Pandemic: Coronavirus Edition

Natural immunity updates, herd immunity delusions and Matt has deja vu

October 23, 2020 Matt Boettger Season 1 Episode 47
Pandemic: Coronavirus Edition
Natural immunity updates, herd immunity delusions and Matt has deja vu
Chapters
Pandemic: Coronavirus Edition
Natural immunity updates, herd immunity delusions and Matt has deja vu
Oct 23, 2020 Season 1 Episode 47
Matt Boettger

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Matt's Living the Real Podcast

  • Check out Matt's latest episode on how to live a more frictionless life here.
  • Download Matt's technology cheatsheet (with examples) of what he uses to keep himself as frictionless as possible.

Things Discussed on Episode:

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

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.

Matt's Living the Real Podcast

  • Check out Matt's latest episode on how to live a more frictionless life here.
  • Download Matt's technology cheatsheet (with examples) of what he uses to keep himself as frictionless as possible.

Things Discussed on Episode:

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

Matt Boettger:

You're listening to the pandemic podcast. We equip you to live the most real life possible in the face today's crisis. My name is Matt Boettger, and I'm joined with dr. Stephen Kissler, an epidemiologist at the Harvard school of public health. And the way I introduced him, it sounded like it was a baseball game.

Stephen Kissler:

So that's right. Yeah. In a second. I'm sure.

Matt Boettger:

Yeah. I know how you doing, buddy.

Stephen Kissler:

It's good to see you. Hi. Yeah, it's good to see you too, man. It's I'm doing all right. It's the, this thing just keeps grinding on, you know, Mm.

Matt Boettger:

And what, what, what, anything, anything special? Anything new you're working on right now? Any kind of research from the past week?

Stephen Kissler:

Yeah, so we just posted a pre-print. so this is looking at, Some of the, it's a collaboration we did with the NBA. so working with them in their bubble and pre bubble. and so one of the cool things that we got to do is since, since the NBA was testing all their players and staff and people associated with the resumption of their season, Really frequently that gave us the opportunity to, for the few people who got infected. This was all pre bubbled because once, once the bubble got started, none of the players of staff got infected. But before that, they were doing this testing as well. And so there were a few people who got infected with, with, COVID during that time. And so you can see their entire sort of viral load trajectories go up and down, which, as an epidemiologist is really useful, because then we can use that information to help, To help determine how long people are infectious, how quickly they get infectious, how much variation there is between people and how likely they are to be infectious, those kinds of things, which will hopefully help feed back into some of these guidelines, to make them a little bit more precise and know like how long we need to self isolate when we turn positive and how long can we test positive? And what does that mean? So those are those questions we were starting to try to answer. So that's up on med archive. Greg. He wants to take a look.

Matt Boettger:

That's awesome. You can do like a fun, like Skype or like with the NBA, like a LeBron, like, Hey, so LeBron. Hi. How are you feeling today? That kind of stuff doing symptoms or you probably, do you have any personal contacts with the, with the team?

Stephen Kissler:

Yeah. yeah, I I'm, I'm definitely on a first, first name basis with King games. so, okay. Yeah. It's, it's been great. So he'll be on

Matt Boettger:

the podcast next week. All about the pandemic.

Stephen Kissler:

That's right. That's right. Yeah. Stay tuned.

Matt Boettger:

That's great. Well, good. A few things before we get rocking and rolling on a number of things I want to talk about. That's really kind of surfaced in the past seven to 10 days is always reviews and we've got a couple of fabulous ones in the past seven, 10 days, one John dash SLC. I think I know who you are. I'm not sure, but it says an excellent and balanced review of the reality behind all the myriad aspects of the COVID-19 pandemic straight talk. And clear analysis. And then also, I think this is bridge bird at bird guests. Nine. I started listening to in March and found this show to be a great source of information. Find information without a political viewpoint is so hard. And I feel that the three of you do that very well. Thank you. You're welcome. It's awesome to be here and be with Steven and Mark, who are the team here. So if you want to leave a review, please do so you can do that at, on Apple podcasts. And by doing that we'll feature, you will read your review. On our next episode and it helps us get this into hands of more people. And if you have the opportunity to give patrion.com/pandemic podcast, as little as $5 a month helps us keep this going, or one-time gift PayPal, Venmo all in the show notes. Also, I failed to mention last week, I dropped another living in the real episode on friction because man, friction is all around right now and there's just, even Colorado was just crazy with all the fires and the, and the, and just my heart goes out and prayers go out with all the fires that are going on. And it's just, it's just, if you haven't heard, there's a big fire that just, just erupted the other day. And I don't know if you knew this Steven, but like the equivalent to, I think essence like 120,000 acres in one day, which just the burn alone in one day is the second largest forest fire in Colorado history. And that one day burn and so many houses being just burned up and rumors. And I say, this is just purely rumors, of, my, sorry, my sister just texted me, said she's watching right now, live on the, so I got distracted for a second and then we, had the fires erupt, and there's some rumors that, that some people maybe did not get out by the time. it came and I've heard at least one story of it. So please put your heart, your heart and your prayers towards Colorado and all the fires that are going out in Estes park was completely, just evicted basically last night to just for the impending threat. So it's a lot going on. It's been heavy hearted, so I dropped the podcast on friction. And then if you want to check it out, I. Put together a little PDF. You go to living the real.com/frictionless. And it's about all the technology I use to try to live a less friction life and, you know, totally random. But I totally got introduced to this concept of friction in a fun way. I went, I took a physics class in undergraduate, which I could not stand whatsoever. I got really excited. Like I had the idea of physically I'm going to love physics. I went in there and within like a week, I'm like, this is the worst nightmare of my life. And so, but there was one thing I learned that I loved. And this thing was about this, this, friction coefficient, right? And it probably, this is probably normal for everyone already knows this as idea that it has before something moves, right. It has this coefficient. And then once you begin to push it and it begins to, to move that, that coefficient drops just like when you're trying to start to move something, right. It's so hard. But once you get it to go, you just don't want to stop because it was long as it keeps going. Even if it's an inch, every like. Couple seconds. It's better than once it stops. It takes so much more effort to start things. And so that whole concept of my life of how do you actually start things, lowering that friction coefficient your life. So you can do those things that matter most to check it out and live in the real on my podcast. let's get into this, the news. So I was talking to you off officer off the, the recording of this Stephen, that man, my heart's a little heavy now, Colorado. Totally. But I feel like we're were back in like March and April and a little sense. Now I can dramatize that in the sense of, thinking of yep. Cases, the rising death rates. You're just, you were saying death are starting to increase in certain areas, but there's a lot of things I want to talk to you about, CDC coming out, what just days ago about changing the nuance of infection, how it's being transmitted. And so this. Causes a little bit of concern, this constant quest for herd immunity. And now we're looking at natural immunity, some things servicing around natural immunity. And some maybe like, to what extent, how long do we have immunity? And then the idea of reinfection and, and what it might mean. And so there is just a number of things going on in the case. I feel like we're back to March and April, that I'm going to get clarification with you. But before we do that, we've got to talk about one important thing. Because my kids are really excited about one thing coming up. You know what that is? Steven?

Stephen Kissler:

it's Halloween.

Matt Boettger:

Yeah. You have no idea. It's Halloween. Yeah. What month is it? Christmas? I don't know. It's a 4th of July. It's too cold outside. so yeah, so they're like totally stoked for Christmas. And so, I mean, at Christmas they are totally random. Okay. That's totally okay. I had to say, my kids have been pairing for Christmas since about July. They've been making their list, talking about it. It's been absurd, but right now they're into Halloween and they want to go out trick or treating. So I know a lot of people are thinking about trick or treating. What should we do? Do you have any tips? Like what should we be doing right now? Should we be staying at home? Can we go out will be the safe way to, to, to engage Halloween as a family.

Stephen Kissler:

Oh boy. So I think that's a tricky one. It's, it's a, again, depends on a lot of different things. So first of all, I think we can probably start by saying that if, if you are going to go out, like if you have a family with young kids and have decided that you're going to go out, trick-or-treating, Finding creative ways to incorporate a mask into your costume. Probably a good idea. and, you know, I think that the fact that, you'll be spending most of your time outdoors is good. Yeah. you know, and trying to really just keeping in mind all of the same sort of precautions that, that we've been thinking about for the whole pandemic is, is worth doing, You know, and, and that said if, if you're living in a community right now where a case was really are spiking, I think that really thinking twice about whether it makes sense to go out at all is good because, you know, it is you, it trick or treating does often put you into contact with many people who you wouldn't normally interact with. and so while the risk of transmission is not. Nearly as high as if you were sitting in a room with those people for a long period of time. Nevertheless, it's it's there. so I think just being mindful of that, and, and yeah, and, and, and being respectful of, of course of, anybody who's decided to not give out candy this year for whatever reason. I know many people in my neighborhood here. have put out, signs, basically like lawn signs that say like, this house is going to be staying dark for Halloween. we, and we've like taken what we would have spent on, on candy and decorations and things this year and given it to the local food pantry or something like that. so people are doing that kind of thing, which I think is. It was fine. I mean, we're all sort of making these decisions. It's not to say that that's something you have to do or that trick or treating can't happen this year. but I think that, when. Events come up like, like Halloween, like holidays and things. It's, it's easy to forget the date, the day prevention measures that we've been building up over time, just because it's just not part of our normal routine when, like we haven't, we haven't experienced a Halloween with this pandemic yet, even though we've experienced a normal weekend with the pandemic. So I think just really taking the extra step to keep all of these same things in mind and find creative ways to integrate them into the, the things that we do is the most important thing we

Matt Boettger:

can do. That's good. You know, Tom, to throw you just not under the bus, that's not what I want to do, but I want to throw, I'm gonna, I'm gonna throw a curve ball too really, really painful. I heard this about an hour ago. Is this true? that, so I know someone who is, was infected with COVID, and then they tested positive and then they shared a drink with someone. Just that same day when they tested positive did not get positive. The other person did, did not get positive. And they, they were, they told me like, well, you know, I, we heard that ingesting food contaminated with COVID that you can't get COVID because you're ingesting your stomach and the stomach acids kill it. It's a, it's an ha it's inhalation. Do you, is there, is there a truth to this or is this another kind of little bit of folklore combined with other stuff?

Stephen Kissler:

well, so, So it's true that that COVID is less likely to be spread through, surface transmission than through airborne transmission. now if they were sharing a drink that suggests to me that they were in pretty close contact anyway, so that's a real why we're paying for the sharing of a drink if you were probably breathing the same air for awhile. but that said, so, Yeah. It's, it's not extremely likely, like if somebody were to sneeze on a sandwich that you were going to eat and you didn't eat it immediately, you probably wouldn't get COVID. But the thing is like, yeah, your stomach acids will kill COVID, but the it's got to get to your stomach somehow. And it has to pass through the epithelial cell layers that are in your throat and your throat. Shares. I mean, it's, it's, you know, at the very top, it's the same pipes that you use to breathe as it is that you use to, that you use to swallow. And so it's, it's that part of the, ingestion process that could potentially give you COVID. So I can't say that the risk is zero, but I think that the highest risk would be sitting next to someone and breathing the air that they're breathing more so than sharing a drink or, eating food, even though those things aren't like, I can't say there's zero risk, but sure. Yeah, sure.

Matt Boettger:

Okay. I'm just curious if this was on my mind when I'm sure some other people want to know the same thing. so let's get into all the, all the stuff. There's a lot of things that have been going on. Let's start with the vaccines. Right. So I just saw Madonna completed their enrollment right there. The, I think this is like whatever, phase three, stage three. can you just talk into, like, what does this mean for, from a donor right now? Where are we at and what could we expect in the next month or two or longer with at least the Madrona vaccine?

Stephen Kissler:

Yeah. So, I mean, I think that Moderna, and a couple of the other vaccines are sort of in, in this part of their trials where they're enrolling large numbers of people and, and, and pushing through phase three trials, which is really good. and I think as another sign of success and of the sort of health of the vaccine, horse race, if you will. and so. I think as a, as an indicator of that, there there've been some recent, opinion pieces that have been put out in scientific journals that are talking about, okay, so, so what do we do now, if, and when we have a portfolio of, of effective vaccines, which is a really good position to be in, but like that right now, it's actually a tangible possibility that we won't just have one effective vaccine, but that we might have a whole suite of them. And so with Madrona in particular, I mean, it's, it's, it's a good sign that they've made it to this stage and that they're enrolling people. trials do take time because the endpoints that we need to measure in these trials, Take time. I mean, unless they're actively challenging people with virus actively trying to infect people, which I don't think many of these vaccine trials are, you have to wait for the person to get infected and you have to then be able to detect it. And then you have to follow them up for a while after that infection to see what the outcomes are and whether they, you know, so it just, these things just take a fair amount of time. but that said they're moving as quickly as possible. And I do think that we'll have some pretty good answers. With respect to the overall effectiveness of these vaccines. probably by the end of the year, beginning of next year, I would say we'll have some pretty reliable evidence. So I think that's a good spot to be.

Matt Boettger:

Okay. And I noticed that with the, particularly the maternal one, I read a few articles that this is a complicated vaccine where it's it's. one of the reasons, I mean, I don't know all of the myriad of reasons why that modern has been so successful in pushing a vaccine to be a front runner. Is also one of the defects in the way by which it's stored in and given is unusual, like extreme cold temperatures in many dosages. And it just seems like this could be a complex. vaccine to be able to give, I could see it easily at hospitals, big metropolises, big cities. When we start talking about rural America, I feel like it's going to be a hard, has there been a lot of talk either at Harvard or roundabout, like the complexities and how, even though this might be pushed out one of the front runners, it actually might be a difficult process to actually get into the hands of the people who need it most

Stephen Kissler:

that's right. Yeah. So certainly. Yeah. The, the periphery of vaccines is a really important question too, because you can have an effective vaccine, but figuring out how to get it to the people who need it can be a whole different question. So I think you're right. I mean, so I'm not totally up to date on all of the restrictions within the, during a vaccine and, and many vaccines do require sort of a cold chain to keep them refrigerated or frozen. up until the point of when they're administered. but that, that can make it really restrictive. It can both increase the cost of the vaccine and also make it so that you can't distribute it as widely. and I think that's why having a whole range of vaccines can be really helpful because we could imagine potentially say Madonna gets theirs approved first. Then, even if it does have these restricted measures, then as you say, we could probably administer it to healthcare workers. And even if we couldn't administer it to the broad population, that would go a long way towards keeping our frontline workforce safe and towards interrupting onward transmission. because those. Yeah, those people are both at highest risk of infection, but that therefore translates into a potential for transmitting disease as well. so, then, then I think as other vaccines come available as well, that are more stable, that don't require as much infrastructure to sort of keep them cool and to distribute them. Then we can use those for sort of the more broad distribution later on. So I think, this is again, why it's really important to have multiple, multiple shots on goal.

Matt Boettger:

Absolutely. Well, one more, excuse me. One more question. Before we get into, well, two more before we get into the really meat and potatoes of this discussion, that 14 year old girl, did you read much about this? About the 40 year girl who got the $25,000 prize for research, the potential coronavirus cure. I was curious if you read this. Okay. Okay. No big deal. We'll pause that

Stephen Kissler:

for now.

Matt Boettger:

I don't know much about it. I was wondering if you knew like what this like technology that she was advancing, that she won this prize. We'll put that on pause and might come back to it next week when Mark's back as well.

Stephen Kissler:

Take a look. I'll do some research and come back. Yeah. We'll probably need Mark to weigh in on that too.

Matt Boettger:

Yeah, I know. I'm pretty excited to hear what this and what the ramifications are. So. One more basic question on COVID. And so I read this article that health experts are dreading how bad COVID situation will be in the next week. Right? So we're seeing these rises going on. I see Colorado and it's uptick. There's a lot of, there's a lot of, States really feeling the pressure and the hospitals are ready and it's, it's not even November, which makes me a little concerned about November, December, and January. But one thing that I wanted to bring, I wanted to ask you. In this article, it mentioned, now we know the CDC mood from 14 days to 10 days of quarantine. Now there's two things I want to ask you. Number one, is that I always forget is that 14 days or slash now 10 days referring to the first day being the day of our exposure or for sign. And the second question is, did you also hear about this in this, in this article about, that there's been some further research that maybe it might move from 10 to seven days of a quarantine.

Stephen Kissler:

Yeah. So there's some interesting things going on here. I think so. first of all, the, the 14 days or the 10 is, to my knowledge refers to basically when you first find out that you are. basically from the first positive test. Okay. or if you're not tested from the onset of symptoms. and so that's, that's the idea. So, because we can never be sure when you were actually exposed. and so, and, and so those guidelines are developed sort of. Understanding the course of infection from first positive test or from first presentation of symptoms, that's sort of the time zero in, that, that was sort of, incorporated into these decisions. So, but as you said, it's, it's gone back from 14 days to 10 days and then from 10 days, it sounds like there's, there's some, some question as to whether we could bring that back down to seven. So essentially on the scientific side what's been happening here is that the, We found with, with, with COVID infections that oftentimes people were testing positive and they would continue to pet test positive for a very long period of time. And oftentimes they would test positive for 14 days, but some people will even go on to test positive for weeks and even months afterward. and the so. When the guideline was 14 days, we were sort of erring on the side of saying, well, we know we, we know that we're able to detect this, these viral fragments, this virus, RNA, and that could correspond to infectious virus. So we need to make sure that, we're quarantining people for the entire period of time when they could be infectious. Now, as, as we've, basically as more people have gotten infected and we've been able to study these trajectories, we've been able to see how long the infectious period actually lasts. It seems like the actual period of infectiousness is, is probably a little bit shorter. And that the reason you continue testing positive for a really long period of time is because basically your body is chewing up and spitting out these viral fragments as it's recovering, but it's not actually viable infectious virus that it's putting out. And so those that, that tail of the period when you're testing positive is probably not a period when you're, a risk to other people. And so that's why we were able to put it back down to 10 days. And then I think now we're just sort of fine tuning that, that the end of that is trying to figure out where exactly that should sit, from a, you know, I'm not sure how much value I would get from being able to spring free from quarantine and day seven versus day 10. And I think I would probably prefer to err, on the side of, yeah. spending a couple more days in quarantine just to make sure. but nevertheless, I think that these are useful things and, and, and the reason where it's coming back as is, is really in response to continued research, trying to understand really how long a person is infectious for. Okay,

Matt Boettger:

great. That's helpful a lot. And I, I, I clearly missed. Understood. I was thinking, Oh man, maybe from the time of exposure, but then again, you're right. You have no idea when the actual exposure is related to the one. So let's get to the heart of this. This has been the perplexing one where, I mean, we've been talking about herd immunity. I feel like for weeks now and now it just keeps continuing to grow. And it seems like a little bit complicated. So, I want to throw it past you. We, you know, there's this, one of our listeners, John sent a series of emails to us about, this. The, the natural immunity and once I mean infected, and it seems to be that there is some more research being developed that isn't necessarily the greatest news and I don't even fully understand it. So this is why I'm glad I have you, because I would read this stuff. I'm like, I have no idea what, what IgM is and what these, these kinds of things. So. What's going on with natural immunity. Now we, we seem to know that at least lasts like five months is the minimum that this seems to be. And it could be naturally longer than that. Now this article from the Lancet seems to show that there is a possibility of reinfection, which we know for sure we've seen people be reinfected, but I think there was before this, this Lance article, I felt like there was like this assumption that, Oh, people probably get reinfected, but because of the memory of immunity, it's not going to be nearly as bad. So. You kind of like, it's going to be, it's going to be less, it's more tolerable, but this says the suggesting that 50% of reinfection are worse than the first. what, what are you hearing in the side and what's, what is this inferring to, or is this even true?

Stephen Kissler:

Yeah. So I want to, I want to immediately sort of unpick that 50% figure because this article was based on four cases. So two, two, two of them were reported to be worse and two of them were reported to be bettered. So statistically speaking that doesn't give us any certainty whatsoever about how, how likely it is to be more or less infectious. Furthermore, we're much more likely to see. More severe outcomes, right? It's, it's much easier to detect. So people assume frequently that, that when you get infected, you're probably immune. And so we're only going to notice the people who. Gut COVID tested positive thought they were immune and then had a very severe infection later on. So, so this, these statistics are going to be hugely enriched for precisely this population. That's the most alarming for the people who have been reinfected and reinfected severely. So I think, I think it's, it's important to pay attention to, you know, these are case studies that are saying that it is possible for you to get reinfected with COVID and it is possible for that re-infection to be worse than it was before. But the question of how likely that is, it's still very open. And I think that. that there's, there's no evidence that I'm aware of yet, which again, lack of evidence does not imply evidence of a lack, but there's no evidence that I'm aware of that. That, that there there's this really widespread phenomenon of people getting COVID and then getting reinfected with COVID and then unending more likely to have a very severe outcome. I I'm sure that it happens in, in cases. but really the question, and this is really a huge question we're trying to answer as epidemiologists is how frequently does this happen? so we can break into this a little bit more. So again, COVID is, is such a new illness that we know very little about it. So, well, we know a lot about it, but in terms of the duration of immunity and the dynamics of immunity, that's something that we won't really know for sure until it's been with us for a little while longer, but we, there are some examples that we can draw on. So we know that the other Corona viruses that we have, the seasonal Corona viruses, we know that you can get reinfected with those two on the order of a year after you've been infected with them. In most cases, the reinfection is less severe than the one that you got before, but in some cases you do still show symptoms and those symptoms can even be more severe. So, so all of this seems to be in line with the closest relatives of SARS, cov two as well. now there are. There are illnesses. There are viruses that you can get infected with where a second infection, a challenge with a new infection can actually be worse than the one that you got in the first place. So, the, the classic example of this is Dan gay. it's a mosquito borne illness. And there are four, four, I think. So I'm not a DNA specialist, so I'm probably going to butcher a lot of this. But, but to my knowledge, there are four main types of DNA, four main genetic variants. And the issue is that if you get infected with one, usually you have sort of a minor feverish illness and then you recover. But then if you get subsequently infected with a different strain, there's something about the biology of it that basically it's called antibody dependent enhancement. And so what happens is that the antibodies that your body develops. To fight off the first infection because of the way that the virus is structured. It actually can use those same antibodies to help it infect your cells. And you often end up getting a much worse illness the second time around. so, so that's possible. That's definitely something immunologically speaking that we've been thinking about from the beginning of the pandemic, but, I think if that were happening on a large scale, we would probably have seen pretty clear signs of it by now. And to my knowledge we haven't. So while it is possible, again, for people to get infected and to get reinfected more severely, I can't write this off entirely, but I really don't anticipate that this is going to be a huge element of the re-infection story. So, yeah, so I think, I think that's, I'll leave it at that.

Matt Boettger:

Okay. And it's funny because Steve, we have we've we have 47 podcasts almost underneath our belt, and I feel like, Oh my gosh, Steven. So when you talk about times like, Oh my gosh, we covered this. Like I remember, I remember I was just like, this is like deja VU, because you said almost the exact same thing. And this is why I, sometimes I feel like you and Mark are so ahead of the curve. Like when it comes to like dealing with stuff that then when it becomes popular, like, Oh yeah, we talked about that like three months ago. But because then I came back and said, Oh, this makes sense. And these, these are the words I said to you. It's like back in March, right in April when we were dealing with the first round of infection and the death cases were so high, like, Oh my gosh, it's so terrible. And then you were like, wait a minute. It's just because it's, you know, we're getting the worst from the hospital. That's, we're getting, but more than likely, it was much more. And now we're just having Groundhog's day again. But with re-infection and bet, we're asking the same questions and doing the same thing as if. I didn't even listen to my own podcasts and we didn't even realize that April happened. So,

Stephen Kissler:

yeah. I mean, it's, it's hard though. I mean, you're right. Like a lot of these things are things that we've, we have spoken about before in different contexts, but it really, it's not always natural to reapply them and to see how they, they connect. so. I think it's good. It's good to rehash. but it's also nice to see when sort of the same principles sort of keep a rising.

Matt Boettger:

Yeah, absolutely. Someday we'll just create this entire mind map of all 47, 50, 80 episodes of how we all circled back and connected. It's going to be amazing. It's going to be amazing. It's so, okay. All right. Let's continue on now just quickly. I don't know if this is relevant anymore, but, but he mentioned this IgM and immunity. What is IgM just for my own wellbeing and how is this related to his question? I mean, maybe it is for my wellbeing. I am first my immunity. So, but for how to, what is this and how does this relate to this question?

Stephen Kissler:

Right. So when we're, looking at antibodies from infections, there are two main antibody metrics, that, that are measured. And so, Very, roughly speaking, you can think about these as sort of like a short term and then a long-term sustained antibody response. So, what this refers to is, the IgE refers to immuno gob immunoglobulin. and so it's like an immune response cell, basically. Okay. And there's, and then it's appended with an alphabet. So there are different types of immunoglobulins. and so IgM. It was one of the first ones that you produce. So you it's basically like your body's first response to an infection. And so quickly after you've been infected, you can detect IgM in your blood, but it spikes. And then it comes down pretty quickly. And then basically IgM pretty quickly becomes into tactical. But your IgG, which is sort of more of a sustained response, usually comes up. And then for many infections that, especially the ones that induce long-term immunity, you sustain this detectable level of IgG afterward. So clinicians can use these and the relative fractions of these to help sort of triangulate how long ago a person has been infected. So if you test positive with IgG for something but not IgM, that means you had an infection a long time ago with something. Whereas if you're positive for IgM, but you can't find IgG, that means you're infected very recently. and so you can sort of use these to try to figure out how long a person has been infected and, and with IgG, whether they've mounted a long-term response. So, Yeah. So, so looking at how IgG trails off has been, one of the ways that people have been trying to measure this potential decline in immunity to SARS curvy too. But with that in mind, how did you always declines over time? No matter what the infection is, and it just really matters sort of at what point it levels off. To determine how long your immunity lasts. Okay.

Matt Boettger:

So I don't know if this is irrelevant because you just said this, this LANSA was for people. So this question about the, the, the, the, the IgM, that they noticed that in these, I guess, four people, the ones who got the worst, second round of sickness had detectable IgM in them. Is that any, is there any point to that? Is there any correlation, is there any, or is it just that they probably were just recently. Diagnosing. I

Stephen Kissler:

think, I think that's the idea is basically providing more evidence that these were actually novel infections and not sort of reactivations of some old infection. Okay.

Matt Boettger:

Chris. Okay. last part of this, another question kind of related to this with, COVID and the research behind it. Again, this is new to me. I have no idea what it, so basically COVID has given us BSL three designation and the, and apparently it's very expensive for these labs. And the question was, you know, is this preventing further research because it's so expensive as this kind of an unusual designation. And is there any way to lower this designation? So that research can be more, I guess, accessible if any of this is true.

Stephen Kissler:

Yeah. So I think this is a really tricky question and I don't have any clear answers to it, but it is. To my knowledge, pretty standard to have infectious respiratory pathogens stuck into BSL three labs, which were, pretty, yeah, I, high security thing. and that generally makes a lot of sense. You know, you don't want these things getting out and spreading in the population and you certainly don't want a lab to be the epicenter of that. Nope. It has been argued, certainly that like the people working in these labs are more likely to get COVID from the grocery store than they are from the labs. So why, why keep it behind, you know, this lock and key. but I think that there's, there's something important too about, the, almost even the image of this, that, that, that there are certain types of risks in certain types of contexts that we're willing to make where. Getting groceries as essential and something that we all do. But there, there seems to me to be something that would be potentially worse about an outbreak that got started due to an escaped lab strain. I think that that would go a long way towards undermining the scientific research as a whole. And so I think that the scientific research almost has to be held to a higher standard in a way. And I think that's okay. There is definitely this trade-off because that does make that, that can sort of slow down the research that can make it so that it's harder to, it just takes longer to find some of these conclusions it's more expensive to do the work. there are fewer people who are able to do it, and. But I don't, I'm not convinced that the answer is necessarily to reduce the, the security level that, that COVID needs to be worked with. it also depends a huge deal, I think, on what type of research is being done. Of course, where, you know, if you're, yeah, I think that if. Yeah, it just, it, it depends a lot of what kind of research is being done because, by, by definition and doing research we're, we're trying to answer questions that we don't know the answer to. And so when you're doing biological research, there's just a lot of uncertainty there that I think is worth sort of protecting both the scientists and the broader public from, cause we're not, yeah, we're just not totally sure what the outcome will be. And well, all of the researchers that I know about aren't, you know, like making, you know, They're being very responsible and even the ones who are doing work in, the, the highest security labs are not like, even then you're still thinking about risk and thinking about, you know, potentially contaminate contamination and things like that. And they're, they're doing their due diligence to make sure that, you know, that everything that's in the lab stays in the lab. but, yeah, so I think, I think it's just a very difficult question and, It's one of these tricky, trade-offs where there's no clear, there's no clear answer. but I don't, I don't think that the answer is necessarily to just reduce the security

Matt Boettger:

Yeah, well, I mean, gosh, Steven, I mean, after all science, the scientific community clearly right now has so much trust behind it and the whole us that, of course, there's some margin to, to, to just waste the trust that with you guys don't have right now, which is an justice. Well, I get it. This is not the time. And I think for the scientific community to take some risks, to, for the sake of public health, in general and, and, and I mean that in, and it's a much more comprehensive, holistic sense. The last thing I wanted to talk to you about is the CDC and the modification of this transmission of COVID. This came out this week, you know, What, what does this mean? Because, so for those of you who haven't heard this basically CCQ for up until this point, there was the, the advice of just less than 15 minutes. so don't, don't stay around someone for more than 15 minutes and less than six feet away. Otherwise you really increase your chances of being infected with COVID. Now, because of this example of this prison, I guess, I don't know the full extent of basically some prison guard or some advisor had a series of inmates that had COVID. and it's nice because you can see them on the camera. So you can actually literally count how many moments minutes of exposure this, this prison guard had. And it would never was with anyone for 15 minutes, but. When you count up all the kind of moments of these, infected, inmates and equal to 17 individual minutes here and there throughout a 24 hour period, and that individual minutes accumulate in his body apparently. And then he was now infected with COVID. So now the, the, the, the, the mandate or not the, the advice is. That, it's a series of 15, basically minute encounters with COVID with someone. Right. So can you talk a little bit about this? And also my question is, is this just with the same person or does this matters? It doesn't matter anyone. It is 15 individual minutes. Any exposure outside?

Stephen Kissler:

Yeah. because I think to my mind to this, this update is not particularly. New really. It's just sort of like a clarification of, of what was there before in a way. and because the, the point is when it comes to infection, the point is, you know, not so much like. time with a person or in a space it's really about how much virus you ingest, right? And there's, there's this dose response curve basically where the more virus particles that you breathe in, the more likely you are to be infected. So that can either happen by being in close contact with one person for two minutes or relatively distant contact with one person for 15 minutes or very short contact with multiple infected people, repeatedly over the course of a day. And sort of as that virus builds up, You're more likely to get infected. so, so that's really the idea. It's the fundamental idea is no different here where, where the thing that leads COVID to spread is duration and proximity. Right. And the CDC has been trying to put sort of. Guidelines around that. but I think there's something interesting here because, I think, I think what we're talking about here is, is actually something that's, you know, millennia old. It's, it's the difference between the letter of the law and the spirit of the law. Right? It's that's, that's the question that we're talking about here is like, is it. 15 minutes or is it one person or 10, you know, like what is it? Well, the, the importance and the thing that we can engage our reason with is like, okay, so there is this law, but we also have some understanding of how disease spreads. So what's the spirit of this law. What is it trying to tell me? And how can they use this to infer more broadly sort of what the principles are that lead to greater levels of risk. And I think that's, that's what we're being. Asked to do here. and it helps to have more and more precise sort of guidelines around these things, but, but no set of guidelines will ever be comprehensive enough for us to apply to every situation that we have in our lives. And so the important thing is always to just keep in mind that like, w w what is this rule trying to tell me, and how can I live my life in accordance with the intent of that rule? I think is, is, is the most important thing that we can glean from this.

Matt Boettger:

Wow. That's that's great. Now you say it's a difference between going by the letter of the law and the spirit of law. And that's really great if we still have a spirit. Right. And I think then they think that's part of the problem. Is that in a large sense, I could see it. Is it when, when I am exhausted and the spirit is just, just a plead in me, I go to my most Bazell lowest. Common denominator. What do I need to do? And okay, 15 minutes. I'm not gonna think about this as a much, but I get it. We need it. We need it. It's complicated. It's nuanced. We need to take this up and keep the spirit of the law and you're right. It's not that it's not, it's not that different. It's 15 minutes. Whether how you get the, it doesn't really matter. It's not like a, it has a mind of its own to strategize. It has zone timer that it sets itself off for 15 minute increment in intervals.

Stephen Kissler:

Yeah, and I really, I really want to reiterate that, like, that doesn't mean that this is easy, you know, we know like th the other thing about the spirit of laws is that it's often is much more demanding to figure out what exactly that spirit is and does require a certain amount of. Learning and understanding of like the process of disease transmission in this case. And it's like, so, so that's not to say like, Oh, well just interpret the rules. it requires a certain amount of learning and engagement with, with the underlying principles to know how to rightly interpret them and to interpret. So, and that's hopefully something that we can do on this podcast too, is like through this discussion. I think that discussion is the best way to understand. What that is. and so, so I'm glad that we can, we can sort of have these conversations because I, I recognize that some things that might be very intuitive for me, for somebody who has been studying infectious diseases for the last 10 years and has been thinking about pandemic pathogens all the time, what makes total sense for me as the spirit of a lot might not actually translate. And so it's through these discussions. I think that that, that that can hopefully emerge.

Matt Boettger:

I think you just we'll end on this because I think this is important thing to end on is that coming from you, Steven, you come from the spirit of the law and then you, you, you come from that as your source, because, and the reason why I say this, because I just talked to someone today about this nuance of the CDC. Right. And they rolled their eyes like a, another, another rule, right. As if it's like, as if, as if we're going from the rule. The unique rule and then adding more rules to them as it's just another rule, another regulation rather really it's the other way around. It's the spirit of the law by which we're trying to simplify it for the common good of public health. And then of course, by simplifying it, we can then air a little bit and then we have to keep nuancing this. Right. So then it looks as if we're currently like, like, like a shotgun, Bebe's all those like, like just being drilled to death by these laws. That's not the case. It didn't start from this one digital law. It started from the spirit of the law and then trying to give it to a place where it's digestible for public health, but then it has to be nuanced. Right. And that's an important direction that, that helps relieve that, that pressure valve for, for many people. But it's not an, it's not an, it's not another mandate it's always been there. It's just the try to simplify it, but then there's nuances and then we have to address it when the time comes, when the time comes. Right. Right.

Stephen Kissler:

Great.

Matt Boettger:

Great. Well, listen to that. Thanks Steven, for being on. Good to see your lovely face. and if you want to reach out to Steven, always can you can, you can tweet him. S T P H T N K S S L E R. A love to hear from you guys all around the world. Fergal wrote back. It was awesome. I think I sent it to you guys. Thank you for it goes great to hear what Ireland is going through. It looks like there's a little bit of riots in cases, but, love to hear from you, all of you. So you can do that. Matt Elim in the real.com again, check out my website, live in the real.com or the podcast. You can find it living in the real and, yeah, leave a review. And if you can support us patrion.com/pandemic podcast. Thank you all for listening and we will see you next week. Take care and bye-bye.