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Matt is getting ready to drop a new episode on Living the Real on the surprising importance of Maintenance in your life:
Things Discussed on Episode:
We offer transcription now! Caution, it is AI transcription so please excuse AI errors.
[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 faces of these crises. My name is Matt and I'm joined with my good friends, dr. Steven Kissler and epidemiologist from the Harvard school of public health, as if you'd probably didn't know by now. And dr.
[00:00:14] Mark Kissler doctor at the university of Colorado hospital. These are not new people. Hey guys, good to see you two times in a row. This is awesome. And we might, we just might get a third streak, right? It is possible. Or the buzzer.
[00:00:28] Mark Kissler: [00:00:28] Yeah. Yeah. It's got to go guys. Good, good. Hanging in there. We were just talking.
[00:00:33] We were, we, sent, we're sending our kids back to school this week. So there's a lot of, it's just a lot of craziness around that. So that's been the big, big news in our house.
[00:00:42]Matt Boettger: [00:00:42] What's a, what's been crazy. Talk about it. How are you guys adjusting?
[00:00:46] Mark Kissler: [00:00:46] I'm good so far. I, you know, I think it's good. yeah, a couple of them, one of them was just super excited to get back and start to see people again.
[00:00:54]you know, we've been, we've, we've opened up a little bit. We've been seeing some friends and, you know, in smaller [00:01:00] settings and I like, I've gone to the gym and, you know, and worked out with the mask on a couple of times, you know, and as our case rates have gone down over the last few weeks, but globally we're, we've, you know, we're still pretty.
[00:01:11] Pretty cautious and kind of where he, especially since I'm working in the hospital. and, the number of just the sheer number of contacts that happen because of school, you know, is like exponentially higher than we have had any, you know, any in the last six months. And even with me going to work and like, and even engaging in kind of some of our normal, you know, normal activities and things like that, you know, in a distanced manner, this is just a whole new.
[00:01:36] Whole new thing. and so then, you know, just the number of number of kids who are in contact and things like that. And I'm happy. I'm happy for the kids to be engaged, excited, and getting back, and, and hopeful that, you know, I think their school is doing a really excellent job so far about doing that safely, but it's crazy, you know, it's always crazy, no matter what.
[00:01:56] Matt Boettger: [00:01:56] How, you know, I'm curious, how are they doing it safely? Like, what's, what are a couple of things that [00:02:00] they're like? I mean, I'm sure every school is different, but when you look at them, you're saying, Hey, they're doing a great job. What, what comes to mind when they're like
[00:02:05] Mark Kissler: [00:02:05] doing a great job? I think so they've reduced the class sizes, and they've, they have some online, only options available, the, and are working to make kind of a more robust online curriculum in anticipation of.
[00:02:18] Possibly shutting down again this fall at some point, you know, I think that's on everybody's mind. all the kids were wearing masks at school. but it's, it's, it's, it's not like, you know, they're not in plastic desks and like little cubbies all day long. They're able to move around the room and do things like that, which feels, you know, healthy for the kids to not be kind of isolated in this tiny.
[00:02:40] Cubby hole all day. but at the same time, they're doing kind of the common sense things about like wearing a mask. They take their temperature before they go into school every day. nobody comes to school if they're sick and there's like a waiting period. If they have a fever for several days after the fever where they can't come in and, you know, even a cuff or runny nose, you're not supposed to come to school.
[00:02:58] So just a lot [00:03:00] stricter and kind of monitoring. And again, the goal seems to be. To prevent sort of a super spreading event or like a big outbreak, and to tolerate a certain risk of transmission, you know, for the sake of, you know, weighing those things. so it'd be interesting. They've done a great job communicating and stuff too.
[00:03:18] So that's always helpful. I mean, I think, yeah, if there's one thing that's made a difference, this whole pandemic has been quality of communication. It's it's, it's stunning to me how confusing. It is for everybody. Yeah. Like it's just really hard for anybody to figure out where to get good information.
[00:03:38] You still, you know, it's really hard to leave it.
[00:03:41] Matt Boettger: [00:03:41] Yeah. I, I it's. Okay. I'm glad I waited this long to go back to work. But I feel like I could have been a better ally to similar people on the podcast. I went to bed if I went to work earlier, because I feel like it's night and day radically. I mean, because it's one thing to cerebrally, talk about the pie, the pandemic and how it infects you.
[00:03:59]but [00:04:00] now we're, you know, I think we talked about last week. We're just trying to figure out how to do something and we're just doing the searches across the board and we can't find a consistent material to even know how or what we should abide by. And so then that's a big hurdle. It's just been hard for us.
[00:04:13] I mean, just, We're on, we're on the university of Colorado. So we're dealing with a plethora of students. I don't live what we call the Hill. I live out here, boondock called Erie. so I live out in the middle of nowhere. but I, I have friends who live on the Hill and just last weekend, like it's just a constant ranger, right?
[00:04:30] Just loud, obnoxious people everywhere. the whole Hill Hill is just occupied. and so we see this going straight into some of the stuff and how it relates to me. We're seeing university of North Carolina being shut down already after one week. One week of classes, we see Michigan state, we see Notre Dame yesterday.
[00:04:50] We're starting to drop like flies guys. And we're like, we're not even a week. I'm like, what is going on? Did we not have the foresight to realize that we're in endemic? And that may be [00:05:00] just maybe 18 year olds. In 19 year olds may not be the most cautious imprudent individuals. Hey, if you're that, that's awesome.
[00:05:09] But just in general, in my experience of 13 years, they have a tendency not to be that. And so I'm glad they got their deposits, the university at the universities. I don't know what to expect. It's hard for us. We, you know, we're, we're, you know, there's students don't want to wear it, want to wear masks.
[00:05:26] There's even a difference of opinions in the context of her own work and how to navigate this. And it's just really, really excruciating painful.
[00:05:35] Mark Kissler: [00:05:35] Yeah. Yeah. It's interesting. You know, I think there's, there's that other layer of, just the social dynamics that happen when you actually go back to work or go back to school or, you know, see people where all of a sudden.
[00:05:48] No matter what your kind of framework is from an intellectual standpoint and what your sense of like, okay, you know, these are the common sense measures that don't create too big of an impact on life, but still [00:06:00] address spread, you know, then, then you go into a social situation in which everybody's come to a slightly different conclusion about those.
[00:06:07] Yeah. And it's super tough. There's just so many implicit ways that we, that we just get along with each other, you know, by. and, and it's, you know, it's, they're good things in some ways, you know, we take cues from the people around us. We adjust our behavior in these subtle ways to kind of try and fit in and, you know, and pick up all the subtle social cues and stuff around.
[00:06:25]but then it creates this whole other level of confusion and complexity when we're doing all these new. Weird things, you know, all of a sudden. and, yeah, again, yeah. We talked a lot about COVID fatigue last week. so we don't want to get COVID fatigue, fatigue, you know, talking about it too
[00:06:41] Matt Boettger: [00:06:41] much,
[00:06:42] Mark Kissler: [00:06:42] but still there's a sense that really plays.
[00:06:46] Oh yeah. I can get real deep we can go soon. Anyway. That's it's just a, it's tough. It's tough.
[00:06:55] Matt Boettger: [00:06:55] Yes. Hey, and speaking of which in this time we need friends, we need [00:07:00] friends. We need people. Like I have a few, I have Steven and Mark, which are indispensable. And again, I say this over and over. I can't wait to physically hang out with them someday.
[00:07:07] It'll be great celebration. They're like, sometimes I feel like my only two friends, I do have a couple, well, other ones here and there, but here's the great news guys. We had a number of reviews come in. They were awesome. Last week. I don't know what it was. I don't know if it was Mark and Steven's charm. I don't know what it was, but we got a lot.
[00:07:24] I'm so thankful for these reviews, but we had one here from mercy Brown, and this is going to be my third friend. Apparently this Britt says after listening to pandemic for at least five months. So first of all, thank you for all you on that one with itself. That's pretty, pretty phenomenal. I consider myself one of the guys.
[00:07:41] Right. Every week, Matt, Mark, and Steve, and unpack the recent events and news reading. COVID-19 I'm digesting the news along with them. When it comes to coronavirus. I have three here's a trust. Check this out guys. Dr. Fowchee. Matt Mark and Steven number two. We're right next to fetch,
[00:07:58] Mark Kissler: [00:07:58] you know, my favorite, my [00:08:00] favorite thing about this post is that they, that the doctor Pat she's put in the right place and like, like, I would feel like we're doing something wrong.
[00:08:07] If we were first.
[00:08:09] Matt Boettger: [00:08:09] Yeah. It's like, this is
[00:08:11] Mark Kissler: [00:08:11] good. This is good scientific communication. You know, we're like we're coming in well below the national experts from the list, you know, inappropriately that's that's. That's perfect. That's exactly what
[00:08:26] Matt Boettger: [00:08:26] normally in the Olympics, I hear statistically that like the bronze medal is the worst to get, right.
[00:08:31] It's like, you might as well get the silver medal because you know, bronze, but here. I'm ecstatic
[00:08:37] Mark Kissler: [00:08:37] for the bronze, just
[00:08:38] Matt Boettger: [00:08:38] ecstatic. So three, anyone who follows a pandemic podcast, look at that. We have a community, anybody who follows it and then fourth people, I mostly don't listen to.
[00:08:50] Hey, Lisa, please. We didn't run head to head with them. That would have been a bad one.
[00:08:56] Mark Kissler: [00:08:56] Such a falling off. There was a little,
[00:08:58] Matt Boettger: [00:08:58] yeah. Yeah. Big [00:09:00] precipice. You want thoughtful and measured nonpolitical perspectives on the pandemic and information that will allow you to make your own smart decisions. You're in the right spot.
[00:09:09] Somebody more Erica . Thank you for yours. A Ruthie Al who actually sent an email as well. And about a question, thank you for all of your reviews. Keep them coming. It helps us to get this more into other hands. I do think. Unbiasedly. Okay. I'm bias. We have the best podcast on, on COVID-19. Yeah, I, I, it's all I do.
[00:09:31] I sleep with it. It's my meditation at night. It's what
[00:09:34] Mark Kissler: [00:09:34] I do
[00:09:36] Matt Boettger: [00:09:36] have nightmares for three nightmares, but it's for the it's for the sake of the community, right. It's for a, for a greater cause. So I'm so thankful. I do think we're the best. I think Mark and Steven provides such as sober analysis. Both of them together have constantly nailed on the head where we're at, where we're going, because they take the complexities and allow it to be just that.
[00:09:56] So finally, the people share this podcast, I'm the talking head, [00:10:00] I'm the one that's coming fuse and they helped bring sobriety perspective and clarity into my life and into yours. So thank you. And if you want to help us more than just listening. Patrion.com/pandemic podcast. It is helpful. We have a lot to build a pay off.
[00:10:14] I really appreciate for those who are continuing, donating as little as $5 a month can help tremendously. If you don't do that just one time, donation, PayPal, Venmo, all in the show notes. All right, let's get into a lot of stuff that we've got to talk about. There's a hand. We already talked about UNC chapel, Michigan state.
[00:10:32] I don't know what's going to happen next week. We're having bets. Xeu how long we're going to last. I missed, they thought a month, month and a half. Now I'm on the order of weeks. Just an FYI. I couldn't believe that you guys, like a month ago at sea, you, it was all about the coming back. They're going to have classes.
[00:10:47] They're going to be precautious. They're going do temperatures or do mass. I heard this whole form and they get here and I'm talking to all these students and I could only find one student. One who actually is going to class only one [00:11:00] time a week. Everyone else is online remote. I'm like, wow. That's, that's fascinating that they got here and probably over 90%, aren't going to class.
[00:11:10] Mark Kissler: [00:11:10] Yeah. That's so interesting. I wonder what the, I don't know what that means. You know, I don't know what that indicates necessarily if it's, you know, in an abundance of caution or if they feel like they can learn better that way or it's more convenient or what, I, you know, it's, it's an interesting phenomenon.
[00:11:23] It'd be interesting to just kind of continue to get a pulse on what's going on there. You know,
[00:11:28] Matt Boettger: [00:11:28] you know, I kind of get what they're trying to do. I mean, yeah. I could do the conspiracy theory way, which I just want to get deposits so they can fund their university. Or I think it's a little complicated where it looks like they're doing something different this year and this may be a moot point there.
[00:11:42] They're putting people in dorms, according to their majors. So they're all kind like a unit and they have class together. So that gets into the unit. So they go in and talk together on the same floor. So I think that's what the EDS were trying to accomplish. And I think that's a noble thing they're trying to do now in reality, are those little, little, 18 year olds are [00:12:00] gonna escape their little quarantine and run over to the next one and like talk to them.
[00:12:02] I'm guessing. So, so the idea ideologically, great idea. Yeah, no practically we're going to see in the next year, three weeks was probably going to unfold. Okay. So let's talk about the first big thing. I want to talk about flu shots, right? It's now it's, it's, we're reaching the end of August. September is, is rising, which means that it's already on the forefront of my mind.
[00:12:23] Mark. Before we started, you already hit a big thing. It was already in my mind were when should I get my flu shot? And how is this going to impact COVID-19 because I'm thinking in my mind, Steven, you were talking about this as well. Like I might get it now before there's too many, too many cases. I'm gonna run over to my doctor.
[00:12:39] Get it now. And then be safe versus waiting till October where there may be. There could be this huge spike and now I'm more vulnerable. So I want to say two questions. You guys, how do you, she flew impacting COVID particularly you Mark in the hospitals. I mean the flu in the hospitals with COVID-19 and Steven, I would also talk to you about when is the best time that I should [00:13:00] be taking my flu shot.
[00:13:01]Mark Kissler: [00:13:01] Yeah. You know, I think Mark, you had a gun who knows, you know, we'll see some, some flu seasons are better than others. and you know, it always. It's one of those things that's really difficult to predict. and so, you know, we'll just kind of start to see as things unfold. I do think as we've talked about a lot of the same, social justice, you know, it's funny, it just strikes me that we were talking about the flu when we started all this too, that we were, we were talking about.
[00:13:27] Yeah, back in March, you know, the tail end of the last flu season, that a lot of the same social distancing measures, hand-washing things like that are going to be effective as well against the flu, you know, as any respiratory virus breads. and, you know, here we are, again, kind of at the very, very beginning end of the day next, flu season.
[00:13:47]So I think we'll see, I think that, The dynamics of spreader or are slightly different with COVID and kind of the way that we have been interacting or ANCOVA does, it's just a different thing. And it's important to just emphasize that it's, [00:14:00] it is a different thing and we need to kind of treat it in a different way.
[00:14:03] And I do anticipate that we'll see a spike in flu cases as we often do in the, in the fall. I don't. Yeah, no, we don't usually get to the point where, where the flu is overwhelming our systems, you know, that's not really what. Is usually expected. And I think that there's going to be such a heightened awareness this year with any type of respiratory symptoms, and a lot of the early stuff, you know, and a lot of the symptoms in general kind of overlap between the two.
[00:14:27]and so I think that there'll just be such a heightened awareness that hopefully that'll mitigate. Some of the flu season, just because we're paying attention to covert stuff. so
[00:14:37] Matt Boettger: [00:14:37] we'll see. And I just, I just want to Mark, Mark that right now. I guess pun intended says you're the one talking, but like Mark, I'm going to Mark this as being, I really feel as if this is going to be the seed of another conspiracy in about three months, it's just going to happen.
[00:14:51]Like I like flu is going to maybe not, it could be, it may not be nearly as, as big, right. I just, it's going to be. Another reason to [00:15:00] somehow
[00:15:01]Mark Kissler: [00:15:01] this crusher. Yeah. I'm sure. There's, it's interesting. Just the ways. it at a certain point that anything, you know, any novel can be turned and twisted into a narrative, of suspicion.
[00:15:14]and it's, you know, it's very hard, I think, to weed through all of what's happening, and just try and be, to feel really grounded and, and not, you know, not to whip up the panic, not to whip up, you know, a sense of like overblown. Fear at the same time, but, but it's super tough and we'll probably see, I'm sure there'll be a lot of skepticism about the flu and flu vaccination and things.
[00:15:38] And that's just kinda what, what I expect.
[00:15:40] Matt Boettger: [00:15:40] Yeah. And before I get it to Steven, I just want to also footnote this when I'm teaching the students this year, the biggest theme this year that I've got from you guys, particularly, right. And this is idea that I want them to know that when they encounter or talk to someone else.
[00:15:54] And they, and they disagree with them or whatever it is. The first thing they need to tell themselves is more than likely [00:16:00] this is more complicated than I presume or they presume, right. I really want them to stop trying to bite down over simplify things, to actually engage complexity and assume things are more complicated and arrest in the okay.
[00:16:12] That you can still bite down on things and allow things to be complicated. However, we unfold all that together as a, as, as, as a group, but we've got to maintain that because we've seen the result of over-simplification and boiling things down and just toss. In other words,
[00:16:24] Mark Kissler: [00:16:24] So I liked that. I liked that. I think there's so much to learn right now that we're all learning together about, how do we come to a common understanding?
[00:16:32]how do we deal with, you know, different types of evidence and how do we deal with fundamental misunderstandings and differences of opinions? These, this is like, if the, you know, w this is the meta curriculum of the pandemic, and I hope that we're taking good notes.
[00:16:47]Matt Boettger: [00:16:47] Yep. Absolutely.
[00:16:49] Stephen Kissler: [00:16:49] Okay, Steve, again,
[00:16:51] Matt Boettger: [00:16:51] I totally
[00:16:53] Mark Kissler: [00:16:53] we're back.
[00:16:54] We're back.
[00:16:55] Matt Boettger: [00:16:55] We're back
[00:16:56] Mark Kissler: [00:16:56] in mental. See if I can do that one more time. So stay tuned by the other [00:17:00] podcast. There will be one more comment.
[00:17:02]Matt Boettger: [00:17:02] Oh, we just need to have like a, like, for those of you are watching, I think the one person, put a bunch of like helium balloons behind you just to reflect this beautiful, like, you know, the loftiness of your over your thoughts, Steven.
[00:17:12] Yeah. Talk to us about a win and stuff, and maybe your future research coming up here soon. So when we get a flu shot and what are you going to be, we'll be looking to, to when it comes to flu and COVID-19 in the future.
[00:17:26] Stephen Kissler: [00:17:26] Yeah, so definitely like depending on the flu season, a very severe flu season can, can definitely stress hospitals, especially, you know, urgent care and these sorts of things.
[00:17:37] And so I think the biggest concern is just, you know, with the two of these coinciding. You know, it's fluid just sort of raises restricts capacity a little bit. And, and it's really like hospital capacity and healthcare capacity that we're, we're really, concerned about. Like, that's one of the chief concerns here.
[00:17:54] So, so that's one of the big reasons to think about, to, well, to get a flu vaccine. you were talking [00:18:00] about the timing of the vaccine. Like, should I get it now? Should I get it later? Does it matter? and so. I want to say first that the most important thing is that you get a flu vaccine. I mean, that, that's it, you know, and if you can get it now do it.
[00:18:13] There is some evidence that, that basically the protection of the vaccine can decline some overtime. And so, Flu season usually tends to run somewhere from around October to around February, March time ish. so you'll probably want to get it before October. there could be some benefit in like waiting a little bit, and getting it a little bit closer to October then getting it right now when it first comes available, because that might sort of help sort of help that protection bridge a little bit more into the winter.
[00:18:42]but again, the most important thing is to just get it from my perspective, One of the other things that I've been thinking about. I haven't run this by anybody yet, so it could be absolutely ridiculous fit. So you guys are the trials,
[00:18:55] Matt Boettger: [00:18:55] man. You hear hearing the hearing this first you're hearing today
[00:18:58] Stephen Kissler: [00:18:58] first.
[00:18:58] Yeah. Yeah. So, [00:19:00] right. So one of the biggest issues with, with COVID transmission is that it seems to be very transmissible, maybe even most transmissible, right before you start showing symptoms. And so. That's when people are doing a lot of spreading is a day or two before they know that they've actually gotten it.
[00:19:16] Right. And we also know that, as the CDC often puts it around the flu season, that coughs and sneezes spread diseases. Right. That's the, that's the whole tagline.
[00:19:24] Matt Boettger: [00:19:24] Oh, I never catch it. That's really cute. Yeah. Yeah. I'd actually like to live there. It's good.
[00:19:29] Stephen Kissler: [00:19:29] Okay, well, I've got another one coming for you in a second.
[00:19:32] So get ready. So, so the, the problem here is that, so of course COVID and flew spread in very similar ways, right? So they spread through a largely, probably droplets and potentially contaminated surfaces. There's the question about aerosols, whatever, but either way the respiratory pathogens spread through.
[00:19:51] Direct contact. And so I do think that there's, there's a good chance that COVID and flu will spread together a lot. And that oftentimes people will be coinfected with [00:20:00] both, through the same sort of transmission events. Now that also poses a problem because, the incubation period for flu, the amount of time that it takes for you to start developing symptoms is on the order of one to four days.
[00:20:12] And that sits right in that asymptomatic period for COVID. And so you could actually start sneezing and coughing. Due to flu while you have COVID, which might actually help covert to spread because you have a co-infection with flu. So, wow. I'm calling this the sneezing for a different reason hypothesis.
[00:20:29]sorry
[00:20:30] Matt Boettger: [00:20:30] is
[00:20:30] Stephen Kissler: [00:20:30] brilliant. So yeah, so that's something that, and I don't know, like if that will actually like play a role in transmission, but, but that's the idea is that you could be. Yeah, coughing and spluttering and these sorts of things for, for allergies, for flu, for something else or other upper respiratory illnesses that are very common in the winter that could actually COVID could almost hitch a ride on those other things.
[00:20:51]in a way that over the summer, when those things weren't really much of an issue, they were, they were asymptomatic and not helping it to spread. So that's another reason to think about getting the flu shot because you could, [00:21:00] the flu shot could actually help you. Could help prevent COVID from spreading.
[00:21:04] Does that make sense? Yeah, so, I don't know, to what extent that will actually be important to the population scale. That's something we might start looking at, but. That's another, another plug for the flu vaccine.
[00:21:13] Matt Boettger: [00:21:13] All right. I love it. And, and just a PSA, Steven is not taking commissions from the vaccine, the spread, just, just for some weird way, whatever.
[00:21:22] There's no money for this. He actually cares about people and it's really strange, but Hey, it's we have him on, so, okay. but I do. Can I play devil's advocate for a second? Alright, so. Would it, could it also help because if you're asymptomatic before you get COVID, when you're like how much highly, but yet you get flu symptoms before that you start seizing.
[00:21:43] You may not go anywhere because you got the sneeze. During the ACE, the medic period. So you stay home cause we're already hypersensitive, right? I'm not trying to say don't get the vaccine. You want to get the vaccine. But if for some odd reason you get the sniffles and he starts sneezing during that, chances are, you might just stay [00:22:00] home.
[00:22:00] Stephen Kissler: [00:22:00] Yep. Yep.
[00:22:01] Mark Kissler: [00:22:01] Possibly I think both of those, both conjectures are operating very much on the level of like high conjecture about what could pop. Possibly happen. And so I think like the most, like, I think the, the most likely cases and what we offer, you know, I often think about as usually if you get sick, it's one thing that's getting you sick.
[00:22:19] And I wouldn't expect, you know, unless we're seeing massive rates of co-infection. That that's going to really change meaningfully change the dynamics. So I think we have to be cautious about, you know, especially in a, yeah, in an environment in which there's so much suspicion about experts anyway. And yeah, like I think we have to kind of be a little bit.
[00:22:41]really, really highly precise in what we're advocating for and very consistent in the communication, just because there's already so much suspicion about what's being said by scientists and epidemiologists. So I think , that would be my only feedback in terms of, I think you're probably both of you are right.
[00:22:57] There's like yes, either of those scenarios can have, [00:23:00] and then the question is so what's, so, so what's most useful and representative of the truth. that we can communicate in a clear and consistent way. And I think that that to me is the big key, to not confuse the messaging.
[00:23:13]Stephen Kissler: [00:23:13] Right. Right. And, and regardless of either of these, the thing that we mentioned first, which is going to be by far orders of magnitude, the most important thing about lowering strain on hospitals stands.
[00:23:24] And so I think that's by far the most important reason, these either of these will just be small correctives on that, I think.
[00:23:29] Mark Kissler: [00:23:29] Sure. Yeah.
[00:23:30] Matt Boettger: [00:23:30] Great. I love it. Okay. So the next thing I want to talk about is this long haulers concept. I've never heard of the concept. I've never heard of the term, right? This was the first week I've heard about.
[00:23:40] Now. I've heard of the concept of people having like the side effects or I'm just wrestling with COVID symptoms for months on end after the initial infection. In fact, I know someone who I just. I met with last week whose daughter lives in New York, New York was one of the people who got infected during that really dark time.
[00:23:59][00:24:00] back in March and in end of July was still having a tough time breathing, having chest squeezes. And, just now as of August starting to come out of it. So that was my first, like my personal encounter with this. And then I just read this article this morning and hearing that there's a pretty decent population of these people, about these long haulers to deal with complexities.
[00:24:19]What, you know, what's going on with this? Have you seen this Mark people coming back in with, with after like a month or two? And what does this say about, about COVID?
[00:24:29]Mark Kissler: [00:24:29] you know, I think so I've, I've heard of this phenomenon and it's been getting more and more attention as the weeks go on. and I've heard also anecdotally of, you know, someone.
[00:24:40] Who had COVID and has had longstanding symptoms, especially shortness of breath with exertion, and kind of a chronic fatigue type picture. and just this sort of a malaise that just lasts for weeks and weeks and weeks beyond what you would expect. Yeah. I think this is, there's enough. Reports of this, that we need to pay attention to it and listen to [00:25:00] it and wonder what's going on there.
[00:25:01] I don't know if we have a clear physiologic mechanism, that's all been worked out about like what exactly is going on in the body. And also think that it's important to recognize, and this is not in any way to, to dismiss symptoms, or anything like that. But I think we have to recognize that there's a very complex overlay also.
[00:25:20]between sort of the, just the, the physical effects of being really sick and also the psychological effects of being really sick and isolated. and so I don't think the COVID long haul is only by, I do not think the covert long haul phenomenon is just a psychological phenomenon. But I think an important overlay on the COVID symptoms and on kind of the duration of symptoms and these longer is that there's there, there's other things at play other than just, you know, when we strip away kind of, you know, it's just Disney on exertion or it's just.
[00:25:56] Dysautonomia. It's just these things that there's this kind of a complex [00:26:00] clinical syndrome. and that, that requires a lot of, a lot of attention, you know, in terms of just like listening to what's going on and, and trying to suss out the symptoms and help people cope with the longterm, manifestations.
[00:26:12] Does that make sense? But do you guys think, Steven, do you totally disagree with that? Or what do you think.
[00:26:17]Stephen Kissler: [00:26:17] Yeah, no, I do agree with that. I've been thinking sort of along those same lines and similarly have, no, a number of people who, who have. Sort of similar experiences, long post COVID, the, that you just described to Matt.
[00:26:30] So it's and even, a colleague who's a primary care physician. Who's also been describing this a lot in his clinic. And, and so, so I think we're seeing it a lot of different levels and it. So it's, it's there and it's something to contend with. And then I think Mark, what you bring up is, is important.
[00:26:43] It's
[00:26:44]
[00:26:44] Mark Kissler: [00:26:44] yeah, I almost hesitate all of these things. I almost hesitate to say, because I think one of the things that we've seen with the COVID long haul symptoms is that often they're dismissed a lot. So it's like, Oh, it can't be COVID. You should have gotten over it by now. It's just in your head. And so I don't, I, again, I don't [00:27:00] want to say, say that at all.
[00:27:01] I'm more what I'm coming from the site as often, we don't. Take a more holistic look at the whole picture. And so that needs to be part of it. but that there is a risk, I think, of dismissal, you know, when you hear something enough, even if it's like, well, that can't be possible in your preconceived notion that maybe there's a time to reevaluate and say, well, this there's something about this pathogen that we need to learn more about, you know?
[00:27:27]and this seems to be, there's just enough evidence that there's something going on. I'm very interested to see. You know, some longer term studies and a little bit more resolution on the data about what exactly is happening with this.
[00:27:41] Matt Boettger: [00:27:41] So we talked about this whole long haulers, new to me, a totally trite, small conversation, solid news.
[00:27:48] I kind of smiled frozen chicken wings, everyone. I don't eat those, but often frozen ones tested positive for coronavirus. Should we even care? Should we, I mean, now we're in August. Should we even be really caring [00:28:00] about this at all, and this isn't by the way. Okay. This is not the first time that we've actually had food here.
[00:28:04] Right? We know this is, so this is like a big awakening. It has made a headline news, but I wanted to drop it really quickly. Here is this is anything like that. This really concerning right now.
[00:28:14] Mark Kissler: [00:28:14] I mean, I do think that when should watch one's consumption of frozen chicken wings, from a general health
[00:28:20] Matt Boettger: [00:28:20] perspective,
[00:28:22] Mark Kissler: [00:28:22] but that's something that should be done in moderation.
[00:28:25]that's just my, that's my, my 2 cents for the doctor side. Not necessarily because of COVID but more because about through a sclerosis,
[00:28:35] Matt Boettger: [00:28:35] there you go. That's the point?
[00:28:38] Mark Kissler: [00:28:38] I don't know. I don't know. Who's testing frozen. I don't know. This is interesting. I
[00:28:42] Matt Boettger: [00:28:42] just did was mind blowing to me the fact that we even tested it.
[00:28:45] Like clearly we have a lot of time on it. Stand
[00:28:48] Mark Kissler: [00:28:48] done by a frozen chicken wing at that point. I think it's under frozen. I think, you know, I don't
[00:28:54] Matt Boettger: [00:28:54] know. It's India.
[00:28:56] Mark Kissler: [00:28:56] I don't know. I mean, there was some conversation in [00:29:00] New Zealand. I had heard that maybe some of the food imports were related to this re.
[00:29:07] Resurgence. I'd heard that as Steven, is this something that you've heard too, that there are people blaming that? So I wonder if that was the question that raised to the testing or something like that. as far as, as far as I know, and it's even, you, you tell me, but as far as I know that these same mechanisms for transmission are really the big players.
[00:29:25] It's looking more and more like surface transmission, and food transmission is really not something that we need to be putting our emphasis on at all. Is that fair?
[00:29:34] Stephen Kissler: [00:29:34] Right. Yeah. It's and maybe it's sort of a historical perspective too. I know this is not to say that. Food borne transmission doesn't occur, but definitely in, in every major outbreak and especially pandemic that I'm aware of food is one of the first, the places that we sort of psychologically go to as possible, actually one of the sources of transmission.
[00:29:55] So for example, I remember during the 2009 H one N one swine flu [00:30:00] pandemic, There had to be very consistent messaging from the CDC that the swine flu is not spread by consuming pork. Right. And like, but that, that, that idea had taken hold so strongly. Like I think there's something there's something there that, that, that really wants to, and it makes sense.
[00:30:16] Like we're like putting something into our bodies and it's like, it makes sense that the it's like a very visual sort of intangible route of. Potential contamination in a way that that breathing is sort of less so. And so I think maybe that's part of why we attach these things together. So I just wanted to flag that too, that it's, that's a very common theme in pandemics as a whole, that sometimes is the case, but I think in many, especially with respiratory pandemics, it's often not.
[00:30:41] And in this case certainly is not the major, driver of spread.
[00:30:44]Mark Kissler: [00:30:44] Great.
[00:30:45] Matt Boettger: [00:30:45] as we land here, the, I got another article, this vaccine, away, we talked about a little bit over. We know there's a lot of vaccines, a lot of hopelessness, a lot of going on this, this particular article caught my attention that said that the vaccine 19 is hard.
[00:30:58] COVID-19 vaccine is [00:31:00] hard. Making one for kids is even harder. insight to this, this particular article of what makes the vaccine harder, particularly for, for kids.
[00:31:10] Stephen Kissler: [00:31:10] maybe I can start in the market. You can fill in with, the clinical and immunological side, but I think that there are two things that I'm aware of.
[00:31:17] One of them, is, has to do with just the complexity of the immune system. I know that for flu, for example, there are different recommendations for which flu vaccine to get. If you are, I think under six months old versus over six months old. and some of that has to do with the immune response that it just differs in important ways.
[00:31:36]leading to the need for a different flu vaccine, I believe. But then the other thing has to do with, with trials. that generally when you're doing things like vaccine trials, you're often yeah. Enrolling, basically people who can give consent for themselves. and that precludes kids. And so, so part of it is just that you're not, simply because you haven't really.
[00:31:56] Done the same safety and efficacy studies in kids. You can't really [00:32:00] justify giving that same vaccine to kids in the same way. so, so part of it is, has to do with biology and immunology, but part of it just has to do with our knowledge and our, sort of system of, of, of approving these things I think.
[00:32:11] And those two things can come together to make it, so it, it's more just giving vaccine to kids is just sort of a more complex question.
[00:32:18] Mark Kissler: [00:32:18] Yeah. They know before, before,
[00:32:20] Matt Boettger: [00:32:20] before you say Mark, I was going to say, and you can speak into this. That we talked about the soft off we've started recording. Is, is it going to be more different for COVID-19 vaccine?
[00:32:30] Because we see the complication. We're trying to rush this out. We're trying to get it out now. We're trying to make sure we rush it in, in a safe manner. Of course, we're trying to check off the box that we're not Russia. We're trying to do all these things. And we also see a population of kids who aren't quite affected by it.
[00:32:45] I could see as a scientist, I'm like, you know what, you know, I got to cut corners, but I want to be safe. So let's like, let's forget the children. as we begin to think about it, we already have a difficult time getting children to be on board because of, you know, consent. It's already a roadblock. Let's really fine.
[00:33:00] [00:32:59] Tune this for. The population is being effected the best we can and we'll deal with it later. Is there a, I mean, is that, is that a possibility? I mean, I, I'm just, I'm curious in my head,
[00:33:10] Mark Kissler: [00:33:10] you know, I don't know exactly the, the motivations are or what they're doing to prioritize the vaccine development.
[00:33:17] There does seem to be. Growing evidence that transmission rates indefinitely, as we've known epidemiologically, the severity of disease among kids does seem to be generally lower. And there's been conjectures about why, transmission rates are lower and kids. I've seen things as varied as they have lower tidal volume breathing.
[00:33:36] So like they don't breathe as deeply. and so maybe there's different viral transmission because of that dynamic, or which is strange because. Other respiratory viruses. We don't tend to see that we actually see higher rates. You know, I've seen there's conjectures about, is there a difference in the ACE two receptor expression in kids?
[00:33:54] There doesn't seem to be, it seems to be similar to adults, so that doesn't really line up necessarily. [00:34:00] Well, maybe there's something related just to the way that children are. A children's immune systems are made to encounter novel pathogens, and to develop. Responses to those because it's everything that they encounter, you know, from early on in life, as a new, disease to them.
[00:34:17] And so maybe there's some kind of a, an immune response. That's turned up a little bit in kids. That's helping them in this particular, With this particular pathogen in ways that it wanes and its efficacy, as you get older, all that to say it's hard to know, but it does seem kind of globally epidemiologically that the younger kids at Pew pre pubertal kids in particular are not spreading it quite as.
[00:34:41] Aggressively, you know, as people of that age cutoff, not to say that they're immune and not to say that children haven't suffered effects from it. but I do think that that's something that, that comes into play as we think about, what do we do with kids and, you know, do we send them to school and do [00:35:00] we vaccinate and that sort of thing.
[00:35:02] I do think this looking at the article that you were drawing from mostly they're emphasizing, not the innate immune response, but the, the hurdles to approving any sort of pharmaceutical intervention in high risk populations. And so, very appropriately there's a lot higher. Bar for ethical acceptance of things.
[00:35:21]so it's very difficult to study things in pregnant populations, in children. and, and there's some other kind of special protected, popular patients through w or, through review, essentially pre trial review. So that will. Make it harder to do something like a rapid ramp up that we've seen with a lot of the adult vaccine trials.
[00:35:43] And, but yeah, I think some in a lot of ways, those protections are so important, that feels to me to be a reasonable trade off. Steven. What do you think?
[00:35:53] Matt Boettger: [00:35:53] You, you hit it. Oh yes. Steve, anything else?
[00:35:55] Stephen Kissler: [00:35:55] Yeah. I mean, with, certainly with the COVID vaccine, the, one of the high risk [00:36:00] populations that we're concerned about is the elderly who also are often excluded from many vaccine trials.
[00:36:04] Similarly, because they suffer, tend to suffer stronger impact from the infection. and we know that for a lot of vaccines, vaccine efficacy is not as high in the elderly population, which, which also poses a difficulty. cause we need to know more about. Dosing and about frequency of explanation in the elderly as well.
[00:36:21] Many of the vaccine trials are, are in fact enrolling elderly people because we know that that's, it's such an important age group, but I think, yeah. Yeah. Speaking to the articles pointed in some sense, that's the population that I'm more concerned about in terms of rolling out the vaccine and in this context,
[00:36:36]Matt Boettger: [00:36:36] Oh, you just had a really important point, Mark.
[00:36:39] And I just want to go back to you guys when I was taking Greek back in the day. And then I remember when I was just there, my first year of Greek, they would tell me you just know enough to be dangerous, right? So here we are in this, in this place where. We I've really cared about this element of science well for my entire life.
[00:36:55] Right. And so, and now it's being presented through the media [00:37:00] cause you just expose what I've been repeating in my head and questioning. I want to throw a question to YouTube because I'm getting these, this, this, these articles sent to me and you just said they just article in the context of COVID-19.
[00:37:11] However, this applies to everything. It's a general scientific issue that, that, that, that, that is an umbrella. Problems so to speak. Do I, is it sometimes like you're, you're, you're seeing the media take things that you already understand as being, we already know this, this is part of science and then they're packaging it through a COVID-19 flavor, which makes me think it's COVID-19 related.
[00:37:34] It's specific to COVID-19, which then elevates my anxiety, my stress. But when you guys are sitting here thinking, Oh my God, we learned this in the first year of med school or whatever, this is just normal. Get over it. People are you sensing that? Cause I'm starting to see it more and more and more where they're taking this and it applies to just science.
[00:37:53] Mark Kissler: [00:37:53] Oh yeah. All the time. You know, I think that this is, and I think so. I think there's the phenomenon where. [00:38:00] Basic things are being reported on with the COVID-19 teen spin to try and generate interest. and as we talked about with that article, that was saying like, you know, X percent of Americans are at risk for severe Cova disease.
[00:38:13] That was actually an article that was talking about X percent of Americans. You don't have diabetes and hypertension or whatever, that, that, that ad to the noise and it adds, in a, in a, you know, not to unfairly target that article cause it's happening. Over and over and over again. but in a time when communication is already hard and everybody's siloed that, that, that adds to the sense of noise and adds to a sense of someone, someone out there is trying to generate panic.
[00:38:39] You know, that, that charge that because everything, I read, everything I opened his, his COVID related. I think the flip side of that, that I've also seen is, Suspicion being thrown on quite well established, scientific techniques that have been negotiated. For a long time and refined for a long time to do things in a [00:39:00] robust and ethical and safe way.
[00:39:03] And now all of a sudden, there's this huge amount of suspicion about those things. And now we're thinking, you know, there's a lot, it seems as if, some people are saying, well, we can. Sit and without, without having participated in that dialogue in a meaningful way, and like really understanding the history of where these things are coming from, we can criticize the word of experts because of XYZ, you know, and we're appealing to these other authorities.
[00:39:29] Other than this sign Reno established scientific method. I think that comes in part from a lack of understanding of what the sign, the, you know, these methods are used for and the proper way to use the science. There's a lot of running towards conjectures on both sides, about what things mean. but that's the other troubling side of it that I've seen is, people kind of impatiently saying, let's check all this out.
[00:39:52] It doesn't make any sense, you know, before really understanding kind of deeply what. What is actually going on with the science and [00:40:00] what are the scientists actually saying, then let's have a conversation about, these, these societal effects of what's been going on.
[00:40:07]Matt Boettger: [00:40:07] Absolutely. That's great. Thanks for that.
[00:40:09] I believe it's been mulling in my head for months and we haven't talked about it. I'm taking, I'm starting to see this pattern. my wife just texted me. She needs me upstairs a little bit. So we're gonna have to wrap this up, but I want to talk one last thing. I thought it was just the whole article that Ruthie brought up.
[00:40:23] She's one of our listeners, excuse me. As you said, the successful elimination of COVID-19 and transmission in New Zealand. So this article comes up and then she wants to know how it happened. I'm going to refer her back to a previous episode. I think we've talked about it. And it was a really good episode.
[00:40:38]you know, Mark, you were talking about, it's an Island, it's smaller. There's a lot of complexities. It's a very different. The one thing I want to talk about is just, this is why I don't say anything on Facebook. I just keep my mouth shut people, because what happened is Mark, you're talking about this, right?
[00:40:53] This article came out and it was really the next day. I think the next day they had their first handful of cases, right? [00:41:00] I'm like,
[00:41:00]Mark Kissler: [00:41:00] Yeah, and I think right, it just, you know, and it, and it's to be expected. We're still in the middle of, you know, we're still in the middle of a pandemic and, some places are doing a lot better than others and some places we've seen a really sustained a client.
[00:41:13] And, there's not a lot of community transmission going on. But I think we have, you know, you want to be always cautious about declaring, you know, premature victory over silver, some for something, something, or really is, you know, not victory but closure. and, but I do think it seems to me, this article was really trying to highlight, in a well intentioned way.
[00:41:32] Like these are, these are the things that, that can be really helpful, you know, on a societal level. Again, it's just tricky because New Zealand is not, the United States is not, Australia is not, England is not Italy. There's just a lot of differences locally that have huge, huge effects. that being said, I do think there were some valuable things in that article, some valuable conversations about, measures that have helped them control the spread, and help [00:42:00] them, especially early on the pandemic to control it relatively quickly.
[00:42:03]Matt Boettger: [00:42:03] Yeah. Yeah. And I'll put it in the show notes. So you guys can read that on your own. A lesson learned just to be cautious we're in the second, any, and this isn't the end of the book. So there's always more chapters ahead of us. This is why I say nothing on Facebook. Cause I know that by definition, if I say anything the next day I'll wake up, it will be the opposite all over the news.
[00:42:20] So I don't want to cause that for you, people. So I'm going to keep my mouth shut and just listen to Steven Mark and realize it's complicated and I'm more ears than mouth. So on that episode, in that episode, I'm going to end this. Thank you so much for listening. If you want to leave a review, please do.
[00:42:34] If you can support the podcast, patrion.com/penn dental podcasts. When reach out to Steven S T E P H E N K K I S S L E R on Twitter, matt@livingthereal.com. If you want to send us a message, tell us how we're doing. tell us what's going on. You're not inside of the world and we will see you. All next week.
[00:42:51] Take care. Bye bye.