Pandemic: Coronavirus Edition

Rushing the vaccine, and pursuing urgency over expediency

August 31, 2020 Dr. Stephen Kissler and Matt Boettger Season 1 Episode 41
Pandemic: Coronavirus Edition
Rushing the vaccine, and pursuing urgency over expediency
Chapters
Pandemic: Coronavirus Edition
Rushing the vaccine, and pursuing urgency over expediency
Aug 31, 2020 Season 1 Episode 41
Dr. Stephen Kissler and Matt Boettger

APOLOGY: Matt is very sorry for the audio quality of this episode! He is a technology geek and in the name of making a great streaming experience for those who financially support us, he messed up the audio.

We had two options:
1) Give you a lower quality file that had the entire conversation or
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Show Notes Transcript

APOLOGY: Matt is very sorry for the audio quality of this episode! He is a technology geek and in the name of making a great streaming experience for those who financially support us, he messed up the audio.

We had two options:
1) Give you a lower quality file that had the entire conversation or
2) A higher quality audio where it cut out four times for a few seconds while Stephen was speaking.

We choose having the full conversation over that of better quality! It will be fixed next week!

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

Please help us raise the last $450 to pay off all the equipment and software we needed to pull this podcast off well and quickly:

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

New Living the Real Episode Dropped Last Week

  • Subscribe/Listen to Matt's Living the Real Podcast: https://bit.ly/3fyPIlx
  • Click here to download Matt's 3-M Journal Template: http://livingthereal.com/journaltemplate

Things Discussed on Episode:

\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

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 in the face of these crises. My name is  and I'm joined with my good friend. Mark is away. There's even Kissler is an epidemiologist of Harvard school of public health. Mark is way of the hospital doing his stuff, whatever he does.

[00:00:17] So, Stephen, Hey, how's it going? Good to see you. It's 

[00:00:20] Stephen Kissler: [00:00:20] good to see you too. Are you good? 

[00:00:22] Matt Boettger: [00:00:22] It's a it's Monday is our new rotation. It's exciting and starting to stay fresh, just a talking about COVID stuff. So let's get going right away. You have a lot to talk about like usual reviews, please leave them hugely helpful.

[00:00:36] Here's one, I'll put it into an Opsis. It was a critical is a critique of us. So I went through with you guys just to help. This was from swordfish. Just talking about how he loves our content and loves the wisdom of Mark and Steven. In that sometimes we can go a little bit long about personal life stuff.

[00:00:52] So. he mentioned it was seven minutes last episode. And once he get straight into the good tidbits of information that they have to offer. So if that's [00:01:00] a concern, I know some people give us a lot of feedback, kind of love, corporate and our personal life and what's going on in life. So we've been doing that a bit more, but if you would like us to reel it in a little bit more, if you tighter to get straight into the good stuff of the questions with Mark and Steven, email me, Matt at  dot com.

[00:01:16] We want feedback after all we're here to serve. We're just trying to get information. We're not trying to just talk about our days and our kids. We could do another podcast for that. So, or the hopeful kids of Steven and his future, his future life and all that kind of stuff. So please let us know, but nonetheless, leave reviews hugely helpful.

[00:01:34]if you want to leave a donation, we now have $450 left payoff. We're getting close. You can just do a onetime gift, PayPal, Venmo all in the show notes. If you want to contribute as little as $5 a month, that's at patrion.com/pandemic podcasts. And last I dropped another episode of living the real it's about the one habit that can change your life.

[00:01:54] As little as 10 minutes a day. It's about journaling and I give my 3m journal template away for free. So you can [00:02:00] have that. It's a great episode. Check it [email protected] Okay. Let's get in. So the first thing and Steven, I want to talk to you about this. So it was about three weeks ago. I was having a tough time at the end, Boulder.

[00:02:14] And we're trying to figure out when we're just being exposed already was in the first week of COVID. I had so many students ask me, what should I do? What should I do? So of course, what do I do? I, I got my, my, my phone and text my fellow epidemiologist friend, to talk about what should we do? And you gave us a really good, very practical two step process.

[00:02:33] And I went through it your way, Steven, to just tell everybody else. Cause it's been helping us a lot. When it comes to someone being exposed, we kind of get it. You can repeat what, what we should do. But here's the difficulty when you're exposed to someone who's been exposed, what do you do? What was your two step process you share with me that you can share with other people?

[00:02:49] Stephen Kissler: [00:02:49] Yeah. So I want to preface this with the fact that we're okay, this is, this is the opinion of an epidemiologist, and this is not necessarily something that we can sort of like. [00:03:00] Modeling or trials or anything around it, choosing how to behave right now. It's as it's so tricky, I've had so many conversations with people.

[00:03:07] Like even, even me as somebody who's been studying this as my full time job since January, like I still sometimes just don't know how to act. And so like, like whether it's safe to do this thing or that thing or whether I should, whatever. So, so this is basically the first framework that I'm thinking about in terms of exposure.

[00:03:26] I'm definitely up for. Debate, but, but this is, this is sort of the way that I'm thinking about it. So, the first off, if, you know, for sure that you've been exposed to someone with COVID and that it could have been in that period when they were infectious. So anywhere from a couple of days before they tested positive or felt symptoms anywhere to a week or so after, you should sell isolate.

[00:03:48]if that's at all possible. because a direct exposure is, is a direct exposure and it's, you know, you should self isolate until you get yourself tested. And then, yeah. And then if the test comes back negative, then you can consider sort of [00:04:00] going about your life a little bit more, a little bit more openly, but then you asked about the exposures to the exposures.

[00:04:05] You know, what, if you have these secondary exposures where you, you know, that you've had close contact with someone who's had close contact with someone who's tested positive. And I think in that scenario, you know, is probably not necessarily, and for you to go out and get tested immediately. Hopefully we'll, we'll reach a point where we haven't, you know, all the tests available that we need and they can turn back quickly.

[00:04:23] You know, if you're in a community where testing is really straight forward, by all means, go for it, you know, go get a test. But I think the most important thing for those people, just to make sure that you're restricting the contacts, maybe not. So isolating totally. But the thing that we're trying to avoid is these major, super spreading of that that's that was sort of alluding from one thing to, and the best way to do that is to just make sure that you're not interacting with more than a couple of unique individuals over any single period of time.

[00:04:48]I've been doing this since the beginning of the pandemic. I've I've, I've tried to make sure that I'm not seeing any super spreading events ever, because I don't, I've always sort of been treating myself as if I could be infectious. So I've been limiting the number of people who I've seen [00:05:00] within any two week period to five to 10 at the absolute max.

[00:05:04] And so I think for people who are these secondary exposures, that's something that makes them off a lot of sense to do, to make sure you're not spreading to Lawson. And then if any of the people who've been in direct contact with Ben become positive, though, and just sort of shift up that pipeline.

[00:05:16] Now you have a direct exposure, you should self isolate yourself. But, but that's the main thing is making sure that if you have the contact of a contact, just make sure you're not spreading it to large numbers of other people and just be mindful. 

[00:05:27]Matt Boettger: [00:05:27] Yeah. I could totally see this going off the charts and CNN, you know, epidemiologists throws ranger, and then, you know, a hundred people in fact with Kobe would really go well with your particular career.

[00:05:38] Stephen Kissler: [00:05:38] That's not great for the PR. I'm no 

[00:05:41] Matt Boettger: [00:05:41] good at choice by staying close at home. Well, good. Thank you for sharing that. It was important to me, and wanted to be able to, share it with others as well. Okay. All right. So let's be the other thing I just wanted to put in here. The CDC was really helpful. they offered a, an article or [00:06:00] publication on how to deal with grief and loss.

[00:06:02] So not much to talk about here, but I want to put it into your virtual hands up in the show notes. It was a good, good little list of resources that. Everyone is suffering some sense of grief. It's a, there was my sister just sent, an officer little from some what's it called some good news, right. That whole great, great platform.

[00:06:20] Check it out. It's very inspiring about this poster, like on somebody's lawn, it had electrode. It was, she just said, look, we're all going through a hard time. It's okay. Basically, you know, just treat yourself. Okay. So it was, yeah. Awesome. Inspiring comments, but we're all good. We went through a hard time.

[00:06:34] We all need resources to check it out. Another thing before we do another couple, a couple of deals, dives here is mass research. We're not going to talk about this again. We've talked about this before, but thanks to Steven and Mark, we kind of got a short list of some good articles and some tests have been done on mask because if people who are anti mask, I'm sure some of our listeners are, how do I address this in a sensitive, [00:07:00] charitable way?

[00:07:00] Well, in the end, we got to follow science. That's our best means. And when you're just trying to pit one media outlet against another, it becomes difficult because then you kind of getting this idea that I'm CNN I'm I'm I'm Atlantic in versus let's just go behind that. Let's look at the best science possible and make the best decision possible.

[00:07:19] Check the show notes, some really good material there that you can read, digest, send to your friends and just have a good discussion about the effectivity of masks. Okay. Now I want to go back to Steven. There's a couple of things here. There's I feel Steven, there's this kind of like the slippery slope, sorry to happen.

[00:07:35] So these articles are related first more of a knock EWAS one. Just want to get your perspective on this, that the CDC changed their guidelines when it comes to getting tests. So I think it was that if you're exposed to someone, even if you're asymptomatic to get tested, now they changed their guidelines to if you're exposed to someone that had COVID.

[00:07:55] And if you're showing no signs, you don't need to get tested. I would love [00:08:00] what are your, what are you thinking about this and what was the change? I mean, in my mind, I'm thinking, of course I'm not trying to be pessimistic. I'm just like, Oh, we know we're having a tough time dealing with the tests. So let's just kind of knock that out and just focus on the people who need it.

[00:08:12] And that's the reason, not necessarily science. What do you, what do you, are you concerned about this at all? 

[00:08:17]Stephen Kissler: [00:08:17] Yeah, I am frankly. And I think that many of my colleagues are too, you know, it's, the, the, it's all of the evidence that we have suggests that, asymptomatic and especially presymptomatic spread, is really a main driver of transmission of COBIT outbreaks.

[00:08:33] And so if you're not testing those people, you're not gonna find them. And, and so I think that the guidelines are, Are confusing from a public health standpoint. So I'm not really sure what, what the, what the motivation was for setting these up. You know, I know that, in terms of, of testing shortages, that the issue that we're having right now is it's not so much that we don't have enough tests in the country as a whole, but it's the distribution of those tests.

[00:08:57] I mean, this is the age old problem with distribution of goods and [00:09:00] everything, you know, like this is, this is, this is the fundamental problem in our society. And it's showing up in testing as well, where. it's, you know, here, here in Massachusetts, we have tons of tests and lots of labs that are able to run those tests, but then a lot of places that are currently seeing bigger outbreaks just don't have those and have to ship their tests to places like Massachusetts and then get them shipped back.

[00:09:21]Sure. So, yeah, so that said, you know, there, there continued to be issues with testing and especially the distribution of tests that really need to be addressed. but I don't, I don't see why a guideline like this will actually help with that. so, so frankly, I'm, I'm a little confused by it and, and I don't think that it's, instead it aligns with, with public health realism.

[00:09:44] Matt Boettger: [00:09:44] Yeah. And this is not the first time. I think we've been confused by something the CDC or who has said, which makes it all the more difficult because we're trying to advance. A uniform cause to bring COVID down and then this, I think all it does is kind of in my, in my opinion, and I'm sure I'm going to see it next [00:10:00] couple of days.

[00:10:00] It just helps the suspicion and that this 

[00:10:04] Stephen Kissler: [00:10:04] it's unneeded. 

[00:10:05] Matt Boettger: [00:10:05] Right.  okay. So we have that, the next thing here is the next part of the slippery slope, but I think is more difficult. It's just like last week we talked about, the, what was it? The, not the bone, not the Oh, plasma, right? Yep. That was fast paced.

[00:10:20] And we didn't know kosher what they really meant. Now. The FDA, once again, is fast paced and REM disappear to treat COVID-19. So, kind of, maybe I'm not sure what this really means. Stepping over some of the scientific procedures and making it more widely accessible. Is this any concern to you where the room disappears, safe, have to do this?

[00:10:39] I'm just starting to have some little bells go off in my mind, right. About now, like again, it could be because I'm thinking of Russia. And so it's an unfair comparison and I'm interpreting things like this. Like in my mind, America was this way. We have our procedures and we do, we do this for the safety of everyone and not act like it's being chipped away.

[00:10:57] And I'll, I'll, you know, I'm tending to put this with the other one too, [00:11:00] because you just didn't even worry. You're aware of this, but they're still related it. Justice. When I saw FDA commissioner says he's willing to fast track. Coronavirus vaccine past phase three. So we have plasma from disappeared and now an openness to fast paced.

[00:11:16] Are you concerned about this? Like what is going on? 

[00:11:19]Stephen Kissler: [00:11:19] Yeah, so with the, with the convalescent serum, question that, I think that it was, it was kind of mixed. So a lot of my colleagues were very, were absolutely concerned about it, for sure, because it did seem like it could have been in response to pressure being put on basically by federal government.

[00:11:35]to try and basically just come up with something. and so it is very strange. I mean, like Mark said, like they've been using this since the beginning of the outbreak. and so why, like, why now, why, why the emergency approval granted now it would just be, because, you know, it seems like the weight of evidence was suggesting that maybe it's helpful.

[00:11:53]I admittedly haven't dive into that particular research. I wish Mark were around because I think he'd be able to speak a lot more clearly to, [00:12:00] to these things. But certainly, you know, with, with, from desert beer now it's coming out, you know, very quickly after that as well. And again, I think,  yeah, people have been using them designated in hospitals very frequently.

[00:12:11]and I suppose the, the emergency lifting or allowing the emergency authorization of it allows you to use it outside of the context of trials. again, unclear that will have any effect on the actual treatment of patients in any way. and so it seems like, you know, Again, the two, the two options are either that in the way of evidence suggesting it's probably not that harmful might have a benefit for some people.

[00:12:34] So we'll just authorize it. again, coming on heels of the Plaza and sort of some of the issues with the vaccination.

[00:12:40]Yeah. It's just there, it's just not really clear what's what's happening and what the motivations there. So, but the thing, I think the issue with the vaccine, it is it's something that, That's where I think I shift towards a little bit more concern. Whereas before I think I was walking more of a middle path where it was like, well, you know, like sometimes things happen together.

[00:12:58] And like, I know that [00:13:00] we're all sort of in this really charged political atmosphere and like, you know, people are going to draw meaning from things where it doesn't necessarily exist and that sort of thing. But we've talked to him so much about trials and about the importance of trials. And I know that in previous episodes, we've talked a little bit about.

[00:13:14] Yeah, FDA approval for the tests. And then we've talked about, you know, like why can't they just approve these and, and, and the issue, there is not so much with the tests isn't that we want to certainly vent FDA approval. It's that we want them to establish a different route of approval for things that are used for surveillance rather than clinical medicine.

[00:13:30] So really we want to use the structures that we have available and improve them. and, and not certainly nothing. But, but the issue with, with sort of this openness of, of what is it sounds like basically shortcutting things three trials is that it actually is circumventing some of these, these instants and these procedures that we have in place that are really very important.

[00:13:50]as we were talking before the show, you know, you brought up the, that the FDA director was saying that, yeah, that he would be open to it only if it was a, what was it like supported by science [00:14:00] or 

[00:14:00] Matt Boettger: [00:14:00] he was a very, he was very kind of.  very specific. The say that this is not political, that this is will be only grounded in science, which I want it like that when we're talking about, I was confused.

[00:14:09] I'm like, how can this be grounded in science? In my mind, I'm searching for a reason because you have this whole process for a vaccine. And you're going to say, I'm going to circumvent that in the name of science. So either a you're concentrating yourself, or there is a higher level of principles that's governing the FDA, which I'm unaware of that.

[00:14:26] And maybe you have the inside track of this Stephen and what the, those guiding principles are that can. Fast paced cities, but if that's the case, I want to see that otherwise I'm suspicious. 

[00:14:34] Stephen Kissler: [00:14:34] Right? Totally. And I think that the, it was, it was precisely, I see that statement that really gives me pause and, and some amount of alarm because, Frankly science is political.

[00:14:45] You know, we do our best to be objective, but yeah, where the thing, the question that we ask and the things that we decide are important are things that are based on value judgements that exist outside of the realm of science and the question of vaccines. [00:15:00] And when you approve a vaccine, how you approve it is.

[00:15:04] Absolutely a question that that is yeah. Formed by science, but it's, it's not fundamentally assigned question, right? It has to do with our level of risk that we're willing to accept. It has to do with this complex weighing of risks and benefits of future risks. Wait with future sort of less known benefits and vice versa.

[00:15:24] It's a very complex thing. And those are the sorts of questions that science can't answer. Right. And so. Part of the, you know, you asked about like, what, what are these other principles that are, that are guiding this? And I think that there's, there's a really interesting thing going on here because, and this is getting into sort of the, in some senses, the philosophy of institutions and of culture as a whole, because I think that some of those principles, you know, historians and political philosophers, you know, we do our best to articulate.

[00:15:54] What those principles are. But to some extent, the reason society as a culture is what it is, is [00:16:00] because those things are to some extent on articulable or difficult to articulate and really their best form is as they are embodied in our institutions. So part of the reason we have this three phase trial is because it's, it's actually expressing it's instantiating, these, these higher principles and their principles of, a trade off between safety and risk and a certain openness to risk.

[00:16:22] And we can try to articulate what exactly those things are. But the fact is that the clearest expression of those things is precisely this three phase send them trials. And that is, that is how we express our, our willingness and openness to risk. And I think that there's, there is a huge danger in trying to circumvent that because what that's essentially doing is looking at this thing that we we've developed over time, through, through this entire history of things that have really gone wrong.

[00:16:48] And things that have really gone. Right. And we've been adjusting this through this sort of collective, knowledge experience over time. And what we have is that's informed by all of this stuff. [00:17:00] That's, that's really been built off of the mistakes that we've made in the past and the successes that we've achieved.

[00:17:04] And if we somehow then come in at this point and say like, well, no, we'll just trust. Science, you know, and, and circumvent all of these things, all of these values and all of this, the sort of thing that's been developed. Like, I think that's very dangerous because what that's doing is it does two things.

[00:17:22] First of all, you know, I think circumventing it. It already is, is, is, is dangerous because it's, you know, it, it just ignores a lot of that wisdom. I think, of, of what, for the, I mean, for the sake of hopefully, I mean, I think that there's probably a kernel of Goodwill behind, so, you know, you really want to save lives for sure.

[00:17:40] And I really sympathize with that. You know, I want a vaccine too, and I want one that works, but that's the thing is I want one that works and I want to make sure that it works. Then I want one that I can have confidence in because the second problem here is that if we do end up with one. That doesn't work well, that erodes trust in science, because it was remember, it was precisely science that this FDA director was saying is the [00:18:00] thing that guided us.

[00:18:00] Yeah. And if it goes wrong, people have very good reason to not trust science. Right. Because you can draw it direct link, suppose, you know, between, between things going wrong. And I'm the science. And so it's like, well, if we get that one, yeah. And that's, this is what we don't need right now. We don't need mistrust in science.

[00:18:16] We don't need mistrust. It seems, what we need is science that works in vaccines that work and both of those to serve culture and to serve. You know, the more for politics to serve culture and to serve these sorts of people greater, these greater and articulable principles that are embodied. And so I think that's why that's my concern here.

[00:18:36]and why I think that it's really important to make sure that we're dotting our I's and crossing our T's, especially with respect to the next. 

[00:18:43]Matt Boettger: [00:18:43] That's great. Okay. So this a couple of things I want to unpack, because I think you just nailed it. You gave me chills for a second. When did we talk about how we're I think.

[00:18:51] By doing this or you mean suggesting this we're kind of, I mean, I'm not a scientist, but the science community is being cut off at the knees. We're already in a place where I [00:19:00] feel like what you just said, science has already been looked at suspiciously and it's almost as if we're being open to the possibility to repeating the whole mask, like problem.

[00:19:09] Right. It's it's, you know, right away, no big, you know, don't wear a mask, no big deal. There is, there's not a uniform consensus. And then of course now we're mask. And so now, because there wasn't a uniform consensus. Now there's suspicion about MES and other things as well. And it's now it's gotten out of hand and if we do this and say, okay, we're just going to go ahead and fast track this.

[00:19:29] What is this going to do? Wait, isn't it. I mean, let's skip ahead to, we're gonna talk about it a little bit about the vaccine and there's some good articles about this and you and I were talking about how you already have a little bit a rightful, you know, suspicion, not suspicion, but caution with the vaccine.

[00:19:46] And so the next thing we'll talk about in a related as 

[00:19:48] Stephen Kissler: [00:19:48] completely. Be 

[00:19:49] Matt Boettger: [00:19:49] talking about fast pacing. The vaccine I'm hearing from a hand full of people saying we're not, I mean, this is before this happened. Okay. So now, and now it's even more, so weeks ago before the FDA suggests [00:20:00] it was already about, Hey, they're fast, they're rushing the vaccine.

[00:20:04] It's at it's at record pace. Well, so then my, my conclusion is they're cutting corners, so I'm not going to take it because they're cutting costs initially before I saw this article as well. I mean, I want to talk to you about how that's not the case. That is maybe it's more complicated than that, that it's the whole world working together in collaboration.

[00:20:23] It's that we have new methods. We have new technologies that's able to, for us to still do our pro do the scientific process as it always is. Right. But at a, at a, at a, at a rate that actually is bringing it closer. But now with this, it's just, it's not, it's muddying the waters and I'm even more concerned about whether it's take the vaccine.

[00:20:43] So I noticed a complicated question. It was meant to be simple, just, Hey, show the audience that this is actually okay. That, but now with this one, I'm like, okay, I don't know. Maybe it is a little shady. So what, where, where, where do you land on this? 

[00:20:56] Stephen Kissler: [00:20:56] Right. So I think that the choice [00:21:00] of vocabulary here is so interesting.

[00:21:01] And I think that, you know, again, historians are going to have such a huge source of interesting things to look at from this time. So, right. The question of like is the vaccine rushed, you know, like rush itself suggests a certain amount of, of throwing caution to the wind. Right. And I would say, you know, the science that has been happening around developing these vaccines, this has been happening at an unprecedented rate for short people are, but that's, that's also built upon a lot of vaccines technology that has been developed over the last decade or so, where.

[00:21:34] There are these new platforms, these new routes of delivery for vaccines that have, that have really come about, but haven't really, haven't really gained prominence just because there hasn't really been a reason to develop them. You know, we have other reasons too. We have other ways of administering vaccines that have worked for a long period of time, but now sort of all of these different types of technology, we're sort of poised and ready, for, for, you know, this urgent need to develop a new vaccine against any pathogen.

[00:21:59] So that's [00:22:00] part of why. This has been happening so quickly was because we really were sort of at this cusp of, I think, a revolution in vaccine technologies. and so, many different, companies and academic institutions I've been, sort of yeah. Using these new platforms to develop vaccines, very rapidly.

[00:22:16] And so on the one hand, I mean it rushed. Yes. I mean the. Yeah, it's, it's tricky because again, that word, when it connotations what's going on, you know, like people are doing very careful and science around this to try to make sure that they're developing vaccines that are safe, effective. And that's basically why I think we need the regulatory process to work as networks as well, too, because the science is going quickly.

[00:22:43] And we need to make sure, you know, in some senses the regulatory process is a check and balance on that speed of science because, you know, we need to make sure that it's safe and effective. And so, so I think that doing things quickly and efficiently is not a problem. [00:23:00] as, as long as we're doing, you know, There's this great.

[00:23:04] I think it's like a Mumford and sons lyric that, that it's, it has to do with like the difference between urgency and paste. It's talking about like, I will love with urgency, but not with pace. And I think that that's important, right? We were in a time where urgency is at the utmost importance, but haste and the carelessness that it implies is something to be, cannot afford.

[00:23:22]right. So vaccine technology has been proceeding. Hugely quickly, really exciting. And I think that it's actually opening the doors for a lot of other types of vaccines as well, that might not have been developed because these other technologies have, you know, so like, I think that this will actually be a really big benefit for public health over time.

[00:23:39] Again, if it's some responsibility. and, but, you know, like you said, I think that there's still, you know, there's still absolutely. I think. Like I absolutely trust the vaccines that we have. and I'm still very competent and have a lot of faith that the vaccine that will, they get their COVID will also be safe and effective.

[00:23:59] And I do still [00:24:00] trust our institutions to a very large degree. and so, so I think that that's, you know, that's, that's worth mentioning and that, and I think that. It's, I, you brought up the question with masks as well earlier. I think it's just really important to hear, to try to avoid some of the tribalism that comes with us as well.

[00:24:18] And to recognize that like, there are people who have legitimate concerns about mass squaring, and there are people who are very legitimate concerns about vaccines as well. And, And I think we need to speak to that and grapple with that and try to understand that and take those concerns on for ourselves.

[00:24:34] Because again, like you said, there's, there's, there's all sorts of reasons to be, to be cautious as well. And things that, that, that can be causes for concern. I think, I think that's important, you know, it's, it's, we, we reach a greater consensus by. By listening to that and through that dialogue, and, and not just sort of, you know, saying like, well, you need to wear your mask because the science says you need to, and you need to get a vaccine because the science says you need to, [00:25:00] because the science will tell you, you know, like science, science is a dialogue too.

[00:25:04] And it's, it's, it's just incredibly tricky. So I think that this is something that we may have to revisit as we move forward too, because I think it's a really complex process. You know, the, the, the history of. Certainly vaccines, but also vaccine hesitancy and vaccine refusal has its own really interesting history and its own sort of cultural embeddedness.

[00:25:23]and, and there are all sorts of reasons for it. and all sorts of reasons that people, people elevate, some of which are, are, you know, not, not actually reflected in the science. but some of which reflect, I think actual concerns and just different ways that people are weighing their own risks and benefits.

[00:25:41]and so I think that what's necessary is, you know, remembering that a COVID vaccine as with masks. That's what so many of our public health interventions is ideally meant to protect you, but also hopefully, you know, depending on how the vaccine works to protect other people as well, and that's most important.

[00:25:57] And, yeah, so I think that this is something that [00:26:00] we'll have to continue talking about a lot. So, again, I have a lot of trust in it. I have a lot of trust in the process. I have a lot of trust in vaccines in general. and I think that we need to continue to engage the people who don't, lovingly and mindfully, cause they're bringing something important to the table too.

[00:26:13]Yeah, 

[00:26:14] Matt Boettger: [00:26:14] no, that's great. They, so a couple of things I want to just reiterate what Steven said. Oh, maybe like a month ago that hit me hard because yeah. I'm worried, like, you know, the whole phrase, like this is time trusted. It's a cliche phrase that you use. Like, so with this is it, the time is a very shorter span.

[00:26:32] So that, that doesn't. Give me as much confidence. Now I do fully aware that like time isn't the exclusive variable 

[00:26:39] Stephen Kissler: [00:26:39] to success, like 

[00:26:40] Matt Boettger: [00:26:40] clearly technology, we've seen this and it's so many different things of, of our lights that were technology expedite. It's been a good way and great bringing about just as much quality in a fraction of the time.

[00:26:52] So it's a different kind of metric that we have to use today then just time trusted. And, but one that you did say you just mentioned again and reiterating [00:27:00] that with older people. Typically the vaccine doesn't work as effectively as younger people. Cause it requires immune response other than this from Steven.

[00:27:07] So of course that encouraged me all. The more that also has me internally conflicted of like, I want to do my due diligence to get the vaccine yes. In general, to help those who don't, it doesn't quite affect as well, but specifically my own mother-in-law like we want to see. And so there's a lot of pressure in our own family to like take it right away.

[00:27:26] But I think. Like most of the people, the day I take this and especially if it's right away, am I going to be nervous? Yeah, I'd be nervous just because it's just a short period of time. And I don't know, you know, like my, my wife wants to ask, like, what's the longterm consequences of, because we have no idea because a longterm requires it to be around for awhile.

[00:27:44] And that's the scary part. Like you're part of that longterm, you know, I can't answer that without just saying it hasn't been there for that long. Right. So thank you for sharing that. Going back to something you just said earlier, and this goes back to the other thing, this rapid [00:28:00] antigen testing 

[00:28:01] Stephen Kissler: [00:28:01] for $1, that's 

[00:28:02] Matt Boettger: [00:28:02] still, hasn't been approved by the FDA.

[00:28:05]you mentioned this and I love this. It came from an article and put in the show notes that the thing is that there is, there is a push to make a distinction. So if there's, you don't know what this is, it's just basically a saliva test at home kit. You can, within 15 minutes know whether you are negative, positive, COVID super cheap as little as $1 a day.

[00:28:22] Could be a game changer to us, for sure. Sure. And the problem is that is currently being seen as a medical diagnostic tool, which is then under a particular camp and principal we just talked about. And so this is not like, I think it's the perfect example. You've just seen Steven. It's not that we're asking or the community's asking to redefine principles, but shift it to a different case category of principles.

[00:28:44] So rather than it's something medical diagnostics to shift it to a virus control tool. And have its own set of principles to govern. Is that kind of correct? We're trying to shift it to, to maintain standards, right. We're not trying to shift standards on this. Right, right. Yeah. So I love that distinction [00:29:00] and it removes that.

[00:29:00] Cause it would be so effective. It's not as, it's not as sensitive as clear for the PCR. And I went, so this isn't, I think allegedly antigen test at home kit, Steven, what's the difference mean this in the new items new or if it's just, all I know is nearest of Colorado. And having students take two tests all the time.

[00:29:18] So this is my first awareness they're taking the PCR test, which is kind of the common vocabulary for the past number of months. And I guess for me, they're also taking the antigen test at the same time. And they're getting that back faster than it's usually days later before they get the PCR test, is this the same antigen test, but maybe slightly modified as the, at home tit.

[00:29:38] And it wasn't between these two. And why would we take both of them if they're both effective? 

[00:29:42] Stephen Kissler: [00:29:42] Yeah. So I, to my understanding, the antigen test that, that's being administered to people in the clinic, along with the PCR test, is similar, not quite identical to the one that, that has been talked about for these like rapid at home tests.

[00:29:57] I do think that the, these clinical antigen tests [00:30:00] still requires some like special chemicals, some special reagents to show the findings. so that makes it less, you can't quite map it to, to the home setting quite as easily.  but the good thing is because they are rapid they're similarly rapid, like you said, they can turn it on results within 15 that's.

[00:30:16]the, the, the reagents that they require are sort of less expensive. So, you can get these turnarounds a lot more quickly and really important that you can scale them up massively. And the company that's producing them right now. So it would be able to produce millions. I think it was like tens of thousands, at least not millions each month.

[00:30:33] Right. So that's, that's like, that's true. So that's going to expand testing capacity, hugely improve testing turnarounds. Now the reason they're administering both is because again, the antigen tests aren't quite as sensitive. and I don't remember about the specificity either. So with sensitivity and specificity, again, being controlling, the rates of false negatives and false positives, the PCR test is really the gold standard.

[00:30:55] But it takes longer to run again because in many places you have to ship it off somewhere and get back. [00:31:00] So essentially by combining these two together, if you have an antigen test that comes back positive, there's pretty good chance that you're in fact. And so then you can immediately change your behavior and, and make sure, you know, you can start the contact tracing.

[00:31:12] And then the PCR is sort of used as a confirmation of that antigen test. Because when you use two tests together, you, you hugely improved the sensitivity and specificity you would have if you just use one in isolation. So essentially they're using these two tests together to generate this like, super test that that's, that has a very high sensitivity and very high specificity.

[00:31:34]and so, so I think that's helpful. And then the antigen test basically gives you the added benefit of giving you those results that much quicker so that you can then. So implement all of these other public health strategies, contact, tracing isolation, more rapidly. Okay. 

[00:31:47] Matt Boettger: [00:31:47] Now I want to go back to something you mentioned, and I don't know if you were thinking about this way back when, but you were proposing.

[00:31:53] One of the theories is in of course, most pandemics or at least the past couple, it started in a big state, like New York, and then [00:32:00] eventually in the fall went to like rural areas. Right. And you were just talking about there, there are some places like. Like Boston, where you're an epicenter. Like you, you can get tested and get that it was all the same day, but it's like the compound effect.

[00:32:12] If it's true. And we're seeing this already, that the false heading and starting to hit rural communities, which clearly doesn't have the same kind of laboratories. We're complicating things where you guys are already thinking about this. Like, Oh man, this is going to be difficult because it's going to hit rural.

[00:32:24] And then on top of that, we can't get tests back like as quickly. And it's going to take days or. Is would the at home tests be this great way to, to, to circumvent that or to help that, or now quickly to the antigen test? Is that something that has to be done at a specific lab in Boston, or is that more of a, can be offset to his local hospital, 

[00:32:44] Stephen Kissler: [00:32:44] right.

[00:32:44] That's something that can be offset basically to outpatient clinics. So that's exactly like, that's the kind of thing that will help, I think a lot in these more rural and more remote outbreaks. Yeah. Yeah, exactly. So that's okay. Hugely beneficial 

[00:32:56] Matt Boettger: [00:32:56] now hitting the fall if he does it. Okay, great. Okay. Let's [00:33:00] let's talk about, we've got a few more things.

[00:33:01] One more big one. I want to talk about this we've mentioned last week. Want to go this deeper. So we talked about the ho Hong Kong reinfection. So I wanna bring this back to you. There was a great article that my sister gave me about the four scenarios to develop immunity. And it was a specifically set in the context of this reinfection of Hong Kong.

[00:33:17] Like, and I don't know if you have the chance to read it, but it just, you know, the immediate immunity last rubber one that grows kind of over time. The more you're infected and then down to the fourth one, which is basically your it's like a museum, you'd have no clue that you were infected. You get just as bad the second time, which is the least likely.

[00:33:34] And he said, it's pretty much not on the table, but somewhere in the middle. So I want you to talk more about this specialist specifically in the context of there was another reinfect. Now we're starting to see them more and more they're coming up and you already mentioned, this was not a surprise and epidemiology is to be expected.

[00:33:49] This is not like some kind of line sidedness. But the Hong Kong, I think gave me and maybe a mother, other people, a sense of a calm when you saw the first one was [00:34:00] maybe worse. The second one was less worse. So the immunity has a response. The second one, it's not nearly as bad. That's helpful. Then the Reno case shows up, which is just the opposite.

[00:34:10] It is not so bad. The first time. A lot worse the second time. So now, as, as me, as a layperson person hanging out over here, I'm concerned about immunity and whether it's going to be blind, or how do I make sense of this all in light of what you see and is this expected and how can I have some constellation here that, that, that immunity is even if you get reinfected, it's not going to be as bad as the first 

[00:34:35] Stephen Kissler: [00:34:35] one.

[00:34:36]Yeah. So I think there are a couple things to note here. First of all, you know, these, these reports that are coming out, like you said, they're, they're not surprising with any infection, even the ones that we normally think of as permanently immunizing, like nasal surgery, there, there is still some, yeah, very small probability that you can get reinfected.

[00:34:55] And that has to do with just this huge variation in the individual's immune response. What [00:35:00] particular parts of the virus, your immune system is targeting that sort of thing. So, yeah, so it's, it's interesting because I think, but the, like the Hong Kong case it's, you know, really exploded like in, in the media and people, you know, like this is weird, people are gonna get me infected.

[00:35:14]scientifically speaking, it's just sort of like, all right, so now, now we have that first, like that first confirmed case of reinfection, it's confirming something that we knew as possible. We can get a little bit more information about the timeframe and that sort of thing. Like you said, the fact that it was less severe is really, really good.

[00:35:31]now with respect to the case that lives re-infection presumed reinfection, that seems to have been more severe. you know, that's, that's well within them, the realm of possibility to now, now my hope is, so I'm pretty sure, yeah, certain that re-infection will be possible and could actually affect you clearly.

[00:35:47] It's possible, but. The question is like, is it going to be a major source of like, is it going to be an epidemiologically important thing? I think that's also possible. I do think that just based on what we know from the other Corona [00:36:00] viruses from other sort of respiratory viruses, it is likely that you can get reinfected, but that re-infection on the whole will probably be less severe other than the original infection.

[00:36:09] That's just based on what we know from the other infections. So you can imagine that, As we're beginning to look more intently for these cases of reinfection, you're going to be much more likely to pick up a re-infection this morning, then the one that's less severe. So, in terms of our detection strategy, right?

[00:36:26] So like if somebody like this person comes to hospital or wherever, because, because they have a severe infection and then it comes out that they've been infected before. you're more likely to detect those cases that the people who are getting reinfected and have no symptoms whatsoever. So, so that could be part of what's playing into this too.

[00:36:43] It's like, Oh my gosh, this person's getting a more severe reinfection. Well, we sort of expect to see those more severe infections before we see the ones that don't actually cause any problems at all. and so that's also not necessarily a huge cause for alarm, for me again, it's well, within the realm of possibility that.

[00:36:59] Re-infection can be [00:37:00] more severe, but I don't think that this necessarily means that it's like, you know, just going to be totally random and you're going to get reinfected and it's just going to be like, the first time could be, could be. But I think that it's, again, based on what we know from other viruses and from other coronaviruses in particular, I think that on the whole, in bulk, it's probably going to like your past exposure will probably help protect you to some extent in future, future severity of infection.

[00:37:23] So yeah. You know, with, with respect to that, that article that, was it, your sister had mentioned with the four different ways of developing immunity, you know, that that's kind of outlining sort of four different paradigms that we think about with different infectious diseases, right? Where measles is sort of a canonical example of something that gives 

[00:37:40] Matt Boettger: [00:37:40] you permanent 

[00:37:41] Stephen Kissler: [00:37:41] immunity.

[00:37:42]there are other things, so part of the reason we need booster shots, for example, why you have to get, you know, three different shots against. all sorts of different things when you're a kid is because that immunity can Mount and then as you sort of get repeated exposures, then that gives you that sort of long lasting permanent immunity as well.

[00:37:57] And that happens with natural production as well. But we normally [00:38:00] see that with diseases that we get vaccines for, because we've developed vaccines for these it's because they were so bad. you know, cause you didn't want to get them over at the time.  and then yeah, immunity can also decline over time and that sort of flew like paradigm where we're going to have to get re and, and I think that that's probably a pretty likely scenario for coronaviruses too, because those circulate year after year after year.

[00:38:20] So, and then the last one, you know, we absolutely do have disease infectious diseases that really don't give you any, any clear immunity whatsoever. the, some sexually transmitted diseases are like that, especially, but. From the evidence that I've seen, it's very clear that people do generally Mount an immune response to coronavirus.

[00:38:42] So I think it's already clear that it's not in that case. 

[00:38:44]Matt Boettger: [00:38:44] Okay. you know, it just reminded me of, I feel like we're doing March all over again, is that like, we had the same discussion in March. We're like, Oh, we have a hundred cases. But what you're seeing are cases in the hospital, more than likely those are just the worst cases and it's probably more [00:39:00] mild.

[00:39:00] There's tons of more cases. And we were not aware of it at home. It's like, we're just having deja VU. It's like March all over again, but now we're just having the re-infection where you're just seeing maybe the more, the more intense cases and there could be reinfection all over the place. So is even more mild, the disagreement show up.

[00:39:16] So to put that in perspective, great. Let's end with two quick questions and then we'll sign off. We're about 42 minutes in. This comes from Molly. she says, you know, we're busy doing step at can someone with positive antibody tests. Pick up and transmit the virus while they have the antibodies. So she has some friends who have been tested positive antibodies, and they're going about their normal pre COVID thinking that they can not spread it.

[00:39:40] So if they have that, should they still be concerned at all? Or is there any kind of caveats to deal with this particular test? 

[00:39:47] Stephen Kissler: [00:39:47] Yeah, so, I mean, you can still have antibodies at some level for something and to get reinfected and infect other people. So I think it's possible, you know, the antibodies will help protect you.

[00:39:57] It'll probably reduce those [00:40:00] probabilities. again, so this is going back to what, what I would do. and I think that even, even if I were the test positive for COVID and I found out that I had antibodies and I went through the illness and whatever, and I had antibodies afterward, I think I would still not really change my behavior.

[00:40:16] I think I'd still not see more than a couple of people. In any two week period, I would assume that I could be just as infectious as I was before, basically immediately upon the symptoms resolving. Now that's maybe a little bit pessimistic. It's probably a little bit cautious, you know, but nevertheless, we, we don't know.

[00:40:34]and so, and there's, there, there is absolutely, there are infections you can get reinfected with despite having some level of antibodies to. Yeah. So, so again, I mean, I clearly, with these various cases of reinfection antibodies do not imply immunity to reinfection, not as, you know, community to infectious.

[00:40:52] So I think, I think that some caution is still absolutely warranted. 

[00:40:55]Matt Boettger: [00:40:55] Great. And I think it's also good to precaution. Again, I'm not the expert, Steven, if I read this, that [00:41:00] there's still the outline question of even if you are reinfected, whether you're actually transmissible. Is another question up for grabs.

[00:41:07] We just don't quite know. So it's not to put that up. We have no clue. Last question. this actually came from my wife. I think it's a great question because we talk about the upcoming fall. What's going to look like that's already been part of our, our, our talk or discussion. We end with this. Like, what do you think next spring might look like?

[00:41:23] Steven? I know this is really copy. And now we're, we're, we're, we're prophesizing six, seven months out in the next summer. So I know I'm putting you on the spot and the chance of being wrong or highly likely. But in the current context of what you see, and I know there could be a vaccine. What, what are some scenarios, a couple that could outplay that's that you see are the most predictable for summer and spring next spring.

[00:41:46]And 

[00:41:46] Stephen Kissler: [00:41:46] so I think that, yeah, like you said, it's, it's hard to predict, but this is, this is actually exactly the sort of question that we were asking back in April too. And that some of the modeling work we did was, was oriented towards trying to understand. So, so based [00:42:00] on some of that work and again, on what we know from historical pandemic, respiratory viruses, pandemic, flu sort of thing.

[00:42:06]People are probably going to, I mean, they're absolutely going to continue getting coated through the winter. I think that it's likely that transmission will accelerate in the winter as people are crowding more indoors and, as potentially the sort of the climate factors make it more likely for transmission to happen.

[00:42:23]but then we come into the spring. So at that point, I mean, ideally there will be a lot more people with handy bodies in the population, whether it be shift again. and so I think that it's, it's likely that it will be easier to control in the spring and over the next summer than it was this spring and this year.

[00:42:40] I think that, yeah, it really depends a lot on how bad the, the fallen winter are. To know how bad the spring and summer are going to be. They're sort of, I think an inverse relationship there probably to some extent,  you know, if I'm doing a really good job of reducing transmission over the winter, then, then there will still be things to contend with in the spring and [00:43:00] summer.

[00:43:00] For sure. and, and that, that does not mean that we should just let things run ramp. 

[00:43:04]Matt Boettger: [00:43:04] Yeah. Going be very 

[00:43:06] Stephen Kissler: [00:43:06] clear about that, but that is not right. I think we want to go because again, like, again, the big issue is overwhelming hospitals. We're going to have coast circulation with flues. So that's going to also put a strain on hospitals.

[00:43:16]so these are the reasons why we need to be very careful and cautious of individual. So I think that, most of them, the mystics scenario is that we have a vaccine by springtime. and so again, that will help that won't sort of immediately switch off the pandemic though. it'll take a while for that vaccine to get to people.

[00:43:33]there are a lot of people who won't get the vaccine, you know, so we're going to be living with Conan for awhile. And I think it's going to be part of our lives, four, you know, easily through the next spring and some of that as well. but hopefully it will be less of a central part of our lives at that point.

[00:43:48] You know, it'll be something that we're living with, but I think that we'll have a lot more, hopefully we'll have better treatments. Hopefully we'll have some sort of vaccine that's protective, more people will ideally be immune. our testing will be ramped up with more contact [00:44:00] rates. You know, all of these things will be ironed in our favor and we'll make it sort of less, you know, when I talk to me, like when I talk to people, like where I wonder what we talked about before, you know, like that's what we talked about, right?

[00:44:10] Like what the heck, you know, that's, that's what I'm hoping for is that it will become less of a central part of our lives, even though it will still, it'll still absolutely be here. 

[00:44:20] Matt Boettger: [00:44:20] Yeah. Here's hoping for that. And we do our part wearing masks. there was one article in here that we didn't talk about. I loved it.

[00:44:27] I put it in the show notes. It's about the masks, this idea of Tokyo looking at them and Japan, of course, we're in mass, but also the idea of more silence in this space, he was called shut up. It's like when you're in, when you're in public. Yeah. Especially like the idea of a subway. Just don't talk, wear your mask.

[00:44:42] Don't talk. Whisper usual voice. you know, one person made a kind of a tongue in cheek remark. If we just didn't talk for a couple of months, we'd probably be over this or you, or at least you'd be a lot better position. So I'll put that in the show notes as well. So the model we're not going by, Steven is Kobe parties now, so we can have pool parties in the [00:45:00] summer.

[00:45:00] That's not what we're trying to say. Nope. Nope. So even though the temptation, we're not going to do that, let's keep it at Bay. Let's do our part. All right. Thanks so much, Steven. Let's end with that. If you want to, of course, support us, please leave a review. Do that. There's a link in the show notes. So check it out.

[00:45:17] Please support us as well. With $450 left to pay off, you can do that as shown us as well. Then no, check out my podcast drops last week and living the real. And if you wanna get in, get in touch with Steven S T E P H E N KSS, L E R on Twitter. Or please, please leave comments. Let us know what's going on.

[00:45:33] [email protected] was sharing with Mark and Steven. All that good stuff. And, thank you so so much. And we will see you next week. Take care. Bye bye.