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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 this crisis. My name is Matt Boettger, and I'm joined with yes, not just one, but two of my good, good friends, Dr. Stephen Kissler and epidemiologist, the Harvard School of Public Health and Dr. Mark Kissler, a doctor at the University of Colorado Hospital. It's the eighth team they're here. Good morning. Both of you. How are you guys doing?
Stephen Kissler:Doing pretty well hanging in
Mark Kissler:there. Yeah, it's been kind of a, a crazy week though. I don't know if you guys had a crazy week and
Matt Boettger:hard. For those of you who are listening, you guys are no it's hit home close to here. The Boulder massacre, the shooting. It was pretty intense. I was talking to Stephen before Mark got on. And I feel like this has been like when the longest weeks of the year for me. And like, I remember it was just prepared this morning. I'm like, Oh my gosh, have we skipped a couple pandemics? Because I feel like I haven't seen you guys in forever, but I think it's like narrative times slowed down dramatically because of this event and there's other circumstances. But, but this by far eclipses. Everything. And so first and foremost, I think we, I speak on behalf of everybody. All of us is that our hearts just really go out for those have been affected by this really, really dark moment. And it's just been hard. It's just, I feel like for Colorado, just manifold it's to have this happen to any one is just, just, there's no words. I almost texted you guys just like I was at S like, what are you guys feeling right now? Because I don't know what I'm feeling. I'm just like at a, at a loss for words, and, and then to happen to Colorado, which just it's become this infamous place known. And I don't really, I understand why or how or why we, we, we, we happen to have more than other people in this circumstance, but it's been hard. It's been a long week. And that just, I think that just made things trickle through with other things. And then as we're going to talk about with. Just seeing the ramifications of COVID in Brazil and now Paris just, it's just like icing on the cake. That's like a really bad IC. And obviously, so that's been, what's going on for me. How about you, Mark? What's been going on for you in the week has been similar
Mark Kissler:kind of yeah, yeah, similar. So thinking a lot about my time up in Boulder and especially the students that I've been. Engaging with over the last couple of years up there and friends and family up in Boulder, it's, it's, it's tough. It's just not something that you I don't know if I have anything encapsulated to even say about it really, except for that, this is just yet, again, another of those instances in which I feel the social distance feel the. That sense of being away from other people, especially, those broader contexts in a big way. And that that's not just a minor thing that's for sure. Absolutely. Yep. Yeah. Okay. Yeah. Yeah. That's it. Otherwise, otherwise though, things are things are going well, we've been, been hanging out. Katie, my wife is defending her PhD thesis right after this. And so hopefully by the time, our, by the time our listeners hear the podcast. The hope is that. There's a second, Dr. Kissler in the house. Sweet.
Matt Boettger:This is awesome. I need to get those eight K so we gotta let us know. And then I'm going to put that confetti back on next time for our live stream. Awesome.
Mark Kissler:Jess, just for Katie, put
Matt Boettger:her idol flower. Her was confetti. And all the, all the good virtual stuff. That's great. Great.
Mark Kissler:Yeah, but it's a huge accomplishment I'm like, of course, of a pretty, pretty
Matt Boettger:crazy year. Phenomenal. Congratulations. I'm excited to hear how it, how it ends. So, or the new beginning, so, we're, we're gonna continue on here and like always, we love reviews. Please keep them coming. We've had a couple more, we had a great one from Kat. Thank you so much. She says I've been listening to this podcast. It's a began. Just consistently nonpolitical, current and factual, the podcast features and intelligent well-spoken curious moderator. Hey, it's me a physician who brings cutting edge experience into stories, the hospital in which he works in a Harvard epidemiologist. Who's knowledgeable about all things coronavirus and can speak about vaccines and fomites and trans visibility in a way. That's understandable. There's even more to it. Thank you so much cap. We had another not so great review. So I just want to do publicly to make any kind of apologize, an apology. I know that I have called Dr. Elstow osterhome Dr. Doom a few times that apparently this person did not really care that I called him that and I would, by no means, do I ever want to make fun of Dr. Ostrom because I never knew him before the pandemic and now independent Mick. I know very much about him, at least on this area. And he's incredibly. Respectable. I know that from Stephen and I never want to bad mouth him whatsoever. I didn't even make up that term. I'm not that creative. That came from an ex CNN and I used it, but I think we all say from the past we uphold Dr. Ellis from tremendously. And Stephen has definitely, always took him very, very seriously. Never dismissed him. So we don't dismiss anybody. And so if anybody felt that way, I truly apologize. Sometimes my humor can get the best of me. So I just want to make that. And then the other one, the other criticism of that is three white guys on here. We got, we gotta, we got knocked off for that. And that's totally true. And I wish I could have more people on, but man, this is tough. Just pulling the three of you on the two or three of us. And so I would love to have more people on, we've had a couple of people in the past, but it's just hard unless they have somebody on the side doing it for us. So I would love to have that. Yeah. Yeah. Okay. We're going to get going and move on. Oh, I had a question for you, but Mark, but we're not going to talk about it now because we didn't talk about off the air. I don't know if he looked at that question from Kim and Canada, but if he didn't will, did you, did you look at that at all back at the time,
Mark Kissler:but no, but I can, I'll try and pull it up while we're you, while we go. And I'll let you know if I can address that
Matt Boettger:directly. Go ahead. So just, yeah, please leave a review. We'd love it. If you can support us$5 a month, as simple as that patrion.com/pandemic podcast, also Venmo and PayPal on the show notes for one-time gift. We'd greatly appreciate that. So let's get going with some of the information here. Some stuff's going on, let's start strong. I haven't already on my show notes. I know we talked about this, but it came on my radar a few days ago. It was shocking because I just put it in the background, but we heard the Trump CDC, chief coronavirus escaped from Chinese lab. Read the article. Obviously sometimes the titles can be a little bit more dramatic than the actual substance of the article, but he just, he just frankly said, this is an opinion and he's, that's all he's offered. And that's what he's. That's what he's providing. And so this has raised alarms for me and just wanted to throw it past you, Stephen, and is this something that's being talked about still or is this a real possibility and it has something changed. Between, six months ago now that makes us feel like this could be something more credible, but can you speak into what a, this, this, I forgot red. I always say, I don't know his name, but you can say his name for me.
Stephen Kissler:Robert Redfield. I think it is Robert Redford. Yeah. Yeah. Yeah, so this is, I think this was a really Yeah, this is an important thing to think about and address right now, especially because I think part of the reason that it's some of these things are coming up more and more now, as it's not so much that anything about the evidence itself has changed, but just that we're starting to get a little bit more of a handle on the crisis itself. And that's allowing us to take a step back and start thinking a little bit more about. Where did this come from? What is, w how do we, how do we emerge from this to ask some of those other sort of like book-ending type questions. And I think that it's it's important to tread a very, I don't like. Carefully in an important way around this, which is just the, to, to make sure that we're, we're upfront about what exactly it is that we're talking about and what the implications are. So I think the way that I want to introduce sort of the way that I've, I've been thinking about this is that we, we. There's a lot of very good evidence that suggests that it's pretty, it's pretty plausible. And I, and I, and to my mind, the most likely place where we're starting to Coby to emergency terminals from a crossover, from animals to humans, we've had pretty well documented events of that happening before with major infectious diseases with, with flu pandemics. It's, it's a very well-known well-trodden. Route for emerging infectious diseases to come from. And we've detected, we've found viral genomes that are pretty similar to SARS cov two in bats in particular. And so that would, that, that route makes an awful lot of sense. So, I'm I'm actually doubtful whether we will BA whether it will be able to say for certain where and when exactly sorry to COVID to entered into humans. And that includes a definitive answer to this question as to whether it, it transferred over from animals or whether it was the result of an escape from a lab or something like that. The reason why I'm saying this is that is that so. Yeah, there, there is a, there's a history of of pathogens escaping from labs. It's, it's rare. And usually even when it does happen, it doesn't cause a major contagion event. But there have been, many epidemiologists My own one of my supervisors, Mark Lipps, which has actually done a lot of work on this in the past where scientists were conducting gain of function, experiments on flu, meaning that they were basically evolving it in the lab to make it more transmissible or to gain different, different things to, to try to understand how many mutations would it take and what sorts of mutations would it take to make a more vigilant, more transmissible, flu strain. And he was really instrumental in saying like, we need to stop this. This is, the, the things that we could learn from this. Are not sufficient to justify the risk of having an escape from a lab. And and that work was actually really instrumental in, in putting in an international moratorium on that kind of work for for at least a period of time. And there's a lot more recognition about, about the risks of that amongst the scientific community as it stands. So I think all of that goes to say that when, when we hear things like this, that like, I think that, that the virus escaped from a lab it's really easy to go to the space of conspiracy theory and say like, that's absolutely ridiculous. We can't possibly think that. And, and in some ways it is one could say a dangerous thing to think because the, the, the downstream, it's, it doesn't. The temptation then immediately after that is to attribute blame and say, attributing blame can be a very blunt object where we can blame an entire nation or entire people or an entire culture for originating. This. Virus, something like that. And I think, I think we have to do this very carefully. I think that the most important thing is that, no matter where it came from, we have a crisis on our hands that we need to deal with and wherever it came from, the way that we're dealing with it now doesn't change. We still, the same measures are still effective at reducing its spread. And we have a crisis on our hands and I think. Maybe one day we will have more clarity as to where it came from. And like I said, I think a lot of the evidence is still pointing towards crossover from animals, but this is one of those things where it's it's it's okay for reasonable people to disagree on this. And it's something that may never be fully resolved. And, and I think what I would most like to encourage is just that no matter what we do to to just try to avoid the strong temptation, to attribute blame where there is none. And even when we do so to do so with, with a spirit of, of compassion and mercy, to the extent that we're able to. It's great
Matt Boettger:marketing with you to add to this.
Mark Kissler:No, I don't think so. I think it's just another case of first off, just to, just to emphasize, the, who has been saying that they think this is very unlikely, but again, Stephen's kind of drying out the sense of, are we ever going to know a hundred percent for sure. Is this always going to be something that maybe people are talking about, but there's this, I, I agree that there's this sense of discomfort. W anytime this question gets raised, because I think I'm conscious of the other discourses that are in play behind the assertion. Does that make sense? So that there's immediately are invoked these other. Things whether it's blame or whether it's, intentionality and, mal-intent and all of these things and, or, whether it's on the other side, like we can't trust anything that, this, this individual says because of his political affiliation or whatever, in, and the way that that gets. And so I think that Yeah, I like that. And I think Stephen's answer is good that just trying to, trying to be aware that we have to be able to start or try to disentangle some of these things as much as we can, but also recognizing that, as with many, many, many of the things in this pandemic a lot of these things are really messy and interconnected. And it's tough,
Stephen Kissler:but okay. And no matter where this, where, where it came from, the, the fact stands that like, All, all of, all of the possibilities that are on the table remain on the table for a future pandemic. And so I think we need to, be serious about the fact that like, we, we should be doing more surveillance about crossovers from animals to humans. We should be, like even, even if you, even if that unlikely scenario did happen to be true, that this wasn't a crossover for animals, it could still happen. Absolutely. And so just even, even disentangling where this came from does not, does not necessarily change our route forward. Yeah. In many ways. So I think that, yeah, that's. Great. It's a, it's a valid question, but one that I think, we still have a lot of work cut out for us. And, and I don't know. I also don't know how much we would gain from a very clear definitive answer to it. Sure.
Matt Boettger:When I read the headline, it definitely made me take a seat back a little bit just because yeah, my nervousness is just that. Okay. This is going to derail the main part, the main goal, like the last thing we need is like, yeah, my heart was like sinking in the sense of, see, it's just. A Chinese thing. And so I told you, this is just some kind of conspiracy. This is something then we're already in this position. We're going to talk about in just a few moments where testing is being reduced. And I get that's complicated because vaccines are on the rise and States are releasing all these policies right. And left, left, and for better and for worse and everything is just revving towards full steam ahead. There is an enormous light. In a tunnel and that tunnel is short and we're going to get there and we're going to cruise. And so this happens. And then again, it's like that That comment a few weeks ago, we got a not so good review about mask and how we're talking about wearing masks for help people to feel safe around us. But that, wasn't the main reason why we're asking to wear masks. We, we believe they're actually effective. And also on top of there's another great advantage by helping people feel as if they're comfortable outside. And I feel like this is the same kind of reality where it's. By advancing this idea. It is absolutely true in, it comes at a really, I think hard time because just what 10 days ago. So there was that shooting in Atlanta, and you're just saying that, like this can pack other things with it. So we, we can't just treat it as like a trivial piece of information that has no ramifications in other parts of life. We've got to treat it pretty delicately, right? Because it can have a cultural impact that's significant. And if it's not true, the collateral damage is. I would say unrepairable, but it takes a long time to get out. So, yeah,
Mark Kissler:yeah, yeah. Our words have a lot, a lot of power and I think we just have to absolutely. Yeah. Just have, have to be aware of that. Yeah.
Matt Boettger:Great. Let's move onto another, another question. That's not specifically targeted. To COVID, but I want to go back and hit maybe just for a couple of minutes, Stephen, about this flukes and another article came out about the flu and just saying, Hey, we know we caught this early a few weeks early. You and I, and Mark, we talked about this maybe like a month ago about this idea of a Cate. The flu has been non-existent. Hey, this is something to celebrate. Wait a minute. Is it something to be celebrated or is this like an impending dark reality? Come next winter, which I just can't take Stephen I'm like, I I'm, I'm going to be the first dude that signs up to go to Mars. Just, just so I can get away from this, even though clearly it's not, it's not very Maui ask from the picture that I'm seeing coming back from the, from the Rover, it's very desolate, but it's making me a little bit nervous. So. Here's the article talking about, there's a couple of comparisons of different years, but which we've had similar realities, not this dramatic. Is there any indicator or are we just going to be that this, this winter could be a challenging winter? What is what's, what's the update on this? Like what, what do we think about what this winter could be look like?
Stephen Kissler:Yeah, so, I I'm concerned that definitely the, the low rates of flu from this year and by low, like extremely low could contribute to a more severe flu season next year. But, but you're right that this, this paper and others have looked at historical patterns in the flu and, and tried to attribute, if you have a low, low circulation one year, does that affect how much you get the next year? And all of the studies that I'm aware of, haven't really been able to pull out any definitive, predictive relationship between the two. And part of that is because I know it flew and, and this is part of why I've enjoyed studying it so much is because flu is just this very complex virus. We have different strains that circulate from year to year and those strains vary also within themselves from year to year. And that can have a huge impact on, on how many people get infected the timing of the outbreak shifts. And we don't really totally know why. And. There's just a lot of complexity to it. So to, to, to draw some of this out, even further in in a number of flu pandemics, including most recently in 2009, we saw that actually rates of infection were. Lower than would be expected in people over. I think it was the age of 65 or 70. And that was partly because they were carrying immunity from a flu strain that they had been exposed to in their childhood all the way forward through their lives. 60 odd years later to have a clear discernible impact on the case counts in those populations during another pandemic. And so I think that, that the, the easiest and most straightforward thing to say is that, we haven't had much flu this year. It's going to be worse next year. I S I still think that that's possible and plausible but not certain. Okay. Well, the ramifications of having very little flu this year, we're going to continue to see for probably for decades, which is going to be super interesting. And I, we don't really know for sure what those are going to be. So I think that there is, there is some risk, for sure, like the things that I'm concerned about for next year is that. We will likely have flu after a season when we haven't had much flu. So there will be more susceptibility to flu. We will probably still have circulating COVID 19 as well. There may be less awareness. There may be less physical distancing. There may be less masking. So all of that could contribute to the spread of both of these in what we've been calling a syndemic which sounds really sinister, but it has Y N rather than S I N, but need to send meaning synchronous. Two, two epidemics over the same or at the same time. Yeah. And and so, so, so I think that, it's in public health, we're always thinking about Relatively, it's in terms of probabilities and we want to avoid low probability, very bad outcomes. And so that's why I've been spending a lot of time thinking about this sort of thing, but I want to be very upfront about the fact that it may not happen at all. We may just, next year may just happen to be a low flu season again. And, and that would be great. And that's what I really hope for. So we're going to try to prepare for that bad situation, but I want to be very clear that it's we don't Oh yeah.
Mark Kissler:Does, does it change the data that you have to model based on in any way?
Stephen Kissler:The yeah. So the like having glow flu this year, you mean, or,
Mark Kissler:yeah. Right. Cause don't you, yeah. I'm just curious about how that interacts with the models that you're able to build about. Viral transformation and things like that for the following years.
Stephen Kissler:One of the most important areas where this is creates a difficulty as in predicting would we develop the flu vaccine each year? We, we use the previous seasons. Strain at desert like a basis for predicting what the next season strain is going to be. And that we have no idea what to do. I'm really not sure whether it's going to be more like the strain from, from 2019 or if it's going to be much less like it, because it went through this really strong evolutionary bottleneck, where there were probably little clusters of flu circulating and it's anybody's guess as to which of those is going to spread. So. Yeah, it's it really does complicate things quite a bit, especially in the near term. I think that after we get another year or two under our belts, then we'll have a much better sense of what's what's going to happen and what will happen in like the next decade or so. But yeah, this was, this was pretty unprecedented in recent memory that we've had this little flu circulation in both hemispheres. So that's yeah, we, it reduces the data that we have for making those predictions and we're just not really sure what's going to happen. Exactly.
Matt Boettger:And curious, how does the Southern hemisphere help us like any relevance? Now that Australia is entering into their, what I don't know, fall winter, like is, is, is there clearly not a, one-to-one obviously there'll be a lot simpler solution, but how much relevance will that be in light of the, we both shared a very unique circumstance that it might prepare us for.
Stephen Kissler:Yeah, it will help. I think all eyes are going to be on Southern hemisphere countries right now to see what happens with their flu epidemics and what exactly is circulating. That's yeah, that's definitely a place we often look for anticipating what's going to happen up here and vice versa. They look to us to see what's going to happen there. So I, but, but I think that that attention is going to be a specially focused this year. That's that's really the only basis we're going to have.
Matt Boettger:Absolutely. Okay. Hey Mark, did you get a chance to look at that question from Kim and Canada? Are you able to speak here's the issue? I know that you always qualify these things. You're not a physician, you're not her doctor. Right? So you're going to say all that, but I just feel for when I read that I'm like my heart, I had no another woman, right. And this kind of relates, and it may, this might help. I'm going to, I'm going to put this out. This might help. This is again, this is like one case I have a friend. Her name is Morgan. And she graduate from CU and she's now had the job in Seattle and she, her immune system is just obliterated. She goes to an anaphylactic shock randomly every few weeks, nearly almost dies cause the hospital, she has to have Abby pins all the time at her work. Right. So she, her immune system is just constantly in this fight state. And it's just fearful. I feel terrible for her. I She's in constant fear when she is not she's over it now, but she could, at any point in time, she got the modern of vaccine. Great. It worked out right. She was very sick for Amnet. Sorry, not Madrona. They recommended not Madonna because it already has a higher sense of, so they recommend a Pfizer, sorry, clarification Pfizer. And she was sick as a dog for a couple of days. Like the flu totally fine. After Sunday. But you saw, I don't know if that helps Kim have one dose, again, that's just one person, but in light of your circumstance, I would give some information to give her what can we give Kim to help her and set the stage for this question as well?
Mark Kissler:Yeah. Yeah. It's a good, it's a great question. And I can summarize it a little bit and I do, I will go ahead and do all the disclaimers of, not, not giving medical advice. And I think I'm going to try and stay away from giving any even particular advice in this case. Rather just to engage with this. The sentiment that she has, which so one of our listeners shared that she has a long history of having a pretty high overactive immune responses in the sense that, in, with different kinds of illnesses, different kinds of scenarios in her life. She's just had a lot of trouble from that other side of things. And a sense of not necessarily fitting in to the typical, this is what one's body should do. Her body just feels like it. Reacts differently to stimuli that maybe wouldn't cause such a negative effect to others. I think it's tough and I think sometimes it's hard. To it's sometimes hard, especially in, depending on, the way that you're getting care and who you're getting care from, in the medical setting to feel validated in a different experience like that, a different. Embodied experience. And sometimes I think people, we, we talked about this a little bit with the long haul COVID too, where people start to feel like, is, is this real, or am I crazy? Or, or do people are, I know that it's real, but people don't think that it's real because it's not the way that typical things unfold, I think that's just a really, really hard place to be in, and one of the things that we've talked a lot about is the sort of the layers of, of the complex layers you an appropriately of, of the decision around getting this vaccine right. Where there is absolutely a social responsibility component, to making this decision, there's absolutely a. Personal risk component to making the decision. There's all sorts of things that come in with people's histories, histories with the vaccine histories, with other vaccines or with other therapeutics and things like that. And, and that, and then also, the differences that everybody experiences, they're different embodied experience. Like they may have certain degrees of trauma from the medical system, or distrust from, physicians for a certain reason. Yeah. And, and all of that, all of that plays into. Sort of a complexity of this decision. The difficulty is, I don't think that anybody, I, I don't think I can, standing from the outside, say, this is what you should do in that scenario. And I think that we can, that the best that I could do and what I would hope for is to be able listen, listen deeply on this in an individual case and walk with somebody, from point a to point B, which may not be all the way, to the decision about whether to receive the vaccine or not. But I do think that that, that there's. There's a degree to which that kind of real deep listening and accompaniment through the experience of illness which can be extremely alienating, alienating from yourself when you're sick. It's like you get dislocated from your, your story, your projects for you get alienated from your own body. You feel alienated from other people. It's it's profoundly isolating in this very multifaceted way. Yeah. Now add onto that, societal pandemic and all of the other things that are going on. And that it's, it's a lot that is a lot to deal with, for any individual person. And so I think the hope would be that for somebody like him, somebody like your friend Morgan, that that there can be people in their lives who can accompany a little bit and alleviate a little bit of that isolation and say, on some level, this decision. It's a complicated one. It's not necessarily going to be black and white for every single person, and that's okay. And that's okay. I think we can still uphold, the, the, the norm on one side that, I think it's really important for a lot of people to get this vaccine. I think that from a public health perspective, this is crucial for us to get better control of, the, the virus that has wreaked havoc on our economy on people's lives on families. Yeah, absolutely. And also yeah, there is space, I think for individual experience and to validate, that, that as well. And so I think that's one of these funny intersections between the broad public health perspective. The clinical medicine perspective. And even recognizing that the clinical medicine perspective often will have certain blind spots or not be able to engage with somebody's story or individual embodied experience, without a huge amount of slow listening and attentive care, and so I think, the hope. I think for, for a lot of, for clinicians is to be able to at least if not do that attentive care perfectly because I'm never going to do it perfectly is to nudge in that direction. And, and maybe that helps to alleviate some of this burden that people feel with the decision and with the experiences of illness things like that. Has does that make sense? Does that, I hope that, that, it doesn't speak to the question. It doesn't answer the question. But I don't think that I can but I can validate the fact that there is a question there. And I do think that's really important and worth listening
Matt Boettger:to no, I think it makes. Yeah, it makes sense. I figured that as a direction, you'd probably go Stephen, anything to add to that, that conversation that we're just making. Okay.
Stephen Kissler:No, I think, yeah, just, just echoing that it's it's so hard to weigh all of these things together and yeah, like Mark said, a lot of these decisions, we feel like we're making these decisions in some degree of isolation as well, and fearful of both the particular and disembodied Judgment that we imagine coming from either individuals or institutions or just the universe itself. And it's just an incredible burden to bear. And I think that, yeah, just like really reinforcing that it's, it's hard and, and these, these questions exist and are, are important to grapple with and recognize that others are doing so as well.
Matt Boettger:Yeah. And I think this maybe re I think this is a great opportunity to say what a huge blessing or opportunity to have technology right now, because when you deal with an issue like this, that may be affect less than 1% of a population outside of technology that isolating feeling is exacerbated by a million. But over a global reality, that 1% is a bigger population by what you can talk and like, the opportunity. I don't know if I can do that, but connecting potentially Morgan to her, people who have similar realities to be able to discuss in some situations to make it feel as if you're not alone and in this situation. So highly encouraged finding groups, I just think in the long hollered stuff, right. It was isolating. People didn't know what to think. It was just, Oh, is this psychological? It's just anxiety. And then because of the now group started forming on Facebook about the same symptoms and having this kind of coalition of people to deal with it together. And then it becomes a much more, I think swallowable pill not easy. But you at least have people who share that same reality and can make decisions not alone. So highly encouraged that as well to seek those out. And if I can, I'll I'll try to connect Morgan and cam if it's possible to start that conversation to have more people. Cool, great. Let's continue along the thing. That's on my mind outside of the shooting last week, the second biggest thing is watching Brazil just explode. And I, my heart is just, just breaking for this, this country and. Also making me a little nervous. Last week we talked about you guys. I, I was on this like optimism, like, ah, this is going to be we're we're through this. I feel good. Maybe I'm just, I'm just following the way of everybody else right now, but I felt pretty optimistic. Things have changed for me, not pessimism. I think it's going to be way, way different, but the possibility of a fourth wave and some. Some idea, some concept of fourth wave, I think is much more real for me now. I've seen it now here in Paris. So it's not just Brazil, it's Paris and there's other countries that are suffering as well. So, Stephen, wanna throw it back to you and again, with last week and what we're seeing, what do you expect to happen in the U S we're? It's 2125 States are seeing, maybe up to 10% increase in cases. And just to make it more difficult, I'm going to read this from this article. I'll put in the show notes. The good news is America. 71.8% of Americans, 65 or older have been inoculated with at least one dose. That's a huge success, right? So clear. We're going to see a very different look of a wave of that 27.6% of the us populations received at least one dose, a 15.1, both doses. So that's, that's hopeful news on the testing side. Not so good. our ability to test there's lowering. I hear because of we're focusing on vaccines. So we've not been testing is we don't, I don't know if we know exactly where we're at right now. We're seeing cases arise of the 10% in certain areas. So with all of these. Things happening. It will be talked about two weeks ago. It's almost more difficult now because there's so many more variables to determine what it's going to look like in the next few weeks. What are you guys talking about at Harvard of what the possibility is there anything new information that you guys are thinking of? What we might see in, in April?
Stephen Kissler:Yeah. It's the, the signs in many parts of the world are not encouraging for sure, as we're starting to see real spikes and infection in, in a number of different places. You mentioned Brazil where this is the continuation of, of, of a really long standing crisis in where there's just been a lot, a lot of, of, of COVID spread. And, and it's continuing to be. And so, I think that there's yeah, there's, there's a lot of different, there's a lot of different elements in play here. I think, the best, the best thing, the best thing we can do is just many of the things we've we've been doing all along. I think, I think you're right to point out that the declines in testing are not, not very encouraging. Meanwhile, I think that we can do even better with testing than we've done in the past where making tests available, making them cheap, making them rapid Can really help with addressing some of these flare ups. So while we're getting the vaccine distributed now, the I, I think we spoke about this a little bit last week, and I've heard some comments from colleagues about this as well, that with with. Relatively high rates of vaccine uptake in many of the most vulnerable populations. And particularly in the U S we're starting, or probably we'll start to see this decoupling of case counts versus hospitalizations and deaths. So, during the course of the pandemic, there's been this this really consistent relationship where you see a rise in cases, and then. Two weeks later, you see a rise in hospitalizations, and then two weeks after that you see a rise in deaths. And, and that's become a very, very reliable pattern, but vaccination is, is going to play a really big role in, in, in messing with that. Messing with that in a good way, because we're protecting, ideally raises in cases are not going to lead to as many downstream hospitalizations and deaths. I think we'll probably see longer delays. We won't, there will be a lower proportion of cases that lead to those hospitalizations and deaths. Ideally. Which is a good thing. But we still, the there's a, there's a lot of work yet to be done. I A lot of the reports out of Paris are pretty alarming in the sense that, they're saying that many of their ICU's are, are reaching capacity and cases are really starting to increase rapidly. So I think the important thing to note is that the, I think. As a country in the United States, our outlook continues to look okay. Even though cases are starting to rise. And I think that's something we're going to have to pay close attention to. We have the spread of variants. We're not out of the woods yet. But like you said, vaccine rates are high and an increasing. And so I think the outlook overall is good, but that doesn't mean that there won't be particular communities that could still be very vulnerable and could still get hit very hard. And I think that we have a responsibility as our entire society as a world, as a nation. To do our best to prevent those, those really catastrophic outcomes in particular cities, particular communities. Because that's, that that's really the story of this pandemic is that that different places get hit at different times to different severities. And we want to make sure that's not happening anywhere, it's it's fine and good to have relatively low case rates when you average across 300 million people. But when you have flare ups happening in a particular city, that's causing their ICU to be overwhelmed. I think that's, that's unacceptable if we have a way to prevent it. And so that's, that's really what we need to be focusing on. And that's why it's, that's why we're also interconnected. That's why cases in Brazil are tied to cases in Colorado are tied to cases in Boston, in Paris, all of this Even though it's your degrees of separation. All of it is tight together and all of it affects each other. And so, so we have a real responsibility to try to try to keep a handle on this epidemic everywhere we can. So I think we're, we're entering into sort of another sort of uncertain phase and I, I still remain hopeful for the overall outlook, but I think that there still could be some really difficult time ahead for particular communities.
Matt Boettger:Okay. Speaking of testing, I just want to bring this up because we didn't bring it up. We mentioned this back in may and we even brought up since then, and I saw this article in the New York times. So I want to throw it past you and Mark, have you seen this? We kept talking about this like antigen at-home testing and apparently is it here now? Because I just saw the article about Citi group. Is, is there one of the great they're actually making all their employees test three times a week through his home antigen within 20 minutes. They know whether they have, and they can go to work. And it's making obviously city grit feel a lot safer because now they're with their peers and at least so I, this miss my radar. Is it out in the open now that people can take these or any, any updates on this?
Stephen Kissler:I wasn't aware of that with the, with the city group. I knew that Generally in the U S these things are still only available with a doctor's prescription, or at least to be when you take the test, they have to be supervised by a physician which really limits their access and limits the ability of a small businesses. For example, to have their employees be tested multiple times a week. So I think we still have a long way to go in the regulatory part of this, even though the technology is all. Pretty well dialed in.
Matt Boettger:Okay, great. I'll check into this because this a city group began providing at home COVID-19 test kits, names of workers in Chicago and New York. Each kit includes a nasal swab, a paper strip, and a liquid solution. And people get a result within minutes. It looks like pregnancy test. The medical director said, so I'm not sure where this is coming from, but it's at home not supervised and they just take it and then they go to work. So. Oh, maybe we'll check into it and follow up. See where that, where that, where that is. That'd be great. That'd be awesome. Okay. Let's continue on and talk about, we talked about Brazil and what's going on within the spread issues. One question I want to follow up with, with this Stephen, I sent you this study about the masks, cause this is relevant because it's, it's still, it's still an issue. I hear it. It's hard now because now that there's so many like, green lights everywhere, that there's just more pressure for me not to wear my mask. And as if I'm in a huge alarmist. And we used to all of our previous review from a couple of weeks ago that there's still, clearly a lot of a belief that mass don't work. And can you talk a little bit, I'll put this in the show notes about this kind of particular study of the efficacy of masks and what it was actually talking about, because I think it's important at least to have the discussion, because it does show that masks aren't fully, fully effective. Right. When we've been talking about that. And can you talk a little about this and what the study was about and what was it trying to actually show.
Stephen Kissler:Yeah. So this this was a study conducted right here in Boston at one of the hospitals down the road from here. And and the idea behind it was the motivation for it was, was that there's There's been a lot of discussion that, that surgical masks can they're, they're not fully protective in the sense that since SARS COVID two spreads via aerosols it the there's still a possibility for transmission. And so, And so basically what they were trying to do is to see if they could document any, any cases of transmission amongst people who were masked. And if so, under what circumstances they occurred. And so these were transmissions that all occurred within a hospital setting. They are likely transmissions. It's, it's really incredibly difficult to say for certain. That one person infected another their evidence is, is pretty good. They, they have so in one case it was two masked nurses in a room with someone who was with a patient who was unmasked and these nurses spent hours and hours with this patient trying to keep the patient. Safe basically. And because the patient also had some psych diagnoses that were concurrent. And so, and so the idea was that the, these nurses were, were in the room for, for a very long period of time, the patient tested positive for COVID and then four days later, the nurses also tested positive for COVID with and identical, genetically identical strain. And so, so that's pretty good evidence that they were infecting. It, it doesn't completely rule out that they might have both been infected from some third-party that also, like there's, there are other alternatives here, but, but that makes an awful lot of sense, but also we need to be very clear eyed about like the type of exposure that this was, they were sitting for hours inside a closed room with a patient who had COVID during the time when the patient did not have COVID when they were admitted, they acquired it somehow, probably in the hospital or had recent or had been infected just before coming in. And so they developed their infection while in the hospital. So they weren't hospitalized for COVID. They were hospitalized for something else. And so these nurses were with the patient precisely when their viral load was the highest for hours and hours and hours, which is like an optimal scenario for transmission to occur. And it did in fact happen. There are a couple of other scenarios, sort of like this as well, where long period indoor exposures, even amongst people who are masked led to Henri transmission. So in my mind, and none of this was surprising it's we, we know that this is th this can happen and, and, and the authors were very clear about this too. They were and stated very upfront in their discussion that masks do. There's, there's a very solid body of evidence that says that masks do reduce the probability of transmission. All they were trying to do is show. The possibility of it and the circumstances in which it could happen amongst people who are masked. So I think all of the evidence still stands that the, the point of masks again, is to reduce the probabilities of transmission. They're never going to be fully a hundred percent effective at keeping you totally protected from infection or totally protecting the people you're in contact with. And we know that's the case, and that's why they're just one part of these, this sort of multi-faceted approach towards preventing spread in the community. And so that's, that's the idea here.
Matt Boettger:That's great. And that's the reason why I wanted to say this because I want to just show that. Exactly. You said that we we've never advanced mass would be in this flood protection. That's not what we're here for. We're just trying to help reduce. And this is a perfect example of that. And I want to elevate this study just for the sake of everybody listening that we're trying to do the most balanced picture as possible. And that will reveal this just as much as anything else about infectivity and noneffective. You have a mask Mark. You have to go in like eight minutes because there's a big deal going on, but I want to hit this. Now, one of the reasons why Kim, I mentioned the Kim thing it's because for some there's 1%. It could be therapeutics that they're looking forward to because they decide that they just can't do the vaccine. Right. And so I want to also bring hope to therapeutics. Right. So we haven't talked about this. Can you talk about this therapeutic? That's going on my question to you. I don't know how to say the word, so you're going to say the word, but my question to you is, is this pill, this Brown pill? Is this the MRN therapeutics? Or could this be so you can unfold
Mark Kissler:it? Yeah, that's a good question. Yeah. So yeah, first I can talk about it a little bit. I also. Probably cannot pronounce it, these antibodies and these antivirals, but it looks like, yeah, it's a, it's a Merck product. It's mal new mountain appear severe is how I would say it's a mall, new peer Revere. And that is probably not quite right. So this is a pill, this is a nucleoside analog. It's an antiviral medication. And so as we're talking about our different paradigms for how do we address Therapeutically the effects of COVID, this is an interesting potential drug target. And one of the things about it as they think it actually may have antiviral efficacy for multi, multiple different viral strains. Now the way that it works is it. It looks like. So as a virus is replicating they grab, different building blocks for their proteins right. And the end as it's doing that and it also grabs different building blocks for its DNA is for its genetic material. What this does is it looks like one of the building blocks for the viral. DNA. But it has a slight difference. So it's got a side chain or something that's a little bit different and it causes errors in replication of the virus. And so all the virus reaches for what it thinks is its own nucleoside to make its DNA and it grabs this. Drug PR instead. And then that either terminates replication or it causes downstream effects and it gets incorporated into the viral genome as an error. I saw in that article, you sent, I liked this analogy. They described it as a sand in the gears. Okay. So you get like sand in the gears, the viral replication. It may not bring replication to a halt but over time, this aggregate effect really does have a pretty significant effect on the ability of the virus to replicate. The difficulty with therapeutics like this is you really want to be certain that it's not causing ill effects in the host. Right. And so that you're not also causing deficient replication of the genome in cells that should be doing that normally. And so that's, I think one of the questions and that they're still working through, safety and efficacy data for this target. So what I see in this, the, the limited data that I have is that they, that researchers in this pharmaceutical company think that this is a promising potential target. It is a mechanism that has been proven in other in other therapeutics, there's this or sort of drug class has been used for HIV drugs, for instance. Now the difficulty is that they often will have certain side effects too. And so we have to just make sure that those side effects are not worse than the thing that we're trying to treat. And that's a complicated scenario. This is something that's going to take, a lot of testing and a lot of vetting before it's. Comes mainstream. So I think it's a potential, it's it's, it's definitely, there's been proof of concept. I think it's potentially, very helpful therapeutic, both for SARS, Coby to influenza and maybe for other, other viruses. And but it's hard to say, I think there's just a lot that needs to be done. So, to your question, is this the MRN of, of treatment? Yeah, I think that's an interesting one, right? Because number one, are you asking, is this going to be a fancy new technique? And I think in a certain sense in that. In that limited way. Yeah. This is a fancy new technique. This is a new, that we have some proof of concept in other diseases. We're applying it to a new one. Is it the MRA in the sense that there's questions of the way that it interacts with the host? Yeah, absolutely. I think there's, it's a complicated mechanism that's going on there and we have to be really sure that we're doing this. Safely. And so I think it's interesting. I, I'm very interested in continuing to follow the development of this and, and other, antiviral medications as we go. Cause I think that could be a pretty interesting game changer both in a clinical setting. And then also as another element of our public health response to the future. Events like this. So
Matt Boettger:super interesting. We'll, we'll continue to follow it see where it goes and then over the course of the months, the next year or so Mark, if you have to go, let me just go ahead and bail. If you want us to grant few more minutes. Go ahead. Yeah, it's
Mark Kissler:great to see you guys. I'm going to clear, clear the internet,
Matt Boettger:so
Mark Kissler:we'll see you soon. All right.
Matt Boettger:Okay. So continue along a couple more things I want to talk about going back to Brazil. Stephen, I want to mention about how younger people are dying in COVID from Brazil. Do you know any information about this, whether this is something that is because of the mutation or the variant, or are these, the conditions of of COVID in Brazil is the thing that we should be concerned about or is this just not really rebel relevant statistically?
Stephen Kissler:Yeah. So, from what I've seen there's. I may, I may maybe I'll approach it this way. So I I don't know if you remember this, Matt, but, but we had almost the same conversation a little over a year ago about Italy where we also saw reports coming out from Italy, where after the epidemic had been raging there for a while, there was, seemed to be this increase in hospitalizations and deaths amongst young people as well. And there's a question like, it has something about the virus changed is there's something about like, What's going on in Italy, in particular, their age structure or their context structure or something that's causing this to happen, maybe with all of that. In my mind, the most, the most likely scenario is, is simply that the, when you have a real surgeon infection, the first people who are going to have severe illness and the first people who are going to die, or the people who are most vulnerable to those outcomes, which include the older, the elderly. So we're going to see a real surge in deaths, amongst people who are old. Younger people are going to have a better ability to fight off the virus, but some of them are inevitably going to also get hospitalized and some old die as well. But, but the amount of time that that takes, we've talked a lot about these, these lags between cases and the clinical outcomes. It's, it's on average going to be much longer for young people. And so partly what we're seeing. I think, you know what, especially as, as the epidemic begins to crest, We'll see few, relatively fewer older people getting hospitalized and dying, but the younger people are still catching up because those are the people who got infected six weeks ago. And, and so that lag is a little bit longer. And so the relative proportion of, of, of hospitalizations and deaths is going to shift. Just because of the, the standard clinical sort of process of becoming ill with this, with this virus. So I think what it really does underscore is that young people are still vulnerable to severe outcomes from this. And that's really important, the, the risk is lower than for older people, but it's still absolutely there. And and it's something really worth paying attention to, and as, especially, pernicious because you don't necessarily like, you don't see it as quickly, it's you don't notice it. And so it seems like it's less severe for young people until you take the entire picture of months into account. And so, so that's part of the difficulty here. So, so I think we do still need to be asking questions about, is it something to do with the variant? Does the variant more, more vigilant for younger people somehow? Is something going on there as well? We also know that transmission tends to be higher amongst young people that, that young adults are, are responsible for a lot of spread. And so just higher rates of illness can, can lead to some of this as well. But I think probably the, the, the clearest explanation in my mind is that of these different. Lags that that's causing sort of what we're seeing now. Great.
Matt Boettger:Well, as we end this a few more, just small things just saw a record breaking for the record for the U S for vaccinations 3.38 million doses in one, one day, averaging 2.6, 2 million a day in a seven
Stephen Kissler:days. Lievable isn't it that's like those numbers. I'm a mathematician and I don't understand what a million is. I've never been able to grasp like that number. It's crazy that we do that every day.
Matt Boettger:That's phenomenal. So this, so, land on this, because we're seeing you mentioned last week that all States are committed to rolling out the vaccine for all, for everyone by May 1st, that's the goal, these 46 States agree to that? I think we're seeing some. Roll that out earlier. Colorado being one of them I think is like April 16th or something a couple weeks earlier than may. Which seems to be really, really good news. But is this also bad news from what I'm guessing? That we're rolling them out a little bit earlier because we're starting to reach vaccine hesitancy. And we're trying to get this open as quickly as possible, which makes me a little nervous. Cause I think we're at what, 21.7% right now completely vaccinated. And then, already getting to that point, it feels like we're almost falling short from what we even thought sought from polls. So just. One last question to you from what you guys are discussing as Dean vaccinations, and then rolling out are you seeing this as being a concerning thing in the next few weeks that they're opening up earlier than expected as being a sign that we could be having to have in a big public health initiative to help get people ramped up to the safety of the vaccine.
Stephen Kissler:Yeah. I think, I think you're right. I think that in some places where we've seen vaccine eligibility open up early, it does reflect that some, higher rates of, of the vaccine, not, not going into the arms of people who have been initially prioritized. There are some differences as well, just in terms of policy and, different places will make different decisions as to when to open things up anyway. So, so I don't think that there's necessarily a perfect one-to-one correlation there, but, but I think you're right. I think that, that it, it is, on the whole indicative of this, of this. Issue where certainly different communities have different rates of vaccine hesitancy. Also different communities have different rates of lack of access to the vaccine, which is an entirely different problem. And so part of it is maybe the, that people don't have the ability to get to the sites or don't have the ability to sign themselves up. And so we need effort there as well. And so there's a lot of really interesting efforts all across the country toward, in that vein. Where in some communities, people are even going door to door with vaccine information, or even sometimes with the vaccines themselves have, have licensed providers and asking people if they would like the vaccine right there at their homes. And I think that we might hopefully see more of that just to make sure that, that, that issues of accessing the vaccine, aren't getting in the way of all of this as well. So I think that, yeah, I think especially as, as we're starting to. See, different rates of uptake in different communities. The most important thing is to really understand what's behind that. And, and once we do know that, then, then figuring out what we can do to
Matt Boettger:address it. Okay. That sounds great. One last small question I mentioned is off the record, but just for those people receiving there's a second vaccine, it just came to my mind. Getting your first vaccine. I saw another study, Pfizer, COVID just the first one has a robust response. After the first one. I know this is addressing the UK problem of, of delaying the second vaccine and looking to study to see how robust that first one is. If they can delay the second one, it looks like that first vaccine is really, really robust and does a really great job. And then the last, the second vaccine is important. Now for those of us taking the second vaccine. Is there anything qualification with that? Cause I know if you're have a robust response to the first one, when you get your second one, is there any indicator that you take a couple of steps back before we move forward? Or is it just kind of like this idea where you get your second one and you keep moving forward and it keeps increasing its immune response, not having any kind of gap. Do you know anything about that or is there any idea about that?
Stephen Kissler:Yeah. It's so yeah, I can't point to any like specific scientific studies about this for SARS cov two, but I, and I chatted about this a little bit with Mark ahead of time, too, but thinking about just the way the immune system works and the way that it interacts with the vaccine. I think that we can almost certainly expect that your immunity will just continue to increase and that you're not at any. Heightened level of vulnerability once you get the second time you'll feel like crap, but but yeah, your actual vulnerability to infection is just getting lower you're you're getting better and better protection
Matt Boettger:over time. Right? Awesome. We're done here. Thank you so much, Stephen. If you wanna get ahold of him, S T E P H E N K S S L E R and Twitter, you can follow his feed as well as a bunch of great epidemiologists in viral adjusts. That he respects. If you want to support us patrion.com/pandemic podcast or$5 a month can go a long way or one time payment, Venmo, PayPal on the show notes. Thank you so much. Have a wonderful week. We'll see you next Monday. Take care. And bye-bye.