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Things Discussed on Episode:
Can you Rate and Give us a Review in Apple Podcasts?
Please consider financially supporting 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!
You can also follow Matt on his Living the Real podcast where he recently released an episode about what he has learned from the Pandemic so far. You can find his podcast here.
Things Discussed on Episode:
You're listening to the pandemic podcast. We equip you to live the most real life passport in the face of these crises. My name is Matt Boettger and I'm joined with my one good friend, Dr. Stephen Kissler, an epidemiologist at the Harvard School of Public Healthy. And Dr. Mark is at the hospital doing his due diligence, saving lives, doing all those good things. How are you doing Stephen? I'm doing all right, man. How are you go? You know what? I'm envious. I, no, I'm not envious. I don't wish you harm on any level, but I'm jealous that that, that I hear birds chirping right now in your cause right now, believe it or not, we are in. A winter storm watch yet want to go once a year. This just never,
Stephen Kissler:never ends for you guys. It's just like, it seems like every other time we talk, you're like in the middle of a snow
Matt Boettger:storm, it's going to be like June, July. I'm like, yeah, it's snowing here. And it's just crazy, crazy weather. So if anybody wants to bring their sunshine and one weather our way greatly appreciate it, I'm ready for spring and summer and all that great stuff. But. Here we are another episodes episode 71. I think it is so many episodes, so much to share. So let's get going a couple small things that we needed. Normal stuff that if you want to leave a review, it is greatly appreciated. For sure. You can do that by going to Apple podcasts and any other place that leaves reviews. We really appreciate. We haven't had one for awhile. Helps us just become more noticeable and inspires us. Second thing, if you can support us patrion.com/pandemic podcasts, a little$5 a month helps it goes a long way. Or do you want to give a one-time gift then Mo at PayPal? All in the show notes, that's all the good stuff. So, I think there's a decent amount of stuff to chat about today. There's a lot of stuff in the news and all that stuff. And I've got some stuff that I might share about it if we get to it that makes even life more complicated in light of COVID Steve and I were talking about it just before we hit record. So the first thing I wanna talk about you with Stephen is this idea of Paul's article. Again, I think this is a resurface of an article or a re made a rehash of it from the Atlantic saying hygiene theater. Deep cleaning. Isn't a victimless crime. And we've talked about before, we're not going to rehash the whole concept of, whether you can get COVID from a box and that kind of stuff. This article was tremendous. And the one thing I want to share with you is this is a complicated subject, Stephen. So I know there's gonna be no surefire answer to this, but here's my predicament. I've seen as we talked about a little bit with. Last week's episode with Mark about how sometimes the language of the CDC just gets confusing. We know he talked about the whole of the soap stuff last week, so we're, I guess I'm on a hygiene kick. Apparently. I don't know what's going on, but it talks about soap, but then if the COVID is actually in your house not to use soap, Makes me confused. This is related because it's talking about for months now, we've known that this is principally an aerosol reality, right? It's airborne. And that we really do not get it from boxes or services. In fact, we've known for quite a while, apparently from this article that when you talk about respiratory diseases or respiratory viruses, it's typically not the source to get from a box. Even the flu, it comes more, I think they gave one exception is a Rhoda virus. That might be one where you can get from, but generally they were saying any way that it generally from. Contact from people. So you may think that might be a bit might require nuance, but nonetheless, and then they begin to criticize a little bit how the CDC of like, okay, the CDC is just now maybe starting to update the language about fomite language, that kind of stuff. So what the point I'm trying to get to is where is the distinction between science. As a good scientist and the CDC, and then caution because those are those, I think I'm guessing it can conflict. And I think it has conflicted whether it's California, where in mass outside, even when you're not with someone, which makes no sense because out of caution, but I don't think science is on that side. Really. And how do
Stephen Kissler:you, right? Yeah. It's all over the place. Yeah. It's it's really difficult. So I think one of, one of the chief difficulties is that it's, it is very difficult to, first of all, sort out the science itself, like where, where do most of the transmissions happen? Because we've spoken about before that tracing the Yeah, basically just tracing infections themselves. It's just incredibly complicated. Part of that is, is because we have trouble recalling our own exposures to places where we might have gotten the virus. And usually we know we don't have just a single exposure that we can attribute it to. Say we were going to a restaurant where we had to get to the restaurant somehow, and maybe we took public transit or maybe we walked, or maybe we drove or whatever. And then there might've been like interactions that we had totally forgotten, but you don't remember going to the restaurant and you'll think that that's where you got it. And there's a very good likelihood that that is the case. But it, it becomes The problem here is that it's very difficult to rule things out. It, you can have increasing probabilities that like, Oh, you probably got it here. It's the most likely place, but it's really, really difficult to rule out venues and avenues of infection. And so that's, that's part of the, the precautionary principle. I think that has been going into this and why some of these changes have been relatively slow. And because now the evidence really is overwhelming for SARS Kofi to that, it gets it's primarily an airborne. Virus is, is something that you generally get from it, the virus building up in the air and you're very unlikely to get it from surfaces. In my mind that actually contrasts quite a bit with flu where surface transmission is actually very well-documented and is, is a, is a pretty consistent and as part of why there was so much emphasis on cleaning surfaces early on is because we, we knew that that was an issue for flu and In the absence of other information, it made a lot of sense to disinfect surfaces. Cause that that's absolutely a way that flu can spread now flu probably the dominant mode of transmission is through droplets. And then to some extent through aerosols, but absolutely all, all three are important. Whereas for SARS COVID two really the emphasis is moving more and more and it's pretty. Strongly towards aerosols. Some of this has to do with, with how do we, and this is both a a statistical question and a psychological question, but like, how do we update our beliefs? In statistics, we have very formal ways of thinking about this, but the intuition is the same where we have this prior belief that something might be the case that's based off of our experience with other things or with similar related things. But then it takes a lot of evidence to update that belief and rightly so, because, it's It, it, it should take a lot of evidence to dethrone a, a strong conviction that we've had before for good reason. And so I think that's the process that we're going through right now. So, but you're right. It's, it's difficult because I, there have been instances, I think, in which the the communication of how to keep ourselves safe relatively safe from. SARS cov two infection has lagged behind Some of the most up-to-date scientific information. And, and you listed off some of the especially egregious instances where, where, you know, even if you're in the middle of a field with, 10,000 feet around you and nobody around and all you hear are the birds chirping, maybe you should still be wearing a mask. And it's like, wow, that's, that, that doesn't actually. Makes sense. And, and part of it, part of the difficulty there, I think is just, then, then becomes, it becomes much more of like a, a messaging and a consistency issue and interest. The fact that we're like in the middle of a crisis with limited time to devote, to isolating each specific context. And so you have two choices, one of which is, do you communicate the principles on which. These ideas are founded so that you can make decisions for yourself, or do you just give rules for when you should or shouldn't be wearing masks? No, as I, I generally prefer to communicate principles and really that's what we're in the business of doing on this podcast. We're like trying to understand the underlying principles behind why we do the things that we do. But oftentimes when, when, when setting guidelines for a community that often has to take place on the, on the plain of rules, and it's really difficult to isolate out all of the different circumstances when masks are good or, it would be advised or wouldn't be advised. And and so it becomes much easier to just say like, right now we're in the middle of a crisis wearing a mask in the middle of a field, probably isn't going to hurt you. Sure. So do it. Yeah. Like, and so, and, and, and that becomes a lot more straightforward because, because then equally there's a criticism from the opposite side where it's like, these things are so complex. There are all these different rules. There are these rules and rules are rules. I don't have time to read all this. What are you doing? You're just trying to pull the wool over my eyes. Right? That's another criticism that's constantly leveraged towards public health. And so we're in this really, really difficult. Area where there's, there's no desire to either dumb things down or to pull the wool over anybody's eyes or anything. But nevertheless, like practical decisions have to be made for how to communicate these things. And it's, it's a difficult, it's really difficult area. I'm glad to be in the space where I am, where I do. Academic research in public health. And so I'm able to speak on the level of like principles and try to break down the complexity of things. But if I actually had to operationalize some of these things as the CDC, it's absolutely we can criticize all sorts of decisions they've made in different public health agencies have made. It is a really difficult job. And it's one that I'm. Aye. Aye. Aye. Speaking of envy is one that I don't envy the dance.
Matt Boettger:Yeah. Helpful. Stephen. I think that really shows again, like the nature of this podcast, the very beginning it's complicated. And that helped me to see the realization you're right. I mean, gosh, if you could if you constantly had a nuanced exception for every rule, like, in this case then maybe you don't need a mask or in this case, no, it sounds like you need a mask and people are gonna be paralyzed by decision making. I mean, all this research in decision-making. Applies here. Right. Once you have, it's like the end, if you remember that, if you heard about the jelly jam research, where there was that store, where had like five jams for sale, and then they did another one with 27, which sounds delicious by the way, 27 different jams. I didn't even know that existed. Right. So there were both, well like, attended. Even, I think the 27 jam one was even more attended, but when it came to the end of it, very few people bought from the 27 because of the decisions. Right. Is this too much? So could you imagine, now just reverse engineering, what you just said, apply it to my, my, my kind of criticism of CDC. So I retracted completely. Is that okay? Then you just don't do it or in the case where, you know, okay. If you're open you're, if you're in an open field, then go ahead and don't wear a mask. And then all of a sudden, which I've done this before, Stephen, where I've, maybe I'm in the equivalent of an open field, whatever that is. And then I forget, and then I go into a non open field. Right. But I forget that I'm not wearing my mask. And here I am just like, maybe in the grocery store, walking into one, so they have connections. So this is. Great point. I appreciate Stephen a lot. It's complicated. Speaking of complication, Stephen let's, I want to get your idea of this whole vaccine passport stuff. And I know politics, second stuff. This is not your, but I want to get just idea of like, is there anything you guys are talking about and about this idea of the vaccine passport, where it's advantageous? I know it's a, it's a very complicated reality because. I don't, I haven't done a lot of studying on this, but apparently there's a lot of Christians. In fact, we had one of these and then there's reduces the sense of freedom that it's my right. To choose either not to get the vaccine. Cause I'm either cautious. I'm a little nervous. There's there's, there's still, we're in the wake of still Johnson and Johnson being paused. So that's create a whole other concern about the safety of vaccines. So, Hey, I'm going to wait then all of a sudden I'm gonna have to have a passport and not go to places because I don't have vaccine it's discrimination. Do you have any insight to this whole dilemma of passport vaccine passport and the advantages of it and what we can. Is there anything we can pull from this?
Stephen Kissler:Yeah, it is. It is a raging debate. And I think that, that rightly so. I mean, I think that there's all sorts of room for disagreement on how this ought to be implemented. Some of the things that I've, I've been thinking about with this is that, first of all we can, there's, there's the issue like the, the word discrimination is brought up for sure. I think it's, it's worth sort of being clear what exactly it is that we mean about this? We, we, we discriminate all the time. Businesses, for example, have, have the freedoms, there are the signs that say, no shirt, no shoes, no surface. Right. And they have, they have the freedom. And one of the things about this country in particular is that there's the freedom to deny service in certain circumstances for certain reasons, especially related to health and hygiene. So there's one, there's, there's one issue where where maybe, you could think about vaccine passports in that realm, but then of course, equally on the other side, you don't want to be denying full participation. I want to be very careful about how I say you don't want to be denying participation in the essential elements of society to anyone, right? We shouldn't be doing that now. One of the things that I could see that could in an, in a parallel universe that would really complicate this is if if the vaccine were not freely available, if you, if you had to pay and have health insurance and have like certain barriers to getting the vaccine and that, that would immediately say there's a difference in the opportunity to get the vaccine and w. Then it becomes really difficult to discriminate based on vaccination status because there, there are differences in the opportunity to get the vaccine. Currently, there are still differences in the opportunity to get the vaccine in many places, in many places, people aren't eligible yet. I think there can still be a case made in both in both ways as to whether a vaccine passport makes sense there. And so you can think about it in terms of discrimination. You can think about it in terms of corporate rights. Do, should, should, should we just allow corporations to make the decisions for themselves, maybe. So, some people will choose to have vaccine passports and some shouldn't, that's a very kind of like, red blooded American, like, idea, right? Like we should just let you know Laissez-faire let the corporations decide for themselves. And and that's one way of thinking about it, but I don't necessarily know if that's the best one. We can think about schools, there's to, to go to public school, your children have to have a whole range of vaccines, and that's a certain type of vaccination passport that we've already largely signed on to as a society. That makes a lot of sense. We need those to keep our kids healthy and safe, and so, so I think that really, what I'm trying to say is that there's, there's precedent for certain parts of this idea. There are ways in which we deny access to certain liberties based off of choices that we have made because they may threaten the health of others who are participating in that place. There are. Yeah. And, and, and that has to do both with, with vaccines and not with vaccines. And so, so I think that it's worth thinking about the ways in which that we've already navigated some of these waters as a society. But also being very clear about the fact that like, we We don't want to be unduly limiting liberties and participation in society. Like that's, that's not what we're in the business. So if we don't, this isn't a fight about like, shaming people for getting the vaccine. And if it becomes that we're wrong, like it's shame, as, as much as as much as, my own review of the evidence really suggests that the vaccines are a very good idea and are safe and effective. Shame is never helpful. I mean, it's very clear through all of the history of public health that shaming people into or trying to shame people into doing something always backfires. And, and it's just not a very, Human collegial thing to do, we should, like, we should be in the air, like presuming the Goodwill of others, to the extent that we're able to. And, and, and working in the space of like listening and persuasion, if we truly believe that something is the case and, and working in that area. So, yeah. So that's a long-winded way of saying that. But I do think that there's a, there's a grounding there's, there can be a justification for things like vaccine passports. I think that there's precedent for them in our society. And I don't think that they necessarily infringe unduly on certain liberties. I think that it in, in certain arenas they can make sense, but I think we really need to tread these waters very carefully because it can quickly become sort of a, a partisan brawl which is not productive
Matt Boettger:for anyone. Yep. No, that that makes sense. I was thinking about, you mentioned shame and we saw it here in Boulder, where even one of, one of the people I work with hesitant about even guidelines for COVID and this kind of stuff, on the other side of what this podcast talks about. But one of his reasons was just really frustrated with the shaming propaganda. There was a couple episodes in Boulder where, it came out as an article, direct articles saying that we did this to basically to shame them. It, it was basically because it was students, they came in hard on them and exposed them and put their names in the paper. And they said, so then that creates a whole other difficulty. Yeah, you're right. Shamed it's then distorts the whole picture. And then we can't see clearly, and that it prevents the whole movement of the truth to be seen. Right. Yeah. In one of these, we'll go back to, and just mention briefly, you mentioned about whole beliefs. I, that was fascinating to me. This is the really weren't talking about the CDC about beliefs are hard to let go, and it goes back to there's another researcher study done, which is fast about how before. And this is, I think to me, one of your sub lessons here is be careful what you believe, because not only, not only because of the content. That's one thing, but it's hard to let go once you get it. And there was that whole study about how it's one thing. If you don't have the$10 bill in your pocket and you negotiate what you want to do with that$10, but once you have possession that$10, all of a sudden it takes on more value than the$10. And now it takes like 50 or 60 or$80 to get rid of this$10 equivalent because you possess it. And so there's a big lesson here. What we take on, we've gotta be careful. And I've seen this in my own life by not just money. But just random stuff where like, you, you take it on and it's hard to let go. And in fact it becomes the new normal. And then you up the level, right? So there's this whole cautionary tale of once we take on a belief, there's, it's hard to let go of it. A number of reasons. So caution there. Okay. A couple of things I wanted to mention here, I said about a month ago by the Citibank, there was a really cool at-home testing that was done. And I haven't really followed up on the success of it. But what I did want to give is clarification that Stephen was completely right, that this is not being offered to everyone that this was just a unique thing, given the Citibank and. All its employees as just a study to see what would happen if a particular business did at-home testing and how it would change the, I guess, the culture and the infections. So yeah, it is absolutely not being given widely. It's just part of the study. So wanna make that clarification as well. Stephen, let's talk about a quick update on variants. Anything that we need to be aware of, of variants. And, one of the things I wanted to mention is I think there's a number of things I want to talk about this, but one thing is it was mentioned that by the end of March, that we would see the variants be the dominant virus here in the U S particularly now I'm getting mixed messages. I think I'm just not reading the headlines correctly, but it seems like at least the B one 17 surpasses 44% of the, here in the U S. Are we seeing the variants in general being the dominant or are we still not there yet? And if not, why might that be the case?
Stephen Kissler:Yeah. So we're, we're beginning to see it in some communities. The variants are beginning to. Constitutes, more than half of all of the cases that we're seeing, which, which, as you mentioned, we predicted that like roughly around this time, spring timeframe in the spring we, we would start to see this. And it's the case now, now one of the things that has made this more complex is that more variants have arisen. So when we were really concerned, primarily with And then the other two, the, I think it's P two and B one. Oh gosh. Now I'm mixing up. I'm I'm working on a project with these variants and there's a list of like 12 of them that I'm dealing with. And, and they all have these like totally obscure names, which is an entirely different topic that we really need to simplify those. And, and so, but like, so there, there were like a handful of variants, but, but this is the point, right? Like now Yeah, we could have estimated that B one, one seven was going to increase in prevalence. But at that point, we, we didn't know about the variants that we've seen emerge in California, for example, which have caused their own emergence of infection and seem to have a different constellation of these mutations that give it a little bit of different kinds of behavior, but that can partially out-compete B one, one seven. Not totally, but it makes the situation a little bit more complex. And so. Absolutely. You the variants as a whole are becoming more and more prevalent ardor being responsible for an increasing share of cases. And that is continuing to make the pandemic a little bit more difficult to control. There was I was just Speaking yesterday about so here in Massachusetts, we've had our winter spike and then it's gone back down now. It's, there's this really curious thing where cases have more or less flat-lined for like the last six to eight weeks, which is crazy because Epidemiologically speaking that is like, that's a really strange thing. Like we can account for cases going up and we can account for cases going down, but, but to have everything aligned just perfectly and perfectly tuned to keep transmission just like going flat. Like that is crazy. That's crazy. And so, so what that means to me is that, so, so there are two things. First we have the rise of the variance that's being counteracted with the increase in vaccination. And so those things are counterbalanced, counterbalancing, each other, and then you layer on top human behavior, or we're all paying attention to how much there is in our community is, and how much variants are spreading. And, and, and even in ways that we don't totally realize ourselves, but we're, we're responding to that. And we're changing, do we think twice about Wearing a mask in this crowded area outside, or do we, maybe like postpone plans to see someone or maybe, like, and we're constantly titrating our own behavior to what's going on epidemiologically too. And so that's creating this really complex landscape that it's hard to make sense of. So there's a lot going on there. We absolutely have continued spread of variants. I think that it's something that we're going to have to continue to deal with, into the early summer, mid summer. There've been reports in India that there's they've spent detection of a new potentially variant there, but it's not really clear what to make of that either because there hasn't been a ton of sequencing that's been going on. And anytime you have a major outbreak, there's going to be something that's responsible for it. And so it's the question is, is the variant the cause of that outbreak or is it just, it, it just happened to be the one that got lucky and all of the stars aligned for that thing to emerge when it did, where it did. It's really hard to tell. And so, yeah, so there's a lot of difficulty here, but but I think that the variants continue to be an important element of this whole thing and will continue to be they're absolutely making the pandemic a little bit harder to control than it would be otherwise. But again, so far the vaccines generally, especially the MRNs vaccines have shown to be pretty effective, especially against fear, disease and illness, whether it's the bog standard SARS cov two, or whether it's the variance. And so I think that that's really good news. And Really thankful for that.
Matt Boettger:That's great. And so, first of all, are you just telling me that Massachusetts has just re reach enlightenment with the virus? Like you guys are like one with the virus, like you were able to, you were in the symbiotic relationship by which you agree, you're keeping it just status quo.
Stephen Kissler:Exactly. I wish we could have found something else to the ins end with, but that's right. Yeah. We're just yeah.
Matt Boettger:Hey, I don't think anything says you need to be in Zen with anything particular. You got Zen great work accomplished. Let's hit quickly about India. I know you just said. And you probably just answered the question already. What is going on? Is there, wha what do you, do you have any idea of why India now? Or is this again the same thing? Like every state, every country, it just, it's just too complicated.
Stephen Kissler:Yeah, I exactly, I think, I think that's the case. It's like, I mean, some of this gets down to talking last week about, about how do we attribute a cause to something. And so frequently, like the w w R R like reductionist, Western mindsets wants to, like, we want to drill off all the way down to a genetic mutation or something like that. We want to drill down to the deepest level. We can and say like, this is the reason for. What we're seeing right now. And to some extent that that is the case, but you're right. I mean, there's, there's so many behavioral population level climate-related factors that play into this, that I think, epidemiologists are going to spend a long time after this pandemic is over trying to make sense of why different outbreaks happened when they did, where they did. And the answer. I mean, we, we don't know right now. And so you're right, this, this could just be another episode in this seemingly endless novel of, this place got hit now and where you don't really know why, but it's just, it's just there. And that's just the way it goes. Is it just enough? Infections picked up steam could be partially driven by, by what has been detected as, as potentially a novel variant. There absolutely could be part of the story there. But it's probably not the whole story. Part of it is just how many people were susceptible and what different behaviors were and, and what policies were in place and where the virus got lucky and all of these things too. And it's, it's all just sort of this, this thing. So, so far, I think that it's Yeah, we, we have, we started to formalize these tiers where we have variants of interest and variants of concerns. So the variant that we've detected in India is absolutely a variant of interest. Something we want to follow closely because there's reason to believe that it could be partially behind these surges, but there's no conclusive evidence yet that suggests that it is really the reason why we're seeing it now and not at a different time. So something we'll be watching closely, but at the moment There's. Yeah. There's not enough evidence for us to really say for sure that that's, what's going on versus just one particular variant of the virus that got lucky. Yeah.
Matt Boettger:I, I know you're probably used to variant of interest being a common vernacular for you, but it's just like, I, I almost exploded in laughter because all I envisioned, I think we need to try to recover to this as a little COVID virus with handcuffs and interrogation room, just being screamed at for like, why are you eating? Why it's like, this is awesome. Okay. One more question. This is confusing to me, but you've already answered, I think, but I, again, it could be all about semantics, about words being used, but even osterhome will use words like these variants are more severe than the regular one, but yet at the same time, I see all these other articles saying that it's not more severe. It's just more infectious. On your guys' stance. Cause cause severity can mean a lot of different things. Obviously you've talked about this for a long while, but maybe in the sense of objectively on its own merits, does it bring a greater severity to disease, to people not by like statistics and more infections? Are you seeing that or is it pretty much, we're just continuing to seeing that these variants, these 12 ones, at least you'd mentioned are pretty much the same in severity. As we saw back in last may.
Stephen Kissler:Yeah. Let me. A quick look. So, so we know for sure that the, probably the variant that we have the most information about is the which is the one that was first detected in the UK. There's a very good evidence. I mean, that one is clearly more transmissible and actually there's pretty good evidence that it causes more severe infection. On average more, more severe outcomes of infections. So, so absolutely some of the variants are capable of causing making it more likely that you end up in hospital, for example not all of them. But certainly B one, one seven. And I think, I think the, the one that was first detected in South Africa as well seems to be associated with more severe infections. Now of course, like you said, we have to be very clear about what we mean by severity because even just an increase in transmissibility can make it much more severe on a population level, because that means that more people will end up going to the hospital anyway, because more people are getting infected, but on a per infection basis, these two variants at least are also. More severe in terms of causing more severe infections which is not good news, but all the more reason to get vaccinated.
Matt Boettger:Yeah. And just repeating what Stephen said that these vaccinations, especially the MRN ones are roughly just as effective, maybe a little nuanced, but it's, especially when it comes to hospitalization and death, right. That's, that's very, very effective. What's the variants as well. Right. In one thing I wanted to mention just because not much for Stephen to maybe chime in on this, but I thought it was just enlightening. Speaking of Zen the vacant middle seats reduced COVID exposure risk, which was really fascinating because when I heard about empty middle seats, I'm like, this is, this is, this is hygiene. Again, this is ridiculous. But apparently studies show that it actually taking a look and we all know people, these middle seats are like three inches wide. They were like, like for like little bumps, right? So there's not much space being given, but a study should be anywhere from 23 to 57% reduction in exposure. So now granted, this is complicated because the airlines were not removed. That, that thing pretty much for most airlines are, they're now filling their middle seats, which this article proposes that maybe it's, that's not that big of a thing right now, given the direction we're going. Nonetheless, the point I want to make with this is just, it's all about particles. It's not about just the objective exposure being with someone, but it's the amount of particles which goes back to the idea of the importance of just wearing the mask, because yep. It does not completely remove that particle. That comes your way. But what it does do is it reduces the amount of particles and this study really shows how even a foot and a half, whatever may, can re dramatically reduce with with, with exposure. So just want to bring that to the attention. Stephen. Yeah. Yeah.
Stephen Kissler:I I do have thoughts, so I I'd be curious. I would need to go back and read this study for sure to see exactly how they measure it. The reduction and risk of infection, because in my mind, The important thing here is not necessarily so much the extra foot of distance, but the fact that there's a third, fewer people on the plane. And so, and so that's a, and so in my, and actually, and I think that this carries through to like some of the questions, we were talking about at the very end of last podcast, like, six feet versus three feet of distance, like in a classroom, like, does that actually matter? And it's like, actually, I'm beginning to think that it's not so much the distance that matters, but when you have three feet of distance between people, you can pack a lot more people into a room. And so when there's a super spreader, they're going to be able to infect a lot more people. And that's really going to increase the proportional risk because there's just more people who have been exposed in that, in that space. So one of the things that distancing does, our, our rationale for doing it early on was because we thought that spread was through droplets. And so if you, if you spread people out six feet, then you know, the, the droplets aren't going to spread. But the other thing that it did was it reduced the capacity within indoor spaces, hugely and in doing so to reduce the number of people who could be exposed to a super spreading event, which also, mitigated aerosol based spread, even though that wasn't necessarily our rationale. So I would want to look closely at this. So, yeah, so I think that sure. A little bit of extra distance absolutely helps masks are really helpful because they do reduce the number of particles that get through and spread in the air. That's very well documented. But also in this case, I think that it's, it probably has less to do with the distance itself than just with the number of people in total who have been exposed. Good point. This
Matt Boettger:is why you're the epidemiologist and I'm not. We'd be going all over the place.
Stephen Kissler:This is where I'm getting the big bucks or something
Matt Boettger:and it's like a confusion. Oh gosh. Speaking of complexity. I didn't mention this to you, but I saw this study, regular exercise shielded COVID-19 patients from hospitalizations deaths. So this goes back to, we were saying in April Stephen, where I think we saw Dr. Katz and that episode, like this is a public health reality. And so exercise is really important and dramatically by two and a half times reduces the risk. Now, the reason why I say this is complicated, right? Because in my mind it really exposed. The importance of exercise. So I think at least 150 minutes a week, that'd be four. There's really this two and a half times fold of a. Dramatic shift and hospitalization. So this is important. So all of you get exercising important at least 30 minutes a day for just your own exercise and for COVID, but here's the deal, Stephen? You just in the same thing you just did with the plane, I thought about this. I'm like, and I'm sure they thought about this, but. It's not like people who exercise regularly eat like, exercise regularly and then eat Twinkies. Right? Usually there's this correlation between if you're exercising 200 minutes a week, I bet you you're having an extra dose of broccoli over that late potato chip. Right? So it's probably a little more complicated than just exercise, but there's probably a many other associations with a person who type that type of person that contributes even. More. So just generally yes. Exercise, but I would imagine you would say exercise, sleep and nutrition. This is that's the big that's, that's the next big pandemic, right? To do a drug to address.
Stephen Kissler:Yes. Yeah. All of these things are so well-documented that they like have bearing on so many different areas of our health, whether it's our immunity or our susceptibility to chronic disease. Even our psychological health, like all of that is like, yeah, if you get to sleep, you need to rest or you need to sleep. You need to exercise. You need to eat well. And that's just like, Nuts and bolts for everything. So, it's not surprising to me that, that, that that affects COVID infection, risks, and outcomes, and these kinds of things too. Okay.
Matt Boettger:So the last one we're talking about is a loaded topic. So I'm going to start this phrase, this, and we're going to get into it. I think in whatever way we can. So I want to frame this. I had a personal story. It just happened recently. That's, that's plagued our household and I want to set the stage for last week. We heard about Johnson and Johnson being put on pause because of this rare blood clotting issue, which you're going to have to, maybe if you can unpack some of this Stephen, cause I don't know whether they overlap at AstraZeneca or if they share the same kind of blotting blood clot characteristics, but we know the AstraZeneca. And we see here now, and also put this in perspective for everyone listening, that it is like one in a million chance that looks like for these sorts of very, very rare. These are hard statistics that I've learned from you, Steve, and actually come up with until you get to that point of having well over a million people participating in this reality. And we live day to day with much higher risks. There's this beautiful pup or this kind of image I'll put in the show notes of pregnancy. It's like one out of every six blood Claudine obesity, one out of like 10, I got the numbers wrong, but they're roughly proportionate. You could, I'll put it in the show notes, lots of different things that we live in day to day to day that are much higher risk for blood clotting. So this is coming out of a sincere sense of caution and looking into what might this be happening? So last week, Stephen, this is brought up with Johnson and Johnson. And also last week, my wife was diagnosed with a blood clot. So, this has complicated our own household dramatically because my, my wife got the Pfizer vaccine on April 1st. So you could see this is within a timeframe close enough that it could cause a lot of alarm for us. It just wonder, especially it's like, I feel like it's our life, which is the perfect storm sometimes. Like yeah, of course it would come out on the Johnson and Johnson week. You know that we get this and now we're struggling through this wondering what's the best thing we can do, but I think. Now, I'm not saying that by any means that I think that it is the Pfizer vaccine, the vaccine that led to my wife's, it's a superficial blood clot. It's not anything that's deep. It's very shallow. Just one small one of course these concerns. But the biggest thing I want you to talk about Stephen, is that. It seems as though when it comes to blood clotting with the vaccine, particularly Johnson and Johnson and or AstraZeneca, it's a particular kind of blood clot, right? It's not just the superficial one that my wife has is a different kind of one that we're dealing with. Is that correct?
Stephen Kissler:Yeah. So the, the blood clot that is the type of blood clot that has been really causing concern or at least as it has been, has led. So the pause of the vaccination with Johnson and Johnson in the United States is a cerebral venous sinus thrombosis CBST. And so, and so that's, that's already one of the important areas for, for distinction, but also one of the reasons why Yeah, why I think that the vaccine trial was, was, or why the vaccine Why the mass vaccination with Johnson and Johnson was put on hold to review the data because so these are blood clots that are generally happen with, within veins in your, in your head. And so they can be a lot more severe generally speaking than than the superficial blood clots or even the, the DVDs and all of these are worth checking with your primary care physician. Absolutely. Like if you're concerned that you might have a blood clot for any reason, Absolutely get it checked out there. We, we have ways of dealing with them. They're, they're actually a very common thing. Generally. They're a very common health concern. Certain types of blood clots, especially things like superficial blood clots. That's quite a common that's quite a common Presentation. And so, so absolutely. I mean, I think first and foremost, if there's any concern whatsoever, just, check with your primary care doctor and go in and get checked out. Cause cause each individual case will differ from every other. And I think that's the important thing. But we can, we can talk about this with respect to the, to the vaccines and the trials and the broader questions of like, is, is this caution merited? Or should we be doing, we, we have these competing risks and like you're right. That like, Yeah, by a lot of metrics are probably more likely to get killed in a car crash on the way to the vaccine site than you are from from one of these blood clots. But, but I think that the there's also, that, that doesn't. There's a little bit of a false comparison there that it's not totally a comparison of apples to apples. And so it really what I want to say. So first the question about blood clots has, has principally arisen with so far the Johnson and Johnson vaccine and the AstraZeneca vaccine both of which have a common Yeah, basically mode by which they work. They're, they're both inactivated virus type vaccines, which is very different than the MRD vaccines of Pfizer and Medina. And so part of the reason why this Paz has been put in place is because there have been these rare reports of blood clots associated with each. They have a common mode of action. And so we need to investigate, is, is there maybe something about this, the, this platform of vaccination that, that leads to an increased risk of blood clotting? Again, blood clotting is very rare. You're actually much more likely to get a blood clot from COVID itself. And, there've been a, COVID has been associated with strokes and blood clotting and heart attacks and these things. And so it's that, that I think is really a worthwhile comparison because there you're far, far, far more likely to suffer from we, we talked a lot in many podcasts ago about COVID being a vascular. Illness and that remains the case. Absolutely. And so, so in terms of the risk calculus there, COVID, COVID remains much more risky of a proposition than these vaccines, even after we've seen these vaccines rolled out to millions of people. So, so there are all of those issues, but, but then the question is, should, should we have positive the vaccine the, the mass vaccination, should we have, stopped. Giving the vaccine was this merited or, because there is a trade off there too, right? Like there's there's a, trade-off both in the people who might be immediately be able to get vaccinated. And the vaccine may have saved many lives that people will go on to get COVID and, and, there there's a real ethical difficulty there. It also is an issue with the image of the vaccines. These vaccines are especially going to be important. For communities that have difficulty storing the MRN vaccines, which requires special freezers and difficulty just distributing. And so will that undermine our ability to vaccinate populations that, that need these vaccines too. But, but also, we want to make sure we're doing this safely, right? Like we're Getting a vaccine is, we're, we're administering a, something to a fully healthy person in the, in the aim of preventing future illness. Right. And so we rightly should have very, very high standards for the safety of these things. Because we're essentially, asking and encouraging everyone who's healthy. To get these, and so, and so we should be very certain that like, if that's going to be our platform as a society, these things should be very safe. And so I'm encouraged by the fact that, in many ways, this is the, this is the vaccine review process working as it should. We reviewed the data. One of the things that this does as well, is it alerts physicians to the fact that there may be a link here. And so, that will hopefully help with the gathering of data. And the ability to make more robust estimates of if there is a link or not. And to what extent that link is there. And so I think that it's, it's, it's really important that we do this. And, and generally I'm, I'm, I'm encouraged by the fact that it's it's proceeding the way that it is. It's really difficult because there are so many trade-offs and there are just no clear cut answers for, for how to weigh trust and risk and all of these things together, especially on, when we're thinking about the, countries with millions of people or the world as a whole But yeah, so I think that, that it's, it's good that we're following up on it. There's, to recap, there, there have been reports of blood clots that may be associated with these two particular vaccines. And have generally, to my knowledge, they haven't been reported with, with Pfizer and Madrona. And even with the AstraZeneca and Johnson and Johnson vaccines, they're extremely rare. But they also can be very serious. And so it's something we need to follow up on.
Matt Boettger:So two things with this number one is, from what I've read, at least the Johnson Johnson. One, one of the big articles I read is that it wasn't paused so much to just to figure out whether about whether they should stop giving the vaccine, because it is a really rare thing. It seems as the biggest reason was how to make sure we're all unified in how to treat it. Because maybe there was some confusion on how to treat it, if it does happen. Right. There's rare, rare occurrence. Right. So treatment's really important that we're all on the same page of how it's gonna be treated if we become aware of this rare, rare one in a million thing. So it can be treated in care. Second follow-up question is that you're leading into this. I don't know if this is a, you can answer this, but is this standard for this vaccine or the vaccine general just higher than normal. So. If this was any other vaccine, that's like sub sublime, not in the news every day. Just going through its normal humdrum, say a flu, your annual flu. And this came up with this similarly be paused. Or is this something that's so rare that it would have just kept going along the path and just being treated? Is this something that we're giving a higher standard too, or is this normal practice? It would have happened on any circumstance with, with the vaccine.
Stephen Kissler:Yeah, that's, that's a great question. And, and I don't know if I can say for certain if that's the case, you're right. The COVID vaccines are, are under an intense amount of scrutiny right now. And so in some ways you can imagine that the bar is even higher for them than for many of the other vaccines that we, that we have in that have already been broadly accepted as, as safe and effective. I, I anticipate that That if, if we did see these kinds of things emerging for something like a flu vaccine or for other vaccines that are more routine, that, that that we would pause their administration and, and, and try to sort out what's going on. I do think that the regulatory agencies really do try to to, to treat these things similarly when, when, when they are in fact similar. But it's, it's, it's difficult to say because you're right. There's This is it, it is a new vaccine. We, we haven't had any Corona virus vaccines prior to this one, really none that were effective on this level. And so, so we are in proportion to that we are giving it more scrutiny. And so I think, I think really the answer is that if if we were to. Observed these kinds of events with other vaccines. I, I'm pretty confident that we would stop them. I guess part of the question is whether, whether we would in fact be able to observe it and whether even the people who got the vaccines themselves necessarily notice and report, that, Oh, I got a flu vaccine two weeks ago and now there's this thing. I don't even know if that link would necessarily be drawn in many cases. Whereas now it certainly is. So there's a lot of complexity there too.
Matt Boettger:Yep. It's complicated. Okay. We have one more thing to talk about. First of all, I'm gonna drop this quickly. I saw this in the news a couple weeks ago. I thought it was interesting about NASA. Just, I didn't think about it before, but they saw some, some study on actually helping the immune system. We're in a mess because of just the idea of the humidity within your own mask. And like that mucus is a really important part of helping to filter out things. And so there was some evidence about even showing how wearing a mask and the humidity can actually help with reducing infection just by having that. Whatever, it's not in your nose. All right. So I'm
Stephen Kissler:going to go over. It's super interesting. I, yeah, it's just like a really interesting idea because it's true. I mean like respiratory viruses in particular in temperate regions, they spread generally when it's cold and when it's dry and you're basically making a little a little tropical environment right there in front of your face, exactly right. It's like Maui. And so. Yeah. And, and it's, it's hard to know, like what is it necessarily about the cold and the dry that makes the virus more likely to propagate in the air and these kinds of things. But, but I think it's a really compelling idea and I, I love it. I'm glad. I'm glad there are people looking at this.
Matt Boettger:You're awesome, Stephen, this is a great, okay. Last thing I want to drop this, even though I have to use the bathroom as soon, but we're going to keep going, because I want to talk about this is that one in three COVID 19 patients are diagnosed with a neuropsychiatric condition. I switched you to riff about this for me, because when I first read it, I'm like, this is weird. I'm I didn't know where to put this in my category. Cause I'm like. Oh, I thought, Oh yeah, PTSD, normal. This is what happens with anything that's like, especially now with a pandemic. And if you get COVID, you've got a stigma, you got it. You're afraid, if if you have a long haulers, so of course you're going to have, you're going to wrestle. Right. I would imagine on some level, just in your own mind, but it seems like this article is taking that intake into another level of it may be potentially associated that maybe COVID itself. Could be contributing maybe to some neuropsychiatric condition. And I know before I didn't quite get where you're going on this before we got on the air, you were I think talking about how this is something that, that is understudied, but, but maybe there could be other relationships with other viruses that actually contribute to this a little bit that we just haven't been able to dive deep in. So can you talk about this about a little bit in the context of other viruses as well?
Stephen Kissler:Yeah, totally. I mean, so yeah, it's, you're right. There's, there's so many difficult things here because first of all, like we, as a society have been through a pretty traumatic event. And whether or not we've gotten a COVID certainly we know people who have and have been afraid for them. And yeah, it's just really difficult. And yeah, so there's. I think that it is worth highlighting that those things, there's, there's that phrase that I, I, I don't particularly like, which is that, you know, Oh, it's all in your head. It's like, Oh, of course, like everything to some extent is, is in my head that doesn't make it any less real, and, and so certainly the stress. So the, the recovery from the trauma, from the guilt, from the concern from the anxiety, like all of that is weighing on everyone. And, and that can really be exacerbated just by the experience of having had to COVID and still being concerned potentially for your future health, because there's more and more evidence that that long. But COVID that these chronic manifestations of COVID two are absolutely there. And it's interesting because like you say, like some of these things do have a neurological elements to them, a neurological component, and it is something that we don't fully understand. There, there is a fair amount of overlap with. Certain elements of long COVID and something called chronic fatigue syndrome which is also a relatively rare thing, but it's basically just marked by chronic extreme exhaustion. It's generally more common in women. If they're, to our knowledge, there's no clear cause, but it does seem like it can be brought on generally by infections sometimes. And it can last for months. And and. So there seems to be elements of long COVID that seemed to be consistent with that. And that is absolutely seems to be a neurological phenomenon. But it's, it's something we're really only beginning to understand. Like we don't totally know why a COVID would would have these neurological symptoms. But it seems to be there, And it's, it's something that really deserves a lot more attention. It's something we're starting to pay attention to. And one of the issues with chronic fatigue syndrome and other other illnesses like it is that it can be very easy to just sweep them under the rug as somebody who's being overly. Dramatic or, someone who is playing up their symptoms or something, or that maybe it's just, something that requires it's like a psychological thing, but certainly can't be something that's associated with anything medical. And partly because of that, because simply because we haven't had a clear medical explanation for it, I think that in many cases it's made Medical research blind to it. And so we're trying to catch up now because it's, and now it's becoming pretty pretty unequivocal that there are elements of this that can be associated with COVID. Especially in young people who have gotten COVID and we need to understand it better, but we're still at the very beginning of that.
Matt Boettger:Okay. We'll try to keep a little pulse on that. See where it goes as it develops. I think it'd be a fascinating thing to talk about more as we see more. Related to that, I think that brings us to the end. There's more we could touch hat about, but this guy has to take a bathroom break. So we're going to close this up. If you wanna get ahold of Stephen S T E P H E N K I S S L E R on Twitter. If you wanna reach out to us, let us know how you're doing, how we can help. If we can answer a few questions, you can just email me@mattatlivingthereal.com. You can check out my podcast as well, living the real, have a new one dropping soon. That should be pretty fun. And I think that's about it. If you want to support us patrion.com/pandemic podcast is a little$5 or one-time PayPal Venmo all in the show notes, have a wonderful week. We'll see you next Monday. Take care. And bye-bye.