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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. The face of these crises. My name is Matt Boettger. I'm joined with my good friend, Dr. Stephen Kissler, an epidemiologists at the Harvard School of Public Health. How's it going
Stephen Kissler:buddy? Hey, hi. How are you doing?
Matt Boettger:Doing great. We had like tons to cover because gosh, it was last, last week. It was just you going so low on a recording and so much has happened since then. We got lots of talk about, right?
Stephen Kissler:Yeah. It's pretty wild that like a year after we started this thing, that we're still able to fill up as much content as we are. I know.
Matt Boettger:Yeah. I'm I'm surprised. I mean, I, I mean, it's probably wasn't for the variant. There wouldn't be quite as much to talk about, but there's so much going on between the variant and the vaccine, all this kind of stuff. So we have a lot to cover and not a lot of time. So let's get started right away. Just a couple of things, normal stuff. If you can leave a review, we greatly appreciate it. We love just reading them ourselves. It inspires us. It keeps us motivated. It helps us to get this podcasts into more hands. So greatly appreciate that you can do that on Apple podcasts. And you can find the link to the show notes there. If you wanna support us patrion.com/pandemic podcasts, as little as$5 a month can go a long way to help us continue this going, or just a one time donation through PayPal, Venmo all in the show notes. Okay. I think that's all the big information let's get started. Stephen. I have a bunch of things I want to riff with you about, and I think this'll be really helpful for all the crowds that are listening right now. First thing is. I saw in the Atlantic that hospitalizations have gone down. So they're finally falling says Atlantic. Now I want to go back to, is this good news? Obviously it's good news, but is this like permanent good news? Could we see a winter tapering off next three months? Or what do you expect to be happening in the next month or two in light of this kind of hopeful news right now?
Stephen Kissler:Yeah. It's like you say definitely good news. But I think I've learned to never call anything permanent in this kind of fortunately, so yeah. It's you know, it's, it's good that the hospitalizations are coming down and I think that that's. That's roughly in line with our expectations, right? We knew that the holidays were probably going to contribute to a fair amount of spread. And we did see spikes in a lot of different places following Thanksgiving and Christmas. And that was super imposed over the top of when Corona virus, transmission, like the other Corona viruses that are constantly circulating anyway is always at its highest. And so. So, so we were really expecting, and even from April, I was really expecting this period of time that we've just come through to be the hardest period of time for controlling COVID. And now I think reflecting that we're starting to see cases come down a little bit, so, so that's very good. In the absence of these new variants that are coming around. I think that I would expect cases to still continue to sort of bubble along. We would sort of have this long trajectory. But I think that as we're sort of emerging out of the beginning of the year and you know, Spring still feels like a long time away, but epidemiologically speaking you know, we're sort of at the tail end of what we normally think of as the respiratory virus season, not quite the tail end, but we're in we're in the later half for sure. And so I would expect those to sort of start coming down. Now experience in the UK shows that even with substantial physical distancing intervention measures that the new variants that we're seeing can cause substantial spikes and infection Despite what we're saying. So, so that, that sort of throws a curve ball that I don't really know how to anticipate here. My guess is that it will, it'll continue to make, COVID sort of difficult to control and hopeful that we won't see across the country, these sort of huge spikes that we saw in the UK. But I do think that over probably be sort of sustained for awhile and that we really won't see major progress until we really increase vaccine uptake. And until we sort of emerged from this winter period of time and get into the spring and early summer, so. I think we're still in it for a while longer. But but hopefully it won't be emergency measures at least not widespread.
Matt Boettger:Mm. Well, okay. So putting these into perspective, you and I talked about this just before we went on that I saw a little graph about flu and how flu is like non-existent right now. It's lowest. Now. I don't know how long it's been low. Like, is this the lowest ever been in history of recording? I have no clue, but it's almost not existed. And around the world, we barely see it. And I want to bring the, every attention. Cause I think this is a huge indicator to everything that what we're doing is working. So hear criticism, we hear spikes. We see what California is with having the California, thankfully in some areas starting to peak and kind of come down and saying, look, the stuff we're doing is not working, but the flu in my mind, when throws past you, I'm like, isn't this a perfect example that what we're doing is working and the flu is nothing. Like COVID the fact that what we're doing right now making the flu non-existent. And what we're doing right now is making COVID go crazy in certain areas. Just shows two things. Flu is not nothing like COVID. And I think this is just clear evidence that what we're doing is working. If we weren't doing this, could you only imagine where we'd be in light of the flu, where it's at now, what it normally is at typical time of year? Can you respond back to that?
Stephen Kissler:Yeah, absolutely. You know, and that's a great point. And I appreciate you bringing it up because I, I hadn't thought about it quite in those terms, but that's you're exactly right. You know, we, we've been seeing even over the summer where flu season is at its highest during our summer in the Southern hemisphere and it's winter there. And many Southern hemisphere countries basically saw no circulation of the flu. And up in the Northern hemisphere, we're still seeing some circulation, but it's much, much lower than it normally would be. Which is pretty remarkable. So I'll, I'll throw a little bit of scientific jargon back at you to to basically restate exactly what you said, but when we're trying in epidemiology or really any form of, of sort of observational science, even experimental science. But if you want to try to evaluate, if something that you're doing has an impact, what you look for as a counterfactual. And that means basically a scenario that That is a control for the thing that you've done. So it's something that you can compare it to, to see, you know what, what the effect of your intervention is. So ideally, you know, throwing all of our ethics and everything out the window, ideally we would have a second earth. In which everybody behaved exactly the same way they do here. And then you had released COVID exactly the same time that it was released here. And you would compare, you know, one place that had interventions, one place that didn't, and you'd be able to compare side by side. Of course we don't have that, but flu. Is is, is a really good sort of counterfactual here because we know a lot about its spread and we know that it spreads in a manner that is that it, that is really similar to COVID. You know, it's, it's not identical, but it's, it's another respiratory virus that it has a lot of the same characteristics. And so if, if we're tamping down the spread of the flu, that much, that really shows that We're reducing spread in a big way. And and yeah, so I think that that does show that that what we're doing is, is effective in reducing the spread of respiratory viruses is very effective. And that if we weren't doing these things, the spread of COVID would be probably a lot worse than it is right now. So it's, it's one of the clearest and best points of comparison. I think that we have honestly,
Matt Boettger:Great. Good. Well, take that everybody out and hopefully use that as part of the gospel message of basically trying to get people to understand what we're doing and it actually working. So I'm going to jump forward a little bit, cause I know the next thing that are outlined is about talking about the variance. But I think maybe let's talk about mass right now because I think this is an appropriate time. Now you talked about it in a great way last week on the recording. I want to bring it back because this is part of the whole, Hey, it's working. And then you have the Atlantic, which you talked about last week saying, why are we wearing better masks? So I honestly, when I read that was totally confused because I'm a relatively educated person when it comes to COVID because I'm forced to read it every day. And as I was reading things throughout the summer and early fall, I kept hearing this kind of message saying, just wear a mask cloth mask. It's all going to work, you know, save and 95 masks for the hospital. And then even some research. I w I, that I have clipped somewhere showing that even N 95, compared to just regular masks that are just like considered good mass are not that big of a difference. So just wear the mask. So. I've been listening to that haven't bought in 95, but just wearing cloth masks, right. Thinking that I'm totally doing my job. And then hearing this article, I'm like, wait a minute. Now I'm confused. Should I be being in 95 mask? What's the deal? Is there, is there like confusing research on mask or where did the message get? At least in my opinion, get messed up along the way to say that we're wearing the wrong mask now.
Stephen Kissler:Yeah. So I think that's a great point. I would say that the message that I would hope to get across is not that we're wearing the wrong masks, but that we can always do better. And I think that there's, there's sort of a long history in this pandemic and in many of them where where we're sort of letting perfect to be the enemy of the good. And I think that's, you know, for example that that's the, that's one of the big issues with the testing as well with, with rapid tests, right. We don't want. Hmm, a rapid test that has relatively, you know, like middling sensitivity for detecting virus in a body. Even if in many ways, it's like a very, very good tool. What we want is a vaccine that's a hundred percent effective and it doesn't give you any side effects and that will, you know, give you immunity for life. And I think that's been part of the issue with us avoiding. Uptake of these other very good interventions because we're really sort of seeking after something perfect. And it's, it can be hard to sort of separate those two things out. So from everything we can tell wearing cloth masks properly helps and, and is a good thing to do. Absolutely. Now, w. And 90 fives are engineered specifically to block the spread of respiratory pathogens. Right. So, so they've undergone a lot of testing both sort of testing, sort of like looking at how, how it does filtration on like, Mechanistic level as well as, you know, trials within hospitals to see how they prevent the spread of infection. So the evidence-based behind them is a lot stronger. Part of the issue with the cloth masks is that the evidence-base about cloth masks in particular isn't as strong. And so we've had to sort of extrapolate from what we know about other types of masks and then to run some of these studies on the fly as we're going now, constructing these studies is actually very difficult because The world's a complex place, right? So anytime, you know, you could wear a mask, but there are all sorts of other things that could make one scenario of disease spread very different from another. So you really need to compare huge populations over long periods of time. And we just don't have the time or the resources right now to, to develop those studies. Now, now, now they're ongoing they're happening now. But we just don't have all those clear, clear answers yet. But that said based on what we know on the, the efficiency and efficacy of masks in the hospital setting I think there's very good reason to to believe that cloth masks are very effective. But not as effective as N 90 fives. And so so I think that, you know, continue wearing your cloth masks. I think that really the argument from my perspective, the argument that was raised in the Atlantic is, is really not so much from an individual perspective. Like why aren't we buying masks and wearing N 90 fives, but rather sort of work from a policy standpoint? Like why, why haven't we invested in this? Why haven't we sort of. Increased the amount of PPE for people, especially who are working on the front lines, but not in hospital settings, which I mean, I've, I've been trying to tweet about and talk about on, you know, the various people interviews that I've had over the course of the year until I've been blue in the face, because like, that's really what we need to be doing, but, but again, it's, it's an imperfect intervention, you know what we want, like it's People are still going to be exposed. And so it's there, there's a lot of complexities here, but I think that it really, the upshot of it all is like masks really do seem to be effective. Cloth masks can be very effective. They're not going to be as effective as hospital grade and 90 fives. If you have access to one. By all means you can use it. I mean, we're not in the same sort of levels of shortage as we were early in the pandemic. But also be mindful of that, that like these also probably aren't things that we should be hoarding. Like we were hoarding toilet paper early on because that could create another shortage as well. So be mindful of it. And and think about it. But I think really the people who need to hear this are the people who are investing in their production. And so that's, that's really what we need to be paying attention to you now. Great.
Matt Boettger:And it, it, you know, it was saying in this article about, I had no clue about fake and 95 masks. Now, do you have any idea of like, how to know whether you have a real or fake and 95 masks? Because we bought like a handful of them a month ago. And I remember receiving them like, Oh, this is weird. You're like totally different than the original ones. Don't have a little filter on them. Say in 95 they look a little more flimsy and I just never thought anything of it until I read this article. I'm like, okay. So. There are just public service announcement. There are fake and 95 mask. Apparently. Do you have any idea of how to know whether you have a real one or not?
Stephen Kissler:Yeah, so a real N 95 mask. And I think the best way is to just look at pictures of what they should look like online. And there's, there's a variety of types of N 90 fives there, hospital and 90 fives. And then there are like industrial and 95 split, but they're all meant to filter the same. Degree of particles. That really the difference is the fit. There are a number of companies that produce them. I mean, 3m is the one that really comes to mind. They're involved in. And, and 95 production. So you can be pretty confident if you're buying from them that it's an a 95 and 90 fives, you know, should, should have the little rectangle that says N 95 on it. Of course you can fake that, but a lot of times the so I guess two points based on some of the things that you've raised. So there are also things called K N 90 fives, which are, yeah. Are, are not, they're not Tested and validated to the same degree that proper N 90 fives are. You can call them maybe like a knockoff variety in a way, but but there's still. Useful by and large, you know, they don't again have the same evidence-based behind them. But they're, they're masks, you know? And, and so, and they, they probably fit well, you know many of them are, are, are shaped so that they fit the face. And that's really one of the key issues is that you. Any mask is one of the primary things that affects how well it works is, is how it fits. Almost regardless of what it's made of. Now, you don't, you don't want to like use fishnet for a mask, but like, if you're not doing that, then the, you know, th the fit is really one of the main things that matters here. And so if we're using a N 95 or a can 95 or a cloth mask, really what you want to make sure is that you have a snug fit. Now the other thing is, is you mentioned these filters. And so that's something that I would really watch out for in many cases, like on airlines, they don't even allow masks that have filters on them, like little plastic filters because those masks will filter the air coming in, but they don't, they allow air to sort of pass out And, and so there's, the filter is sort of a one-way filter. And so that means that the mask might provide you some protection, but it doesn't do the main thing that masks do, which is protect the people around you. And so really you want to make sure that the mask is not one of the ones with the little plastic filter, because that isn't really providing any protection to the people around you you'll really want sort of a uniform mask that's made out of cloth or paper, like a surgical mask or an N 95, K a 95. All of those are good options right now. Okay.
Matt Boettger:Okay, great. That's hugely helpful because I had no idea about the difference between the filter and non filter. So at least like if like I'm doing okay, I got to listen to in 95 masks on, but for those of you can get him, get him, if you can. And I think I've, this is like a wake up call for me, cause I'm wearing a mask anyway. So why not just put it in 95 one? And by the way, those are your wear glasses. Eight. I know it's like a miserable experience. Wear glasses, glasses. I've heard about this anti-fog stuff. I need to buy it like some spray putting your glasses and then, then you can put your mask on it. Doesn't fuck up your glasses. I think it could be a miracle thing. So I'm gonna try that
Stephen Kissler:as well. Yeah. You know, one last thing I would point out with the, with the masks is that I think one thing that I've been doing is it's also, I think, useful for us as individuals to have sort of a spectrum of masks as well. So I have some masks that are, you know, relatively thin and like, I wear them when I like. Go outside, but I spend all of my time outside and I'm not going to spend any time with anyone. It's a little easier to breathe through. You know, it has like two layers of cloth. And so, you know, that's fine. And then, but if I know that I'm like, if I were going to spend like a long period of time indoors with a bunch of other people, then I would probably want to use, like, if I hadn't a 95, I would probably reserve it for that. And that's sort of one way of getting around sort of. We're creating a surge in demand for the N 90 fives, because if you're just, you know, if I'm just going on a walk out in my neighborhood you know, in those circumstances, like there's a question as to whether you even really need a mask. If you're like outside, if you're distanced like w generally up here in Boston, like people are still wearing masks when they're out and about, but when they're exercising often you don't and I think that's fine, you know? And so, but if you do choose to wear a mask, like a lighter mask, easier to breathe through is a good idea. And 95, save them for hospital workers or for when you're in a situation where you really need it. And and I think that that'll sort of help everything along.
Matt Boettger:Good. That's a great tip. I'm going to definitely use that because I, there are times where I just don't want to wear such a heavy mask. I don't even need to use it when we're going out to walks. We, we live in rural Colorado, so we usually don't wear masks. There's nobody around and we're just out in fields, flawless, you know, frolicking around. So it's all good. Great. Thanks Stephen. Okay. Let's hit variants. Now. This is a big topic. Continues to surface. We're going to go back to this. More and more variants are coming out. We don't need to get in the specificity of it. Stephen needed a great job on the recording last week kind of explaining of where we're at and how this kind of came about. And from what I got from it, if I'm, if I'm right, because I listened to it after the fact that I published it, did some editing to it in that is that. It seems as though this is kind of like a little bit of an explosion of the mutation, but it's something that's kind of maybe predictable that it was all kind of revving up towards this and it was kind of falling the same kind of, you know, iteration process as an, as a mechanism typically does. And then it is now it's at that point where it's just kind of starting to do with mutations and that's where we're at. Is it kind of a fair assessment of what you're trying to say in layman's terms?
Stephen Kissler:Yeah, that's it. I, one of the analogies that I was sort of thinking of is like this is maybe a stretch, but if you know, when you study science, you study the history of science, you often find that like multiple different people come up with the same ideas at the same time. So like how calculus was like this Newton and live and various other people all sort of discovered calculus at the same time. And it's like, why is that? That's crazy. Right. But the part of it is just because sort of the intellectual scientific atmosphere was such that. People could discover calculus and I, and so taking this back to the virus, that's sort of, what's been happening with the mutations. Like it's like, why are we all of a sudden having all of these mutations pop up? And it's just that sort of the background, you just needed a sufficient amount of diversity. You needed a sufficient amount of time for these things to build up. And then all of a sudden, all of these different viruses sort of found the same type of strategy and they're all coming up with it at the same time. So it's, it's remarkable. I mean, biological evolution doesn't have to happen that way. But it makes some sense that it does. And so I think that the fact that we have a lot of different variants sort of popping up right now that we're concerned about is unfortunate is something that I hoped wouldn't happen, but it was also not terribly surprising at this point. So.
Matt Boettger:Okay. Well as well. So we hear about all these different variants kind of to be expected, hoping that it wasn't the case. I hear a couple of things. So we, two weeks ago when we were together, We were kind of pretty consistent that at least the great Britain mutation, the UK one was highly more transmissible. I heard from someone up to 50% more transmissible, but not as deadly. Now, our article just came out from the UK. I saw two of them saying that they declare it more deadly. So I'm gonna lump these in, and then now I hear also South Africa, this fair, which is different being that made it, it evades the immunities that we have from the previous infection. So we had these two any kind of research you've seen on this. Is that true? That it looks more deadly in the UK and does a South African does, does it have a tendency to avoid the antibodies from natural immunity? And does that mean that we the vaccine won't work
Stephen Kissler:with it? Yeah, so I'll I'll try to tackle each of them. So I, haven't not been able to find the primary data that the UK. Declaration that this virus was more deadly was based on. So so while I can't weigh on, for sure and say that that is, or is not the case. I do trust the people who are advising the government over there at the moment. And so I, I anticipate that they've, they've largely, you know, that they've Communicated well, and, and, and done, done the science to the best of their ability. Now there's also a question as to whether something was lost in translation and like, what exactly do we mean by more deadly? As we talked about a couple of weeks ago, a virus, that's more transmissible. On the population level is going to be more deadly because it's going to infect more people and lead to more deaths overall. But I think really what's in question here is, is the probability of death in this case per infection higher as well. That's a lot harder thing to get a handle on because. We, we still don't even know how many infections are even happening with the, with the non variant version. Now I do feel like this reflects a lot of the concerns and questions that we had about the infection fatality rate early on in the pandemic. And a lot of that was rooted in the fact, again, that we didn't know how much was spreading. And so there's this bias where you usually identify the more severe cases. And so. It, it can artificially inflate the infection fatality rate a little bit now, of course. There's and we talked about this back in April, I think too, but on the other side, if the infection is increasing, then you're you're not then basically there's, there are more people who will die from it than you've observed so far, so that can cause it to go the other direction. So there's still an awful lot of uncertainty and all of those same principles still apply with the new variant. An added complexity here is that one of the features of this new UK variant is that it knocks out one of the primers and the PCR test that's used to identify it. So there are still two others that are effective. But one of them knocks out, knocks out the PCR. And so if it basically makes the possibility of missing. The new variant, a little bit higher. And so that, that affects things as well. And so surely if somebody is, you know, in the hospital and is really sick, then you're going to really try to be sure what exactly they have. But but we might be missing a lot of the other. Less severe cases, partly because of the biology of the virus now, too, because it sort of found a way to evade the test on some level, not completely, but partially. And so all of this plays into the fact that estimating this is really hard. I think it's important that this, the, the, that they've declared that this. Is potentially a more deadly version of the virus. And I think it's something we need to continue to look into, but I think really the bottom line is that it's pretty clear at this point that it's more transmissible and that's really the, the main point of concern at the moment. And so yeah, so there's that.
Matt Boettger:Great. Well, then now let's get into this because we were dealing with mutations. It's kind of little dark talk. I'm like w what's the future. And now modern has come into them some mix again, right. With some great news. So we would talk about what's going on with Medina in light of what they saw with its current vaccine and its efficacy with the mutations and what they're preparing for now with the variance.
Stephen Kissler:Yeah. And thanks for, thanks for priming the, I realize I didn't quite get into the second part of your question about Univision either, but that, that absolutely links up with this as well. So part of what we've observed with the new variant and the way it interacts with the immune system is that in many cases it doesn't. Prompt as strong of a B cell immune response. So that's, again, one of the arms of the immune response that we've studied. Part of the reason why we know that arm of the responses, because it's easier to identify. You can, you can measure a person's B cells in their blood by just taking blood serum and measuring it basically. Whereas the T cells are sort of a lot more hidden. There are a lot harder to measure, right? But we also think that T-cells are the things that are behind a lot of the immunity that lasts for a long time. So while the B-cell response does decay there's still a lot more, we need to learn about the T cell response. And so we have this now, now modern is sort of pitching their hat in the ring and making some comments about this. So, so they've been closely studying the effects. Fact of their vaccine on the novel variants and based on what I've what I've read. And admittedly, I've only read it this morning because I think that's when the first press releases came out, but it seems like the Madonna vaccine is a little bit less effective against the, I think they were talking about in particular, the South Africa variant now. But only a little bit. It's still the, the bottom line is of the vaccine is still effective. Against against the the South Africa, variant. I don't know exactly what the numbers are and I don't know what the, if those have been released yet. But it still does have high efficacy, even if not quite that like 95% that we saw before. And. The cool thing about this though, is that, so is that they're, they're already working on producing a update to the second dose. That would be more specific to the to the new variant. And this is one of the really cool things about the MRN vaccine platform is because you can do this sort of thing on the fly. So this is part of why these MRMA vaccines were the first ones to come out in the first place, because all you need that is glossing over an awful lot of complexity, but all you need. It's the genetic sequence of the virus. And then you can basically start making a vaccine against it, against the specific pieces. Now, now you need to know which parts of that genome are important for eliciting an immune response. So it does take a lot of ingenuity and a lot of testing and this kind of thing, but what's nice now is that we've done a lot of that basic testing. And now we're sort of just trying to tweak something that we've already got. And with other vaccine platforms that can be incredibly difficult because you have to generate an entirely new protein and you don't know how that's going to interact and how it's going to form. But with the MRI and a vaccine, it's really just sort of adjusting that genetic code. And we're really good at making MRNs sequences. We can synthesize those very easily. And so it's really just a matter of swapping that out and then we can sort of stay up to date. So it's, these MRNs vaccines are potentially a huge Breakthrough, basically in our if you call it almost like an evolutionary arms, race against evolving pathogens. Because we can stay a lot more on ahead of that curve. And stay up to date. You know, we, we only found out about these variants, you know I guess it's been basically two months that we've known about them potentially circulating and about a month that we've really known that it's, that there's something to be concerned about. And now we're already talking about it, a vaccine that targets that specific variant. That's pretty remarkable before, you know, I think Massachusetts only saw its first case of the variant, like a week ago, Colorado had one, a couple of weeks before, but it doesn't seem to be in that widespread circulation in the U S and we're already talking about ways to prevent it. Pretty remarkable. And and I think we'll only get better at this as, as it continues. A lot of questions about how do we regulate that? How do we, you know, like it doesn't have to go through the same levels of trials and these kinds of things. So there's, there's a lot of questions about how we actually implement this thing, but we're going to iron these things out. And I think it's pretty exciting. That's
Matt Boettger:incredible. So you just already said a couple of things that probably is going to answer my question, but taking that out, take the idea of, we don't know about how to regulate this, how, what kind of test it needs to go through? Could this be a game changer, M RNA for the flu vaccine, because it seems like up to this, like we get it and then we just hope that we've targeted and then we're done for the year. Right. We just give it to everybody. I mean, if, if we could somehow reduce the amount of trials and tweak it, cause we do like in real time adjustments to the flu vaccine, once we see like, Oh, here's a dominant one, here's a new one. Could that be possible?
Stephen Kissler:Yeah, I think so now flu is a very strange virus. Its genome is split up into a bunch of different segments. And so I don't know if there are other considerations that one would need to develop an MRA based flu vaccine, but theory, that should work. Now. One of the really valuable things as both being able to tweak this on the fly, but the way that, the way that we do flu vaccines right now is because since it, since it takes so long to produce. The standard type of vaccine that we have. You, we usually look at what was circulating the previous season and make our best guess as to how the virus is going to evolve over the next 12 months. And it's, it's not a total shot in the dark, but it's, it's a shot in pretty low light. You know, it's like, we're trying to do our best to like figure out where this thing's moving. And sometimes we're good. Sometimes, sometimes we really miss. But the nice thing about the MRNs vaccines is that they in theory would take a lot less time to develop. So you can. That, that delay, you basically have a much better sense about what the dominant strain is going to be. Then you can produce the vaccines and hopefully we'll get a much better match. Exactly. Like you said, that's so I think there's a ton of potential for this and for a lot of other pathogens that that we're still trying to get a handle on.
Matt Boettger:Great. A couple of things I want to talk about. I didn't mention this to you, Stephen, but I thought it was really cool. I don't know if you read this in the show notes, but there's two technologies that have surfaced. Researchers are developing color, changing stickers for mass to detect COVID-19. So you've put it on top of your mask and then by you breathing on it, it changes color. If it, if it, if it's positive picks up, COVID positive, whatever particles that's in my layman's
Stephen Kissler:term. Right. That's super cool. I, so I hadn't read about the color changing masks, but I mean, I think it works in a similar way, like the paper strip tests, right. Where people have likened them to a pregnancy test where they basically spit in the tube and you stick the thing in the tube and then something changes color. So presumably there's just sort of this like antigen sort of thing. That's been printed on top of a paper mask and then it, it it. The texts. It I've. I have heard of people who have been working on basically putting electrodes into masks also that that can detect COVID somehow. I dunno how exactly that works, but it is something that people have been thinking about so that you can sort of have this, like on the fly, really up to date. Information about whether or not you're infected in infectious to other people in the place where you're infectious, which is really cool, right? It's like measuring your breath, which is like, what, what you're going to infect somebody else with if you're going to infect them. So I think it's pretty cool. These sorts of things are like really innovative and are like, I mean, I'm so thankful we have a vaccine, but like these, these things are yeah. Are really going to help us get through this pandemic and future ones a lot better.
Matt Boettger:Absolutely. Yeah. I feel like we should put like a big Scarlet letter that shows up on the, on the front of your mask. So they're like go away. Well, there's the other one that came out too. Did you see this one? Stephen new studies show Apple watch can detect COVID. This is really amazing. So they've realized that up to 80% effective so far in the two separate tests totally separate ones can confirm this, that I forgot what it's like. I forgot what it was, what it's called, but like, I think it's the The distance between heartbeats, whatever it is, whatever it is that it changes when you have COVID and you can actually detect it up to eight and a half days before symptoms. That's the watch kin, which are, yeah, so it still has to go under studies, but just these things just fascinate me and like in this really paving the way for the future of the next pandemic. So I just want to put those in there. Let's talk a little more about the vaccine I saw here, a couple signs of the CDC mentioned about Medina's particular reactions to allergies and those kinds of things where they call it allergic reactions. I went through a past few with Madrona, particularly or maybe Pfizer, which one does wonder yeah. The other, did they have a higher rate of, of reactions than the typical vaccines? I know Mark laid the precedent well over a month ago that just FYI, this is for all vaccines, right? It's not specific to. So is this just a hyper response to, this is what vaccines do and millions of people get them, or do you detect this as a higher rate with MRN a of allergic reactions?
Stephen Kissler:Yeah. I, I, from what I've seen now, I haven't actually compared the numbers directly, but sort of anecdotally, which I should never say as a scientist, but nevertheless, I mean, it does seem like it's pretty much in line with what we see, like many of the people who have gotten allergic reactions have a history of allergies, either to vaccines or to just things in general. And, and importantly, you know, we have a pretty good, like, we're very good at treating allergic reactions. You know, we know we know what to do with those. And so even when you do have an allergic reaction, you know, you're, it's usually right after you've gotten the vaccine and you're still in the health care facility. Usually they have you stick around for at least 20 minutes after you've gotten it to monitor for these things. And if it happens, you're treated and then generally people go along their Merry way now, no, I don't want to downplay it. You know, there are we have heard a couple of reports of deaths that have been associated, or at least on the heels of the vaccine. And I think that those need to be taken very seriously and and studied. And so that we understand exactly what happened in those cases. But by and large, it really seems like the, at least in terms of the allergic reactions and the severe reactions there There are quite rare and in line with what we've seen with other vaccines. Now, though, the allergic reactions of course differ from the standard immunological reaction. The thing that makes everybody feel like crap after they get the MRN vaccine. Right? And so that, that is relatively stronger compared to, for example, the flu vaccine, but that's, that's not an allergic reaction. That's. And immunogenic reaction. And that just shows that the vaccine is working. You don't need to feel those symptoms in order for the vaccine to work. It might still be working otherwise, but it is a indicator that the vaccine is working. If you're, if you're really feeling crappy after, after you've gotten the vaccine. But that's different than the allergic reaction, which, you know where you might need a medical intervention And so, so I just wanted to make sure to distinguish those two things. But basically what we've seen while the immunogenic reaction tends to be stronger than what we're used to with other vaccines, the allergic reaction seems to be pretty well on par.
Matt Boettger:Good. Good. That reminds me. I didn't mention that this has been great of my family. So my side of the family and my wife's, my sister just got the vaccine. I think the Madrona I think four or five days ago, because she is kind of in the healthcare industry. So she got that and had very little side effects, but get a little sluggish. The next day, but she didn't know if that was because she was a sluggish in general or because of the vaccine. And then my parents, which is really big news today, they're getting the vaccine so super excited for them. And then we mentioned, I think weeks ago, I propose the question to you and market about my grandmother, who yes, got the vaccine like a week ago. And it seems all be going well with that. So it's nice to see people in my immediate family already getting the vaccine and just seeing it really starting to spread to more and more people. The bit of good news, Stephen, I don't know if you saw this. We didn't talk about it again. But study says Pfizer vaccine immunity is so strong. It might prevent Cub in 19 transmission. So that's, that's one of the big questions we had, right. That
Stephen Kissler:is one of the big questions. Yeah. So yeah, and that's, that's one of the main things that I think people are studying and starting to monitor now I'd seen something similar. Actually I think, I think maybe this was the same thing with the Pfizer vaccine, where they were looking at how much virus the body produces and shows that it, that also is less basically that you can still get infected even after you've gotten the vaccine, but you definitely produce less virus, which is great. So that's, that's the first thing you need is to lower the amount of transmission. Similarly, with the new variants, one of the things we've seen is that those. Those seem to cause you to produce more virus. And we know that they're more transmissible. So it does seem that this virus, the transmissibility really does correlate pretty well with how much virus you're producing. And so it's not a perfect proxy, you know, we need to still measure how much infection is actually happening in the community. But I think that is pretty good evidence that there's there's. Transmission blocking behavior. We still don't know exactly how strong that is, but but at least it seems to be there. So,
Matt Boettger:yeah. That's good news. So hopeful news that this is like a hopeful week. Last question I would propose to you. We talked about this and this is, it's a whole issue about the vaccine scheduling. Now there's two parts of this. I think we're going to focus on one part today. It's first of all, you know, the squadron and the scheduling is more of, do we give it three weeks out or six weeks out? AstraZeneca had mentioned in one of their studies that as far as 12 weeks out, it might be like actually beneficial, eight to 12, actually be more beneficial. But it's still preliminary. We don't really know. I think Pfizer and Medina is more like three to four weeks out for the booster the second round. But here's my question. And this was in the article. I'll put this in the show notes as well is we're going back and forth two weeks ago about, Oh, do we, do we, do we keep the second dose or do we relinquish that to give more people the first dose? So we can get the vaccine and the more hands of people, especially in light of the variant. Now, as you mentioned last week in the recording, I know you mentioned weeks before as one possibility because of the variant is because it's been in the body for so long because of either treatments and hospitalizations and it's and it's, and it has a time to sit in a body to mutate more and more and more. It's a possibility, it's a scenario. This article suggested. Wouldn't that be a dangerous thing to relinquish the second dose and have a bunch of people have vaccinated. Could that in theory, present another round of mutations by having people not fully vaccinated so it can get in their system and stay in longer. Any thoughts on this, Stephen?
Stephen Kissler:Yeah. So I would say that it is, you know, it is a possibility that people have, that colleagues have raised as well, that, that not fully vaccinating people could potentially affect the way that the virus evolves and might you know, and under that scenario that you just outlined could potentially contribute to like a vaccine escape variant, which means that the virus would evolve. To no longer in the front so that the vaccine would no longer be effective or as effective. But a couple of counterpoints to that. So first what it looks like is that from the data that we have available, is that the first shot that you get provides. Very good levels of immunity. But the question is how long that immunity lasts. And so really what the second booster shot is for most vaccines that we have is not necessarily increasing the total amount of immunity that you have, but making sure that it lasts a long time. And so that first shot will probably give you a very high degree of immunity, but that made a client in 12 to 24 weeks. And that's why you need the booster so that it, hopefully I can give it to you for five years. And so I think that and the other thing is that one of the most. Useful things for a virus to have, if it wants to evolve and to mutate around a vaccine is for there to be a lot of it out in circulation. Right. And so if there's a huge population of virus circulating, then it has a lot more opportunities to evolve that resistance to whatever we have to treatments. To the test, to the vaccine, whatever. And so one of the good things about the strategy of vaccinating as many people as possible at once is that it will hopefully reduce the number of cases a lot faster. And so that sort of counteracts this this scenario that you just outlined where where now there's just less virus. So it's less capable of evolving those sorts of things. Which is good. So. It's a complex question. You know, there, there are forces working in opposite directions. And so we can't know for sure how it'll play out, but I think that there's very good reason supporting the idea of getting as many people vaccinated with the first dose as possible. And I think that even from the perspective of the evolution of the virus, that still may be the optimal scenario.
Matt Boettger:Great. That's awesome. Well, I love this episode because I had lots of questions. We answered all of them, Stephen, and I feel way more hopeful. Cause I mean, man, with all these variants, all this news, obviously some of them being sensational, some of it being a little bit accurate, right. That just could get a little discouraged. I'm like, man, I don't want to get to a point where we're like, Hey, the vaccine's here. Your, your turns up, Matt. And it doesn't work. You know, that's what I don't want to hear. So with this morning and what you provided, I'm a lot more hopeful and I hope you are as well. Those of you who are listening, if you want to get in contact with Stephen, it sounds like he's an active Twitter. So S T E P H E N K S S L E R. Check him out there, follow him. He's got a lot of great information that he's sharing there. You can contact us just through my email address, Matt, at live in the real.com. Let us know how it's going. What's going on. If we can answer questions for you. I know we still have questions to answer, but it's hard because we get delayed and then there's so much stuff that needs to be put out here to help get us informed with all the differences of opinion in the, in the market.
Stephen Kissler:Yeah. And I'd also wanted to give a quick shout out. Mark and his wife, Katie also just got an article accepted at the new England journal of medicine. It's not on COVID, but it has to do with attention the attention of the caregiver in the clinical setting. It's awesome. If anybody's interested in taking a look at some more of the research that Mark does that isn't related to COVID go check it out. It's pretty cool. And quite an accomplishment,
so
Matt Boettger:that's awesome. Can you give it to me? And I'll put in the show notes, do we have the link to it? Okay, that'd be great. That's phenomenal. I had no idea where to drop that bomb. The very end, Stephen, it's always good to leave a hanging bomb at the end. The people stay, stay until the very end. Well, good. I can't wait to read that one. So Matt livers, roll.com. Let us know. How's it going on? You can support us at patrion.com/pandemic podcasts as well as one-time donation through Venmo PayPal on the show notes. I hope you have a wonderful week. We'll see you all next Monday. Take care and bye-bye.