Pandemic: Coronavirus Edition

A vaccine that works just as good with elderly, and why the death rate isn't as big as the Spring

October 28, 2020 Dr. Stephen Kissler and Matt Boettger Season 1 Episode 48
Pandemic: Coronavirus Edition
A vaccine that works just as good with elderly, and why the death rate isn't as big as the Spring
Chapters
Pandemic: Coronavirus Edition
A vaccine that works just as good with elderly, and why the death rate isn't as big as the Spring
Oct 28, 2020 Season 1 Episode 48
Dr. Stephen 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.

Matt's Living the Real Podcast

  • Check out Matt's latest episode on how to live a more frictionless life here.
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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 of these crises. My name is and I'm joined with my good friend, dr. Steven Kissler, an epidemiologist, the Harvard school of public health. How's it going?

Stephen Kissler:

Hey, doing all right. How are you doing? You? Keep your warm up there.

Matt Boettger:

Oh, my gosh. As you can see for those of you who are actually live or watch this later in some capacity, my background is a beach with an ocean and that's my inspiration. Cause right now it is the other end of the spectrum here in Colorado. We, we got like 10 inches of snow, crazy, which I mean, normally I would just say. I cannot stand. No, I'm 42 years old. I'm overweight. Now I get why people move to Florida. Steven, I get it. When you get older, however, I'm never moving to Florida. No offense to anybody who's in Florida. Just not my style. I, I don't know where he goes to maybe in the California or Maori someplace like that, but right now, 10 inches of snow, not a big fan, but given our circumstances and the fires all around Colorado, I'm so thankful for the precipitation, so glad to have it. And my boys are just, it's like, is it Christmas? Is it Christmas now? I'm like, well, no, it's, it's snowing.

Stephen Kissler:

Oh man, that's

Matt Boettger:

a little bit longer, but they're excited about Halloween, even though we will be doing much. We spent a little extra money on, on Halloween outfits this year, just because we realized we're gonna be very limited and everything else. So at least they can run around in the day in their house with their outfits. So that's our, that's our bonus. Okay. Let's get rocking and rolling. so need reviews. We love them. We got not another one from, I love Stephen. I just love usernames because you can put whatever you want. So this one is pizza understands one, three, two, a pizza understands a one, three, two. Yeah. So no idea, what that actually refers to, but sounds fascinating. This person writes. Factual podcast on COVID-19. Thank you for this podcast. I've been listening since this all started. I appreciate presenting the facts as we know it at the current time, I like how they break things down for a lay person to understand as an infection preventionist specialist, I have always agreed with what they've presented thus far. I'm sure I'll continue to agree. I think it certainly helps explain the why's and the rationales behind the recommendations. And of course the transparency of, Hey. This is complicated. And in a nutshell, this is why we think this way, but it can change as we get more information. Of course this whole situation is complex and we will have many different impacts on our lives and our communities countries, and in the world. I wish more people would listen as, as this would help dispel a myth from fact keep up the great work. Thanks long one. Awesome. Thank you so much for pizza. Understands one three, three, one three, two. Love these, keep them coming. If you want to support us financially, you can do that. patrion.com/pandemic podcast. We greatly appreciate the efforts to keep this going. You can do a one-time gift at PayPal Venmo all in the show notes. All right, so let's get started. So our first thing was the question. So we have a question. Now this is long overdue. This is from Amanda about opening school. So I'm going to throw this to you, Steven right now. And this is, she is concerned. She has, I think seven, eight year olds. It's been difficult, like just online virtual learning has been complicated. Just doesn't work. She gets these mixed messages that she's seen. Some articles say, Hey, it really doesn't impact the spread of the virus. That's okay. Other articles are saying the opposite really wants your feedback. And then on top of this, their school, their superintendent is saying that, look, we are not going to reopen schools until there is zero risk. And I'm like, Whoa, that seems really complicated. I want to hear your response to that. If you go under a Zurich, zero risk PO policy, will there ever be school again in their lifetime? So what do you think about right now about reopening schools and the superintendents response?

Stephen Kissler:

Yeah. So from what I'm seeing, the reopening of schools doesn't seem like it's led to big. Well, and so I'm an epidemiologist and a statistician, so I'm going to qualify everything I say in about a thousand different ways. But, so. Reopening schools has, of course, led to outbreaks in certain places. There have been outbreaks in schools COVID can spread in schools. that's especially true for, older students, middle school, high school aged, but it can spread among kids as well. but that said, it doesn't seem like schools have sort of been these big drivers of community level transmission. Where, for example, in, in the spread of the flu, it's often the case that it's like, it's like young school aged kids who are, who are spreading the flu out. Like they that's, that's like what they do and what they, so it does seem to, just, just spread a little bit differently and it's still something we're trying to gather information around, but, but schools really haven't been these big drivers of transmission. Part of the reason we, we, we know this is because a lot of the spikes that we're seeing now are not in young kids, it's in young adults. and so. it's the places where young adults seem to be gathering and getting together that, that is leading to a lot of spread of transmission. so yeah, so I think that, and this is something that we were talking about earlier on too, are that, schools with reasonable prevention measures, ideally with some sort of ventilation and masking, can be relatively safe places to be, especially for young kids. And so, Yeah. And that, that seems, that seems to be bearing itself out right now. which is, which is good. the, the, the statement of zero risk. I mean, I definitely have some sympathy for it, right? Like the superintendent is talking with parents who are nervous about kids and the kid, their kids sending to school and really wants to like drive home the point that like, they're going to do everything they can and bend over backwards to make sure that these kids are safe. But of course, I mean, nothing. Is there a risk, right? Like I had a bowl of oatmeal this morning and I could have checked on it. Right. Like that. The, and so, and especially with respect to COVID like, anytime you get two people in a room together, anytime you touch a door knob, I mean, I don't want to make anybody feel like paranoid because like, these are low risk things, but nevertheless, there's always the possibility of sprints. So, so eliminating risk is not really something we can do. Ever in our lives completely, but, it seems like schools have by and large have gone a long way towards really reducing that risk. And that's, that's what it's all about. we don't need to sort of obliterate risk from our lives, but as long as we're reducing it enough, then, then, then sort of all those, all those efforts compound and we get better and better at reducing infection in the community as a whole. And that's really what we're. Yeah.

Matt Boettger:

Great. Yeah. I was reading an article earlier about, you know, one of the arguments for. Kids going back to school would be just that way. I think we just mentioned is like, this is probably a safer place than maybe alternatives if they did not go to school. And they were just running rampid, doing wherever they wanted to. Right. Because I mean, this is different for like little kids. Right. But teenagers, that kind of stuff, the alternative would be. In the school there's, there's, there's strict rules, one through, out of school. They can do whatever they want. Right. Right. So in fact, it could be a better option depending on how the school policies are in place to, to, to help slow down the transmission. So.

Stephen Kissler:

Great. Yeah.

Matt Boettger:

Awesome. Okay. Next thing I wanna get into, I saw this, Adam, if you have feedback on this, but I just was fascinated. I know it was like a few months ago. We were just talking about the nature of vaccine. And not just, not just COVID, but just in general. And how will we, what we see is typically that vaccines don't have quite the immune response to the elderly as they do to the younger generation, but we just saw an article come up, by BGR saying that people who need coronavirus vaccine the most just got great news. and this, this is re you know, this is referring to, what was this one? The AstraZeneca. A vaccine. I know that was put on hold for a little bit. I think it's back in trials again, but this has mentioned that particularly this vaccine has a similar immune response with the older and younger adults. And in fact, it's saying that AstraZeneca. Has less adverse effects with the elderly even. So this seems incredibly promising. Is this unusual Steven or, or is this, is this seen from vaccine? The vaccine?

Stephen Kissler:

Yeah, it depends a ton from vaccine to vaccine, but definitely, My sort of my, my prior hypothesis going into this is that we're more likely to have a vaccine that's less effective in the elderly population. So I think this is really encouraging. it's not, you know, I wouldn't say that I'm blindsided by the news, but it's, it's definitely, a pleasant surprise. so if some of the modeling work that we've been doing lately, again, suggests that vaccinating, the elderly vaccinating people who are at high risk is probably the best strategy. Even if we have a vaccine that's not, You know, th that, that does decline in effectiveness with those older age groups, just because the risk of severe disease is so much higher in them. but the fact that if this is true, then that will make those vaccines all the more efficient and, it could be a really huge help. So, Now importantly, there are different ways of measuring the effectiveness. So first you have to Mount an effective response, but then also part of the question is how long does that response last? So my guess is that this trial is referring to that first thing, which is very good, but there could still be differences in the, in the rate at which immunity wanes after getting vaccinated. And that could also differ by age groups. So we're not necessarily out of the woods yet with, with determining equal effectiveness among different age groups, but this is the first crucial step and it's, it's definitely encouraging.

Matt Boettger:

Yeah, I got at least excited about the hopeful tendency. Cause I know initially when you were talking about, I was like, man, I didn't know about this a little bit down like this. I feel like this is a difficult reality with our own mother-in-law and that, but then this seen this. Okay, well there's a sign that maybe there could be something that would help adjust as much for me as it could for her. And we'll see in the end. So I was going to bring it to your attention, the listeners. Good hopeful news. We'll keep it real. Keep it on the radar as well. Okay. As you would imagine, those who are listening to podcasts, there has been an enormous increase in cases we saw Friday. this is a, the largest, spike, since the pandemic, I think it was over 80,000 cases on Friday, man, 81, 82,000 cases been fluctuating somewhere in the 71. Epidemiologist says it's not gonna be surprising to see in the next two to three weeks, potentially tipping over the scales of a hundred thousand. daily cases, we see this in Colorado right now. We're having a spike. We're having a surge, governor Polis has now, I don't know all the details, but I think, and that it's 10 people like usual, but now reducing it to no more than two households coming together and having an extra restriction to keep it a little more contained. What are your thoughts right now? Going on what you're seeing. Do you agree that we're seeing this kind of continuing to rise, that we see a topping over a hundred thousand? what what's, what do you see is going on right at the moment?

Stephen Kissler:

Yeah. And, I'm pulling up some, some of these case counts now, but, but you're right. I mean, cases are starting to rise across the country and it really is driven by a lot of spread in sort of the Midwest upper Midwest mountain West. But, but we're seeing upticks in cases around the country. And, again, this is, this is sort of something that we've been talking about for a long time, that we were probably going to see patchy outbreaks over the course of the summer. But a lot of times with these respiratory pandemic illnesses, you do see those sporadic outbreaks and then in the fall, and in the winter, you sort of see one large wave that seems to hit everywhere. More or less simultaneously. And so I think the fact that we're starting to see upticks in a lot of different parts of the country. and in fact, in Europe as well, suggests we might be at the beginning of that, of that fall wave. So, cases are rising. they're rising substantially and at anytime we're, we're sort of entering into that exponential or maybe. A little bit sub exponential growth. we can get a lot more cases very quickly. So I think that that, that benchmark that you mentioned is not, yeah, we're not too far out of sight from that many from seeing that many cases. So, yeah. So what do we do? I mean, I think the key is that separate from. Other types of natural disasters, like a wildfire, like a hurricane? Well, actually, I mean, maybe a wildfire is, is a reasonable, comparison in that, sussing that, that Springs up, but there are still things that we can do, right. There are things that we can do way ahead of time to try to prevent the spread. But now, now we're sort of in this place where it's like taking off. Right. And so, but there's still things we can do. And so I think that again, since we, since we know that super spreading events are really important and that people have a tendency to gather in larger groups around this time of year. Anyway, I think that those restrictions on gathering sizes make a lot of sense. and I think that, If we think about it in terms of trade-offs, we can either do that or have other types of much more restrictive, rules. And I think that from a lot of the, both of the basic epidemiology and the modeling work suggests that restricting gathering sizes can actually go a really long way for preventing community transmission, and can free us from having to undergo some of those other types of really strict lockdowns that we went through earlier in the spring. So I think that that response makes an awful lot of sense.

Matt Boettger:

Great. You know, I was, it's one of the things where, well, we mentioned again, like a month ago or two months ago, how I want to like, hold my breath and bite my tongue for anything, because what it is today is gonna be radically different tomorrow two months ago. And we already kind of mentioned about. What was like three months ago and how South Dakota didn't do much. And they were, you know, they were doing great. And, and, and I asked you, why is that? And you go, we don't know when it could be, just because it hasn't happened yet. And now we're seeing the highest cases per a hundred thousand in North and South Dakota right now. And again, I still want to bite my tongue. Who knows. Could it go all the way down to zero and two weeks? Maybe I have no idea, but right now, what we're seeing is what you just said is it could have been just. You know, happy luck it's three months ago, and now you're getting the rent. Of of, of the problem. And we're seeing this, this is why it's it is, it is so complicated. Everybody has, you will look at this, look at these, look over here, see told you, right. And then we'll just, wait, you just don't know what it's going to happen two months from now. And now we're seeing this. Right. And, and, and so, hitting the rural communities as you suggested months ago in the fall, Doing just that. and, I'm, I just, I hope that people can take this seriously a little more seriously now and do the very little things that are being asked for. And this reminder, this, this, this kinda reminds me of the question I'll throw. I just saw this on Facebook. So. And throw it your way. I don't know the whole context of this. Some people are a little irritated by it, but apparently governor Polis was quite exposed to COVID on a Friday. And then, his, his, policy, his experts told him that he didn't have to quarantine because there was no risk of being transmission. And I kind of looked into it. It looked like they were outside. There was some event I'm sure in true good governor fashion, they were at least six feet apart. They were all wearing masks. And so in light of that, you're outside. You're probably six feet apart. You're just giving some kind of talk on some kind of steps. You're all wearing masks. I would imagine that when all those are put together, the risk isn't exception really low. Am I, am I correct? To assume that yep.

Stephen Kissler:

Yep. Yeah. That's right.

Matt Boettger:

Yeah. Is that people just having probably why isn't he? And I'm like, I, I think it's a different circumstance. If I was wearing a mask outside and having distance and there was somebody in front of me, six, 10 feet away from me. I don't think I have to worry about it that much. So, it's not that high. Okay. Let's get now let's go into from CA case increase. We're seeing this case increase. It's going quite dramatically. Now the death rates, we keep talking about this. The death rates are increasing, right? We saw this last week, first, they weren't Mark asked the question and you kind of gave a really good explanation of, well there's a lot of factors involved in one such factor is it's hitting the younger community and it takes an extra level of time for it to then get to the next set of community, which is older. Before they get exposed, they get infected. They have difficult times and they find themselves in the hospital. What we're not seeing is that the rate at which the death rates we see are not. As big as the first wave. So the question is why, why is the rate now we've talked about, we've talked about this last week. We circled this idea of, could it be because we have better medicine, but we've noticed that some of the medicine isn't having the effects studies, Shea, show. But, but my big question, I just want to suggest, and maybe you don't have much to say on this. I saw a couple of articles just alluding to the ventilator early on. We really, really try to, Just put your use of ventilators, because that was, we thought a really great opportunity to keep the patients alive. We're seeing now research that maybe it have caused some, some, some more problems in the lungs. And then we thought, is it possible? Do you see anything out there? Speculating talking about the, the idea that ventilators could have contributed a little bit to, the vulnerability of the really sick in the first couple of months.

Stephen Kissler:

Yeah, I, so I've never, I haven't seen any hard data on that. I I've heard this sort of similar anecdotes from people who have been in hospitals and been using ventilators. So I think for me, what this really gets back to is, She's the doctors have learned an awful lot about the normal progression of COVID about, how to care for patients. And a lot of that, manifests itself in ways that aren't really measurable, like administering a drug can be, I mean, I. It would be so interesting, I think to go back and just sort of talk with Mark in April or may about just like what, what it's like to see a COVID patient versus like what it's like to see a COVID patient. Now, my guess is that, and I wish you were here to sort of fill this out, but my guess is just that he can walk into that. Room with a patient just a lot more confidently and have a much better sense of like what the trajectory of the illnesses, how to act in certain ways. And he might even not fully know what he's doing or why he's doing it, but it's sort of built through this, this, really deep interaction with patients, and many patients over time. And I think that that probably, It goes an awfully long way in, in improving patient care. So, yeah, it's things that are really hard to measure. And, and it's these decisions. I mean, you reach these decision points, like, do we put this patient on a ventilator or not? and you have to make this decision in the midst of all of these sort of complex different inputs and, And, and I'm sure that, they're getting an awful lot better at just determining for which patients it's going to be a good idea, and for which patients it's not, and this sort of thing that can only come with experience. So, so I do think that there's, I'm sure there's a lot of this does come down to, just better sort of better physicians sense in a way that, that comes through more experience with us. as well as all of the epidemiological things that you were just mentioning as well. But I do think that this is probably part of the story. Yup.

Matt Boettger:

And he reminded me of a great book. I love this book called the happiness advantage. Now we're moving now from quantitative to kind of qualitative research where he kind of has all these examples of how happiness proceeds really all of our life that we can't really try to achieve happiness. It's kind of like a presupposition. And he talks about this concept, these studies that have been done where you were one that is just as fascinated me, where you would tell a patient and that what you're going to rub on your arm is poison Ivy. And so you tell them that and you rub it on their arm. And it's amazing how many people that sit in the study broke out with poison Ivy, even though it wasn't poison Ivy. And then they told some, the other group of people that it. That it wasn't poison Ivy. It was just a random leaf, but it was poison Ivy. And how many people didn't break out because of this and the power of the mind, right. To be able to overcome even physical realities. So how's this, what is the context I would imagine. And again, I wish Mark was here and we'll pull them in. We'll pull them back in this conversation next week that I would imagine when you were first coming in in March and April, it was just like, Unknown reality, a little bit of nervous uncertainty that may be even was transmitted from the doctors onto the, to, to the patients themselves. Now, I think there's a much higher degree even just enduring this for seven months of a sense of walking in with confidence, right. and then just having a doctor, walking with confidence and having even a hospital that is not running with its head cut off. Right. A little sense of greater sense of order. Just communicates to them that I'm going to be okay. And even in that same way of having that actually brings a higher sense of recovery, right. That mindset. it's not the cure all, but it definitely is a factor that considerate. So I can't wait to pull in Mark on that conversation. If you haven't read, I'll put in the show notes, have some advantage. It was a really, really good book. I think he was at Harvard for a little bit, but then he left. I'm not sure. so just want to pull that plug in. Okay. another part of this that I wanted to just say, and I, I want to say. Is this something you would agree with? One of these articles I'll put in the show notes from CNN, talking about the soaring rates of coronavirus, and really trying to make a call towards a less focused on treatment and more on prevention. And great-grand, that's a sweeping claim, but interestingly, he gave an interesting scenario. Why don't we it'd be so much less expensive, more affordable for the government to provide free testing kits. To every family for two to three months. Right. It's free everyone. Got it. Everybody gets to do it. And if you test positive, You're paid. You're paid to stay home for two weeks. Right? You're getting a check. I mean, I, I, why didn't people I think about this. I don't know. Maybe they did. Maybe they thought it wasn't that, that wasn't feasible. I'm like, this is fascinating. I wanna get your feedback on it. Cause I'm thinking of back in Boulder, when the students were locked down in an extreme measure, I don't have any data to back this up. Just human intuition. If I was 19 years old and told that I could see no one but myself for two weeks and tell these rates go down right. I am not going to be able to, you know, what I'm gonna do. I'm going to basically just, hide. And if I have it, I'm not going to go get tested. Right. Because I don't want to keep the numbers going up. I want to be free as a bird. Right. So, what are your thoughts on this?

Stephen Kissler:

Yeah, I think it's interesting. It's, it's, it's not too far off from some things that, like, Michael Mina and other colleagues have been proposing, about the rapid testing, essentially that we need to get tests out to everybody as much as we can give them to families. And I think the crucial element with this one too, is that we would not, basically it wouldn't be, Like a top-down legal thing for people to stay home. It would be an incentive for them to stay home. And that's really important. I mean, public health interventions almost always work better when there are incentives rather than, you know, impositions of rules, things like that. So I think that that's, it makes a lot of sense. you know, there is a question as to whether it would be. like whether the finances would work out, but, but I think there's a good chance that it would, I mean, I think that the potential of this to save money and save economic productivity and save lives, right? Yeah. In the longterm. Totally. Would be huge. and I think it would be a good investment. So I think also part of this just comes down to the sorts of things that we prefer. And this is like a sticky cultural question where it's really like the prevention, isn't it, isn't flashy, you know, it's not, we want to cure, we want something that will allow us to really do kind of whatever we want. And then if we get sick, we want to be able to be cured from it. And there's, there's something almost like more dramatic about going through like, Oh, I have this illness, but then I was able to be cured from it. Like we want we're we're really driven by like pills in a way, like there's a pill for everything. Like before there was an app, there was a, and it's like,

Matt Boettger:

literally.

Stephen Kissler:

And so, so I think that that's, that's another thing that I'm, I'm still not able to really totally wrap my mind around because it's, There, it seems like there's sort of these deep sort of like cultural preferences that are in play here too. That caused us to prioritize, developing a vaccine or developing a treatment over developing preventive measures that are actually going to be much more effective in bringing down cases and probably more cheaply. In the long run. so that's, that's not a problem. I know how to answer, but it's one that keeps me up at night for sure.

Matt Boettger:

Oh, absolutely. I have a couple of things on feedback before we do the next one, a couple things. First thing was the fact that the proposal was like, it would probably cost. The government $6 billion to, to, to do this versus the $2.4 trillion we have done. Right. So a huge gap in probably saving money. The second thing to your, to your, to your comment as well. another great book, the checklist manifesto. Do you have you read that one?

Stephen Kissler:

I have not read that.

Matt Boettger:

I may Mark one it's really, really good, but he talks about his whole sense of what you're just trying to say, like, there's this idea of either the pill to fix it, that something that actually has much more advancement to it, like they would, they would spend his, his idea was they would spin the medical industry would spend trillions or billions or millions of dollars to promote some robotic arm that can reduce. Right. Errors is in surgery by 10%, right. But spend millions of dollars. But yet the checklist manifesto you was saying, if I created a simple checklist for the surgical room that actually reduced that specific problem, the side effects of surgery by 60%, 60%, a simple checklist by taking and it got no publicity, none. Why because it's, it's not cool. I mean, prevention is like, that's stupid dude. Like, but I, I, you know, I, I wanna, I wanna eat my cake and have it too. I need my cake take a pill and flush that, flush that sugar out of my system. Right. And I think that's our mentality, right. So, but that's not the best, the best, best way to do this. So. I love it. Brian, thanks for the comment. I just saw an interesting comment about mind control. I hope you check it out. I had, for some reason it's not showing up here in the, in the, I think it's all being, offload as he can't see the comment. I just put it on the, the live feed here, but thanks for putting it on there, but check it out. the happiness advantage is an awesome book. Okay. So COVID effects. I want to talk about this. We, we mentioned that yesterday you have some insight to this, and this is the new study shows a link between COVID-19 and heart damage. Now we've talked about this before, at least twice, but this one caught me by attention because it was more specific. Now. I think it was something about, I haven't, I'm not looking at it right now. So I'll put in the show notes, you can read yourself something about 65%, something like that. people who have get COVID. Are susceptible to a heart attack in the future. Do you know much about what's going on with this, this, these studies right now?

Stephen Kissler:

Yeah. So with that specific statistic, I'm not entirely sure. but, but you're right, that we we've talked about COVID to being a vascular illness, and that it really does affect one's. Yeah, cardiovascular system and that's, that's actually not even just something that's specific to, SARS COVID two and COVID-19, that was actually an even bigger part of the SARS outbreak. back in 2003, where many of the people who were infected with that, the, the thing that they ended up. Dying from heart attacks actually, there was, it was involved with pneumonia as well, but really heart attacks was like one of the hallmarks of this thing that really separated it out from many other respiratory illnesses that we knew of. So, so this isn't really altogether unexpected or a huge surprise. We know that the severe coronavirus is can, can do this kind of thing. now. As to whether, you know, I'm not sure what their baselines are for, how many people are at risk and whether, yeah. I mean, there's, I don't, I don't suspect that they're doing this, but I always think back to this, example that, in my high school statistics class, which my mother taught, she, she always likes to bring up this example that, That throughout the entire course of history, 100% of the people who have eaten pickles have died within a small margin of error. Right. So therefore, you know, pickles are, are, are deadly and we shouldn't eat pickles. Right. And so, but the idea, so, so part of what I'm wondering here is that like, so yes, maybe 60 odd percent or whatever it was if people who are infected with COVID are at risk of heart disease, but I wonder how much different that is also from the baseline as well. You know, how many people who are infected with flu or how many people who stubbed their toe are also at high risk of heart, heart disease. and so that's what I'm not entirely sure about, but I need to read the study and, and I anticipate that they're probably doing something much more sophisticated and intelligent than what I've just outlined. But nevertheless, when we're hearing these numbers, I think we need to be. Yeah, it is sort of like the deeper point is that, you can make a very compelling and frightening statement about something that doesn't necessarily have anything to do with the two things that you're putting into comparison. and statistics has a way of doing that.

Matt Boettger:

That is awesome. My mind went wild when you did that, like I was thinking, okay. I could create so many awesome statistics that are true. Like I could just say, I bet you probably around one of the side effects of COVID is probably at least 40 to 50% end up adopting a dog. Great. You know, I'm sure. I'm sure. Just a joke,

Stephen Kissler:

right?

Matt Boettger:

Oh my gosh. That's priceless. Okay, good. Thank you for, for, for putting some light onto that, that, that, that a study. Okay. Two more things. We'll all do one more thing. And then I'm just going to give you guys a link to the show notes to a cool article. I read. so back in March and April, once again, You Mark, we're talking about Italy in comparison to the U S and how Italy his response was one of solidarity. you have family that are in Italy. we're you're getting feedback. We, we, we were showing videos of them singing from their there, you know, just in solidarity. It seems to be a very different reality. In the past couple weeks. And I don't know if it's true. It could be just a media blowing this out of proportion. That's all. I have a w I hear about protests. I see fires. w first of all, what's going on? What have you heard from your family if you've heard anything in Italy and do you, what made, do you perceive the difference between the March response and in the now response?

Stephen Kissler:

Yeah, so I, I haven't heard, from a relatives out there in a little while. certainly not since. Case was really started rising again there. so I mean, I anticipate that, that some of this probably has to do a little bit with just like what makes it across the ocean in the, in the news, that, you know, earlier this year, well, we were all just really terrified about this thing. You know, we were just like looking for good news and for something that showed like the resilience of the human spirit and that kind of thing. And, and, and, and there were plenty of examples of that. And now, I mean, I'm. Yeah, I'm feeling exhausted and jaded and all these kinds of things. And so, so part of what we're sort of seeking is examples of that outside of ourselves as well. But I think that there's something, I mean, I mean, like I said, like my own response has also sort of gone through that shift. So I think that there's probably some truth to it too. I think it makes some sense. We've been talking a lot about, among my colleagues about COVID fatigue. and we've talked about it here on the podcast to just, yeah. It's it's really hard. I mean, there's, there's a cognitive, physical and economic, burden to just dealing with this and always having to worry about, the risk of going outside your house. And, and so between like the, the social sanctions and the behavior changes and just the ways that our lives have been upended and just sort of this constant sense of worry, It's exhausting. It's exhausting. And I think that it drives people sort of to this edge where, the you're at some point and everybody's sort of limit is at a different place, but you just sort of feel like you've had enough. and meanwhile, I think that part of this is really complicated by the fact that different places have had such different responses to the virus and yet have also seen such different. Trajectories in terms of the, of what's happened with the virus. And, and, and we've talked a lot about how a lot of that just comes down to randomness and to population of factors and population density and things like that. But nevertheless, I mean, our, our tendency is to attribute. Actions and especially political and governmental actions to immediate outcomes. And so because of that, inevitably there have been a lot of actions that have either seemed too severe than they needed to be or less severe than they needed to be. And so there's sort of been this erosion, I think, of trust as well. And so now when governments are really trying to get the trust of the people who are living in their countries, it's really difficult because they're like, well, you told me to do this, you know, a while ago. And it seems like it wasn't necessary. Yeah. And like, what are we doing and why should I trust you? And it's hard. It's really? Yeah. So I think that that's actually one of the biggest, concerns in my mind, going into the fall and into the winter because, we do have a very clear sense of what can help prevent the spread of COVID, but there's also this sense of exhaustion and a mistrust. And I think that that's, that's going to make it a lot harder to actually, implement these measures, than it might be otherwise.

Matt Boettger:

No. That's great. Yeah. I think if we all just do our part right. And do the simple things, I think we can get by with, we were talking about weeks ago, but the super spreading and the relationship to the super spreading and how wearing a mask, keeping distance staying outside of the best you can, you know, eliminating the people you, you, you you're with, but you know, not necessarily being alone, these simple things can really. Take the place of a lockdown, given that we're more and more stuff, but if no one does it, then of course it's like the last recourse, right? He wants to do this. Nobody wants to go to participate in this. Thanks Steven. Oh, the one thing I, and I didn't get permission to say this, but I think you, you nailed it as well. so I won't say who it was, but, somebody I know talked about going to a chiropractor. Just cause they really needed an adjustment and they just were feeling as part of the, the stress of COVID and there's a complexity. Normally you would just go there and you would just get it. And it was, and it was, and she really needed it. And she got there and no, he was wearing a mask. None of the doctors, none of that, none of the family, none of the people was walking in. you know, this person, she had the mask on and then she was being taught as she was being treated about how masks are pointless. Right. And so, and how you don't really need to be wearing them. And it's kind of passive way and like, This is now it's becoming so complicated and it's, it's almost just exhausting. Like now I have to find someone who I initially trusted, but now I feel vulnerable around them. And now I feel even just like pressured and what once was an easy thing to go to is now complicated. And it's just like, everywhere you go, unless you're in your own house by yourself, it's complicated and it's, and it does become drudgery. So of course, there's going to be a response that isn't favorable to the public. Okay, lastly, I'm going to mention, just drop it here. I love this article up in the show notes. I'm young and healthy. Should I get a flu shot? I'd love to this article. It's from the Atlantic. I'm going to post it. I know some people are against the flu shots. Some people are for them. all I ask is that if you get a chance, read this and maybe share it with a friend, because it really opened my eyes and put context of the responsible thing to do. And it was, it was well written, right? In a way that did not come across being polemical or just simply agenda driven. Simply agenda dribbling. so check it out in the show notes. I think that's it for this week. we're doing this on Wednesday, so we're slowly getting back to Mondays. Our goal is to be back on Mondays next Monday. So this would be less than a week to our next episode. Thank you all for listening again. If you want to reach out to Steven S T E P H E N K S L E on Twitter. if you already have dust. Any questions that you may have for us, you want to add to the next episode, you around the world, hearing what's going on in your neck of the woods. [email protected] If you want to support us patrion.com/pandemic podcast, as little as $5 a month helps. And then one time gifts in Venmo, PayPal, all in the show notes. If you wanna check out my other podcast, living in the real, you can look it up. It'll be in the show notes as well. Having a wonderful. An awesome week. I'll stay here in my virtual beach for the next 30 minutes. And, and, and you can be in your cold sweater over there. Stephen, we'll see you on Monday. Take care. Bye-bye.