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Things Discussed on Episode:
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Things Discussed on Episode:
You're listening to the pandemic podcast. We equip you to live the most real life possible and the face today's crisis. My name is Matt Boettger and I'm joined with Dr. Stephen Kissler and epidemiologist, the Harvard School of Public Health. How's it going and Merry Christmas to you. My good, wonderful friend.
Stephen Kissler:Merry Christmas. It's going all right. How are you doing Matt?
Matt Boettger:Not too bad. We are going to have a shorter episode today because we've been spinning Oh, about 35 minutes trying to patch in Mark. But for some, and we cannot get them in from his own home. So we'll keep trying to throw them in and tell his a lot of time at 10:00 AM. If we can get them in. Otherwise it's just going to be Stephen Knight today. And hopefully next week we'll be back with all three of them. If he's not back at the hospital. So let's get started right away. We only have about 20 or 30 minutes to get started. First, leave a review. If you can. We love them. Keep them coming. You can do that on Apple podcasts. Please support us. If you can. patrion.com/pandemic podcast for a monthly, a donation, or just a onetime to PayPal or Venmo all in the show notes. So let's. Get started right away. We're happy holidays to everyone out there who are listening, Merry Christmas, all that wonderful stuff. I hope you have a wonderful time during the new year. And last week, we ended up spending a lot of time on vaccine hesitation. And because of that, we kind of missed a couple of things that was kind of like hot news. Last week and it's kind of old news, so we're like slow to, to the, to the, to the catch-up. But nonetheless, I think it's really important. I want to start with you Stephen right away and just get the big picture. And let's get a vaccine update. We know that modern has been approved. Yay. That's awesome. I don't know when they're going to unroll that if they have already, maybe you can help me out know when that's happening, if it's happened already. And have you heard anything as of now about new reactions, new side effects, is there anything that's a bell alarm for you or is everything still for you and your mind? Kind of like a green light go things are still going well with the vaccine.
Stephen Kissler:Yeah. So Madonna got their emergency use approval from the FDA. I time ceases to exist for me right now. So I have no idea when that actually happened. But it was recently. And and I, I believe some of the first vaccines of the modern vaccine have been administered as well. So there. We're rolling out now as well. And as we mentioned before, the great benefit of the maternal vaccine is that it can be stored in more commonly available freezers. It doesn't have to be stored at quite as cold of a temperature. And so that makes it a lot more accessible for for places that don't have those really heavy duty freezers, which is great news. So, so it's really good to have both of these being rolled out. That means that there's. Two different groups doing all of the productions so we can sort of ramp that up as well. And it seems like there there's a mixed story. So at the top level, I mean, I think that like that overall, like, you know, we have the vaccine it's being rolled out. It's being rolled out very quickly and that's generally very good. As far as we can tell, I mean, a lot of the symptoms that we've expected to see we're seeing and people are getting the vaccine, interestingly And actually this isn't terribly surprising, but just as COVID can really cause a really wide range of, of severities and symptoms. It seems like so to can the vaccine and while the the vaccine, I think, as we've said before is more reactogenic than many vaccines that we have that were like the flu vaccine that we would normally get something like that. So a lot of people feel it. You know, you really, you, you feel like you've gotten a vaccine for a day or two afterward, for sure. You can get the chills, you can get a fever. And so they're, they're still watching those really closely But so far, I haven't seen anything that really trips any of my alarm sensors here. And it's just like, it's working as it should. So, so that's good. Now of course, there's a lot of complexity with vaccine rollout. I mean, there've been reports of like, within institutions, some amount of like, Arguing and infighting about who should get the vaccine first. And, you know, when do you like change, which age group is getting the vaccine and should we be prioritizing the groups we're prioritizing right now? So I think there's still a lot of things to get figured out there. And the rollout will continue to be. Bumpy, but the fact is that's being rolled out and that's, that's a good thing. It's
Matt Boettger:amazing. So, yeah, and I wish Mark was here cause we're, I'm let him speak for himself, but you know, he got the vaccine and he's had some stuff going on in his own life and we wanted to have him talk about feed patches in for a few minutes. We'll let him speak about his experience with the vaccine and some of the things that have happened over the course of, I think it's now it's been about two weeks since he's or, or so since he's got the vaccine, but whenever we get him back on. We'll allow him to speak about it, his personal experience. But the big thing I want to talk about now is this, this mutation that we got word of about two weeks ago. Now, I want you to paint a, a little broader picture because we've, I've mentioned this to you ask this question to you before earlier on like months ago, you're like, well, it's not quite a mutation. There's not this like other things that I heard buzzing around now, from what I've read, it seems like this is a little bit different than the little small things that we saw in April, may and June, correct me if I'm wrong. So talk about a little bit, like, what is this? It's a UK. I heard also like South Africa or something that there was another one that happened that we've seen paint the picture. And should we be concerned about this?
Stephen Kissler:Yeah. So it's, it's an interesting spot to be in now, because as you said, for most of the pandemic I, and many of my colleagues have been sort of following these mutations and sort of being like, you know, this is what viruses do. It really probably doesn't mean very much for their spread. With, of course there's the one exception earlier this year where it turns out that, that one. Point mutation. There is one spot in the viral genome that mutated that, that did generate a virus that seems to have spread that sort of displaced the original virus that was circulating. So there's one mutation that did make it a little bit more transmissible. But by and large, you know virus mutations, Happen. And usually don't do an awful lot. So we're in the interesting position now of of having, having something somewhat different going on. And so for a very long time, sort of like calling people's concerns about mutations, you know, this, this, this is something to pay attention to. And so. And there are a couple of reasons for that. So one of, one of the things that really surprised researchers about this virus is that rather than being just mutated in one or two points and sort of being really closely related to the things that we had been sequencing before this one had. Quite a few mutations a lot more than would be expected by just sort of the normal transmission evolution of the virus. And so what that suggests is that the sort of the leading hypothesis for how this came about is is that. It may have arisen from someone who had a long-term infection, who might've been immuno compromised. And so had the virus circulating in their body for a long time. And so we're exposed to a lot of different sorts of treatments trying to get it beaten down. And so then. The whereas virus evolution usually sort of happens in the space of infection between people. Now there's this whole virus evolution process going on within the body where the virus is being exposed to these different evolutionary selection pressures. And and so eventually what you can get is sort of a virus that The, that looks quite different than the thing that the person was originally infected with. This doesn't just happen with SARS cov two. This happens with a lot of other pathogens that cause these long-term chronic infections. And so it seems like that's likely what happened with this. As well. And so then it was able to spread again. And and, and now, now the question is, is what does it mean for the epidemiology of the virus, for how things are going to plan to pan out? And so there, there are two possibilities. One is that it mutated a lot, but really it's no different than what we were seeing before. You know, it just has a different genome, but, you know, whatever, it's just kind of like changed shirt and is now kind of spreading around the world. And so or, or the other is that, you know, maybe, maybe it is fundamentally different than a couple of important ways. So there are a couple of reasons why I, and many of my colleagues do think that this one is somewhat different. And in particular, there seems to be pretty good evidence that it's more transmissible than the Other variants of the Corona viruses that has been circulating. So, so what that means is basically a higher reproduction number, a bigger R. Okay. And so so far we haven't seen any evidence that it causes more severe clinical illness or anything like that, or that it really changes like the amount of time that you're infected or infectious. There's a really good study that just came out of the there's a group at the London school of hygiene and tropical medicine where many of my colleagues work and they're sort of breaking down this basically using mathematical models to break down some of these different assumptions. And the clearest one that sort of was most consistent with all of the data we have is that it's more transmissible basically. Okay. Higher heart. In addition to that, the virus has a number of mutations that have previously been identified. In in laboratory studies to affect different ways that the virus behaves in the human body. So there are, I think a couple of mutations that affect the way that it binds to yourself receptors when you first get infected. So probably allowing it to more easily cause infection. And so there are both biological reasons and epidemiological reasons to, to believe that this thing is, is, is more transmissible in a way. So from the epidemiology side, we've been seeing that this This virus has really been surging. And despite the fact that there were a lot of other variants of the, of the coronavirus around this one has been sort of displacing it. Meaning that the, that the relative proportion of this virus causing infections has been increasing over time, which you wouldn't expect given how much circulation was already happening with the other viruses. So there's a lot of pretty good evidence that that this, this variant is, is actually more, more infectious than the ones that we've been dealing with so far. Which is not what we need. Right. You know, it's like right on the heels of rolling out the vaccine. And so now what we've essentially entered into is, is in some senses sort of like trying to vaccinate people more quickly than this variant can spread. It does seem like, you know, we, we still need to do the direct trials, but there's no reason for us to believe that the vaccine is less effective with this variant than the others. It is possible for viruses to. Evolve and sort of become resistant to vaccines, but it doesn't seem like this one has the mutations in the right spots that it would need to do that. So I'm pretty confident. My colleagues are pretty confident that the vaccine will still be effective against this variant, which is very good news. But the fact is it's more it's it's, it, it, it looks an awful lot. Like it's more transmissible. And so that's going to make it harder to control the epidemic. And it's also going to raise that threshold of people, that the number of people that we need to get vaccinated to, to achieve the level of immunity in the population to finally stamp it out. So a lot of complexity there, I just, I just laid a bunch out on everybody. Yeah, that's great. That's what we know.
Matt Boettger:So a couple of things. Now it's in the UK right now. How do we know when it comes to the U S do we, do we know this from like PCR tests? Or is it more of like a different, I mean, how, how are we, how do we discover this? When, if, if, if, and when it lands in the U S
Stephen Kissler:yeah. So The reason why it was probably discovered in the UK is because the UK has this immense and really incredible system for sequencing the genomes of pathogens and specifically of SARS cov two. So they've been sequencing these genomes, they've been sequencing thousands and thousands and thousands of them just in the last weeks, really. And so they've been looking at all these variants and they were able to detect those very quickly because they've been sequencing so much. We're not doing nearly as much of that sequencing here in the United States. And so I anticipate that it's already here and it's spreading and we just haven't noticed it yet. And is in fact a lot of the reports over the last couple of weeks have said, Oh, well, it's in, it's in Germany, it's in Italy. It's an Iceland. It's in all of these cases, there's a related variant in South Africa. It's an unclear, like how much they're related. So. The crazy thing is that it feels in some ways, like we're returning back to some of what we were talking about back in April, where it's like, it's, it's already. Yeah, many places and some senses it's already everywhere. We just haven't been looking. We don't have the tests to identify it. We're not really sequencing the genomes to identify where it is. And so if it's already spreading and all of those different places, I would anticipate that it's, that it's here as well now. One of the things and this, this was actually a stroke of good luck from, from the mutation, if you can call it that, is that the way that the many of the PCR tests work is that they, they identify three different parts of the virus. Basically they look at three different sequences of RNA to identify, you know, this is definitely SARS, cov, U2, interestingly, this new variant. I think that this is a little bit outside of my area of expertise, but it had a mutation that basically knocked out one of those three. Identifiers. And so if you have a PCR test that lights up to, but not that third. It's very likely that it's coming from this from this novel variant, you can't know for sure without sequencing it, but that's one good proxy way of identifying if this new variant is spreading. So in some ways that's a stroke of good luck because you can actually kind of test for the virus, just using the PCR tests that we have available. So we're going to have to watch that as well. But again, that's, I'm, I'm not sure if we're using the same PCR tests that they're using over there. So I'm not sure if it will actually if that will work here as well as it's working in some parts of Europe, but that's, that's it. So the only way to know is by actually doing the sequencing. And so there's a big push right now to ramp that up right now. Okay.
Matt Boettger:I was curious, did you even know, like, why are we behind in sequence? I feel like we're always the last player involved in these situations. Is it just a lack of. Just technology or it can be technology, just lack of resources, any idea of why that's not on our radar screen, as much as the UK.
Stephen Kissler:So two things, I mean, one is that a lot of the original academic research that pushed this what, we're, what we call genomic epidemiology. So looking at epidemiology from the genetic perspective of the pathogens that are circulating A lot of the leading people who developed that are in the UK, but certainly not all of them, you know, there, there are many here in the U S too, and it's become a very important field. So, so we do have the resources and we have the, sort of the intellectual firepower to do this. Honestly I think that there's. There are a couple of different things in play. And I would imagine that part of it is just the, the political structure of the United States in the sense that we're w our, our public health departments are governed at the state level. We have the CDC, but the CDC can only really give recommendations. And so. In some senses, it's kind of up to each state to develop this. And that really inhibits a lot of the resources that you can deploy in a country like the UK, where you can say, we're going to take our entire country's worth of resources and apply them to this specific problem. So, so I think that's part of it. And then, you know, a part of it is just differing perspectives of of what it is to. Be healthy and to conduct surveillance and where we put our priorities priorities in terms of public health. And I think part of it is just sort of a sequence of decisions that have been made up until this point that have put us in a spot where we just don't have the infrastructure available like they do in the UK.
Matt Boettger:Okay, sounds good. Now one more follow-up question. Before we do two more of the topics we lay on this plane. You mentioned that it's more transmissible. I want to make sure that you mentioned that it's it's more it's trends more quickly. So it seems like it's not like a whole different gateway, like you said, that's why the vaccine might still work it just more quickly. Does that also mean not necessarily more dangerous? Just right now, it's just more transmissible.
Stephen Kissler:Yeah, and right. So from what we've seen, it doesn't seem like the virus is, is more dangerous for a particular, like when you get infected, it's not necessarily more dangerous. Those patterns could still emerge. Maybe it's a small difference, but the, the clear difference is the difference in transmissibility. But part of, part of the answer to that question also comes down to, you know, w what is, what is the threat that. You're fearing, like what is, what is the danger we're trying to avoid? So in terms of an individual infection, you're given an infection you're, you're less likely probably, or you're probably about equally likely to develop severe illness and these kinds of things. But with this new, very, you're more likely to become infected in the first place. And so the probability of just getting COVID in the first place is a little bit higher. And then of course the big problem is the same one we've been talking about early on is that the thing we really are concerned about with COVID is overwhelming healthcare systems and making it a lot more difficult to control the virus. At a population level and, and that, I think that's the real concern here is that it, it can amp up the transmission of the virus during a time of year when it was already high and make it even harder for to manage it. It really plays a huge burden on healthcare systems. And that's, that's the thing that I'm most concerned about with this variant is not necessarily how it affects individual bodies relative to the previous variant, but how it affects. Public health systems, clinical health systems, and sort of what that means for us in terms of getting medical care for a whole range of things.
Matt Boettger:Okay. So speaking of overwhelming the healthcare system we were, I did mention talking about that. We D we, we mentioned it earlier, but we see California Southern California, 40 being overwhelmed, especially LA. So I'm starting to see Facebook posts, text messages, come my way and say, see right, California is being overwhelmed and they done lockdowns. Look at Florida. They didn't do lockdowns as much. They're doing great again. Now turn this into a political thing we talked about over the years. I really want to kind of hammer this. How do we help again? It's like, Groundhog's day, we're saying the same thing. Is there something to this, or is this just pick your flavor of a week and determine what political party gets advantage of this?
Stephen Kissler:Yeah, it's like I mean, once again, it's, you know, this, this virus spreads is very transmissible and basically comes for every where at some point in time. And that, that was part of the reason why really early on, I was cautious to, I mean, there's some like, eh, It makes a lot of sense that New York city was one of the places that got hit first and hardest, like very high population density, very high international connectivity. You know, a lot of things were in favor of New York city getting a really bad outbreak early on since then. I mean, there's just like, because of so many different factors of this virus, The intersect with human behavior, but are also just properties of the way that the virus spreads itself. It's its propensity for super spreading and all of these different places where it can, or is less likely to spread. There's just a lot of randomness in the severity and timing of outbreaks. And we, we have this huge desire to say like, Oh, like to pin responsibility, almost like in a moralistic way that like you're getting punished for this type of behavior or this type of way of thinking or something. And this virus. You know, like the, the severity of the outbreak that you're seeing right now as a direct result of that. And that's an ancient, ancient way of thinking, you know, we've, we've thought of plagues as like the judgment of, of the divine for millennia. Right. And, and, and I think that there's some of that tendency to creep in here now, now granted. Yes, absolutely. There are elements of our behavior that do affect the spread of SARS cov two, but in terms of when it hits The intensity of its spread. Like there's a huge amount of variability of randomness there too there in the timing and in the severity. And it's just like the, the, the links that we can draw with human behavior are, are they're. I mean, they're, they're absolutely clearly things that we can do to reduce its spread, including wearing masks and physical distancing. Like, there are things that we can do to slow down the spread, but. There's not a lot that we can do to stop it altogether. And there's when you sort of take this, this larger view of like a given geographic location, like there are so many complex factors that intersect that lead to why one place is infected at a particular time, in a particular way. That it's There's just no way to draw any easy correlations here. And so so it's, it's just, it's just complex. And what I really want to reiterate is that like one way to interpret that as a, as sort of this nihilistic stance, like, Oh, well, nothing I do matters, right? Like this place is good. You know, California has this huge outbreak and they've had lockdowns and they've had, you know, whatever, but I really do want to reiterate that like, To the extent that we're able, you know, keeping ourselves from being infected. It's good for our own health is good for sort of slowing the spread and we can never know what would have happened in the absence of these interventions. Right. We can say that like California had a strict lockdown or, or people live been distancing and we're still seeing this outbreak and yeah, absolutely we are. But what would have happened if we didn't right. We never get to. I see that. Yeah. And that's what we've avoided is this unknown thing that, that absolutely would have been worse than what we're seeing now. And really what we're seeing is the ability of a virus to spread despite our best efforts. But that doesn't mean that those best efforts are in vain. It means we're doing what we can. And we just have a really, yeah. Challenging fo here.
Matt Boettger:That's great. One thing. I want to take a step back and just, just put a bookmark back into our previous subject because you alluded to this, but I just want to, for the sake of the audience we're going back to the mutation. You were talking about how it's it may have come from this kind of standing in one summer, somebody by kind of fighting the virus itself. There's an article, put it in the show notes. And by the way, if you can send me the article you're talking about about the mutation as well, put in the show notes as well about. They don't know exactly where this virus is mutation came from, but it could have been potentially speculation that just from patients having treatment and then keeping it in their body for a long period of time, trying to fight it over months, giving it a bigger chance for it to mutate and possibly coming from that reality. Now, again, Mark, before you got on here and Stephen, you guys mentioned that this is purely speculative, so who, who, who on earth even really knows, but this random, that. If that is the case, if right. A big strong, if that would change. Public health when it comes to doing trial drugs, these kinds of things, and being slightly more cautious. Is that, is that you were saying you were kind of hearing similar things in speculation as well.
Stephen Kissler:Yeah. I mean, I think that yeah, like you said, that's a, and that's a guest for where this thing could, could have, could have emerged from. And it makes a lot of sense given what we know about other other viruses and the way that they evolve. But like, of course we don't. We don't have like a, an individual patient or an individual, like treatment course that led to the development of this, of, of this variant. But you're right. I mean, I think that that really, in some ways this is a wake-up call where if, if that is the case as it very well may be, then that that really does suggest a certain way of monitoring patients who have long-term infections with certain things. And And making sure that people who are enrolled in long-term trials, who might be immunosuppressor for any given reason might be in populations where where the virus sort of leads to a longer term infection. This really indicates that Not just for the patient's health, but really for the, for the public health perspective, that there's a real importance to sort of understanding what's happening with the virus within that, within that person. So yeah, it'll be, it'll be interesting. I don't actually know in what ways this could change. The structure of trials or public health. I think it's too early to say like what direction that exactly would head, but it's, it's going to be something that we're thinking about an awful lot in the weeks to come. Because it's again, if, if that is truly the way that this emerged, then that really indicates that there's there's in some senses, like a vulnerability that we need to be aware of and to sort of shore up to, to avoid something like this happening again, to the extent that we're able.
Matt Boettger:Great. Yeah, we just wanted to make that. And then going back quickly, I'll just make the bookmark that as Stephen was just saying for going back to, to LA being overwhelmed and then Florida, not that there is no political party with COVID, it doesn't look like a donkey or an elephant under the microscope, but like, it just depends on what week you're on. You can use your political affiliation to point your finger. Indiana. It's way more complicated, just like a month ago. The Democrats would point to North in South Dakota and now the Republicans are pointing to Florida and California. So next week, happy new year. You can point your finger at the other political party. It's way more complicated. Thank you for Stephen for elaborate on that issue. Last thing I wanna talk about, we're going a little over on 10 by we're going to talk about this. This is the question. W w I thought we needed to create a new element, a new, new segment of our podcast. Maybe what? The question, the question is that just crazy talk question, Mark. And just put subjects that seem to be outside the realm, but we don't know whether it's just crazy talk or there's. So I started with Mark asked him about vitamin D and we're not gonna talk about the day, cause I just keep seeing articles. We did sneaky. Do we need to do more research to figure out what's going on with vitamin D and COVID, but then Stephen came in and said, well, speaking of which that you, if you want to kind of fill in about sleep and what you've been kind of talking amongst your colleagues and its relationship to COVID.
Stephen Kissler:Yeah. So there's, I mean, yeah, there's, there's a really interesting sort of thread of COVID research going on here. And, and recently there was an article in the Atlantic by, on their medical writer, James Hamblin Who was writing about the relationship, the potential relationship between COVID and sleep. And the article started off by clinical researchers looking at the relationship between COVID and melatonin in particular, and looking at whether there was some relationship between the outcomes of patients who were taking melatonin versus those who are not these kinds of things. But one of the things that the article brought up was that and that one of these researchers. Suggested was that you know, maybe, maybe it's not the melatonin, but just, just the fact that these people are getting better sleep. And we know that sleep has has a large effect on our psychology and our physical health and these different sorts of things, our ability to fight off infections. And so, so there's this really interesting sort of thread going on where you know, on the one hand I think that we, we really, really deeply want for there to be a Like a, a supplement therapeutic, something that like cures COVID that is cheap and safe and effective. And, and so there's sort of this, this like real draw to things like melatonin or vitamin D or like you know, maybe, you know, maybe, maybe there's something to this. But of course, you know, there is there are all sorts of. Confounding factors here too. One of them being human behavior where you know, you, you get vitamin D when you're out in the sun a lot. And so what some of this might be saying is that if you're getting lots of sleep and if you're generally spending more time outdoors than indoors, you might be less likely to get COVID and that's likely to get a severe infection, which, you know, when you say it that way, it's not terribly surprising. And so some of that might be what's going on here. Now that said, I mean, it's still, I think really worth following up some of these, these questions, part of the difficulty of measuring relationships between things like supplements and outcomes of, of, of diseases that these supplements like vitamin D like melatonin you can get from taking them, but you also get from natural. Places. And so it's really hard to have a trial in which you have people who are having statistically different levels of these different molecules in their bodies. And yet where there isn't some other behavioral sort of circumstantial explanation for the differences that we're seeing. So it's really difficult to just do science about these things. And that's part of the reason why we don't have really clear answers to some of these questions. But it's worth following them up to the extent that we're able, but also I think remembering that there's, they're often a lot of other experts, two for why, why these relationships might be, might be seen. Yep.
Matt Boettger:Yeah. And I was just, we were just talking about that again, man. If this was in the eighties, problem solved, I rebellion like these, these, these sunbeds right. We can know. Is it the outdoors or was it just literally the vitamin D from the sunbeds, but as you were saying, Stephen, thankfully,
Stephen Kissler:we don't have sun beds anymore,
Matt Boettger:so we have a whole different pandemic going on. Well, that's awesome. Thank you for putting that in perspective. And the complexity of all this stuff. I hope you guys enjoy the recording. Please leave a review. If you can, on Apple podcast who want to support us patrion.com/benjamin podcasts, Venmo PayPal on the show notes. We hope you have a wonderful week happy, happy new year, and we will see you all next week. Take care and bye-bye.