If you have time to fill out our five-minute or less survey to help us understand whether or not we should continue our pandemic podcast with a new focus, please do it by clicking the link here. Thank you so much!
Can you Rate and Give us a Review in Apple Podcasts?
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:
If you have time to fill out our five-minute or less survey to help us understand whether or not we should continue our pandemic podcast with a new focus, please do it by clicking the link here. Thank you so much!
Can you Rate and Give us a Review in Apple Podcasts?
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:
Before we get started. I just wanna apologize ahead of time with this particular episode, because when Mark came on, which we're so grateful that he was able to join us this week for two weeks in a row, that we had some computer issues, like usual, some internet issues that caused some feedback. So it got a little staticky at times. I did my best to reduce that as much as possible for you. So it's not too terrible to the years. So I just want to let you know fully aware of it. So sorry, kept him in because his message and his. Content was incredibly valuable and I hope you still enjoy the episode. Okay. Let's get into it. You're listening to the pandemic podcast. We equip you to live the most real life possible. The face to face crises. My name is Matt Boettger and I'm joined with my two good friends. Yes. Two weeks in a row. This is huge. Dr. Stephen Kissler and epidemiologist to Harvard School of Health, our favorite epidemiologist and Dr. Mark Kissler, a favorite doctor in the state of Colorado and the United States and maybe the whole entire world. I think it was called the hospital. Dr. Mark, Dr. Stephen, how you doing guys? Hey.
Stephen Kissler:Doing all right.
Matt Boettger:We're now getting choppy with Mark and we're losing him altogether. We have such a Mark is pre choppy and getting kind of staticky for some reason. This goes back to those who you went to last week, that fiber optic a fund would go fund me. This just cements the whole thing in. So welcome everyone to the pandemic podcast. This is another great episode. Number 66, got a lot to cover a couple of small things. Obviously, if you want to support us, we really appreciate that at patrion.com/pandemic podcasts, there's a$5 a month can go a long way. Can help. One-time gifts are well-received at Venmo and PayPal all in the show notes. Now, Stephen is just you and me right now until Mark Mike gets back. But so this is crazy. So this is the week of my birthday week, which I'm not trying to do that for like self, like happy birthday. Yeah. Thank you. Thank you. But it was a big milestone. Yes. I turned 42. Now I'm turning 43, but March 11th, which is my birthday is known not so much for my birthday by the world. But the day by which the, who declared the coronavirus a pandemic. And this was like, I remember, I remember like literally in my yeah, on my birthday realizing I can't go anywhere on that day. Things radically shifted into what it is. I pulled a couple of things. So I use Evernote. I have all of our clipped articles and just searched March 11th. And they're just like, we got like 50 articles showed up on this one that, you know, the, who declared a pandemic on March 11th. W Oh yeah. The Atlantic says on March 11th, 2020, the Corona virus pandemic seemed to crystallize in the national consciousness, which it did another one. I loved hearing all of, Oh, this is from Kiersten. From last week. She actually referenced March 11th and her own email to us last year. Cause that was the day by which they shut down her own program. The NBA froze the lottery. On that day. Trump announced the European travel ban on March 11th as well, even Denmark things shut down on March 11th. So this was a big day this week. I think now we're kind of coming full circle and revisiting now the first time, almost like I had this app called day one, Stephen, I'd love to get a journal app that it's, it'll say on this day. And then it'll repeat like, this is now for the next few months we're going to have like on this day. Right? How? Yeah, it's just so crazy. So crazy. So I found that fascinating. So I will be having my second pandemic birthday, which not everyone has been able to, I guess, enjoy. But I would say that with tongue in cheek. So but luckily there'll be a little bit less intense as last March. Okay. Let's, let's hit a couple. Stephen, the first is we have two really good questions. From our listeners. So first one is from Carla. Now, number one, I'm gonna open this up right now because she actually about two weeks ago, it was two weeks ago, Stephen or, or less now, or it could be more. I talked about how my, some of my family read in the news about, Oh, the vaccine only lasts three months and we couldn't figure out where what's from. Carla. Was awesome. She listened to our podcast and then suggested that she might know the actual answer to this. And that is, she says that the CDC recommendation at that point in time was that three months post vaccine. You don't need to test or quarantine if you're exposed, but after three months, then it's a different perspective. And I'm guessing now, I don't know if you have any feedback to that, Stephen of why they would suggest that. So my, my, my layman's guess is that because the vaccine has been out for luckily three months, we know it's effective for at least that, but we don't know as time begins to move forward. Do you have any other ideas of why the CDC would recommend just three months before we had to get tested again, after having the vaccine.
Stephen Kissler:Yeah, I think right. It's part of it is just because of the length of time that we've had the vaccine. Part of it is what we know about immunity to respiratory viruses generally, and to Corona viruses in particular where we know that the immunity to the other Corona viruses. That we know of can decline over time. We know that you can get reinfected with some of the common cold Corona viruses after a year. And so presumably there's some point prior to that where some proportion of the population will be able to be reinfected as well. Cause there's, there's a distribution, right? Some people will be protective for longer, some people for less time. And so essentially what they're probably trying to do. I mean, it's, it's, it's rough. It's probably just a rule of thumb, but they, you know, somebody at the CDC decided that about three months was probably. A safe period of time where you could be pretty confident in the immunity that you got from a natural infection. But after that, given everything we know all of these different types of information, then it probably makes sense to get tested. Now, of course, I mean, the other, the other thing that's weighing into this is it's not just the, the epidemiology and the science, but but the, the nature of the thing that they're asking you to do. Anyway, right. It's, it's a test, which is not a particularly invasive sort of thing. Right. So if they were saying, you know, that you had to undergo like some painful, like preventive treatment or something, then, then they'd probably revisit that and try to get a lot more solid data around that. But part of the reason. It hasn't been investigated as closely as, because also what's on the other side, which is asking for something that that is for, for most people is sort of a minimally invasive event. And so all of those things sort of come together to give us what we've got, I think.
Matt Boettger:Okay. That makes sense. Helpful. That was just the first part of, Carla's just helping us to understand why my family may have read something like that and kind of came to the conclusion. But the other part was a deeper question. And this was about the idea of, okay. She is living in Michigan apparently. Yeah. Pretty intense. They're just now open up restaurant at 25% capacity, but she's just confused because they have less than 10 per a hundred thousand cases that are not value is like a 0.88. So there is below one there's there's you know what, what else would there is going on? There's some other things going to show that there's there's, there's, they're doing pretty well, but yet. They're just still so enclosed and we're seeing this all over, right. We're seeing this with Texas and they're they, the, the, one of the first biggest States to just undo mask rules and those kinds of things. So we're seeing even California having more open options. How do we deal with this Stephen? Like, I don't know. What's the best response because some people are thinking, see, this is, this is going to go on forever. We're we're doing better. Cases are plummeting, but we're still being forced. To wear a mask. There's no rational explanation for this because it's things are great, right. Nicotine to be great. So what's the science behind this. And I, again, I think I'm guessing I'm going to hear from you is that it's complicated. Right. But at the same time, is there some kind of measure by which we can say yeah. What you did, Colorado, what you was, was a good move. What you did, Texas was actually totally imprudent at this point in time. Not just because of, Oh crap. There's a scary int, which was there, there was an article about that. That that's kind of funny. I love that word scary. Right. But, but because of this science, this data, it is best for us to continue this kind of measure. Right. So can you give us, help us understand and see where we're at? Is there any way we could, by which we can have some measurement to see when we can begin to open up more and more.
Stephen Kissler:Yeah. I mean, this is, this was one of those areas where science and culture really intersect in important ways. So in terms of the science and the epidemiology you know, there, there are a lot of different reasonable measures that one can take. But I think one of the consistent stories with this pandemic and any pandemic or emerging infectious disease really is that Early action and Swift action and especially strong action when cases are low can pay dividends in the future. I mean, I think that that's that by and large, I think is the story that we can learn, for example, by the difference between our experience in Australia and the United States, you know, So setting aside all of the many, many, many, many differences between the two countries and their demographics and their, you know, different types of interconnectivity, you know though that really captures, I think some of the difference in response and again, not just in Australia, but many other countries who. Decided to have sort of Swift strong measures to prevent the spread of cases while they were very low versus having some tolerance for cases, allowing to allowing them to spread. And then ending up sort of needing longer term mitigation measures much like we've seen in much of the us. So I think that, you know, again, there, there are. As this intersects with with, with culture, there, there are cases to be made for different different approaches and you know, it's Some of the having, having businesses closed. And I think that especially can be, it can be very restrictive and really affect people's livelihoods and that, that does have to be balanced against a certain amount of infectious disease risk. I think the most important thing is that when we're making these decisions, we're thinking not just about now, but about two weeks from now and two months from now. And so that it's in that context that I think some of the decisions, for example, like are being made in Michigan can be a little bit more easily rationalized Okay. We right now we have modeling evidence, but especially, you know, it's just crazy how familiar some of these stories seem, you know, like you said, we're coming back on a year from when the pandemic first started spreading. And a year ago there was a lot, we didn't know about the Corona virus, but what we did know was that was the experience in UConn and the experience in Italy, for example, where we saw that it really could spread explosively And and cause a lot of a lot of damage and that's where we're beginning to see what the variants too. And we saw in the UK that it could cause explosive spread. And now it's really starting to take hold in different countries in Europe as well. And so we, we have evidence that the new variants that are spreading can cause this, these kinds of really major surgeries that require much stricter sorts of interventions in the future. And the only way we know how to, how to sort of. Stop that from happening is to have relatively strict action now. So it's, it's, it's tricky. But I think that that's really that's the best way that I can think about it as no matter how things look now, we know that things that as we've seen for the whole course of the pandemic, things can change so quickly, so rapidly. And I think that some of the places that have are adopting stricter measures now are probably doing so to try to heat off some of that Some of those bad outcomes that could happen in the future.
Mark Kissler:Yeah. You know, I think I just wanted to kind of jump in on the end of that. Cause I think one of the points that I hear a lot in casual conversation is like you know, can we look at these case studies in individual local places and decide and say, well, see here's evidence. You know that the decision was good or the decision was bad, or the decision that we, you know, we should prioritize the economy or we should prioritize public health and looking for vindication in these local stories. And I think that's something that we've been, you know, really consistently and. Cautioning against, because there's so much geographic variation. There's so many as Stephen was alluding to just so many different factors in each of these places that we really need to look at bigger, broader historical trends, bigger epidemiologic data and not necessarily look from individual place to individual place for that small you know, evidence that often I think is used to justify one zone sort of. Preexisting point of view about, you know, this is, this is how we should operate or see, it's not so bad or see, it's a lot worse than we thought. And so just, you know, continuing to, to be able to traverse between the local and this kind of global broader scientific view of superstar,
Matt Boettger:that's a good point. Absolutely. And it's actually just realizing that. That it's, it's a, it's a really big gray scale. It's not like a switch where like it's on or an off, and that makes it all the more complicated, you know, look at Michigan and 25% allowing for restaurants versus maybe 50%, could they do 50% versus 25%? I'm sure that's a very valid discussion, but like, that's like, I mean, that's, that's just a part of it, right? I mean, it's, it's, it's, it's the fact of the matter we have to take measures. It's not a black and white switch. And so whether one state is doing 50% of the prison, twenty-five percent that, that there's nothing about a grave disjustice. It's just a matter of a nuanced understanding of how we. How we deal with this, right? It's hard. It's complicated. And then bringing in Stephen osterhome in the whole mix, where again, he came back on talks about how we think he thinks that we're in the eye of the hurricane. So this is in the midst of this same discussion. And I want to throw this back to you because you have been more cautiously, optimistic, cautiously optimistic, and in osterhome is more cautiously paralyzing. I don't know how to say it, where he just he's very much emphatic that, that we're we're we're we're upcoming. We're getting into a hard spot. So he mentioned, he believes we're in the eye of a hurricane. He used said, Hey, look, last time I was on this, I forgot what he was on. You know, the very was, had had hold of the U S by about seven or maybe three, seven, 10%. Now three weeks later, it's now 30 to 40% as a whole of the U S it's not going to be long before it's over 50%. Hey, look at the countries that have over 50% of the variant rent going to go in across itself. They're in bad spots right now. So that is his litmus test for, we are approaching a pretty hard spot in a matter of weeks, maybe. Can you speak into that? About how his 50%? Cause I know again, he's probably. Maybe only has 10 minutes. So he's not being a nuanced approach. You have a little more time to do that. That, like you just said, like Mark just said, countries are different. We're different. And there's reason to maybe feel like that maybe after the 50%, it may not be like other European countries who are being sucked into the very end. Can you speak into this a little bit? This dire situation by Australia?
Stephen Kissler:Yeah, absolutely. It's I mean, I think that I anytime Michael Waltzer home speaks. I listen up, you know, that's, that's the first thing that I want to say is you know, he's absolutely, you know leading expert in all of these things. And so I, I take what he has to say very seriously. Anytime that he does say something. So so I don't so much want to Police myself, you know, against what he's having to say, but maybe to fill out some, some nuance into like, why? Well, what I imagine things might look like from, from my own sort of experience with with the pandemic and related things. So First thing, is that again, the sort of casting our minds back to what was happening about a year ago? We were really concerned about huge increases in coronavirus cases across the country. But of course they happened very locally. And it happened at different places with different severities at different times. Each part of the country sort of had their own. Period of time when they were in the spotlight. And I wouldn't be surprised if something very similar happens with the variant where we don't necessarily see a massive unified surge that just overwhelms the United States as a whole, but there will be particular cities, particular communities that will have a very hard time. Grappling with the variant. And we just don't know which ones those are yet, because there's so much about this that is random. That's driven by super spreading. That happens to be, you know, just a place that has low underlying immunity at the moment and just gets in at the right time and the right community. And so so we can't really predict where those places will be. So on a local level, I think it's true that, that we're, we're entering a period of time. That is a lot more uncertain than we've been in. And so I think that's really worth some caution now that said Some things that distinguished the situation that we're in from from some of the countries that have seen a lot of spread of these variants in Europe, for example first that the time of year is different. I've mentioned this before. I really think that and I've reflected on this, you know, while last year I was Yeah, and this was born out by the data too, but one of the key things of some of the modeling we did was that COVID was going to spread in the summer, the summer weather, wasn't going to take it away. And that was, that was absolutely true. That said, I think that I have I think that the seasonal force, the, the, the change in the virus's ability to spread by time of year is still. Powerful. And this year we're in a, in a different situation where we have a lot more underlying immunity. We have a lot of people getting vaccinated. And so again, it, it won't go away, but I think that that'll help prevent some of the major surges that we've seen in some other countries as well. And likewise, this is, this is not necessarily good, but we have had a ton of spread in the United States. Some groups expect that, you know, 20 to 30% of the U S population has been infected with COVID, which is. A lot higher than many other places. And then you layer on top of the vaccinations. In addition, you know, we're still a far cry away from herd immunity, but that does slow things down a bit. And it does seem like previous infection and vaccination do seem to be effective to some degree at preventing at least illness, if not transmission. So I think all of these things are sort of conspiring together where We are entering an uncertain time and there will be places that see real surges from the variants. But but I don't, I don't anticipate that it will necessarily be a major surge. Like we saw this winter. I really hope not. It could be, you know, there's, there is a possibility that it could be, but I I synthesizing what I, what I know and what I've seen. I don't imagine it will be like that across the country as a whole.
Matt Boettger:Great. That's good. I mean, it's kinda what I'm feeling as well. I'm feeling hope. I mean, again, mind just intuition, right? I'm done on anything based on science, but I'm hopeful that this is going to be the case where you continue to see declines and maybe some hotspots here and there. This is a followup to this. Cause we talked about how Texas has released a masking for the, for the state. The CDC has advised this. Maybe not be the case. This is our second question. And we can open up to this and I want to kind of start with Mark now. It sounds like he might be staticky. I can kind of hear it, but we'll see in just a second. Because this comes from her. If I say her name correctly. And first of all, Carla, thank you so much for the question. I love it. It's really helpful. This one comes from a moron Mariah more. I I'm sorry if I spoke your name, terrible with names. I think I mentioned in a previous episode and really, really bad She talks about how I'm going to pull this up here. I think it's fascinating where she, her husband went to a doctor's appointment. So I start with you Mark. And I'm just I'm, I'm just, I can't believe this is still going on, but of course it is. It's a complicated situation. And then her, she went to, he went to the doctor and then the doctor tried to convince him that mass are not, they don't work and put that in quotations work. And that in fact, he would take the next step to actually send an email to him, to give articles. About showing the proof that mass just don't work, right. Again, quotation what work really means. I think that needs to be unpacked. I consulted to you Stephen and Mark, and we got some articles and I'm going to send that to her as well. But I want to start with you Mark on this idea of like, this is a doctor, right? You're a doctor. And I w w not just your observation, but who you work with or there's people, there were doctors that you work with, who are you guys are in disagreement about mask? Is this like a. Because, I mean, I'm, this is not the first time I've heard at least two other doctors, doctors say that mass don't work in my small network of people who go. So I'm like, is this an epidemic or among doctors, are you syncing to the hospital? Or this is a weird anomaly that I'm just giving we're grouping gravitated toward these, these, these kinds of people.
Mark Kissler:Oh man, I don't even know where to start. I, you know, I think this was, this was tricky. Am I coming through? Okay, good static issues earlier. You know. Okay. So there's a couple things there. This is, this is sort of a meaty question, I think in terms of some of the meta issues that we've been talking about over the last year on this podcast. So number one is I think just for me, just a reminder to be patient around this mass question, because in a lot of ways, this is one of the things that I think has been settled. By the science for quite some time. And I think that there was a big disadvantage because of early communications, particularly from the CDC in which they were. Yeah, urging the public to not wear masks in the very, very first week. So the pandemic, because there was a concern about the supply chains in the hospitals. And I think that that initial recommendation was really deeply damaging to the, sort of the public communication around masks and their utility. And part of that was because they were saying that a cloth mask does not prevent you from getting COVID. And there's, you know, there may be a slight reduction in the viral load that you received, but sure. You know, that's that, you know, potentially is the case. There are better masks to be used to prevent the spread, both of that, the droplet and the aerosol mechanisms. The thing is, is that cloth masks and any masks do significantly reduce the amount of virus that you put out into your local environment. And so from the beginning, I think the most compelling argument for masks is one of communal responsibility. And essentially of good stewardship of everybody else's health. You know, as we've talked about the, one of the big things that's been hard is this is transitioning from a point of view of how do I prevent from getting sick to how do I prevent this illness from spreading deeply into my community. And often the people that I don't ever see or interact with. And so this is, you know, as somebody who works in the hospital Over and over and over again, the people that I'm caring for are very, very often the disadvantaged folks of our communities. They are people who don't have homes. There are people who live in nursing homes, group homes, they're, they're the invisible people. You know, they're the indigent population, not exclusively, you know, everybody everybody's at risk. But it's often those people who we don't see. You know, we being, you know, I'm presuming, you know, a lot of the people who are having these, these conversations about masks that we're interacting with who are deeply affected, but nonetheless, by our behaviors you know, for me, this is one of the most compelling arguments for corporate responsibility and just like visible signs of like, how do I care? In a deeply physical way for the people in my community who need that care. And so, so yeah, I feel it, this a group personal frustration that, that they're, you know, that there are physicians who are still throwing casting doubt on this claim and, you know, sure. We can get into, you know, what does it mean for a mask to work? You know, and are you having a conversation around, like, is a mask going to prevent a hundred percent of the time from you. You know, Matt bod cure getting infected with COVID fine. We can have that conversation, but I think I want to shift the discourse around masks. I've, you know, I've wanted wished that the discourse around mask would have shifted over and over and over again through this whole pandemic, because I just don't think that's the point. And so, okay. So that's my I'll deal with, you know, my emotions around that particular issue get off of here. I think the other question is what do we do? What do we do with the sense of like, well, I heard it from a doctor, you know, and you know, of course on some level You know, we, we want to be able to trust our physicians. There's sort of this esteem that we give, you know and I think most of the time, these are medical doctors that are making this recommendation. Right. And I think you know, something else that I've been thinking a lot about in the course of this pandemic is the degree to which physicians are also human beings in like this like primarily right in this super, super important way to remember. And I think it's funny because there's And I, and I appreciate this. I'm grateful for this. There's this sense of sort of valorizing the physician, you know, there's the sense of this heroic narrative of, of the physician, the physician hood. And I, and by physician, by I really mean clinician, I mean you know, nurse practitioners, advanced practice providers, I mean, pharmacists nurses, anybody involved in clinical care. So I don't mean to be exclusive in that. It's just That being said, I think there's a way that that heroic narrative can let us forget the ways that we're deeply fallible. You know, that we're dealing with our own stuff that we've got our own interests and worries, and preoccupations and foibles and prejudices and blind spots. All of that is also true. And I think. So, yeah, we've got, we've just got a wreck. You know, our, our docs are also people and our docs are probably going to say silly things sometimes, and I'm going to say stupid things, you know? And we've got to keep going back to the broader evidence here. As far as I'm concerned, the evidence around masks is more than settled. And I think that the articles that Stephen provided and we can put in the show notes are really helpful to having those conversations. And. It, it just, it's one of those things that I think that we have to be really consistent in our messaging, particularly because of the inconsistency early in the pandemic consistent, clear, you know, gentle, but firm, that's something we've got to do and it may be, we have to be, maybe we have to do it for a while and it really, really matters to other people, even if it doesn't matter to you and your individual
Matt Boettger:health. Absolutely. Well, well said. Stephen you have need to add to this whole thing. I mean, for you, I'm sure on your end it's it's like a closed door. You, this is not even a discussion piece, cause you're probably not even run into this kind of reality. Correct.
Stephen Kissler:Yeah. I mean, it's maybe amongst my colleagues for sure. But but it, but there are a lot of conversations, like like you said, like with with people who are maybe one step removed with, with friends and acquaintances where, where it is really similar, it's like, what's, what's the point of this. And yeah, so I don't, I don't really have anything to add. Other than that I've Yeah, I share that experience and some of that frustration,
Mark Kissler:can I, I might just go out on a limb real quick and just speculate here. I know this is dangerous to speculate in public, but I,
Matt Boettger:well, you're getting a little staticky and choppy, but keep going
Mark Kissler:just a little blip on the internet. So I think, you know, one of the things I want to just speculate about a little bit and like I said, I don't know if this came through, but I know it's dangerous to kind of speculate in public here, but I'm curious to hear what you guys think. I think that one of the difficulties throughout with masks has been how visible they become and how quickly they become subsumed into other discourses around the pandemic. And, you know, I think there's a strong sense that people feel if the masks are gone, we're through it. It's over. You know, we, we made it and there's the sense of, you know, victory and restoration of normalcy and all this stuff that is symbolized in taking off the mask. And so I think that we just have to be aware of the fact that sometimes we're having a different conversation than we think we're having. And I think anytime we're talking about masks, that's almost a hundred percent of the time is we're actually having another conversation that we seem to be having a conversation about masks, but it's actually about something else. And so I think that I'm really sympathetic to that that restitution narrative, right? The sense of like, I want things, things were fine, they got bad. We had an intervention and now they're good. Again, we're back in normal. And, but I also think that there's just very few times in the reality in the messiness, especially in the messiness of a global, the pandemic, when a restitution narrative is actually the most appropriate narrative that we have. And so as much as we want to, you know, be liberated and go back exactly to how things were. I just think that that's there's, there's so much that we have to talk about
Matt Boettger:around that. Yeah. I think that's great. Yeah. I, I mean like a storyline is just not linear and it just, just, that's not how reality is. And it's the fatigue that's going on? The desire, like you said, to not wear a mask, what it symbolizes the alignment of that and all that kind of stuff. Or am I, my picture just went away. So yeah, is loaded. There's a lot of things in it. The great moral of the story is that we just have to sit with them and and just help them understand, like I get it. Like, I don't know why I'm asking you there. It's a, it's a, it's, it's really frustrating. At the same time, it's a low bar to, to, to be able to help prevent the number of cases. So I hope those resources are available. I mean, are, are useful. I'll put those in the show notes, the great that Stephen and Mark and I had a couple of ones from earlier. The sea of Mark sent to me a few months ago that had archived. I put those in there as well. Let's move into the word, scary ins again, this great article from the wired about how we're getting a little too, maybe hyperactive to variants. So there is definitely some grounding for being concerned about the variance. And there's a lot of hype around this as well. And the mitzvah is I want to throw it back to you, Stephen, because I learned something in this article. That it's not just so much about doing genetic testing. That's a really great first step, but there's this whole other area, which I think is going to be open up to Pandora's box of other questions that have they're related. Of that there's variant characterization, which is a whole other step set of information. And so the reason why I want you to talk about this, Stephen, because I think it's going to help put some ease to people, especially when you keep hearing like, Oh, California variant, and here are the, we have given a test and it doesn't affect the antibodies don't work from natural immunity. And so now we're getting. Scared and we're getting nervous. And then we heard another article or another research being done that showed that that's not the case. It's more complicated. It's not just antibodies. And so we need a good variant characterization to see the complexity of this stuff what's going on. It doesn't happen overnight. You know, th it's one thing to get the genetic testing that there is a very, I'm sure that's relatively quick. If we have the right resources. But the characterization of it, what it actually implicates, what it actually, infects is a longer story that needs more time to develop. So can you help? Cause you've been doing something you're, you're about ready to do some study about this with New York. So can you talk about what you're going about ready to do with New York and how this kind of help us understand between the actual testing and then the characterization process.
Stephen Kissler:Yeah, absolutely. So with the variance, I think that we're again in this interesting time where the, the public and the scientific community are learning at the same time, you know, we're, we're trying to figure this out where, and so I think, you know, some of the work that we've been thinking about with respect to the variants are Really just, how exactly do you bridge that gap that you just mentioned? You know, you can do genetic sequencing of the viruses. But when is something, a variant of concern? And what we're actually thinking about is something that's a lot more straightforward, which is, if you already know that there's a particular. Genome sequence that you're looking for. And you want to know if it's spreading in your community, how much sequencing do you have to do and where do you have to do it? And vice versa. Once you've found something, once it's popped up, how many people has it spread to already? And those are just sort of statistical problems that you can answer, but then there's this sort of broader question, which is, okay, so now we have genetic sequencing. Do we know if there's a new variant of concern and Yeah. Just like, when should we be alarmed? Like, I think the naming of these things is so interesting, right? Like variant of concern, like that sort of like highlight, like when should we be concerned? That's like a very subjective measure to apply to something that's very analytic. So I'll I'll talk about this from a, maybe a couple angles Sue. We are. And again, this is so reminiscent of things that was happening early on, but I've been joining some some calls that include scientists from across the different institutions. All of whom are looking at the spread of variants from different angles. So including epidemiologists, people are doing the genetic sequencing people who are looking at the laboratory results to see if they escape different arms of the immune response, like all of this. And we're all sort of like trying to brainstorm. How how to grapple with these things. I think one of the really interesting things that came out of the most recent call was this really Frank discussion amongst all of the scientists about like how, how do we communicate about these things? There was a preprint article that said that they had identified a new variant of concern out of I think this was out of California, but I don't actually recall exactly. And, and we had this Frank discussion of like, Is it, is it our job as individual scientists and individual research groups to apply that label of variant of concern, especially knowing that, you know, once you've said that, you know, the cat's out of the bag, and then all of a sudden you're being interviewed by a thousand different media agencies. Trying to figure out, you know, what's going on. And you know, it's the, the answer that we sort of converged to is that, you know, probably, probably not, you know, that's, that's the job of something like the CDC or world health organization or public health agencies, or at least a consortium of scientists. Because what we can do is we can identify when a certain lineage of the virus is spreading more rapidly than we would expect. And that's already a very complex problem because you have to have a sense of what you should expect. And this is something that's really driven by a lot of randomness. It depends on how much immunity there is in the population. There are different things that can be concerning about the variant, whether it spreads more easily or whether it escapes immunity or whether it's more severe. And all of those things look different in the epidemiology, but all of them sort of become these variants of concern that we're trying to pay attention to. One step down from that as a variant of interest. So these are starting to get sort of categorized, you know, there's this sort of, sort of level of risk, right? And so that's, that's sort of how how we're thinking about them and the, and there's no clear delineation between, you know, what these things are yet. And then pile on top of this, that the waste that we're naming these variants. And this is something else we talked about on that call is absolutely crazy that we have the and the and the P one. And you're like, none of these have any actual, like, you know, they, they have a genetic relevance, but they don't give us any insight as to what is actually concerning about these variants. So there's, there's a lot of discussion going on about just the taxonomy and nomenclature and sort of like how we communicate about these things, both amongst ourselves as scientists and to the public. Because you're right. I mean, Viruses do what they do. They're mutating, they're changing and that's going to happen that has been happening. And so now that we're looking at really paying attention, returning up all of these different things that are spreading in ways that could be alarming, but we're not totally sure yet. And so, you know, when you trigger that alarm, that's really, you know, fundamental question in public health and one that we're grappling with right now
Matt Boettger:makes sense. That's great. Mark. Anything to add?
Mark Kissler:No, just that the 21 pilots song that they released during quarantine was called level of concern that they should have called
Matt Boettger:it. Okay. You, you, you, you got choppy on that first part, at least on the street. What was the name of the band or what was it? 21
Mark Kissler:pilots.
Matt Boettger:I've never heard of them by let's fame. Okay.
Mark Kissler:We'll work on that. That's okay. I mean, that's okay that you've never heard of them, but, but anyway,
Matt Boettger:totally. That's that is now. That is now our new intro. That's why I'm here. You're here. And for the go fund me page, we really want to support you in that particular reality. Oh, gosh. Oh man. Okay. So we're getting close to the end, but a couple more things I just want to chat about. And again, just a brief, can you give us a quick distinction for essentially of people who are first listening to this episode and how was the previous ones, a different variant, mutant and strain? Because we're on the variant is, is the season right now down the road, it might be a mutant. And I don't know about strain. I don't know if we've talked about that in the context of of COVID recently, but can you give a quick distinction between those three?
Stephen Kissler:Yeah, so, I mean, and these terms are all sort of evolving too. As we're trying to figure out the best way to communicate about them amongst ourselves, even. But the way that I think about it is that a mutant is anything that has a single mutation. So a mutant is with respect to some reference strain. And so you might have one variant, one, one particular type of Corona virus that's circulating in a mutant would be something that differs from that in at least one genetic position. A variant is usually something that is a little bit more distantly related. It has multiple mutations. And so it is something that Yeah, it's basically just like a collection of mutations within a single virus and also sort of implicit in that often we think of variants as things that have that may have a different, what we call phenotype which means that it behaves a little bit differently. Somehow it might bind to your lung receptors a little bit more easily or something like that. So usually a variant has melted. Mutations. And it has mutations in places that might affect the way that it behaves. And so that's what we think of with the variant. Now strain is much more distantly related. So I wouldn't call any of the things everything that SARS cov two is part of the same strain and to get to a different strain that's that's thing like SARS COVID one or MERS or OSI 43, the things that cause the different common, cold Corona viruses, things like that. So that's, that's quite more distantly related. The New York times defines it as 95% genetic divergence. But I think that that's not very useful. I think that it's it's, it's just, yeah, it's just something that's very different than has a different name and behaves in a very different manner. So.
Matt Boettger:Great. That makes sense. And then I had no idea. I mean, I should have known better, but number one, when you get a COVID test that there's, that test gives you no indication about what what variant you're actually happy and correct. We just had a discussion. So then if you get COVID and you get positive, I go in and get covered next week. I'm just testing positive. I have no idea what I have, right. I mean, nobody has a clue unless it's somehow I was one of the lucky ones, right. To like, get through one of the genetic tests and, and have it tested. So we just,
Stephen Kissler:well, who does that? Yeah, so you won't know, but there is one possibility. So with the variant, which is the one that emerged in the UK, it has this interesting mutation that causes it to essentially knock out one of the three primers. That you're using the PCR test. And so rather than testing positive on all three, you only test positive on two. And so that's one of the ways that we've been doing a lot of the epidemiological surveillance for this is because over time you see just to have those primers light up instead of all three, and that gives you sort of a proxy measure. Of of how much of this variant is spreading. We're actually really, really lucky that that happened because that knockout doesn't seem to change the way that the virus behaves, but it makes it a lot easier to keep track of. But you won't hear that in, in, in your test response, you know, as long as you turn positive on one of those three, you'll get a positive. But epidemiologically, it helps us a lot.
Matt Boettger:Okay. And, you know, curious, I mean, just totally random Mark does it when you're going to hospital somebody test positive. Do you see that? In the live from the lab. And then you say, Hey, that person might have it. Or is that hidden even from your wall? Like, you're just like, if you're testing somebody in the hospital,
Mark Kissler:No, I, well, I now I'll start paying attention to it cause that's not, I didn't know that that's pretty great. I you know, I think just out of curiosity, I do think that we can get the data about you know, they w they break down our general, it reports out on our electronic medical record just as positive or negative, but I'm positive that. I'm certain that we can go and like get the, you know, which of the primers from our lab. If we're interested in, so I'm quite into
it,
Matt Boettger:you heard it here next time he's on, which might be a month from now. He's going to report back and see what he found and obviously with, with whatever, obeying all the HIPAA laws, of course, but whatever that means. So okay. A few more things where we land this plane CDC added a few more side effects to the vaccine. I'm trying to find it right now. Let me see here. Yeah. Three news, three news side effects. In addition to pain and swelling on the arm where the shot is administered. People might also experience redness as well. This is the systemic reaction. The CDC added muscle pain and nausea to the list. Muscle pain is, should not be confused with pain at the site of injection. I'll put that in the show notes as well. Now I noticed my, my mom got the vaccine Stephen, and she said she also fig the second round. The second round. I know what you did. Madonna or Pfizer. I think she did Madonna the second round. She actually had tingling in her fingers as well. So that might, I don't see that in the side-effect, but just so you know, it happens. It's potential. So that is there. What else about the vaccine? We talked about? The big news Biden says that by may every one. They will have access to the vaccine, which is huge news. It's awesome. It's exciting. Big statement. I don't know if we can get in this room. I can go to it's next week, guys, but me going a little bit deeper about the nuances of the vaccines, because I still get it. I still get the, you know, what, I'm going to hold out for Pfizer or Medina and really kind of exposing, because it's, I think we're in this war right now, where there was overreaction to Johnson and Johnson. Right. And I feel like in some sense, there was a media correction and maybe the media over-corrected by putting too many, maybe a little bit too much of a promise. Behind the reality. And I think our great job is it's complicated and it's nuanced. And I want to provide that to our listeners. So next week, next week was prepared for that to help our listeners know the nuance between that just to so they can know what they're getting into. Right. I think that'd be an awesome thing. I think that's all we have time for for now. There's a lot of things on my list, but we're going to save all that vaccine stuff for next week. So I think it can, I think it can hold we're already at 45 minutes in, and I know these important, wonderful dudes have things to do. So we're going to land this here. I hope you guys have an awesome wonderful week and we will see you next Monday. All right. And then also last few things. Check us out. If you want to subscribe patron to accomplish pandemic podcasts with a$5 a month can go a long way. One time payment, Venmo PayPal in the show notes you want to, if you want to chat with Stephen S E P H E N K I S S L E R. Twitter. He's got a Twitter list. Now, check it out. I'll put in the show notes. I followed the epidemiologist. It's fun. It's way over my head. I get really tired, but I still watch it. It's pretty awesome. It's really, really good stuff. So check that out as well. And we'll see you guys all next week. Take care and bye-bye.