Pandemic: Coronavirus Edition

Did you say "Hydroxychloroquine"? Drink!

August 05, 2020 Dr. Stephen Kissler and Matt Boettger Season 1 Episode 37
Pandemic: Coronavirus Edition
Did you say "Hydroxychloroquine"? Drink!
Pandemic: Coronavirus Edition
Did you say "Hydroxychloroquine"? Drink!
Aug 05, 2020 Season 1 Episode 37
Dr. Stephen Kissler and Matt Boettger

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Things Discussed on Episode:

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Show Notes Transcript

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

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  • See it on the podcast website here -

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

  • Give monthly (as little as $5 a month) on our Patreon Page -
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Matt dropped a new episode of Living the Real featuring a great conversation with Mark Kissler on what "real" means to him, and how he tries to live it out in his professional and personal life:

  • Subscribe/Listen to Matt's Living the Real Podcast:
  • Download Matt's visual map of his conversation with Mark here -
  • Listen to Matt's episode on building margin in your life here -

Things Discussed on Episode:

Support the show (

[00:00:00] Matt Boettger: [00:00:00] You're listening to the pandemic podcast. We equip you to live the most real life possible and the face today's crisis. My name is and I'm joined with my good friend, dr. Steven Kissler, an epidemiologist, the Harvard school of public health. And dr. Marcus Lee is not here. He's out in the hospital, running ragged, doing things.

[00:00:16] And we don't have anything from him because I think Fred to tell him that we are recording today, which is Tuesday, even though this will be put out on a Wednesday. and so we don't have any for members. Okay. Steven. 

[00:00:27] Stephen Kissler: [00:00:27] How you doing, buddy? Hey, I'm doing all right, man. How are you 

[00:00:30] Matt Boettger: [00:00:30] doing pretty well? You know, I it's just, it's August.

[00:00:33] It's what, August 4th as we're recording this and I feel exhausted. 

[00:00:36] Stephen Kissler: [00:00:36] Yeah. 

[00:00:37] Matt Boettger: [00:00:37] Summer, it's supposed to be like this type of frolicking 

[00:00:41] Stephen Kissler: [00:00:41] and, 

[00:00:41] Matt Boettger: [00:00:41] and I'm like, Oh, we're going into fall semester. And I'm like, where was the break? I'm tired. I want to take a nap all the time. Yeah, 

[00:00:50] Stephen Kissler: [00:00:50] that's right. I can relate to that feeling so much.

[00:00:53] Matt Boettger: [00:00:53] Huh? Oh yeah. But no, we're not going to nap. We're going to put another episode as to talk to you about some fun and [00:01:00] exciting things. A few things before we get started, always love reviews. You've heard it. We could use more. It helps us move in the ratings. Just get another one recently on July 22nd from rainy bird.

[00:01:10] So number one, great name, Randy Bird. Love it. She says five stars. Excellent. This is the best podcast out there on the pandemic. Thank you. Ronnie bird three hosts are intelligent and well-spoken discussions are based on science and real life experience. I'm a registered nurse. Therefore, what I most especially appreciate is that information is not dumbed down or scripted.

[00:01:28] There's very little political opinion expressed, and it's clear that the topics are well-researched not by me, but by Steven, Mark, you have the great work gentlemen Marine from Philly Marine. Thank you. Appreciate that. 

[00:01:39] Stephen Kissler: [00:01:39] Thanks. That's great. 

[00:01:40] Matt Boettger: [00:01:40] So, you know, one person that always shout out her name is Diana. If you know Diana.

[00:01:45] She was one of the first subscribers to pandemic and she's emailed us a few times. and so I just want to say Diana, you know who you are. You're one of the first ones we've emailed a couple of times. Thank you so much. The podcast you sent a recent one, let letting us know that she still listens to it.

[00:01:59] So. [00:02:00] Patrion love the support. we still need to pay off some stuff. Debbie podcast. Check it out as small as $5 a month, it can help a ton, one time gifts from PayPal Venmo, right in the show notes. And then last week we dropped another episode or I dropped an episode on living the real on my other podcast.

[00:02:16] Mark gave some awesome insight to what it means for him to live the most real life. he was pretty vulnerable, had a raw week, so I'm glad I kind of snagged him at that point in time. Check it out. They've been really that calm, described the podcast. Good stuff going on. Okay. Let's get in to the good stuff of coronavirus.

[00:02:33] So last week, Steven, I was kind of feeling this weight of like, man, we're we're, we're getting a lot of new cases. Deaths are on the rise. Things are getting nerve wracking for me. Is it just going to keep climbing up and climbing up? And then September and October is just apocalyptic moment, right? So, but now we're seeing that things are dipping.

[00:02:51] It's it's, it's a, you know, even there was in the sixties, I just woke up this morning to, in the fifties. So what, from seventies to fifties, a second straight [00:03:00] day, ABC, ABC news says, so what do you think is going on? Are we kind of getting out of this, this next big? I know there's, it's not, it's still the first wave apparently, right?

[00:03:08] We're not like having these. Are we kind of getting out of this, this crisis or is it transferring? What are you perceiving? 

[00:03:15] Stephen Kissler: [00:03:15] Oh boy. Yeah. So I think, I think what's happening is complex. So I'm definitely encouraged by the fact that like case counts are seeming to level and maybe turn back around a little bit.

[00:03:25]the thing that is giving me pause right now is looking at the test positivity, which is actually holding steady in a lot of the places where the cases were first standard rise. So looking at, California, Florida, Texas, I was, I was just looking at Florida's positivity now. And. They've dipped maybe a little bit in the last two days, but, but it's basically, it's sort of Rose and then just sort of held steady right around that, 18, 17, 18% level.

[00:03:48] And this is based on the Johns Hopkins tracker. and as you can see that the number of tests that they've done has have risen and then actually started to decline a little bit. So, so part of the, just because some of the increase that we were seeing was [00:04:00] partly driven by increased testing. Some of the decline we're seeing is also partly driven by backing off of, from testing a little bit.

[00:04:06] It seems so. So I think that that's, that's one caveat worth mentioning, although the fact that the positivity is leveling. It's a very good sign. and, and I think that there's, there's, there's definitely reason to hope that like some of the intervention measures that we've put into place, some of the places that have stopped or reversed the reopening, some of the places that have looked at, and particularly done a lot more contact tracing, done a lot of really targeted sorts of things.

[00:04:30] I mean, we knew that that was going to be what we were going to need as the epidemic moved forward was to move from these large scale sort of hugely societaly disruptive things to sort of more targeted approaches to try to stop the spread and. And I think that, that those are, those are helping for sure.

[00:04:45]and so, but that's, that's why I'm sort of taking the decline in cases that we've seen with, with a bit of a grain of salt, because, it's not, it's not totally clear that that actually reflects a true decline right now, even though it is definitely is better than going up. 

[00:05:00] [00:05:00] Matt Boettger: [00:05:00] Totally. So how do you. Now, this is again, I'm gonna ask one complex question and then give you another one, because I know some people are probably looking at the number and it's dropping and just saying, see, there's no point in taking this like seriously and doing all these things.

[00:05:16] And you're saying, well, you know, I feel there's that. Part of this drop has been contributed because certain areas and locations have taken it more seriously. Right. We've have States putting mask mask mandatories. Right. We have that in Colorado for 30 days and another place to have known the same thing.

[00:05:31] And, you know, talking with friends who see these things go down, you know, that we talked last week with Florida, that 53 hospitals were over overrun and the a hundred and forties were still okay. And it's a complex issue to talk about how this is something to be taken seriously. How is there any way we can begin to infer or know that, you know, a lot of this decreased it's probably because of, we were actually doing things or just like, Oh, well, we'll.

[00:05:56] Well write about this 10 years from now and we'll figure it all out then. 

[00:05:59] Stephen Kissler: [00:05:59] Yeah. I [00:06:00] mean, that's, that's, that's the problem, right? Cause it's so hard to attribute any, any change to any behavior that we've done in the past. Just because the, the, the way that the disease spreads can be so complex. There's so many ways that it can spread so many venues.

[00:06:14]and, and there's so much delay between when you've even gotten infected, when you might begin to show symptoms that you don't even know when, you know, even if you've been infected, you don't know where or when, or how, or if anything that you did contributed or didn't contribute to it. So, I mean, this is, these are problems that are going to be, studied by epidemiologists for years to come.

[00:06:34] For sure. Yeah. now, now that said for sure, was very solid evidence that, the non-pharmaceutical interventions that, That we've been undertaking in aggregate can do a very good job in limiting transmission. Like that's very clear. Yeah. And it's it's no, no one of them is the silver bullet. It's not masks, it's not physical distancing.

[00:06:53] It's not, you know, any one of these things alone is not enough, but it's very clear that in the aggregate, these things do. [00:07:00] Absolutely have a substantial effect on slowing down transmission. And unfortunately that's, that's about all we know about. Sorry, Scobey too right. I mean, that's, that's really painting it, you know, we know a lot more than that.

[00:07:11] Sure. Yeah. But, but that's, you know, in terms of controlling its spread, that's something that we know for sure. And there's not a lot else that we know for sure in terms of limiting its spread. And so that's, that's kinda what we're left with. So yeah. You know, and in some places you're going to have to try harder than others because people interacted differently.

[00:07:26] The age structure is different. So no, no one prescriptive process is going to work in one place the same way it's going to work in another too. And that's part of this complexity and that's part of why it's so difficult. I mean, these arguments keep a rising of like, What are we doing? Why are we doing it?

[00:07:40] And, and why does it look different here than it does in, you know, the place where my friend lives and it's, it's, it's because of all of these complexities and, and, and we're all learning on the fly, you know, I don't have the answers either, but 

[00:07:51] Matt Boettger: [00:07:51] yeah, absolutely. Is it, it gets to this other article we're kind of jumping down a couple of a couple of points, but the article is why aren't we talking more about ventilation?

[00:07:59] And, [00:08:00] you know, I think this has been maybe part of the reason why we're starting to see a decline because we're becoming more aware of where are those concentrated areas by which it really does, or it is a game changer for us, right? So March and April, and we're still in doing this at home, I mentioned this last week, they were still wiping down surfaces and we're scrubbing things and there's nothing wrong with that at all.

[00:08:18] But we're, you know, I love this article was that we're seeing such an emphasis, even in a lot of the prescriptions for when you go back to school and what you should be doing, and especially the grade schoolers and how often you should scrub down the desks and those kinds of things, and their suggestion, the Atlantic here was like, wait a minute.

[00:08:33] Should we kind of, maybe since this is, you know, something particles slash airborne, right? Should we put a greater emphasis in the sequence of. First and foremost, why don't we talk about ventilation and how we can really bring about a greater movement of air inside buildings to keep this similar to an outdoor venue, knowing that we see not so much contamination outside.

[00:08:55] So have we, is this part of the equation probably as well? Just the awareness of like [00:09:00] being outdoors more often and not being indoors and those kinds of things. 

[00:09:02] Stephen Kissler: [00:09:02] Yeah. I think that that's a big part of it. I mean, as, as we've moved through the last couple of months, it has become. More and more clear that it is, it is extended.

[00:09:13] Close proximity, gatherings, indoors that really contribute most to transmission. Again, it's not the only way that it spreads, but that seems to account for it. The majority of it. So, and what I mean by that is that if you could cut out out that route of transmission, you'd go up a very long way towards preventing epidemics, really taking off in your community.

[00:09:30]So, absolutely. I mean, I think that, that we've, we've always sort of. Knowing that ventilation was an important element. It seems to be more and more clear that like that's, that's, that's, that's really important. And that increasing ventilation to the extent that you're able is, is a really valuable thing.

[00:09:44]I think part of the reason it hasn't gained as much, Attraction is because it's, it's a much harder thing to implement. It's a lot harder to reengineer a building's HVAC system than it is to spray Clorox on a desk. Right. I would wash your hands. Yeah. And so I think that in a way we're looking for the things [00:10:00] that we can implement now and we can implement cheaply and that we know how to do.

[00:10:03] And so I think. That's partly why a lot of these other things have, have sort of gained a lot more prominence in the collective discussion. But that said, I mean, there are things you can do. You're opening, opening up windows and turning on fans and holding classes outdoors, if you can. But I know that's really difficult, but it's that kind of creativity, you know, again, remembering that it's like this, this a whole bunch of different factors working together and that ventilation is a really important one.

[00:10:25] Yeah. 

[00:10:25] Matt Boettger: [00:10:25] And I know that if my middle child went to school at this point in time and had an outdoor class, that'd be the last jam I'd ever see my child, because he'd be like sprinting someplace, frolicking into some random forest or something like that. Okay. So I'm just curious when you say ventilation, I think in like lowest common denominator is like, ah, let's put a few fans, but I mean, I mean, does that, I mean, is that just circulated inside and you're just like making the little particles go everywhere or is that enough to be like, you're just like, just.

[00:10:51] Allowing them to kind of go faster and hit other people, but it's something as simple as just fans that just blow air inside enough, or it's like, ah, we need to [00:11:00] probably have some outdoor exposure, right. 

[00:11:04] Stephen Kissler: [00:11:04] Outdoor exposure for sure. You're trying to basically reduce the concentration of viral particles in the air.

[00:11:09] Having a fan inside, depending on how big the space is, could help too, because it'll, it'll prevent, you know, the biggest risk is if you're like sitting next to somebody who's actively infectious and having a fan inside can sort of help disperse those viral particles. So the, eh, but it's, it's dangerous, right?

[00:11:23] Because it might protect the people right next to them, but it could spread it a lot further. 

[00:11:27] Matt Boettger: [00:11:27] Give it to my neighbor. I'm like, no, you're gonna say let's blow it that way. 

[00:11:30] Stephen Kissler: [00:11:30] Exactly. Right. Right. So, so you have to be a little careful with that. So I think the key really is, is ideally getting outdoor air in and indoor air out.

[00:11:38] Matt Boettger: [00:11:38] That totally reminds me of, so I grew up in a town and a small town in Gretna, Nebraska, and a shout out to anybody who might be listening as in Gretna. That'd be awesome. I doubt it, small town, but so we had back in the day when I was a young man, there was a huge cow lot Jess, across the street from our high school.

[00:11:56] And so whenever the winds would blow lunchtime would be really painful [00:12:00] because you'd have your entire inside smelling like cow stuff. So anyway, I just reminded me it was blowing. It depends. 

[00:12:07] Stephen Kissler: [00:12:07] You want to pull out the right way? Not all outdoor air is equal. I should, I should know. I used to get the cat.

[00:12:12] Matt Boettger: [00:12:12] Yeah. Yeah, totally. Oh, good. Old, good old Gretna. So it's grown up since then. Get a few other things here. I'm curious. Now you were talking about this indoor ventilation, you know, should I be, I'm curious of whether I should be going to my, my physical, because I'm, I get it with the dentist. I'm going to postpone that it's not necessarily to have a cavity, that kind of stuff.

[00:12:31] But my, my, annual physical is coming up in September and not a little nervous. I'm 42. I kinda of wanna be screened regularly just to be on the safe side. you know, should I be going and how should I be. Going and did you go? 

[00:12:41] Stephen Kissler: [00:12:41] Yeah. so I think that this, this is a place where your doctor will be able to help out a ton.

[00:12:46] And I think you can, by and large, you know, you can probably trust what they're doing and what, they're, what they say, you know, it's, Healthcare facilities are from the very beginning of the epidemic. They knew that they had a high likelihood [00:13:00] of being places where transmission should, could occur. And so they've been really on top of, you know, again, just like doubling down on their cleaning and everybody wearing masks and, you know, just making sure that, that, that there's as little possibility for transmission there as possible.

[00:13:15] So personally speaking, I I'm, I wouldn't be. As concerned about going to a doctor's office right now, just because I know it's on the front of everybody's mind, as soon as you step through those doors. that said I, so I, My time for annual physical came up. I think it was last month at some point. And at that point, my doctor's office was not doing any in person outpatient visits.

[00:13:38] So, so I didn't, I didn't go, but I, I did a, I did a telemedicine visit. So I got on zoom with my doctor, and he asked me a lot of the same questions that he does during physical. And so it was a very abbreviated thing. There was no lab work there isn't, you know, a lot of the normal things that happen during the physical, you know, you don't have that.

[00:13:57] Direct and person contact that you're, that you [00:14:00] normally get. But nevertheless, I mean, I made contact with my doctor. He saw that I was doing okay. I was able to ask him any questions that were like burning on my mind. And I think that that was really valuable. So I think for anyone who's, who's really.

[00:14:12] Anxious and worried about going into the healthcare setting, you know, first talk to your doctors, see what they've got in place there. What sorts of measures they've taken, if that's not enough for you, see if they can do telemedicine because that's better than nothing for sure. Sure. and there's been a huge rise in telemedicine over the last few months.

[00:14:27] A lot of people are really relying on it, so, and I think it's a good option for a lot of people's scenarios, so, yeah. yeah. My dentist. Isn't doing cleanings right now. So that also took a decision. 

[00:14:38] Matt Boettger: [00:14:38] No tele cleanings, 

[00:14:39] Stephen Kissler: [00:14:39] no tele cleanings. Nope. They just like play a little drill sound in your microphone.

[00:14:44] I'll give you the chills teeth whatsoever. 

[00:14:48] Matt Boettger: [00:14:48] Awesome. Oh man. Okay. Well, good. I'll check with my doctor. Even thinking about that, maybe. The doing a virtual, call, you know, another thing I want to chat about is we know, I think it was last week, we talked about this, but it's resurfaced and a [00:15:00] few of my friends circles and I dealing with how long immunity lasts.

[00:15:04] What's your, and then really comparing this to the vaccines because a lot of this I think is really old news to you, Steven, because this is part of your life. That's what you do. But, you know, I think we live out of assumptions with our doctors that are probably aren't necessarily accurate. You know, for example, when I go with the flu shot, If you get one, you know, I get one in November and I, and I get one in the following November.

[00:15:26] So my assumption is these are a year in the last, a year, a full year, and then I get a new one. I get a booster. I'm good. Right. And so then he started hearing these things and a lot of that kind of framework about the vaccines and it's, and it's the length of its effectiveness and, you know, with COVID and.

[00:15:43] Double the length of immunity. I just read another article that maybe like a three months. There's nothing. I don't know what it is. The antibodies, whatever. There's nothing left after three months or so in some cases. So two things I want to ask you first in light of the immunity, when there's nothing left two the three months, what does that mean for us?

[00:15:59] I mean, we're now [00:16:00] exposed. I should no longer see my mother in law. Who's 86 after that three months. And then how does this compare? It's the length of vaccine effective affect effectivity. 

[00:16:09] Stephen Kissler: [00:16:09] Yeah. So there's, there's a lot of really wonderful immunology tied up in those questions you just ask. So, yeah. there's right.

[00:16:16] So the immune system is, it's a pretty complex place. It's one of the most complex, I mean, frankly, I've always been intimidated by immunology because I it's like it's like central to my field. Absolutely. But like every time I try to like dive into it and really like it, there comes a time, probably every, like.

[00:16:33] Six months or so where I'm like, you know what, I'm going to learn immunology right now. And I, and I grabbed like a textbook. I look at Wikipedia pages and I'm like, I'm going to remember what the difference is between a T cell and a B cell and a, and all these, you know, like which one is where and how different.

[00:16:48] And it just like every time I like really dive into it with the best of the best of intentions and it just, it just makes my head swim. So that, that said, you know, this, this is probably something where we should talk to Mark because he's able to just like dive through [00:17:00] this and. Such a  with such clarity, but, but so speaking from giving, giving all those caveats, So one of the, one of the studies that really caused a big stir about the declining immunity, looks like they were just measuring sort of one aspect of that very complex system.

[00:17:16] And I think it was the B cell antibodies that they were, they were measuring basically how much it's circulating in your bloodstream, so that if you were to be rechallenged with virus again, if you, if somebody were to. In fact, you again, would your body sort of immediately be able to fight it off again?

[00:17:31]but there are also other pieces of the immune system. So the T cells are sort of the things that remember what you've been exposed to before I think. And so, I don't know. Right, right. So, but there's a part of your immune system that does that. Right? And that's that usually circulates in much, much, much, much, much lower concentrations, but when you get exposed to something.

[00:17:49] It locks in. It says we've seen this before. It knows exactly how to call in the reinforcement and then it, it mounts an immune response. You're able to fight off the infection and to my knowledge that. Part of the immune system [00:18:00] just wasn't measured in this study. And that's one of the crucial parts of the immune system, of course.

[00:18:05]and that, that might be one of the things that gives us longer term immunity, given vaccination. So, so I think there's still a reason to hope that both natural infection and vaccination could lead to longer term immunity than then, then some of these initial studies have suggested, So there's, I mean, and you asked an interesting question about the relationship between flu and coronavirus and is coronavirus immunity going to last for a year.

[00:18:26] And there's an interesting distinction there too, because immunity to Corona viruses and immunity to flu work very differently. So the reason are the reason we need a flu shot every year is because flu mutates. It, it changes so much from year to year that if we were, if, if the same exact flu strain was circulating next year as circulated this year, And you had gotten the vaccine or you and the vaccine was effective and, and, or you had been infected with it the year before.

[00:18:52] You'd probably be fine. You wouldn't get infected again. Okay. but flu evolves like flu is like the case study for viruses that [00:19:00] evolved. Like it just, I mean, it flew in HIV or like the things that are just like mutate, like Matt, Coronaviruses are a lot more stable. And so it's actually a factor of our immune system.

[00:19:07] In the case of Corona viruses, where we, our immune system just coronavirus has kind of just don't trigger as strong of that type of immune response. And so with all the Corona viruses that we know our immunity does seem to wane over time. Okay. So that's totally expected with this one too. So that's why we might need boosters of a vaccine.

[00:19:23] If one comes available. and it's still a big open question as to how long that immunity will last, so stay tuned. But, but as far as you know, the, the cutting edge of the field still does not know. Great. 

[00:19:35]Matt Boettger: [00:19:35] well, you know, put it in layman's terms. I, when you were talking to Steven, I thought the comparison of either like short term and longterm memory, right.

[00:19:42] When it comes to like, whatever the B cell T cell, those kinds of things, one's kind of immediate response. One's a longterm memory. Or I know there's a lot of times in my life, this is the techie, right. I love keyboard shortcuts, Dave, I'm obsessed with them. Right. But you know, it's something I'll ask you, Hey, what's a keyboard shortcut for X, Y, and Z.

[00:19:57] I'm like, I have no clue, but if I'm in front of my computer, I [00:20:00] just couldn't do it. Like if it's up there, but I, I have to reference a manual. If you actually want me to tell you what the same, same thing. So maybe this is kind of a similar reality of like, well, yeah, I can't tell you, but pull in front of a computer and trigger it for me.

[00:20:10] And I got it down. 

[00:20:11] Stephen Kissler: [00:20:11] That's right. Exactly. Exactly. 

[00:20:13] Matt Boettger: [00:20:13] Well, here's hope, here's hope that, the, the, the immunity lasts long, and the vaccine lasts longer as well. That's right. Okay. So we talked about the vaccine. We talked about immunity, we talked about ventilation. So now I want to hit this Yale epidemiologist.

[00:20:27] And I think you have a lot to say about this for qualifications and all this. I saw this a few days ago. This is like, this is not it's maddening to me, Steven. It's constant coming up and I don't know why. I'm just like, I. It's really just to become a political reality. And I wish we could stay in the scientific realm of understanding what works and what doesn't, but this Yale epidemiologist.

[00:20:47] So when you hear yell and you're hear, hear epidemiologist, you want to listen. Right? And so it says in this person, hydroxy chloroquine could save up to a hundred thousand lives. If use for [00:21:00] coronavirus. So I get this, I'm like, okay, we've been talking you and I, and Mark about how study after study is, seems to lend itself.

[00:21:07] That it's really not that useful. And here we have an Ivy league epidemiologists saying, we're wrong or they're wrong. Can you help filter out what's going on with this? 

[00:21:15] Stephen Kissler: [00:21:15] Yeah. So there's, there's a lot of really interesting things in play here. And I think, Yeah, the, yeah, the, the politicization of, of different aspects of the pandemic, including particularly the drug hydroxychloroquine is, is really remarkable because as with all of the treatments that we have available, we're still conducting research on them.

[00:21:33] And so it's, there's a. It seems like a treatment is a very simple, simple thing, right? You give somebody a treatment and they either get better or they get prevented from getting the illness. But of course there are so many issues in terms of side effects, in terms of, at what stage you give the treatment at what dose do you give the treatment, whether it's, whether it's preventative, whether it treats, you know, the downstream effects.

[00:21:53]and so. I mean, there, there are still active studies with hydroxychloroquine going on. And as of yet, [00:22:00] I, I don't know of any convincing evidence that the benefits of hydroxychloroquine outweigh the risks now that's, that's the key there. So, so one of the things that this, well, so let me take a step back.

[00:22:11] So. There's there's an element talking about sort of hydroxychloroquine and its effectiveness and that sort of thing. So, so I want always just sort of flag that now you mentioned, you know, we hear about a Yale MIT and we really want to listen. Right. So, and I think that that's, that's worth doing, and it's also worth sort of digging into these people's qualifications.

[00:22:28]and it turns out this is an epidemiologist of cancer. Who's published extensively on the risk factors contributing to cancer. But as far as I can tell, is not a specialist in infectious disease. Whatsoever. and we've seen that with various epidemiologists that a lot of very high level institutions, including Harvard, where various, they've been asked for comment because they're epidemiologists, but they might be an epidemiologist in nutrition or an epidemiologist in cancer.

[00:22:51] And that doesn't mean that they don't have anything useful to say, you know, like as epidemiologists, there's a lot that we share for sure. Sure. But there's also a lot [00:23:00] of. Particular expertise that comes from studying a specific problem in the way that infectious disease epidemiologists do. And I like I, so, Yeah, I, I would not be able to tell you much about a cancer treatment about how it works about whether it would be effective.

[00:23:16] Like I would not, like I just couldn't comment and I would, I would, I would ask, I would ask Mark. I would ask Allie my girlfriend, because she, she, she like, does it. Basic research on cancer drugs. And I know that they do stuff to disrupt tumors and that, you know, that's about it, you know? And that's, and so, and so I, I can't really comment on that.

[00:23:35] And so, but here we have someone who's, who maybe has done a lot of background research, but, but to me it seems like this is again, sort of a selective reading of. anecdotal evidence isn't necessarily taking account of the fact that, you know, maybe, maybe you could save or prevent that many deaths from giving hydroxychloroquine.

[00:23:51] You could cause many more premature deaths from heart failure because we know that's one side effect of hydroxychloroquine as well about to balance all of these things together. [00:24:00] And frankly, the, again, the, the, the evidence just isn't in and the, and the evidence that is in suggests that there's no added benefit, as far as we can tell.

[00:24:09] So, so, you know, it's. It continues to be this sort of odd political debate. And it's like, you know, I want hydroxychloroquine to work. You know, man, like I would love, I want everything to work. I want everything we've got, I just want this thing to be over, you know, I want it to be done. And, but, but it, but the problem is that if.

[00:24:29] You know, we can undermine so much trust in science and in medicine by touting things that are either unproven or frankly ineffective or actually harmful. And so we have to be really careful about this. And so, and so I think that that's my frustration is that like, it's, it's not that I don't want it to work, but I.

[00:24:46] Yeah. Part of the reason, I'm sorry, I'm holding back so much is because I want it to work so bad, but, but I don't want to be duped, you know, like it's it's so we need to, we need to know and, and we need to make sure that the, that the, [00:25:00] that the treatment isn't worse than the, than the illness that it's meant to prevent.

[00:25:04] Matt Boettger: [00:25:04] Yeah. No, I, yeah, I'm just like sometimes Steven, I just wonder, I mentioned last week, he might've conspiracy theorist or cause I mean, it's everything, everything that comes my way. I have so many friends who are touting things that are different than what we talk about on the podcast. And I, and I, and almost seeing this fight for hydroxy Kogan to actually work and you're right.

[00:25:22] Like I like I wanted to work, but my wanting it doesn't actually make it work. And that's a huge problem. And I'm just so utterly confused and like who, who would want to keep. A cure back, right? I mean, what would be the purpose now? I heard some people just as of today, I mentioned they're like, they think that after the elections of this, this, this credit bars will just be over all of a sudden, right.

[00:25:43] Cause it's all moving to move the elections towards one way. And the very next day, eldest poof disappeared. And, yeah, I have a pretty strong feeling that they're going to be. awoken to a really bad reality at this point in time. So maybe that's the reason why, but it's just, it's, it's maddening to see this political situation come in and it's already complicated [00:26:00] with trying to find the cure and then having people take sides on medicine, for a reason that we don't, I don't fully understand.

[00:26:06] So I hope that helps. It helps me to understand this better and it makes me want to be much more precise in who I ask. the answers to when it comes to this particular issue. And I encourage you guys to the same. It's not easy. you know, I'm thankful that I have an epidemiologist who actually in infectious diseases, who's a friend of mine that I'm sure not every single person has.

[00:26:26]one of those friends in a one degree separation. So, this is why you need to give this podcast to other people. We're gonna end on this. So I want to go back schools starting up, just into the university color of Boulder. It's going to be opening up. And it's going to be a, I'm assuming kind of a grand experiment.

[00:26:42] I feel so bad for the universities. just hearing what's going on on the inside and how they're trying to deal with all these complexities and how to keep things. you know, I was hearing that even RAs. those who are like that are like literally doing all their one-on-ones virtually like all their encounters with their dorms are going to be virtual just through zoom.

[00:26:59] I'm like, wow, this is [00:27:00] a whole other world. So, I mean, good news is they're taking it incredibly seriously. Right. They're doing everything they can to keep distance. but. In light of that, we hear Fowchee. We met this last week, you know, he kind of declaring that. He believes that any kid over nine years of age, transmits, Kronos, just as well as adults, you mentioned something like this last week, and then I saw another article kind of speculating.

[00:27:21] Like, you know, why, why might this be the case from zero to nine? I'll kind of throw it back to you. and, and, you know, you even looking at us an epidemiological, looking at other countries of, of why that might be the case of zero to nine, or have some how maybe not transmitting as intensely. 

[00:27:38] Stephen Kissler: [00:27:38] So as, as far as why, We still don't even begin to know my, my leading hypothesis is that they're closer to the ground.

[00:27:44] That's 

[00:27:44] Matt Boettger: [00:27:44] fine. 

[00:27:46] Stephen Kissler: [00:27:46] It's just my labor. They're smaller. Right? Right. Exactly. So, but no, so I mean, it's, it's not totally clear why, why that's the case, but it does seem that from, and, and this, this is data coming from places [00:28:00] that have opened schools in different countries, sort of a comparative epidemiological analysis.

[00:28:05] And as far as we can tell, it does seem like. young kids still can absolutely transmit COVID, but don't seem to do it at quite the same rate as older kids do. Okay. Now, part of the reason the cutoff is at age 10 is just because that's a convenient cutoff that people often use when they're sticking age groups into different bins.

[00:28:21] And so, so, so we're not really sure. I mean, it's certainly, it's a continuum too, right? There's some kind of spectrum, there's not any clear like cutoff point. and so, so, so that's all worth bearing in mind too, but it does seem like, That younger kids, the, the bulk of the evidence, which admittedly is not a ton, but the bulk of the evidence that is available does seem to suggest that that really young kids just don't transmit.

[00:28:45] Kobe does as much, as much as older kids too. But I think the important thing is that even as young as 10 or a little bit older, you absolutely can, and you absolutely can to the same extent as adults do. And I think that's the real takeaway is that, Yeah. As, as we [00:29:00] think about bringing schools back, we really need to, you know, that's, those are the age groups that we're really going to have to think about how are we going to keep those students in those kids safe?

[00:29:08] And that means both preventing transmission in the school, but that also means making sure that a transmission in the community is as low as possible. We need to do our job as an entire community to reduce cases so that the kids aren't bringing infection to school in the first place, because they got it at home or wherever else.

[00:29:22]and that's really where we need to be focusing as much as we can because schools, I mean, schools are. Are incredibly important. I would say essential services to some extent, right. And, you know, education is hugely important. And so we ought to be putting that. It's pretty incredible. Hi. And if there are other things that are vying for, you know, that we're trying to decide between, you know, if there's something that's going to make.

[00:29:46] Educating children. Like let's, let's think about it. If it's going to make educating children and the people who educate them a more dangerous prospect, like we really need to do what we can to, to help with that. and I think that that's, I think that's pretty clear [00:30:00] and you know, how we do that. There's, there's all sorts of room for argument and debate and these sorts of things.

[00:30:04] But I think that that's. That's really important and it's not, it goes beyond just sending the kids to school with masks, the responsibility lies on all of us to make sure that they're living in a safe community, 

[00:30:15] Matt Boettger: [00:30:15] like paper tests. 

[00:30:17] Stephen Kissler: [00:30:17] Yes, like that'd be, Oh my gosh. Is 

[00:30:20] Matt Boettger: [00:30:20] there any seat on that or no, 

[00:30:23] Stephen Kissler: [00:30:23] no, no. So there's been a little bit of, I think there was some kind of induce release or something by somebody at the FDA that they were starting to consider some kind of.

[00:30:32] Adjustment to the, to the levels of sensitivity or something, partly in response to some of this. So, boy, but we're, we're, we're pushing, we're trying as hard as we can to see if we can, make some moves in this way. So 

[00:30:43] Matt Boettger: [00:30:43] I hope it doesn't come as late as it becomes a stocking stuffer for me. I like it before that.

[00:30:47] Now 

[00:30:47] Stephen Kissler: [00:30:47] I know, I know. Right. Me too. 

[00:30:50] Matt Boettger: [00:30:50] Oh man. Well, you know, one quick question for weekend, you mentioned about the transmission of young kids. Now I heard this, is this correct or not correct, but it talks about the transmission of zero to nine about [00:31:00] not being that effective. It's not quite as at the rate, as someone said, it's only, it's only within those, that population of kids, but they could, they could transmit it to other people who are adults easily, or is it just in general, the transmission?

[00:31:12] Stephen Kissler: [00:31:12] It seems to be in general. I think, I think, but that's, that's a great question though. That's a, and that's a really good way of thinking about it, right? Because that takes into account how infectious they are and how susceptible to infection are they. And those are the two key components of you, of spreading.

[00:31:26] And, and I, I actually don't think we have enough data for sure. To untangle that. I do think that it seems like the secondary attack rate. So the number of people, a young kid infects is lower across age groups as far as we can tell. So it seems like they're less infectious, I think, but that's like. Yeah, whoever asks you that question.

[00:31:42] Absolutely kudos for like, thinking about that, the way an epidemiologist ought to. So those are the sorts of questions 

[00:31:48] Matt Boettger: [00:31:48] we got. Yes. That's my wife. She's right. She, she should be on this thing. She knows the questions to ask all the time. Yep. So great. Well, this has awesome, Steven. Great to have you on again.

[00:31:59] Hopefully, [00:32:00] we have no idea until he in this, whether it's streamed live on our private Facebook group, we're going to get this nailed at sometime soon. I'll figure it out. We tried a new service, but yeah, by simple donation, we can put you in the private Facebook group and get to go live with us. And once we get figured out, you can ask questions as well.

[00:32:16]but anyway, thank you guys for listening to this week's episode of pandemic. If you can leave a review, we love it. If you wanna get ahold of me or have any comments about the podcast or want to tell us what's going on and your side of the world, or the country or state [email protected] to check out my conversation with Mark.

[00:32:35] And then two weeks prior to that, in my conversation with Steven, they were really, really good, subscribe to that podcast. And I think that is it. I, we will see you all next week.