Follow Matt on his Living the Real podcast where he just released an episode about what he has learned from the Pandemic so far. You can find his podcast here.
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:
Follow Matt on his Living the Real podcast where he just released an episode about what he has learned from the Pandemic so far. You can find his podcast here.
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:
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 I'm joined with Hey, only one of my good friend to the, to Dr. Stephen Kissler, an epidemiologist to Harvard School of Public Health. How's it going up in Boston, buddy?
Stephen Kissler:Hey, it's going. All right, man. Like 60 degrees today, finally. And we're it's just absolutely glorious. Yeah,
Matt Boettger:man, I would, I wish I was just gonna give you my, my show you my webcam. Cause now it's snowing again and we're under a snow storm watch and thankfully set up to a foot. But but only about two or three inches here. So far so good, but Ugh, man. Like I said, Facebook just complete. That one that was allowed was the straw that broke the camel's back. Once it told me that it was going to be early spring and it's not no more. Can I trust Facebook? But I'm so happy at 60 for you, man. That's great. So hearing the birds chirp and seeing some loose, some greenery at all, starting to perk up, it's
Stephen Kissler:not, it's so weird. I was, my phone brought up some pictures of this time last year. You know how it does that once in a while and just like pops up and I, it was amazing because I had taken pictures of these bushes that were like in full bloom, like these incredibly colored flowers and everything is still dead here. It's like the spring here must be a lot later than it was last year too. Cause nerves no green yet, but yeah, it must be coming. So
Matt Boettger:I was seeing the same thing on the last year. I was like, and I remember it was a really early spring and here in Colorado and it was awesome. It was one kind of benefit. But then of course, that led to a really terrible summer in Colorado with the enormous amount of fires and devastation. So Hey. I don't like this. No, but if it's precipitation, we're good, but we're not here to be the weathermen. We're here to talk about all things COVID. So before we get going, a couple of things, we love reviews. Hey, we got three or four of them in the past week. That was awesome. Would love to see them. It gets us motivated. Got one here. I'll read this a positive, fun one here. If I can open it up ups, wrong one. We'll go back here and we'll do this one. Well-rounded and good. Oh, it's not showing up. I'll read the small print. It says a well-rounded and good insight. I love these guys started listening from the beginning. It was been the longest shortest year. I always look forward to everyone. That's, that's what it feels like. Everyone's perspective. Thank you for all the time you put into the show. I'm glad you guys ponder the same questions. I have been thinking about such as vaccines for kids. If vaccines protect against severe disease and kids already are very low risk. Is it better? To let them get exposed and let the disease become into endemic over time. So she put it in the question in the context of this, I think one only time will tell. So we had one of those and then just FYI, we got a not so good review. We got two out of three stars from somebody whose feelings are now science. So just what did a, not a good review. And I ought to bring this elevate just to clear up any, anything. It was a, basically a pretty bad review over about us talking about masks and talking about how. The complexity of all and the issues of that mass also helped for healthy other people feel safe as well, but that wasn't the only reason. Of course. We also believe that actually scientifically granted we wouldn't say that they don't work. So just put them on to make people feel good. I'm the person who left this review. Probably haven't listened to our previous episodes. You can go back to 66, I think it's episode 66. Just a couple down. Yeah. We talked about again, and there's a bunch of links in the show notes of the science behind masks and their efficacy that that Mark and Stephen has shared with me. They show that they actually do work. And of course the complicated question by talking about what it means by work, but we talk about it there. We've talked about in the past. So we've, we have a long story about dealing with masks and it's not just feelings, it's science, but also as Stephen has enlightened my mind to that, like all things epidemiology is complicated. It's not just that there's also dealing with, how do you deal with just. To health and a large scale on all different levels, which can, which is considerations on different things. So check our previous podcast, Stigler 66. If you want to support us$5 a month, that's all it takes. patrion.com/pandemic podcast, or just a one-time gift, a PayPal Venmo all in the show notes. Okay. So let's get started, Stephen. So I'm gonna start with this. We were talking off. Before we start recording about what you were up to you're working on something. I thought this would be a great catalyst. Talk about tons of things with COVID related. So why don't you share what you're talking about, what you're working on right now with vaccines, and then let's chat about how that impacts us and what's going on in my world, particularly as well. Yeah.
Stephen Kissler:So there's the vaccine landscape seems to be changing by the minute. It's been, absolutely unbelievable. And and what I mean by that in particular, as we recently found out that States are generally going to be opening up their vaccination to all adults on May 1st, if not before. And so that's, that's a really big deal because a lot of what we've been talking about so far is about vaccine prioritization. Who should we be giving the vaccine to first, but with the eligibility of vaccination opening up much more generally then the conversation starts to shift a little bit because now it's not so much about prioritization, who gets it before or to the exclusion of others. You'd rather how do we strive towards making sure that the entire population is as protected as it can be? And so what we end up with is is essentially these shifting notions of what we need to be doing. A lot of the research of course, has suggested that and indicates very clearly that as you get older, your risk of severe illness and death from COVID really increases quickly. And so that's what has been behind most of the States that I think every state in the U S so far has adopted some sort of age based guidelines where they're trying to vaccinate by age older people first Based off of modeling that we were involved in, that other groups were involved in. That seems to be a pretty sensible thing to do, but it's not the only thing to do. Of course people who are older are not the only people who are at high risk of severe disease and illness. And that risk also tracks by other demographic groups by occupations. People who are working front facing very public facing jobs are also at increased risk of acquiring disease. Many of those people also come from communities where they have lower access to healthcare, where. Rates of co-morbidities are higher. And that can also translate into higher risks of severe disease and illness for those very same people as well. So oftentimes we, we lumped those people into essential workers. It's not exclusively that, and I think that that term can be problematic on different levels as well, but that's the term that we've adopted to speak about some of these populations and some modeling also indicates that vaccinating the elderly alongside essential workers can also be a really important way to reduce cases overall and to reduce overall. Morbidity and mortality from COVID 19. So that's fine and good. But now, there's some of the things that I've been hearing is that all of that is now moot. As we transition into, now everybody's going to be valid eligible, anybody can get the vaccine. And so that's great. It's, all of this like careful prioritization and trying to figure out who needs to get the vaccine first out the window, everybody's going to get it. It's going to be great. Yeah. Which is on the one hand. Great. Like I think that opening up vaccine eligibility as an indication that we have enough vaccines for people to get them who want them, which is great. We need to be getting as many people vaccinated as, as we can. It's really helped get control of the pandemic. But the very same groups that we really need to be vaccinating that we've been prioritizing for vaccination also tend to have the highest barriers to vaccination as well. That includes the elderly, the, like many many, rates of technology difficulty and difficulty of just like transportation. Oftentimes older people don't. Aren't familiar with computers and are kept like access things on the internet. So if they don't have somebody who's younger and technologically savvy to help them, how are they going to get their vaccine appointments? There are ways, but we need to be really proactive about that. It's not just enough to make a webpage say, sign up here and to assume that everybody's going to be able to get vaccinated. Same is true for essential workers. Many of them are working hours that are at odds with yeah. The opening of the vaccine clinics. So we need to make sure that we have vaccine clinics that are open, that we're giving people paid time off to get the vaccine that we're providing childcare for people who don't have it when they're getting the vaccine, when they're recovering from the symptoms that the vaccine induces, right? Like all of these things are things that we need to think about and that affect people who need the vaccine most. To a disproportionate degree. And so that's part of what we've been thinking about with this vaccine allocation group is just recognizing that if we really do want equitable vaccine distribution, if we want basically the entire population to be vaccinated at similar rates, there's some populations who are going to need extra support and extra help. And we're trying to figure out how to provide that.
Matt Boettger:That's great. And this is a great example. For those of you who've been listening for a while, you guys have known, I've mentioned my mother-in-law over and over and over and having taught my own parents because my parents are younger and they're further away and. They're able to get vaccinated quite easily on their own in Missouri. Great news is my mother-in-law just got her first vaccine on Fridays. It's a huge milestone for us and our family, but I couldn't, I just couldn't, I couldn't believe how much work it took us to get her. We're working on this for two to three weeks. We actually for us, it was about two weeks we had to step in because I think she was just roadblock after roadblock. She was confused. She was trying to call her primary care physician to get it there. And then. They weren't responding right away. And so then, and then somebody said we'll just call you and let you know when you're ready. And, but then there's no phone calls, but this is just odd. And thankfully we got in through a grocery store who is some of the, some lady who was just really caring. Literally what it was nothing about the system. It was the exception to this system that God has said, because the lady felt bad for us and said, hold on, wait. And then a minute later, if you come in the next 15 minutes, I got you. One, like that was the only way we're going to get it. So not through the, and so it's gosh, I can only imagine. And that's with my wife and me most by wife, they're like 99% of it trying to work on navigating the system to get her the vaccine. And it would just cause of a gracious woman in, at a grocery store that got us. It is so I can imagine how this has felt. And I saw this as well. And if you can speak into this, but I saw this article that a vaccine hesitancy may not be why people of color are getting COVID shots at a lower rate. And I'm guessing this is a similar reality. It went through, they don't have the answer where they're like, when you look at vaccine hesitancy, it's really no different from non. Color color. We look at basically the rates, so it can't be necessarily that. And, but they're like, I think it's really just accessibility. It's where it's located at the right time. And as we were saying, it's probably just not a low, the lowest hanging fruit. And so it becomes something you just postpone and spread, not the right thing that we need to do. We need to get a little extra love to those people where in there's areas where we just need to get it, to make it lower and more accessible.
Stephen Kissler:Yeah, absolutely. And, even to the extent that the vaccine hesitancy exists amongst all different demographic groups and populations and these kinds of things. And and I think that an important thing there too, is that, it's really easy to blame the vaccine hesitant for their hesitancy. And even long before. COVID I've always thought that we as public health professionals really have a responsibility to recognize, we're living in a free society in which people do have the freedom to turn down the vaccines if they so choose. And so our job is to. Develop vaccines that are safe and effective and to give very convincing arguments and reasons why we believe that these things are worth getting. And so if we see high rates of vaccine hesitancy in certain populations, that really reflects back on those of us who are who are working to develop the vaccines and distribute the vaccines, because that means that we haven't. Haven't sufficiently done our job with some folks we haven't really, reached out. We haven't shown that love in the way that we need to. And that's really what I think that it points to. So I just wanted to definitely put in that point, cause there can be a lot of, blaming of, of the people who are not getting the vaccines and, I that's understandable, in a way, if it's easy to. Yeah, demonize people. We don't agree with these kinds of things, but I think especially as those of us who are deeply committed to public health just recognizing that it's a, it's an element of it of truthful and honest Sharing what we believe to be true and hoping that others will find those arguments valid.
Matt Boettger:That's great, Stephen. And it goes to the whole idea look, I think, honestly we're called to follow our conscience. Our conscience is one of the things that need to be elevated and we need to follow it. And as I, I guess I can speak personally, my conscience can suck at times and so it needs to be formed. And who do we look to to have a formed conscience? And that is qualified people. It's hard, especially when you have all like a chaotic cacophony of voices talking about differences, you're trying to form your conscience. What should I do? And there's no linear approach to this and it's all over. Who do you look to again? The same thing it's complicated. So just thankful for you like Stephen and all the epidemiologists around the country who are on a United front to help, just not to shame, but just to educate. And help bring to light. What's the truth about the vaccine? What's the truth about the virus and hopefully allow it to settle down all the other chaos around us, principally in social media. Okay. Speaking of craziness and chaos, this question came from Sarah. She's not crazy or chaotic. Her question is awesome. It was one of the questions that like, I didn't even know where to go with this. So thankful Stephen and Mark we're here. Now. I know you're mentioned that Mark needs to weigh in on this as well, but I wanted to start the conversation. Frame this for us, Stephen. Cause this is a really interesting question. So I'm not even gonna read it as a long email, but you can maybe get the idea of what she's trying to propose. You mentioned ADE and I was asking you guys what that actually meant and something about this idea of the vaccine could cause potentially more problems for us down the road. And is there evidence for this and you guys were even saying that either Mark or you were talking about there is evidence as some other coronavirus may have had done something like this, I'm not sure, but can you set the stage for this question and help us understand what she's trying to unpack and how we can give an answer to her?
Stephen Kissler:Yeah. So at the, at the center of this question, is this idea of antibody dependent, enhancement or ADE. And the idea behind that is that some some viruses, I think it's mostly viruses that I'm aware of. It's it's relatively rare, but, but what they can do is, is you, you can be excited Bose and get an infection from a virus. And that first infection will just proceed like a normal infection. But the issue is that then when you are exposed to a related, but slightly different virus a different virus strain. Then the antibodies that your body has produced to protect you against that first infection. Actually, the virus has figured out a way to hack those antibodies and to use those as a way to more efficiently infect yourselves. And often it can cause a worse. Infection the second time around. So the canonical example that we usually think of when we think about antibody dependent enhancement, where my mind immediately goes is dengue fever, which is a mosquito borne illness. And it usually causes a. You, you feel rough when you get it the first time. But the second time around it can be life-threatening. Not always, but it can really, usually it's, it's the second, second exposure that, that causes a lot of issues. Now. This is really important too, with, with the question about vaccination, because there was a dengue gay vaccine that was developed and it was ultimately pulled because Partly because of these issues of antibody dependent enhancement, because if you had been exposed to dengue and then vaccinated, the vaccine worked very well, but if you hadn't yet been exposed to dang, you got the vaccine and then were exposed later, the vaccine basically acted like that first infection and could actually enhance symptoms the second time around. So that's something we've been watching very closely from, from the very beginning of the pandemic. I remember when we were, when we were still working in person. So this was back January, February of 2020. That was on the table. That was something that we were talking about with our group at the at Harvard, I'm trying to understand could this be the case? If so, how would we know? And so we've, that's something we've been really paying attention to. And there were some articles written even early in the pandemic sort of speculating, could this happen? What are the different ways that it could happen? I can maybe direct you to one in the show notes that that we could post as well. So with, with, with Corona viruses antibody dependent enhancement is just one of a couple of ways in which previous infection can affect and potentially exacerbate later infections. With previous coronaviruses we've seen other types of, of this these interactions between different infections. But to my knowledge, they don't quite fall under the same umbrella as like antibody dependent enhancement, like we've seen with Dan gay. And, and it's not totally clear how frequent they are, if there's actually anything, really to pull out from that, it was, it was really speculation, and, and it's grounded in some science, but the, the sizes, the sample sizes were just not big enough to really draw out anything super conclusive. So what all of this goes to say is that we're, we are in a time where, where there's Yeah, we have, we have variants starting to emerge, which in theory could maybe be different enough from an initial exposure where if antibody dependent enhancement exists, then it, it could, it could it could lead to that. We haven't seen that on a, on a large scale we've, we've seen people certainly who have been exposed and re-exposed to both the same type of coronavirus and, and to the variants. And I think that if this were a widespread, severe phenomenon, We'd probably know by now. That's not to say that that it couldn't possibly happen, but but I, it's not something that I'm on, on the level of, on the level of things that I'm concerned about with SARS cov two, I think what I'm much more concerned about is a variant that becomes more infectious of AIDS immunity and is potentially more severe something more like the variant, for example, that we've seen circulating in Brazil. Yeah, it's starting to spread outward. So those, those sorts of things are I think in these axes of likelihood and severity, I think that's more on the, the more likely and potentially more impactful sort of thing then than antibody dependent enhancement, given what I know now. Okay. But, but it's a great, it's a great question. And it's something that, that we have been and are continuing to pay attention to Yeah. So I don't know. I don't know if I have anything more conclusive to say than that, but
Matt Boettger:no. Would still indicate this may not be, this is outside of the, the, maybe it's inside the conversation, but it's obviously, I'm just curious. So first of all you mentioned about it can hack the system. Now we mentioned like with Mark. You guys talking about how it doesn't really have a mind of its own. Isn't really a contentional in doing it. He doesn't really hack like with an intention and it just is this something like dengue that we're just literally just random that it happened or is this something that's is it just, it's just a random thing that, that is inherited Dan gay, that particular strain of Dan gay or whatever it is, or is it just a random thing? Just, just a fluke that this happens this way.
Stephen Kissler:Yeah, basically. So speaking in terms of evolution, basically what you can imagine happening is that. We start off at some point in history with a single dengue virus and then it mutates and evolves. And, those are just random and, but eventually it, it comes up with a couple of mutations that allow it to hitchhike on antibodies. And so what that allows it to do is then it spreads a little bit more easily. And that's the thing that, that pathogens are evolving to do since it can affect cells. If, if this variant were spreading in a place where a lot of DNA had already spread, most of these mutations are just going to die out because your immunity is going to protect you. But one of these lucky things is going to be able to come in. It's found a strategy now to, to infect yourself, even in a place for dengue has already spread. And because of that, that too is going to spread. And as it spreads that rises and prevalence and that's. That is what leads to its existence and its ability to spread in the population. So right. It doesn't have a mind of its own, but the idea is, is again, always pathogens are The thing that they're selected to do in evolutionary terms thing that that yeah. That they're selected to do is to spread. It just like with any other organism, their thing they're selected to do is to reproduce. And so when they do that successfully, then, then you start seeing them and that's, that's what happened here.
Matt Boettger:And then my second question is Sarah mentioned this, and I don't know how this would be related. It's at say you she was saying wait for a better vaccines. Everybody was going to get their vaccine. But in this situation, would that be an answer? Cause it sounds a dengue, you just pulled the vaccine. That's just theirs. So in theory, if that was the case, I'm not saying there is, but would you just not have a vaccine for that? Or is there ways by which you're like in theory? I just, I would just, I was curious what's the answer if a random virus that spreads all over is that is in a vaccine off the table or is it still on the table? It just, you have to do new. Research or
Stephen Kissler:something. Yeah, I think, I think it would just involve new research. And this is, this is getting outside of my depth. So I, if any, if any, vaccinologist are listening, please write in and correct anything that I'm about to say, but but I think, this is, this again is one of the reasons why people have been so excited about the RNA vaccines, because I think that in theory, if you could. When we get the flu vaccine, we're actually vaccinated against multiple flu strains. It's usually a tri Vaillant or a quadrivalent flu vaccine. So that means that we're getting vaccinated against two different types of a flu and usually two different types of B flu as well. So there is the same thing had happened where maybe you could have a vaccine that protects against all of the different types that are around, and that could provide this broadly protective immunity against all of them and prevent you from, from any one of them sneaking around your immune system that I think is the direction we would like to
Matt Boettger:head. Okay. Great. That makes sense. Okay. So let's continue on just just bringing the attention to the Atlanta shooting last week and just the violence over that. And. Just how devastating this is and how much, just, how much hate has come from COVID and just goes to show, I love, I just wanted to Mark this with Stephen said months ago, we're talking about super spreading and the parade of principal, and I was really pushed into what type of person. And like you were even saying like an epidemiology, we just, you guys try not to do that kind of reality of, because you know what, it can do that by, by hallmarking the traits of a person, you single them out and off the time that this leads to just this kind of sense of like violence. And we see this here, that, the great example calling it, the Asian flu, the China flu, that kind of stuff. These don't really do anything to help, but only just, just draw the attention to greater sense of violence and prejudice. So just our hearts go out to that, our hearts and prayers and just Yeah. So I just wanna bring that up. Hospitalization, here's a question for you. This is what I wanted. So we're seeing cases go up just this morning, 21 States now, nothing dramatic, but we're just seeing a small tick and there can be lots of reasons for this. Obviously we know a lot of States just relaxed. Their policies. So it could be just, that also has probably more complicated. It's more, but here's my pointed question that I thought of this morning and that is we're having 2.5 to 3.5 million people in vaccines every day. It's it's, it's increasing quickly. We have more and more people becoming naturally immune up until this point we've just focused on. Okay. You'd always say cases, go up. They spike. And it's not till about two or three weeks after that, that we started seeing the hospitalization. So it's a lag indicator. So my thing, my, all of a sudden I'm thinking, could this now be inversing now where if we're having more will people vaccine, which means they don't really have as many severe symptoms and may have more mild symptoms. So they may not even want to get tested because they don't even notice it, but yet they have it. So then the tests don't go down, but then we still have less, but more hospitalizations start. Could we see the inverse by which. We actually started seeing hospitalizations first and then rates go up second. Is that a possibility now? Is that a thing you're talking about or no?
Stephen Kissler:Yeah. So this is I really love this question because this is, this is a classic example of how to think like an epidemiologist, like that's a great, yeah. And yeah, so these are the sorts of things that we do and, and are thinking about, although I hadn't really considered this, this exact scenario. So yeah, so let's break it down. So you, you, you basically proposed like one, one hypothesis, right? Where there's People are getting vaccinated. The vaccine reduces your tendency to get a test. And yet eventually, COVID will spread to somebody who who ends up getting hospitalized. And so we'll start to see rises and hospitalizations. So that's one possibility. On the other hand. So we now we're in a period of time when we've been really highly vaccinating, the people who who are most likely to go to the hospital in the first place. And so what we might have as a scenario in which, if I'm I'm 30 something and I got to, if I, if I got COVID and I felt it I'd go get a test. I haven't yet been vaccinated. But the, it would take somewhat longer if I, if I happen to spread it onto someone else, the number of. Transmissions that would have to occur before it reached somebody who actually was at risk of going to the hospital is somewhat longer. And so you could actually imagine it going the other way, too, where we start to see rises in cases in, in young people, for example, but then they become decoupled, right? Where you can see, ups and downs and cases, but you can imagine the extreme scenario. Where everybody who's at risk of severe disease and illnesses are vaccinated and nobody else's. And then we'd see all sorts of changes in the cases, but we wouldn't see anything happening with the hospitalizations because it would, everybody who would go to the hospital is already been protected. This is another great example of, of that things are complex. I
Matt Boettger:have no idea. I have no idea.
Stephen Kissler:No idea what's going on here. But, but you're right. I think that you bring up an important point that, that the vaccines are going to affect this There's this lag somehow they're going to do something. And I think this is, this is where modeling. This is why, this is why we do what we do as, as mathematical epidemiologists, because this was something that one of my colleagues mentioned when we were doing the vaccination article, was that when, when common sense suggests two conflicting outcomes, that's when a model is really helpful, because it allows you to really rigorously think through all of the different possibilities and different magnitudes of how these things might affect. When people get a test or when people go to the hospital and it allows us to distinguish those things when common sense is good enough, we don't need to write down a model, but when common sense tells us, two different things, that's, that's, that's what my job. That's interesting. Yeah.
Matt Boettger:Yeah, no, that's fascinating. Yeah. Yeah. So I'm just interested to hear that. Thank you for sharing the complexity of this, and I'm curious, what's going to happen. And I would imagine that when you start adding just like anything, once you add more variables into the mix, models become more complex in some sense, Maybe, even though that it was March and it was April when you got that big publication that you did and all those different scenarios, like three or four different scenarios of what could be in the next summer and next fall, maybe in some sense, even I'm totally, this is not right. I should. I'm way over talking here is, is could those models were. Not simpler, but now then they get more complicated because now you had another variable vaccine and they're like, okay, now not, here's not four models. Here's 17 different, really strong, positive abilities and all are equal. That's great. Okay. Let's keep talking to the vaccine. I want to quickly just go back to variants. Wasn't our notes, but is there any variants to be concerned about right now or anything on the horizon? I haven't been following that as much. I haven't seen much in the news particularly to keep the same ones repeating. Is there any new news on the variants that we need to bring to the surface for this
Stephen Kissler:episode? Yeah. Not a lot other than, the, the prevalence of certain variants, especially and the related variants, some of the variants that were detected first in California, like the one, four to seven, I think can be one 49 have been increasing in, in many States. I know that Massachusetts also just marked its first detected P two case, which is the variant that we first detected in Brazil. We can go back to previous episodes, I think, to, to talk about some of the differences between those, but really the key differences that we're thinking about is differences in how infectious and it's ability to potentially get around to the immune response to some degree So I think for me, the, the variants that are more transmissible, the, usually the B type variants are the ones that are, seem to have taken hold really in a lot of places and are starting to make up a higher and higher proportion of cases, even if they haven't yet. Really been associated with surges of infection. That may just be a matter of time. Of course, there's a lot of complexity around this too. So there are going to be places that see more and more cases of the variants, but don't actually see an increase in total cases for all sorts of reasons, including the fact that we're turning into summer and that climate. But debit varies and behavior varies between different places. So having a variant and having a very high prevalence, it doesn't, it doesn't guarantee that you're going to see a surge, but it makes it more likely. And I think that's what we're starting to see where we've seen cases start to increase in Michigan. For example, really notably it's a pretty clear increase in cases over the last couple of weeks. And so there's, Again, it's, it's all of these things and then some, but, but we are starting to see more and more circulation of variants and it's something that we're trying to pay close attention to. And again, it's as always, it's a race between the variance on the one hand and then vaccination and changes in the season and all of these other things on the other.
Matt Boettger:Okay. And you're curious, going back to Dr. Doom, Dr. Elster home have we seen any States or is there any statistics of. Tipping over 50% of the vary of any particular variants in one of the States showing examples by which is Michigan one of those, or is that just, it's too hard to tell? Do we have that data?
Stephen Kissler:It's hard to know. So again, many States, there's a lot of variation in how much surveillance different States are doing for the variants as well. I think in some of the bigger States where a lot of surveillance is happening, we have evidence, I think in in California, certainly parts of California and parts of Florida. We have where the variants have tipped over to over 50% probably happening elsewhere. And we may not yet know as well.
Matt Boettger:So great. Continuing on a vaccine related. I saw this article. I know you said a number of these articles were in a postpone from Mark, so there's some good ones from arc, but when it talk into this, I saw an article from and good the importance of sleep after getting the COVID vaccine. So this is perked me up because I have a have a tendency to have a lack of sleep for a number of reasons. And, and working on that and this one now, is this something that is true and how is sleep? I'm assuming it's an immunological things. That's what the vaccine does. Have you seen anything like this and heard anything about this?
Stephen Kissler:Yeah, this doesn't surprise me. Sleep is an interesting thing. It's like this super mysterious thing from a medical and a psychological point of view. Like I think, we know a lot about sleep, but there's a lot, that's like really mysterious about it too, but we do know that it's so deeply integral to all aspects of our health. I know that, early on. I, I would love to be able to point to some scientific studies on this. And I think that they're out there. I just don't know what they are, but I'm pointing to the importance of sleep when you have COVID infection and that just getting sleep and especially making sure that you take time for sleep and for rest. If you're experiencing longer-term symptoms of COVID long-term fatigue, things like that can be super important. For for recovering from that, the vaccine is, is. Different, it's not, it's not an active COVID infection. But sleep sleep really does play a large role in our immune response, in our ability to Mount a robust immune response. It's no accident that it's easier to get sick when you're really sleep deprived. It's your, your body just needs those, that energy to regenerate the immune cells. You can imagine Your immune system is this remarkably dynamic thing, right? It's like constantly producing these new cells and always on the lookout for these new variants. How exhausted you get when you're constantly looking out for something when you're like waiting for something bad to happen. And you're just like waiting and waiting, but you're just sitting there, but it's exhausting. And your immune system is doing that, it's like constantly producing cells and always on the lookout doing the surveillance around your body to try to detect these invaders. That's hilarious.
Matt Boettger:A lot of energy. You just, you just stated what it was like. In the, at the, at the end of the pandemic, like we were, we were like, we were like, we were empathizing with her immune system by like constantly like looking around, never resting for the COVID particles that we wouldn't get infected and not knowing where they're coming from and just the fatigue. And I'm like, wow, what a microcosm of the reality of her, of her.
Stephen Kissler:Totally. Yeah. So I think that's, that's basically it is that sleep sleep helps make sure that when, when we do get the vaccine, your body can Mount a good, robust, solid immune response and give you the best chance of being protected.
Matt Boettger:Great to get your sleep. I'll we'll keep working on it. I'm chugging away. This all here, COVID vaccine trials for children are under what? That's good news. We've talked about it in the past. How, how complicated that must be parents and their children, and just God bless those, those children who say yes to help this move forward for everybody else to be able to vaccinate their children if they want to vaccine. This is interesting question. I know we got to cut this off here in about five minutes. Stephen's got to go to another meeting. Vaccine. Death reports are not what they seem. This disparate, this sparked this question from you, Stephen. I don't know if you had the answer to this, but I'm like, yeah, that's absolutely right. But in my mind, I'm like, what's the term limit for like, when someone not to make light of this, but like when somebody dies and qualified that as an open opportunity to study and see the connection, because someone gets vaccinated, there's hundreds of millions of people they're getting vaccinated. So you don't, you you're just like, Oh, it's three years later. And, count me in for a connection clear, there's a cutoff. What, how does this work? Do you have any insight of. When you, how do you deal with
Stephen Kissler:the complexity of this? Oh, boy. Complex. I don't think that there's any hard and fast cutoff, but you're right. That like implicitly there has to be some but there's, there's a bit of complexity around that too. So the clearly, it's This, this gets, this really gets into the depths of causal analysis, right? Which is a big area of both mathematical study and philosophical study. What, what can we do to attribute a cause to something it's incredibly difficult? One of the things that that is evidence of causality is when one thing follows another very. Predictably within a certain amount of time. And so usually causal analysis, attributing a cause to something is made easier when two things follow each other very in a very close period of time. And it just gets harder and harder as time goes on because there are more intervening factors that can, that can, can have found this, this conclusion of one thing causing another. On the one hand, it's easiest, if, if somebody who got the vaccine and then we suddenly saw within a week or two, high rates of some outcome you can be pretty sure that that, that one is causing the other that sort of decays over time. No, it doesn't decay equally for all things. So if If, for example, we're, we're vaccinating a ton of people right now. And if all of a sudden, in five years we saw a bunch of people starting to break their arms. Like a bunch of people were just having like freak accidents, breaking their arms. They were just like tripping over the sidewalk. We might not, it's probably not related to the vaccine. Like I dunno, like it's, we're, we'd be looking for something else, like maybe something else is, I don't know what would be causing people to break their heads, but there's no sort of like mechanistic link between that. Other than, maybe the vaccine, you can speculate all sorts of different things, but this is to illustrate basically the, the alternative is that if all of a sudden we start seeing these really weird immunological. Things happening then it's maybe we should revisit this idea of the vaccine and what it's causing now. There's again, there's really good reason to believe that that's that again, the vaccines are safe and effective both in the short term. And it seems in the longterm, because these there's been a lot of questions about the RNA vaccine. And, and we've had, we've been administering RNA. Through vaccine type avenues to people with cancer for a very long time. And there've been animal trials for decades. And so there's good reason to believe that we're not going to see that kind of thing happening in the future either, but just to illustrate that, that one way to help with that analysis of attributing a cause is if there's. Reason to believe from our understanding of the system, that, that two things might be connected as well. So for certain things that span of time as longer for other things that span of time is shorter when we can attribute causality. And, but, but the interesting thing is that I don't think it's very well articulated and that would be a really interesting thing to look into. Okay. So 30 philosophers of science listening to this podcast right now
Matt Boettger:we don't, let's talk about this. Yeah, that'd be great. No, it's fascinating. I just curious about this and the connection between these two things. And then, and then my mind started exploiting. I know some people are really into privacy and I guess this is, this could be a visor privacy, but like the idea of Oh, That this is clear to be undocumented, that I got the vaccine, whoever gets the vaccine gets the vaccine and that, down the road, like six months from now, Alison there's like a pattern evolving. Is there a system that's like that's randomly watching this Oh, there's, we've had a hundred million people get the vaccine. And then all of a sudden, in six months later of these population, we see a rise in a flag of this similar reality. That, that'd be. Fascinating reality to put together, but I understand all the privacy and HIPAA and that kind of stuff that goes into play with that. But they're like that fascinates me to see that connection. We have to end here in just a minute, but I just want to drop this really quickly. AstraZeneca there's been a lot of problems, not a lot of problems. It's been blown up about this blood clot in this possibility know anything about the AstraZeneca and the blood clotting and that rare possibility. Yeah.
Stephen Kissler:There's, there's a lot of, as you said, like there were various European countries that pulled their approvals for the AstraZeneca vaccine and now many of them are readopting it? I think the important thing to point out is that this is, this is the health regulation and self and safety system working as it should. The, the rates of, of blood clotting, to my knowledge, Yeah. To the extent that they exist with respect to these vaccines. It's actually, I think quite a bit like COVID itself causes a lot of blood clotting and a lot of strokes as well. And your risk of, of of, of blood clotting from the vaccine based on all of the evidence that we have is, is again, substantially lower than, than if you have. COVID now that's not to say ideally the rate would be zero. We, we don't want people to be getting blood clots from a thing that they're putting into their bodies to keep themselves healthy. And so it, it merits review it merits caution for sure. Sure. And that's, and that's why the, it was, it was, it was right. Like I think, I think that all of this was made good sense. This is what we should be doing. If there's a concern for safety we might be starting to see these rare events as millions and millions of people get vaccinated. And when they pop up, we need to do a review. We need to, we need to check into that. We need to see what's happening and that's what we're doing. And that review is proceeding in heart has proceeded and seems like there's nothing really to be alarmed about as far as we can tell at least as an undo, again, everything has has some level of risk. And, and that's the question is we're not, we're not saying that the vaccines are without risk. But we are saying that the level of risk that you take with getting a vaccine is so substantially much lower than the level of risk that you hold by getting COVID itself, that the vaccines are, are very good. Yep.
Matt Boettger:That's great. Yeah. And on that, I think it's, I know some people were questioning whether they should, should've been pulled cause that's like millions of people that could get the vaccine and save their lives potentially for some small reality. And I think that's up for grabs, but in the end, I think it's also, you mentioned before, so like the healthcare system in general needs. To be shown that it actually is being cautious. And so there's something about doing this to keep swinging that you guys are actually taking this seriously. We're just, we're not pushing it out for pushing it sake. If there is anything we'll stop. So there's a message that, that, that implants a future trust. And I'll end on this. It was part of this article up in the show notes. That. I don't know if it's true. I didn't confirm it. It said that the blood clots, what the vaccine did, people were actually lower than the expected yeah. In the general population. So I think it's also a good sign that that whatever it is, it's very, very nominal we got in there at, Stephen's got a, another meeting in six minutes, Stephen. Thanks for joining us. So good to have you and see you there, buddy. If you guys want to check out him you can follow his Twitter list. It's pretty awesome. Connect with him on Twitter. S T E P H E N K I S S L E R. Support us. Please pend a patrion.com/pandemic podcast, or pay Venmo PayPal on the show notes. I hope you guys have a wonderful week. We'll see you all next Monday. Take care. And bye-bye.