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Things Discussed on Episode:
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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!
Things Discussed on Episode:
You're listening to the pandemic podcast. We equip you to live the most real life possible in the face of these crises. My name is Matt Boettger and I'm joined with my good friend, Dr. Stephen Kissler. Yep. Now Dr. Mark Kissler case, that was totally blew up. When epidemiologists at the Harvard school of public health, how's it going? My friend. Hey, I'm doing pretty well. How are you? Doing well, here's my, for those of you who are gonna watch this either live or animated, here's my contribution to check that out. Happy Valentine's day. Is that great? That's amazing. I didn't know. It was amazing. Yeah. There's so much I could do on this thing. So how's your Valentine's day, buddy?
Stephen Kissler:It was good. Yeah, it was, it was pretty quiet. Yeah. Yeah, it was just, did you make a meal? We ended up getting takeout from a restaurant here is like this really good Italian restaurant in the South end. Which was great. First time we tried
Matt Boettger:it, so that's awesome. And I'm curious, do you guys have any like allergies, like it, can you go full board Italian at your, at your apartment? Or do you have like gluten dairy activities?
Stephen Kissler:Thankfully? Yeah, there is it's No concerns. So
Matt Boettger:what a gift that's awesome. Well done. Well, our Valentine's day was pretty pretty good. The boys loved it. It felt like Christmas, a Grammy and Papa mailed gifts and they were fantabulous. And so they were. So, if you guys can hear this, he might able to hear this humming sound to background, because of course I'm in my basement. We have wood floors of love, and one of the wonderful guests was a little car and there they're driving it back and forth and back and forth and back and forth right now. So a little out, but that's okay. That's what we're here. So it was good. It was fun. Happy president's day for those of you guys who are presidents. I guess all over the country, the day off, I'm not a president, but it was nice to have the day off and relax. So that's why we're coming to you a day late on Tuesday. It's wanting to hang out with the fam one extra day and then do this this morning instead. I think that's good. Normal stuff. We love the reviews. It was so we got another great review about our professionalism in journalism. I don't have it in front of me. So that was really kind, it was funny. Whoever wrote that it was like one of the best compliments and then three out of five stars. We just thought it was funny. So whether they meant three out of the five stars, there was a bite. Nobody did, but we love the comment about the humility and a professional journalism greatly, greatly appreciate that patreon.com/penn debit podcast. So if you wanna support us, it's those$5 a month can go a long way to help us keep this going to make things more automated so we can get this out to you quicker. So we greatly appreciate that you can do on the website or just a one-time donation PayPal, Venmo. That is all in the show notes for you. Okay. So let's just get rolling on a handful of things. You know, a couple of weeks ago we had a lot to chat about we're kind of in another place. Now I feel like news a little bit slow. Other topics are kind of being Don they're dominating the media market now, see that's my perspective because. I look at just the media. You're probably looking at like scientific journals all the time. I'm like, ah, that's not me. I get glazed over. And so my main outlet is a media has been a lot of stuff coming forward, but there's a handful of things I think that are worthy of talking about for this week. The first thing is it's the same thing. I just want to get an update with you and you can roll in a couple of things you mentioned before the before we started recording. And that is just dealing with this idea again, that we're seeing. Cases dropped dramatically. And article saying we're in the lowest, since October, we've had one of the most sudden drops we've ever had in cases. So now we're seeing kind of this response around the country where certain States are starting to really kind of release an ease, mandate, even mask mandate. So now this is creating a buzz. Of like should be releasing, you know, mask mandates. Where are we? You know, we have this limit of variants that are always kind of percolating in the background. We don't know what's going to happen. I just want to get your kind of 2 cents of where you think we're at right now. You know, are we, again, to what extent can we be preparing for a fourth wave soon? And do you think. That some of these States releasing mass mandates is a good thing. Or where should we be? A little more cautious as we enter into February and March.
Stephen Kissler:Yeah. It's, it's a, it's a really interesting time. I mean, like you said, there's I do feel like COVID has been less than the news. And there is a lot of good news, you know, coming, coming out with more and more people getting the vaccine and and just cases dropping so much in so many different places. So I mean, that's all really good. I do think that there's, there's some little bit of concern in the back of my mind. Definitely that that, you know, as, as we're thinking about opening back up and releasing mass mandates and these kinds of things that that we're, we're sort of in that, that sweet spot where cases are generally going down, but some of the variants are really just starting to pick up and take off in certain places which, which is not too different than. Where the UK was in early December, where they had really brought cases down quite a bit. And then they started to surge again. Now, of course, for all the reasons we've talked about, things are different here than they were in the UK at the time, given that we're sort of emerging from the coronavirus season. But nevertheless, I mean, I think that that we need to be prepared for surges in different places potentially. I know the last couple of weeks I'd been saying that I was more expecting sort of a gradual decline in cases rather than any extra surges, but I actually think that since cases have been coming down so quickly, faster than I imagined they would, we might actually see a surge just because. We've reached such a low baseline so quickly that when the variants start to emerge now, rather than just extending that tail of infections, we'll actually start seeing bumps in different places as well. So, yeah, I think that it's It's still worth sort of proceeding with caution over the next couple of weeks and months, because there's still a lot that we're learning about the variants. We haven't really had them for a very long time. And we know that they, they definitely can cause surges of infection both in places that have, and haven't yet seen major outbreaks so far. So I think that it just really reinforces the importance of doing the surveillance to know where they are, how quickly they're spreading. And I think the main thing is that it's, it's not necessarily bad that we're to release some of these restrictions, but I just think that again, we need to be mentally prepared to turn them back on if need be, because these things can really, again, it's back to that discussion of exponential growth and they can really spiral out of control quickly. If we're not staying really closely on top of them, Yeah.
Matt Boettger:Yeah. It's been a hardest position for, for me as well, just in general because of when I'm going to work and there's no really overt pressure or anything, but besides just the normal kind of social pressure, because I think everybody's just chill about it now. So, because, you know, and so I'm trying to play the more cautious, not, not, not this kind of sense of. Trying to be hypersensitive, but just trying to wear a mask. But like, I feel like sometimes I'm the only one, you know, doing it at times. And so then the pressure of like, am I overreacting? You know? And cause the variants were just looming for me. I'm like, I just. Do you know, I'm going to do my best and it's not that big of a deal. So I feel like it's just another one of those hard spots to be in. If you're kind of like in the, in the state where like, ah, I'm a little concerned about the variant because cause cause it's unknown and it could just raise its ugly head at any moment. And so I'm just trying to be extra protective, but then the pressure is. You know, S you know, six months ago most people were kind of rematch. You kind of fit in like a sheep pretty well. And now I'm not quite that you know I dunno what I am. I'm a, I'm the Wolf. I don't know what I got. It's just like, it's a
Stephen Kissler:hard spot. Well, yeah. And it's funny, cause I mean, some of these conversations sort of keep recurring, you know, again I remember that after sort of the first major lockdown or shut down, whatever it was at the beginning, you know, it was, it was pretty clear, you know, Pretty much everybody who could stay home was staying home. And there was, it was pretty, you know, what we were expected to do was, was relatively clear. And then there was this really weird period of uncertainty where there wasn't a lot of guidance and everybody was kind of responding in a different way where, you know, and as we entered into the summer and like, what, what, what is safe? And I'm trying to look around and we had all sort of developed our personal habits as we were sort of clustered in our homes. And then there's suddenly this social negotiation now too, is as things start to shift. And I think we're sort of entering into that again now. People are getting vaccinated. And so there's sort of these different groups of people now, in some sense where, you know, some have been vaccinated, some have not, that sort of changes what people can and can't do, and cases are down. And so people are responding to that fact in different ways. It's this really tricky social negotiation where again, you know, the habits that we'd built up and sort of this set point that we had reached over the last couple of months is now really shifting in an abrupt way. Again, it's hard to navigate and I think like the social pressures Or some of the most difficult to figure out what to do is we're just like trying to figure out what it means to behave safely and responsibly. And
Matt Boettger:yeah. Yeah. I think you hit the nail on that. Cause you were talking, I'm like, Oh yeah, that's what I think I'm also feeling this. Another dimension is that I've built a new habits in the past year. And it's could be a really weird to say this, but I don't want to let them go. Like, like, like some of them I've already, I've spent all this year developing these new habits and I'm like, I don't think I'm ready to go back to normal in certain ways. And that's certain ways clearly seeing people having to fly to Denver, go to a bar pub hangout. That sounds all great. But other things. I'm kind of an introvert and part of this has been kind of a nice little advantage, right? So I'm like, so there's, there's, there's a lot of mixed emotions going on within my own heart and soul. So I got to figure out myself
Stephen Kissler:well. Yeah. And I think that's really natural, you know, it's like I think that there's, there's also this emotional side of things I think is really interesting because it does intersect with mental health and physical safety and all of these things, because it's, you know, I've been thinking a lot about like there's I I've sort of seen and, and personally experienced like the whole spectrum of emotion from like almost like there, there can be like an element of jealousy when people are like, sort of just living their lives, sort of very normally. And. Like, it's like, everything's going fine. And I feel like, you know, either can't or I'm not willing to, but then on the reverse, there's sort of this perceived sense of like, well, am I being, am I being judged for my actions? Am I being sort of like Oh, like, are people sort of praising them for my actions in ways that I don't really feel like I deserve. It's like, so, and so I think that like, as we're beginning to navigate this, I think one of the most important things is to recognize that this is just like a really complex thing for all of us and that something that might seem so crystal clear for the way that I think I ought to behave. Somebody else's crystal clearness looks entirely different than my own. And to sort of both be graceful with ourselves and with other people, as we're trying to navigate this really complex process and, you know, not re necessarily too much into what other people are doing and like assigning them, these, these, these labels of like, Oh, they're being rented. Bliss or, Oh, they're being overcautious or, Oh, whatever, you know, it's just like, this is just like a really complex space right now. And I think we all need a little bit of grace, so I think, yeah, that's, that's my biggest hope is we're moving forward and that serves the public health aim as well. Like, you know, If we're all comfortable in what we're doing and, and feel able to communicate with other people and enter into dialogue about this is why I'm behaving, how I'm behaving that serves our ability to control the pandemic much better than it does if we all sort of feel timid about what we're doing and trying to hide our behavior. It's. So I think that that, that can be really important and something that I'm really trying to keep in mind. That's
Matt Boettger:great. That's a great, I love that. I mean just, yeah, the whole purpose is, you know, I was, I was kind of being reminded of, you know, me reading the scripture passage about, you know, causing meat in the stubble. If he has ever read it, no big deal. But this whole issue with Corinth about this meat issue and people are eating this unclean meat, Paul, just like, Oh gosh, what add people. We understand that like meat is just meat. We get it. We can eat it whenever we want to you. But you know, some people think it's unclean. Some people think it's not really good. So instead of judging them. So I was like, just go with it, like uphold their conscience. Don't try to judge them. I think that applies today. I'm like, we may have an idea that like, you know, we'll talk about some of the, in the second, how back in March and in April we were seeking to like, don't touch any of the, the, the, the surfaces and keep your mail out for like three days. We just didn't know. And then over time we realized, Oh, you know what, it's really not a place by which we can, we'd get, you know, get. Get COVID. I mean, it's possible, but it's really not problems at all. So, but at the same time, there's a lot of people who still, even our own household, you know, just still clean off groceries. And even though it's not really needed. But I think of the conscience, we just support it. Right. Because everybody has their own timeline by which they enter into the world and the thing that we can do and I'm, and by the way, I might be speaking sound like I'm speaking to our listeners. I'm pretty much speaking to myself right now. So, so it's just kind of like like I, I need to be able to walk in a company that people. And in a powerful way, and it allowed them to enter back into the world of their own timeline, right? It's going to happen. It's not like that fear that somebody's gonna be stuck in the perpetual grocery. You know Clorox swiping for the next 75 years is really unlikely. Right? They're going to enter into the real world, just allow them that freedom. Love it love it. Okay. Well, other things we gotta talk about that's important or at least important to me because I found on the news. So when let's talk about it, I saw this article, Stephen Australia is still doing lockdowns the right way. So we've got Bruce, our good friend hadn't heard from a while. I sent him an email love to hear back. What's good on Australia. Australia seems to be kind of like this, like this beacon of light, oftentimes for how they're doing things. I'm not sure whether that's a right judgment or a bad or the wrong judgment. But they keep coming back into this circle of conversation. So I just want to know, what's been talks about in your neck of the woods. Right now, when it comes to looking at Australia lockdowns, have they've dealt with it and whether good or bad and how that might be a lesson for us and epidemiology
and
Stephen Kissler:that kinda stuff. Yeah. I mean, it seems like the I'm glad you brought this up. Cause I think this ties into some of the stuff we were talking about before. You know, again, way back when there were sort of these different notions of flattened the curve and crushed the curve and we were trying to figure out like, what, what, what should we be doing here? Exactly right. Yeah. Yeah. Yeah. And I think in some ways, you know the United States and in many other countries and Australia sort of took different tax on that in, in the way that Australia really went after the crash of the curve thing, you know, they, and they went after it and, and have succeeded in that largely, you know, of course, you know, I think again, it's like, There are so many things that make the United States different than Australia. But nevertheless, I mean, Australia is a very big country, has major cities has substantial international connectivity. And so there are, you know, I think that there are lessons to be learned there. I think one of the most thought provoking. Messages that I've seen there's I have a colleague who's in Australia and was just talking about the fact that like, you know, he had, you know, it was, it was a weekend and he had just been to two parties out to dinner and he was about to go to like, you know, some, some other social gathering and that's like, you know, there's hardly any COVID cases there. And so the, the point that he made was that like, you know, I hear so many people talking about how strict pandemic control is antithetical to freedom. And he's like, I just can't. I just don't understand what this means, because like, look at me, I'm like living a very free life. That's been enabled by the fact that, you know, there were these relatively strict pandemic controls early on, but now they're sort of reaping the benefits of that. And so, I mean, everybody sort of has to choose their own path to some extent. But but it seems like we've sort of like chosen two different approaches to controlling the pandemic. And And that's just sort of the place that we're at. Now of course, one of the other big benefits of having cases really low is that when you don't have much virus circulating, it, there's less possibility of variants evolving and emerging as well. So that's one of the great benefits going back to the conversation we were having before about whether we should let up or whether we should really continue with our. Control measures is that if we sort of keep allowing COVID to sort of bubble along at this level, then that increases the chances of variants emerging and spreading. And so there is, there's also a public health benefit in that sense of really reducing cases as low as we can. So I think that it's, you know, yeah, there, there are so many different ways to control the epidemic. And, and again, I really want to reinforce that like there's The countries are just different too. There, there are different aspects in play. And some of the things that might've been a possible in Australia may or may not have been possible here. Sure. But nevertheless, I think that there's, there's a useful there are useful things to learn there. And it seems like, you know, again, that. Very strict control early on really did allow them to enjoy certain types of freedoms that were still sort of can't hear. Yeah.
Matt Boettger:Yep. Absolutely. And I mean, I'm curious, I want to go, go deeper into Australia at some point in time because maybe Bruce can chime in at some point in time and help us understand how things are going on. But, you know, you hear things like really strict lockdowns for like four months during the, during a peak time of, of in Australia. And I don't know which city where it was at. And so, you know, my first, because of the polemics that go on here in the U S. One of the first things that comes to mind is like, well then how are the restaurants? And, you know, being funded, you know, how are they being compensated? You know, like all these kinds of things to help people. And so they may have a different paradigm by which they just, I have no idea, but like, I'm curious to know when they do over and over Easter lockdowns, how are they being cared for? It sounds like they are, because when I at least, I mean, my one dude, I know Bruce, right? It's a very small sampling. That sounds like that. Overall people are okay with it, which means there must be some, some compensation to help them get through. So I'm curious to know how this works. Another obsession of mine. Stephen, we've talked about this now. Now we didn't talk about it last week. I brought it up. We weren't ready to talk about it. I'm being more obsessed with this. This article comes from a couple of days ago, the Washington post, why you can get a cold even while masking and taking other COVID-19 precautions. So Stephen, you have some things you want to contribute to this conversation. I asked for things I'm going to contribute. The reason why I'm fascinated with this is because, okay. I'm just getting obsessed with surfaces and viruses. Not, not, not, not like wearing, I don't care about it. I totally get it. I don't, I don't, if it was up to me, I wouldn't wash my stuff. I wouldn't wear gloves. I get the balance, but just, I'm fascinated by how some viruses we're concerned about with actually being on services COVID or not. And so in my mind, my small little feeble mind, I'm trying to figure out how to wrap my head between different kinds of viruses and how they are can be Be hard for us on surfaces and be contagious and otherwise not. So back in the day I worked at Starbucks. Good old coffee, loved it, loved my time. There had some great friends that I still think about all the time. And one of the things they talked about, a good cup of coffee, they made it simple for us. It's just three dimensions. It's like, yeah, of course. It's the coffee bean. Right? You've got a good solid coffee bean, but it's not just that. It's the grind, the quality of the grind. That's the second variable. And the third one is of course, with water, right? You got a good filtered water. If you don't have filter water, it tastes like chlorine. You're going to get in the coffee. So that kind of tastes like a real good cup of coffee. And that's, that's carried with me on this day. So now I'm taking this and I'm like, Hey, what are the three dimension Stephen of like, of like of a virus on services where we can say, okay, this is why, right. COVID, we're not that concerned about. Whereas like we heard about the rhino virus, the rhino virus is still kind of, it's raising its ugly head. It's it's, it's a passing mask mandates and they're probably contributed because of probably surfaces. We're getting it from surfaces and that's where it's at. So I'm fascinated by this of how do I understand that the mystery of how these work and like, do you know, I've heard like a. C diff or, you know, very aggressive sounds like you can stay on services for like flipping ever. And you know, and how many particles do you need to get contagious? It's so I'm just, I want information about this. So I would love for you to just to vomit whatever knowledge you have to help me understand this complexity of the situation and how these things spread.
Stephen Kissler:Yeah. So, I mean, probably the clearest analog with, with viruses, as you've said with your sort of three axes that we're talking about are, are things that we have talked about. It's like surfaces, droplets, and aerosols, right? Like that's sort of the way that we think about like the different ways of which viruses can spread and different viruses have different Each of those has sort of a different importance. And so I think that as, as we've been learning more about COVID, it's really interesting because it started to COVID too. We sort of really shifted all the way from one access to the other, where we really thought that like, you know, maybe, maybe surfaces are really important. And that was partly informed by what we know about flu, where surfaces can be very important. They were like, well, surfaces, probably not so much, but mainly droplets. And now it's like droplets. Well, actually really aerosols are kind of the things that we, you know, The things that you really need to worry about. And it's just, as we've been learning more and more about the virus, we've been sort of clarifying that, but you know, you're right. Each virus has a sort of a different type of behavior that has to do with just how stable the virus is and what it needs to sort of thrive. And you can think of all sorts of different viruses, you know, that I mean, there's, there's all sorts of, like, you can imagine like the Ebola virus, for example, which, which is generally, you know, the main mode of transmission is through direct contact with bodily fluids. Right? So that's an entirely different, like that requires a really special kind of contacts you know, and Other mosquito transmitted viruses, for example, they're there, you know, you need to get bit by a bug and and the virus can't really persist like outside of the body. You know, these kinds of things are so yeah, so it's like, it's very, it's very complex. So, so, but that has to do with viruses and of course, viruses, aren't the only things that cause colds either, you know, we have bacteria as well and bacteria sort of obey entirely different types of life as well in different ways of sort of maintaining their stability inside and outside of the body. And so so getting back to your original question, right? So we were, we were asking about like, what is it we're wearing masks and we can still get sick, you know, what's. Yeah. What gifts, like, like why is this and that? So part of it is, you know, yes. So, so things can persist on surfaces. Flute can persist on surfaces and so we can pick it up, you know, you touch a contaminated doorknob and then you adjust your mask or something. And all of a sudden you've given yourself a pretty decent inoculum. And you can get sick. But one of the other things is that a lot of bacteria, for example our, what we call commensal bacteria they're things that generally just sort of live happily on our skin or in our respiratory tract or in our digestive system, but then certain things can happen that basically we make them angry and cause what we call invasive disease. So streptococcus pneumonia is, is sort of like this, it lives in our noses, in our ears and generally it doesn't really cause much of an issue. But strep-pneumo is I think the leading cause of ear infections in young kids. And so sometimes it just kind of. Makes that move and becomes an invasive form of strep pneumo. And, and then you get a cold, you get an ear infection, you get a fever, you know, whatever. And it doesn't even necessarily have to come from an external infection, although oftentimes it does, but sometimes it can just sort of be something that happens within your body too. You know, our bodies are so incredibly complex in that, like we have What we know, there's a lot of research now in the microbiome, which is essentially all the little bugs and critters that live on us and in us that also help constitute who we are, you know, like that's the whole idea behind probiotics, for example, too, that like, you know, there's this whole microbiome that's living in your gut. That's like doing things for you. It's like helping you like break down certain types of food. And and some of it is really beneficial, but then some of it can cause disease. And a lot of it just doesn't really do anything at all. And it just kind of hangs out. But all of that is sort of in play here. And so sort of this, this traditional paradigm that we have where there's this invader that invades and causes disease and that our body fights a battle and gets rid of it. There's a lot of sort of complexity to that too. And while that, that serves well enough for sort of a high level picture of how infectious diseases work, there's a lot else going on under the surface that can cause illness or health that is worth us paying attention to.
Matt Boettger:So. That's great. I mean, this is, I think this is an important, maybe it's only for a fringe audience for this, but for those of us, who've been at some point in time and like a pretty intense lockdown for maybe two or three months, and then you get sick. I've had it where a couple of friends, like how on earth has happened? Like, and so what happens is I see this fear of like, Did a mysterious like virus penetrate our walls. And if that, if that's it what's next, you know, these like these militant viruses, like knowing that I'm at home and knocking on my door and that know that it's, it's it really? And then we've, we talked to a doctor who said something similar, like it's complicated because there are things that just stay on you. And then one day they want to raise their ugly head out of nowhere and the whole family could get sick. And you may have not spoken to a single soul in person or left your even house for a month and you can still get sick. It's not because of a random package necessarily. It could just be, Hey, something could became active and that's simple as that. And it happens that's life. Yeah. Yeah. That's good. I had a question though. Another one. Do you know, like when it comes to a COVID when it comes to COVID we do, we know that it's a certain amount of virus that's needed. Before we're actually infected. Is that, is that typical for I'm guessing for all viruses and that fluctuates like some, you may only need quite a particle, whatever, like one small little thing, and man, you're just gone. Others need a lot. So is it true that some things, it could be a very small and it just gets you going and others, you need a lot.
Stephen Kissler:Yeah, absolutely. It's so the it's interesting. I was actually just looking at this the other day. I was trying to figure out sort of what the infectious dose was for SARS cov two. And it looks like based off of some really interesting contact tracing and genetic sequencing data that people have been working on. It looks like on average, the infectious dose. For SARS, cov two is on the order of a thousand viral particles. Okay. It can be infectious, probably at lower doses as well. They, they documented some infections that might've happened as low as a hundred or so 50 to a hundred particles. But it seemed like on average people generally got a dose of about a thousand particles from the person who they got it from. The sort of on the other end of the, the, the, the super, super, super infectious spectrum. The, one of the viruses, for example, that I usually think about, about, like, that's able to infect you just like on a dime is norovirus, which usually causes gastrointestinal distress. And you can get it from eating contaminated foods, but I think can infect you with, I think as, as few as two or three viral particles, like you barely need any of it and it will just like, Make you feel like crap, you know, really bad. For a couple of days I speak from experience. So there's, this is kind of a funny anecdote actually. So I was at a I was at a conference for infectious disease researchers last year. And and we were So everybody was giving these talks about infectious diseases. And there were a couple of talks about norovirus and there was actually they were sort of as part of the conference, we were sort of we could volunteer to partake in this study where we would have like small bits of our blood drawn. And then they would like, look for antibodies in the blood to try to understand sort of what we'd been exposed to previously in our life. And at this conference of infectious disease researchers, there was this huge gap norovirus, something that we ate. Yeah. It's like. It was, I think it was at the conference dinner, you know, it was like the second to last night. And then the next day, all of us woke up with like fever night sweats. Like we were all just like really rough. It was just like the irony of ironies. And so, yeah. Yeah, so anyway, it wasn't actually planned as part of the conference as a way of sort of closer to our research, but it's not so. Anyway. Yeah, it's super infectious. A lot of us came down with it. So it was really, actually, it was funny to see like this like epidemiological community. We were all like staggering around, out of our rooms, but like, we were trying to figure out like, what happened? Where did it come from? Like, you know, how many of us are getting infected with reproduction number? It's ridiculous.
Matt Boettger:So. Yeah. I feel like that painted your, that like literally is like a milestone of your life that prepared you for COVID because like you're like now you're like, Nope, this is not going to have with me. COVID I'm never going to leave my apartment. I'm just going to go out for a brief walks, get takeout and I'll see my university and about a year or so again, looking back, tell it's like totally painted exactly how you're handling. I will not have this happen twice. Oh man. That's great. So I'm just curious. So with the other one, you just said a Nora virus does it also subsist on surfaces longer than like COVID so it's like a double whammy, like small particles. So that's like a very intense one. Okay. Good to know. Random. Just wanted to say again, I love the flu stats. I'm just mesmerized by this. We're not going to talk about it. It's on NPR posts. He was NPR. On a tweet that, that mentioned since October, there's been 165 hospitalizations. I think that was it. I'm not looking at it right now. And then normally we'd have 400,000, so 165 currently to date, normally 400,000 hospitalizations. That's intense. That's crazy. So all that'd be insane. Good job for those of us who have to everyone trying to, to work with COVID and do the best protect everyone. Because even though it may look. Complicated. And a lot of people may not be wearing masks that we're talking about. Nonetheless, it's still having a big impact and we see that reflected in the flu. Okay. Next article. I want to chat with you about this article called COVID absolutism from the New York times. And we just address this idea of people, or I think have a San Francisco or I'm not having in front of me right now. I think it was there someplace. And California city really imposing some pretty strong mandates wearing masks of course, but wearing masks out, running outside, even by yourself, all these things it's just constant mandates. And just, it was basically a suggesting in a very intense way that like this is number one, unnecessary and, and will most likely backfire. And I wanted to get your feedback on this. I was thinking of. Me in productivity and test management. I was talking about this. It's like due dates for those of you who use task management. And the only thing you have is the due date in there. What you're often will do is you'll put a due date for things that are actually due. And the thing is the guy, you know what I'd like to exercise tomorrow, so do tomorrow, right? Exercise. And then you end up being tomorrow. It's not really a due date, so then you postpone it. But then when you lump and you put due dates on everything, the real due dates get lost to the met and the mess. Now due dates are now suggestions, and then you become overdue on things that are, I feel like that's kind of similar, like what's going on with my mindset of this. Like when you impose this all over then mask in general, lose its intensity. And then when you, like, we've learned over a period of time that willpower it's finite, we wake up usually refreshed. And by the end of the day, we're exhausted. It's why it's best to work out in the morning when you have a good, strong willpower. And it's why you go for the donut X 6:00 PM instead of the actual exercise. Speaking from a human experience because you're exhausted and you're stressed and you don't exercise. And so you end up just falling from this. And so that we're doing this, we impose this all over the place, but it's not necessary like outside. I'm pretty relaxed personally, when it comes outside, I really don't do much. I mean, don't. I don't get in people's faces either. I stay across the other side of the sidewalk, but I don't wear masks, but boys don't wear masks. I feel like it's okay. But I do wear them in the important places inside, especially in close quarters, but if you're always wearing all the time, you get fatigued, you get exhausted. And then you're like, then the one time you should have worn it. You're just too tired. You wear it, you get infected. I just wanna hear your thoughts. Is that a similar train of thought that you've been having and discussing there?
Stephen Kissler:Yeah, absolutely. And it's always it's, it's always a difficult balance to strike, but one that we're always. Alien for as epidemiologists and people who are involved in public health, you know, it's you're right. Like it's based on everything we know, like being outdoors and being relatively distanced from people is like pretty safe. And you know, generally, like not wearing a mask when you're out for a run, as long as you're not like, you know, Ghost and somebody and like running right up behind them for like 20 minutes, you know, like as long as you're not kind of being a weirdo anyway, that's probably going to be okay. And so yeah, and so it's really tricky because there's, there's this fine, fine balance though, because There is, you know, as an epidemiologist, a lot of the feedback that I hear comes from two different perspectives. One of them is, you know, well, we'll try to communicate something and it's like, ah, that's just too complicated. Just tell me what I need to do and make it simple. Like why do you have to make it so complicated? Just give me some simple rules and I'll follow them and then that'll be fine. But then, you know, with something. Okay. So I'll give you a simple rule. Let's it? Masks everywhere masks outside. And that's when you're running is wearing masks all the time. And then it's like, well, what do you mean? Like, I, you know, I need to, like, that's just too much. I, you know, and th and clearly, and, and rightfully so, you know, it's not You don't need that. We don't need that. And it, and people can, you know, rightly like people are not, people can, are not dumb, you know? Right. They can see like what's effective and what's not. And can see if like something that they're being asked to do. Doesn't actually map up, match up with something that would be effective at controlling disease. And so. I think, I mean, the, the best thing we can do is just keep communicating sort of the nuances and complexity of the situation and and trust people to make good decisions for themselves. And, and I think that that's the best we can do. So you're right. I think that the sort of blanket rules that can be made that that don't necessarily, that aren't necessarily grounded in you know, really good at infection control strategies can absolutely backfire both because, you know, people. Rightfully recognize that what they're being asked to do is not useful. And and it sort of erodes trust too, because they're like, well, why, why do you ask me to do that? If it's not actually founded in science and in our understanding of how disease spreads Now, of course, there are certain circumstances where the other, the other variable that we have to pay attention to here is limited knowledge. And so that was one of the things that was really prevalent of course, early in the pandemic. And why sort of widespread lockdowns uniform masking, all of that made a lot of sense then, because we didn't really know what we were dealing with. And all we knew was that COVID could decimate a city in a matter of weeks and we didn't know where it was when it was going to happen. And, you know, and so in that sense, We didn't know what the right interventions were, but we also knew that this was potentially catastrophic and we needed to do everything we could to stop it. Now our understanding is a lot more nuanced. And so, so I think that we can be a lot more targeted in our interventions and I think we need to be, to maintain trust and to make sure that people are, as you said, actually using masks when they're inside in crowds around lots of people in the places where they're going to be most effective. That's great.
Matt Boettger:I mean, yeah, you're showing the complexity of the situation. It's kind of math, you know, it's a, you're a kindergartener and you learn basic one Oh one. You know, we're working with our oldest with math, he's doing a great job with addition and subtraction. And he may think that may solve the world's problems, but actually you need more than math and eventually you need stats and then DBQ and matrix theory and all these different things that help the complexity. And you realize that. That you start with the simple things and it's kind of, that's just how the human mind works. We bite down on something that's actually digestible right away. It gets us going and it might be overly simplistic. And then when we've mastered it, we want what's next. What's the nuance. It's it's the it's it's the. You know, the basic art class in kindergarten to the artist, you know, and who has the, the ability to shift and be nuanced, but, you know, so all those complexities are, are needed for this whole part. Great. We only have a few more minutes before we got to end, so we can move on to other things in our own life. But one thing, variants, I want to talk you about that. Just updates on variants. You're discussing it right now. You've been really busy this week, talking about variance. What's the scoop? What do we see? I hear that U S has some more variants anything concerning on your horizon and what's the update.
Stephen Kissler:Yeah. So we've been thinking a lot about the variants, for sure. And again, there's you know, more information is coming out little by little suggesting that many of the vaccines are still effective against preventing severe disease caused by potentially the variants. Even if the variants are able to escape some level of vaccine effectiveness for mild and moderate disease. So that's still by and large good news. As you said, there's, there's this recent study by Emma HOD, Kraft and her colleagues. And in many ways she's the guru of, of serous curvy to genetic epidemiology. So it is still a pre-print, but it's a pre-print that I'm certainly going to pay close attention to. And I would encourage others to as well, if, if you're you know, interested in these sorts of things and they've basically identified Another key mutation that they've picked up that seems to be associated with increased receptor binding. So again, that's similar to the variant that we saw in the UK that might allow the virus to be a little bit more infectious. So through a slightly different mutation that's involved. So I think that that's something, you know, again, that we're paying close attention to, we're going to keep seeing these things pop up. There will be a number of false alarms. There will be things that that will be concerning for a while, and then we'll just sort of Peter out. And that can either be because they aren't actually more infectious or because they are, but the randomness of the way that this disease spreads just caused them to die out anyway, like both of those things are possible. And so I think we, we sort of need to buckle up and, and recognize that like some of these are gonna be important. Some of them aren't we're going to be hearing a lot about these in the coming weeks. And to sort of just try to maintain that middle ground of sort of sobriety without panic of, you know, understanding that there's that these things are worth paying attention to and are things that we're going to have to contend with in the coming months. But again, we also know largely how to prevent this. Viruses spread. And it might require, you know, special effort at different times in different places. And I think we need to be prepared for that for sure. But I think we're past the stage where we really need to panic about these things. We, we kind of know what what's expected of us. And the most important thing is to just kind of pay attention to what's emerging and how cases are going and your given community. And yeah, just just to do our best to Yeah, maintain, maintain what we've been doing all along. Right?
Matt Boettger:Random question. I don't, we may have addressed it before, but I have had people ask me what the Darian's so far to this point. Does that mean people can get reinfected right away or are they not so strong enough to where the first natural immunity seems to cover? These variants as well.
Stephen Kissler:That's a great question. I don't think we know that yet. My impulse would be that probably very soon after infection, sort of the, the huge B cell response that you get after an initial infection will probably protect you more broadly from Corona viruses for a little while, including the variants. But but that, that obviously wears off such that you can get reinfected with. W with similar coronavirus variants. And now we have these other variants that might be more effective at immune escape. So I imagine it's probably not immediate. You probably at least have a couple of weeks window in which you're pretty well protected. But yeah, so I imagine there's some amount of time there that needs to pass. Great. That
Matt Boettger:reminds me, we made a bill to get into this today, but I wouldn't have just ask you quickly. I saw an article about this, about how I think it was from the Atlantic about how our immune response seems to be can be even better than the initial infection. And so it's talking about idea that how it can actually, so here's my equivalent. I'm going to put in my layman's terms, does the immune system, does the immune response. Have like a fuzzy search option, you know, it's kind of where you do like a, you know, and like certain things like Google, you put in, you know, you might be a grammatical variant basically. Right. But it's enough to figure out, Oh yeah, you mistyped that. And here's the actual result. The same solution does the immune response have like fuzzy search where like here's, here's COVID but here's a rough model. So that could handle some sense of variance on its own. Yeah.
Stephen Kissler:Excellent. Yeah, absolutely. And so that's, you know, it, because what the immune system is targeted to is really just like it's, it's the shape of the virus and it's the shape of certain parts of the virus. And as long as that's close enough then even with some mutations than the immune system can still recognize something. That's not right. And Mount a similar immune response that will still be mostly effective against that. So I think that's a really good analog it's it's doing essentially the same thing. It's looking for sort of the different grammatical structure, but trying to figure out what exactly you meant. That's awesome.
Matt Boettger:Can you write some kind of scientific article about that and call it fuzzy search? I really, really, really appreciate that. That'd be awesome. It'll be out next week. We'll let you know. Steve, will you send me the the note the article for the pre-pub we were just talking about any, any information about that. Girl. I think that lady that we can redirect direct them to. Yeah,
Stephen Kissler:absolutely. Everybody follow her on Twitter and yeah, just talk to be and start listening to her,
Matt Boettger:whatever I was totally random. And I was using my Twitter a little more cause like, ah, kinda like it's fun. And so I looked you up and I followed you, which is funny. I haven't been following you. And and I, I, I hit the list option, but there was no lists that you were. That you had, I'm like, Oh, I do have lists that are public that I can, that I can have of, or no on Twitter. Interesting.
Stephen Kissler:I didn't even know that that was possible, but I'll take it
Matt Boettger:right. Well, I'm going to work with this with Stephen. He's going to compile a list of people he found he follows on Twitter and then we'll make it public. You can follow their list, but we're gonna have together. Okay. That's about it. A couple of other things, just to say this, it looks like maybe Dr. Fowchee said in September that have your kids might be able to get the vaccine and that's the, all the big breaking news. Thank you guys so much for listening. I really appreciate it. We'll be back next Monday with a great episode. And again, if you want to reach out to Stephen S T E P T N K S S L E R and Twitter, I just now since followed him after so many years. And if you want to support us patrion.com/pandemic podcasts, there's a$5 a month or one 10 payment at Venmo PayPal. All the show notes. Thank you so much. Have a wonderful and great week. We will see you next week. Take care and bye-bye.