Pandemic: Coronavirus Edition

Mark's surprising experience of the Pfizer vaccine, and a COVID-19 variant update

January 11, 2021 Dr. Stephen Kissler, Dr. Mark Kissler, and Matt Boettger Season 1 Episode 58
Pandemic: Coronavirus Edition
Mark's surprising experience of the Pfizer vaccine, and a COVID-19 variant update
Show Notes Transcript

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Things Discussed on Episode:

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Matt Boettger:

You're listening to the pandemic podcast. We equip you to live the most real life possible and face today's crisis. My name is Matt Boettger and I'm joined with two friends we're on here live. We don't know how long it's going to last. We spend our entire prep time just dealing with technology and all that kind of stuff. That this is going to just be a free for all. We're going to talk about Dr. Stephen Kissler, an epidemiologist at Harvard School of Public Health. And Dr. Mark Kissler. So we actually have him on, we got him on AOL dial up. We're really, really excited to have him on here. Dr. Mark,

Mark Kissler:

I'm going to have to pause to crank the generator every couple of minutes,

Matt Boettger:

but Oh man, Lord have mercy. How, how much work it takes us to get on?

Mark Kissler:

Yeah, it's pretty remarkable. You know, it's 2021. We've been doing this for almost a year. Yeah, we're still terrible

Matt Boettger:

struggling mornings. Oh my gosh. But we'll see how long this lasts is still choppy here and there. But I want to just quick do, Hey, if you leave a review, we got some good reviews and next week I'll read some of the reviews. If you haven't read them, Mark and Stephen, get on there. There's some, I think Apple delayed them. All of a sudden three came from the past month. And they were awesome. Super exciting. Thank you all for leaving a review. We'll read them. We could use some more of them. You want to, if you want to help us to do that. patreon.com/pandemicpodcast or one time gift PayPal Venmo, all in the show notes. Let's go straight into this because. 20 minutes. Mark goes into high broadband mode with his kids. And so I want to throw it right into you with Dr. Mark, and you haven't even been on forever the last time we, you were just about ready to get the vaccine. It

Mark Kissler:

feels like a long time. Yeah, that's right. That was, Oh yeah. I think it was just a couple of days after you got the first dose at, which was early December. December.

Matt Boettger:

So it's been like, you have a lot to share. I want you to talk about three big things, the hospitalizations what's going on there, but talk about how was it getting the vaccine and the great, great revelation of what happened after the vaccine that nobody knows about at least on the pocket.

Mark Kissler:

Yeah. So I guess we could go to just go in order hospitalizations, you know, we're seeing, we saw a little bit of a peak over the winter again Turned up our staffing. And then right now we're seeing more dwindling cases. So we're doing a lot better from a numbers standpoint here in Colorado. So we saw a lot of what Stephen had kind of projected, which was this big Sprig, spring peak, a little bit of a taper off during the summer months, then another. Relatively big fall peak. And I think, you know, it's hard to say, and it's hard to attribute. I was wanting to attribute causation, you know, I'd say like, we've been doing a really good job in certain areas of Colorado doing social distancing or the things like that that kept us from getting super overwhelmed. I think, as we know with this. Illness and with big you know, big epidemiologic processes like that, it's hard to draw direct lines necessarily, but I think, yeah, I'm feeling really fortunate from where I'm sitting right now in terms of how we've been affected so far in Colorado. And it's been, you know, it's been. It's a tough for a lot of people. It's been tough for a lot of healthcare providers and definitely for a lot of the members of the community, but we're seeing, I think we're starting to turn that corner again and see case rates going down. We're doing a lot better in terms of volumes in the hospital. We're seeing a lot more. Kind of non COVID patients coming into. And and so I think, you know, from that standpoint, I'm, I'm guardedly optimistic. We have vaccines rolling out now for healthcare providers and for you know, kind of first tier folks who are not. Frontline workers. So we're just kind of see, you know, I'm hopeful that we're going to start to see a little bit more herd immunity, start to see a little bit more you know, continued social distancing and relief of the burden on the healthcare systems. At least fewer sick of people in the hospital. That's great. So that's kind of thing. You know, number one, I, I spent the last week I was off last week off the podcast because I was working. I spent half the week on a non COVID team and then half the week on a COVID team in the hospital. And it was interesting, you know, it was good to dip back in. It had been a few weeks since I'd done the COVID work and it's always been interesting to kind of see the ways that the therapeutics there's just kind of slight refinements in the ways that we're using things. Yeah. And our respiratory interventions and things like that. And it's still, you know, there's still some very, very ill people in the hospital. I think this is a really tough time to get sick because we're, as a society, we're thinking a lot about getting through this or being done with it and. Yeah. You know, of course there's still some people who are getting COVID for the first time and who are, you know, in the hospital. And and so I think it's just complex you know, as, as we interact with that. And so, but very grateful to, you know, my colleagues and the folks, you know, kind of top to bottom, who've been working just day and night on COVID stuff. Cause it's really makes a big difference. So, so that's hospital updates. Vaccine updates. So the vaccine is interesting. I got the Pfizer vaccine. I got my second dose on what is today? Monday on Thursday of last week. And so I got two doses 21 days apart as was the recommendation and You know, the first dose was complicated because I'll tell you, tell you about that. The second dose. I did get a little bit symptomatic and I talked to some of my colleagues. I had a couple of colleagues who were like, I didn't feel anything during the second dose. And a couple of colleagues were like, Ooh, I felt real bad afterwards for about. And so, you know, we had my symptoms after the second dose were about probably eight hours after the vaccine. I started to feel a little bit. Icky. And then overnight I actually had shaking chills and fevers. And then the next, all the next day I was feeling a little bit out of it. So it definitely still pretty fatigued. Like I had the flu you know, with, with a bit of an edge on it. So a little bit of headache and just a lot of fatigue and and pretty impressive fever. Chills over the night after the vaccine, then about 24 hours after my initial symptom onset. So that evening update, you know, day one. I started feeling a lot better. And you know, just a word just in terms of like, I think it's super important, of course, for people to be you know, informed about that and to expect the vaccine side effects and a couple of important things, you know, number one the, the actual kind of immunogenic effect of the vaccine or the thing that makes you feel bad. Is also helping your body to generate some of the immunity. Or at least that's a sign that your body is sending immune cells where it needs to go. That it's irritated that your, you know, your immune system is woken up and is acting on something. There's recommendations. Based on what I think is pretty decent evidence that pre-treating with things like Tylenol or ibuprofen may lower some of the effects, you know, that initial effect of the, kind of the immunogenic cells getting the antibodies that they need. But that once you've started to have those symptoms, like once you've started to feel sick, that effect is there. Those processes are already rolling. And so you can. Probably take some Tylenol and feel a little bit better afterwards. But not recommended the pretreat. Stephen, is that what you've been hearing from your, your side of things?

Stephen Kissler:

Actually? Yeah, I wasn't aware of that. So I defer to you doc.

Mark Kissler:

That's great. Yeah. There's so there's been some evidence in the pediatric literature as well that pre-treating with like acetaminophen, you know, beforehand, before vaccines may slightly reduce the amount of Antibodies that are produced. And so my, you know, soft recommendation would be to avoid pretreatment, allow those symptoms to show up. And then if you're, if you're feeling bad to go ahead and treat after the fact. And the other thing I think that's important to remember is that. None of these vaccines confer, a hundred percent immunity. And so if you start to develop symptoms like cough or shortness of breath, or if your symptoms last longer than that, 24 hour window or 36 hour window after the vaccine You should still seek medical attention and consider the fact that maybe there's an infection going on, on top of the vaccine effects. And so I think that that's important as well, so that you don't attribute, you know, long-lasting or respiratory kind of specific organ system. Affects just the vaccine, which brings do you have a perfect exit? Part of the reason that I've been gone for awhile, which so unfortunately my I and my whole family contracted COVID late or right after our episode last month, I was actually feeling pretty sick. The last time I was on the podcast and had gotten a COVID test the day before, but was waiting on the results. And it turned positive. Timing was pretty terrible. You know, I think there were, there have been reports of other folks. Who've had a similar event where they got the first vaccine and then sometime in the next week or so they tested positive for COVID and I think it's hard to, you know, I don't, I think it's really important to stress the vaccine. Doesn't. Give people COVID, it doesn't contain the genetic material that makes that possible. So it contains just a snippet of the spike protein and, and you can't get COVID from the vaccine. That being said, getting the vaccine number one. Doesn't necessarily mean you haven't been exposed to COVID either before or shortly after, before you have full immunity. And it's not a hundred percent I don't know what to be honest with you. I have a, I have a lot of thoughts, you know, it was, it was pretty, it was really stressful. We were very, very fortunate as a family. And we had, you know, relatively what I would consider objectively mild symptoms, those subjectively it felt terrible. And so, you know, we were really fortunate, nobody ended up hospitalized. You know, we haven't seen any of the severe complications right now. You know, in, in anybody of our immediate family who got it. And it, but it didn't make me sicker than anything has made me in quite some time. I was pretty knocked out for several days, like three days of. Recurrent fevers and just pretty crushing fatigue for about 10 or 11 days. And so did my wife, Katie, she was really for, you know, three or four days was really staying in bed for most of the time. And it was I don't know where the immediate thought is. I really want to attribute causation. I want to know exactly where we got it and why, you know, I want to say this is where. I slipped up or I made a mistake so I can blame something, you know, for getting it. And it's tough because we've actually been even more careful over the last month than we had been previously because we never anticipating seeing seeing my in-laws and we'd really been. No. I, I wonder if perhaps I picked it up at work and had late manifestations you know, from it I think it's probably the most likely and but it's hard to know. You know, and so my, you know, some of my reflections, I think, related to that In addition to the symptoms itself. I was impressed by how stress, how stressful and how frustrating it was just to be sick, you know, and particularly to be sick with something that we've all been talking about and trying to avoid for who knows how long it feels like forever. And even though I, you know, from an, from a. Like an intellectual standpoint, you know, I've done, I've thought a lot and read a lot. And through, you know, about the way that illness is this big interruption and that we really want to attribute meaning to that that any illness, no matter how big immediately kind of throws you into this state of chaos, whether it's a minor chaos or a major chaos where you're all of a sudden you know, you're needing to attribute, how did this happen? You know, and I want to know. Essentially, what does this, you know, what does this mean for us? You know and, and it's very hard because there's not answers to all of those things. And even knowing, even expecting, you know, that that's what you might go through going through it yourself as. You know, it's a very different thing. COVID is tough and COVID in particular, you know, in the setting of this pandemic is tough because it's, it's such an isolating illness and any illness, I think, regardless of what it is, One of the big the big difference of illness is that it is fundamentally kind of an isolating thing. You know, you're experiencing something in your body that's that other people aren't necessarily experiencing you add on that, the element of contagion or worry about the people around you. And you know, the tremendous, whether it's earned or not a sense of guilt, you know, especially in this pandemic of like, I must have done something wrong, you know, I've been trying. Really hard to not get it so that I don't spread it to other people. I must have slipped up somewhere. And so there's this, you know, this overlay of, of guilt and frustration and, you know, all of those kind of building emotions. And, and I think for me, like I recognize that I could see it happening while it was happening, but experiencing it. Was a whole different thing. And very humbling, you know, I think it's just so humbling. That's my big takeaway. And I think our pattern we've done a lot of, you know, kind of like armchair epidemiology as a family to try and figure out like what happened and when, and you know, join the club. Like everybody in the world is doing this. And And even though, you know, we've been talking about it and I feel like we had a pretty good grip on how this spreads and how to avoid it and things like that. You know, very humbling to actually get it. And very humbling. I think to go through that minor experience, you know, fortunately we were spared, you know, the most severe, but even that minor experience of being the patient. And feeling this in your body and in my body and worrying about my family members was just very, very humbling and always so humbling, I think to remember how, how different that is and to be just super, super sensitive and attentive as I'm. Caring for people. And and to recognize that overlay, you know, the, the very complex overlay of all those things, I do have to say, you know, Stephen was just stellar and super helpful, you know, it's always great to have him on the hotline and like, you know, all these questions. And also to be honest, you know, the things that that helped us the most were these little gestures of care from our family. We had my, my aunts you know, who live close by in Denver, brought us Christmas dinner and like waved at us through the, through the window of the house and dropped it on the porch. And you know, I have another aunt who lives in. Texas and Pueblo who like sent us a meal online. And to be honest with you, I mean, those things, it really meant a lot. It was incredible. Yeah. And just so humbling. And so just a lot of gratitude for. You know, the folks around us and thinking about all the folks who've been sick, you know, this year a lot in that. So kind of an intense thing. We have, we have several friends who've been sick recently as well. And you know, again, I keep going back to the, I kinda want to wrap this up before, you know, before reading small group starts, I end, I've been thinking a lot about. How we've emphasized again and again, on this podcast that for young healthy people, you know, I think there's an argument that's like, well, you know, your risk is relatively low. You shouldn't worry so much that. The reason that we are so careful, the reason that we're doing this is not necessarily even for ourselves or our immediate communities, but it's the, every single infection event puts other people at risk often folks who we don't see and often folks who we forget about in our daily lives, because we don't see them. You know, these are the, these are the people who are living in group homes or nursing homes who are living on the streets. It's not exclusively that. Yeah, I think there's people very much, you know, who were like us who are young, healthy people who have severe side effects, but it's really it's for other people that were being so careful. And so trying to reconcile the fact that, you know, even though it felt really bad from a, yeah, it just felt kind of morally like crushing to finally get it and to be, you know, to, to be a potential vector and all of that, and to worry about, you know, health. And yet, I think it kind of reaffirms that we're still in it all together, you know, and we're really, really trying to do our best and kind of get through this all together. Not, not being paranoid, but just being careful and the same old things. I think, you know, Still hold true. So, yeah, it's been a kind of a trip. It's been a, it's been a, a little bit of a tough month, but I'm just super, super grateful. You know, and and we'll just kinda kind of see how this changes. I think I have a lot of thoughts, you know, that are still still getting crystallized about that experience, you know, for myself. And so very grateful to the folks, you know, who've helped us out this month.

Matt Boettger:

So thank you for sharing, Mark. It is a couple of things that the first thing is just like a PSA that, like you said, everything's still holds true wearing mass social distancing. And these are all really important things that really help to protect us. Cause I know some of us, I've shared your story to a couple of people, very close to me who then got very nervous of like, well, if Mark can get it then and wholly, then there's no way of escaping it. Right. I just want to say, I don't want to go down that rabbit hole of like, I mean, we never, we promoted, we never talked about this, but there's this Korean study of this, like, you know, infection that happened by just randomly somebody being 30 feet away, but in a jet stream of an air conditioner that happened to be siphoned directly down them like eight tables. You got the whole table infected, but nobody else that is true. Totally uncommon, but it does happen, right. It's

Mark Kissler:

really random. Yeah. And I think that's, I think that's one of the things that, that illness in general and this in particular strikes home is that it doesn't mean that we shouldn't do the common sense things, but the, the level of personal control. Yeah. I still, I still had a pretty strong sense that I could control this pandemic, at least in my little universe. And and giving up that even that little sense of control is super, super hard. You know, for me, I'm very concerned, very control, oriented, and again, it's just like, it's super, super humbling. So yeah, and I think exactly that, I don't think it changes what we're doing.

Matt Boettger:

Or the the, the last thing I'll say on that before your thing is, it reminds me, I just dropped an episode of living in the real, but this applies to you Mark, but it does apply to me. I call it the Christmas effect where, you know, we start preparing in October and November for Christmas and we're revving up. We're going nonstop. And my boys are talking about gifts and then December 25th happens and there's somewhat of a letdown. And you know, and now it's different in this pandemic, right? It didn't go to physical church this time. So there's a lot of differences that, that changed the mystery of in the beauty of Christmas. But in general, there is a letdown on Christmas because we put so much into the expectations and preparation. It just can't really. Take the burden of, of what we're doing versus the simplicity of Christmas, those who celebrate Christmas. Right. And I feel like us in a pandemic, it makes it all the worse because we've been preparing for this since March and we're like working. So flipping hard that when, when, if somebody gets it, it's all the more devastating because the divide between the expectation and then the experience, it's such a chasm now that there's just no way the burden. So you would probably feel it anyway, but this, one of all things. And then being Dr. Mark on top of this, right? I mean, you you're, you're in a complex reality. That's why my heart just broke when I, when I heard you said it and now you know, that people have way worse and I'm not making light of that, but just in this, for the situation with you and the expectations of Christmas and your family, all just kind of. Yeah. Out the window.

Mark Kissler:

Yeah, yeah, yeah. I think it, it emphasized the elements of sort of the waiting and darkness, the longing, you know, for, for help and a recognition of needing help that comes from outside myself, those elements of Christmas, it was very much, this was a year of advent and less a year of Christmas, to be honest with you. And it was, and I think this has been a, you know, this has been a very. Long year and protracted your, of going deep and waiting. And and just, I don't know, it's, it's been in some ways it was powerful in that way. You know, illuminating that kind of flip side of the Christmas story for us in our family in, in a really powerful way that, you know, I'm hoping to kind of linger in and, and meditate on a little bit more. So anyway. Yeah, I appreciate it. Thanks for, yeah. Thanks for your support and prayers and thoughts and, and everybody who is, you know, involved in. And I think. Again, just kind of continuing to turn, turn outwards towards our neighbors. Just super, super important in all of the small ways we do. It really matters. Absolutely.

Matt Boettger:

Yeah. And I just say that I put this in the podcast so that the protagonist of all human history is the beggar. The idea that we, we try to, we try to be able to do to, to, to white knuckle our life. We have a tendency to control white knuckle control. Then the end fulfillment comes with our hands open wide and state of poverty and just receiving life is uncertain. That doesn't mean we don't try to play in, but we, but we also, in the midst of planning, we elevate our hearts towards receiving uncertainty so that when the time does come, we can find the gift in that it's so easier said than done. If I have covered, I'd be just like crying, like a little baby on my chair, hating life until the market, everything I ever spoke about is crap. And I hate everyone.

Mark Kissler:

It's so true. It's so true.

Matt Boettger:

It's so easy to say it when I don't have it. So, but thanks for sharing, Mark. I really appreciate that, man. Yeah. Okay. We're going to keep going. I don't know how long, how long we'll have Mark on here, but you can pan out whenever you need to, but I want to get in, there's a lot of stuff that Mark said that's kind of related. I want to hit to you, Stephen. You know, let's just go straight to the variant because I want to get updates on the variant. I've heard more. This is the one thing I want to talk about right now. I'm a little confused on the variant because I hear a couple things. Now I'm gonna try to boil this down and I need help. Understanding number one, we've learned. That the coronavirus in general does not mutate as quickly as like the flu. I just read the article. I put it here that you guys can see in the show notes. It's like something like ten one when it comes to. Right. But then here in the same article, however, with this new variant, right. When now we're, so I'm a little confused on where we were in the variant. How worried should we be? I saw an article all about South Africa, which seems to be maybe a similar mutation and like, well, will this. Effect the vaccine. So I kinda want to get an update of like how, again, how concerned we should be with the variant. And it was this to be kind of expected Stephen, or is this kind of like an anomaly, like, wait, this coronavirus may not hold the same kind of adaptations and changes as we've known in other coronaviruses.

Stephen Kissler:

Yeah. So I think a couple of things here. So the you're right. The, I think to answer some of this we need to take it step back and talk a little bit about viral evolution and how that works. So usually yeah the ways that viruses evolve and it is through sort of slowly accumulating these. Additions deletions mutations in their genetic code. And most of these things are either meaningless. They don't really do anything to the virus or they hurt the virus. And so then the virus mutates, and then it gets out competed or dies out based off of its relatives. Once in a while it gets lucky. The virus gets lucky, we get unlucky and Hmm. So the virus mutates and, and that mutation basically makes it a little bit easier to spread. Which makes it sort of out-compete its relatives, which allows it to spread really far. And so that's similar to what we saw earlier this year, where there was that single, what we call a point mutation. I forget what exactly the numbers were, but basically it was a single mutation that made the virus a little bit more transmissible, a little easier to spread than its relatives. And so that new variant that was earlier this spring was able to take over and is now the dominant variant in the world, which is a different one than the one that originally started spreading at the beginning of the pandemic. Now, there are a lot of ways to measure the rate of evolution of viruses. Usually we measure it in terms of how quickly these point mutations accumulate. And so when you're talking about the relative evolution rate of Corona virus, SARS cov two versus flu that's, that's what we're talking about. Flu really mutates quite quickly relative to this average mutation speed of the coronavirus now with both flu and now apparently with COVID there's. Another element to evolution where once in a while it makes these big leaps basically. And this is really well characterized and flu. And in, in flu, we have a name for it. We call it the difference between antigenic drift, which is that first thing I was talking about. Versus antigenic shift, which is where there's this substantial qualitative change at the proteins that are around the virus capsule that basically allow it to evade the human immune system and that, and that's why we have that's, that's part of the reason why we get flu pandemics because rather than sort of this slow shift that allows it to sort of evade the immune system little by little, and we get these seasonal outbreaks, then suddenly we basically have a new virus on our hands. And so so, so these things are partly responsible for this evolution of flu, which happens both in this very gradual way, but then once in a while in this really sort of dramatic way now with Corona viruses, we've seen this sort of slow progress of evolution, but we weren't. Sure whether or not, it could also undergo these sort of big shifts. Now, the reason why the coronavirus might undergo big shifts, biologically is different than the reason why flu undergoes its shifts. The structures of these two viruses are very different, but epidemiologically, qualitatively speaking, it looks like there's something similar going on where in some very rare circumstances you can nevertheless get these really big genetic changes in the coronavirus. That leads to something like the new variant that we have circulating now. No as scientists, we're still trying to figure out what exactly it is that leads to those shifts. Because like I said, it's, it's different than the flu. So all of the same sort of biological mechanisms that we have in mind, don't, don't apply to the coronavirus. It's still kind of a mystery, but this is part of what we were talking about last time about, you know, maybe, maybe there's something about immunocompromised patients who are getting certain types of therapies that allow the virus to evolve and sort of accumulate these mutations within a single body. And then it can sort of spread, but th that's all still. Speculation to my knowledge, you know, but it's, it's one plausible reason why we might see these sorts of big shifts. And so that's, that seems to be what's happening and, and that's important because prior to this new variant, we didn't know that that was a possibility for the Corona virus, but now very clearly is. And it suggests that the same sort of thing could happen again in the future. And so so it's something we're going to have to continue watching closely. So not only is this new variant important too in its own, right? Because it's more transmissible. And so we're going to have to work a little bit harder to keep control of it, but also it means that it can continue to evolve in this way as well. And so we're going to have to sort of keep up our surveillance to make sure we're aware of it when these things start to happen. And hopefully prevent them from spreading too far when they do.

Matt Boettger:

Okay, that makes sense. Yeah. So this is all the more reason why. That I think we're just promoting the vaccine and why it needs to be in the hands of more people. It's not just propaganda. It's the fact that there's just the coronavirus is everywhere and it's it's mutating. And it's even though the more chance it has a mutate, the more chances it has to turn into something that maybe the vaccine doesn't have the quite impact. Not that it is now, but it can turn. So hopefully another, another PSA for hopefully getting the hands. And this is why. I think you probably mentioned, we mentioned a couple weeks ago where when Biden becomes president and that he mentioned that you just mentioned to me that he just recently said that releasing probably all the vaccines for first dosages to everyone in the U S is that correct?

Stephen Kissler:

Yeah. To my understanding that's, that's his plan now, now of course, there's, there's a lot of room for reasonable disagreement as to whether or not that's a good idea. That's, that's a ongoing debate among epidemiologists too. So. You know, it's, it's a choice for sure. And I think that there are good reasons for it. There are also reasons why it could be risky as well, but everything we're doing right now is a little bit risky. And so so I think there's a lot of room for reasonable debate on that. But that seems to be the plan that that he is adopted based on his advice from his advisors. And so that seems to be the direction we're probably going to head.

Matt Boettger:

Okay, great. What, another question related to something related to this? W w when it comes to spread, is I, I swear, I thought it was like a weeks ago, or maybe it was months ago. We talked this idea that asymptomatic people really did not transmit that often. And I just saw this recent, maybe I was wrong. I saw this recent article that the CDC model found that I think it was like something like. 60 59% of all transmissions come from people without symptoms. Now 35% of those cases come from presymptomatic people. So that's different, but still 24% come from people who never develop symptoms, which seems to be a, a decent chunk. Now was I, am I under the misunderstanding? That actually was never the case that we thought that we, that ACE and white people did not really spread it, or is this new nuance information?

Stephen Kissler:

So there's been a lot of, sort of it's been really hard to pin down. I've always sort of figured that asymptomatic people were doing a lot of spreading. And I think that's sort of been. And and an assumption by many of my colleagues simply because it's, it's hard to reconcile sort of what's happening without that now presymptomatic spread. Absolutely. And I think that a huge bulk of transmission is happening from people just prior to developing symptoms. But there are some people who develop no symptoms or minimal symptoms as well. And I think the key distinction there is that the well, So based on some of the work that we've done it seems like people who do and don't show symptoms still have pretty similar levels of virus in their system. We're not entirely sure what it is that leads to symptoms versus not. So that suggests they're likely to be just about equally transmissible as people who are showing symptoms. Now, even if that's not the case Well, symptoms are a pretty good way of limiting spread. You know, when, when you start feeling sick, you're, you're probably not going to be going very far as Mark candidates test to you know, and and so part of what you get is this sort of balancing where even if a person who is asymptomatic isn't necessarily producing as much virus, they're still going to be engaging the community in the same way. And so that effectively makes them responsible for more spread. Even if on an individual level, they might not be as infectious. So epidemiologically speaking, asymptomatic people in presymptomatic people are playing a huge role. And I think that that gets at this key distinction between looking at things from a public health perspective, versus looking at things from an individual perspective where even a person who might not be as contagious individually can still have a profound impact on the overall population spread of this disease.

Matt Boettger:

Hmm. Great. Awesome. Thanks. Well, Mark, throw it back to you for a couple of things. I don't know if he did my study on this. I know we threw a couple of things your way, anything. I saw this in the news, a couple of things in the news about new, new research on how COVID affects the lungs. We mentioned you and I talked about, there was this random article about how maybe COVID potentially I'd again, this is just. Maybe anecdotal evidence could affect the brain directly. We know it. We know it definitely affects it indirectly by you Mark. You're just saying, just feeling fatigue and just feeling maybe foggy, headed, but that's more like a side effect, but those two things as, and then as well as this whole thing of vitamin D. So the lungs research vitamin D this has been a perennial thing that I've been trying to bring up all the time. Article upon article, it comes up. I don't know if there's. Any relevance whatsoever, or if there's just something, a preventative thing, I have no idea. Do you have anything to speak to about these three things, especially within your clinical work?

Mark Kissler:

I'll I can talk a little bit about the, excuse me about the lung and the brain. But less about vitamin D just cause I haven't been up to date on that recently. So I'll try and I'll try and look that up. Cause that is a question that keeps coming up and there's there's I think one of the places that we see that the vitamin D question is that. As they've tested individuals who have severe COVID a lot of those individuals seem to be vitamin D deficient or, you know, maybe more than we would expect, but it's hard to know if there's some testing bias. We talked a little bit, I think, early, early on that there was some evidence that vitamin D may help lower the severity of certain respiratory infections kind of writ large. And so wondering if that maps to this, but to be honest, I haven't reviewed all that data in great detail yet. So I have to look at it, look at the vitamin D stuff a little bit more. In depth before I speak about it. The LUN, the article you sent me about the lung you know, I w what I see in that is that that adds maybe a little bit of nuance to our thoughts about how SARS COVID two affects lung tissue and what I'm, but largely what we're seeing is the same thing that I. Think about with regards to a lot of viral respiratory infections, which is that there's potentially a direct effect of the virus itself, you know, causing cell damage. And then there's the secondary effect of the immune response. And so you'll see things like w words like cytokine storm or immune mediated damage. And all of that is, is similar to what we've been thinking. And really, to be honest with you, it's very similar to what the flu does. It's very similar to what a lot of our respiratory. Illnesses due to lung tissue at a certain point, you know, the appropriate body response to an infection can become overwhelming and start to damage lung, you know, our own tissues. And that's something that we see sort of across the board in it's sort of a fundamental tenant of our especially critical care that at a certain point, the balance that should be helping our health ends up. Pushing a little bit too far and we start to get sick because of that immune response. And I think it's interesting, you know, just a side note on that. In terms of the vaccine side effects that we're seeing a little bit more of the post vaccine blues, you know, the Malays and chills and stuff in younger folks than they are in older populations. And I think that's in part because it's the appropriate immune response to a foreign. Antigen, you know, and do you have a little bit more robust? You tend to younger people tend to have a little bit more robust response know because your immune system is kind of re raring to go. And so that can be, you know, in flu and COVID that immune response sometimes can cause some of that damage and some of the more severe damage later on down the road. So I think that what I saw in that article was it was talking in particular about macrophages, which is one of the. Cell types that goes to respond to infections. You know, we see there's lots and lots of different cell types. Let's the different mechanisms, but I think it's all a part of a similar story which is that this is, you know, there's multiple things going on. One of them is the virus. One of them is the immune response. And, and, you know, sort of that's, that's kind of what we've seen seen throughout the other questions about, you know, cancers, Coby to directly invade the brain. There's been some, I think pathology studies of, you know, individuals on autopsy who have shown. You know, they think, you know, presumably there's some crossing of the blood brain barrier symptomatically, you know, a lot of people have what kind of is described as brain fog associated with the COVID virus. There's a lot of headaches and things like that. And it looks like perhaps the spike protein itself can cross the blood brain barrier. So they think that probably the whole thing can, I wouldn't be surprised. I mean, I think it's pretty I'm not sure to be honest with you, how much that changes the way that I think about. The whole virus and infection. I wouldn't be surprised if there was some, you know, CRA permeability, the blood-brain barrier to this, just like a lot of other tissues in the body. Yeah, I'm interested to see, I think we're gonna understand a lot more about the pathways and exactly how. This affects each of our tissues in a few years as we kind of get a little bit better resolution data. But I think that's, you know, it seems to be physiologically plausible, at least. And, and again, you know, it's one of those things that I think is important. It helps our understanding. It doesn't necessarily change the way that we act or our kind of epidemiologic recommendations. But you know, one of the. Strangest symptoms for me of this whole virus was getting, was losing my sense of smell. And I think that's, you know, and well, it looked like from some studies that that was actually related to support cells rather than neurons in the nose and kind of a nasal pharynx that it's, that you lose those support cells. And then the neurons get a little bit sick and they stopped doing their job. And then it has returned, you know, for me that though, for some people that lasts a lot longer, last about a week and a half for me, the, the, you know, loss of sense of smell. Effects on tissue and all sorts of tissues that, you know, all over the body. And you know, the long-term effects of that. And, and even the short term, I think we're still working on characterizing, so. Okay, great. Does that, how does that kind of

Matt Boettger:

speak to a jury? Yeah, that's exactly. I think just a note of just a caveat that you're talking about, the immune response to vaccines, and just let people know that if you do not have an immune response, that's that dramatic? It doesn't mean. That the vaccine isn't as effective as other people that have that. That's not good. There's

Mark Kissler:

not a cost. I don't think there's a, not a good, I don't think you can draw a line between how bad you feel and how strong your immunity is, but I think it's not directly related like that. And so, well, you know, I think it's just part of part and parcel. Maybe, you know, you have. You have the bad luck of getting sick or you have the good luck of not getting sick and none of that's necessarily correlated to your subsequent level of immunity. Yeah. Okay.

Matt Boettger:

Great. Well, I'll end on. This is kind of related, so let's look back at Christmas and now we're two weeks in and we're seeing a surge in certain areas. Now, Mark, you're saying, it looks like Colorado is looking pretty good at the moment, which is awesome. Something, you know, I don't know what it'll be tomorrow or the next week, but other places are suffering tremendously. Like my sister in Southern California, just being rocked and just really, yeah. Unnerving Stephen, I want to throw it to you of just like, where do you think we're at in this? So now it's about two. Is this kind of the expected effects of Christmas? Are we a little early? Are we right in the middle of it? And where do we expect to see this with the variant and the, and the reason why I ask this question, because some people are saying, well, you know, I don't think we're going to be like the UK. Cause we're different. We didn't, you know, we're already are going crazy here in the U S and some people predict that maybe up to 10% of the population has COVID or had COVID or, you know, as immune and wearing masks. So we're in a different area than other countries, right? So there may be a chance of variant may not have the similar impact maybe not have as many hosts. Right to, to, to be as widespread as the UK. So I'm hearing this where do you think we're at generally? Are we in the, in the midst of the, the, the Christmas break and in the next three to four weeks, do you expect the variant to have a big impact on this? Because I'm not seeing a huge change, but I'm just seeing the continue rises right now in the U S in certain areas.

Stephen Kissler:

Yeah, it's I mean, it's so hard to project forward. I think that the, the variant is absolutely going to make our job more difficult in the next few weeks to months easily. I think in the absence of the variant, I would probably expect that that the current virus would continue to spread in different communities, but that sort of, as we emerge from January, it would probably get. A little bit easier and cases might start to come down and especially with the vaccine coming in, like things would start sort of looking up. I've been pretty alarmed by what's been happening in the UK with the new variant, the, the rate at which cases have been spiking is is pretty remarkable. And if you look at particular places within the U S it's hard to attribute, you know, whether, whether any of this is due to the new variant or just to holiday Know, holiday travel, but you know, across the U S cases sort of are flattening still continuing to rise somewhat, but in some specific communities we've seen them going down another spike right back up. And so I think that. One thing that's in our benefit is that it doesn't seem like as far as we can tell the variant has really gotten, it's definitely spreading in much of the U S but probably not at the same prevalence as it is in the UK. And so my hope is that we got to get through the holidays so that any super spreading events that happened over the course of the holidays, we're hopefully dominated by the less transmissible, variant and up a new one, which will hopefully make it a little bit harder for the new one to sort of get its toehold. And in, in addition to that, we're sort of moving evermore outside of the span of time when other Corona viruses tend to spread most. And so, whereas in the UK, sort of everything seemed to align in the worst possible timing. I think that here, even though the new variant is probably going to surge, hopefully we have some other things, including the vaccine, including the time of year, including the distance from the holidays that will sort of counteract that a little bit. So we've got a really difficult job on our hands. Absolutely. I mean, this is like the, I think we really need to take this new variant very seriously and recognize that it's going to be that much more difficult to control that it will require that many more people to get vaccines. And and that the level of immunity that's in the population will help, but we're still a long way away from herd immunity in the United States. Yeah, at least in most communities of the United States. So there's still plenty of plenty of people who could still get infected. But I think if, you know, epidemiologists should never make projections that are based on aren't based on an awful lot of models, but, but I do, I, this isn't a projection, but it's a hope and it's, it's a, I think it's a, it's a well-grounded hope that That we will probably see cases continue to rise and sort of be at a high level for a longer period of time than we would have otherwise. But I'm hopeful that we won't see the same sort of catastrophic spikes across the U S that we've seen in the UK, of course, in places like Southern California, you know, things are in a pretty dire situation right now. But, but my hope is that that won't sort of play out sort of broadly across the U S and instead. It'll be hard, but but hopefully not catastrophic.

Matt Boettger:

Yeah, no. Good. I mean, I I'm hopeful that, that, that your hope will be the hope that comes to comes to pass. I personal question, this is a, hopefully it's useful. Like what should I do? Because like, I, I feel like I'm in this weird position of like cases aren't that bad in Colorado. They're not too bad, but there's this looming variant. So do I host my class in person? On tomorrow and just in, so, you know, we're still okay. Or should I start having my meetings again in person, but you know, being cautious of my normal thing or should I say no, the variant is a variable by which I should take an extra level of precaution and buffer myself. I just feel. I almost wish I don't, I don't want to be Southern California, no way in HD, double hockey sticks, but it would make my decision-making a lot easier. I would just stay home and fear life, just show game don't fear life. But any, any, any ideas recommends to what I should be doing in the midst of this would be an improvement, just normal stuff? Or should I take an extra level? One step further

Stephen Kissler:

of caution. I think that that not necessarily taking a extra step one step further yet, but I think that just like, this is a good time to check back in and sort of ask ourselves, you know, to what extent are we Actually doing the things that the, that we hoped to do with the spread of this virus all along you know, how are, how are we doing with mass squaring and with distancing and these kinds of things, and just sort of check in, I don't think we necessarily need to like really go even harder than that than we were this spring. You know, right now it's, again, the same sorts of things that we've been doing all along should still be effective against this new variant. It's just a good time, you know, it's it's the start of a new year. Make it a resolution to to just take a step back and evaluate our actions and think about how we're doing and, and if there's any, anything that you can do that that maybe is in line with, you know, what you, what you feel you maybe should be doing all along then, then don't go for it. Absolutely. But I don't think we're at the point yet where we need to like double down, even harder necessarily. Yeah.

Matt Boettger:

That's helpful. My one last personal question till I ran, it might help other people. My grandmother is going to be going into assisted living soon at two weeks, two or three weeks. So I'm not in charge of this, but I'm hearing how it's going because they wanna get her vaccinated before. Cause there's actually gonna be more exposure. She's 90. Yep. So and I just don't have your recommendation right now. There we're working to negotiate her, getting the vaccine, going in to get her vaccine before she goes into assisted living. And they gave me two weeks before she gets moved in, but that's before she gets her second one, is that a typical okay. Response? Or should we push to like, no, let's just see if we can push to like the second one, then add another two weeks on top of that and push everything back. What do you consider being a good, good response

Stephen Kissler:

for that? Yeah. And maybe Mark can step in on this one too, but from my perspective, I think that that's I think that having the first dose and waiting two weeks Is probably okay. It seems like the first dose does give some amount of like a decent amount of protection. The big question is how long is that protection lasts, but as long as she's planning to get the second dose on schedule I think that, that, that seems like a perfectly reasonable thing to do, right. Mark.

Mark Kissler:

Yeah. Yeah. I agree with that. I think there's so many nodes and so much that we try to control with all of this. I think that getting windows to the vaccine is a great idea. And you know, as long as they're using appropriate protocols to keep her safe in the, in the home, which I presume that everybody is I would say just, you know, move forward with what, what you guys need to do. Yep.

Matt Boettger:

Great. Thank you guys. Thank you all for listening to this week's episode, I have a lot of editing to do up front, all the crazy technology. If somebody could go down that soon, if you want to leave a review, please do so on Apple podcasts. If you want to get in contact with Stephen S T P H E N K S S L E R and Twitter, matt@liveinthereal.com would love to hear back from all the people around the world who listened to our podcast, hear how it's going and how you guys are fairing. And if you wanna listen to my live in the real podcast, episode 16, you can find that in the show notes. And I think that's it. I hope you guys have a. All a wonderful week and we'll see you next Monday. Take care. And bye-bye.