Pandemic: Coronavirus Edition

Was the lockdown necessary and where do we go next?

June 25, 2020 Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger Season 1 Episode 31
Pandemic: Coronavirus Edition
Was the lockdown necessary and where do we go next?
Chapters
Pandemic: Coronavirus Edition
Was the lockdown necessary and where do we go next?
Jun 25, 2020 Season 1 Episode 31
Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger

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

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  • Next week, Matt will be talking about the second of his 3-M framework: Momentum. He also has a free resource he will be giving away that he uses exclusively with his clients. 
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Things Discussed on Episode:

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

Show Notes Transcript

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

  • Download here - https://bit.ly/383ak2W
  • 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

Subscribe to Matt's Other "Living the Real" Podcast:

  • Next week, Matt will be talking about the second of his 3-M framework: Momentum. He also has a free resource he will be giving away that he uses exclusively with his clients. 
    • Living the Real Podcast: https://bit.ly/3fyPIlx
    • Sign Up to be notified about when he will be offering his Quarterly Momentum Plan template for free! - 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 Boettger: [00:00:00] You're listening to the pandemic podcast. We equip you to live the most real life possible and the face today's crises. My name is Matt . I'm with my good friends, dr. Steven Kissler and epidemiologist at Harvard school of public health. And dr. Mark Kessler was a doctor at the university of Colorado hospital.

[00:00:15] Hey guys, how's it going? You too. 

[00:00:17]Mark Kissler: [00:00:17] Hey, Matt. 

[00:00:18]Stephen Kissler: [00:00:18] Good to see you. 

[00:00:19] Matt Boettger: [00:00:19] I am seeing Mark and Steven in two different environments. One is ticking Mark. You're aware. I 

[00:00:26] Mark Kissler: [00:00:26] met my mother in law's house. We took a couple of days out and the kids are hanging out with their grandma and, and it's been awesome. 

[00:00:34] Matt Boettger: [00:00:34] So jealous.

[00:00:35] That's awesome. And then Stephen, you, are 

[00:00:38] Stephen Kissler: [00:00:38] I a, yeah, I took a big excursion this week out to the living room. 

[00:00:44] Matt Boettger: [00:00:44] Totally dark background. 

[00:00:45] Stephen Kissler: [00:00:45] I 

[00:00:46] Matt Boettger: [00:00:46] was like, where are you? He's I'm like, wow, 

[00:00:49] Stephen Kissler: [00:00:49] that's the furthest I've been in the last few days. 

[00:00:52] Matt Boettger: [00:00:52] So I am still in my dungeon of a basement. So I haven't changed. And, that's put it.

[00:00:57] We are, we apologize. This is coming a day [00:01:00] late, maybe two days late. Depends on how long it takes me to edit this thing. It is currently Thursday in the afternoon and my wife has to go someplace at three 45 and it's two 49 right now. So I will do my best to get this out tonight, if not tomorrow morning.

[00:01:13] So, Mark was away yesterday. We really wanted to have him be a part, obviously. So we just shifted one day. And, here we are. So let's, before we get started. A couple of things, always reviews. Thank you for those who give them. If you had a second or two minutes, please give one. leave a couple of words, if you can.

[00:01:29]we're always looking for some more support. We thank you so much for the people who have given, somebody to help us pay off all the stuff. I, you know, I got one thing that reduced my editing down from an hour and 45 minutes to four minutes. So thank you to that person who've been helping with that.

[00:01:42] That helps tremendously. So, we still have a few things we have to obtain. so if you can, $5 a month helps a lot. patrion.com/pandemic podcast, or just one time donation at Venmo. Or PayPal, check them out in the show notes. And that is it. I have a new episode on living the real coming out next [00:02:00] week on momentum.

[00:02:01] And why momentum matters. Go ahead and sign up. I'm going to offer a free resource a so subscribe now and it'll be out next Wednesday. Let's get into the news. There's a lot of talk about, hopefully some of this won't take too long and we can get to some cool deep dive stuff. One thing just. It just, just to mention it, I just saw this New York imposes quarantine on eight us States.

[00:02:22] I think this is the first time this has happened. It's one thing to let a, to not other, let other people from other countries come in, but now we're saying, Hey, if you're coming in and just stay in your, well, you know what? It's not true. There is one place that did this, right? the, the destination place Maui in Hawaii, right?

[00:02:36] If you, you could go there, but then you had to stay in your lovely condo for like $280 or $400 a night. And just look at the ocean from a distance. Right. 

[00:02:45] Stephen Kissler: [00:02:45] So it doesn't sound so bad 

[00:02:48] Matt Boettger: [00:02:48] if it's free.

[00:02:52] if anybody would like to go ahead and donate that to us, just let us know. We'd be happy to sit there for two [00:03:00] weeks and just look up the ocean from inside. So, things to comment on CDC broadens guidance on Americans facing risk of severe COVID-19. I saw this, the, one of the things was, obesity that, they're looking at, more and more how obesity does affect, the, the, the severity.

[00:03:18] Of of COVID and moving the BMI from 40 to 31 thing, I was shocked about that among this article, there was no mention in the context of broadening the risks of the black community. And there was another article I saw a couple of days prior on Vox, and I don't know how true this is, but it said that blacks had a nine times higher mortality rate than whites.

[00:03:40] That is, that is huge, right? I mean, that's like, that's pretty significant. 

[00:03:45] Mark Kissler: [00:03:45] Yeah, that's true. That's very, very significant. I think the difference being, you know, is you're identifying patient care, like individual patient characteristics, such as obesity, diabetes, hypertension, or populational risk factors, which are not [00:04:00] necessarily causation, but are correlated to different outcomes.

[00:04:03] And so those are, you're seeing kind of two different approaches to dealing with that data there. and both of which are important and important to understand, For sure. and so I suspect that's where. Some of the differences coming from. it's interesting, you know, I think it's, it's one of the things that we've talked about a lot are the ways that sort of this cluster of metabolic syndrome, where we call.

[00:04:23] So these things like diabetes, obesity, hypertension, often run together, and they often have a huge amount of vascular risk factors, right? So you have increased incidences of heart attack and stroke in. Individuals who have those comorbidities, and similar sort of, this has been a theme throughout about the physiology of COVID hijacking that H two receptor on blood vessels affecting, you know, preferentially cells that are involved in some of those pathways.

[00:04:51] That for some reason, maybe we're seeing an upregulation of base two or. Feed cells are already baseline more vulnerable, you know, in that population than others. [00:05:00] and so it's definitely something that we've seen. And I think the more awareness that we have about that and the more awareness that these are models, often modifiable risk factors.

[00:05:07] And so again, you know, striking back to that point that we've made at a couple points, but just how important. You know, population health and cheap interventions, cheap, but important interventions that help to improve our baseline health in a, reduce the rates of diabetes and high blood pressure and obesity in our communities.

[00:05:25] Those are actually, could be potentially very consequential. and so, yeah, that folds in really nicely with some of the things that we 

[00:05:32] Matt Boettger: [00:05:32] know. Yeah, I was, when I read that I was a little, like, kind of freaked out for the first time, like crap and went from 40 to 30. You guys. I know I am like overweight and I almost ran out before we, before we had our time together to go put me on the scale.

[00:05:45] So it tells me my BMI. Right. And I'm afraid to see I'm probably going to be tipping over well over the 

[00:05:50] Mark Kissler: [00:05:50] 30, but the fact that the CDC. Lowered their guideline doesn't change your personal risk at all. It's the same as it was yesterday. 

[00:06:00] [00:05:59] Matt Boettger: [00:05:59] Yes. Psychologically 

[00:06:01] Stephen Kissler: [00:06:01] not psychologically. 

[00:06:02] Matt Boettger: [00:06:02] I'm having a panic attack right now as we're recording.

[00:06:06] Yeah. So I saw that. And then on top of that, CDC adds three new coronavirus symptoms. Check this out guys. They're huge. Runny nose. Nausea and diarrhea, moral of the story. If you guys are feeling a little bit icky, you just might have coffee. So I don't know how that helps runny nose. I'm like, this is breaking news.

[00:06:28] Mark Kissler: [00:06:28] Is this new, this is not news to me. I don't know if this is new, 

[00:06:33] Matt Boettger: [00:06:33] it's new to this particular media outlet. And I'm not going to say so just because I don't want to, I don't want to make things feel slanted or whatever. Okay. Another thing. I think we mentioned before, but it keeps resurfacing. It makes me feel better, better, better, better.

[00:06:46] How exactly do you catch COVID-19 there's a growing consensus, Steven. So basically it seems like, okay, it's not from the U S P S necessarily. It looks like we're looking at now, we're getting better, better consensus. That [00:07:00] is really is a person to person, and not just person to person, but it really is a duration issue.

[00:07:05] Right. 

[00:07:06] Stephen Kissler: [00:07:06] Yeah, it really seems to be, I mean, that is the key it's like, close contact indoors. always sort of seems to be what was largely behind transmission, but really, it seems like things are really slanting that way that that's like, That's that's really the most likely way to get it. So not the only of course, but it's, you know, I think by and large, most cases that we've seen seem to be coming from that route, 

[00:07:25] Mark Kissler: [00:07:25] this seems to fold in, I mean, Steven, you had talked about sort of number of number of viral particles being the operative thing.

[00:07:31] And so whether it's. Time or intensity, that it's really the number of viral particles that you get exposed to that increases your chance of having an infection. that's clinically apparent. and so, you know, this is good and it's, I think it just continues to add resolution to our, you know, to our knowledge and our suspicions from earlier that there are some high yield interventions that you can do.

[00:07:52] And then there's a lot of stuff that you can do, you know, that's much, much lower yield in terms of. Preventing infection so much so that it's probably not worth [00:08:00] worrying about. you know, so like we're in about quarantining the mail or wiping down the groceries or things like that are just not things that are, are going to be 

[00:08:08] Matt Boettger: [00:08:08] needed.

[00:08:09]Yup. I, this helped me a lot. I mean, I've been seeing the past couple weeks we've been going out with walks with our kids. Now we knew this for a while now, but just, just the psychological feeling. Okay. When somebody passes us by, right. I mean, they'd be like two months ago. I'm like, ah, I didn't even, I was a little nervous.

[00:08:23] Right. But just hearing this for me, they passed by, we say, hello. Things feel normal, you know, we're not, we're not having a conversation now, granted, it was a perfect time scenario where they sneezed directly in my face within a four inch radius at the time, that would maybe cause my alarm, but that doesn't happen.

[00:08:38] So it feels good to be out and it feels a little more normal. So I 

[00:08:42] Mark Kissler: [00:08:42] think that puts them some objective data to, to just the shifting frame of mind and the shifting psychology. Right. I think we can be a little gentle with. Ourselves about how we felt two months ago. Right. and when there's a lot of unknowns and things, and, and also recognize that we can [00:09:00] shift, and that's a good thing.

[00:09:01] That's like, we're moving in a positive direction where we have more objective data and we can modify our behaviors in a more precise way because of that data. and you know, those are good things that should hopefully bring a level of, you know, easing some of that, that fear and anxiety. 

[00:09:17] Matt Boettger: [00:09:17] Yeah. And it's hard cause Steven, like right now, things are kind of crazy.

[00:09:21] I, I think I just read one of the articles that we're back to one of the highest, you know, you know, confirmation rates in the U S since like two months ago when this all started. So, you know, in one, in one side, we're saying, Hey, more news, you know, and I know news doesn't actually bring down the virus, but we're learning this idea that it's not quite as.

[00:09:40] Transmissible, you know, through the mail when we thought, and now we're saying it's kind of more in enduring, long exposure inside, generally speaking, but yet it's like the wild West right now. I mean, things are, you know, Florida's blowing up Texas blowing up, you know, what do you contribute to this what's going on?

[00:09:57] And what do you see, coming down the [00:10:00] pipeline the next month? 

[00:10:01]Stephen Kissler: [00:10:01] Yeah. I mean, I think you're right. There's there are a lot of different metrics that we've been paying attention to. One of them is actually, the mobility there's, people, different technology companies have been sharing, you know, at a very aggregate level, like how many people are moving around versus how many were moving around a couple of weeks ago.

[00:10:18] And the mobility levels right now are almost back up to what they were. Pre pandemic times get a lot of places. And so, you know, a lot of what some of this is suggesting is that like, you know, there's, in some places there seems to be almost this, like. Binary sort of, you know, either we're in lockdown or we're not.

[00:10:33] And that's also something that we spoke about before, too, that it's, it's almost easier if you're just getting locked down or if you're not, but like there's middle ground and you know, all of the gradations of things that one can do to prevent spread, is just a lot murkier place to live right now.

[00:10:46] But it's unfortunately where we are. I mean, it's not really a surprise. That cases are starting to go up in a lot of places. We kind of expected that to happen a couple of weeks to, you know, maybe six weeks after the lockdowns and, and the, [00:11:00] mobility restrictions were started to lift. So, I mean, in a way it's, it's kind of just playing out in a way that we expected it to, And now I think the best we can do is just pay attention and, you know, use the things that we've developed.

[00:11:12] In the meantime, you know, we are testing a lot more than we were. So the fact that we're seeing cases rise in, in certain States, you know, if we had been doing testing at the rate that we're doing it, now, we would have seen this in New York city probably weeks before we actually noticed the rise there.

[00:11:26] So, so even though things are looking really dire when we are noticing it sooner than we would have noticed it earlier. And that's a very good thing. The key now is to make sure that we. Responds to that. And, you know, recognize that we could enter another phase of exponential growth and that, it's just important to, you know, walk that middle line.

[00:11:42] Matt Boettger: [00:11:42] Yeah. And what would be like what? Okay, so a couple of things. So the response, like what, what, what, what should be the next response? Do you have any ideas in my mind? I'm like, no, governor. Is going to call her lockdown. Who's gonna be the first one to do a second lockdown. Like they're there there's some big trouble.

[00:11:57] Right? So, I don't, maybe that was [00:12:00] maybe it's going to happen. I know Texas just came out and like, they're going to put their opening on pause. Right. which is great, but okay. If, if a lockdown is out of the question, great. What would be, what would be the next response that could help this or the situation.

[00:12:15]Stephen Kissler: [00:12:15] Yeah, it's, it's hard to say, but I think that, you know, locked down has sort of, taken on this very, sort of intense sort of meaning and rightfully so. You know, when we were thinking lockdown, we were thinking like the entire United States as like, you know, Staying at home. And so I think what we'll be seeing is, is things that maybe feel a little bit like lockdown, but there'll be a lot more localized and hopefully lasts for less time.

[00:12:38] And that's why testing is so important because we had to do a national lockdown at the beginning of this. Cause we had no idea where the virus was and where it was going to hit next. But now we have a much better sense of that. And so, you know, rather than locking down entire countries, we can maybe do that in parts of States until we get things under control.

[00:12:55] And we're sort of. Yeah, entering this phase of epidemic. Whack-a-mole that we've sort of been [00:13:00] talking about for awhile. We're just going to try to keep tamping out fires as they arise so that, you know, things don't spill over, and cause too much damage in any one given location at a time. So I think it's.

[00:13:11]Right. So in a way, it's good. We got some practice with lockdowns earlier because we all sort of know what to do now, and I can see that sort of thing returning, but, but in a much more local and hopefully a less extended period of time. 

[00:13:24] Mark Kissler: [00:13:24] Do you think, Steven, I'm just curious about this. are we in a place where we have more.

[00:13:28] Kind of information and finesse and we can do something more like what it has been called that surgical approach to quarantine, as opposed to the blunt instrument of the total lockdown. Is that a realistic thing? Or can you talk a little bit as to the difference between what we did and what was recommended in the first wave and what we might be doing this fall?

[00:13:49] Stephen Kissler: [00:13:49] Yeah. So I think that, we won't be able to act with as much finesse as I hoped because we weren't able to actually bring cases down. As far as I hoped we would be able to, Through the [00:14:00] lockdown measures initially. I mean, if we compare, for example, the cases in Western Europe versus the United States, you know, they'd dropped Western Europe to a much lower level than they are here.

[00:14:09] And the value of that is that when, when, when you don't have a lot of cases, you can do contact tracing. You have a lot more options for this sort of surgical approach because your response systems are completely overwhelmed. But right now we just have too many people getting infected to do things like contact tracing.

[00:14:24] So it's maybe not so much of a surgical approach, but. I don't, what, what is the difference between a surgery, a scalpel and a hammer is, but 

[00:14:32] Mark Kissler: [00:14:32] I guess it's, it's large. We can talk about that offline. That's what there, 

[00:14:38] Matt Boettger: [00:14:38] how's your med school. 

[00:14:40] Mark Kissler: [00:14:40] I went to school for a long time to learn the difference between those two.

[00:14:44] So if you talk to an orthopedic surgeon, if there's any orthopedic surgeons listening, they may have other 

[00:14:50] Stephen Kissler: [00:14:50] thoughts about, all right, well, maybe we can get them to call in next time. You're right. I think, yeah, definitely targeted, but I it's, it's going to be some intermediate between the two, because it's the [00:15:00] first, the first set of measures.

[00:15:01] Wasn't, wasn't quite as effective as I think we all hoped that they would be. and so that sort of leaves us again in this middle ground. 

[00:15:07]Matt Boettger: [00:15:07] And let's let's maybe go there. We're kind of skipping down the line, but this is the most natural, I think we're going to go because you just said, you know, we didn't, it wasn't quite as effective as much as we, as we hoped.

[00:15:18] And Mark, you were talking about before we talked before we got on and start recording how you're getting a lot of this information to people sticking to the lockdown was pointless. what we, what was here that, Oh, I had it somewhere. I don't know where it went, but David was pointless, that it's not necessary.

[00:15:34] These kinds of things. So. Doug telling this with Sweden. Right? I want to talk about this. So let's look at maybe why, why do you feel like the lockdowns, Steven wasn't. That effective for us in particular, we look at Sweden and of course they didn't do a lockdown. And I don't know the full extent of Sweden.

[00:15:50] I read an article about how the epidemiologists there thought that the lockdowns were crazy. They stayed, they stayed their route. Now they're kind of suffering some of the highest per a [00:16:00] hundred thousand cases, in the world. So they're seeing the, The recourse of this. But then again, I was, as I was reading the article, I was thinking in my head, well, that's not the reason why we had a lockdown.

[00:16:09] Right. We didn't have lockdowns to prevent deaths. We slowed them down so that the hospitals wouldn't be overwhelmed and then kind of slowly drip them back in. Right. So to speak, not to be kind of crude about it, but, but to, to put them over time. So we don't overwhelm the system. So I'm seeing Sweden not overwhelmed.

[00:16:27] Right. And, and I don't know how much. Worst. They fared per a hundred thousand than the rest of the world. I don't know how their economy is doing, versus the rest of the world. So this is kind of a big equation. So taking Sweden and then using this to look at us, Steven, like where, where do you feel like we as a country failed, through the lockdown and why maybe it wasn't quite as effective as we hoped it was.

[00:16:48]Stephen Kissler: [00:16:48] And so I think that, so. First of all, I think that, and I want to be careful to distinguish, you know, that we necessarily failed in the lockdown versus just that it wasn't as effective [00:17:00] as, as we might have hoped it would have been. I mean, it's in a way, one thing we know for sure is that just the, the, this epidemic just behaves really differently in different places.

[00:17:08]and so comparing Sweden to the U S is really difficult because Sweden is the size of many of our U S States. and there are many U S States that really haven't seen much like an awful lot of transmission yet. At all. we could maybe compare Sweden to a place like Florida, where we also expected cases to really explode at the beginning of this outbreak.

[00:17:25] And they just kind of didn't, you know, and it's not really clear why, and there's certainly rising now and, and the rising in Sweden as well. And so part of the story is maybe that it just didn't happen soon. You know, like. There's just a difference in timing here as well. but I think the thing is it's like, there's, there's such, there's such a strong desire to, link up what is happening with the epidemic with the actions we did or we didn't take.

[00:17:47] And there's certainly a correlation there, but. There is an awful lot there that's outside of our control, I think as well, or at least outside of our like rational ability to, to it's like really changed the course of the epidemic. [00:18:00] And so certainly like we wish the cases in the United States were lower than they were for sure.

[00:18:04]but it's also not clear to me. Yeah. It's not clear to me what exactly we should have done. Or could have done to make that happen for sure. And I don't know, maybe, maybe we just got unlucky, you know, I think that, you know, and I think that there's certainly a story to be told about, you know, adherence and, and common, you know, joint like a very clear messaging coming from leaders and buy in from the public.

[00:18:28] You know, all of these things are things that historians are going to be trying to unpack for a long period of time. You know, the fact is that like, we're just in a really unfortunate situation right now in the case of still are relatively high. And that means there's lots of sparks that are allowing these epidemics to, to, to come about.

[00:18:42]but it's really difficult to say why that is or what we could have done differently for sure. 

[00:18:45]Mark Kissler: [00:18:45] Hmm. So just to kind of, for my listening and understanding too, it sounds like you're saying you're speaking from this perspective of there's a huge amount of variables. right. We anecdotally we've got, you know, a few of these variables that are like, well, I didn't [00:19:00] go, you know, I didn't go to the grocery store for a month and you know, I've been doing XYZ and I'm not seeing the results of that in our national numbers.

[00:19:08] And you're saying that really there's so many hidden variables underneath that, that contribute that it's really. Tough to tease out and draw a direct straight line. You know, I think, you know, it sounds like you're saying that you're still on the, on the ear of the opinion that social distancing, and some of these measures are going to be the most important arsenals in our tool, you know?

[00:19:30] Sure. You know, whatever tools in our tool kit for preventing. Rapid exponential growth again. Right. And so that you may recommend kind of some of the similar things yet, again, even though it doesn't, you know, there's some feeling that maybe we didn't achieve as low, but, you know, trough as we had hoped, right.

[00:19:48] Cases. 

[00:19:49] Stephen Kissler: [00:19:49] Is that fair? Yeah, absolutely. I mean, I would even go so far as to say that those, those are the only tools in our toolkit, right? That's the only thing that we know how to do that actually has an effect on [00:20:00] transmission. And, you know, mass squaring helps in these sorts of things. Everything has to do with interrupting transmission and physical distance.

[00:20:05] That's that's it at this point that is. All we can do. and we know for sure that that can help and often has helped historically. And that, will, you know, if, if we do want to turn the number of cases around that, that we'll have to do something along those lines. but, but yeah, it's, it's hard to say because.

[00:20:24] In addition to those things, there are a lot of other things that can cause cases to go up or down that are outside of our control. and so it's just one of many things, but it happens to be the only one that's in our control, 

[00:20:34]Mark Kissler: [00:20:34] how much, And in what ways do you include some of these other? So the other thing that's that I'm hearing are people pick their, you know, pick other variables such as, you know, economic strength or things like that.

[00:20:47] And, say, well, these need to be factored into our equations about the. Morbidity or mortality, you know, that were causing, this was the argument we at the beginning, and that's resurfaced in various different forums sorta throughout that [00:21:00] were causing more harm, by our response than actually that the coronavirus would do.

[00:21:06]and I'm just interested to hear kind of your take on that. And some of your thoughts about the ways that you from a big picture perspective, think about. you know, those other issues. And how does that factor in to the recommendations that you and your colleagues are making? Is that a fair question?

[00:21:23] Stephen Kissler: [00:21:23] Yeah, I think so. That's so I mean, of course it's, you know, it's, it's impossible to factor everything into, into a single framework of thinking about a problem, but the question that you bring up about, The real human impact of, of shutting down parts of society like we have done, was, was very much on our minds and, and contributed to the development of the models that we, that we put together over the course of this outbreak.

[00:21:51]it's. So maybe, maybe the best way to think about it as a sort of how our thinking has evolved over time. So early on in the outbreak, we didn't really [00:22:00] know where the coronavirus was, but we knew that it could decimate regions of countries that it could just absolutely overwhelm healthcare systems.

[00:22:08] And we didn't know if there were other places that have low level of circulation happening, but we did know that Rahan had been overwhelmed. And Northern Italy had been overwhelmed. And we knew that we had places in the United States that looked a lot like UConn and looked a lot like Northern Italy.

[00:22:21] And those were the only places we knew where the coronavirus had visited yet. And so we knew enough at that point to know that this virus has enough to bring a health system to its knees. And that was a big enough damage that, that, that essentially, you know, all of the conversations around that time were basically saying, you know, we, we need to do everything.

[00:22:41]Everything within reason to avoid that. And we don't know where it's going to hit, and we don't know what places are going to have these sorts of outcomes, but we know that it's possible. And so given our lack of understanding and given our lack of knowledge, but given what we do know, The response that I think we took was, was probably necessary and prudent. [00:23:00]

[00:23:00]and so as we've been learning more, we've been realizing, okay, so the virus seems to have been circulating in a lot of other places as well. Like Sweden, like Matt brought up, and it hasn't brought the health system to its knees in quite the same way. And we still don't totally understand why that is.

[00:23:13] Again, part of it might be a question and maybe just not yet. A part of, it might be a question of just crowding or underlying comorbidities or, you know, all sorts of things, age distribution in the population. you know, there's, there's a whole list of factors that can affect why one place might see a much worse outbreak than another.

[00:23:31]and so now given that knowledge, we can come back and say, okay, so we can, Start to adjust our response and think now about how we can respond in ways that are a little bit less economically disruptive. So I think that the key thing is that we're learning more and more about what the two sides of the equation are.

[00:23:50] We knew that there was this huge detriment to lives and ultimately to the economy, that would have been told if, you know, if, if the worst case [00:24:00] scenario or even the most likely. Bad scenario had played out. and I think we did manage to avoid that. And I think part of the reason we avoided that is precisely because we did what we did.

[00:24:09]now we can be a little bit more targeted moving forward. but I think that it's, you know, it's, it's difficult. We're, we're, we're sort of learning on the fly. and we're just going to keep trying to incorporate this as we move along. I don't know if that actually addresses. 

[00:24:20]Mark Kissler: [00:24:20] Yeah. 

[00:24:21] Matt Boettger: [00:24:21] I think that that helps a lot.

[00:24:23]Again, not to always keep talking about the idea of the complications of this, but you know, another one we're kind of jumping again, but Mark, you had us read this article of like, you know, we can protect the economy from pandemics. Why didn't we? So this, this whole case of this, who it was that was moving towards trying to sell pandemic insurance, like up until 2018 and nobody wanted to buy it.

[00:24:43] Right. And, this, this, this idea. of, you know, in the same way that Mark mentioned months ago at the very beginning, that it's so hard to wrap our mind about exponential growth until we actually see it. And by the time we see it, it's now too late. And we're beginning to see some of this in, in, in Texas and legitimate [00:25:00] fear, starting to arise out of Texas.

[00:25:01] I mean, two weeks ago, the Texas, the Texas governor would just kind of like whatever we're going to slip it up. And then as of today and yesterday, there is a. That sense of worry with him. I mean, his words seem to be like, please, please stay at home. I mean, there's just like, there's this cry of petition to help us get over this.

[00:25:15] Let's not overwhelm the system. So what am I trying to say in the complexity in this article? I think it was a great one. I'm going to read this paragraph. It helps put things in perspective of, we're not just dealing with the aftermath of a lockdown that's oversimplification. We're dealing with the continued aftermath of, of a virus that is, that is unknown and does crazy stuff at crazy times.

[00:25:36] So this is. He reflects upon, I think his wife , it's been a while since I've read this, I'll read this from the 2015, the Zika virus outbreaks superscript texts arrived and crystallize. The reality, that fear was a critical variable and understanding the economics of outbreaks fear. Right. A mosquito borne disease with no vaccine or treatment Zika almost never killed its victims, right?

[00:25:59] This is [00:26:00] almost never, but in pregnant women, it could lead to a rare and terrifying birth defect called micro  or whatever, whatever. There you go. After decades of low level outbreaks, the disease suddenly surface in Brazil and raged, North northward causing billions of dollars in tourism losses across South of central America.

[00:26:19] Even two years later, open Heim who's wife was then pregnant, canceled a trip to a conference in Boca Bogata despite the fact that, that, his, his own company's research told him. The risk of Zika carrying mosquitoes at the city's altitude was a negligible quote, our member thinking we have to solve this.

[00:26:36] He said to the question of how to model fear, because if a pretty rational person with access to a lot of data is making an emotional decision. Imagine this magnified in a pandemic. Right. I think that just causes the complexity of all of this, where, you know, we, we just, we went back and seen the, the open tables, reservations declined, precipitously, precipitously, you [00:27:00] know, a week before, you know, the lockdown that, as you said, Stephen, I think you said it well that given what we had, it's not like this was the best choice.

[00:27:08] This was the only choice we had. It's not like you have 30,000 tools in earth. Like let's pick out the lockdown. It's like, we've got a couple and we've got to use them right now. Right. Yeah, that's interesting. 

[00:27:18] Mark Kissler: [00:27:18] There's such a temptation, I think right now to, to kind of take stock, and to look around and make some pretty significant judgments about what we did in March and April.

[00:27:30]and what we should do, you know, in September. and. And yet, you know, there's a certain way in which we still have to have that really strong degree of, of nuance and reliance on good data and good science. and there's this, I think there's just this, growing what's it feels to me to be just sort of a growing sense of, well, we've, you know, we're through it.

[00:27:51] We're through the first part, and now we can, you know, we have learned all of these important lessons and we have, you know, we have learned a lot of lessons, but I think a lot of the [00:28:00] important lessons have remained implicit, and have been, you know, have remained, just like you were talking about that.

[00:28:05] There's just these layers of complexities and layers of variables. and so not that that is to stoke. Fear and anxiety by any means. You know, I think in a lot of ways we're relieved at a lot of the information that we have now that we didn't have in March about transmissibility and mortality rates and all that.

[00:28:21] There's a lot of good, potentially good, good news, about this. And yet, you know, we're not, it's not as if we're out of the woods and we're like, you know, we're still very much in a dynamic situation that relies a lot on scientific expertise and. A tremendous amount on good scientific communication to the public.

[00:28:41]and, you know, boy, if, if there was a single hope that I had, you know, for the next wave it's that we have some really, really, really good scientific communication and very, very good and nuanced listening on the parts of the public. so that we can all get on the same page. 

[00:28:56]Matt Boettger: [00:28:56] I guess, Stephen, you have anything?

[00:28:58] Stephen Kissler: [00:28:58] No. 

[00:28:59]Matt Boettger: [00:28:59] Yes. [00:29:00] Yes. Well, you said the second way, is there really a second wave? Like I just feel like it's just going to be like burning. We're just like, we're just, this is it. We're just going to, I can't even imagine a second way. Cause that means it has to like the, the wave has to retreat. I just don't imagine that having Steven, I mean, at this point in time, do you even consider a second wave being like a practical thing to talk 

[00:29:23] Stephen Kissler: [00:29:23] about?

[00:29:24] Yeah. It's I mean, I think that there's, there's kind of two scenarios that are playing out, you know, either one is just sort of the infections, just going to keep bubbling along for the next, you know, eight months or something. until we reach enough immunity in the population that, that it starts to die down.

[00:29:39]you know, it's, it's hard to say it, part of it's gonna depend a lot on what happens this summer. I mean, I think the places that, It kind of, kind of ironically, but it kind of makes sense. You know, places that have achieved a lot of control over the outbreak are probably at more risk of a major second wave, because there's just a lot more people in their population are still susceptible.

[00:29:59]but there [00:30:00] may well be enough people still here in the U S that are susceptible, come September, October to, to see another rise in cases, even up and above what we're seeing right now. so, you know, I think personally, I still think the second wave is, is likely. but again, the severity of it. Timing of it is a, it's going to depend a lot on what happens over the next two or 

[00:30:18] Matt Boettger: [00:30:18] three months.

[00:30:19]And I'm just like perplexed because we have people who are scoffing at the lockdowns and thinking them being useless. And then, and then, but, but then there's these other things that are much less sacrificing. That even that can't be adopted, like wearing the masks, right. Going the mask. I just had this article by, of course the Atlantic.

[00:30:40] I love it. The dudes who won't wear masks, right. That's the name of the article. And you think it's going to be this entire article about ripping really strong muscular dudes who. who don't wanna wear a mask, but it wasn't that at all, it was really showing the complexity of the situation, which I think you speak to Mark as well.

[00:30:55] A little bit of the, the integrity of the scientific community, [00:31:00] where early on there was this kind of dismissal of masks, right? And again, it's complicated because the dismissal was, look, you're not going to prevent you from being infected. And so let's not wear masks. And then pretty much it's like let's wear max masks because it won't prevent you from being infected, but you might not.

[00:31:19] In fact other people, cause we have more information that you may not have the symptoms, but yet you still might give it to someone. Right. So that came off as being duplicitous and then you have government coming in and maybe making a mockery of it. But then I think the most insightful thing was it's probably not the best thing to go on Facebook guys and post these really sweetened beams that say like, if you don't wear a mask, it means you hate people.

[00:31:44] Right. It doesn't really motivate you to want to wear a mask. Right. That we need to have a shift that this is, I think, is something to public health and the same way 80 in the eighties. And they talked about at the HIV and the problems with that. And they, they tried methods. They tried the shaming method, right.

[00:31:57]of, of trying to prevent people from getting [00:32:00] HIV, and it didn't work and they had to switch it, and to a more positive, Benefits and its value. And I think that's the thing we have to shift to if we're a bit, cause there really are simple things. I think if we wear the mask, if we wash our hands, if we keep the six feet at a distance, I would imagine,  maybe we could prevent some of these cases of having the big spikes.

[00:32:20] Stephen Kissler: [00:32:20] Right, right. 

[00:32:21] Matt Boettger: [00:32:21] Yeah. And, in the finally ending on, we had to go back to this. I just want to have to mention it again, because I had never even thought about this, Mark. You, you, you're the one that gave us this, this idea of pandemic insurance, like, how that could have been. I know to me, it's like, I still, I read the article.

[00:32:35] I didn't quite. Fully grasp it. Like how on earth do you really get pandemic and of cause by, by nature, unless we've inhabited Mars. So we have, we can collectively take from their, their, their, their, their economy. Right? 

[00:32:49] Mark Kissler: [00:32:49] some of the nuances of how that all works. I have not, not qualified to comment on, but you're right.

[00:32:55] And there is a sense, I think. You know, the argument being that it's hard [00:33:00] as, as difficult as it is us is for us to think about exponential growth. then it's also hard for us to think about cyclical events that occur on the scale of 100 to 500 years. and to situate ourselves. Meaningfully in a history in which that could happen, you know?

[00:33:18]and, and how, how much easier it is for us to kind of forget, you know, and have this collective forgetfulness about that. and I think that's a really interesting topic more broadly, and thinking about like, what are the elements of culture that preserve memory across generations? cause ultimately that's one of their things is how do you preserve a cultural memory?

[00:33:39] You know, that lasts a hundred to 500 years, that, and that speaks to how do you approach, know societal level crisis like this in a way with, you know, integrity in which that, you know, you're not eroding the pillars of the society you're in, but you're reaching out and, you know, trying to have, you know, protective, vulnerable members of [00:34:00] your community and things like that.

[00:34:01] Like those are, those are deep. You know, cultural questions as well. And how do we, create and sustain the types of practices, that, allow us to be resilient, you know, these kinds of prac, you know, resiliency. And I think, yes, there's science that plays into that for sure in the way that we interact with science and data.

[00:34:19]but there's also, you know, the ways in which. How do we learn to do that? Well, you know, and who do we learn that from? And, and how, how has that kind of a part of our culture too? So that was the, that's kind of like the other level of interest that I had in that article. You know, I think there's, there's this interesting economic argument, you know, in this kind of business focused thing of like, how do we.

[00:34:39]Create a system in which we have a safety net, you know, in the case of extreme social distancing. but I think it's important to remember that before this happened, the, even the terminology of social distancing, and sort of the, the fact that that could be a thing. That we're asked to do. It was not in our consciousness and it was sure it wasn't in mine, you know, maybe it was in, [00:35:00] it was, it wasn't Steven's cause it's his field.

[00:35:02] Right. but it wasn't something that I did all of this I've had to learn. and he very quickly, you know, and so I think it's just very interesting. And yet, you know, there were things like in 1918 that we were doing some of these things, you know, in certain local communities. And so it's not as if this is brand new.

[00:35:19]it's just that we forget very quickly. 

[00:35:21]Matt Boettger: [00:35:21] It's our nature. And then I think it's going to be all the worst with today. Like, it's one thing to, like, I know this is totally just not probably the right way, but if you're saying like tribal reality sharing stories of craziness and like here's a story of a pandemic and what am I going to share with my kids?

[00:35:36] Like I watched Netflix that stayed at home and it was, and it had a green screen behind me for three months. Right. Pop up in Maui places, but not really. Not really. It's just my little son, it's all sent background. So like the story just by itself, I mean the larger story, right? It's the larger story that needs to be told, but like my own personal narrative is [00:36:00] not so convincing for me to want to share, you know, then, then the more widespread, general one, 

[00:36:06] Mark Kissler: [00:36:06] I wonder.

[00:36:07]I wonder about that. and I do think that there's, and you know, this is something I'll have to think about a little bit more, and maybe we can talk about it some other day when, you know, cause, and, and you've got to go pick up, you know, relieve your, your wife sued. So, so, you know, but I 

[00:36:21] Matt Boettger: [00:36:21] think,  

[00:36:21] Mark Kissler: [00:36:21] there's a way that in our lived experience too, we kind of minimize what we're doing and it's like, well, it's.

[00:36:27] It's everybody's experience, you know, what is this worth? 

[00:36:31]

[00:36:31] but I think about like what I would do now to have some real authentic, Personal reflections from my great grandfather during the depression, and him running his farm and like the, you know, like the most quotidian thing in the world is like, he's milking the cows and he's helping the neighbors.

[00:36:52] And you know, he's doing these things as a first generation Italian immigrant, and it's like not a big deal cause it's kinda [00:37:00] life. But for me, that's really deeply meaningful. and, and I think within the texture of that, and kind of within the layers of that, you start to get at some of these bigger things like, so what are the value?

[00:37:12] You know, what motivated him? You know, what are the values, what are the things that he's making these decisions based on? And, and. That I think some of that comes very much from the particularity of it. You know, we're, we're tempted to draw like a big moralistic, like to tell the story with a moral at the end.

[00:37:29]but I'm, I'm pretty convinced that the most important stories that we have to tell are those of the real extreme individuality and the particularity of the life and that it's from that, that you speak to the more universal values. you know, it's, it's in that. That kind of traffic between the universal and the particular and like that highly particular aesthetic.

[00:37:49]that's what makes real stories so compelling, I think is that they speak to bigger truths out of the particular. And so, so I think, you know, I, yeah, I do. I do [00:38:00] think it's important. And I think there are things that we're, you know, each of us are doing in our homes and families and everybody who's listening that is worth telling about, and is worth reflecting on.

[00:38:11] Yeah, absolutely. 

[00:38:12] Matt Boettger: [00:38:12] That's great. That's a great way to in this, it kind of reminds me back to just the idea of discovery and you've hit. I think just, you know, I kind of say that tongue in cheek, but there is a truth to that even just seeing and reflecting back the past couple of months of just how my wife and I have engaged our sons and the new ways by which we're trying to inculcate different values, that, that weren't wouldn't have been here.

[00:38:35]before the pandemic. And I think, I would probably go in just this and this is why it's so meaningful to reflect and journal and know the reasons why you do what you do. Because if I just allowed this to be another moment in time and I just keep on the conveyor belt of life. But yet, in some sense, just subconsciously I'm inculcating a new value system to my, or a nuanced value system to [00:39:00] my boys.

[00:39:00] And one day they asked me why I'm like, I have no idea when it all along, it started with this idea of the pandemic. And some of the things I realized that we needed to do as a family, to, to protect ourselves and to still make ourselves a resourceful and valuable to a society and to bring value to society that shifted for me.

[00:39:15] And so, you know, we we've, we've literally, I've just now realized, you know, because. We're using new stories and new phrases and new words to them to help encourage them to be a certain kind of person for a new kind of future. And I think up until this point, it was just habit. And I realized I need to reflect more on the why, because I want to be able to, for my kids to know the why, because as we know the why really does sell it helps them to understand the importance of it.

[00:39:43] So thanks for sharing that, Mark. I appreciate it. Okay, we're going to wrap this up. I got to go upstairs and relief my, relieve my wife to go get paint. We're going to go paint the inside of her house. We mean she, so, I hope it's she, I hope it's not me. I can't stand painting 

[00:40:00] [00:40:00] Mark Kissler: [00:40:00] the same green that we've been looking at 

[00:40:04] Matt Boettger: [00:40:04] this lovely green.

[00:40:06] So my whole house is basic. That'd be the coolest thing in the world. You guys green screen house, you could turn your entire house into an Island 

[00:40:14] Mark Kissler: [00:40:14] virtually. I mean, coolers is one word for that. Yeah, 

[00:40:17]Matt Boettger: [00:40:17] totally. Oh my gosh. That's terrible. I need to get outside. So I'm going to go outside right now. I'm going to go get a good breath of fresh air.

[00:40:24] I realize it. That reality is better than virtual. good to see you guys. And thanks for you guys for listening. Sorry. This is out a late, if you want to get ahold of me, [email protected] would love to hear more stories of what's going on in your neck of the woods, whether in the U S or outside of the U S if you want to check out Steven S T E P H E N, KSS, L E R on.

[00:40:44] Twitter and check out living the real.com. We'll have a new one next week and a free resource. If you're feeling stuck, like I am sometimes tell him to get a foot forward and get redirected and get a new direction going so we will see you guys all next week. Take care. [00:41:00] Bye bye.