Pandemic: Coronavirus Edition

What's the deal with Boulder, and where are the deaths with the increase of cases?

September 28, 2020 Dr. Stephen Kissler and Matt Boettger Season 1 Episode 44
Pandemic: Coronavirus Edition
What's the deal with Boulder, and where are the deaths with the increase of cases?
Pandemic: Coronavirus Edition
What's the deal with Boulder, and where are the deaths with the increase of cases?
Sep 28, 2020 Season 1 Episode 44
Dr. Stephen Kissler and Matt Boettger

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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 today's crises. My name is Matt  and I'm joined with my good friend, dr. Steven Kisler and epidemiologist of, or at the Harvard school of public health. He's not actually the building itself or the university.

[00:00:14] He is a person. And dr. Mark, here he is. And dr. Mark has gone. He's at the hospital doing his thing, Stephen. Good to see you, man. How you been? 

[00:00:23] Stephen Kissler: [00:00:23] Yeah, I have. It's good to see you too. I'm doing well. I'm doing tired. Well, that is 

[00:00:28] Matt Boettger: [00:00:28] awesome. Great hashtags for this episode. I'm doing tired. Exactly, man. I, you were just talking about off the air, just.

[00:00:37] Like everybody else wrestling with, well, I think you're in a whole other level because like, for me it's how do we cope? How do we do things? How do we see friends? You mentioned this off the air, but you are more of a consultant as well to all of your friends as well were like, wait a minute, I am going to go to this.

[00:00:53] What should I do? So that's 

[00:00:54] Stephen Kissler: [00:00:54] got to be exhausting, man. Yeah, yeah, no, it is. I mean, I think we're all, we're all sort of bearing our own exhausting things in our own [00:01:00] way. You know, like you were saying, you were just up with kids a lot of the night. That's not something I have to deal with, but that's. it's, you know, we each have our own, our own burden to bear.

[00:01:10] Matt Boettger: [00:01:10] So yeah, we're recording this a little bit later than normal because we were to do it earlier, but my youngest side to get up at one and then it just kept us up almost all night. And then, all these great articles that I had clipped were just empty when we were getting ready for the podcast. So I had to find some new materials, so it was just one of those perfect storms, but we're here.

[00:01:29] We still have some awesome content. So let. Get going before we go. I'll obviously, always please leave a review. You can find the link in the show notes, to have a podcast. We love them and helps us rise in the rankings. Get, get the most exposure. Here's a couple that just kind of facilitate why we're trying to do this here.

[00:01:46]one is from, let's see, got em. It's kind of a little bit, hold on. One is from M stock 23 and he says, or she says, thanks. I appreciate any news source that offers unbiased, non political information analysis of [00:02:00] coronavirus so far. This is the only one I've found. And that's awesome. And also incredibly sad that we're the only one that he's found so far chic.

[00:02:07] That is really sad. Yeah. That's, we're trying to here to do other one Q 27, Al thank you so much for this informative and clarifying podcast. It is particularly in these times when there is so much misinformation and disinformation circulating a relief to come upon information of this quality. Thank you so much.

[00:02:23] Thanks. Q two seven L and M stock 23. That's so helpful. And if you can, please, please leave a review. If you can also, still trying to raise the last 350 to pay off everything. Thank you so much for all your generosity. If anyone has the means would like to. You can do that really simply just go to show notes, PayPal, Venmo links right there.

[00:02:42] One time donation would be incredibly. We'd be incredibly thankful. Okay. We start with this Steven, a question from Debra. I think this paints a good picture for, for all this stuff we were chatting about just before we even recorded. It kind of is the big umbrella. She says, thanks for your podcast. A quick question.

[00:02:59] And this [00:03:00] is, this is by the way, the question I've been getting at in Boulder at CU as well, just this past week, I see if a case is rising, rising, especially sadly in Boulder. We'll talk about that. That in just a few minutes, it is a bummer, but all, but she says bummer, but all over where I see cases rising, I don't see a similar rise in deaths.

[00:03:18] Hmm. What's up with that Debra ass. So, Steven, I know we had this question kind of similarly around Memorial day. And the aftermath of this. And I think this is kind of a similar question and what is going on and why we're seeing the increase increases in infection, but not death rates. 

[00:03:34] Stephen Kissler: [00:03:34] Yeah. so great question.

[00:03:36] And I think it remains, it remains relevant and will throughout the fall. And, and I think you really, the biggest part of this is, is the lag. and we hear about the lag between, you know, cases and hospitalizations, because it, it takes a while for a person to get sick enough to go to the hospital. But there's also a, an epidemiological side of this too, which is that, you know, One of the things that's really driving.

[00:03:57] A lot of these rises in cases, there's students going back to [00:04:00] school. and many of those people are young people and so, are less likely to go to the hospital anyway. and so there's, there's that additional delay then where those people then have to infect other people who then infect other people who then in fact, people who may go to the hospital.

[00:04:15]and so, So I think that we're, there's the biggest, the biggest explanation for it really is as the lag. Now, part of it too, is just the increased amount of testing that we're doing. So we're able to see these increases more quickly, and we had just sort of more sensitivity in a way to see the cases starting to rise.

[00:04:33] Hmm. And you can actually see this. If you look back at, the relative number of cases and deaths in the U S overall or in some of the places that sort of saw two different waves of spread, thinking about Florida, Arizona, and you know, what, what you see is that the relative number of deaths for cases was, was pretty high in the spring.

[00:04:51] And part of that was because we really weren't. Testing alone. We didn't have our testing capacity at very high. And then as it went on, there was definitely, there was about a month long delay between cases and [00:05:00] deaths, for example, in Florida. nevertheless the deaths Rose, but they didn't, even though the number of cases was a lot higher than what we saw earlier in the spring.

[00:05:07] The number of deaths was sort of comparable to what they saw earlier in the spring. And that's because of the increased testing. So we're sort of seeing that as well, where we're seeing a lot more cases. So. Unfortunately, you know, unless, unless we're able to keep a handle on things, you know, one thing leads to another, you know, it's, there's really no way to avoid it unless we really can tamp down spread quickly.

[00:05:29]and so, unfortunately I think it's, it's probably yet to come, But again, I'm, I'm hopeful that, we'll be able to, we know a lot more about what we need to do to prevent the spread and, and the only way to prevent those downstream deaths and hospitalizations is by preventing the spread. Now, even if right now the spread is in young people.

[00:05:46] Yep. 

[00:05:47] Matt Boettger: [00:05:47] Yeah. I know we see a couple articles. I just I've been seen this past week and the Midwest many States I'm like, I mean, it changes every day, so it's hard for me to even. Just know where we're at. Like it's 21 States, 22 States are seen [00:06:00] rises, kind of build up. I see his article about a, I'm not sure what this exactly means.

[00:06:04] I kind of have an idea, positive Coke. COVID-19 test rates, top 25% in some U S Midwest States. So we're seeing a rise in the new year, say maybe about four weeks or so ish. That typically we started seeing a rise in death rates subsequently. Now I think it makes it all more complicated with Boulder. We're talking about this, just like the sadness of this, where there's a couple of things we'll talk about are if you guys have heard in the U S or maybe over overseas, that.

[00:06:32] Boulder is taking a particular stance, on, on a lockdown. And we'll talk about this and whether it's a good thing or not so good thing, but I think it's all the more complicated with college towns because it, again, same thing, it's a rise among young students, which we do know they're not escaped from mortality from this, but it's, it's, it's, it's obviously a, a, maybe a lesser on the scale of this.

[00:06:53] So we're, this is one of the things that always kind of makes me a little unsettled. Cause, you know, I'm having conversations, [00:07:00] you know, within, with college students and all over the place at Boulder and they see the rise of, of infections and contagiousness and the rates of COVID. But then they're meeting questions.

[00:07:10] Like, look, there's no deaths, you know, so that'd be deal. I'm like, do we, do we really have to have that be the litmus test of like, Okay. Once we get a death and we lose someone, then we can say, okay, let's talk, let's start taking this seriously, or can be a little preventative, but it makes it complicated, right?

[00:07:24] Because there's college students. So they themselves have to probably go, well, you know, generally speaking, go hang out with some elderly people, some older people, some immune compromised people. And then another three or four weeks before we see the collateral damage. And so let's get into this because I think it's fascinating.

[00:07:41] Last week. I may not even know it until somebody brought it to my attention that Boulder took a unique stance. So to paint a picture for you guys, Boulder is a college town. when, when you know it wouldn't. The students come to Boulder. I don't know what it does, but I feel like it almost doubles the size of Boulder.

[00:07:57] It's just an enormous population increase. And [00:08:00] so they have an enormous influence on the whole community. And so imagine Boulder is an older, slightly older demographics, older demographic. It's incredibly expensive to live there. We don't live there. We have to live far away from Boulder. And so, it's a wealthy town as well.

[00:08:13] A lot of people who've retired. professors as well. And so there's been an increase of COVID cases and we saw that it looks like almost 80% of the cabal cases are around 18 to 22 year olds. So we're, I mean, this is not a big shock, right? I mean, they were going to be at new Orleans, new Orleans, you know, Northern library doing their studies and their individual cubicles.

[00:08:33] They were going to be other places you've heard it before the Hill party and those kinds of things. So as of Thursday, there was a dramatic shift. But by the whole, like the muni municipal court, it's, it's, it's the city of Boulder saying for two weeks, two weeks, Steven, that anyone between the ages of 18 and 22 can not do anything outside of a party of one.

[00:08:55] Like, literally that is it. They literally say if it's more than one and [00:09:00] yourself that is breaking the law. Right. and that there is there, you can go to jail for X amount of months. There's definitely, I have to be fine for two weeks. You can do nothing. Besides be with yourself now, what is your opinion on this Steven of like, is this inappropriate thing?

[00:09:14] Is this considered a surgical maneuver? Because it's a demographic 18 to 22. It's an interesting surgical approach. Is this the best thing that they should maybe be doing? 

[00:09:23]Stephen Kissler: [00:09:23] Yeah. I mean, so that's a, that is quite a response. And, you know, like you said, I've, I, I'm not totally up on all of the details of, you know, what, what the, what the new mandate States, but, it's pretty important to reduce spread, you know, that's something that we know for sure.

[00:09:40] But at this point in the pandemic, we have pretty good sense of what we need to do to do that. And we know that relatively speaking. Small gatherings, bubble type things, you know, where you're only seeing like a small number of unique people over time, masked, outdoors, like all of these things are very effective at reducing spread, and can mitigate the, a lot of [00:10:00] the other problems that can come along with.

[00:10:02] Literal isolation, for long periods of time, especially at a time when people are separated from their families, many of them for the first time, are in communities that they may not fully feel a part of. you know, it's, my transition to college was a pretty rough time in my life, you know, like it's, it's, it's really hard.

[00:10:20]and I think that, you're both being separated from all sorts of community and, And also, you know, having like some of the consequences that you mentioned are pretty severe, like there's, there's like a certain fear of, you know, in addition to the fear that comes along with contracting or spreading COVID now there's also a fear of, of, of legal response as well.

[00:10:41] If, if you're seen with another person, and I mean, So the real danger. So, so I want to, I want to think about this from a public health perspective. and public health is full of a long history of, of very strong responses, trying to get people to change their behavior. and oftentimes [00:11:00] the strictest measures, can backfire.

[00:11:03] So we think about this a lot with, with respect or like national travel restrictions, and often those can delay the spread of infection, but, But there are circumstances in which people do need to travel. Okay. And, and so sort of issuing a blanket statement about that. It can lead to a lot of sort of, resistance and it can sort of undermine the credibility and the authority of, of the policy makers.

[00:11:25] And that's what I'm worried about here is that, that with such a strict set of guidelines that frankly, You know, w we have, we have ways of controlling the spread of this virus that are not that strict. and, and I, and I fear that it will undermine and sort of create this antagonism when, when public health public health is built on trust, you know, like nothing works unless we trust each other.

[00:11:48] And unless we trust our authorities. and, and that's been part of the tragedy of a lot of this. Pandemics so far is that I think that, for all sorts of reasons, we've lost trust in each other and in our authorities. Yeah. And, [00:12:00] for all sorts of different reasons. No. We were talking a lot about lockdowns earlier in the pandemic and, and, and sort of like, so, so what am I doing here?

[00:12:07] Right. Like I was certainly and advocate for, for sort of large scale lockdowns early. Yeah. And the pandemic. And where are we now? And, and, and again, it's, it's, it's because we've, we've learned so much, you know, early on in the pandemic, We didn't know if spread was indoor, outdoor, droplet, Harris, all, whatever.

[00:12:21] All we knew was that it could bring cities like UConn. It could bring cities, like, Milan in Northern Italy to their needs. You know, it could completely overwhelm places and we didn't know where it was, how it was spreading, but we knew that something needed to happen or else we would see a similar sort of catastrophe in cities here.

[00:12:37] And so we needed to sort of have this like blanket response because we didn't know anything, but we knew enough to know that this could be catastrophic. Yeah. We know a lot more now. And, and so I think that like, it's, it seems like the, the order that's in place there is, is as to try to prevent is to try to prevent parties.

[00:12:54] It seems like, you know, it's to try to prevent like large gatherings of people, indoors or outdoors, but, you know, it's [00:13:00] like, it's a very specific thing that is trying to prevent, but it seems like it's doing it in a pretty good. Crude manner. and it concerns me, you know, I, I worry about trust going forward and trust is what we need most.

[00:13:11] Matt Boettger: [00:13:11] I agree. And then, you know, I talked to my sister about this, which was, she's been on early on a couple of times. And, you know, her first response was, Oh, I wonder to see you has a bumped up. There are counseling services because this is going to be a, I mean, that's the, I hope they really proportionately leveraged, you know, all of the possible resources they can have because this is.

[00:13:30] I mean when I meet with students, you know, I mean, obviously right. They don't have happy faces right now. They're they're frustrated. and the point of tears, right? This is a whole me being 42. I don't think I'm ever going to truly appreciate like where they're at. I'm so removed and the need for this kind of community after all.

[00:13:48] That's why they, well, okay. Hopefully they helped me with, I came to college for an education too, but they also came. For the connection and the community and to find themselves. And then all of this is just so it's, it's all the more, I [00:14:00] think, this, this, this, this law or this or this, whatever we want to call it, it is all the more, I think, painful for the suit for the college students.

[00:14:07] So, yeah, it's, it's crazy. I agree. It's it's really is just cracking down the parties. That's that was the issue, on the Hill, lots of them. This was their way to crack down on it. could there be a different, different means of doing it? I'm guessing. So, as he said, we've learned so much and it gets me this next article, but this is related because we're no longer in March.

[00:14:26] We're not in April. We're way past that. We're now approaching October. And even though it's been seven months or eight months, whatever, it's been a long seven months, it feels like five years. And I feel like in some sense, we've learned about an unknown virus. And amount in seven month period, what sometimes takes years and decades to be able to understand appropriate.

[00:14:46] So thankful for that for a worldwide effort to do this. And here we are with a seat, see reversing its guidelines on this airborne virus. Okay. And I have to tell you, Steve, I'm reading this stuff and I'm like, you know, I, I [00:15:00] WTF, like, I'm just, that's all I'm going to say, like what is going on because. Who gives a rat's behind.

[00:15:05] I say that only because I don't want to have to put the curse word filter on this episode right on that. But like, I just don't get this Steven, because I'm seeing this, that we're, we're all this effort in the media is talking about the reversal and it's airborne. And does this even matter, Steven? I mean, am I just buried my head in the sand or have we come to the point in our podcast episodes?

[00:15:24] Like, look how this thing spreads generally speaking. I mean, if you want to do that 2080 rule, and I think it's even more than that, it's like 20, 99, even though it doesn't add up, but like of just it's about duration of exposure, proximity, right? So in my mind, it's, it's not a CA it's not these like these evil little molecules, once one hanging around at whole foods, just waiting to infect someone.

[00:15:47] And that one little molecules is destroy a population, maybe, but it's like, it seems so outlandish. Like, what is the point of this that we're talking about? Isn't the truth just let's stay away [00:16:00] from big grout groups indoors. Let's keep masks. And I put this in the context of Boulder only because again, I think this reflects maybe.

[00:16:08] We we've learned so much and we've gotten so far, this may not have been the approach necessary to be able to, is this really important to talk about still. 

[00:16:17]Stephen Kissler: [00:16:17] I mean, so it's, again, it's like important from a scientific perspective so that we know sort of, you know, what this thing is and how it spreads. And as we're getting, you know, hopefully eventually we get to the point where, you know, we're really trying to tamp down infection as much as possible where, you know, I was just talking with a friend of mine from New Zealand the other day, you know, and they're, essentially all restrictions are lifted.

[00:16:38] He was telling me that they, they didn't have any new cases in the entire country yesterday. Awesome. Yeah. Right. And so, so at that point, they're really trying to like prevent every, every single transmission if they can. And that, but that's, that's a different game, you know, over there that they're playing right now where we're just trying to like stop the, you know, we're like trying to slow down the train a little bit.

[00:16:58] And, and we know, I think [00:17:00] the, the, the biggest issue is that there's, so frequently I think in public health, but also in so much of our discourse, we, we enter into the either or. Mindset rather than the both and mindset and how does everything fit together? And so it's either droplet or aerosol, but that's not, that's not the case.

[00:17:15] It's, it's both. And it's predominantly though cover this PR like every shot out of evidence that we have available is that, the phrase you used earlier was the meat and potatoes, right? Like that's, that's the way that it's largely spread is through close, long duration, indoor air contact. That's you know, that, that, that all of the contact tracing that we've done, you know, it all seems like that's, that's really the predominant mode of spread and like, you know, can aerosolized virus spread, you know?

[00:17:43] Absolutely. That's that's, you know, it can spread that way for sure. But if. Yeah, that's the key thing about epidemiology is that we don't need to stop every single transmission to get on top of this virus. Right. We need to stop some fraction of them. and, and if we're interested in stopping a [00:18:00] fraction of them, we can do that through all of the things that we have available.

[00:18:03] And like, we know, we know we know how to do that. And so there's, there's no big shifts here. There's no like. Breaking news that like all of a sudden everything that we thought was like thrown out, thrown to the wind. It's like, it's, it's the same virus that we've been dealing with. We know a lot of what's effective and we're learning about it.

[00:18:20] You know, this is, I don't want to say that this is unimportant. And I think that it is important to acknowledge that this is a possible route of spread because, Yeah, it is there it's and it, and it, it, it, well, I think the value of it is that it shows that the, you know, six foot masks rule is not like, like this like magical barrier.

[00:18:41] That's going to prevent everyone from getting infected, which is also sort of like this, this idea that, that seems to have taken hold, you know, like, It's not, it's not this perfect bubble that you're building around you, but, but it's, it's, it seems to be sufficient. Yeah. and so that's the important thing here?

[00:18:58] Matt Boettger: [00:18:58] No, I think you're right on, [00:19:00] this is something I'm just particularly passionate about Steven. I think it's just like, I, I just love, I love the idea of maximizing what I can get out of my investment. Right. That's anybody's desire. Right. And so all these extra layers of insurance policies that we add up that might.

[00:19:16] That might help, but at what cost, you know, I think we see this is a perfect example with Boulder. This, this might help. It may be not help, too. It depends on, like you said, if, if there's this mass like Exodus of like, you know, screw this, right. That's not going to help it, but it may help. But what about what consequence or in this?

[00:19:34] I think this is the issue, isn't it? Cause even like the, both sides of the issue of those who are, I don't want to, I, I it's like there's no either or so everything is a false dichotomy. It's not like pro pandemic against pandemic. It's obviously it's so much more nuance. There's a whole flavor of what you see about Kobe, the response, how we should behave.

[00:19:53] And everybody I think is on the same level, except for, I guess if you say. The extreme conspiracy theorists that believe [00:20:00] that cover doesn't actually exist. That's what I think on a different playing field. But those who actually believe that COVID is something we're all in this same spectrum of like whatever we do, we've got to do it in such a way that as we said, back in March, that the solution isn't worse than the problem.

[00:20:15] And you're all for that. Everyone's all for that. And as we've gone through and we're now we're in October, we've kind of fine tune that answer a little bit. And it seems to be working pretty well. And we don't have to have all of, all of this. We don't have to have every single possible infection of COVID down to zero.

[00:20:30] Right. I think Fowchee was saying, if we got it down to 10,000 a day, we'd be in a great spot. Right. You know, and, but we're, you know, we're not there. So I'm just mesmerized. I'm confused. I see why those people who are hesitant, like you said, or distrusting, because these things happen. And we're wondering, what is this really.

[00:20:50] Is this really the right solution or somebody being lazy. I don't know, but it just doesn't seem so. Thanks for sharing that. another thing in light of more [00:21:00] stuff about this, like, the Scotland stuff, this is kind of the same complexity. I saw this yesterday, Steven, and I'm like, Oh, I wanted to pick your brain.

[00:21:07] You had some interesting insights. So Scotland is having another surge. If you don't know yet. And they're trying to understand what they're going to do. I'll put the link in the show notes. I think you have a link as well that you can give to me. You mentioned off the, off the air about this a little bit.

[00:21:21] So Scotland initially did apparently a pre pretty significant lockdown had like roughly 4,600 death cases. Then you have Sweden. have like, I don't know, I'm just guessing it's roughly 5,600 death cases who didn't do a lockdown and now Scotland's like, Whoa. This was pointless. And we see that, you know, the economy for Scotland was more than twice impacted as Sweden.

[00:21:47] They're looking, they're looking to Sweden saying they might be the answer. Is that, is that where they should be going? Is it more complicated? Is there a difference between Scotland and how can we use this to navigate our own train, the terrain here in the U S [00:22:00] of those people who were like, see Sweden's the answer, 

[00:22:02] Stephen Kissler: [00:22:02] right?

[00:22:03]Yeah. I mean, it's tricky. Like, you know, it's, The, one of the canonical rules and epidemiology, is that something that works in one country, like almost as a rule will not work in another, when we think about building models. So like the example that I'm thinking of is that there is somebody who is building a model of how measles dynamics work in different countries.

[00:22:23] And, you literally have to use different models because in some countries, the dynamics are. Totally governed by birth rates. Basically a new measles outbreak comes every time you get basically a new pool of susceptible kids being born. Whereas in other countries that has much more to do with vaccination rates and geographic dispersal of those things, you know, it, and it leads to totally, totally different things, even though it's the same virus, right.

[00:22:47] And it's due to differences in population structure, how the population is oriented in space, all sorts of things. And so, The good thing, you know, and in this article you mentioned, they were saying that, you know, the edge, it shows [00:23:00] that, this light touch approach that Sweden has used can't work.

[00:23:03] And it's true. I mean, it's that, it's like, you know, it's, it's true. To some extent, it depends on your metric of work too. You know, they've, they've had a much higher fatality rate than anywhere else in Scandinavia as well. so it's worked on some level and. Really failed in other ways. And, and so it really depends sort of like what your end goal is here, too.

[00:23:20] Sure. but the other key thing is that I've been spending more time sort of thinking about how Sweden differs from the United States. But some of the key things is that the obesity rate in Sweden is way lower than it is here in the U S and also the proportion of people living in single occupancy households is way higher.

[00:23:37] Right. So this goes back to the motive spread, that we know that there are very clear risk factors for severe illness. And we also know that prolonged indoor exposure is the thing that leads to spread. And so if you're living alone, you're gonna have far fewer opportunities to spread to other people.

[00:23:51] And it just, the epidemic is going and to stay more contained. And so it's really important to bear these differences in mind, as we were thinking about, you know, what, what can work for [00:24:00] one country versus another same goes for New Zealand, you know, like great for them for basically having no cases, but like, you know, in the U S we could try to emulate that, but we can't, we're not an Island, you know, just not going to work here the way that it works.

[00:24:13] And that's just because of the constraints that we have for being the country that we are. and so each country has their own challenges. And so I think that, You're jumping too quickly to saying, you know, we should have a lighter touch because it worked for Sweden is, is, is a little bit dangerous.

[00:24:26] You have to like, look at your, the demographics of your population. You have to look at, household occupancy. and you also have to recognize that there's, there is a lot of randomness here too, you know, part of the cases that were in Scotland were probably driven by their proximity to, you know, the.

[00:24:41] There there's a lot of movement between there and London, for example, London as a much bigger city than Stockholm. and you know, so all of these things play into it. And, and so I think the most important thing we can do is, implement the policies that we think are best, but maintain really strong surveillance and make sure that we're able to turn [00:25:00] on a dime if things start spiraling out of control.

[00:25:03]so I, you know, I I'm, it's totally. I think it's fine. If, if Scotland feels like they, that, that the best thing for their country and for the, for disease control is to have a lighter approach. You know, like they said, Sweden has had some success in some areas in doing that. And so, you know, that that may be, that may be a way forward, but, but you gotta be prepared to 

[00:25:25] Matt Boettger: [00:25:25] change course.

[00:25:25] That's great. That's I think it's perfect. I just love what you said. It just shows again. The complexity. You're just India. Like Sweden did have good, some good results. It's great. We're you know, it's not like this, like lockdown pro locked down, antilock down. It depends on where you're at what time what's the situation, the circumstances it's, it's, it's part of the process.

[00:25:43] So thank you for that. It helps us again, show the complexity for those people who still come to me and like, see Sweden was the answer. We should have done this. And again, It's it's way more complicated than that. And thank you, Ken, for elevating that once again, again, hopefully this was useful for those of you who are listening for those of you who I still come [00:26:00] encounter with these kinds of people, just to elevate the complexity of the situation.

[00:26:04] A couple more things I want to chat before we close up. I see this often as well, and this is kind of related to what we've been talking about as well. We talked about, I wanna talk about the fall. What's going to be expecting in the next 12 months. We, I know we talked about this last week, but again, I just keep seeing these articles that I want to throw it past you.

[00:26:22] To me, I feel like it's sensationalism. When I constantly hear it's not going to be over until 2021, the end of 2021. And for me, I feel like it's a little bit of fearmongering because what is over mean? Is it that like, is it the last possible residual effects of the coronavirus are finally over? Will it be over?

[00:26:41] Cause I get the sense the way the article drums up. Is that okay, well, next spring is going to be not too different than last spring, but I just feel like everything in my heart says, and my mind says that's not the case. Like next spring's to be fundamentally different than last spring. So this concept of over number one, as you mentioned off the record, I think is misleading.

[00:27:00] [00:26:59] Number two. I don't even know what that over means in the context of next spring, because in my mind it's going to be a lot better. Next summer is going to be a lot better. And so this it's more sensational, Steven. 

[00:27:12] Stephen Kissler: [00:27:12] Yeah, no, I think you're right. It's I, I'm pretty optimistic that next year will look a lot different than this year.

[00:27:18] Did. Book-ending epidemics is a really difficult thing to do, you know, with, with viruses, with novel viruses, like SARS Kofi too. it's a little easier to pinpoint the beginning. You know, we can say, you know, like crossed over at this point, even though it's been sort of evolving and moving around, probably, you know, like in different animal hosts, whatever, but like we can say, you know, the first jump into humans, like we can sort of pinpoint that start date very easily.

[00:27:42]But if you think, like  in the history of the world, there have been very few ends dates for any, any pathogen whatsoever. You know, we have an end date for smallpox, that there was, you know, we've, we've, we've managed to eradicate that. just recently, you know, great news that the, [00:28:00] that polio, appears to have been eradicated from the African continent, you know?

[00:28:04] Awesome. Amazing. Yeah. It's still circulating elsewhere in the world though, you know? And so like, what is, what is actually the end and, It's hard to say, you know, so I think it's pretty clear to me. Like I would be absolutely shocked if, anytime in the next few years, like I think, I think Sergeant Kofi too will be with us for a very long time.

[00:28:25]you know, I think that the virus will continue to circulate through 2021 and. Probably through 2030. And it's just like, I think that it's likely that it will continue to circulate, but we'll find ways to manage it. Hopefully our bodies will build up a bit more of an immune response to it. Maybe it will become a seasonal type coronavirus.

[00:28:42] Maybe it will be more severe than a seasonal coronavirus. I'm not totally sure what that's going to look like, but I think it will be with us for awhile. But the question of like, when will the pandemic Veo? I think it's tricky. I don't think there's going to be an end to it really. I think that, you know, next spring again, We know a lot more about the virus.

[00:28:58] We'll have a lot more testing. Hopefully we'll [00:29:00] have some vaccine candidates that are starting to be distributed to people and that will help. And that will give us, you know, each of those things, in some sense, buys us a little bit more freedom and a little bit more sort of agency over our lives. and that'll be way different than this past spring, where we had no idea what we were dealing with.

[00:29:14] And then we have these widespread locks. I don't think it's going to look like that. And. It, it will probably continue spreading and it may continue spreading through the summer and the fall. And I think that's it, there there's something good behind these, these, proclamations, you know, it's not going to be over until the end of 2021.

[00:29:31] I mean, in some sense, I think that I might be a little bit responsible for that because this year it was basically, you know, it was saying that essentially this, you know, that we're going to be dealing with us for a long period of time. And that was, that was the crux of the paper is like, we need to be in this for the long game.

[00:29:47] Yeah, that's true. we're going to have to find ways to manage and deal with this for a long period of time, but that's the thing we're, we're, we're transitioning from a state of sort of acute acute care to chronic care [00:30:00] population. Since we're trying to figure out how to live with this, how to live our lives in the midst of it.

[00:30:05] And I think that we're going to have more and more. The technologies and strategies between testing and vaccines and treatments, to be able to do that and to do that well. and most importantly, among those just knowledge, knowledge of how it spreads knowledge of what constitutes yes. Behavior, that's, that will help.

[00:30:20] So, so I think that, you know, it's. Yeah, I, I'm not going to pick an end date because in some senses, I think 2120, the end of 2021 maybe is like too long in a sense. But in a lot of other cases, I think it's way too early, you know, like I think it's going to be with us for a long time after that. But, but what that actually means concretely for our lives, I think is, is, is different than what it might seem on the surface.

[00:30:41] Matt Boettger: [00:30:41] No, that's helpful. I think the reason why I wanted to bring it up is because in my mind, When I hear these things, and I would imagine there's probably a few listeners when he sees articles. It's, it's hard not to think your current experience April and apply it to that, that, that measurement. And I just want to just put that down.

[00:30:58] I, I, as you already said, [00:31:00] I don't think on any level that's going to be the case. And I think when we say the longterm that it may never be over. I mean, just thinking your image, what you just said, Steve and other people were listening like polio and these things that like that's stuff will subsist in certain counties, but it's not at the top of your mind.

[00:31:14] We've learned to live with it, not in this white knuckle sense, but in a proactive sense. I think that's what I think I wanted to, like, I want to help free people to think that I don't think it's gonna be the white knuckle version of in 21, but it's going to be more of dislike. Open up and we're free or sense of, it's not a top of mind.

[00:31:31] That's because we learned the way to deal with deal with it and go back to our new normal. Hey, Andy, some things about living with it are going to be awesome. You're going to go to a hotel place and it's an East spotless for the rest of your life. They're there, they've nailed the cleanliness. That's going to go forever and ever, and ever, right.

[00:31:47] There's some great consequences that a, you know, for, for those of you who are worried about germs 

[00:31:52] Stephen Kissler: [00:31:52] and hotel, 

[00:31:54] Matt Boettger: [00:31:54] so PSA for you guys. Okay. Before we land this, you just talked about vaccines. What's the update [00:32:00] on vaccines. Is there anything coming out of pal? You were mentioned like Johnson, Johnson. I'm out of this loop.

[00:32:03] I don't know what's going on. What's the update on it? 

[00:32:06] Stephen Kissler: [00:32:06] Yeah. So there's a, another vaccine candidate that has entered phase three trials being produced by Johnson and Johnson, which is great. you know, again, the more shots on goal, the better, one of the good things about this, that people have been excited about is that most of the other vaccine candidates require two doses.

[00:32:20] And this one only requires one. Nice. and so that could make it a lot more sort of scalable, which would be great. so, so that's, that's really one of the key things. there have also been reports with one of the other vaccines that there may have been a couple of, adverse reactions to it. severe adverse reactions.

[00:32:35] And I think we're just going to have to stay tuned and see what that means for the development of that vaccine. And that was that one again. It's I believe it's AstraZeneca. 

[00:32:43] Matt Boettger: [00:32:43] Yeah. So that's the same one from, and I'm curious, have you had any updates on Moderna? Cause that's like Greg, your neighborhood, right?

[00:32:49] It's in India, 

[00:32:49] Stephen Kissler: [00:32:49] right? Yeah, just up the road. But, yeah, I, I haven't heard any updates, but I, I, during a phase three trial, I think that no news is good news. you know, it's [00:33:00] cautiously speaking, but, yeah, 

[00:33:02] Matt Boettger: [00:33:02] so great. That leads us to that. We're at the end. Thanks so much, Stephen. It's great to be on again with you.

[00:33:08] If you want to get in contact with Steven Best way Twitter, S T E P H E N K S S L E R. If you wanna reach out to us. [email protected] I always forward those on directly to Stephen and Mark so they can get the good news of how their wisdom has, has changed, informed and give you hope in your own life and to deal with the new normal.

[00:33:25] Once more, again, trying to raise the last 250, feel free, go in the shownotes Venmo and PayPal. Just one time gift would be so incredibly. We'd be incredibly thankful. And anything else? No, I think that's it. Leave a review and we'll see you guys all next week. Take care. Bye bye.