What the Hanta (and Ebola) is going on ?!? Infectious Disease Discussion with Dr Ryan Westergaard

Transcript

0:26

Welcome back to Pulse Check Wisconsin, where we explore the intersection of healthcare, public health, and the issues impacting our communities every day. Today, we are very fortunate to be joined, by Dr. Ryan Westergaard, who is an infectious disease physician at the University of Wisconsin School of Medicine and Public Health. Uh, he's also co-director of the Syndemics research group and is an authority on communicable diseases here in the state of Wisconsin and throughout the country. Dr. Westergaard has spent years working at the intersection of clinical medicine, infectious disease surveillance, outbreak response, and pandemic preparedness, which we'll discuss as well. Um, today we are going to discuss the current global concerns that we have, uh, surrounding Ebola, what Wisconsinites should realistically understand about the risk here in the state, uh, as well as in the United States, and we'll explore the growing public interest surrounding hantavirus. You know, we see it in the news all the time now, uh, particularly with the Andes strain, and what clinicians and communities both should know moving forward. Ryan, thanks so much for being with us.

Speaker 2 1:30

Yeah, it's a pleasure to join you. Thanks for inviting me.

Speaker 1:32

So, you know, we, we, we, we gave you the intro there. A lot of our listeners now are hearing it, you know, wherever they go, right? So, we had Gene Hackman, who unfortunately died related to hantavirus. Uh, then you hear about this cruise ship. We, we've heard Ebola for years. You know, people are all over the place with about what they should be listening to, what they shouldn't be listening to, and you add in social media, it's the perfect recipe for anxiety and for disaster at the same time, right?

Speaker 2 1:59

Yeah, that-- you're right. We did s- we sort of received a double whammy in, in exotic-sounding viruses just in the past couple of months, and I'd say the two outbreaks are quite, are quite different. Um- Yeah they're both viruses that we actually know quite a bit about. Hantavirus is a family of viruses that, uh, is well, well-described, well-known to, to science, and we don't hear about it a lot because the, the types of hantavirus that we have in the United States, and it is in Wisconsin as well, uh, are not the one that's spreading on the cruise ship, and it actually, we don't believe is capable of spreading person to person. So hantavirus is what we call a zoonotic disease, meaning it's an, it's an animal disease that sometimes can jump over to humans. And the, the animals, the wildlife reservoir, the, the s- place where this is found in nature is, is mice and other rodents, but mostly mice. And, uh, there are some mice in, in Wisconsin that have this virus, but it's very rare that they cause infections in human. The people have to have quite, have to have a sort of intense exposure to, to rodent feces or urine. Um, it's more common in the desert southwest, where it's dry and things can get aerosolized as well. But so to put it in perspective, the hantavirus, you know, numbers that we have, uh, through our disease surveillance, I would say in a typical year, we have zero cases. Yeah. We've had two or three in the past 10 years. Most of them are people and travelers, and I, when I looked, we-- in the past five or so years, we've had one, one case of hantavirus that was transmitted to people. So that's, so, so it's some- a disease we know about, but we don't see very much. Why it's in the news, why everyone is ex- you know, is paying attention to it now is a couple things. One, anytime we hear about infections on a cruise ship, it gets people's attention because a lot of people take cruises, and we have- Mm-hmm memory of the early days of COVID and the Diamond Princess and, uh, diarrheal illness. So everyone sort of acknowledges that when you're on a cruise, you're in close quarters with each other, and, and you're s- can be sort of worried about that. So anytime there's a outbreak on a cruise, it gets people's attention in the news. And the other is that this is a, the, a hantavirus that we actually don't see in North America. It's a rare, it's a rare strain that's in, um, South, South America called the Andes virus, named after the Andes Mountains. And what it's different from The virus that we have in the US, which is called sin nombre, it's also a Spanish word, it's, uh, because it wasn't named for a long time, so without a name, uh, is that this one can spread person to person, not very effectively, but when you have people are living in close quarters and on a ship where you're sharing dining rooms and being in, in close quarters, it did. So, so this was an unusual outbreak where a lot of things lined up to cause a, an outbreak of about a dozen cases on a cruise ship, and a couple people have died. So it was, it was scary for that reason, but the important things, important public health messages are that we've had no cases in, in the United States. The, the cases occurred in people who lived in other countries. The people who were exposed on the cruise ship were all transported back and monitored closely. The people who were close contact are actually staying in a quarantine facility, and now, uh, several weeks, weeks, a couple months have gone by, and we're not seeing additional cases. So the, the, the, the threat, the, the risk, the probability that someone on the ship might still develop the infection is, is non-zero because this is a virus that has a long incubation period. But we, we, we feel like we're Pretty close to being out of the woods in terms of seeing more hantavirus cases. So we can rest easy, but this is not a threat to the health of Wisconsin.

Speaker 5:30

Yeah, and you brought up a good point there, right? 'Cause a lot of times what was focused on, uh, especially in the media, especially on social media, was the attention over that possible person-to-person transmission. Um, and you know, a lot of people have PTSD from COVID, right? Like, you know, you and I both worked- Yeah in COVID. You've had the opportunity to work internationally where there have been, uh, epidemics that have popped up, right? Uh, and so people hear that trigger word and they say, "Okay, you know, are we in the midst of another pandemic?" How significant is that risk of person-to-person transmission when you look at it as the same risk as something like a measles infection or COVID-19? Is that risk the same for hantavirus, or are we, are we in totally different ballparks?

Speaker 2 6:11

Totally different ballparks, yeah. And the two examples that you brought up are good ones because those are about as, as transmissible or as easy to catch as, as possible. Measles, we, we think of all the viruses and bacteria in the world, that, that one, you know, a person can be in a very large room, like a, a basketball stadium and s- and sneeze or cough, and someone up in the upper deck could, could catch measles if they're, if they're not immune. Hmm. So it's really just takes a very small exposure. COVID we learned, um, too late, unfortunately, that it's, it's, it's in that, that same ballpark of being highly transmissible. It spr- it spreads through the air. So those, those respiratory viruses are really easy to catch, and that's why COVID was so devastating, and that's why measles, before there was a vaccine, essentially everyone got is when, is just by, you know, living, living on planet Earth. Because when the virus is around, you know, it's, you, you generally catch it. So those are, those are on one end of the spectrum in terms of highly transmissible. There's other, other diseases that spread person to person. You know, think about things like strep throat, um, staph infections, which isn't through the air but person to person. So these are germs that are really all, all over the place, but most people don't get in-infected with them. Um, so this is, you know, there are infectious or communicable diseases that can spread person to person, but not very efficiently. You know, we wash our hands, we do, uh, we have pretty good hygiene. We don't get most infections. So that may be a middle road. The hantavirus, the Sin Nombre virus, the one we have in the US, is, is not even in that territory. Like, we, we don't think- Yeah it spreads from person to person at all. Um, and, and then the, the Andes virus, which is the, the, the, the one rare type of hantavirus that can, it's probably just a little more transmissible than that. So, so it's, um, the risk of this causing a pandemic is, is very, very low. We don't- Yeah we d- we don't even ha- we don't really need to worry about that. But it is a, a very serious infection. It can be fatal. It can cause severe pneumonia, and people who are in close contact for a long period of time c- um, are at risk. So that's, that's why this was an important one, not because it's spread easily person to person, but if it does spread person to person, can, can, can be fatal in, in a lot of cases. So, so that's why the buzzword is, like, prolonged close contact. We take it really seriously, but it's not a risk of spreading, you know, spreading quickly through a community setting. So, so that's, that's why it's really a, is a different, different ballgame altogether.

Speaker 8:47

Yeah. And you know, I, I, I will say, you put a lot of our listeners at rest there, at ease, including my mother-in-law, uh, who, who had a lot of questions- Yeah about hantavirus, uh- Yeah as you know, the cabin season is coming back up, right, with mice all around. Yeah. So, uh, but let's do this. Let's, let's, let's switch gears here, because for our listeners, uh, who may not, uh, follow infectious disease trends closely, they may be hearing now, um, public health experts weighing in right now where it seems the lens is turning, currently watching Ebola. Um- Yeah why has Ebola returned to the headlines again? We've heard it, you know, I, I remember as a kid growing up in the '90s hearing it all the time. You know, we had Outbreak, you know, the movie that came out. But now, you know, we're focusing in on it again with this, um, incident that's occurring right now, uh, overseas. What's going on?

Speaker 2 9:33

Yeah, this is a, this is a really serious and, you know, potentially catastrophic public health emergency in-- currently in, in East Africa. And so, um, Ebola is, is, um, when you think about all the viruses that it-- that infect human-- infect humans, Ebola and a family of viruses which, which cause what we call hemorrhagic fever, so fever and bleeding, um, are really some of the scariest. And, uh, I'll, I'll, I'll talk about, you know, how serious and how... You know, I don't like to use the word scary with, with patients, and I don't think it works here. But, but I think when you talk about the virus and what it can do, it's actually appropriate for Ebola. But then I'll also talk about why here in Wisconsin, here in the US, our, our risk is very low.

Speaker 10:16

Hmm.

Speaker 2 10:16

So on the one hand, there's a lot of people who are, who are suffering and gonna be really desperate because this outbreak is happening in Africa. But on the other hand, when you look at that spectrum of how, how a disease can spread, this is also a disease that doesn't spread through the air. It requires close, intimate contact of getting, you know, blood, stool o-on your hands. So healthcare workers who are taking care of very sick patients are at risk, but it's not something that spreads through the air like flu or COVID or measles, like you said. All right. So, so that's-- I think the bottom line is that it's not-- we're, we're not, um, at great risk of having Ebola in Wisconsin or, or even in the United States. But let's talk about why it's such a serious disease and why it's, um, requires a lot-- appropriately a lot of attention overseas where the outbreak is. So Ebola's what's called a, a filovirus, and just like hantavirus, it's considered a zoonotic or an animal disease. It probably lives in, uh, bats or some other animals. They haven't worked out exactly if there's one wildlife reservoir. But it's a, it's a virus that's probably been around for centuries, if not thousands of years, and it very infrequently can jump from the animal population to a human population. In communities that have close contact with animals, um, in, in, in the, in the Democratic Republic of the Congo, where there is a lot of, uh, uh, actually a lot of really beautiful wildlife and a lot of people living in close proximity with wildlife, um, that's the place where it's, it's turn-- it has tended to happen. The, the, uh, first type of Ebola virus that was i-identified was in Sudan, which is also one of the areas we're worried about now, and it's called the Sudan virus, so it's in that, that, that area of the world Now, when a, when a human does get Ebola virus, it's one of the viruses that can spread throughout the whole body. It damages the liver. It causes the blood cells to be damaged, causes high fever. And o- one of the, the reasons that we use the word hemorrhagic or, or, or, or bleeding risk is because it can affect your, your platelets and your, your blood's ability to form clots. So when people get very, very sick with Ebola, they have high fever, their liver stops working, and they're bleeding. And they can have lots of diarrhea. They can have, um, uh, uh, they can have, you know, confusion, seizures, affect the central nervous system. So, uh, the illness that it cause can be, can be very severe How it's spread, though, is it generally requires contact with one of these very sick people who are having diarrhea and bleeding. So the, the-- one of the things that you hear about that's controversial or that's, that, that's, um, that's causing some conflict or some social unrest during these outbreaks, because traditionally one of the, one of the, um, things that drove outbreaks of Ebola virus is funerals and- Mm-hmm handling dead bodies and taking care of people who are sick. So when the public health authorities, when the World Health Organization comes in, one of their priorities for stopping the Ebola virus, uh, outbreak is to make sure that they focus on safe and dignified burials, trying to help communities understand that this is really transmissible if you touch a sick person, so let's do, let's do this very, you know, with a lot of, with a lot of care. Um, traditional burial practices we need to suspend because if, if they don't involve high infection control. So this is one of the reasons that socially and culturally it's really dis- disruptive as well. So, so those, um, the fact that, that we can count the number of Ebola outbreaks, you know, in the past fifty years tells you it doesn't happen very often. Yeah. But when it happens, and when it happens in areas where there's a lot of, uh, a lot of poverty, poor sanitation, and political unrest, which is all those things characterize, uh, Democratic Republic of, of the Congo right now, um, it can, it, it can spread person to person. It can cause outbreaks. And then the other thing that, that sort of drives this is when it's-- we don't detect it, when there's no testing infrastructure, when we don't have con- we don't have the ability for public health to be in the community and tell people if they need to know, it can kinda get, get outside the box. And I think that's what's, what's so worrisome about, about this Ebola outbreak is it wasn't just in one community. If it, if it isn't just a single community, we can do the public health activity. We can get people to do contact tracing. We can give people guidance on- Right isolating. We can use the personal protective equipment. But it was probably spreading for a month or two and, and planted these little seeds or little fires in different communities, and now it's, it's, it's too hard to get to, to get around. So, so that's why it's really a, a concerning trend in, um, in East Africa right now. But I, I would say, and, you know, when I started working in, in public health, there was, you know, an Ebola outbreak going on, and I was reassured by the director of the CDC at the time saying, like, "We know how to contain this." Like- Hmm "We will contain this. We'll get it under control. It takes time. It takes a lot of resources, but we know the playbook we need to follow to, to contain this," and, and those things are happening right now. It's just, it just probably got started a little late.

Speaker 15:28

Yeah. And, and you know, for, for a lot of our listeners who aren't as familiar with you, Ryan, uh, now Ryan has the stripes. Ryan has been on the ground in Africa when there have been active outbreaks, not of Ebola, but of other viruses or disease processes as well. And so, you know, i- from, from an isolation standpoint, when he says, you know, those protocols are in place, he's lived those protocols. He's, he's, he's operated, you know, under those pretenses as well. Uh, but you know, a- as you said, the risk for Wisconsinites is relatively low at this point in time. And, you know, we know when outbreaks internationally occur, we know that those systems are in place. What systems already here in the state of Wisconsin are in place, and across the United States, uh, let's say if a, if a case was to come about, right, uh, to identify and to contain potential cases quickly?

Speaker 2 16:15

Yeah. Yeah, great question. And, and there's, there's actually quite a lot of, of, of infrastructure of systems for this. But, you know, let's, let's actually maybe go back to and, and remember h-how our experience with COVID again and, and why that was so difficult. Um, the, the issue with COVID that really helped-- you know, got us, got us behind the eight ball very quickly is that the, the virus transmits, can, can be transmitted from person before their symptom, have symptoms. Mm. Like if you catch a cold, you catch a flu, or if you catch COVID, what all those things have in common is what happens is the virus gets in your nose and your throat, starts replicating for a few days. And you don't actually start feeling bad until it gets to the certain, this certain level. But before you start feeling bad, you can sneeze and cough and, and spread the virus to others. So people without symptoms can spread respiratory viruses, and so people get on planes feeling fine and, um, and by the time they land on the other side of the, the, uh, of the ocean, they're coughing and sneezing, and that, that, that's a problem. So that was one of the things that was really challenging. So fortunately, e-Ebola virus doesn't quite work that way. It does have an incubation period, but people are generally aren't infectious until they are sh-are showing symptoms. Mm. So one thing that, that, uh... So how do we, how do we prevent people who are exposed to, to travel outside of the country to a different community? So, well, part of it is, is, is screening for symptoms at the time of travel, but there's also, um, screening for where have you been and where have you potentially been exposed. So, and there's multiple layers of this. So f-people who are in Uganda, where there have been, I think, seven cases now, and in, in DRC, where there have been over 1,000 cases, people who are leaving those countries aren't allowed to get on a plane un-unless they get their temperature checked and a s- and a s- and a s- uh, s- symptom screening. Um, as you mentioned, when I was, when I was, um, I was working in Rwanda, which is right, right actually sandwiched between those two countries of Uganda and DRC, they had a s- an outbreak of a similar virus called Marburg. And when I came home, th- uh, they actually looked at my passport, saw if, if I was on any list of having been exposed, um, took my temperature. It wouldn't let me leave until I had, I had gone through that. Mm. So there's that travel screening at the, you know, are people going to leave the country? Um- On the other side, you know, because that's, you know, the people have been traveling for a while, the CDC in the United States has a whole bran- or whole division, Division of Global Migration and, and Health, that essentially works with TSA. They have a presence in all the major airports. There's a big office at the Chicago O'Hare, and what they do is they look at who is coming on flights from every other place and seeing where they have been. And if you've-- You know, for example, if, if you flew through Uganda, if your travel plans were, were in, uh, Uganda or DRC in the past 21 days, your name, your f- comes up, you get flagged, you get s- sent over, and you get screened. And that might sound a little bit invasive, but, but, but it's actually a, you know... It's, it's, it's, it's done s- so that we can connect people to resources, um, and in these cases, the resources are your local public health department. So if someone Someone travels back from, uh, Uganda next week, and they didn't necessarily have a... They weren't, you know, around sick people, they weren't health-healthcare workers, but they were just-- they were in Kampala. The, the, the procedure would be they'd be met at the airport, they'd do a symptom screening, they'd be given some education, and then they would get on the phone and they'd call, let's say someone lives in Racine County. They said, they'd call the Racine County Health Department and say, "Hey, we've got one of your community members who was in Uga-who was in Uganda. We think they're fine, but here's our strategy. I want you to, you know, you want to to, you know, call them, you know, every day," or sometimes we, we text people or sometimes we use a, an app just to say, "Hey, if you, if you develop symptoms, even though we think it's unlikely, here's what you do." And then we activate the, you know, the, the whole, the whole process. So it's... Right now in Wisconsin, there, there are people who have traveled to Uganda and through this system, um, we think their, we think their risk is, is very, is very low, but, but because the risk is non-zero, we like to know about them. We know-we let them go and make sure that they know what they need to know, and that if they develop any symptoms, we get them evaluated in a s- you know, in a very safe setting. So those are kind of the two, the two levels, people leaving the country and people entering the country. And then what I think we do, we do pretty well in public health is that, is the communication and coordination.

Speaker 21:01

Mm.

Speaker 2 21:01

Um, so we know, you know, every, every city has a, e-every, every community in Wisconsin is under the jurisdiction of some local health department. As you mentioned, I work at the state health department, and we have communications with all of the local health officers, and we are in contact with CDC daily. We all work in the same database, so we, um, so we can keep track of people who have traveled to those areas. And, you know, in this, this day and age, you know, I said this is, this is a disease that 100 years ago only probably didn't escape these, these communities. But now because- Right people travel, it's really the, that's really the risk. So what we're... Our-- When we're talking about Ebola preparedness in, in Wisconsin, it's really focused on travel screening and knowing who's going, who might have been exposed. That's the one part. And then the other part is, well, on the off chance that someone who is traveling in those areas develops a fever First of all, if that happens, it's much more likely that they have malaria or pneumonia or something else. Right. But we want, we want this risk to be as small as possible, so but let's make sure we do the, the best kind of evaluation and make sure that people are, are isolated on the, on the off chance that they have this. So every s- every state and territory, you know, in, in North America is doing some f- some version of this right now. Y- you know, so, so we know. So this is, you know, I think it's, it's not impossible that we could have an Ebola case in the United States, and we need to be prepared as if- Mm-hmm you know, we, we might. Um, so that's why it's, it's r- which, you know, even though there are no cases or, you know, in North America right now, it's really something that public health is, is focusing on, you know, all day, every day, just because this is what it takes to make sure- Hmm that no, you know, no infected people, no virus doesn't, doesn't slip through the cracks.

Speaker 22:45

Yeah, and you know, like a lot of these are lessons from the COVID pandemic, right? A- and Ryan could probably speak to this as well, but you know, a lot of the preparedness that we have for Ebola, for any other scares, you know, we're much better prepared today than we are before the COVID-19 pandemic just because we had to, right? We had to be. We had to learn those lessons while we were building the plane, essentially flying, right? Um, and so, a lot of our listeners, uh, will, will be comforted in knowing that, there are many layers that we are working together, both as, you know, a bedside healthcare system, the state, the federal level as well as internationally, to make sure that if we have a case here, uh, that we're dealing with it appropriately, that we are informing people, that we're tracking, to mitigate, and to also know that, you know, that, that likelihood is pretty low, as compared to something like a measles or a COVID.

Speaker 2 23:34

Yeah. Yeah, absolutely. I think one of the, one of the things that, that there are many ways, you know, that we came out of, of, of COVID. It, it hurt us a lot, you know, at a community level, at a p- at a political level. It was, it was a, it, it, it was a historic, you know, public health disaster, right? All- ma- lots of bad things just in terms of the people who lost their lives and families and communities that were disrupted. You know, it was, it wa- it was really a, you know, a tra- a global tragedy. But when you think... But like, like you said, like what can we learn from that and in what ways can it make us stronger in the future? And, and, and one way that I think is very tangible way in which we are stronger that now than we were before COVID is through this data modernization initiative. So, so the d- data meaning like y- yeah, like you say, like we count, we count cases, we know where positive tests are coming from. That's, that's not a new technology, we've already done that. But our system to share those data from jurisdiction to jurisdiction, from the community, from the hospital level to the county level to the state level to the national level, um, there's been a lot of in- a lot of investment in trying to figure out how to do this in a way that's user-friendly, fast, accurate, and actionable. So, um, I think we are benefiting from the ability to share information, to visualize data. You know, the C- CDC and a lot of other, you know, academic and, you know, non-government agencies have, have gotten in the business of, of data dashboards. So you can see where is the disease, how, how much, what's changed since yesterday. Um, there's a lot more transparency about what we know about epidemics and outbreaks of diseases that we can share, and I think th- those are all lessons that we learned and resources that we built during COVID. Um, so I think, I think you're right. There's, there's, there's ways in which we're stronger that, you know, the public and, you know, your listeners can feel confident that we're, we're, we're, we're tracking the right things, you know, to try to keep the risk as low as it can, as we can.

Speaker 25:35

Absolutely. And we appreciate all that you do, uh, Dr. Westergaard. If, if there is one message that you want Wisconsinites to hear, let's say somebody's worried about, you know, anything that we discussed here today, Hanta, uh, Ebola, you know, another resurgence of another disease process that we don't even know of yet. You know, there's one thing that you want them to hear about our infectious disease preparedness, you know, about protecting our community health, what would that message be to them at this point?

Speaker 2 26:00

Yeah, it's, it's-- It might surprise you, uh, when I, when I, when I think about this question, it's, it's actually not a very sci-scientific or medical question. Mm. And it just, it comes to, it comes to, you know, trust and, and respect is, I think what, what-- the way that we need to be prepared. And w-- I, I've, I work with, you know, I work with a lot of great physicians and nurses, you know, i-in my, in my medical role, and I think everyone knows how hard our, our, our healthcare providers work. Um, I think that the, the local health d- you know, tribal health department staff, the public health nurses, the disease investigators are kind of un-unsung heroes here. Mm. So, so I think one of the things we learned from, from COVID is that this workforce, you know, the, the people keeping us safe, the epidemiologists who are doing all this work, um, you know, are, uh, you know... I, I, I have more, more respect for them than, than ever because of their, their dedication to keeping us, our communities safe and doing it in a way that really people don't, don't see. So the reason I bring this up in response to your, your question is that we, you know, our system really works when people participate, when they trust each other, and when they, you know, if they disagree, they disagree with respect and, and curiosity. Um, what we see in public health in a lot of areas, you know, particularly in the vaccines debate, is people kind of pick sides, and people argue, and, um, there's, there's a, not, not a lot of trust. But what I, what I'd like people to know is that there's some really dedicated, very smart, hardworking people working in public health in the background to try to keep us safe, and that we are here to communicate what we know and try to try our best to do this in a way that people will understand and is worthy, and is worthy of, of, of respect. And so it-- one of the things that's hard in, you know, in our society right now is, is information and misinformation. Mm-hmm. So I, I would say like, you know, pay, you know, be aware of where, where people are getting information. Understand that you're in, in your communities, there are people working to, to keep you safe. And then when people at, you know, health department and your medical field are, are, are reaching out, you know, those are the, those are the voices that we're trusting. To try to earn that trust, we wanna, you know, on, on our side, you know, through, you know, make sure that we are communicating openly and honestly and, and lifting up the best available science. 'Cause I think one of the, you know, one of the most important resources that we have for future pandemics is gonna be, you know- Collaboration and trust. I think we l- in a lot of ways, we lost a lot of that during COVID because there was- Yeah it was just so awful. There was su- such tragedy, and people were, people were hurt and angry, and things got politicized. But I think our best protection against, you know, responding well to future threats is the fact that we, you know, we, we c- we collaborate and trust and respect each other. And I think, um, you know, if we, we do that, we'll, we'll acknowledge that we have a lot of, a lot of tremendous resources to, to be prepared and to keep each other safe.

Speaker 29:01

Absolutely. And, and, you know, b- c- using platforms like this, communicating with the public, that's the whole idea. Try to give folks, an evidence base source for that information to kinda combat some of that, misinformation as well. Dr. Westgard, I wanna thank you so much for joining us here on Pulse Check Wisconsin and for helping bring clarity, to these issues that we're talking about here. These topics can sometimes, as we talked about before, become clouded in fear and misinformation, but I appreciate you doing your part. I hope to have you on again. You know, I, I, I have a feeling that, you know, we may, we may have other topics coming up in the future, but- Yeah would love to have you on again, my friend.

Speaker 2 29:37

I'd, I'd be happy to, happy to come back anytime. Thanks again for inviting me, and thanks for all the great work you do.

Speaker 29:43

Awesome. Thanks, Ryan. And thank you all for listening to Pulse Check Wisconsin. Be sure to follow us on all the social media platforms. Subscribe wherever you get your podcasts. Uh, thanks so much.