Pandemic: Coronavirus Edition

The answer to the meaning of life (including the pandemic) is...42

September 14, 2020 Dr. Stephen Kissler and Matt Boettger Season 1 Episode 42
Pandemic: Coronavirus Edition
The answer to the meaning of life (including the pandemic) is...42
Pandemic: Coronavirus Edition
The answer to the meaning of life (including the pandemic) is...42
Sep 14, 2020 Season 1 Episode 42
Dr. Stephen Kissler and Matt Boettger

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Show Notes Transcript

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Please consider supporting us to pay off all the equipment and software we had to purchase to pull this podcast off quickly without sacrificing quality! We are looking for $350 of one time donations this month to pay off our remaining "equipment bill." Thank you! You can do that in two ways:

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[00:00:00] Matt Boettger: [00:00:00] You're listening to the pandemic podcast. We equip you to live the most real life possible in the face of these crises. My name is  joined with my good friend at dr. Steven Kissler. And epidemiologist the Harvard school of public health. Dr. Mark is gone once again. He's at the hospital. We had a week off.

[00:00:15] It was labor day. So we chose not to labor. Well, I don't know, at least not labor with pandemic podcasts. How did you go? How's it going, Steven? It's good, man. How are you doing? Doing well? What'd you do for labor day? I got to go out for a bike ride, which was lovely. just got around the city a little bit.

[00:00:32]Yeah, the weather was beautiful. It's starting to feel like fall up here. So, yeah. Great. Yeah. Gosh, what did we do? we took the week off, which sounds lovely, but it wasn't, we totally just like gutted our basement. Try to get ready for homeschooling. We ever first in kindergarten, we decided to keep him home for the year.

[00:00:49] It's just complicated with all the back and forth of online in class. Like, you know, let's just, let's just be at home. So we did that, which we have a small house. Now I shouldn't complain for those of you [00:01:00] in Boston or yeah. I mean, your homes are like little cubicles, right? So it's bigger than the average house, but it's small for us with three wild boys.

[00:01:06] So we spend our time gutting our basement and then making a classroom, which is not quite finished. And I'm hearing them upstairs having one of their friends days of school, which is exciting and all the good job and affirmations I hear coming from the basement. So that's what we did. It was an incredibly long work week.

[00:01:23] Not a lot of rest. But now we're back to the grind. So good to be back, Mark. I think hopefully back with us next week. Not sure on his rotation, how it works, but we'll, we'll hopefully have him back really soon. Okay. If you think before we get started, great. Loved the reviews and got another great review from Bailey cookie.

[00:01:40] I love these usernames. They're crazy. So she says best COVID podcast. I started out listening to several COVID podcasts over time. I started to delete those with fluffy content, excessive speculation, fear-mongering et cetera. Also celebrity opinions regarding the pandemic are in my opinion, irrelevant. Oh, there goes Jason Raz having him on our show next week.

[00:02:01] [00:02:00] Mini mini podcasts, just rehashed, vapid, daily news stories without adding any science based perspective. This is the only COBIT podcast that I couldn't listen to. It is the best it offers useful information and insights. Thank you. You're welcome. Thank you, Bailey cookie for that awesome review. It makes me really happy to read these and I'm sure the second.

[00:02:20] Yeah, that's awesome. Thanks. That's that's really that's great feedback. Yeah, it was great. And we also got some feedback we talked about. Sometimes we can ramble for up to seven minutes apparently for our personal lives. I got some good feedback that people, people liked it and they do like to hear it. So if you feel otherwise, Matt, at living the, just email us, let us know how you feel, how it's going, what you want.

[00:02:40] We're trying to provide the best, useful information, but we also do it through the context of being human and we have our own lives that we're dealing with. So we want to share that with you. In context, if you'd like to support this show hugely only $350 more than we need to raise the pay off all the equipment.

[00:02:56] And then we can just keep going with maintenance. So if anybody wants to help contribute to [00:03:00] that, just a one time, one time, a small donation, PayPal, Venmo, all that information's in the show notes. If you actually want to go ahead and, don't donate monthly, you can do that at podcast.

[00:03:14] You can do it there as well. Great. A couple other things before we roll a Biff, I think we had the break last week and I had a new episode on living the real, check it out. You can do that on any podcast player did one on lean love. I love this idea. so I'm kind of a geek. I follow the Toyota way. I've read the book.

[00:03:31] It's have you read the Toyota way, Steven? I have not yet. It's on my list. You got to get it. It's so good. So it's all about Toyota and just like how they changed the whole course of their industry. And you know, I mean, everyone's a Toyota. No, I can't. No, I guess I shouldn't say that I'm going to fight right now.

[00:03:45] Sorry, my bad. I think that all back, I'll edit it out, but a lot of people like Toyota's why, because they're just really effective efficient cars. And the reason why is that they had this lean principle they guided after the post world war II. To really shore up their waste and they develop these seven now eight [00:04:00] principles of, of waste.

[00:04:01] And so I just applied it to love called lean love, talked about the eight different kinds of waste and how to apply it to our own lives and relationships. So we can have less waste. And I'm not trying to have an efficient relationship by the way, those suck, but, but Oh, the relationship that's effective, that's wonderful.

[00:04:16] That gets rid of the waste that's unusable. Well, and then reallocate that waste to something. Wonderful. Cool. So check it out. I love doing, it's just the tip of the iceberg I'd like to write or on this, sometimes students took out living the real. Latest episode as well could also use her help. Stephen, you filled out the survey for me, appreciate as a, as a, my Guinea pig experiment for my profit.

[00:04:34] Yep. So it was really helpful. Love what you wrote. It's just a great way that if you want to help me and help yourself go to  dot com slash survey, just 15 minutes, it's all about dressing your pain points in your life. I love helping people get over those pain points and profits maybe financially, maybe not just actually yeah.

[00:04:50] Find value in the struggles in our life. And by spending 15 minutes will help me understand what's going on in the struggles in your life that I can help address. And I'm going to pick five people. Get on a phone call [00:05:00] and just help for 30 minutes to make their pain point more profitable to check it out.

[00:05:04] Love it. So let's get in to the good stuff while we're here. The pandemic podcasts, we have a couple of questions. first we have one from Sarah. We're going to hold that, Sarah. I know you're listening when market's back on. It's a great question. I think with all that, with both of them back, we'll be able to address that a little bit more intentionally.

[00:05:22] So let's skip to the second question by Harper. She was talking about, we've mentioned a couple of times before Steven, about these long haulers and, it's, it's a really, it's really kind of a recent, at least at least on the, on the scientific realm of just studying this a recent phenomenon what's going on her.

[00:05:37] She had a series of questions. One question, was this idea of what would happen with long haulers if they got reinfected, would they, because of that long haul NIS going on, would they have maybe higher immunity? And so then it wouldn't affect them much or is this kind of a long holler situation, more part of them personally, so that if they did get reinfected, they would follow the same kind of long haul, effects [00:06:00] of, of covered any, any, any research or understanding of what might happen in a situation?

[00:06:05] Yeah, I mean, As, as you said, you know, the, this whole long holler phenomenon is still something that, that we're trying to get to grips with as scientists. And, it's, it's not totally clear, you know, of course what causes it. I think that, one of the, one of the leading hypothesis is that it actually has something to do with, with your immune system response and not even necessarily with the virus itself.

[00:06:26] So, we do know with, with some other, Reactions that people can have, you know, your immune system can react in odd ways sometimes when you get an infection and. Some people can be predisposed to that, but even so like, even if you have that predisposition, it's, it's usually a rare kind of reaction. I'm thinking of, things like Julian Baret syndrome or something like that, where you have like this sort of weird sort of haywire reaction to an infection or, sometimes even in response to a vaccination, and that can happen to people, but we really don't have a good understanding as to why that happens.

[00:06:56]so. I think that in the absence of [00:07:00] any further evidence, I would put my money on not much money, you know, I don't have much and I actually ended, I'm not too certain on this, so yeah, well, yeah, it turns out we don't make much as postdocs, but, the, I would say that the, whether or not you've become a long hauler probably doesn't really have any.

[00:07:21]discernible correlation as to what would happen if you were to get re exposed to COVID. I think that you would probably be the same as to whether it's just a second exposure for anybody. Who'd gotten it in the first place anyway. we could be surprised, but, but my guess is that this, this, this long holler ideas is, and, and syndrome is, is something that kind of, There's, there's probably just a lot of randomness to it.

[00:07:43] And, and it'll be a long time before we understand it. Probably I I'm doubtful that there will be enough cases of it at enough cases of people who are long haulers who get re-exposed in a way that we can discern and detect that we'll actually be able to unpack that relationship very well. And it'll probably be a subtle one anyway.

[00:08:00] [00:08:00] Yeah. Okay, so it's complicated. We don't know, but, wish we gave you more information. Another question she had is maybe have a little bit more behind it. You might have the answer about antibodies. So she talks about the idea. Is it possible that people can get affected? She heard, is it true that some people can get infected with COVID but then have zero antibodies?

[00:08:18] The fact is that true? Yeah. So, I think that it's, it's unlikely that you would have zero antibodies unless you were suffering from some very serious immunosuppressive condition or something like that. your body will produce antibodies and has to, to clear the infection. but whether or not there's antibodies persist, Is is a very different question and the length of time that antibodies persist, you know, I'm, you know, I, I'm a statistician, you all know this by now.

[00:08:43] And should I think of everything in terms of statistical distributions, right. you know, there's everybody, you can put together a population and there's an average height, but people, you know, fall or along that entire spectrum and, and the antibody response and the length of that response sort of follows a similar sort of thing.

[00:08:58] You know, we think that there's. [00:09:00] There's this very strong Nene antibody length of response where hopefully that's on the order of years, right? Yeah. There are always going to be people who fall into those tails. Some people who that's like incredible, really long lasting response, and you're never going to get infected again.

[00:09:13] And some people where it just, just kind of fizzles for one reason or another. And so I think the most likely scenarios, yeah. Most of us are probably going to be protected for some reasonable amount of time, but there's. Always with any infection, whether it's SARS, Kovi too, or anything, there's always going to be some subset of people who, you're just, don't Mount a response that lasts for very long.

[00:09:31]and the tricky thing with this is that we don't know who those people are. So we always kind of have to assume that that, that we might be that person. and so that, you know it, and so, you know, I'm, I'm living my life in a way that, where I always sort of assume that I could be infected. Right. I'm always like every time I go out, I assume like I might be infected and I might be infectious.

[00:09:49] And I think that. Even if I were to get infected and recover from COVID, I would still go around with that same assumption because of precisely this, this phenomenon until we know more [00:10:00] great. You know, a follow up question. This I'm just, I'm curious in Harper did not ask this question, but so there are some people who just for one reason or another may not get the immune response that is necessary to have a muni for wa for a long time with that, then translate to the vaccine for them as well, or are those separate.

[00:10:18] Separate situations. Yeah. It's the same principle holds, although it won't necessarily be the same, like it's not necessarily that the same person who doesn't know how to get her immune response to natural infection will not amount an immune response to vaccination. Okay. So the distribution is the same, but, but the individual responses could differ widely from one to the next, or even from one infection to the next infection.

[00:10:39] Oh, okay. I'm sorry. It's complicated. What's up, man? Yeah. Okay. Let's get straight into the news. Now. Got lots of things. It's been two weeks we talked about, this is old news, probably for all of you who are listening, but I want to bring it back up. I think in the midst of Steven and ours, our conversation two weeks ago, it was just kind of ramping up and then we miss it [00:11:00] over labor day.

[00:11:01] We saw go all over social media that. The CDC was reducing the death toll. So the about like 90 some percent. So cause another wave of alarm. See, I told you conspiracy and I wrote Steven, like what's going on with this? And then you were to say, I'm in the midst of getting ready for journalists calls I'll you know, and it gave me a great summary.

[00:11:20] So what is going on in was this expected? Unexpected? Give us the information. So this is, this is kind of interesting. And as you said, I probably had five or six calls from different journalists at different places about exactly this question last week. Cause it really light generated a lot of controversy and confusion.

[00:11:38] So basically what happened is, you know, the CDC has been reporting data for on COVID and on the number of infections and also the, the number of people who are infected, who, Also in this case, on their death certificates also have other contributing factors listed to their death. and so I think that this came about either [00:12:00] because they updated the way in which they were reporting that basically they just like changed the spot on their webpage, where it was available, or maybe there was more detail.

[00:12:07] Or a, I, I'm not actually sure. It might've actually just gotten picked up by someone, and then sort of spread like wildfire. but, but, so the idea here is that, there's this table that the CDC reported where at the, at the top of the table in this, like where they're basically in the legend of the table, they say that, I think it was for 6% of COVID deaths.

[00:12:24] COVID-19 was the only. Only thing reported, for, for the cause of death. And then the table is basically breaking down, all of the other additional things that have been listed on the death certificates that have contributed to the person's death now. The, the narrative that came around, that was that, Oh, look, you know, there's you know what?

[00:12:44] It wasn't like 94% of COVID deaths were actually caused by co-morbidities and a person just happened to have COVID. But that's the problem is that some of these comorbidities that were mentioned were like respiratory failure, right? And like heart attack and [00:13:00] like things that covert can cause like stroke and like, right.

[00:13:03] So, so what the doctors are doing are absolutely, you know, they're, they're listing all of the things that a person may have had at the, at the time of death. but some of these things are things that were directly caused by the covert and they're trying to distinguish, you know, what is it specifically about the COVID infection that caused this person to die?

[00:13:18]but when we think of the word co-morbidities, we think heart disease and diabetes, right. And, and so. It's absolutely true that there are some people who have died, who, whose death was not caused by COVID they were, they were carrying covert at the time and got into a car accident or, or, you know, or maybe it was like complications from their diet.

[00:13:36] Right? Like the, this absolutely happens. But yeah. The key thing. And this is, this is the great irony of this thing is that if you scroll down a little bit further on the page, there's another graphic that shows the excess mortality in 2020 from all causes. It's basically just like how many more deaths have we had in 2020 compared to previous years.

[00:13:57] And that baseline is. It [00:14:00] is higher than the number of deaths that has been attributed to covet. It's on the order of, I think it's like 200. I don't want to, I think it's like 20,000 something. I need to check the numbers again, but, and it follows exactly the confirmed cases of COVID over time. So, so we need to hold these two things together.

[00:14:14] Right? We know that excess mortality is a lot higher this year than it has been otherwise. And I don't think it's just because a lot more people have gotten diabetes and all of a sudden in 2020. Sure. you know, and it could be other things, you know, there are definitely people who are, who have avoided preventative care because they've been afraid to go into the doctor.

[00:14:32] Right. Like, that's, that's a real thing too. but I think you will, you could also say that those were to some extent costs. By COVID as well, right? Like by the social phenomenon of COVID that, that was also preventable in some sense, if, if we could have been able to reduce COVID cases and make it more manageable early on.

[00:14:48] So holding all of these things together, excess mortality is still yeah. Way higher than it has been in previous years. And that's absolutely attributable COVID. and, and it's just, the reason why there are these [00:15:00] multiple causes of, or, you know, these multiple contributing factors to death on a death certificate is.

[00:15:04] Like that that's that's standard practice in the hospital. You always, if a doctor is doing their due diligence, you're going to write down all of the things that a person had that may have contributed to their death, just because you want as full of a picture as well possible. And so that's, that's all it was.

[00:15:17] And, it just got sort of. Blown out of proportion. Just thinking about this idea of like, I feel like you are before this pandemic happened, you were this quiet kind of in your little cubicle, epidemiologist doing your thing. No, wasn't no one was imposing their, their kind of lack of competency. In your area of expertise on you, right?

[00:15:38] You were just doing your thing. I feel like what you're experiencing now is like what doctors experience daily when they come in, like Googled this and you're saying, it's this, but I think it's that you're like, Oh no, because of X, Y, Z, double Z, B C, D. And so now it's like, now it's the same thing where we have people [00:16:00] this has been going on for ever.

[00:16:02] This, this reality, cormorbidities all these different lists, but now we like, Hey, can I see your book for a second? Can I peek in there for a second? I'll wait, what's all this he'd been hiding stuff from. I was like, Oh my gosh. He was like, I have to do this. I have to, I have to educate you on this and that.

[00:16:17] Can I just do my job? And, I just, I feel like you're just. Yeah, right. This is why you hunker down. You mentioned how it kinda like, probably good for you to stay on the news a little bit, because you gotta do your job. You gotta do your job and the research and your data and not be swayed all over by.

[00:16:31]Us telling you how your job. Yeah, but I will say too. I mean, it's, it is, it is a privilege to some extent, to be able to, to express these things. I mean, one of the, like, this is maybe a personal degression, so sorry for the people who don't, who don't like the banter. But, but I also, I mean, I really love, I love teaching too, right?

[00:16:48] Like I love, Lecturing and getting in front of a classroom, helping students learn concepts. And it's all about taking complex ideas and distilling them into narratives and into ways where you, you, you identify sort of like the [00:17:00] key important factors and communicate them in a way that another person can understand.

[00:17:05] And I feel like I've been relying on that same sort of thing in communicating with the public and in a way it's like, Ooh, It's not surprising, you know, I understand why people really want to know, what's going on and are, and are developing these, you know, hypothesis and theories all the time. Right?

[00:17:21] Like these, these, these things have a real immediate bearing on our lives and in the absence of, You know, direct access to an epidemiologist. We kind of have to make some of these, these conclusions on our own. And so, it's, you know, of course there are frustrations about it, but there is also this real, one of the things I've enjoyed most about my work over the last few months has been exactly this about like, Realizing these misconceptions, having people who really in good faith they're like, there are these, these disparate sources of information that I just can't make sense of.

[00:17:48] And I have no idea what's going on. Like, can you help? And it's great. Like I enjoy that more than almost anything else. That's awesome. Yeah, no, this is great. I love, I mean, it's just a huge opportunity. It's been great to be with you and learn so much about science and [00:18:00] all the different ins and outs and realizing.

[00:18:01] I mean, again, I say this all the time. My life life's can be shifted because of this. How I look at things. And I'm just so, unfortunately grateful. Yeah. I really wish I were totally irrelevant. Like, I would love to go back to that the cubicle and have nobody paying attention to anything. So I think we're still a little ways out from there.

[00:18:17] Yeah. You're you have a couple of years, probably. So  hold on. We will get to that in a minute about. The pandemic century. Don't freak out people. I'm not trying to like say anything right now. I'm just, it's a good discussion point. Hold tight few minutes. We'll chat it. Tidbit. So dr. Scott Atlas, this is the new guy on the white house, new adviser, replacing, I don't even know.

[00:18:38] I can't follow and we're not gonna talk about the politics and that kind of stuff that I just wanna get Steven's opinion of dr. Scott Atlas and, you know, his credentials are great. He has awesome credentials. I don't think necessarily in the area that's being, being discussed and being looked at. so that's one thing I want to get your opinion about, but the biggest thing is his, his, his [00:19:00] response.

[00:19:00] Or his plan, his, his plan. I'm not trying to oversimplify it. I'm sure it constitutes many other factors. What I've seen as one of the things he's been talking about is the, the idea that, Hey, there are a lot of people who can get infected and it's perfectly fine, and this is going to help. Bring about a herd immunity, which is only going to help our country get to this new normal.

[00:19:22] Right. So what do you think about what's going on with dr. Atlas and particularly his response of this constant striving for her to immunity? Yeah, it's so first of all, I, I don't think that this idea I've heard in unity is, is a viable one for, really protecting like. Public health. I think it basically constitutes surrender.

[00:19:43]and, and I don't think that it's a surrender that, that I. I don't think it's very defensible and I can talk about why, but, and like you said, there, there are lots of different aspects to his plan and these sorts of things. So, so I'm not necessarily drilling into like, specifically, like what, what they're proposing at the moment.

[00:19:59] But, [00:20:00] but this notion I think is an interesting one, cause it's a reason. Many times over the course of the pandemic, right? Like people have been talking about like, Oh, look at Sweden or the UK, we have Boris Johnson. Who's, you know, famously said, let's take it on the chin and, you know, right. So, so, but I think, but the narrative around this is I think that that PR precisely that phrase is, is an important one.

[00:20:20] And it shows sort of what we're, one of the, one of the paradigms, one of the ideas that we're entering into this with, which is essentially this idea that, That is pervasive amongst a lot of infections that, you know, just the natural course is the best course. Right? Like we shouldn't intervene. or economics is kind of like this too, to some extent, right.

[00:20:38] Like we think about like non interventionism with respect to like, you know, so it's like, it's like this deeper paradigm. and this idea that, that. Things can just sort of take their course and that that's actually the best course of action. And, you know, sometimes, sometimes that is the case. but in this case, the, the, the arguments for why that might be the best [00:21:00] case, I think fall flat on her a little bit short sighted, Precisely because epidemics don't stay contained to them.

[00:21:06] People who are low risk. If you have lots of people who are infected, who aren't at high risk of morbidity and mortality themselves, they spread it to other people. And part of the problem here is that, so we know that code, it spreads through, especially through prolonged. indoor contact. And so one of the highest risk settings for the spread of COVID is multigenerational households, right?

[00:21:28] So if we adopt a herd immunity strategy, households in which young people are getting infected, but then spending time at home with older relatives are the places where COVID is going to spread most. And those sorts of households in the U S and the UK tends to be disproportionately represented by, by people who already have.

[00:21:46]the worst outcomes for COVID, they tend to be minorities. They tend to be people who, yeah. You know, like, like it's right. So, so in a way it's basically try like, What we're implying with this herd immunity strategy, if you actually take it [00:22:00] to its logical conclusion is basically saying that, like, there are certain groups that were willing to allow to bear the brunt of this pandemic more than others.

[00:22:09] And, and I think that that's, that that's inadmissible. Frankly, because, it, it sounds, it sounds so compelling, right? It sounds like, you know, we'll just build up immunity. We're going to have this really robust, strong, young population. That's going to be protecting the rest of society, but, but that's just not how epidemics work and we're going to end up, as in the case of Sweden, to some extent, you know, A lot of their elderly population has died as a result of this pandemic.

[00:22:33] You know, they have some of the highest mortality rate of any country. and, and I think as, as a direct result of, of this kind of strategy and, And so, you know, if we're going to debate whether or not herd immunity is a good idea, we need to debate on that level. Like, are we willing to accept that as the cost of the strategy?

[00:22:50] If so. Okay. Let's talk. And, but we need to talk about it on that level, because if, if we don't, we're, we're ignoring. The actual implications of what we're doing. And I think that that's [00:23:00] dangerous and, you know, rent yeah. Is just something that we can't do. I think it's inadmissible, but yeah, that's brilliant, Steven.

[00:23:08] I mean, it's so myopic how I'm thinking all the time. Thanks for opening my eyes all the time. It's like war. It's so easy to think about it. And it's kind of like far away distant press the button. A missile goes, even though it's just a completely absurdity, but being removed from it, you're like a little bit more complacent allowing to happen, but you're right.

[00:23:25] I mean, we can't just sit here and talk about, Hey, let's build a herd immunity without talking about what that actually means and say the words, say the actual phrases and words of who's going to be impact on this because you're right. We're Americans, we kick our parents out or kick everybody out as soon as we can so we can live alone.

[00:23:41] Right. Because a lot of us have the privilege of doing it. We don't like people around us. People are icky, you know, on some level. But, but, but that's not shared by everyone because they can't do that. And I'm just saying, that's the right thing to do anyway. Like I think it's probably better to have family in your house and actually have a life, but a lot of people can't do that because they have to support each [00:24:00] other financially by living together.

[00:24:01] And what about those people? So, thanks, Steven. Just bringing that to the forefront of my mind is so powerful and just, this is where. Like it sounds geeky guys, but like almost get teary eyed hearing this because I realized, Oh my gosh, like the extent of charity just, or my lack of it. Out of ignorance or just trying to boil things down, simplicity, or again, this is a whole racial injustice, same thing, how I perceive how I make my decisions or by what my circumstances are like, Oh, my circumstances are there this way.

[00:24:32] So this is a good decision. It shouldn't affect anybody, but however, that's not the way to think. Right? Cause people have very, and circumstances and decisions can affect them way, way more gravely. And we need to bring that to the discussion piece. Thank you, Steven. Okay, thanks. A simple one. Oxford vaccine, I saw this last week.

[00:24:53] I don't want to say it correctly. Astra Zeneca pauses trial. After unexplained illness, it seemed like this kind of [00:25:00] created a splash in the media. Is this something to be concerned about Steven, or are we going to have a delay? What does this mean for us? Yeah, so, I mean, it will, it will lead to a delay in the development of, of the AstraZeneca vaccine.

[00:25:14]But again, it's this is, this is again, phase three trials doing what phase three trials are meant to do. and, and so, you know, it's, it's definitely, unfortunate and, and I think important to pay attention to you that there was a patient who, who may have had an adverse effect to the vaccine.

[00:25:30] Right.  we. I did, as far as I know, we still don't know for certain, if it was in response to the vaccine, although I think it likely right. Was, and we, no, the vaccines do sometimes have adverse effects in people. like that's, that is absolutely something that happens with, with many different vaccines that we have available.

[00:25:46] The key thing is that. you know, as with everything it's, it's the risk benefit analysis. And, the fact that there has so far only been one reported case of this, despite the fact that there are multiple vaccines currently in phase three trials, I think is actually [00:26:00] quite encouraging. because that suggests to me, at least that the rate of this kind of thing, is, is very low.

[00:26:06]so I, this is, this is again, just sort of par for the course. This is the way that trials work. The developers and scientists are gonna do their due diligence to figure out what happened to this patient and then hopefully get things moving again. But again, there, there are many, there are multiple vaccine candidates currently in part in phase three trials.

[00:26:22]and so this certainly doesn't spell the end of, or even necessarily that significant of a hiccup in our development of vaccines. So I'm still pretty, pretty optimistic about that. Okay. Well, this is not related to this for sure. And this next, the CDC sends urgent requests for COVID vaccine plans. By November 1st, we're not going to talk about the date, get into this kinda the theories of what may or may not be behind this, but what I want to get to is we just talked about this.

[00:26:48]gosh, it was a couple of weeks ago. We talked about how. The idea, the concept of rushing the vaccine. We see this with Russia. We see now we've talked about, we've seen with China and that we would do, this is not the right thing to do, and that we need to do our [00:27:00] due diligence. And now Fowchee comes out and says, Hey.

[00:27:03] There is a way by which we can fast track the vaccine and still be science-based and basically, you know, follow this, the phases it's in phase three, it goes swimmingly. Right. Which, which, I'm not sure. I know. I'm not going to words into your mouth. I'm not saying it is going swimmingly right now is what you're trying to say.

[00:27:20]but you know, something like that, that we're in phase three and there's, there's very little adverse effects or maybe none. So let's go ahead and cut it and move it into production. what's your, what's your response to that? Yeah. So, I mean, that is definitely a possibility. And the worked into the structure of phase three trials is this ability to fast track certain things.

[00:27:41]and, and that happens when, Basically as dr. Fowchee was saying, like, if you have just this overwhelming evidence of a clear benefit and negligible risk, sometimes when that effect is so strong, then you actually have all of the evidence that you need before you've actually finished the phase three trial.

[00:27:59] And if you can [00:28:00] demonstrate that, then you can basically call it off early and say, you know, then, then we can implement this as a treatment. So, so I think that that is a possibility now, one place where fast-tracked treatments. are, are relatively common as is actually an in cancer medicine. and, and so there's, there's been some questions like, you know, we, we do this for cancer medicines, you know, why, why can't we do this for a vaccine it's like par for the course, there's a lot of cancer medicines that end up getting fast, tracked and come, you know, come to.

[00:28:28]basically are used in patients before they've completed phase three trials. But I think one of the key distinctions here is that oftentimes these cancer medications are being given to patients who have no other alternatives. You know, they're not being administered to the entire population at once and they're not being administered prophylactically, right?

[00:28:45] Like this is trying to get patients, you know, Maybe some of them, maybe even just another couple of months of life, which is a very, very different sort of risk benefit analysis than we're having with, with respect to a vaccine. And so with vaccines, the, the baseline for evidence and the baseline for [00:29:00] safety needs to be much, much higher, which is why it makes fast tracking these kinds of things, a lot more difficult.

[00:29:05] And so, so I think that's one of the key things to keep in mind. So it's, it's absolutely a possibility, but we would need like, Just absolutely golden evidence, you know, that, that, that the vaccine is safe and effective. And, you know, like just in controvertible evidence, And otherwise then the trials need to be done.

[00:29:22] So, yeah. And I don't know if you, this, this is beyond your scope of, of study, but, right now you're, you know, we, we see this first one of a possible side effect. That's I don't know what it is, but significant, but you said there's like six other ones, at least in, in phase three right now, maybe seven other ones.

[00:29:39] And we haven't heard anything and they've been in it for at least a month. If not two months, I'm not sure where. is, is that normal or are we seeing the possibilities? The, that, that this case it'd be a couple just shining golden gooses that are not having anything I did, because again, I haven't been through a pandemic in my life, so I don't [00:30:00] know whether this a vaccine normally right away in phase three, there's always a couple of hiccups or is this unusual to have seven?

[00:30:07] I mean, who cares? What the quantity, but having one or two, not having anything yet. Yeah, I think, So I would say that I'm, I'm positively surprised by how many we have that, that haven't run into hiccups yet. and that we have as far along in this stage of development, I think that the, the vaccine development that has happened is in response to covert is, is unlike anything we've seen in the past.

[00:30:29]so it's really hard to compare to previous pandemics. so yeah, I think. I'm not entirely sure on the ins and outs. Like I'm not, I'm not sure if, like we would certainly know if, like as for the AstraZeneca trial, like if an entire trial were put on pause, that's something that would hit the news, but if there were other sorts of maybe less severe adverse side effects that didn't constitute or stop in the trial, but couldn't potentially undermine the, The risk benefit analysis that might just not hit the news cycles, in the same way.

[00:30:57]and so I think that the, again, the [00:31:00] absence of hearing about these things does not necessarily mean that there, that there's absolutely no adverse side effects or anything. I hope that's the case, but yeah, that'd be, that'd be fantastic and it's possible, but, but I think we just have to wait for the trials to be reported on before we really know what that, what's going on there.

[00:31:14] Yeah. Well, don't you have your, like your, your, your phone numbers of every single vaccine made or let's give him a quick call. I'm like, Hey, this is Steven what's. What's the what's what's the, what's the DL. We gotta put it on the podcast. Give him a call. Totally. So next one here. I am ignorant of this.

[00:31:30] I saw it in the news. I saw it come through, looked fascinating, and then I was going to read it and I didn't even get a chance to read it. So I'm ignorant of this. But this is why I have Steven to tell me all about it. This article says a super computers COVID-19 analysis yields, a new way to understand the virus.

[00:31:47]what, what is this? I have no idea. Cause I haven't read it. Is this exciting? Is this new stuff? Yeah. So this is, if I've understood it correctly, it's, it's cool from a geeky perspective. I don't know how much clinical, insight it's [00:32:00] necessarily given, but, but the idea is from, from what I understand is basically these, these researchers, Took, basically we all have the different syndromes that they had available that people were experiencing with COVID and fed them into a computer model that, that basically captures how the human body responds to certain types of infections.

[00:32:19] So it looks at like previous infections and different sorts of imbalances that you can get in your body and like what sorts of symptoms those things can cause. And tried to do this, like mapping it's sort of between, the, the symptoms that we've been observing with COVID patients and the different sorts of physiological changes that can, can take place to cause some of those different things.

[00:32:38] And as they let their computer chug for like a week or something, then it basically, we popped up, this, this hypothesis as for like what could be causing some of the, some of the syndromes that. that we're observing with COVID-19, which, which gives sort of a physiological basis for, for what could be happening.

[00:32:53] But that's related to, we've been talking about cytokine storms, which is this overactive immune response. And basically what they're proposing is that [00:33:00] yes, it's an overactive immune response, but maybe it's not cytokines, it's this other, other element of the immune response that maybe we ought to be thinking about instead.

[00:33:07]Which is super cool. Matt, have you read Hitchhiker's guide to the galaxy? Are you okay? Yeah. So I don't know this is going to be like, this is going to appeal to probably like one of our listeners somewhere out there, but whoever's there. Like, man, I like it, it reminds me of this like super computer deep thought where they like, basically ask the supercomputer, like what's the answer to life, the universe and everything.

[00:33:27] And it chugs for thousands and thousands of years. And then at the end it pops out the number 42 and then, you know, right. And so. It just makes me think of that because I feel like something similar is going on here. So I think it may have turned up something potentially interesting. It's probably not something that a human clinician might not have, you know, stumbled upon at some point anyway.

[00:33:46]but it's interesting. I think it's just an interesting, an interesting side note in the, in the sort of overall research. Yeah. That's awesome. That, that makes me want to read that book or at least listen to it. So don't chance to read that often, because that's a great 42. We should name that. Our [00:34:00] podcasts that just, yeah, me too.

[00:34:02] Okay. Awesome. one thing we have a big thing I want to chat about here, but before we get into that, I love this another piece from ed young on the Atlantic. There's lots. I'll put in the show notes. We're not gonna talk about all of this. Just a lot of like one liners that are pretty phenomenal.

[00:34:17] America's trapped in a. Pandemic spiral. He talks about, he starts out with this really awesome, concept of these ants and that they, you know, ants, if they get trapped in their own scent, the leader of this, they just circle around forever and ever, and ever until they die off. And kind of at, Young's trying to present that we're kind of in this kind of cycle right now that we're just kind of going into this circle circle and not actually making yeah.

[00:34:37] Improvements. And it's great. It's a balance piece because he talks about the concept of. The shaming of people going on the beach when actually being outside, isn't really the biggest contributor. And we're putting the energy in these weird places and not in the right places. And we're just going to these circles and we're spiraling out of control or just pointing fingers.

[00:34:52] And you know, why is this it's manifold read the article. I'm not gonna, mention all of this it's really important piece. [00:35:00] I think you need to read it. The one piece I want to land on for a second, because Steven talked about this, did some research about this. He ends towards the end of his article about this idea of immunity from previous.

[00:35:11]a Corona Corona viruses that have the common cold. So I'll read this part. I just want to have you get your feedback on this. He's talking about this enlight of people throwing this around as if some kind of it's like a magical way by which this, this by a wave of this Baton, everything's going to go away.

[00:35:27] And of course the answer is ultimately, things are just more complicated and more nuanced, and we just can't find one thing or two things. That's going to wipe away this pandemic and they're going to go back to our normal life. So he says is his brand and magical thinking in which some factor naturally diffuses the pandemic has been the convenient excuse for inaction.

[00:35:45] Recently, some commentators have argued that the pandemic will, will immune immi, imminently. Sorry. I want to say immunity, but eminently fizzle out for two reasons. First. 20 to 50% of people have defensive T-cells that recognize the new [00:36:00] Krone virus, because they are previously exposed to its milder, common cold causing causing cousins.

[00:36:05] Second, some modeling studies claimed that herd immunity, which we just talked about earlier, whereby the virus struggles to find new hosts because enough people are immune could kick in when just 20% of the population has been affected. Stephen, go back to you. what's the what's, what's the truth of this.

[00:36:21] I know you did some studies on the common cold, any, anything new that come from that. And also just quickly, is there anything relevant to this 20% of population to, that could bring about herd immunity? Yeah. So both of those, it's something that we've been thinking about a lot. so there've been a couple of recent articles that have suggested that there could be some.

[00:36:40] Basically cross-reactive antibodies that you get with the common cold Corona viruses that, that might recognize, SARS Kofi to infection. Now, that could be good or it could be bad actually, because there is, so it could be, it could protect against Cyrus curvy too. But one of the things that people were concerned about, and I don't think that this is probably too much in play, but another thing that can [00:37:00] happen, is, What's called antibody dependent enhancement where actually your immune response helps the new virus to enter your cells and give you a worse infection.

[00:37:07] Right? So it's like, it's like not clear, like, just because you have antibodies from a previous Corona virus that, that recognizes the new one is, is not necessarily your name is either, So, but I think again, you know, we were talking earlier about holding all of these different sources of evidence in mind, and now we have to keep in mind that the coronaviruses are in temperate regions of the globe, are our wintertime viruses and there are.

[00:37:30] Lot of places where earlier this year, right on the heels of what would've been their seasonal coronavirus season, nevertheless saw massive outbreaks of SARS Kofi too. So whatever was happening, those Corona viruses were not protective enough to prevent epidemics in these places. And so from an epidemiological perspective, while there might be some protection there, it's not going to be enough to save us and it's not going to be enough to cause the pandemic to fizzle out.

[00:37:53] There's going to have to be other things in place. And you know, earlier on there, there's like, you know, it's the, the sun is going to [00:38:00] burn the virus and it's just going to speculate. Right. And like, you know, yes, there's, there is probably some degree of seasonal variation and transmission, but it's, again, it's not going to be enough because you know, we see transmission in places that are very hot and very humid.

[00:38:13]And so you just sort of have to hold all these pieces of evidence together now with respect to herd immunity. it's true that, that the, you know, some of the rough calculations for herd immunity, don't take into account the structure of populations. And if you do account for the fact that populations are structured and also that the people who are most likely to.

[00:38:32] Spread COVID are also the ones who are probably going to get infected soonest. That basically tips the number of people who need to get naturally infected a little bit lower. which, which means that in theory, We might need fewer people in the population to get infected, to reach herd immunity. 20% maybe I would guess it's probably a little bit higher than that.

[00:38:51]maybe much higher than that. it's still unclear, but, but the key thing is that even in places that have seen very bad epidemics, there are still like the, the, the [00:39:00] immunity is still far from that. like there was recently an antibody study in New York city and, and the, the prevalence of antibodies in Manhattan was still.

[00:39:08] 10%. Maybe that's not enough for her to immunity. Right. And that's New York city. Right. So, so we're still a long way off from that. And, and I think that's worth keeping in mind that that herd immunity will eventually be the thing that causes this pandemic to end whether it's through natural infection or hopefully through vaccination, but.

[00:39:26] We are not close to that. And we still haven't seen quite what this virus can do. And so I think we need to really, really not rely on that to save us. Absolutely. This leads, a couple of things is the vaccine I saw here that the baby, the FDA might approve a vaccine that has at least 50% effectiveness.

[00:39:47] I'm just curious. I mean, in my mind, like that's a failing grade, you know, if you've got a 50% in school, it's you got to retake the class, right? I'm assuming that's not the way to look at this. Even having a 50% effective rate, will that do, will that, will that do [00:40:00] something significantly to help curb.

[00:40:02]the pandemic here in the U S if that's the case, if it hits 50%, not above. Yeah. It'll help for sure. but again, it's, it's like, it's one of these things. I think this is one of the concepts that's been so difficult, in society is that. Even even a vaccine will be one of many interventions that help us get out of this pandemic.

[00:40:19] Right. we have all sorts of things at our disposal, which include distancing and masking and testing and a vaccine. But especially if a vaccine is only 50% effective and especially if only 50% of people are willing to get the vaccine, which is sort of what it looks like in the U S right? Like that's, that's not going to get as close, like that will help.

[00:40:37] That will help, but there have to be other things in place as well. and so that's, that's kind of the scenario we're in, we're where a vaccine isn't sort of this, like, the savior that's going to swoop in and end everything. It's going to be just one more tool in our arsenal to help us get through this.

[00:40:51] Yeah. Great. So let's get into the big topic. Won't spend a few minutes of running long here a little bit, but I loved this article and [00:41:00] it's, it's, it's kind of. It's kind of the creating a bubble in some sense, because we're dealing with it's pandemic our minds on pandemics. And are we in the era of pandemics?

[00:41:10] I know even Fowchee, I think had mentioned this before that this could be the era and I don't know what that means exactly. So I wanted to throw it to you and just discuss this. This article goes COVID-19 might just be the first big pandemic of this century and this being kind of the century of pandemics, which just sounds absolutely nauseated.

[00:41:28] But at the same time, I feel like. You know, I'm hoping that we're learning so much with this first one that would ever, you know, maybe a long time from now, the next one happens. We've got a system in place to really effectively address it and not have it changed our lives for three to five years before we can get back to our life.

[00:41:44] So I think that there's a couple of things I want to ask you, you know, if we're living in age of pandemics, what makes this a particular age of pandemics? Is there things that we have done? That that, that, that contributes to an atmosphere that's [00:42:00] ripe for a pandemic. Yeah. So I think this is interesting. I might differ a little bit from that, that notion that we're necessarily in the age of the century of pandemics, We've seen a lot of pandemics through human history.

[00:42:12] Like we've, we've probably been in periods of pandemics more often than not. you know, there's been waves of bubonic plague that have swept through Europe and killed half of the population each time around. And that lasted for hundreds of years and cholera and, you know, typhus and influenza and all sorts of things like, like.

[00:42:32]Like we've seen a lot, you know? And, and, and so now, okay. So, but that's the types of pandemics that we've seen have changed. So, so a lot of those previous pandemics have been, largely, you know, now in hindsight, we know that they could be attributable to, Poor hygiene by modern standards or, you know, things like that, that we've been able to prevent like, right.

[00:42:52] We haven't seen a bubonic plague pandemic in, in a, in a while, you know, actually more recently than, than you might think. But, but, but [00:43:00] you know, it's, it's still been, yeah. You know, the types of pandemics that we're seeing are now shifting towards these like respiratory influenza type pandemics. Yeah. But also others.

[00:43:09] Right? We have HIV, color was, it was a pandemic. And, and I think still is, is to some extent I needed to go back like pen down the definition, depending on, it varies depending on who you're talking to. But like, you know, we have multiple ongoing pandemics right now.  and we had multiple pandemics. We had a couple of flu pandemics and, in the last century, And yet here we are.

[00:43:30] So I think that that really the key thing is that we're entering an age where, a certain type of pandemic that sweeps quickly across the world, like SARS, Coby too, is possible and is, And there is an increasing probability of these types of pandemics for a couple of reasons. Now, one of the ways that we know that pandemics arise is, through zoonosis, which basically means that a virus or a pathogen crosses over from an animal population where it commonly circulates into humans, and then it's able to spread [00:44:00] from human to human.

[00:44:00] And, and that happens with flu that's that's where we think that flu pandemics come from. That's. Where we think that star Scobey too came from. that's where we think that HIV came from, right? Like all of these things, that's where we think Ebola came from. and so one of the issues here is that, if, if the interaction between.

[00:44:20] Humans and animals is one of the ways that pandemics can get their spark. Then as, you know, as animal habitats are being eroded, as humans are encroaching on the habitats where, you know, animals tend to be we're, we're increasing the rate at which these interactions can happen, that that potentially could spark a pandemic.

[00:44:37] So, some of the same things that, you know, contribute to, urban crowding and industrialization and, You know, the farming practices that sort of, you know, wipe out animal ecosystems and sort of push people right up on the edge of, of these things. You know, all of these things are absolutely contributing to the development of, and to the emergence of new pandemics that we'll have to face over the next century.

[00:44:59]No, we, we [00:45:00] get a couple of flu pandemics every century, regardless. I was a little bit surprised that this pandemic was a coronavirus one because I was expecting a flu one we're we're, we're kind of due for one. you know, which is, you know, I hate, I hate to say that, but, but so, so there will be more pandemics the century.

[00:45:15] Absolutely. And some of them will be, you know, to some extent, attributable to this, more frequent and different types of interactions that people are having with animal populations and the spread of the population, that kind of thing. so I think that that's kind of what we're getting at here is that some of these factors that are contributing to.

[00:45:31]Yeah, you could link some of them, even with like other ills that we're trying to face, including like global warming and these sorts of things. It's, it's not that like global warming is a cause of pandemics, but I think that they're, they're, they're they share related to causal factors to some extent.

[00:45:46] And so part of the thing is that addressing both of these issues can, you know, at a deeper level could, could potentially help us address both, which is an important thing to keep in mind. But, yeah, so we've had lots of pandemics. but I think the key thing that distinguishes us now is that we're [00:46:00] actually in a place where we can.

[00:46:02] Prevent them more easily, you know, previously, like we're, we, we, we did and have a robust germ theory for a very long time. Right. And the, and because of that, we couldn't really know like how to intervene against pandemics. So we were sort of at their mercy. So I think what actually marks this new era is not necessarily that it's an era of increasing pandemics, but it's that this era, it's this era of like dissonance at irony because we know what causes them and we kind of know what we need to do to stop them.

[00:46:28] But. But now the question is where we have the will and where we have the effort that we need to put in to do that. I think that that's the key thing that distinguishes this century from all others. That's great. You know, we were talking about this off the air and you already mentioned it, but I want to kind of reiterate, because I loved what you were saying is I had a friend come to me again, who doesn't really necessarily agree with coronavirus and pandemic and it's conspiracy.

[00:46:50] And again, I don't know if this is true, so we haven't looked at dev yet. I'll look it up, but apparently allegedly. One of the premier members who said something like, like [00:47:00] the reason why covert exists because of global warming. So then he hijacked that said, see, I told you it's conspiracy is another reason why people are just trying to use this to promote their puppet initiatives.

[00:47:10] And so, again, I don't know if that's true, but the concept was important. You were just saying, I love this. Like whether that was said or not. What the, the purpose, the point of this is that both Corona virus and you were saying global warming. It's not that one. Cause the others at the share a similar cause.

[00:47:27] Would that goes up the chain. And if we address it, that parent issue, we begin to address both issues at the same time. Well, when we went, when it killed CBREs stone and not to put that in lightly, because we just talked about animals and touching them and stop, go out and get rid of them. That's not the solution to the problem at all, but I want to end on this and then this might be putting you on the spot.

[00:47:46] We talked about the, the micro, solution, wash your hands, put on a mask, keep your distance. But what about the macro solution? I know this is not a solution, but we talk about this on a, on a, on a global scale, on a much more preventative [00:48:00] measure. What are what's one, two, three ways to think do to help do our part, to keep it an environment which it's not fall.

[00:48:09] It doesn't fall prey as well to a pandemic. Any thoughts? Yes. Yeah. I mean, that's an incredibly complex question, because there are so many competing incentives there. and, and it's one that the people are working on diligently at the moment, but I think that, you know, one thing of course is, You know, being mindful as, as we were developing our countries and our economies and these sorts of things, just recognizing that this is an important imminent existential threat.

[00:48:38]and that, you know, just, I think that the response could range anywhere from, you know, reducing some of the, disruption of habitats and deforestation and these sorts of things. Finding ways to do that by. Changing our economies changing our patterns of consumption, these kinds of things.

[00:48:57] Right. These are like really big things. But I think that that's, that's the sort of thing [00:49:00] that it'll take. Yup. and then also developing public health systems that are a lot more robust that are able to detect these things quickly. recognizing that this COVID is not a one off thing, you know, like this is, this is going to be something that we'll probably see something like this again, probably in our lifetimes, you know?

[00:49:18] And, And so recognizing that and not getting through this and learning, you know, Oh, well know, wasn't that crazy, glad that's over and done with, we're never going to have to deal with that again. Right. Like we really need to like, realize that like, it's going to be there, there are some economic adjustments and interventions that are necessary, but then also development of public health resources so that when these things do inevitably emerge, right.

[00:49:39] Because again, they have throughout all of human history. Don't think that we can totally avoid them, but we can prevent this emergency new infections from spiraling out of control, similar to what happened with, with the original SARS virus, right? Like we were able to contain that. And some of that was due to the biology of the virus itself, but a lot of it was due to quick.

[00:49:57]And thoughtful response, on the part of public [00:50:00] health agencies. And if we can build that response globally, rather than just in particular countries than, than I think we'll have a much better shot at preventing these things from spiraling out of control, like this one has awesome. That's a great way to end it for all you young cats who might be listening right now or in high school.

[00:50:13] I have no idea how many people were actually in high school, listening to this or college, your career, your future. This is a great opportunity to really invest because this is, this is the air, but which really it's the new frontier, right? It's a new, it's a new war, to help.  The whole world, a quality of life, right?

[00:50:28] Yeah. Thank you. So let's end this, if you want to get into today with Steven S T E P H E N K I S S L E R on Twitter, [email protected] Let us know how you're doing. What's going on your side of the world country, wherever it may be. Please support us $350 left to help pay off the equipment that we can run on maintenance mode with the awesome, wonderful, donors and patriotic supporters.

[00:50:54] And, check out my living the real podcast. Go to live in the If you have 15 minutes, please be greatly [00:51:00] helpful. And I hope you have a wonderful week and we will see you next Monday. Take care. Bye bye.