case. This was probably over a week ago. There could be an update. There's some infections. they admitted that there wasn't a full, followup yet. there could be a cinematic or, you know, pre cinematic, whatever.

[00:21:26] Maybe you're not showing up. But the reason why I'm reading up to it is this seems to incline. There's a lot of still disagreement or. There is disagreement are masks valuable. And to what extent, even, even that article, I just referenced even Mark about the top epidemiologists. He was suggesting look, mass cloth masks.

[00:21:44]sure. Why not? I mean, it'll, it'll help, you know, instead of like five minutes before your transmit policy transmitted, it might delay it till 10 minutes. Right? It's just one person with just a cloth mask. So he's saying it helps, but it's not going to be a cure. All. But this seems maybe a small [00:22:00] case that maybe a mask could be a worthwhile, actually helping to keep the burn of slow burn thoughts.

[00:22:06] Stephen: [00:22:06] Yeah, I think that it does seem like, you know, certainly in this case that, that this was at least as Mark was talking about before, this is a little bit of anecdotal evidence, right. That masks seemed to be potentially helpful. again, there's always a danger of making conclusions from anecdotal evidence.

[00:22:21] You know, one of the things that we know about the Corona viruses that most people don't spread infection to anyone. And a small number of people. In fact, a lot of people and part of that has to do with behavior. But also part of that probably has to do with how much virus you're shedding at any given time.

[00:22:38] If these two barbers were sort of at their peak infectiousness while they were at home at night or something like that, then you know, that could have affected something than if they would have reached their peak infectiousness while they were at work. I'm also getting your haircut is, you know, certainly the masks helped, but I'm there.

[00:22:53]There's all sorts of things that play into this as well. You know, when you're getting your haircut, you know, the person is usually standing behind you wearing a mask you're wearing this like [00:23:00] Gowan sort of thing, you know? So it's a sense of you're like, you're like very protected in a way, which is like very different than if you're.

[00:23:05] Like shouting at someone face to face, you know, like if two people are wearing masks in that situation, that's a very different sort of type of transmission as well. So 

[00:23:12] Mark: [00:23:12] we're seeing something like that. See, singing has been, there's been a lot about, you know, speaking of anecdotal, but the, the choir practice in which.

[00:23:19] You know, almost everyone was infected and the ways that just the act of singing and switching places and being in close proximity for a long period of time, you know, students kind of alluding to this idea of both a super spreader phenomenon amongst people and also amongst different events. and perhaps, you know, for whatever reason, these two barbers didn't fall into that category, they weren't shutting up the amount of virus and the barbershop was not, you know, a super spreading environment.

[00:23:47] Stephen: [00:23:47] Yeah. So, yeah, so hopefully the masks did help. Then I imagine that there's probably a lot planned into this. 

[00:23:53] Matt: [00:23:53] Yeah. Well, we don't have this in the notes, but I wanted to bring it up. It's kind of related to this. Okay. This is just a fear of me. Like I, [00:24:00] I work in Boulder. Well, not right now. I work from home, but I work at my locations, Boulder, and we're going to have students come back and fall.

[00:24:05] Did you guys just see that there's been a surge in Boulder County of transmission and they trace it back to a couple parties, a couple parties guys like to like, this is making me a little nervous of like, if a couple parties with a big amount of people create a surge, what's going to happen this fall.

[00:24:22] I'm pretty sure when you're 18, 19, 20, and you get to campus for the first time, you're like, you know what. I'm sort of stay in my dorm and watch Netflix until December. So I just, I'm a little weary of this whole, let's all come back to college. I get it. It's important, but I, if that, if that's any, if that's a telltale sign, I think we're in for a little surprise come September, October.

[00:24:45] Mark: [00:24:45] Yeah. It's hard to, I mean, it's hard to know. I think as Steven has predicted, I think we're going to have to go through these phases of intermittent, social distancing, and being really conscious just of the, maybe we'll have higher resolution. Like we'll have a little better sense of what are the really dangerous things [00:25:00] that we can avoid and what are the less dangerous things.

[00:25:02]cause I feel like we, you know, early in the, we sometimes compare our level of knowledge. Now, and we're like, well, why didn't we do those things back in February? Well, we didn't, you know, we've learned a lot since February. and hopefully some of those lessons can be operationalized, you know, on campus in the fall.

[00:25:18] And we avoid some of the big. Just super dangerous things and maybe allow, you know, an open up to some of the things that are less high risk. 

[00:25:25] Matt: [00:25:25] I say this tongue in cheek, when you say Mark, like some of them are really dangerous things. I just think of college 

[00:25:31] Mark: [00:25:31] that's 

[00:25:32] Matt: [00:25:32] that, that 

[00:25:33] Mark: [00:25:33] college 

[00:25:34] Matt: [00:25:34] is a category Mark.

[00:25:36] Mark: [00:25:36] Okay. 

[00:25:37]Matt: [00:25:37] okay, so let's, let's get into, into the deep dive here. So last week we didn't have Mark on, obviously had Steven on and we talked about this, this idea of the protests, and I really wanted to pick Steven's brain about, you know, what is really going on. We see qualified medical professionals stepping in saying we support the protests, even though at the same time, we say we need to have physical [00:26:00] social distance.

[00:26:01] And is that a duplicity? Is that a double standard? So we talked about it. And I was, I really loved the conversation with you, Stephen. It was really helped to put a frame around things. and then of course, what I kind of expected is there was some feedback, the only one. and we had somebody leave a review three out of five, three out of four out of five stars.

[00:26:18] The title is to review has lost all respect for the hosts, and I'm not here to bash warrantee. Three-three I appreciate his or her comments. We really do. We want to be fair a very much so. So I'm reading this out loud, out of respect, and there are some good points that he or she brings up that I want to bring into this conversation for another round.

[00:26:37] With Steven and with Mark. And I'm going to take a step back because really I'm the like in star Wars terms, I'm the pad one. I'm the under eye. I'm the learning, I'm the one who's trying to learn. Right. 

[00:26:49] Stephen: [00:26:49] And so we might have lost respect of a whole different set of 

[00:26:53] Matt: [00:26:53] totally. So I'll bring in another couple of one star reviews or Trekkies basically.

[00:26:59] Mark: [00:26:59] Oh 

[00:27:00] [00:27:00] Matt: [00:27:00] man, 

[00:27:03] Mark: [00:27:03] the universe there. Sorry. Sorry. Oh man. 

[00:27:08] Matt: [00:27:08] Oh, no, we can't. We can't. That's another, another podcast we're gonna put out in the fall. So here we are on the pad. When you guys are Jedi masters, you guys are going to talk about this. It's helped me understand this. He or she, this, this individual warrant two to three.

[00:27:20] Thank you so much. Right. And says, I lost all respect for this podcast. When it support the rights of hundreds of thousands of protestors to expose all of us to increase risk from COVID. The hosts were not as generous to employees who lost their jobs. Or business owners who lost their businesses. They need to stay at home at all costs and lose their livelihoods.

[00:27:40] So we could reduce the spread of COVID different standards for different people during a global pandemic. Doesn't remotely make any sense, regardless of the supposed rationale. Right? So this is the comment. I want to throw it to you guys, and, and, and, and respond to it. I wanna kinda retalk about this and help kind of shed some more light to how this fits [00:28:00] into epidemiology and science.

[00:28:02]Mark: [00:28:02] I just want to reflect, I did listen to the episode last week, and I'm interested to kinda hear your guys' thoughts. really appreciate it. Just kind of the. Engagement. And particularly that guardian article, I found to be interesting and to raise some important points, which we can talk a little bit about.

[00:28:18] I think I may have found that even a little bit more persuasive in certain ways, than you did Stephen. And so I'm interested to kind of talk, talk through that in terms of the narratives that have been used from the scientific community and those in authority in the ways that certain individuals feel excluded from that.

[00:28:34] Dialogue, and sort of the implications of that and the implications of using sort of a scientific brand of approval on, you know, particular things. Cause I think that's what I appreciate, appreciate about this comment too, is there is a sense, I think there's an important sense to listen to, that.

[00:28:52] There is a double standard coming from somewhere, particularly with regards to the, individuals in authority, kind of [00:29:00] throwing their weight behind some of these protests. So I also thought Stephen that you had a really kind of cogent argument last time and, and tracked really. Well from a public health frame, why it's not necessarily internally contradictory to support these things.

[00:29:17] And so that, that makes a lot of sense to me that like, if, if your starting point is this public health framework, that there's a cogent argument about why, you know, supporting, certain political action is important. and what we're seeing is this really messy and complex intersection between.

[00:29:36] Science and politics. and before I throw it back to you soon, just, just kind of my reflection as I've been mulling over this, cause this is this, this really, is he is one of the issues that really troubles me. Deeply is how hard it is often for us to speak across ideological lines, and how difficult it is to communicate with subtlety and nuance.

[00:29:58]in a way that is [00:30:00] not that doesn't just discount the other side, that doesn't just dismiss these other concerns. And so I think for me, you know, in terms of. Our broader goals of, you know, scientific communication and how do we, how do we engage in a way that has a lot of integrity and authenticity and, you know, things like that.

[00:30:15]There, there is. There's a, this is an example. I think of one of the things that creates, you know, we ask ourselves like, well, why, why don't. Why are the scientists not being listened to, you know, or why, why is there so much doubt about what's actually happening? I think this is an example of one of those instances that we really have to pay attention to, because if we want to ask that question authentically, you know, this individual who wrote that article from the guardian is telling us like, this is why.

[00:30:42] And so that seems super, super important for, you know, scientists to listen to. What are your thoughts about that? And then maybe we can talk a little bit more about some of this messy intersection between science and politics. 

[00:30:53] Stephen: [00:30:53] Yeah. That makes great sense. And I, I appreciate, sort of the, the interpretation that you gave of our [00:31:00] podcast last week, because I was, that was absolutely the hope was that, you know, just to raise an argument for why, from a certain perspective and from the perspective that a lot of that, that many of these public health officials have put forth, that there isn't necessarily an internal logical inconsistency for supporting.

[00:31:16]well, for supporting in particular, these protests from a public health point of view. but you're right. I mean, it's, there's, there's a huge, there's a huge messiness to this because there's, there's a question as to, you know, what, what exactly are we supporting through the protests and, and also, how.

[00:31:31]How do we interpret sort of what's happening on the scientific side as well in, in the form of narrative? I think that, you know, the it's like basically what story are scientists trying to tell about their position as, as things have moved forward. And I think that one of the interesting and actually really frustrating things to me about being a scientist is that, the, my colleagues and have like, really, it seems like unleashed this, The these like really detailed arguments for why.

[00:31:58]Supporting the protest is not [00:32:00] necessarily inconsistent, but many of us, many of them were not thinking about those things when people were protesting for other things, or when people were saying that they needed to reopen their businesses. So I think that it's my, my concern is not so much, you know, I think that there is, there is definitely a good cogent argument for why one can be in support of the protests while still maintaining a good faith commitment to public health.

[00:32:22]I think my concern actually lies in the dismissiveness. Earlier in the pandemic that I, that, that I actually, I mean, we didn't, it didn't come up so much on this podcast because I think that we amongst the three of us were maybe in a little bit more agreement about this, but, but there were some arguments back in the workplace, for sure.

[00:32:39] When there was a lot of dismissiveness about, you know, what is the value of, of business? What is the value of faith? What is the value of these sorts of things that, that one person might not. See, as, as deeply integral to one's life or even, you know, something upon which one's life hinges, you know, how, how can we, you know, sort of dismiss those things while arguing for these?

[00:32:58] So, so what I actually wish I had [00:33:00] seen was similar sorts of arguments then as we were seeing now, and a little bit more diversity in the arguments then amongst the scientific community. So, So if I think that if there, if there has been any sort of shift, any sort of like, inconsistency in the scientific message, I think that, that the failing actually came from before in some sense.

[00:33:20]those are my first thoughts. 

[00:33:21] Mark: [00:33:21] Yeah. Yeah, no, I mean, I think I, I agree because there were a lot of conversations early on about. you know, things is things as important as the right to assemble, you know, in a religious community, in a religious setting. And that, that, that could be legitimately suspended, you know, by government, you know, in raises all these questions about authority and freedom.

[00:33:43] Right. and, and there was a certain sense of like, well, we'll bear, we'll bear with that. You know, we'll bear along with that because this is. What's important to protect life, that we, that we have these rival goods, you know, there's this good of, of community and this good of, you know, of expression of [00:34:00] whatever, you know, these deeply held individual beliefs.

[00:34:02] There's this intrinsic good to worship, you know, in that framework. But we can suspend some of those goods in the name of another good. and now all of a sudden we see these goods that are being weighed in a very different way. and they're particularly, I think what's particularly divisive about this is that they're, they are weighed in a way that feels for certain people as if it's liberal versus conservative values.

[00:34:23]and so you're seeing sort of the, you know, the liberal values being elevated, whereas the conservative values were, w. Kind of devalued early on in this conversation and those being both, you know, social and economic conservative, socially, and economically conservative values being de devalued early on the narrative about this.

[00:34:41]And I can see, I guess, I, I, this, this is so important, right? We were talking about like, where, you know, where are these conversations coming from? Like, you know, the doubts and the, you know, that this is maybe this is all a conspiracy and things like that. that I'm not, I, it's very hard to see some of those other concerns reflected, you know, in the [00:35:00] broader scientific public health dialogue in a way that is recognizable to the people who hold them.

[00:35:05]does that make sense that sometimes I think one of the most important aspects of listening is also is kind of re representing what you hear in a way that's recognizable to the person who told it to you and not seeing. A lot that's recognizable, you know, in terms of just like the broader public health discourse, you know, to individuals who hold deeply and we're, and I'm not saying deeply different values, because I think most of the people who are engaging in this, you know, including the author of the guardian article, do believe that, you know, racism is, is evil.

[00:35:35] This is not an issue about racism. And that there's a lot of agreement that, that, that is not. But what we're seeing is kind of this meta narrative about. You know, these, these other issues. yeah. Yeah. So hard. I, the other thing that it strikes me in this, the other reflection I'd like, you know, there's well, there's two more things I want to talk about this one first though, is the question of the politicization of science.

[00:35:59]and one of [00:36:00] the things, you know, that I sort of feel is that a lot of times sciences in scientific communication can be very political on both sides. And we talked a little bit about, you know, my friend, Hadley's example of maternal mortality, right? In the ways that kind of from a conservative viewpoint, we may, count maternal mortality in ways that is not.

[00:36:20] Is lower, you know, that makes our current healthcare system look a little bit better. Whereas like from a more liberal standpoint, they may count maternal mortality in ways, you know, including like for the first year after the child is born, that seemed to inflate it relative, relatively, and there's conversations about, you know, even something that should be as cut and dry about as a mortality rate, that the framework from which you proceed.

[00:36:44] Changes the way that you count those things. And, and I think that one of the dangers in scientific communication is claiming, as you know, the author that guardian article says has been claimed that there is a monolithic scientific [00:37:00] viewpoint, right. That science says this it's science says it's okay to do this and not okay to do that.

[00:37:06]and. Even if that's not what you're saying personally, Steven, you know, or even if that's not what is coming out of your colleague's mouth that is what's being heard by a significant proportion of the population. and a significant proportion of population on both sides, you know, or on all sides of the political spectrum, that there is a scientific narrative that is somehow in, you know, distinct from.

[00:37:29] Or, you know, over the political narrative, whereas these things in my kind of, you know, humble and limited experience of it intersect in all kinds of ways and like all kinds of highly nuanced ways. And hopefully we've brought out some of the ways that they're, you know, these intersections between ethics and anecdotes and narratives and politics and science, is sort of shot through.

[00:37:54] Our experience of science. you know, and, and so I think that, that also there, I haven't heard a [00:38:00] lot of conversation about that and about the ways, you know, there's conversation about the ways that science can be hijacked for political ends, but not a lot of conversation about the ways that science is in some ways, always already couched within the culture that it.

[00:38:13]Comes from, you know, and couched within the ideologists from which it comes and that's, you know, it's a much more difficult conversation, but it seems to be important. And like you said, one that we should have had a couple months ago, right. If not years, you know, decades. but, but we're having now in the context of like further division.

[00:38:31] Stephen: [00:38:31] Yeah. You know, I mean, historically speaking, there has been a shift in science even in the last 50 years. In the sense that when, in some of the logical foundations of science, you know, it was, it was conceived to be this, The sort of thing that lie, that that was like outside of the sphere of existence, in a sense of like allowed you to determine what was happening in existence, but there was this like third person objective sort of nature to it that, that worked its way all the way into scientific [00:39:00] writing.

[00:39:00] Where were, where all of scientific writing was in the passive voice. For example, the researcher could never say I in an article because the eye doesn't matter. Right. But over the last few decades, I think there's been this growing. Recognition that that's just not true. That there's, that there is that there is an I, there is a very important eye in the conduct of science, and that that's an escapable.

[00:39:21] And interestingly that that's worked its way into scientific writing as well, where now it's much more common to write in the first person and to say what I did and what we did, which I think is sort of one step towards, towards at least acknowledging the sorts of things that you're saying, Mark, that there's, you know, that science is couched within culture.

[00:39:38] And that, even if there aren't even if there isn't a political agenda or a, you know, any sort of agenda on the part of the scientists who are conducting research, there's never the less always going to be a subconscious preference for certain perspectives versus others. And that's, I think that's, I think to some extent that's an inescapable, and will be informed by the values that we have, the goods that we perceive in [00:40:00] the world.

[00:40:00]and that will change the way that we. Measure mortality, for example, or the sorts of questions that we ask in our research? I think that, I mean, really this is an argument for something that I, I, and I, I very much stand behind is, is, is, is diversity of thought and diversity of background within the scientific community.

[00:40:17]and, and I think that there's, there's a danger of stopping at just racial and ethnic diversity at that point, because there's, there's so many other types of diversity as well that are needed in addition, because truly, You know, there, there are some questions that a person cannot conceive of that another person can just based on their different perspectives.

[00:40:34]and. And, and I, and I think that's, that's one of my biggest frustrations with, with, with the field of sciences. I do think that there, in many areas of science, there is this sort of monolithic, perspective that has become the scientific perspective. There's this sort of impersonal scientific consensus.

[00:40:51] Right. And, and people want to know, like, what is the scientific consensus? It's like, well, yeah, You know, scientists are and should be a pretty diverse field of people, but they're [00:41:00] there even as a scientist, there's this pressure to, to fall in with the scientific consensus in a way, or else you're sort of like not part of the part of the community in a way.

[00:41:09]and there are some people sort of acting against this and, and, you know, I, I try to, in my own way to, And I think that what you're bringing up maybe about the guardian article is that it's, it's sort of another exposition of, of, of the problems that come from this. And maybe one of the, one of the correctives, you know, and it's, it's a corrective coming from, you know, coming from culture, coming from, from journalism and this point talking about, you know, science and, I think it's, I think it's an important perspective.

[00:41:34] Mark: [00:41:34] It's interesting too. You know, I suspect that there are different fields in which this is more and less operative, right? That like in theoretical physics, for instance, there's, there's a different relationship to culture than in a highly fraught relationship in public health. Right. And there are foundations of.

[00:41:50] You know, kind of more what we call pure science and public health, but they're also tremendous foundations in sociology and other, other types of inquiry, that all [00:42:00] intersect. And so to, to even to use the word science, you know, with a capital S to describe any, there's just, you know, there's just so many fields and so much diversity amongst the things that we apply that term to that it's almost not.

[00:42:15] Sensical, you know that, and there's just such a huge spectrum of the ways that those interact with these other, other concerns. And, and I love that, you know, that idea of like, No one, you know, scientists included stands outside of their situated. Thus, you know, that we're saying that we're always situated in, you know, in something.

[00:42:34]and ideally we're doing our best to seek internal consistency, right? We're doing our best to seek, integrity between our foundational values and the things that we do, you know, are in integrity with like just the ways we spend our days, you know, and our overarching hopes for how. For ourselves and our communities and, but that's hard, you know, hard work.

[00:42:55]the other thing I just wanted to reflect, you know, we're getting close to kind of the end of our time. speaking of being [00:43:00] deeply situated, was the, sorry, excuse me. just, I had tremendous empathy, because I've for your reaction to that article, because I've seen. What this pandemic has been like for you in a way that is not as public on this podcast and, and the amount of, of heart and pain and grief, and just deep sense of responsibility that you bring, you know, to your work, that it, that you have not let it out so much, you know, in a public sphere, but you've really suffered.

[00:43:35] Personally, and, and you've taken on your work, you know, in this impersonal unit, the impersonal passive voice. but behind that is somebody who is in the evenings who really suffering over these decisions, and who is not, you know, as you said, blind flee, Making recommendations. And so I think I have, I have empathy both for the sense that, you know, [00:44:00] and that we may, you know, we're fallible, you know, there, there are mistakes in the ways that this has been communicated, that, you know, there's been lots of lapses has been very poorly communicated from a national level.

[00:44:10] There's been very poor sense of unity. You know, as a country, very, very poor sense of like, what are we doing and how are we doing it together? and at the same time, so I, I see all that. And at the same time, I see kind of your walk through all of this, which has been one of, you know, tremendous amount of just like personal investment and heart, and hope.

[00:44:30] And so, so I just trying to hold those two things together, you know, I think is really important and just wanted to reflect that kind of publicly. Cause we've talked about it privately, but we don't. Talking about it on here as much. and if we're committed, you know, as I think we should be to this idea of, you know, what does it mean to communicate clearly and openly, and to take science for what it is, you know, and in the ways that it's limited, I think also the positive side of that too needs to be highlighted.

[00:44:57] So, yeah. So thank you for that. 

[00:45:00] [00:44:59] Stephen: [00:44:59] Cool. I appreciate that a lot. 

[00:45:01]Matt: [00:45:01] I, echo all of Mark's sentiments. And, this is a perfect example of not, I think, a good episode, but a brotherly love. This is a, 

[00:45:10] Stephen: [00:45:10] this is awesome. 

[00:45:12] Mark: [00:45:12] Look it up after this 

[00:45:16] Matt: [00:45:16] with social distancing in mind. as we close this up, I know I want to reiterate something and this is me.

[00:45:21] The Patwin kind of responding back to what maybe I digested and a sentence or two and see if this is correct, or if I'm airing. One way or another. you know, when we, when we started this episode, this whole podcast, I really kind of thought of it as a monolithic reality reality, like just trying to provide science sterile from anything whatsoever of context.

[00:45:41] And I realized this might be the wake up call for me as well, is that everything is deeply rooted in, in a personal reality and a cultural reality. And so what I took from this is that, am I wrong to say, or am I right to say that is it? It seems as if maybe we didn't quite, we, maybe not me, the scientific community, didn't quite take the narrative in [00:46:00] mind.

[00:46:00] Early on as much as it is. And now, like maybe the, the looking back of like, there was the monolithic scientific, response as it as, as, as a, as it initially came on and we had a lockdown and this is what we must do. And it was very, just like, here's what, here's the best decision. And now we're taking on an approach that actually is, still scientific, but grounded in a, a more, a deeper sense of maybe empathy.

[00:46:25] But, but not in scape of sight of science and the overall public health. Is that what you're trying to say? There, might've been a little bit of a disconnect between the early on response and the now response, which doesn't make the now response and valid. It simply looks back and say, we might have a couple of regrets on how we addressed.

[00:46:42]Through helping engaging the wider story. 

[00:46:45] Mark: [00:46:45] I'd be interested to hear Steven, what you think on this. My thought is that we're not, I don't think are as a scientific community or as a culture that we've shifted yet. I think what we're seeing are different facets of a problem that's been there from [00:47:00] before this started and it's playing itself out.

[00:47:02]I would love to say that we have moved to a place of greater kind of understanding and stating our premises and arguing from. Premises that are accessible and not hidden either to ourselves or to our, you know, people who we talked to. I just don't think we're there yet. I think we're still deeply in this place of, arguing for the things that we hold dear, but using.

[00:47:24] Instead of, you know, instead of claiming that and claiming our premises, we use these other things as bludgeons, you know? and, and I wish that I could say, but I think that's why I think these, you know, these things are so important. Like the comment, you know, from more than two, three, three, and like the guardian article, and because until we were able to incorporate and understand.

[00:47:44]That, there's no chance that, you know, ever moving towards a more productive dialogue, that is not so siloed. 

[00:47:53] Stephen: [00:47:53] Yeah, I agree. I, and that helped me put words to, to sort of a reaction to, you know, again, as I [00:48:00] was reading the guardian article was that, There did feel, it felt like right. My, my, my response on one level was that there was, the problem was not that all of a sudden scientists had shifted.

[00:48:11] It was the problem was that nothing had changed. Right. The problem is that that, that these, these issues, or, or like, Are as, as we've been talking about in previous episodes, like this pandemic has unmasked, so many things, like one of the things that's continuing to unmask here is, is these, these really difficult and siloed sorts of ways of thinking that, that have profound activity in the world.

[00:48:36]Maybe on a more positive note though, as well. You know, Matt, you were talking about this concept of progress. And I think that despite the fact that a lot of our, I think institutions and sort of like ways of thinking are, have been incredibly slow to move. I do think that we as humans in the same way that we've been learning a lot about the pandemic and about like COVID itself, we've also been going through this period of, of learning about the moral framework in which we are making these decisions.

[00:48:59] I [00:49:00] think, I mean, I think that, it's the introduction to, I don't remember which of one of them. Allister MacIntyre's books, but he was talking about how, like, one of the most difficult things as a person is to, to know what the good is, to be able to articulate what the good is to order the good and to identify what the threats to that good are.

[00:49:17] And we're sort of in this process of trying to do all of those things at once. So while we're learning about a virus and while we're learning about it, Our political system. We're also like really learning about like, what is, what is the good? And that's like, that is the biggest challenge that we will ever have as humans.

[00:49:30] Right? Like we, we, and we have no idea where to start, but we're, but we're learning. And in the, in this particular context, we're sort of learning about this together. so while I've been, Incredibly frustrated with some of the slowness of institutional changes. With respect to this. I have seen a lot of remarkable change in our individual ability to grapple with, and to understand and to articulate what is the good, what are the principles upon which we're founding our actions, which is just another way of saying the same thing.

[00:49:57]and I think in that sense, we are, we are learning. 

[00:50:00] [00:50:00] Matt: [00:50:00] Hmm. That's a great way to wrap this up. That that yet even scientists are not void of the pursuit of the good, right? That's it. This is not, this is not, that's not a field by which you're immune to. One thing I wanted to end with was just the seeds were kind of planted in the episodes with what we kind of started with.

[00:50:17] Is it dr. Katz was that his name? I forgot where it was. This was before, right. This happened and, and really elevating the sense of wait a minute. There is a bigger, broader problem here at public health. That's not being addressed. And I think going back and seeing, even looking at him, even, even a more elevated light right now in light of what's going on.

[00:50:34]but when we use that as a catalyst to discuss that as a, as an episode before the pro protests have been the, the pretty significant disparity in race, When it comes to how COVID, you know, you know, attaches to people and, and where that comes from, and that it's complicated. Right. and now we're seeing it really hitting a fever pitch.

[00:50:55]so, I feel like, you know, for me, as I've gone through these episodes, [00:51:00] it wasn't like the, we entered into a qualitatively different conversation. It just ramped up, you know, we were, we were already discussing this and it became an acute reality. Right. So I hope this has been meaningful. This has been really as a young Patwin, that's been really helpful for me.

[00:51:17] I had to say, say it one more time, guys. Can

[00:51:23] we do someday we'll do a video podcast. So then you can see them always shaking their heads at me. Like where are you going with this man? And then they come in and correct it for me. That's why I have this. So for those of you who want to get in contact with Steven S T E P H E N K S S L E R on Twitter, if you had reached out to me, but the podcast, just, you know, getting feedback first and foremost, please leave a review, do that on Apple podcasts.

[00:51:47] But if you want to give information, you're, you know, a different place, different country. We'd love to hear what's going on, Matt. [email protected] again, to go check out my other podcast, living the real. Got to live in the world.com. You can check it out there, [00:52:00] have a new one that just dropped, or you can sign up for my newsletter going to offer some free stuff here soon.

[00:52:04]hope you enjoyed this episode and we will see you again all next week. Take care. Bye 

[00:52:09] bye.