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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!
You're listening to the pandemic podcast. We equip you to live the most real life possible in the face. That is crisis. My name is Matt Boettger and I am with no one right now, but I have Dr. Stephen Kissler as a recorded line because this week I took a few days off to celebrate a number of my kids and my wife's birthday. So I took a couple of days off, but nonetheless, there are some important things we want to talk about. I threw a couple of things past Stephen wanted him to chime in about the variant and all different kinds of variants that are going on right now across the world. And what that means for us. Now and in the near future. So I'm going to move now over to Dr. Stephen Kissler an epidemiologist at Harvard school of public health, and have him give us some insight of what's going on right now with the variant and what is to be expected. But before I do that, just a couple of small things. Number one, please leave a review if you can. And if you can go on to Apple podcasts, leave a review, it would be greatly appreciated. And also if you can support us in any way. We would greatly appreciate that as well. You can do that at www.patreon.com/pandemicpodcast for as little as$5 a month or so one-time donation at PayPal or at Venmo and that's all in the show notes. I think that's it. Okay. Let's get going. Let's hear from Dr. Stephen Kissler right now.
Stephen Kissler:So there was this CDC warning that came out a couple of days ago saying that the novel coronavirus variant specifically the one that's circulating in the UK right now could become the dominant strain by March. Which does sound pretty dire. But I want to put this in context. So it's the It's the way that ecology and evolution go that normally when one organism is more fit in this case can transmit to more people more easily. That it has an advantage. And if there's multiple viruses in this case or variants of the virus circulating you expect there to be a shift in sort of the proportion of the total cases that are due to any one of those variants to shift towards the one that can transmit the best. Mathematically speaking, that's just sort of the way things play out. Now, there are cases in which multiple variants that have different levels of transmissibility can nevertheless. Co-exist and coexist pretty happily, but in a lot of cases, sort of the, the, the base case that we have is, is when something is able to transmit a little bit more easily, we expect the proportion of cases made up by that variant to shift in that direction and to shift pretty heavily over time. So it's not at all surprising to me that this would be the case. And so I think that the thing to underscore here is that. Just because the novel variant will probably make up the majority of cases by the time we get to March that doesn't necessarily mean that we're going to see the, sort of the skyrocketing cases that we've seen in the UK as well. As I've mentioned, We're getting lots of people vaccinated. We need to do it more quickly, but it's, it's, it's it's happening for sure. And and we're also going to be moving into a time of year when the coronavirus has just don't seem to spread quite as easily. So all of that is going to be working in our favor and counteracting the fact that we have this more dominant strain coming about. So even though this new strain will be making up probably a larger proportion of the cases And that will make COVID harder to control. I still don't think that it necessarily means a really dire situation. It will be, like I said it, it requires us to, to keep up all of the same sort of prevention measures that we've been implementing and talking about all along But just the fact that we'll make up a higher proportion of the total number of cases, it doesn't necessarily mean that we're going to see really huge levels of like really severe outbreaks in March. We could. But I think the more likely scenario is that we'll see sort of high levels of transmission, but not necessarily massive spikes across the country except for in particular locations. But if we, if we're looking at the country as an average, we're probably just going to see a sort of sustained transmission over the next couple of months. With the virus that is making it, most of those cases sort of slowly shifting towards this new variant. So that's what I imagine is probably going to happen. Why March? I imagine that this is actually probably just based on what we've seen happening in the UK. It's about how long it took for the variant in the UK to reach a majority of of cases. So the UK variant was first detected. Then December, it's probably been circulating since late October, November. And we're now in January and it makes up the majority of the UKs cases, I believe. And so we're just sort of taking that same time window estimating roughly when the new variant really took hold in the U S and that basically gives us March roughly, you know, it's, it's all sort of rough speculation, but, but I think that it's a reasonable estimate now, of course, the UK variant, isn't the only thing that we've been talking about. And. Over the past week or so, there's been a lot of conversation about multiple different variants of the Corona virus that could be concerning. So originally there was the UK variant, the South Africa variant. Now there's a Brazil variant that has been detected as well, that a lot of people are paying attention to. And in addition to those, there have been reports about a whole bunch of different variants. There were two different so-called Ohio variants, for example. And there's just been, this is really on the forefront of people's minds. So I think there are two sides to this. One of them is that with the UK variant, I think we're just paying a lot more attention to these different variants as they come up. So some of this is really just. Attention and news and sort of that that we're noticing them or we're hearing more about them because we've realized that these variants can can be quite important that there are certain mutations. The virus can pick up that. Do you seem to make it more transmissible. And so it's important to pay attention to these as they arise now. But it's not all hype either. I mean, some of these are really are really worth paying attention to certainly the UK variant. There's been especially a lot of talk within the epidemiological circles about the variant that's been detected in Brazil as well. And. There are some reasons for that as well. So each of these variants as far as I know, is, is relatively distantly related to the other ones that have been previously circulating. And we've talked about this in previous episodes, but just to briefly recap We have a pretty rough sense or a pretty good sense for how quickly the Corona virus mutates and evolves. So it was a little bit surprising to pick up these variants that seem to have been have picked up more mutations than we would have expected based on this normal sort of molecular clock that goes on. And so we're trying to make sense of sort of what's happening here and, and it's especially, you know deserves our attention because it seems like there are a couple of these that have picked up similar mutations and similar numbers of mutations that are really starting to emerge right now. So my best guess for what is happening is that there's sort of two different rates at which the Corona virus can evolve and they corresponded. To the two different settings where the Corona virus sort of hangs out. One of them is in the normal person to person, transmission, where you're going, the Corona virus might pick up a couple of mutations over the few days that it's infecting someone. But. The course of a regular infection, doesn't really give the virus very long to mutate before it has to move on to someone else. And chances are any mutations that it's picked up, probably aren't going to be passed on because the majority of the virus that's circulating in a person's body will reflect the thing that the person was infected with. So we see sort of this incremental evolution but it proceeds relative to other viruses that proceeds relatively slowly. Nope. On the other hand, sort of the prevailing hypothesis is that some of these novel strings that we've been detecting that are of concern Might have evolved in a different way. They might have evolved in people who have chronic infections and have been exposed to antibody treatments, for example. But for one reason or another, these viruses have been inside a person evolving over a fairly long span of time within a single person. And that gives them the opportunity to pick up lots of different mutations, especially because they're sort of exposed to this person's immune system and to whatever treatments this person is getting at a low level, over a long period of time. And so what ends up happening is you have sort of these viruses that are very, what we call in evolutionary terms, very divergent very unrelated to the thing that originally infected the person that then can go on to infect other people. And then if they have a transmission to advantage, they can go on to spread in the population. So that's probably what's happening. And I imagine what we are seeing now is that. It, it, it simply took this long for the people who have been chronically infected to develop the number of mutations that you need to basically get lucky and to develop a more transmissible virus. Maybe there are multiple mutations that are needed to achieve that. And w we're just sort of getting to the point where enough time has elapsed for this to happen. Now it's really common in evolution of any sort of organism for Organisms to do what we call convergent evolution. So basically there are multiple different sort of originally. Unrelated or loosely related organisms that nevertheless find the same sort of genetic evolutionary strategy. And so they end up resembling one another simply because their environment resembles the environment that they're all sort of in. So, so they find the sort of the same biological strategies. And so that's, what's probably happening here is that there are multiple viruses that have been evolving over a long period of time. And through this. Phenomenon of convergent evolution. The it's basically just taken this long for each of them to find this same strategy and they're starting to emerge and to spread. So this is something we're going to be continuing to watch. Even though many of these variants share similar mutations, they're also different in important ways. And it's unclear, you know, to what extent the variants differ in their transmissibility, but also in whether or not they can. Evade our immune system. That's something we're watching really closely now is whether whether any of these mutations that we've observed, allow the virus to get around our immune system and potentially around the back so far. There's no clear evidence of that yet. But it's a theoretical possible. And so so it's something that we're paying a lot of attention to, and I'll hopefully have more to say on that next time. So I think that's enough on the variants for now. A couple of the other things that you mentioned were there's this article in the Atlantic asking why aren't we wearing a better masks? I think it's a great question. It's true that the article brings up the important point that the cloth masks that were wearing were really meant to be sort of a stop gap until we had better masks available until there were enough masks available to healthcare workers and hospitalists So that the general public could also start wearing sort of these higher grade masks. And that hasn't really happened. I think that well, there, there are a number of things here. A lot of it, I think just has to do with where we've been placing our priorities. There are all sorts of things that we could spend time and money on. In the course of this pandemic. And while I think this would be still is, and would have been a very useful way to spend that you know, we've, we've, we've made our traces and we are where we are. And I think there's a whole list of things that we could talk about that start just like this art article does, which is like, why aren't we XYZ? Why, why aren't we using rapid tests? Where are we wearing better masks? Why aren't we. Vaccinating in a different way. And a big part of that is just because this was a very complex problem and there are a lot of diverse actors trying to help in whatever way they can. So I think that this is a good idea. I'm really glad that the Atlantic has brought attention to this. And I'm hopeful that in doing so we might be able to increase the production of masks that They're more effective which I think could go a long way in this. There's no circle back to the variants that are circulating, because really we would like to do everything we can to reduce the spread of those variants. And, and again, the same old measures that we've been using all along should still be effective. But since we have a more transmissible variant, maybe we ought to be thinking about more effective masks as well. So one of the other main things this week is that the president elected Joe Biden has been has released a large economic relief in vaccination plan. I have had a look at some of what's included in that plan and I'm encouraged by it largely. It says a lot of very good things and things that I think are are important, including really ramping up the rate of vaccination. Collaborating with local actors and with the States and local governments, to make sure that the vaccines are distributed effectively and efficiently. There's a little bit in there about rapid testing and really increasing testing capacity on the whole. So. It's saying all the right things. And of course the question is whether we actually will be able to implement it as it's written. That's a big question, Mark, and not something that I really know much about at all. As an epidemiologist, I don't get an awful lot of training in these sorts of logistics. So I'm really encouraged by the fact that it's saying a lot of things that many of my colleagues have been calling for. And I think it just remains to be seen whether it's realistic or not. I certainly hope so.
Matt Boettger:All right. Thank you so much for listening to episode 59. We'll be back next week with hopefully all three of us talking, discussing about what is going on with COVID and the pandemic. Thank you again for listening. If you can't support us, you can do that at patreon.com/pandemicpodcast or one-time donation, PayPal, Venmo all in the show notes. Thank you. Have a wonderful week. We'll see you next Monday. Take care and bye-bye.