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Matt's Living the Real Podcast
Things Discussed on Episode:
Can you Rate and Give us a Review in Apple Podcasts?
Thank you to all of you who helped us reach our goal to pay off our equipment for this podcast! If you would like to still financially support us for the monthly upkeep and to help hand off some of the editing responsibilities, you can give a one-time donation or become a Patreon member for as little as $5 a month. See the links below. Thank you!
Matt's Living the Real Podcast
Things Discussed on Episode:
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 Matt Boettger and I'm joined with, Hey, Dr. Stephen Kissler epidemiologist at Harvard School of Public Health. Hey, it's good to see you, buddy. It looks like you're in a, are you in your house by the way? Are you in like in some like, like weird office?
Stephen Kissler:Same spot is always just, I got myself a yeah, a poor man standing desk, which is essentially, I've just taken the chair that I usually sit on and I've flipped it around and set it on top of my desk. So I'm not looking at you from that. I was spending way too much time sitting and so I've been trying to find creative solutions to get around that.
Matt Boettger:We need to get like a GoFundMe page for like epidemiologists of like infectious studies. So for the, like your just so we can get you all the resources necessary, we can crank out really good work and stay physically fit.
Stephen Kissler:That's right.
Matt Boettger:It's like a little, little, those little walking treadmills and those kinds of things as well.
Stephen Kissler:Yeah, yeah. Yeah. Well, we do. All right.
Matt Boettger:That's awesome. Well, it's good to see you. We're episode 50, man. We are already, it's crazy. We have 50 episodes in, we were talking about how, gosh, I just I've been kind of. just wondering when we got to episode 50, what would be like, and just had this kind of, little, little nervousness of thinking that this is going to be a little bit of an intense season. I think it really has manifested that way where it's, we're in a, we're in a tough, tough part right now. And we're just talking off the air. Not that this past week was already crazy enough, dude was just with the election and all the ups and downs and the tools and our job here is not to get into the political side of things, but we'll talk at the end about. Biden's presidency and particularly, light of his, his staff with the pandemic and his advisory committee that Stephen just let me know that he just selected some people. We'll talk about that and see what Stephen can, he can give them judging. We should, we should have like little flashcards. You can judge them. You can give it from zero to 10, whether you think they're actually good for the job or not. We'll talk about that at the end. But yesterday, I was just mentioning to, you and for the listeners I was outside or I was inside, working on some stuff and my wife was working some stuff and I heard my son just like screaming, my oldest Kieran, which when, when he screamed and cried, it's always a bad sign. the other ones will scream at, at the drop of a hat in the cry, but, but Kieran doesn't. So I ran out there as blood going down his face. I was like, Oh crap. And, so we had rushed him to the hospital, to, to the, to the children's hospital, which sucked because number one, Get into it. Number two, this is not the best time to be going to the hospital. So we try to be as perfectly safe as you could still nervous just my son. And I kept the rest of them home in the end. What I found out the story was we have a hose. That does a little stretchy hoses. So you can wrap it up really easily. It can be like 150 feet, but you can, but it's really only about 30 feet of hose and a paleo. My middle child, of course. Oh, Jude. That literally our hashtag is, Oh dude, most of the time. but he stretched it out. it was about 20 to 30 feet, to the end of the fence. And then let that sucker go and just went blazing apparently towards my, my, my son's face and just, got a deep, deep laceration on his forehead, big lump on the side of his head. so he had to get a few stitches, so that was not fun at all. So now you guys can imagine for those of you who have boys more than one, and they're young. And they don't know how to really reason through things. It's one thing to have this happen. It's the aftermath of five to seven days saying just don't play rough. Just don't play rough and don't hit his face. Don't hit his cut. So the next five to seven days are going to be just brutal of trying to get these
Stephen Kissler:boys. They're like, we need to like, get ready to hear that. That is hard.
Matt Boettger:It was hard. So it's been crazy for us. so, thoughts and prayers are welcome for us. It's just that they don't, our sons don't box, my oldest son in the face. And reopen their wound, which is really likely to happen. All right. So anyway, a few things to get talking about reviews, love them. Thank you so much. Leave them on Apple podcast that helps us to get our podcasts out and in the hands or eyes or ears of people, to get this information now that is not politically biased and just science-based with a touch of narrative and story of our own lives. patrion.com/pandemic podcast podcasts. You like to support us. Keep this going for us. it takes a lot of time energy. You can do that easily. Just go. There is a little$5 a month. It goes a long way. If you don't wanna do that, just a one-time gift, PayPal, Venmo all in the show notes. One last thing before we get going, I had Stephen's brother Mark on my live in the real podcast. Again, just a riff about one of the most fought after commodities in our lives today. Which of course I think is obvious when I say it's attention. And, just everything trying to grab our attention, manipulate our attention. So we talked about what is it, how has it being fought for and after, and how do we become masters of our own attention again? So it was a good reflection. So they've been on Mark's mind a lot lately as a doctor. And so I wanted to bring him in to check it out, going live in the real.com. You can check out the episode also in the show notes as well. Okay, so let us get going on all the stuff that's going on. First. I want to go through you, Stephen right now with we've now are reaching nearly 10 million cases in the U S we have just keep blowing our records away with cases. Now we're seeing hospitalizations, just getting out of control in certain areas, local, local areas. The first thing I want to talk to you, Stephen about is this idea of, exponential growth. You've mentioned this all the time, even through March and April, where it's exponential, it's exponential. And now we're hearing articles talk about, Hey, we're in exponential growth. So I feel like we need to just make a distinction between what I think you were talking in March and April, but the virus inherently. Just grows exponentially and then subjectively re actually experienced that right now. So maybe making that distinguish and are we really right now at a point of like experiencing the subjective grow, the, the, the exponential growth of the virus.
Stephen Kissler:Yeah. So, I mean, you're right to make the distinction between there's there's like the mathematical reality of exponential growth, which is when, over a period of time, the number of cases that you see as a constant, multiple of the number of cases that you saw in the previous period of time. So that's the definition of exponential growth right there. So basically what that means is that if this week there are. Twice as many cases as there were last week, that'd be really fast, exponential growth. Okay. if there are 1.2, two times as many cases as last week, that's still exponential growth, but it's, it's exponential growth. That's much slower. So I think in the vernacular, when we talk about exponential growth, usually what that's referring to is it just means that things are growing really, really quickly. and that's true. you know, it's like cases across the United States really are, are rising. Pretty fast. and, and it, it does actually reflect the mathematical reality of exponential growth as well. Over the last couple of weeks, we have seen cases. The case counts would probably been doubling on the order of it. They double every two weeks or so. which is, on par with the increase in cases that we saw at the beginning of the pandemic. So, in some ways that's, we are in a, in a similar, a similar scenario now, of course, a lot of other things have changed. We're doing a lot more testing so that we're able to see this exponential growth and it looks a lot more severe. then it would ha know then the, like the fact that it looks the same as it did early in the pandemic does not necessarily mean that it's. It's exactly the same as early in the pandemic, but nevertheless, it is alarming and it's going up fast. and, and like you said, it's, it's beginning to translate now into hospitalizations and very slowly, we're starting to see upticks in deaths as well. which is the same thing in the first two waves that we've seen in the U S too. so it is, it is definitely something to watch. the rise in cases that we're seeing now is, It was quick. And, and I think one of my colleagues back in the UK put it nicely, I think, which is that, in some ways we were probably doing epidemic control over the summer on what he called easy mode. which is not to say that any of this was easy, but in some senses, the, human behavior, many of us were able to spend more time outdoors. We weren't as fatigued from, from these things, you know, there, there were things that were working in our favor then potentially even the weather itself, that might have made it easier to control them than it is now. And that might be part of what's behind this rapid increase too. So, just really underscores the fact that we, we, we need to keep relying on all of the things we've learned up to this point because they, they do work, but, it. It's a case it was a rising and, and they will continue to, unless we, really turned things around.
Matt Boettger:Yep. And you were saying that every two weeks, that roughly things can double, I mean, could you, I, this is like mind-boggling to me. Cause right now we're at 126, roughly cases a day, ebbs and flows in two weeks from now to be potentially at 250,000. Cases a day now, so that that's a real potential for you, right. For that to be happening. And I just read something, I didn't read the full article and this, this goes, I think it's similar to what you said back in April, that even though we were maybe seeing 126,000 cases a day, it may be more like 500,000 cases of day. If you, if you're just, would you agree with that? I saw an article say that more than likely it's more like 500,000 cases today of all the ones that we're not actually seeing. That's how much it spreading or I think the numbers that we're seeing now is a little bit more accurate given the widespread testing of a good litmus test of what's really going on.
Stephen Kissler:So it depends what you mean by cases. So the cases that we're seeing are our cases. So actually what we're seeing is an under count of how many cases there actually are. So if we're seeing a hundred thousand, there are probably already are 175. and so, but of course not all of those are severely symptomatic. Not all of them are symptomatic at all. and so we're detecting many of those cases too. So, so even the. The counts are high. That does not necessarily mean that there's just like a ton of really severe illness out there. But that said many. I think one of my colleagues who I really, respect who've done a lot of work with is, does think that hitting the 200,000 confirmed case Mark by Thanksgiving is easily within reach. so, and that's, that's exponential growth. Yeah.
Matt Boettger:Yeah. I mean, I don't wanna, yeah. I don't wanna rip on the still time to make it a doom and gloom thing, but it is just, it's just sad. It's scary to see like, And where we're at now, where March, so many people took this so lightly and I get it because it was so local, but now just seeing the potential ramifications, and this is something it's going to sneak up so quickly on us. And like you said, in the past that if we don't do something now, and we're doing 200,000 cases, 250,000 cases a day, and the hospitals are just being over tapped, it's going to be weeks of aggressive. Measures before we see the fruit of that. And then those next few weeks are just even darker moments and just all the more the call to not like stop living your life. But again, it's, it's, it's the simple things by which we can do the dis team try to stay outside. I know, Hey, I'm in Colorado, it's cold today. So it's a snow today and it's not fun. but at least minimizing the people you're in contact with. I love what you said, Stephen. Just sorta bring it right back to the foreground. You said this maybe two months ago. And it helped a lot of people. Steve and I, we got a lot of feedback of them. Even if you're not exposed to someone. Right. And that's where you quarantee, but maybe exposed to someone who has been exposed, but not having had result. Right. That's just one tier more, and we're not trying to like, make this an infinite loop where you're just constant going through this, but just one more tier. Right. And just say, okay, in that case, just find your five to eight or so friends that you want to demarcate as the here's my little nucleus and tell those results. I mean, just these little steps can really keep this from doing what I say. I'm guessing. Doing, what we're seeing now is exponential growth right now doubling every two weeks. So we can do this. We can do together with simple measures, if we're just slightly just keeping at the forefront of mind and not necessarily not, not any way obsessing about it, but just a little bit in the forefront of mind, to the small things. There's one more thing to talk about. We talked about the spread of this, and we'll get that in just a second, about how things spread. One of our listeners had a question about that, but let's get into one more thing about this hospitalizations they're increasing, right? We see this locally. Some of them are meat or close to max capacity if maybe they are, you mentioned in weeks prior about the death, and we've seen a slower growth of the death rate, with this nearly doubling 126,000, I'm here 250. It probably said a moot point, but do we see this as a real concrete possibility of having are the death rate far surpass what we've seen in March and April, in light of what we're experiencing, if it continues to go down or, or do you, do you see some kind of some hope even in the midst of keeping that
Stephen Kissler:at Bay? Yeah, I mean, so I think that it's, it's hard to say it. And part of that is it changes, it depends a lot on how we're. Conceptualizing and measuring these hospitalizations and deaths. So I think one of the important things to bear in mind is that in the first wave of the pandemic, when we were seeing many of these cases, The problem there was that they were almost all concentrated in New York city in a very small area. So it was overburdening the healthcare system of a single city right now they're distributed broadly across the United States. No, the challenges are different because many of the places are more rural areas that have less hospital capacity as it stands. Sure. But a hundred thousand cases distributor it across the United States is very different than a hundred thousand cases centered in a specific city. And our ability to deal with that. Changes, hugely, depending on where those are concentrated as well. So while I, I, I do anticipate that going into the fall of the, the raw number of, hospitalizations and potentially deaths that we see, could very easily surpassed what we saw earlier this year. which is, you know, not a, not a good thing. It, it, there's still, there's still a distinction to be made though, too, which is that, even if it does substantially surpass that it will not necessarily mean quite the same burden on healthcare systems because they're distributed out broadly. So the real thing that we're trying to avoid are these really explosive outbreaks. In specific areas that overwhelm healthcare systems, because then that makes it so that neither the COVID patients nor anyone else can get the care that they need. And that's sort of the worst case scenario that we're trying to get around. so it's really like comparing these numbers is really difficult because we, we can, we can never it's there are so many reasons why. We can say that things now and going into the winter are worse. And I think, I think like it's true in some ways they really are worse than they were earlier this year, over the summer. But also there are other, other caveats that we need to keep in mind, which, which I think, give me some hope that we're not necessarily the it, that we'll still be able to manage a lot of this, even though things might look just like absolutely catastrophic compared to what we saw earlier.
Matt Boettger:That's great that they got this. This is why I go to bed a lot easier at night because I know you're probably waking up at three in the morning thinking I got to figure out these numbers. Right. I can just like, I'm like, I have no idea. This puts things in perspective, keeps this hope alive and understand the reality of the situation. So thank you for all that you do spread issues. Okay. That's the next thing. So you mentioned to me this morning, right? There's these minks, these crazy makes nevermind. I don't even know where they're at. I'm like, no one, I don't even, I haven't seen them make in my entire life. So there's no minks in Colorado, but so can you talk about what is going on about this mink population? Apparently getting coronavirus and people are getting pretty nervous about this. And should we rightly be nervous about where it's going
Stephen Kissler:right now? Yeah. So this is, this is a really interesting story. so humans and animals, we pass pathogens to one another all the time. and, and that's, that's where SARS COVID two came from in the first place. We don't, weren't positive exactly what all of the chains of transmission between animals and humans were, but they're very closely related viruses circulating in bats, for example, For flu, the model organism in science that we usually use to understand flu infections in humans when we can't actually infect people with flu are ferrets. which I am not a biologist, but they look an awful lot. Like it links to me. So it's not terribly surprising to me, but the immunologist, trying to talk about the mammalian biology too. yeah, so they're, they're like these, Yeah, animals that, that for whatever reason, share a lot of similarities in our, respiratory tracks that allow us to sort of understand how infection might behave in humans. So we have these mics. And, so there, there are farms basically res Minx. I'm not entirely sure what for, I think actually in many cases for their fur, which is an entirely different sort of like question as to like, should we be doing this and like, what's going on? And what's the animal rights here. So like this, this ends up spiraling out into so many different issues, but, but trying to maintain focus on the epidemiological side of things here, there've been reported outbreaks of. SARS cov two in Minx. really over the course of the pandemic, usually I've been pretty isolated, but what happened is, in Denmark, I believe they they've noticed that there was a major outbreak of SARS cov two in their mink population. and that some of the viruses that they were sequencing from these Minx, Had a couple of mutations that the scientists there and government thought might be alarming, which caused them to take the rather extreme measure of deciding to coal their entire population of minks in, in the country, like on the order of 17 million animals, which is. Pretty wild. And that really got the intention of a lot of scientists and other people. Yeah. Again, for all of these hosts of different reasons, but like, you don't make a decision like that lightly. So recently there's been more information coming about, about like, what, what is it that they actually saw? Why, why was it that they decided to take such extreme measures? and it turns out that there. In the, in the viruses that have been circulating in this population, they've seen a cluster of viruses that do have a couple of different mutations now. again, mutations are common. They happen all the time and they aren't necessarily reason for alarm. But the thing that did raise people's alarm bells was that one of the mutations was in the spike protein, which is the thing that generates immunity to SARS cov two and some in vitro experiments. So that experiments basically done in the lab, not inside animals, but they showed that this virus was not neutralized quite as well by the antibodies from people who had previously been infected with the normal wild type human SARS. COVID two virus, which suggests that, okay. If this variant got out into circulation and the human population, there's a chance that that could, Re-infect people who had been previously exposed to the coronavirus. So all of this going on now, it doesn't necessarily mean that a vaccine won't be effective because I think many of the vaccines are targeting a different part of the protein. Okay. Where this thing isn't situated. So it's, it's not, you know, necessarily game over for vaccines. Sure. But I can see why, why this was, is alarming and why, why the government there decided to take Swift decisive action to try to limit the spread of this thing. So. Let's take a step back. no, I mentioned viruses and other pathogens transmit between animals and humans all the time. one of the reasons why we want to limit that is because, As viruses evolve. they just, things just become a little bit more uncertain. And one way to speed up the process of evolution is to infect lots more organisms, basically. So the more people who are infected, the more animals were infected. Basically the more chances the virus has to mutate. And so when you have a population of 17 million Minx, then that is basically two New York city's worth of minks where you know, where the virus can spread. And so that's, that's a big deal. And the, and, and you want to try to limit that because mutations then can emerge in animals, which can then transmit back to humans. And then there's just a lot more uncertainty going on now. One of the reasons why this might be a little bit less alarming is that, so for example, some of the mutations that we observed are actually mutations that made it so that the virus could transmit better in Minx, but less, most likely it was basically a mutation that allowed it to attach more strongly. to the ACE two inhibitors in Minx, but it's unclear what exactly that might do in humans. And in many cases, in order to spread well in other animal hosts, it has to adapt in ways that make it less able to spread in humans. Not always true, but a lot of the time. That's true. So I think there are a lot of reasons to believe that, first. It's certainly not necessarily the case that these mutations cause a more severe virus nor do they cause a more transmissible virus necessarily. They may cause a virus that, that can cause re-infection and people who have already been exposed before, but that's also not entirely clear and depends a lot on how your immune system has responded to it. So basically there's, there's this there's a lot going on here. and something that, that, Scientists and governments and people are thinking a lot about from all of these different levels. Sounds very alarming because when we have crossover from animals to humans and mutations and things like that really raises a lot of alarm bells and it is something we're watching very closely. I'm not saying that it's, you know, nothing and something to be swept under the rug. Sure. But I think there are also a lot of reasons why, this is not, not the end of the world. Right. Okay.
Matt Boettger:Okay. So then I have a couple of followup questions cause I, in my layman terms, so this mutation in Minx. Presumably sit in my mind, I'll take it. Oh, was there like a human that had the mutation that was then able to give it to the MIGS? Or is it more like, is more like, did that have mutated in the context of a mink Amica population? And so the question is then keeping it from that mutation population to truck cross over into humans. You know what I'm saying? Because I was thinking, Oh, some random human that had a mutation gave it to a mink that was just right for them. And now we've got to find this one human, or we're going to be like, it's more like it probably mutated in the, in the main population to be receptive. Yeah. Okay. So we're just trying to keep it at Bay. So it doesn't crossover and there's, and, and like you said, there's like, this happens with time. There's tons, there's tons of viruses that are, that are inherent to animals that don't cross over ever. Right. So, just keeping an eye on it. Okay. That makes sense. Great. well, related to this, so would going from community spread, which we talked about community spread and going from non-community spread animals. I want to, one of our listeners, John had a question about, again, hand-washing objects. These kinds of things actually were kind of interesting questions that he had, that he wanted us to revisit. And I think it's a good time to revisit this because there were. Things we talked about and we, and I was probably me, of maybe washing on the rug a little bit, putting the gun, no big deal. It's just objects. You know, it's community spread. Maybe I'm being a little more hopeful of not having to worry. Cause I don't want to have to constantly wash my hands 5,000 times a day or be afraid of my mail. But he brought the cases of like, Hey, you know, within his local community, 50% of the cases are, are, are, are documented as community spread. What about these other 50%? And the granted there's a lot of gray area that just an undocumented community cases, but it seems to be complicated. he mentioned an article that suggested that, this virus can last the 28 days on services. Now, Stephen you've mentioned over and over before that it's not just the, the identity. Of of a virus, but it's actual viral load. So we understand the complexity of that. But then in light of that, he was saying that osterhome who is an epidemiologist, just kind of in the midst of his studies of trying to understand the minimum viral load needed to transmit it to humans is suggesting that it could be as little as a hundred virons I don't know what that means. I have no clue, but this is just, that suggests maybe something little. So this, this, maybe this kind of, desire to read. Initiate a more diligent hand-washing. So I'm gonna throw it back to you and have you read or been talking about this and to what extent is objects being re reintroduced as being a potential big threat? If not, what does this osterhome home study suggest in light of, for us to protecting ourselves?
Stephen Kissler:Yeah. So, I would say that the, the spread of COVID on surfaces is definitely possible. the, the point about washing hands is a really important one. So while I, so just speaking from personal, sort of approaches here, I it's been a very long time since I've disinfected packages or, you know, put my mail into quarantine or anything like that. because I, from all of the evidence that I've seen, it doesn't seem like those are substantial routes of transmission. and of course the longer. The time elapses between when somebody potentially sneezed on a package or something like that. And you're actually getting to, you know, every, every hour that passes basically leads to less and less viable virus on there to the point where the risk of infection is relatively low, but yeah, hands are a different thing. So, okay. So, and, and so I, I mean, I still, religiously wash my hands every time I come into the house, do it for the full 20 to 30 seconds in warm water wash, you know, up past my wrists, you know, do the full, do the full thing and, you know, it's and that's, and I think that, that for me, that makes sense because. Really what we're concerned about, not so much is, is, is not so much, like a single package or the mail or something like that. But the thing that has shown the propensity to spread COVID are high touch surfaces, things like elevator buttons, door knobs, light switches. Yeah. The things that a lot of people are touching at once because their virus can accumulate because other people have sneezed on their hands or whatever, and then touch those things and then you touch them and then it can linger on your hands for some time. And then your hands can bring it directly up to your face. Without you noticing we touch our hands or our touch, our faces and alarming number of times per day, people have sat there and actually counted the number of times people do this. It's amazing. Like this isn't an entire field of research. And, and so, and so that's, that's the issue is that hands are hands are an incredible vector for the spread of illness. and so one of the best ways we can do that is to cut off that channel, the transmission, right there. And so while, while it's possible for COVID to spread on surfaces, really the risk is touching a high touch surface. And then touching yourself. and the best way to mitigate that is by using hand sanitizer or hand washing really frequently. And especially when going from outside to inside the home. so. Yeah, that makes sense.
Matt Boettger:You know, it reminds me of that whole crazy new one wants CDC about 15 minutes. And then no, it's 15 minutes in increments, which you would say it's the same thing. It's just, it's just, we're just kind of, we're, we're kind of bringing out the nuances and a lot of the complexity of stuff, it's like probably the same thing. It's like those things, it's like the accumulation of many hands on one surface, that those things are going to be the most. ripe for transmission. So those are particularly when you're out and about, no matter what wash your hands immediately, when you get back into wherever it is. And I know when we first started back in March, we're trying to not, we were really cognizant of like, not touching and I'm like, man, if anywhere glasses. It's a whole other beast, man, especially when glasses are constant sliding down your nose, while I'm up there, I'm going to go wipe my nose or wrap them around my face or whatever you want to say. Gosh,
Stephen Kissler:it's a,
Matt Boettger:it's diff it's a difficult life. Okay. Well, that's helpful, right? I really appreciate Stephen. So let's get to a little bit more of let's talk about the vaccine. This is awesome. This is a great new Skype. You, you texted me this morning. I saw probably 15 minutes before he texted me. This is Pfizer COVID vaccine prevents it. 90% of infections in study. We would talk about this. It's a great news.
Stephen Kissler:Yeah, it is. so oftentimes one of the places that I turn to to try to understand just how skeptical or how excited I ought to be about something, is I, I mean, I have the great privilege of having a, an unintentionally, highly curated Twitter, or just because of my line of work. I, I follow many of the people who are, who are experts in these kinds of things. and so it's very easy to sort of get a quick pulse of sort of how people are feeling and thinking about this sort of thing. and people are excited, you know, it's, this is, this really is a big deal. this is a vaccine that is, the furthest along of any of the vaccines that we're aware of, in terms of phase three trials, and. If this preliminary evidence does pan out, it's more effective than we expected it to be. It's. many flu vaccines for example, are on the order of 40 to 60% effective. so 90% is a big deal. That means that fewer people would, well hopefully still the same number of people would, would get vaccinated. But, but even if there are people who don't, then that sort of lowers the bar of needing the number of people to get vaccinated. and. So there's still a lot of remaining questions. One of them is the efficacy in different age groups, as we've spoken about. One of them is still safety, so they've proven efficacy, but the trial has not proceeded for long enough to make final conclusions about the safety of it. So while it seems like it's been pretty safe up to this point, there are still a couple of weeks to go in the trial, and it's really important to carry that out, to make sure that there aren't sort of, effects that arise some weeks after getting vaccination. Another thing that is still unclear is the duration of protection that has given. So while that seems to be 90% effective in the weeks after somebody has gotten the vaccine, will it be effective for three months, six months, 10 years? Who knows? so those are still big questions to be answered. so, and the last thing is that as far as I can tell, it's unclear whether the vaccine prevents just illness. Or if it actually prevents infection. And that's a really important distinction because if it prevents illness, then a person who gets the vaccine is protected from severe illness, which is great, but it doesn't interrupt transmission at all, which is another thing that we usually vaccine use vaccines for. If it's 90% effective in blocking both illness and infection itself, then that's really big news as well, because that can then be a tool, both to protect the individual people who get it, but also the people who don't. and so a lot of questions still to be answered here, but, It's, it's very encouraging. it's really good news and, I'm hopeful.
Matt Boettger:That's great. Yeah, no, a few of the ups on this, how do you, how much time typically is needed to answer these questions? For instance, you're talking about, well, how long is this going to last? Now the obvious is we just wait for however many years we wait is how many ever years we know how long it lasts or is there like a technological advancement that allows you to speed up time in the laboratory to like, okay, or does that not exist? Is it just pretty much. Just waiting it out is our way to know there's there's no other way. That's right. Okay. So that checks that off the box. There's no, I didn't know if there's some, you know, some time machine back there you guys have, that'd be phenomenal. Right.
Stephen Kissler:We're working on it.
Matt Boettger:I'm sure you've got an article coming out on that. and then, and then the other one was, whether, infection or illness is that to this just amount of time or is there a way to do that in the context of the current studies right now to build a permanent? So you said it's only a few weeks left, so. And a few weeks of this, this particular stage, would we be able to potentially have an answer when sets three weeks or whatever is up.
Stephen Kissler:Yeah. So, and I think that many of the vaccine trials, if I'm correct, are trying to measure both of these, what we call endpoints. So they're outputs that you measure from a, from a trial. the most common endpoint is whether or not a person gets sick. and for many vaccine trials that is really the fundamental and sometimes the only end point that's measured, but, using PCR tests. So the same thing that we all get. you can measure whether there's any virus present in a person's body and in fact, how much, and so many of these trials are also testing people by PCR. After they've gotten the vaccine to see if they do have viral loads increase in decline over time. And whether there's a difference in how much virus they produce, or if they produce virus at all between the vaccine and the non-vaccine group, that'll be really important information. And that is stuff that potentially we could learn at the end of one of these trials. But it's only if the people who are running the trials had the foresight to include that in the trial, which might be a little bit hit and miss. Okay.
Matt Boettger:All right. And do you ever say it a few more weeks? Do you know, do you have a precise, like when is this, this stage supposed to end? Do you have the date for that at the end of this November or.
Stephen Kissler:I think it's of November, I, from the, articles I was reading this morning, it sounds like they need another three weeks. They anticipate, it'll be three weeks before they can get all of the safety information back. one of the other complications is that, to do these trials, you need to basically hit a certain number of people who actually do get infected in the placebo group. And that requires them to get naturally infected, complicated. And so. In some ways, right? So, so one of my colleagues put it that it, if, if there is any silver whatsoever to the fact that case counts are increasing right now, it's that vaccine trials can actually speed up a little bit because more people are likely to get infected. and so you reach those end points a little bit sooner, but that's, I, I almost hesitate to even say that because I would much rather I'd much rather be in the scenario where we have no disease and we have no idea if the vaccine is effective,
Matt Boettger:Oh, rock and hard place. Okay. and then Pfizer, I sort of just curious, is this Johnson and Johnson one that, or is this which, which one is this, or is Pfizer the actual name of the company?
Stephen Kissler:Pfizer Pfizer is the name of the company. and they've been collaborating with a group out of Germany, I think as well, who have been producing this vaccine. So this vaccine, I think we've talked about the different types of vaccines that are available. this one is, RNA based vaccine. and so there's another company that's based here in Boston called Medina, who also has a similar type of vaccine. Okay. these are interesting because. To my knowledge, these will be the first, if they become a pre-vet to these will be the first vaccines that are approved to use that technology, which is exciting. And it shows that those types of vaccines can in fact, be effective difficulty is that they require two doses and they require a pretty robust cold chain to keep them, fresh. And so that limits their applicability. So,
Matt Boettger:Yeah. Yeah. That's yeah. That's how I was getting. That's what I was getting. I was wonder if that was under that one where we still have some difficult hurdles to jump through the coldness and as well as the fact that this is one of them, you have to have a, a booster basically a couple weeks or a month after. Okay. Cause I know. Okay. So in light of the vaccine, that's immunity through vaccine natural immunity, a study came out and maybe you can speak to this a little bit. that encouraging news that, the coronavirus beauty seems to last a decent amount longer than some other studies have mentioned. So there are some studies suggesting three to four months, or at least this one is suggesting at least six months. And particularly what this study is, is, is it's hallmark, which again, this is beyond my pay grade. So I'm going back to you, Stephen is it's saying that this is a unique study in this particular coronavirus study, because it was a precise examination of the T-cell. And that that looking at this, they've noticed that after six months, this is kind of probably my own way of putting it into it. That for six months, that T-cell response to coronavirus was still very, very high encouraging. So does this, what, I don't know the distinction we've talked about this many times before, between the different types of cells, the short-term long-term cell, but it seems as though this one is a particular study, maybe on the longterm cell that hasn't been given so much love lately. And what is this? What's the hope in this.
Stephen Kissler:Yeah. So, to my knowledge now, forgive me if there are any immunologists out there, because I'm about to butcher everything in your field. So bear with me for a second and please write in and correct me, and then we'll fix it next time. Or if we get Mark on, we'll get him to correct everything too. But, so a lot of the, studies about the duration of immunity have been focusing on B cells and T cells. So B cells are the cells that are produced that, Basically were important in fighting off the virus. but to my knowledge, the B cells kind of do a lot of the heavy lifting. and so your B cell production really ramps up after an infection and then their amount declines over time. And then in many cases reaches a plateau. And for everybody that plateau the amount of concentration of these B cells that continue circulating into your blood, Varies from person to person. And so some people have more, some people have less. One important study that caused a lot of concern early on showed that this B-cell immunity really does decline pretty substantially over time. and might not linger for very long and long enough to really protect reinfection. Now, T cells are more tied up with the memory part of the immune system. Both of them are, but T-cells really, again, to my knowledge are things that provoke an immune response and they can be circulating in very low levels in the body. But as soon as they recognize an invading pathogen that they've recognized before, then they sort of Mount this huge response that follows. So, I'm not entirely sure how all of these things are measured from what you were reading off. It sounds like what they were measuring is a T-cell response. So they may have even been challenging people with Corona viruses, or fragments of the Corona virus. and, and seeing if the immune system responded to that. Whereas I think the. B-cell concentration can be measured more directly, which is part of why we got information about that a little bit. Sure. So essentially, and this, all of this is sort of creating this constellation that, aligns with a lot of research in COVID in SARS cov, two immunity that has been coming out over the last couple of weeks and months, which is essentially. really corroborating this story that B cell immunity does decline, but that T-cell immunity may well present many people and maybe enough to fight off new infections in the majority of cases. So, yeah, it seems to me like this is one more piece of evidence suggesting that that overall story is probably true. Great.
Matt Boettger:And just for the sake of the people listening, I want to be, this is all Stephen. I'm sort of regurgitate what he said before. So anybody thinking, Oh, but wait a minute, we've seen these cases come up right in quotations. If you can see me right. And left of reinfection, re-infection this doesn't make sense of what you're saying to the study. And again, Stephen put great things in perspective about a month ago of like, it's kind of like March where we were having all these infections going on and people were being hospitalized right. And left because early on. Th th it's the worst case that rise to the top and you'll even see all the other cases of infection that, that aren't being hospitalized. So, you know, over time it did it even now, but we, we initially saw really high mortality rates, but then once we got the technology involved and we see the spread and it's low risk, Oh, it's much lower than we anticipated. And same thing for this. So we're yep. You're right. We saw some people be reinfected, but it's like the second wave of the second infection. We're not even seeing probably. Right. The myriad of people who are being exposed, who are, we've been exposed, but aren't seeing any symptoms whatsoever. Right. So just wanted to put that out there as a small little reminder to those who are listening. Okay. Let's end on this, Stephen. let's talk about, we're not going to talk about the election. We're not political here, but with Biden, presumably becoming president in January. One of the things that is really appropriate for us. And this podcast is that he has adopted an advisory board or some task service or, or group of people, to deal with the pandemic. Right. So I want to pick your brain. You just saw this, this morning, you saw the advisory people. What do you think of this? These people and, yeah. W w what do you, what do you feel about the, about the team?
Stephen Kissler:Yeah, so, I I'm encouraged by it. it's so there are a couple of. Known names known to me on the list, that, are people who I trust, and people who I've looked to for guidance and, and indications of, I mentioned this sort of litmus on how I to respond to any of these people are, are, are in that community of people who in your
Matt Boettger:community.
Stephen Kissler:That's right. That's right. That's right. and, so, so I think it's, I think it's very good. I think that, there's some really interesting things I think, going on here, and you know, aside from saying like, you know, this, this is good, or this is bad, or this is who I would have picked instead. given that I'm certainly not the president, I, I think one of the things that really struck me about this is that I think the, the choices here, help us to outline the, sort of how, Biden. And particularly this team is, is conceptualizing the pandemic and what they consider to be important and what we're going to invest in. So, so I'd like to actually maybe unpick that a little bit. That's great. So, we, we brought up, dr. Alster home, Michael holster home earlier on, and he's been very, very outspoken over the course of this pandemic has been making, doing a lot of the work, sort of establishing what the long-term projections are going to be. he's really, a very well-respected epidemiologist and somebody who just knows his stuff about pandemic respiratory infections. absolutely a world expert in that. And he's, he, he's sort of representing the epidemiologist gauntlet on this. on this panel. and that's great because that's, I, if I were like, I have a short list of who I might choose for that. and I voted for you, by the way,
Matt Boettger:you can call me. And I said, look, Stephen, but then I could just, I couldn't do it. Do it.
Stephen Kissler:Go ahead. Yeah. Well that's all right. Next time, sometimes you got to turn things down. Yeah. Okay. Who else? yeah, so, so that's very good. And then just sort of looking through this, it was remarkably difficult to find a list of who is actually on this thing. So I've got marketwatch.com pulled up right
Matt Boettger:here.
Stephen Kissler:Cause you don't have to like dig that deep to figure out like who is actually on the list. But here we go. So, there was an advisory board, with dr. David Kessler, dr. Vivek Murthy, dr. Marcella Nina Smith. Who helped to convene this larger list of people. And all of these people have experienced both within academia and government and various public health institutions, responding to infection. So going down the list of the people who, just came out this morning, so we have Luciana Borio who's, Has a really interesting background here, according to this article, served as assistant commissioner commissioner for counter-terrorism policy and the director of the FDA's office for counter-terrorism and emerging threats. Okay. So what's going on here? so I think that. There's there's this sort of broader field of, existential threat. and there's this, there's an entire department at the university of Cambridge that I was really intrigued by while I was there while I was studying. and it's the center for, existential risk. Basically. And so it's this entire group of people from many different disciplines who are trying to understand basically, like what are the things that are posing an existential risk to humans. and many of those people are coming at this from different perspectives, be it counter terrorism or pandemic response, or climate change, or these different sorts of things and all of them sort of converge in this place. So. What I anticipate is that this was a person who is going to bring this vast knowledge of existential threats in general. And we'll be able to sort of place the threat of this particular pandemic in the context of all of the different threats that are posing our society, including climate, and, all sorts of other things that we talked about that are in fact related to this as well. Even if tangentially. And so I think that this is a really interesting pick because I think that that shows sort of shows a very broad focus and really wanting to focus on not only this particular threat, but also threats in general and how this fits into that broader
Matt Boettger:picture. And just to interject, because you mentioned the climate change, but I'm guessing it's even. Even all the things that are related to the pandemic itself. Cause I want to show the, the expansiveness of this, that including the impact of poverty and all these things that are going on, I'm guessing she is bringing this to the table as well, to great, a comprehensive perspective just for the people who. I know our audience or what it's kind of like preaching to the choir, so to speak. But those people who are thinking that it's just a one mask locked down one initiative only. This is a perfect example that no, it's not a one initiative. The goal is a comprehensive perspective of this issue. So continue, but that's great. That's, that's helpful.
Stephen Kissler:Yeah, it's really encouraging. So, yeah. So then just going down the list as it is here, Rick bright, American immunologist biologists, former public health officials, he was involved early on in the pandemic response, and was demoted earlier on, but is now, sounds like planning to serve here. He has been an advisor to the world health organization and department of defense. Again. so it seems like somebody who's going to be really involved in, as I said, immunology and virology. So looking at the biological scale and helping to understand sort of what's happening at the micro biological scale, is it kill Emmanuel, and oncology? This one's really interesting because last is says that he served as the chair of the department of bioethics at the clinical center of national institutes of health. So this will be really important as we're thinking about vaccine allocation and different sorts of things to have a bioethicist and expert in bioethics. involved. so wanting to make sure that that voice is heard, a tool Gawande who's, gut is a name that's very well known. and, again has. It's that I think there's a, you know, he's just really made a name for himself across health in general. And it's really good. Just sort of has this like broad perspective on, on, on, on human health and, again, bioethics and, and has been a consistent advisor to, other governmental organizations for, Both clinical and public health. so in Gunder, who's again, an expert in, tuberculosis and HIV. and this is the study of TB and HIV in South Africa was Osama Malawi, Ethiopia, and Brazil. I think this is interesting because this suggests that we might also be taking an approach, looking at many diseases, in the context of COVID-19 and then also looking at. The United States role in a global response. And how does this play into the overall global response? And so many people on the team do have really global outward facing perspectives, which is, I think good. Julia Merita, as I member. Or the American Academy of pediatrics. So I imagine looking at the specific issues that are related to your children, dr. Alster home epidemiologists, as I mentioned, Lloyd pace, executive director of the global health council and again, health services worldwide. So again, the outward reaching focus, Robert Rodriguez, who serves as professor of emergency medicine at UCF. So we know that the emergency room is one of the places where a lot of the rubber hits the road with respect to this illness, where a lot of questions about rapid testing. Sort of hit the surface and, it's, it's the first point of care for many people and it's emergency rooms that are the first places to get overwhelmed. So I think it's really good to have a representative on there for that. and then finally, I think, unless I missed someone, Eric who's SPE, who, is. has also been really involved in the HIV AIDS response, which I think is interesting here too, because, many of the people who've been proponents of rapid testing have, have likened their proposals to the sort of testing that happens for HIV AIDS. So I wonder if this might also help with some of the rapid testing approach to sort of apply some of those paradigms and the public health messaging. Yeah. Which I think will be really important. One of the big stories of HIV AIDS is, is the way in which not just the. Clinical and technological advancements happened, but how messaging changed and how public health communication happens with respect to that epidemic. So I'm really hopeful that, that this person will be able to bring in a lot of expertise about public health communication to help us sort of reach sort of a more unified front with respect to responding to the pandemic. There's a quick rundown. That's awesome. And, yeah, so lots to learn. I still have to look up a lot more about these people. So, I only know a few of them very well, but, but I think, these, these choices give us a sense for the ways in which, Biden and his team are thinking about the pandemic. and I think many of them he's hitting a lot of important points here.
Matt Boettger:That's great. well, the, the one thing that initially struck me is like, what two people at least have backgrounds, HIV and AIDS, and those kinds of things where you hit it. It's like exactly the front facing public health message. We it's, I think we talked about it before, either on or off the air, about how bad in the eighties, the messaging was initially about how to cook, how to. Gotta control HIV and AIDS and the whole condom initiative and the, and the, and the, and when it, when it came to, the commercials and how they were, shame-based kind of, and how that didn't fly very well. And so then he had to re re pitch the messaging. So just the whole narrative in the story, by which to address cause the reason why, what, you know, whatever you think about condoms, whatever the whole issue is, this idea of there was a, basically a proposed, an epidemic going on and a way to kind of confront it. And it's through messaging that fell flat. And now we find ourselves in a similar reality where we had a message, a way completely flat. In fact, it just increased suspicion and anger and outrage towards scientists and the desire to adopt public method, public health messaging. So all the more needed to be able. It's one thing to get your facts straight. It's a hub. That's another thing to actually get people to want to imbue and abide and go along with it. I mean, that's, that's. What's the point of, I mean, facts are good, but if nobody's gonna go buy it, that's an important part. So I'm really hopeful in that in a, in a promising, and don't enlightened before it ended. So, and this may be too much because you said you still need to look some stuff up if you were to kind of see right there that, that kind of diverse. Could you kind of pick out what would be the general message of the Biden presidency respond to the pandemic in light of what you're seeing there? Because the reason why is because I'm seeing, you know, I'm talking to people who think, Oh, it's going to be this like lockdown, all this stuff, it's going to be regressive the economy. and do you, do you see that in the mix of those people being, being the response?
Stephen Kissler:I think that, So from what I can tell both based on what, what Biden himself has said, and by his traces of these people, it's, it seems to me like there'll be a very balanced, approach to this and, and, and a far reaching, response that is not, not sort of myopic in, in, in only focusing on COVID. I think that's one of the criticisms that's been leveraged against. Myself and my colleagues is sort of the sense that, that we're focusing too much on just this one specific thing. And like, how can you ignore all of these other effects that lockdowns have, and that the pandemic itself has, but that are unexpected. and, and it's true. There, there is a real danger in solving one problem and then making another, you know, 10 times worse. W we're in a really difficult situation where, where there are these really, difficult dilemmas that, that are facing us. And so, from what I can tell, everything that I've seen is that, that this, this team. It seems like they have the capability and the background and seemingly the desire to take those very seriously. and so I'm hopeful. I think that, it seems to me like the, no one, no one wants to be in lockdown. and it's, it really is sort of this last resort, kind of nuclear option that is that it's sometimes necessary, I think, to, to help bring cases down. But yeah. Like we've spoken so many times before on this podcast, we're using the same word to refer to something that will look very different going forward than it did in the past, because we have so much more testing. We know where cases are. We can do them a lot more targeted. We can do them a lot shorter duration. and we have ways, ways to make they get their effects in a lot of the time. And furthermore, I mean, in a, Joe Biden has and, and others, who have spoken with respect to his response have, have talked a lot about increasing rapid testing and using these kinds of approaches to make it so that we can reopen things, but can reopen them safely. So, you know, I think that there fall into this trap of thinking that the government controls a lot more than it does. and we're only going to really be able to be able to reopen things when people have the confidence that they're going to be able to be healthy. and we've seen that in many other countries, People's behavior has not really reflected whether or not the country went into lockdown or not. really what we need to do is to address this underlying fear and concern of contagion and, and I'm hopeful, that, that this, this team and the people associated with them all. Might be able to bring some of that, some of that forward that, that there is, really, I mean, really the goal is to live happy, healthy, free life, you know, that's, that's what it seems to me like we're all after. and it's, it's clear that it's important to get this virus under control in order to achieve that. and so, so I'm really hopeful that that moving forward, we'll be able to take all of those. There's there's different factors into, into real deep consideration, and find a way forward that, that brings us through this as safely and healthily as possible.
Matt Boettger:Great way to end this. This is one of our longest ones. Thank you so much, Stephen. If you wanna get ahold of him, I guess he is just, just obsessed with Twitter apparent. I don't even know. He's like, he's got a, so go check them out. S T E P H E N K S S L E R. Hey, he may not even share his little, his little, I think like Twitter, you can share your group of, of, of like your little
Stephen Kissler:yeah, you can, yeah. You can see who I'm following.
Matt Boettger:Can you can follow
Stephen Kissler:this down the list of, yeah.
Matt Boettger:Share this, see what he's looking at as well. You won't get ahold of me, matt@livingthereal.com. If you just want to have questions, concerns a different part of the world. When I want to hear what's going on and get any updates we'd love to hear from you again, if you wanna support us patrion.com/pandemic podcast, those$5 a month. Check it all in the show notes as well as my recent episode with Mark on living the real. Okay. I think that's it. Have a wonderful and great week. We will see you next Monday. Take care and bye-bye.