Pandemic: Coronavirus Edition

Still no death rises, a new therapeutic study and the Barrington Declaration ... what does this all mean?

October 16, 2020 Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger Season 1 Episode 46
Pandemic: Coronavirus Edition
Still no death rises, a new therapeutic study and the Barrington Declaration ... what does this all mean?
Chapters
Pandemic: Coronavirus Edition
Still no death rises, a new therapeutic study and the Barrington Declaration ... what does this all mean?
Oct 16, 2020 Season 1 Episode 46
Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger

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Things Discussed on Episode:

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Show Notes Transcript

Can you Rate and Give us a Review in Apple Podcasts?

Thank you to all of you who helped us reach our goal to pay off our equipment for this podcast! If you would like to still financially support us for the monthly upkeep and to help hand off some of the editing responsibilities, you can give a one-time donation or become a Patreon member for as little as $5 a month. See the links below. Thank you!

  • Give a one-time gift through Venmo at @mattboettger
  • Give a one-time gift through PayPal here.
  • Give monthly (as little as $5 a month) on our Patreon Page.

Things Discussed on Episode:

Support the show (https://www.patreon.com/pandemicpodcast)

Matt Boettger:

You're listening to the pandemic podcast, where we equip you to live the most real life possible in the face of these crises. I'm at bought gear. My two great friends, dr. Steven kisser, an epidemiologist from the Harvard school of public health. And dr. Marks back two times in a row. We're sorry. We're delayed. Dr. Mark. You're back in the, in the well, on the webcam. Good to see you guys.

Stephen Kissler:

Good to see you. Good to see you.

Matt Boettger:

This is awesome. And Mark, you're going back next week, right?

Mark Kissler:

Yep. Going back to the hospital next week. and so we'll see how things are going. We're definitely seeing an increase in case counts here in Colorado. both in the community and in the hospital. and so remains to be seen, I think. but we're all starting to brace for our kind of big fall peak,

Matt Boettger:

that, that, that what's, let's put a bookmark on that. Cause that's something we didn't talk about. Off the recording because it was like a few days ago. I was at work. And my wife was like, Hey, this lady came by because we have a Greenbelt behind us. He was like low level of fence. So we see everything that goes on this, this lady came by and said there was like a huge peak ever the biggest peak ever Colorado. We're going to go lock down again and she's like, what's going on? Tell me, so I looked into it and I just do the sources that Mark and you guys recommend. So I went to the website and I saw there was like a huge, positive case, I think on October 11th, even higher than. Back in April and may are even highest, highest peak, but then there was a second chart that put it in perspective to, some kind of equation to count for the increased number of testing. Right. And then it drops significantly to just barely a little bubble. So, I want to, and maybe we could just talk about that briefly right now since you brought it up. Are we seeing, cause it, when it, when it looked like on the ground, we're like, man, we're out of control second graph. We really aren't having much of a difference. So we are seeing. A pretty decent increase increase in Colorado. Are we

Mark Kissler:

Mark? yeah, so I think across the country, we're starting to see a slow build of increase increasing cases again, for sure. and I, but that being said, I think that sort of a metric is important where we go and look at the way that the. Yeah, that compares to the number of tests that we have done. So I don't know. Steven, do you have any ideas? I think one of the things that we should just talk about right up at the top is if you have some go to places for people in the community to look at information, cause I know that there's different, groups that are capturing information and putting it up there. So, Steven, do you have anything?

Stephen Kissler:

Yeah, I mean, I, so I always look at the. lately my go to source has been the Johns Hopkins tracker. and so I try to triangulate between the raw number of cases in a given state, and the positivity. They have some really nice graphics that show the number of tests, the percent positive tests, and then the total number of cases. And between those three things, then you can, sort of sort out, Matt, what you were talking about, how. there really has been a huge increase in the number of tests that have been run, in many places across the country. And so when we see these big rises and positive cases, we can't really compare that to what was happening in the spring because we were doing so little testing back then that the fraction of cases we were grabbing was was, was quite small. so, so that's what I've been looking at and It's it's true. I mean, it, there are many places that look like they're really surging way past the transmission that we saw earlier this year. and I think in most cases, that's, that's probably not the case yet.

Mark Kissler:

you know, the other one that I had, I. Question about, let me pull up the name of this group because I was using this a little bit in the first wave is the IHI and E COVID-19 projections. and that's available at the COVID-19 dot health data.org. And the nice thing about that, I'd be interested to hear Steven, if you have any experience kind of with that group and where they're getting their data, but the nice thing is that they generate graphics. And they break them down by a little bit more specifically with geographic areas. and they have some, what I'm sure pretty smooth curves in terms of projections, but it kind of gives it an interesting, day to day, you know, analysis of where we're at. Do you know, Steven had met, had meant to ask you that before we got on, but if you use their data at all.

Stephen Kissler:

Yeah. So IHM is, is using publicly available data. And they're generating projections unless they've updated their algorithm from earlier this year, their, their projections are actually kind of suspect. I think they're not, they're not terrible, but, the, the issue with their model is that it's, again, and I haven't updated my cell phone this in a while, but, But the model at least that they were using earlier this year, was not an epidemiological model. It was basically just, they were fitting a bell curve to the observed cases. And so it didn't allow for the possibility of resurgences of infection at all. So it tended to generate much rosier or projections of what might be happening later in the year. Then was, than, than, than actually played out with, with the subsequent resurgences of infection across the country. So I think that in terms of now casting, in terms of like actually getting a sense for what's going on currently in the epidemic, it can be useful for sure. but I would have to go in and look under the hood to see what's happening with our updated model. Before I could say I could. I had really trusted for sure.

Mark Kissler:

and where do you look for mortality data?

Stephen Kissler:

you can find it in a lot of places. So the Hopkins tracker, produces that as well. the New York times actually it has, has pretty good visualizations of trends and mortality over time. and, again, that's mortality that's associated with COVID-19. the CDC also has some graphics that, and the New York times do as well, that are looking at just excess mortality overall by state and across the country, which I think is helpful and excess mortality based off of the baseline from like the previous three years or so. So I think that that helps give a sense to, for, for how much additional, Risk of death has been, increased, across the population as a whole, as a result of the pandemic.

Mark Kissler:

Okay. The question that keep getting it. I know we talked about it briefly last time is why, why are we seeing these spikes in a similar to the one map that you were saying. You know that your, your wife heard about on the, when she was out in the green space, the universe we're seeing this huge spike locally, but why have R D it hasn't looked yet like our mortality rates at least locally have gone up that much. Last week. Soon, you talked a little bit that there's a lag. We know that, you know, a lot of this severe manifestations of COVID happened seven to 21 days after. Initial diagnosis. but I want to know if there's other things that might be in play there and just kind of how you think about that data or if that's just a fluke of looking to locally. and if you're seeing different trends on a more national or international. Basis.

Stephen Kissler:

Yeah. so for the recent rise in cases, I think it's just too soon for that to really manifest in a rise in mortality yet, because both because of the, the clinical lag between infection and severe outcomes, but also because a lot of the infections that we're seeing right now are concentrated in, Younger people. and so that requires another additional couple epidemiological steps before it reaches the vulnerable populations, who will then end up in the hospital. So there's sort of that additional epidemiological lag in addition to the clinical lag, which can lead to really substantial delays between the rise in cases that we're seeing and the increase in mortality. I think, A useful place to look for at this actually is the case of Florida. and so, I think actually getting the, some of the, some of the graphics and data visualization in the New York times sort of displays this pretty clearly. And this is just on sort of the dashboard that they have state by state we're in Florida. We saw that the raw number of cases. Peaked early in the epidemic, sort of in the early spring. And then there was this massive rise in cases, during the summer. And you can see that mortality in Florida also peaked both times. but even though the second rise in cases was substantially higher than the first, the total number of deaths, the peak number of deaths was basically the same between the two. So basically there's a second wave in terms of mortality was, was roughly the same as the first. And, That I think that again, reflects the increase in testing that we had available. So we were able to detect that rise in cases. and we were able to see both a higher rise and we were able to detect that increase earlier. So the increase in testing actually leads to even an additional delay compared to what we were seeing earlier in the spring. Because since we're doing more tests than we can just see those rises a little, we have the sensitivity of seeing those rises as a little bit higher. So all of this sort of works together to. Both reduce the, basically you, you have fewer deaths per observed case, and the delays are a little bit longer that we're observing, because of all of these different factors in play. the last thing that might be in play here too, is that, some of the, the people who were most susceptible to the virus, May have already succumbed to it. So in speaking about in Massachusetts, a lot of our biggest outbreaks earlier, in the pandemic were, concentrated in nursing homes and those populations have really been huge, hugely hit hard. eh, just. Yeah, really. there are some nursing homes in Massachusetts that really had massive outbreaks and across the Northeast. and so many of the people in that elderly population have already died. and so, so that's, that's part of it too, is that, it's already ripped through some of those populations. And so there are fewer of them left to in fact,

Mark Kissler:

So just to summarize one other question I had real quick, and then I just want to kind of go through the points that you just said. Cause I think these are, these are good and they, help us as we're thinking about why I feel like we're entering a phase in which we're going to want to be able to look at. The data again, that similar to in early spring, when it was really helpful to have a sense of where we're at, that that's going to be something that's just going to be helpful for people as we make plans. And as we, kind of adjust our lives again, potentially in the face of a second surge. So any, any thought that there's an issue around area under the curve? So the sense that there was that we were looking at the height of the peak, but not how long that peak was sustained over time. And that sometimes we may reach a similar. You know, test positivity rate, but then that falls really quickly. And that results in a much less, you know, total number of cases because the air, the curve isn't stretched over time. So that makes sense. Any thought, is that attributing it all or?

Stephen Kissler:

Yeah. And so by area under the curve, that's basically just the cumulative number of deaths. So the cumulative number of cases, that have occurred, is that right?

Mark Kissler:

and so that's exactly so, right. And so when we look at these visualizations, a lot of times we see a spike, right. but the spike accounts for the number of cases on a certain day, often, you know, or the number rather than have a cumulative measure all the time. And then there's, there's others that say, you know, what, what are the cumulative number of cases in the population? I just want to make sure that we. Understand sort of the way that those different measurements interact with one another.

Stephen Kissler:

Yeah. So I think it's, it's really important, you know, as, as you're saying to, to look at this area under the curve and the cumulative number of cases and deaths as well, because it sort of what we've seen as this, pretty persistent level of infection across the country, even though it's geographically very variable. But if you aggregate across the entire United States, we sort of see elevated cases and concurrently elevated mortality. That's sort of been consistent over the course of the year with some ebbs and flows as well. So I think you're right. If we want to really get a true picture of what's going on, that also is an important metric. part of the reason why I think. We, why the acute rises and infection are still important, is just because, cases be, get more cases. And so if you have a sharp rise in cases, then those can contribute to other cases unless you act quickly. And that can really lead to an overshoot of the amount of mortality that you would have if you just sort of had a flatline epidemic. So. An epidemic that's spiky is generally worse in the long run than an epidemic that's flat. And so there is some value to keeping things flat and some value to responding when things spike. and so I think that that's still worth bearing in mind. but yeah, but you're writing for the overall picture of things. I think the area under the curve, the cumulative number of cases and deaths is, is, is important. too, because that's, that's really a fuller picture of where we've. Come and, and what's, yeah, just what's going on overall.

Mark Kissler:

So just to sum up for my sake, we've had a little bit about cumulative number of cases. There's, a, we're capturing more of the total number of cases than we were in the early spring pandemic. So, we see more cases now because testing has been expanded. The demographics of who is sick has changed pretty significantly that in the first wave, we might've seen a lot more highly vulnerable populations. Whereas these current spikes are not exclusively, but largely younger population of healthier people. And then the crucial aspect that you said was that there's both a lag from the disease course where you see test positivity and then mortality later, but there's also this kind of. Epidemiologic lagging, that's going on, right? Where we get these test positivities, but it's only once they progress one or two more steps into the population that we get into groups where we're going to see higher mortality. Is that right? Fair to what you're saying. And so the other things, you know, the other questions that are is, is it related to some sort of a change in the character of the virus or something like that? I don't think that that's, there's any evidence that that's the case. I think this is the same thing we've been dealing with from the very beginning. And then also the question of, are we getting, do, do I get any credit, right? Not me personally, but dude. Clinicians get any credit that are we just getting I'm better at this. and I think that leads, we should talk a little bit about this solidarity trial. next I think, because that kind of, that folds right into one of the big pieces of it news this week, too. So any other. Thoughts, Matt, from your perspective as we're talking about that stuff.

Matt Boettger:

Yeah, I think that's great. I mean, me living on a campus or working on campus is exactly kind of what I'm seeing. I mean, Boulder we've heard, took some pretty extreme measures and continued them for a little bit. and numbers dramatically dropped. I mean, down to like, you know, maybe 250 in a day, Positive cases to zero in like say eight days or 10 days. and then the same questions were resounding among Boulder. About even we had the spike, we're not seeing the cases and mortality and, you know, Stephen, you kind of flesh it out in more than just one dimension, but our one dimension was look, yeah, exactly. It's a 18 to 22 year olds is why we locked them down for two weeks or three weeks now and a that. You know, and now some are leaving, of course, the, this is the difficulty. Some are sick of being in a place by which they can't go out and barely even get groceries. That's an exaggeration of course. And so they leave to go back home. So now they're flying home to their parents because they can't take any more. So now we have a, an unfortunate negative consequence. That's going to take a few more weeks before we see that. And we're not even gonna see it in Boulder now. So that, that means that he makes it even more complicated. If you are flying. Home. And so where are the cases? Well, they're in Massachusetts now. you're welcome. Steven, they're in there. They're in all the places, right? So it's, it's complicated. So, and then you, you exactly. You dovetailed perfectly in, cause you were, I always thinking in my mind. Yeah. What about clinicians? What about the, the advancements of there, but you're, you'll flesh it out. It's more complicated than I even proposed Mark. Well, you told me off the record. This seems like again, it's kind of complicated. So go ahead and talk about how this. This study adds any value to this conversation.

Mark Kissler:

The solidarity therapeutics trial is a huge multinational study that was looking at the major sort of the front runners for our therapeutics. and it has not been. Published in a peer reviewed journal yet. Right now, what we see is a preprint that was published on October 15th. I'm so hot off the presses. and what it's looking at in particular, I'll just kind of let me pull up the study characteristics here so we can, so we looked at Ramdev severe. They looked at hydroxy chloric when they looked at, lopinavir, an interferon beta. So, those are kind of four of the large therapeutics that we've talked about throughout this. Wasn't looking at convalescent plasma. This wasn't looking at dexamethazone in this particular, study here. it's big. So it's similar around 11,000 patients. and. in, let's see, I'm sorry. Bear with me for one second. I just wanted to pull up kind of give a scope of this here. So yeah, 11,300 patients entered from 405 hospitals, 30 countries in all six of the world health organization regions. And so the, you know, the idea here is that you have a big study that spans a lot of different care settings. you're trying to get information that's really generalizable and trying to get at the heart of like, what's the actual effect of this drug when you. Have evened out the effects that you get for variations in geography, variations in population, things like that. Well, unfortunately, what the preliminary results that they're reporting here are that none of those drugs, including, Ramdev, severe showed a mortality benefit. At 28 days. So they didn't show a statistically significant benefit in mortality at 28 days. that's a little bit different. So we, we have seen some promising, some slightly more promising data about REM death severe, but I want to remind us that a lot of the data that we were seeing about Ramdas severe was about, days, days of illness. and that this 28 day mortality thing, is a really, that's kind of a hard. hard, not meaning difficult, but hard meaning that's a rather rigorous study end point, right? When you have mortality, you know, and you see if you can demonstrate in a randomized control trial of mortality benefit from a therapeutic, that is one of the most rigorous ways that you can kind of support the clinical use of it. So the question now immediately is, so the, the who publishes this big. trial in pre-print form that doesn't show a statistically significant benefit. Do we stop using all these drugs? and that is a much more nuanced question, I think, because it's not saying that there's absolutely no benefit. and it's not saying that in certain settings or in necessarily in certain subgroups that there is a benefit. And so we're going to need a little bit more higher resolution data. We're going to need the kind of flurry of editorials that will follow this after it gets published, both in pre-print form and in. Peer reviewed forum and really dig into the methods and see what's going on here because often in a big study like this, there may be ways to, analyze some of that data and give us a little bit better sense of clinically what we should be doing. so is this, is this practice changing in the next, you know, 24 hours, 48 hours? I would say no. I think we're going to need to have a little bit better understanding of what they're looking at. That being said. I do think that in terms of. You know what one would hope that maybe we would have something that's has a huge mortality benefit. we're not seeing that in this preliminary data. And I would be surprised if that finding is overturned. I think there may be more nuances to it, but I'm not expecting that we're going to have, you know, one of these four drugs is going to be massively helpful in terms of mortality. when we introduce it. So, that's the solidarity trial it's available. If you just Google who solidarity trial results, And you can see the pre-print there and get a little bit more information.

Matt Boettger:

Send that to me. I can put it in the show notes. They can get it directly there as well. So, I mean, would you be saying then, I mean, actually said it's in the reality, it's probably more nuanced, but on kind of on the, on the back of what Steven was saying, the complexity that maybe then that the clinical staff to therapeutics isn't necessarily contributor. at this point in

Mark Kissler:

time to the, do you think that we potentially are seeing a benefit? I don't know if necessarily we're seeing it on a population level or not with dexamethazone, but probably we're seeing a little bit there. and I do think that as we get a little bit better sense of the disease process, there's sort of implicit things that come, you know, from experience with the disease process that, aren't easily. Captured in studies, but there's sort of a sense for how, how we treat these patients. Our processes might be a little bit more streamlined and a lot of our institutions. And so I do think there's probably, I think we're doing a better job than we were in March. I do think that, and I think we'll continue to learn and continue to improve over the next several months. and, but again, I think that, that as we look at the. Big big picture, epidemiologic data, a lot of what we're seeing as the characteristics of this virus. and, as it plays out amongst different populations and over different time,

Matt Boettger:

and I'm assuming this doesn't take into consideration the complexity of, I don't know if you call it cocktails or whatever, do you guys do with rum to severe and then conjunction with maybe a steroid. you know, along the way and, and the, and those multifactor and how that might,

Mark Kissler:

and there are statistical methods that can help us get at that. And so we can get, take raw data and start to, and especially if there's study design, that's appropriate that you have crossovers and groups and things like that. So it's not impossible to get that information, but it takes a little bit more, kind of. A statistical analysis to get that sort of information. Okay.

Matt Boettger:

I mean, this is like a, I think this is the most natural conversation we've had in quite a while. Cause this leads to the next part, which I think this is just, we're just adding these kind of layers. Steven, you just hit that. We just talked about the idea of the death rates for not increasing the suggestions that that might, that might come about from this. And then you have this study that just came out Mark about saying, Hey, there's no statistical value that therapeutics nugget nuanced. It's still pretty, you know, we have this stuff, right. And now the WHL member who talks about how, you know, this has been, I think, pulled out of context, talking about lockdowns and, that is not necessary. And what was the quote I have here? But I wanted to see, I don't think I have it right here, but, basically it's been taken out of context. To really be trying to say that it should not be basically the default means by which we handle, the pandemic. And now we have a what's it called? The Barrington, what is it called? The Barrington

Stephen Kissler:

Barrington declaration,

Matt Boettger:

declaration, something fancy. It sounds something like, you know, so we have this going on. Now. We have the white house kind of taking this declaration and applying it. to maybe a, a public policy now of, of, of, of looking to now, approach herd immunity, and that'd be the solution. Right. It's so we have, we have basically kind of tongue in cheek, this idea of, Hey, therapeutics aren't working or the death rates aren't increasing. Let's just go to herd immunity. And so now we have this parent in declaration what's going on. Even Steven, I just saw there's a dude from Harvard, from the medicine he's on, he's spearheading this he's he's in your building somewhere, hanging out price seven, a cup of Joe. what's what's what's going on with this?

Stephen Kissler:

so the, I I'll say that the, the group that I work with that Harvard is, is, is puzzled by this deeply. So, So, so, and I want to preface that by saying that like, so from, from the beginning and, and certainly still, like we w. Well, we recognize and, and, are very mindful of the fact that, the non-pharmaceutical interventions, things like lockdowns, but even, just certainly distancing and, testing even as, as, there's a social burden and, and real, both economic and social cost to all of those things. So, I don't, I definitely don't want to make it sound like we're, We're we're minimizing the cost of any of those things. But this, this argument about herd immunity has surfaced repeatedly over the course of the pandemic. and at each point, as far as I can tell the same reasons why it's been, bad idea remained the same, And a big part of it comes from the fact that it's, it's sort of setting up this false dichotomy, I think between either doing a full scale lockdown or doing nothing. And I think it ignores a lot of the progress that we've made to both epidemiologically and clinically over the course of this pandemic. So it was what, what this declaration is proposing is essentially that. Everybody, who's not in one of the specified high risk categories just goes about their lives as normal. and the people who are in high risk categories should find ways to protect themselves and public health officials should help them to find ways to, to protect themselves. of course the issue is that we are, our society doesn't exist in hermetically sealed. Population groups. and that if there's more virus circulating in the community, then more people in these high risk groups will be exposed. that's just a matter of fact. and so I think that adopting this, this notion of I've herd immunity, you know, there's in the declaration. There's there's no, There no statement about any of the technologies that we have available, like rapid testing, for example, that would really help make this possible while still allowing people who are infected and infectious to limit their contacts with other people. Presumably, because that would actually undermine the bottom line of developing immunity in the population. You know, this declaration is actually aimed at. Spreading disease, is the idea is that it should spread in low risk populations and that by building up immunity in the population, then that will protect the high risk populations. But I just don't think at this point that that, and again, there is, there is a balance here between, you know, risks and benefits and, acting in the absence of evidence, but needing to make some decision, So one of the issues that I take with it is that, we don't know how long immunity lasts. We don't know the dynamics of immunity yet. and I think that adopting a herd immunity approach is a pretty risky proposition. when those things are still unknown, I mean, I anticipate that SaaS Coby two is going to continue spreading in the population. Pretty much indefinitely. And so how are we going to deal with that? Herd immunity is not going to stop the pandemic. It's not going to stop the spread of this virus. And we don't really know what the post pandemic period is going to look like. Other than that, it will probably include continued spread of the virus. So I think that in the meantime, while, while we're, I'm dealing with the virus, sort of going back to what we were talking about before that it's, it's, it's better to sort of maintain cases at a, at a lower level. Because then that avoids these overshoots and these spikes and infections in cases and deaths. and, and, and we have ways to do that. We have very clear ways to do that. That aren't as disruptive as the sort of broad scale Countrywide lockdowns that we had earlier this spring, we can be a lot more targeted. We can be a lot more, temporarily short while still, Yeah, while still reducing the spread of infection. So, so the, the idea is, is kind of puzzling to me because it seems to ignore a lot of the progress that we've made and just sort of say that we ought to surrender wholesale, but that's my reading of it.

Matt Boettger:

Mark. Anything to add to this?

Mark Kissler:

just that, you know, I think, that paying attention to. Well, dr. Fowchee for instances is also calling this idea as being dangerous. and so, eh, and I think, having an understanding of what Steven was saying, there's, and you alluded to this too map, there's this way that our information gets kind of flattened really quickly. And then we jumped to a conclusion. So where we say things, you know, we see as a preprint trial like that, and we say, Oh, therapeutics don't work. You know? And like, that's not a, that's a that's frankly, a misreading of that. Data. Right. But if then we use that as a presupposition for our next. and, and then also, yeah, do this thing where we're saying, well, it's one or the other. then we do get into a dangerous situation. And I think that having the ability to continuing to work, you know, everywhere we can into having nuanced conversations about these things and conversations that are based in. in an understanding of sort of the complexity and the, as Steven was saying, you know, he there's, I think there's a fault snared narrative around, you know, we shut everything down for the sake of saving as many lives as possible, but we ignore things like mental health and we ignore things like economics and we ignore things. And I think that's just a, I'm not, I don't think that that's actually a real. Narrative, I think that's what people fear and that fear has happened. And that's what they fear is happening with epidemiologists. Just some, but it doesn't, it seemed to me to be an accurate narrative about what's actually going on and the ways that those things are being weighed. and so the idea, you know, Steven has kind of proposed. And his group from, for a long time, this idea that, you know, I have to say, even though I've heard this a million times, it was not fun to hear you say that coronavirus, you know, stars Curry too. It's just going to circulate indefinitely within the community. Like, that's not what I want you to say. Knowing that that's likely our outcome point. you know, this, what Steven's group has been and, and others have been proposing is this idea of we see and respond in the most agile way possible to. Peaks and hotspots. and one of the tools at our disposal in addition to masks and hand hygiene. And so physical distancing, are intermittent in a lockdown and things like that. And, I think that unfortunately, that we're going to have to figure out a way societaly to. Deal with that and to have negotiations around that. and we're, we're having trouble doing that right now.

Matt Boettger:

Yeah, this is, I think, exposes so many of the complexities of the situation. I think you nailed it, Mark. We're just had this great book, I guess, read decisive. and just the, the, the fallacy of trying to constantly go to an either or like either you should do this or not in that. Well, you know, you're in a bad place for decision making. And that's what I kind of feel like this, this idea of this herd immunity is like, well, it's, it's rather than like maybe grounded in science and being proactive. It's more of a reaction to. The whole idea of a radical lockdown. and, and, and I love Stephen and you've been contributing so many times over the months of just allowing the complexity of the situation to rise to the surface and deal with them and realize that this is a nuance reality, and that in the beginning, a lockdown was necessary. And that, and the reason why was because we wanted to flatten the curve and which I think is what you brought up like two weeks ago, Steven, which I think we forgot about, at least I did until you brought it back up. And that is, and on top of finding curve, we didn't have a plan. And so until we have a plan let's default to this, right? It wasn't like lockdowns, like this is, this is, this is the most virtuous thing we could do. This is the worst thing we could do. And it's the only thing we can do until a, we flatten the curve, which we did. There was a, there was never a curve in certain places, but, but you know, the answer, we didn't have a plan. We had a better plan. And what Steven you're saying is we still, we have a good plan and some things we're not even using. So why don't we put, put our efforts into using this and not swing the pen onto the other side, which causes another level of harm, right. Total freedom. Right. But it's going to cause another devastation we don't need to have, we can play the middle ground and kind of. Had not had the devastation. Mark. I think you, you, you took a breath if you wanted to say something.

Mark Kissler:

I, yeah. I, the other thing just that I'm thinking about and, and deserves, I think putting another point on is, that we should be careful in conflating economic productivity, right? In like participation in, work in, you know, in our kind of your work lives with. The, with other forms of, you know, of good. And I think one of the things that I worry about is that sometimes in certain places they say, well, let's protect the economically productive sector of the population. and, and using that as sort of a surrogate for w for worth, which feels really, to me, that that is. And implicit value statement. That is a kind of deep within some of the presuppositions of those recommendations. And that's the thing that we need to examine. So let's go, let's, let's get a little bit deeper and start to, you know, to have conversations about what are the presuppositions there. Motivating some of these things and, you know, let's not make it just about like days of work lost. you know, let's getting towards other, other ways of conceiving. Like how do we think about this? How do we think about. Care care of our community is stewardship of our communities and the frankly, the value in this society for people who are not economically productive, there's huge value, enormous value. That is that. and, and that, that, that, it's also an important piece of that. You know, you don't have to be, I think necessarily. You know, bleeding heart, like, you know, take care of everybody and really, you know, to, to recognize that a society is stronger when we have connection to, you know, to other generations when we, and when we honor honor these connections and these kinds of this depth of relationship in a way that's not merely economic. and, and how important that is, you know, time when we're forgetting. Like by the day, how to talk to each other, and forgetting by the day about how to have deep conversations about values, you know, across ideological divides. but I think that those things are very, very important.

Matt Boettger:

There's so many things that I feel like we're kind of almost in this meta narrative, you guys that we've been talking about since early March. We brought David Brooks or I brought David Brooks back in March and I see it here as well as we're this I'll put it in the show notes. It's a great article. I haven't finished it yet, but basically about the chipping away of trust, societal trust. And this is just a reflection of where we've been such for a long time. And as, Stephen, you mentioned back in April, the sense of fever pitch, and it's just raise it to a fever pitch where we live in this moment of. Distrust that people around us, not just institutes, but people and this great article I'll put in there is from the Atlantic, a ride city that when you, we are suspicious or distrust with people around us, we have a tendency then to become tribal. Right? We get a band of people around us against a common foe. And then we have a tendency to then gravitate towards extreme conclusions in theories because it's a safe place. When you, when you feel vulnerable, when you feel distrustful and you don't feel like you're under attack all the time, you know, on social media. Because if I publish this, I put this up, how am I going to be perceived? How have you thought if I'm constantly feeling this inundation of being threatened by the people around me, I need to find a safe. Place, I need to find it in the easiest way possible and extreme thoughts and philosophies are oftentimes those, those, those safe places by which you can come together and emotional reality and defend them. And I kind of feel like this is part of that part of that equation of we have the lockdown, the anti lock down, and then we're living out of a moment of distrust rather than dealing with the complexities, which really is hard, especially when yeah, I get it. I am frustrated. I'm alone. I hate this. I can't stand the pandemic, even though we have a podcast doesn't mean it doesn't mean that I enjoy it by any means. I mean, the only thing I like to like hanging out with a couple of dudes once a week, but then what do I do? The other. Six days in 20, 20 ours. I just suffer in some way. Right. And I'd be a little dramatic. I mean, there's, there's high points, but I don't want this at all, but yeah. Then to have to sit here and then mentally stay in this complex reality, we have the nuanced approach of how we, how I ought to live my life. It's hard. Do I want to sometimes just move to an extreme measure? Yeah, because it just seems a little bit easier and I'm just tired guys. Right. I'm just tired. So this is my re my event, but I feel like that's kind of behind it, all this stuff. As well, one other before we sign off here, Steve, I just wanted to put this in. I had mentioned off the w but I wanted to state this, or how did the people hear this? There was in this article from about Sweden and it was fascinating to me about how lumping Sweden America as being a category on its own, which is funny because we had different approaches, but we are both in the same category as we didn't do a very good thing. And there's other people like, South Korea, Norway thin when Denmark, Finland, Denmark, Japan, Taiwan, Vietnam, New Zealand, Australia, who are in a different camp who acted early, but it's fascinating that we both have really dismal results. And for those people looking for a herd herd philosophy, Well, it hasn't panned any different than what we're doing with this right now. And one of the things that mentioned at the end is that talking about herd immunity and the idea to try to achieve it. The article mentioned that shouldn't have been a surprise after all herd immunity to an infectious disease has never been achieved without a vaccine. I just, before we end, I wanted to know, is that true? And is there something behind that or nuance that maybe I'm just not getting the way they're trying to say to clear the. The clutter from that statement.

Stephen Kissler:

Yeah. I mean, I think here it's, the, that, that statement is actually referring to, I think what we hope the outcome of herd immunity will be, which is the end of transmission of COVID-19. and, and the right. I mean, the only, the only infection that we've actually managed to eradicate is, is, smallpox, all of the rest of them that we, we well, so, I mean, that's not so. Yeah, the original SARS virus, for example, at a very small outbreak. And then we never really heard from it again. So for things like that have had small outbreaks like that, there have been eradications as well, but for things that have really had widespread transmission, really the only one we know about that we've erratic catered is, is a smallpox and that was through the help of a vaccine. For sure. So I think the idea here is that. We may well achieve herd immunity of a sort to COVID-19. but like flu, like the other coronaviruses herd immunity can build up and then we can lose it again, both through waning immunity and also through new people being born into the population who are susceptible to the virus. And so herd immunity is a dynamic thing. It's not just something you achieve and then have achieved for all time. And so I think that's something that's also one of these implicit narratives that, that I think is sort of starting to break open here is that herd immunity does not necessarily mean, sort of our, our savior from, from this. and so even when we adopt strategies aimed at herd immunity, while that sounds like maybe a shortcut to the end of our suffering, I, I don't think that that's necessarily the case. Okay.

Matt Boettger:

That's great. I just wanted to hit that. So bass you're telling me, Steven, there will never be a herd immunity, merit badge in boy Scouts, because it just never ends. You will get that mirror badge. You get the first day you get the first aid one wilderness survival. You'll never have heard of unity because it will never end. And you will never get your Eagle scout, merit badge. Yeah. Anyway, I'm an Eagle scout had to mention that dropped that. Thank you so much guys, for coming on in. It's good to see you guys. you know, we did a few things we didn't mention at the very beginning, just to common stuff. If you can leave a review, we'd love it. Thank you. We had someone give a wonderful contribution. We have everything paid off. Thank you so much for all of your help and support. If he wants to continue to help us with the monthly, small things and upkeep that we have to do, you can do that at patrion.com/pandemic podcast, a little $5 a month. It helps us go a long way, but thank you so much for helping us get everything paid off. Thank you. Thank you. Thank you. Please leave a review. If you want get a hold of Steven S T E P H N K S S L E R. Again, I want to say Mickey mouse on Twitter, and then as well as you want to contact us, let us know how you're doing across the country student. Still. Haven't heard from you a Fergal, hopefully doing well in Ireland, [email protected] and I keep calling you out until you listen to an episode. Take care everyone, and we will see you guys next week. Bye bye.