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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!
Click here to listen to Matt's Living the Real podcast episode on the three things you can do right now to get your head above water if you feel like you are drowning.
Resources to Help Support India
Things Discussed on Episode:
You are listening to the pandemic podcast. We equip you to live the most real life possible in the face of these crises. My name is Matt Boettger and I'm joined with a good friend once again for multiple weeks in a row. Dr. Stephen Kessler, an epidemiologist at Harvard school of public health. How you doing buddy? Hey, I'm good. How are you doing well, Dr. Mark has gone again, but I think he'll be back next week. I think that's the hope to have him back and I, we have some questions for him. I, so your weather over there is going well for you. Hey, it
Stephen Kissler:is. Yeah. It's finally, finally feeling like spring. I think I mentioned this before, but I've been getting these pictures on my phone where we have these and it's shows me a year ago. How much was in bloom and right now, like there's a lot of trees still dead, but they're finally coming.
Matt Boettger:Good. Good. Yeah, it is. It is a little bit cold here. We're getting some rain, which is great. This is why I love Colorado. For those of you who have not visited Colorado, in my opinion. You want to come like maybe early June now I know it's not the hottest time. And in the mountains, it might be still a little cold and some more snow to man. It is green. And we were joking a little bit ago that when you, if you drive here, you're going to be greeted by a wonderful sign from Colorado saying welcome to colorful Colorado. Now I have no idea who was smoking. What, when I made that, like that bright color for like literally 10 months out of the year, it is either dry and Brown or just Brown and gold. And then they get the one month where it's green. So I don't know. But coming into June, it's fabulous. It's gorgeous. It's green here. Okay, so let's get going. Number the number of normal things. We love reviews, the one came in last week. Thank you so much. You can do that on Apple podcast. And I think there's a couple other directories that allow you to write up a little bit review. We'd love to see them and inspires us. Thank you so much. patrion.com. Slash pandemic podcast. You can Orishas pandemic. I forgot. I forgot, but it will be in the show notes. All of a sudden having a brain lapse, it was only times. Well, you'll find it. Do you want to support us$5 a month? You could go a long way to help us keep this going in so many awesome directions and PayPal, Venmo one-time gift in the show notes. We're thinking about doing this, Stephen. We talked about this. We don't know yet. So if you want to give us feedback, Matt, at living the real.com, send me an email though. Apple podcasts has released an opportunity by which you can basically give, say$3 a month,$5 a month and get exclusive content from podcasts. So we would never want to put our normal podcast behind a paywall because this is public information. So we would never do that. Well, we're thinking about to help support this. And now all of our Patrion subscribers would automatically just inherit this through Patriot. And we wouldn't disown you guys by any means. He has helped us tremendously, but maybe doing like once a month, a rotation of maybe like a book review that we had that Stephen Mark. And I just read a book and reflect them on it for an hour. That's a really good book to help us just navigate life. If you're interested in that, like it's four 99 a month and you get access to that. And then the normal podcast will. Continue to give, send me an email. Let me know what you think about that. If you'd be willing to subscribe to that, to help us. That's four be like sitting like 409 a month. We'd do that. You did that mad@livingthereal.com. Send us your feedback. One last thing I dropped to the episode on living the real, check it out the truck last Wednesday. This was all about three ways by which you can get your head above water, because I know I mentioned a lot of this idea of discovering the gift and things. We talk about this in light of the podcast and sometimes it's really cool. It's like sentimental Oh, that's really great. But when my crap is a mess or my mess is my life is a mess. My crap is a mess. Makes no sense when my life is a mess. You need to get your head above water first. So three ways once you get your head above water and then beginning to discover the gift in life, check it out. And I have another one dropping in just a couple of days. Okay. So let's get going. Here's the big thing, Stephen, I want to talk about long there. So now I'm in thinking about this. We've been dealing with all the vaccinations and this has been wonderful. I think we're like 33% fully vaccinated, 45% or 46% of like that at least half vaccinated. So my guess is, and we're talking about this off the recording is that the shift is going to go probably to children's soon. Now it's always been in the media, but I feel like there's going to be an exaggerated focus on this because now we have this whole set. This whole demographic is not vaccinated. So we're going to be thinking about them. We're going to start seeing cases. I put this in quotations rise because they're not vaccinated. So it's going to cause a more dramatic scene for children. So I want to start with this because long haulers is obviously been in the news since last April continues to grow. The CDC is coming out with guidelines, a deal with long haulers. We just heard from a listener who actually has long haulers right now is going to a clinic. So this is really part of people's lives, upwards of 10% of adults. Suffer from long haulers after COVID. So we don't want to tell people this is there's some of your life. That's probably going to be suffering in some extent with long haulers, but I want to talk about children. Have you been seeing this on the radar? We've had one of our listeners send me some information about this. Some Dr. Daniel Griffin. I haven't watched it yet myself. I don't know to what extent, how credible it is, whatever it may be, but it sounds like it's relatively credible. And he is saying upwards of 12.9% of children, are he seen suffering from some sense of long haulers? So I wanna kind of 30. What are you guys talking about in that sense of children, long haulers, where this is a real thing and whether this is, how do we deal with this in the coming five to six months, as people go back to school have summer vacations and we have a bunch of unvaccinated children.
Stephen Kissler:Yeah. I think, this is I think you rightly point out that this was going to be one of the next major focuses as we move forward in the pandemic. As you said, we're, we've vaccinated a really huge percentage of the older people in our population in the most vulnerable, still got a lot more work to do there, but the proportion of cases that we're seeing across age groups will continue shifting towards younger age groups. Because schools will be open and older people will be more protected. And so the the burden of illness, it will make it seem like COVID is becoming more of a childhood illness than an illness that affects everyone. And I think that will really place a big emphasis on this long haulers issue. Because it really seems as you go to younger age groups, That often becomes a bigger and bigger issue. We've seen especially long haulers syndrome being prevalent among young adults who get COVID. And to some extent kids as well. No, I really do want to emphasize that as far as what we know it's still. Relatively rare we think, but it's really difficult to know. There's a lot of uncertainty as to how many people actually do end up with these sorts of syndromes. Partly for there, there are two reasons for it. Partly one of them is because there's such a variety of different symptoms that a person can develop that can be consistent with long haulers. And they vary in their severity. It can be difficult to say, whether it is in fact long haulers or if it's something else And it also differs a lot in timing. You can develop these symptoms weeks after you had your acute COVID infection. And so it makes it really difficult to decisively attribute it to the COVID infection, although th the power of statistics and the ability to observe many of these cases over time makes it very clear that this is this is absolutely a phenomenon. Like this is something that happens in response to COVID infection. So it's true with the link is there? Absolutely. But now we're trying to figure out the more nuanced, quantitative questions of how many people, how severe, how frequently for how long. And I think those are things that we still don't have a lot of really good information about. Both because we haven't really had enough time to observe it. And because it's really complex. Chronic illness is a really difficult thing to study because it's usually the things that contribute to it are so complex and multifaceted. And and but with all of that said, I think you rightly point out that this is going to be one of the areas where a lot of research is going to go next. Because in some ways this is becoming the new front in the in, in our effort to, to beat back the pandemic.
Matt Boettger:Yeah. I feel like this is going to become a pretty significant fear in my mind because it's one thing to deal with COVID, which is like a light switch. It's either on and off, you get a PCR test and either have it, or you don't. And then with long haulers, like you said, there's, we know that long haulers is a thing. It is a real thing. But when you come with chronic illness, there's not, no say a light switch because it's one thing to say it is a thing. And then when you're, after you have COVID. Then you're like, what is that thing? And they're like, Oh, maybe I have this symptom. And then that's added to the pile of long haulers and then we have to discriminate. What's actually contributed to long haulers and what's, what's going to be actually to COVID and what's something else and that's going to, and then that whole negotiation, I don't know how he even weed through all this stuff, but I feel like it's cause 10 and 12% of people with long haulers it sounds really scary, but of that 10, 12%, what are the, what percentage are those things are actually significant? We've heard from some of our listeners is shortness of breath. Like really can't even go up the stairs, right. This utter fatigue where you can't even work anymore. I These are significant things have long haulers where, you know, but other things that are they're more mild, it's hard. But then if that's lumped in, it sounds like a big percent and is I'm sure right now it's still so certain. Do we have a breakdown at all? Or is there of okay, there's really only. Right now we're currently seeing only the, maybe a 0.5% chance of something like shortness of breath going up the stairs or utter complete fatigue and all these other things are just these mild symptoms. Do we have, is there any resource to see that or is that still being
Stephen Kissler:sorted out? Right. There's like something in my memory that's popping up that I think that there is there was at least, probably a month, six weeks ago. I remember coming across some paper that was looking at the relative frequencies of these things that were observed in some region of the United States. So again, that's already a very specific population and it's hard to know how much that generalizes, but I'll see if I can dig that up. Cause I don't remember what those numbers are but absolutely people are measuring them. And we're starting to get more and more clarity about that. Yeah.
Matt Boettger:And the reason why I bring this up is because I'm a dad, right? And so I had these kids who were unvaccinated and they're, there's six, they're five they're three, and I kind of love them. They're cool little kids and I mostly don't eat most of the time, about 40% of the time. The great, so now here we are, we're going into summer and they're unvaccinated my wife and I will be fully vaccinated soon. We we're thinking about going on vacation, not flying, but driving someplace, but even doing that exposes the risk. And so now with long haulers becoming in my surveillance, it comes on my radar with kids. Now I'm like, at what level do I expose my kids at a risk? And because I'm the person that I'm okay, risky my children now that sounds really bad. But I do that every time I go on a drive, right? Every time we'd go on a drive, I'm risking my children. But I don't want to do anything. That's going to let it exaggerate a risk. I'm trying to figure out how do I quantify this? Is this something to be concerned about? Or you know what, mom and dad are vaccinated. We're okay. If they're, I'm curious, I'm gonna throw this back to you, Stephen again. Cause you see the CDC talking about, okay if you're vaccinated, it's okay to be with other vaccinated people. You can be in small groups with unvaccinated people like one of the household. And I don't know the details. Please check the CDC for the official. I'm just spitting a whatever I'm thinking of. But when it comes to children, is that a different ball game? Because if I'm going to see people, I'm dragging my kids along. So do they fall in the vaccination category of like mom and dad are vaccinated and the parents are vaccinated? Or is that a, do you see the hard distinction? Cause I'm dragging no matter where I go, unless I'm going to work, I'm dragging on vaccines. People to CDC have recommendations for actual families or just individuals, or how do you deal with that mess of going to a birthday party,
Stephen Kissler:right side? Yeah. I mean the, the guidelines are generally just at the moment they're just posted for vaccinated and unvaccinated individuals. So your calls, your kids would fall into the category of un-vaccinated. And so that would be Yeah, that would be that. But again, you're right. It's complex because there, the risk of anything severe happening to them from COVID is small relative to what yours was, for example, or mine before before we were vaccinated. And certainly relative to, what our older relatives might've been even long haulers included, as far as what we know it's a risk, but it doesn't seem to be, if it were like really causing huge amounts of devastation amongst kids and young adults, like we would really notice that. So it's in that, that's, this is taking a step back, but I feel like it COVID has really struck this weird middle ground in so many different ways in terms of it's. Infection fatality rate and it's infectiousness. And now like this risk of long haulers where it's in this like murky area where it's like clear that there's an effect, unclear exactly what that effect is and unclear what exactly we should do about it and how much we should be concerned about it. And it puts us in a suit consistently. I've been just amazed how consistently this infectious disease has put us in this position of just utter confusion. And so I, and I think we're still there to some extent. Broadly speaking, I think that again, from everything that we know young kids don't have a, there, there's not a super high risk of them. Developing severe outcomes from COVID either acute or long holler but it is absolutely a possibility and it's something that we're, we're working to get more information on okay. So
Matt Boettger:now I have to go on another tangent really fast, because this is, I've been thinking about it in the shower this morning. I didn't even talk about this with you, but this is, we talk about things as a possibility now, is that just purely like empty semantics? Because is there anything impossible in the realm of science? That's realistic? Like I was able to, cause really is pretty much everything is on the table. Within, unicorns popping up out of nowhere. I get it. That's not really possible in science. But like normal day to day are things that we're afraid of. Like the things I feel like it's hard to deal with this because like, when he's it's possible when I tell people that, Oh my gosh, it's possible. I go I don't think I could. Any scientist could ever say anything that's like real consideration well, that's impossible. Is that even though I don't think it's even, you can't even use it. That's not even a starter.
Stephen Kissler:Exactly. Yeah. So like within the sort of scientific frame of mind we. It's funny because you should always be very skeptical when anyone tells you that there's scientific proof for something we don't deal in the realm of proof. We deal in the realm of evidence and it's an evidence can only go so far as giving us shades of probability and likelihood. But it can never rule anything. Absolutely. And nor can it rule anything absolutely out. Science is always open to the the rare possibility of something. And and, and that's, I think that aligns with our notions of belief as well, there as our experience and our logic come together to give us, strong reason to believe that something is the case. Then we do take that last leap and say I can lead in my life as if this were true or basically almost always true. Yep. But even, even in something as as rigorous and logically tight as mathematics when we think about this is esoteric, but when we think about probabilities the way that that the fundamental theory of probability is constructed when we say when we colloquially say that something is, has a probability of one, which means that it's certain in mathematical speak the way to say that precisely is that the probability is one almost everywhere. And you can never within measure theory, you can never get certainty. Even within measure theory, it's almost everywhere because there can still be these tiny little gaps that have essentially probability zero and in the limit, don't contribute to the probability at all. But even in mathematics, we head around to this idea of absolute certainty, which is remarkable to me. So if we can't do it in mathematics, we absolutely can't do it in science.
Matt Boettger:No way. This is fast. We're going to go on a tangent. Here we go. We'll get back into the back of the weeds and just a second, but this is this whole idea of like certainty dealing with uncertainty. This is a big philosophical issue, or I think even more, maybe not philosophical, I think anthropologically issue in the U S particularly. So I think we've created this artificial construct of certainty around our lives and we can, everything from the most practical, easy things from air conditioning to heat and controlling our environment, everything's under our control with certainty. And then this pandemic is just, so we've talked about this before. It's just really flip that on its head. And so we're grasping, and I feel like I just, this morning, I just think I feel like possibility and the L in the realm of science as well, when people provoke the scientific community for saying the word possibility. I think it's nothing more than just an emotional response. Like it's probability is much better. Is it probable. Well, no, it's not probably a possibility. It's if nothing is impossible, then everything is on the table so that everything is possible. So you've really, haven't really gotten much ground on your inquiry. What we're looking for is this really probable and then comparing that I think in the end, is it probable? So with children, is it probable that, my, my own child could get COVID have severe reactions and have long haulers. I would say clearly it's very highly improbable. And then even that some moms still raise their, the hair on the back of their neck. Wait a minute. It's still possible. So the only thing the next step has just been trying to cause it's so hard right now, numbers is just something we don't naturally grasp with. And then the best thing we can do is just compare things to our normal day in life of like the things that we normally do have such high risk, but we do them every day because it's just part of our culture and it's not that big of a deal. And so to help bring a mental stability, I know this probably sounds like I'm venting all this stuff, but this has been really on my mind. Like now it's like the next step of like in my, when I unleash my kids, if we, at least our kids are going on vacation and my unleashing them to like some risks where I'm like a bad dad. And I think the answer is no. We're do our normal safety things. Cause it is compared to our normal day life. It's a relatively safe reality. Right? Right. Speaking of possibility, So India clearly thought that it would no way in heck that they would ever reach a second wave. It wasn't possible. They had under control and it's been clearly worse and worse and worse. Another record. I Just when I keep hearing them maybe went down a couple of hundred thousand, like 397,000 cases in a day, which is outrageous, it bumps back up to 400,000 again, the day after this, can you give me a little, just give us a little update on India, what's going on? And particularly if there's anything I've noticed with variants that we need to be concerned about or why it continues to
Stephen Kissler:rev up. Yeah. So this is, yeah, it's something we've really been thinking about a lot. The situation in India really continues to be pretty dire and cases are still going up. And it's yeah, it's they continue to see a, really one of the worst surges of COVID that I've seen yet over the course of the pandemic. Yeah, I think early on, India saw a early your wave of COVID. But it was, was a lot more gradual than this one and even gradual relative to many other countries and they were largely able to manage it. And so there was a lot of speculation as to, as to why that might be the case. One thing is that the average age in India is relatively low. They have a pretty young population overall. And so that really shifts the No, the odds that a given case leads to a hospitalization or a death, if just the average person who gets infected is somewhat younger. So maybe that was part of it. There was some question about previous immunity due to circulation of other Corona viruses or due to people getting the tuberculosis vaccine. There's been some people wondering whether there was a link between getting the BCG and and some level of immunity. So there were all these questions, but essentially what they did is it seems like it, it built up this sort of notion that we haven't really been hit hard yet, so we probably won't be. And I can't say that I find much fault. Yeah. And that reasoning other than, I think that given what we've seen that COVID can do and how much it has the ability to surprise. I think that I, I, personally probably would have been invited to go anyone being too complacent, but absolutely, it seems like from both studies and reports from people who have been living there that there's that notion kind of sunk in. And there has been a lot of Just the many places it is. There hasn't been a lot of distancing. There've been a lot of large gatherings with recent elections with with even religious ceremonies and and India is also just there's just a lot of people there. One of the things that we've talked about really consistently is cities tend to get hit really hard just because the population density is so high. You have a lot of people living, together. And that's part of why we saw such a bad outbreak in New York, for example. And that's absolutely the case in many parts of India too, where there's this isn't to say that, I want to be very clear that I'm not wagging any fingers here and saying Oh, you should have done something different. Like this is, this is just a really difficult reality. That they're just, if they're just a lot of people there and there's just no, no way necessarily to have distancing that that would need to be there to, to prevent a major surge of infection. So all of that is there there's with behavior, with policy and with just sheer bad luck that are probably playing into this. But then so then that brings us to the question of variants and I think I've spoken on previous podcasts about how I generally my. My predisposition is to try to find behavioral and sort of natural explanations for things before I find like biological genetic explanations for things. That's not necessarily, a rigorous position other than in my experience, a lot of the time it's easy to get duped and to think that something is attributable to a genetic difference when in fact it's just a confounded by some other factors. And so I'm usually very slow to accept that there's some sort of, biological phenomenon that's contributing to this, but there's, I was talking with some colleagues the other day and this. That's starting to chip away a little bit with this situation in India, for me as well. So one of the big questions is that the dominant variants that we're seeing in India right now, I think is the B one six one seven. And and the question is, eh, it did that one, just get lucky were there just a number of super spreading events that coincided with these big gatherings that caused it to take hold? And so there's no real difference between that and the others, but that just happens to be the one that got lucky and spread everywhere, or is it more infectious? Is it more severe? I've been holding out on, on saying for certain, which is the case. And I think that I, and I still do, I'm still really not saying for sure. I don't think we have enough evidence either way to know for sure. But some of the evidence that we've been looking at to try to answer this question is the sequencing data from India. Unfortunately, there's not a lot of it. There, there hasn't been a lot of genetic surveillance going on there, so it's really hard to get a clear sense of what's going on. But one of the concerning things that I've seen is that so one of the clearest ways to see whether a given variant is more infectious than other variants is to look at the relative proportions of the variants that are circulating in a given population. And so even as, cases, rise and fall, that's going to have some natural variation to them, but if very consistently one variant enters a population and then quickly goes to make a large proportion of the number of cases in that population. Then that's pretty good evidence that, that variant is more infectious. And we've seen that play out with just the UK variant over and over again, basically everywhere. It's gotten a toehold within a couple of months that has completely taken over it's happening in the United States, happened in much of Europe, very much happened in the UK, so that's like very clear, very solid evidence that's more infectious, more transmissible than the ones that we were seeing before. Now comes to be one six one seven, and there's, there's some early evidence that suggests that in India had entered and was on that same trajectory of increasing. Then some of these B one six, one seven variants and sub lineages emerged and B one, one seven got beat back, which is very concerning because we haven't really seen that happen in other places around the world. Now, again, it's not enough data to know for sure whether that's due to some bias at the sampling, whether that's just due to, you know what, but that for me is the clearest alarm bell that there might actually be something about this variant to that that is more infectious than what we were seeing earlier in the year. And potentially is as, or more infectious than B one, one seven as well. Again, so still we need a lot more data to know for sure. But it's at least on the table. If there's something about this variant too, that's making it a lot harder to control. And that would also partly explain why What's happening in India right now is happening.
Matt Boettger:Yeah. Okay. A couple of things, the first thing was, I feel like the India story seems to confirm what you were saying a few weeks ago. When I proposed that I read an article, I was like, Oh, maybe it's because of the U S we reached so much natural immunity. That that's why we're doing better off than, and he said yes. And California was just got destroyed by variant. So really it probably could have been the variance to cold and then ripple to the East. And it's more of that. We got not just natural immunity from the original. We put some quotations lucked out by being rippled by the variants. And now we're seeing some collateral advantage of this, which is now, whereas I think India being so early on hit. With the first wave, it was probably more of the novel original one. And now the variant is just, wrecking havoc with India. And it's some good news, at least from my read the vaccine, particularly Madonna and Pfizer, I think still is effective with this one that we're talking about India. It may not be quite as effective as it's been, but it still has a good strong hold on it as well. Speaking of which, is there any indicator that this variant in India, the bumblebee, blah, blah, blah, blah. I have no idea what that is, but has it made its way? Have we seen it at all, anywhere in the U S or is it just now we just see in the, in, in
India?
Stephen Kissler:Yes. It's absolutely a spread outward and we've seen some cases I believe here in the us and a number of them across Europe as well. So it's here. We don't really have clear evidence if there's like sustained transmission of it here, I think. But it's been detected for sure. Okay.
Matt Boettger:So it's probably, so it's important to know the distinction, at least from my own mind, if something can actually be here and it could be more aggressive than other ones. And it doesn't mean automatically that's going to take hold because you said it has to have what you just said. I forgot if it, if it's enough to sustain itself.
Stephen Kissler:Exactly. Yeah. It's because with these it's so easy to think about these sort of any virus, but also the variants in particular sort of in isolation. Like what are the properties of this virus? But That in reality, we can never do that. It's always the interaction between the virus and the population in which it's spreading. And so certain variants will be very well-suited to spread like wildfire in certain populations and could die out in others, depending on how much immunity there is and how, what the interpersonal interactions look like and how age structured they are. And how much vaccine uptake there is, which vaccine is it, and, all of these different things. And so an identical genetic variance can look very, very different in two different populations. And at this point there's so much variety in between countries and between regions within countries as to how the pandemic has played out so far. That it's it's really hard to predict, what any one of these variants will do when it's introduced into a new population.
Matt Boettger:Good. That's always nice. It's good to hear that. Always help with it, even though it lands here, there's still things we can do to keep it away. So another thing, double mutant, we talked about a few weeks ago. We just mentioned it, but didn't, I felt this thing in my gut. I'm like double mutation. This is, it makes sense to me because Stephen I'm, are you talking to us about like different mutation and variants? A mutation is like a MI one mutation, a variance, a series of mutations. And then all of a sudden there's a double mutant and that's a big media splash. So NPR corrected me and you're going to correct us that this double mutant like horror film tagline, isn't really based on scientific journals and that kind of stuff. It's publicity. Yeah,
Stephen Kissler:I there's not really, to my mind, it's a meaningless phrase. It other than that, it makes it sound like we're in an episode of X-Men or something, which is kind of cool. Yeah, yeah. Because these variants have many mutations B one, one seven has a lot of mutations. All of the ones that we've detected, that's what makes them a variant is that they have mutated in multiple locations. And now this variant that has arisen in prevalence in India also has a lot of mutations. Nope. Part of what's behind this is that there are some particular mutations that we know are of concern. And so some of the variants have one of those concerning mutations as well as many others. Some of them have two, some of them have three, some of them have many and some of them are clear. So my guess is that this arose because as someone was talking with the journalist and said that it looks like this variant that we're seeing in India actually has to have the mutations for sure. That have been shown to be concerning in the lab. And it's ah, maybe it's, it's a double mute. And well, no, like there, there are other things that also have multiple of these. And the fact is that there are multiple mutations that all matter. And many of them, we don't know why they matter or if they matter, but they'd seem to, because they. They adjust whether these known mutations have a stronger or a lighter effect when the virus is actually spreading. So that said, yeah, it's kind of a meaningless term. And yeah, it doesn't really adjust our understanding of what's happening in India versus the rest of the world at all at this point. Yeah.
Matt Boettger:Good to know. Okay. So let's, I want to throw this back. This is a totally random question. That's maybe not the most timely because we're still in the middle of it, but we're towards the tail end. But I was thinking about this when I was thinking about India, but particularly with the U S now, Stephen, you had the huge article publishing journal that came out back in April. That was big. It was in the what's it called? Science journal, right? The college of science. Yeah. When the biggest journal out there, you were the you're the first person, so great. You did a great thing. It was all about now I didn't read the whole thing, but I saw parts of it. It was really looking at different ways by which this virus could. Right spread and over the next 12 months. And you had different models by different situations. Now, I just want to pick, now it's been over a year since that, that was published, looking back, was there one particular model that you propose that actually fit closely to where the U S to happened? And I would love to pick your brain for just a few minutes. Now, if we could rewind knowing what we know now about COVID would w would you suggest or have done anything different or proposing different back in March and April now that we have so much more information about COVID knowing that clearly that wasn't the case back in March and April, so we're just doing our best to get a stronghold, right?
Stephen Kissler:Yeah. So actually In many ways, I've been surprised that the model that we initially developed turned out to be as accurate for the questions we were trying to answer as it was. So one of the key things that we looked at was that if we want to maintain control of the virus and prevent it from overwhelming healthcare systems, that's going to require distancing or therapeutics or a vaccine. But at the moment, at the time, all we really had was distancing and there wasn't really any clear hopes for a vaccine or therapeutics anytime in the near future. So one of the main conclusions was that if we are going to keep control of the virus, we're probably going to have to be doing distancing through 2021 into 2022. Thankfully we do have a vaccine which, surpassed frankly, all of our wildest expectations. So that it's dramatically changed the landscape. But I think in the absence of that, Then absolutely we would have had to do intermittent on and off physical distancing all the way through the rest of this year. We may still be even with the vaccines. And it probably wouldn't have been until 20, 22 that we were really starting to see some live reprieve which is pretty wild, know. Yeah. I think that that really reinforces just like how fortunate we are to have a vaccine at this point. And at least in some parts of the world to start looking towards the coming summer and the Northern hemisphere and thinking about it with some sense of normalcy, like we're going to be able to see people we love and, and that's, that's really amazing. And I think that's really in large part due to the vaccine So that there were a number of, there are a number of projections there and, we looked at a number of different scenarios. One of the distinguishing factors was whether or not the virus, would it be susceptible to seasonal variation in weather and in behavior? I and my colleagues, I think had a strong hunch that it would but we also looked at models in which it didn't, but it seems like the models where we did incorporate some variation in seasonal transmission seemed to be, to match the closest of what we've seen, where especially in the Northern hemisphere, in the summer months, we've had an easier time controlling the virus than we have in the winter months. And that the real resurgences largely happened in like January or so. Just pretty aligned with what we predicted And one of the things that we're still not sure about, but that is whether there's cross in unity between the other Corona viruses and this one. I think that that's still a question and we don't yet really have enough data to know for sure. And if that will affect the overall spread. But so one of the things that I realized, and I think this was soon after we put out that paper, but has really been reinforced ever since is that one of the things that we really didn't account for there was the vast geographic variation and the timing of outbreaks. So the model that we developed what wasn't meant for that, it was meant to look at these long-term patterns. And so they're going to be roughly. Descriptive of the dynamics anywhere. But one thing we definitely didn't appreciate and totally at the time, and that I think I would have probably extended the model to look at was what happens when you have really severe outbreaks in one location. But the timing of those outbreaks varies a lot. And part of the reason that matters is because of the distribution of healthcare resources. If you have a slow trickle of cases distributed everywhere, that's a lot less scary than a huge outbreak concentrated in one particular place. Kind of like what we're seeing in India right now in many parts of India and that like we saw earlier in New York city and various places. And so I think that that would have really added an important element to the discussion of our findings and recognizing that as we were thinking about these interventions, as we were thinking about distancing, that it was going to look very different from place to place and in a way that we couldn't have really foreseen at the time, but I think has become clearer and clearer as the pandemic has gone on. So by and large, I think the questions that we set out to answer I still largely stand by. But I think that there's also now given what we know now, there's a lot more that we could do to make it even more relevant and align more closely with the particular transmission dynamics that we've seen in the meantime.
Matt Boettger:That's great. Yeah, when I first read that article again, I looked at it this morning from 2022. I'm like, Whoa, that's crazy. 20, 22, suggested still masking and distinct. But then I realized, Oh my gosh, of course. The only reason why I'm thinking that's crazy now is because of the vaccine, because if we didn't have the vaccine right now in India was happening. Oh my gosh. Who knows what would be happening across the U S with these variants? That the vaccine has been a game changer for the U S and I didn't mention this to you, but we went inside for the first time to Nana's house this past weekend. And the boys were like, just, it was the best day of their entire year. They were so excited. It was so hard to get them out. I Still my wife and I were masking sites because not fully vaccinated quite yet, but. The boys just ran around and she, my office, my mother-in-law was fully vaccinated. That wouldn't have happened without the vaccine. And just being close to civil. Speaking of which obviously vaccine hesitancy is still a big issue. We're seeing upwards of 24% of people still being hesitant about taking the vaccine or is saying they may not take it. Which sounds a little intense, but at the same time, it looks like three months ago that was 32%. So we're seeing a slow chip away and more information being put out there. Now I want to bring this up as a, I think it's just a great example of where we need to go with vex vaccine hesitancy and helping people get over that is, the Joe Rogan show the number one podcast in the world. I Gosh, 30, 30 millions in debt. I don't even know how many downloads a week, but just tons, right? And I think it's made all over the news by now, but he in the precepts had mentioned suggesting that if you're a teenager, there's really no need for you to take the vaccine. Of course, then that just splash on the news, got lots of feedback to Joe Rogan's credit of the very next day. He just literally said, I'm a complete moron. I'm not a vaccine hesitant person. I'm just stupid, and he totally agrees with situation, but so I don't want to do anything to throw Joe Rogan under the bus. I think this is just a great example of the way he was thinking. And, and this guy is maybe not the most brilliant man in the world. I'm not saying he's not smart. I'm saying he, but at the same time, he's, well-informed like he, he met with Oster home for three and a half hours in April demands, at least informed. I mean he, and so a really informed individual still makes the mistake of thinking that a vaccine, the criteria to take the vaccine is just, does it matter to me? And whether in my risks is the only criteria just shows. I'm sure many of us. Are thinking that same thing, but yet India is a perfect example of how this doesn't just concern you, that if we don't have teenagers and youth vaccinated and we don't get to a fully that the idea of the mutation that could impact everyone, including myself is really dramatic. So
Stephen Kissler:yeah, I think that, I think that actually, that's, it's really good to hold up. This example is like of That we have the ability to change our minds as evidence comes in. I think I really deeply respect that and I'm so glad that's, that happened it's and the more evidence we get, the stronger, the evidence becomes that the vaccines are very good at preventing against transmission as well. There was just a study that came out the other day from public health, England that was looking at secondary infections within households and showed that basically when you're vaccinated your risk of spreading it to a household member, really declines by quite a lot. And so all the more reason for thinking about vaccinating teenagers as well, because again, they're not even though the risk of severe illness is much, much lower than for many other people still there. And if you know it, it will help us gain control over the pandemic. I think these are important questions to wrestle with because you don't want to unnecessarily medically intervene on anyone. And so I, I think that also raising the question is really important. I don't want to brush it aside and just say that anyone who says that, like we shouldn't vaccinate kids is just an anti-vaxxer and should just fall in line. And absolutely, there's, I think that there is a lot of room for logical well-meaning people too. Think about this and potentially even to disagree on how this ought to play out, but certainly Assuming that the safety and efficacy levels are upheld in kids. I think that it could go a very, very long way towards preventing severe illness in them, preventing long haulers syndrome in them probably, and and helping to lower infection rates across the entire population. So based on the evidence that I'm aware of, it makes an awful lot of sense. But I think that's a, that's really a conversation worth having. Yeah.
Matt Boettger:I'm just so thankful, finding things to be grateful for it in the midst of the pandemic, the way it worked out. I don't want anybody if I'd be affected by this, but the fact that the older people were affected first now I'm not saying that I'm like, they should go here's my caveat is that when it comes to younger children, there is a larger safety net. Like I don't want to risk my children to stuff. So if it affected children the most first, which means we'd have to give them the vaccine first. Could you imagine the dilemma? I think it would have been that times a million, with older people, at least they get to choose themselves whether they want to take it or not. And then there's months and months and months of continued research and then new trials, because it's not I know, sometimes I feel like my sons are monkeys, but they're still human beings. So they're like, so even an adult and a child, granted it can change, but we're in the same species. So we can assume that if it's healthy for an adult, that will, hopefully the evidence will point to the same direction. That'll still be good for the child as well. So we have that and trials going on for children. The fact that I don't have to make that decision for my child and probably till December, January, it's just more evidence to show the support and, Oh, look, it continues to be really good and there's no big side effects. And so I think that's really helpful. I've only imagined if it was tables were flipped, the trauma of trying to make the decision for my child. It would have been a lot harder. Yeah. So totally not that again, not that I want anybody to suffer through this, but continue down the line here. Writing cases where at Colorado market chimed in with a text, just letting us know that cases in Colorado arising that the hospitalizations are about similar to late January. So something we need to take seriously, which is really hard because I just met with an employee who I love dearly a good friend of mine. No, we're just talking. He's isn't there something about, we're put on some kind of event and he's isn't the pandemic over? And, and Oh yeah. I wish, especially we looking at the world, the Hopkins, a rare thing the, we look at the whole world graph. It's it's literally at its highest point, I think, ever on the graph and on cases. So it's not only is it not over, I think we're in the U S it feels like it's over, but just caution to the wind. India thought it was over two and now I think we're in a whole different ball game. Cause we got vaccinations on our hands, but still we got to at least some sense of prudence, right? Yep. Yep. Could you downline, so treatments, I want to talk about this. I saw this in the news, Stephen. I'm like, what the heck? This is, I feel like this is less than, or field of Pfizer. At-home pill for treating COVID could be ready by the end of the year. I didn't even know there was a pill and now it's gonna be right within the year. What's going on with this?
Stephen Kissler:Oh man. I hope it's true. It would be great. It would be great if we had a, we need, we desperately need more therapeutics, very valuable. And part of the reason why therapeutics are especially helpful is because in some ways it helps to to reduce some of the effect of vaccine hesitancy because many of the people who are unwilling to have a medical intervention while they're healthy, will nevertheless be willing to take a pill when they're sick, which makes a lot of sense, like you try to you're when you're sick, you want something to make you feel a little better and that's great. So would be great. Absolutely. I did some looking into this and it doesn't, I think that there's a, this drug is still in phase two trials, maybe beginning phase two trials. So we don't have a lot of evidence yet on either safety or efficacy. And so basically what they're saying is that if everything goes perfectly, yes. Then this drug could be approved by the end of the year. Yeah.
Matt Boettger:It's normally, always happens in science. Exactly. Everything goes perfectly. So this is
Stephen Kissler:right. And yeah. Yeah. So the idea behind this drug is that I think what they're aiming for is something that could be administered earlier in the course of the COVID progression. And so basically prevent people from getting to the point of severe illness, which is not really something we really have right now, the drugs that we have available are things where once you're in dire straits you can give them and they can help you get out of the hospital sooner and recover with higher probability. So this, I think would be something more clinically speaking, it would be something more like you would get like with with a Tamiflu. I think, I don't know if it's quite on that level, but where it's like you have this and you don't want it to get worse. And so you would be able to give this drug. Now it works in a very different way than Tamiflu does. It's a protease inhibitor, I think, which it uses a similar technology to some drugs that work against HIV actually in hepatitis C basically just disrupting the viral replication process. And so it's a technology that has been used with some some efficacy in other diseases, but it still has a long way to go before before we can start saying, we have a new drug against COVID. So I think in some ways this is, yeah, this is probably more of a publicity stunt than anything else. I'm really hopeful, but I just, there's just, the data just is not there yet for us to pin our hopes on a drug like this coming through at the end of the year. So
Matt Boettger:the next article was cure cancer by end of the year. So it's yeah, it's on its way. It's so on testing, I didn't know this existed, it sounds like you were aware of this on a different article maybe, but new blood tests show should show how long a COVID-19 vaccine will protect you. This sounds pretty awesome. It's one thing, cause I, even my wife getting the vaccine, we're just wondering, am I really protected? How can I know if I'm protected? Like how did it take hold and I'm guessing this could offer a potential confirmation in that question? What's up with this?
Stephen Kissler:Yeah, I think so. Actually measuring protection against an infectious diseases is famously really difficult. We have pretty good proxies, but part of the difficulty is that our immune system is so complex and different parts of our immune system respond differently to different infectious disease challenges. And, it varies over time and the virus itself changes. So it's really hard to know for sure if you're protected until you're actually exposed to the virus and you see whether or not you've been finished back. But one of the things that we've spoken about before is that it seems like one of the key parts of the immune system that's responsible for giving us immunity against COVID is the T cell response just harder to measure than the B cell response. And so I think if I'm interpreting all of this correctly, basically this is a blood test that will help to better and more sensitively detect whether that T-cell response is intact. And at what level it's, it exists in a given person. And it's, it will never be better than a proxy for immunity. It's this is again, like back to the conversation we had at the very beginning where science can never really give you certainty. And but but it should be able to help us predict more sensitively and more, more precisely if that immunity exists, which I think is great it will help us a lot to determine, both when individuals and when entire populations are at risk of a variant invading or the same old virus invading which is really important information to have.
Matt Boettger:Yeah. Now I'm guessing it's been like, this could be easily accessible, right? I It's not like Tesco's tons of testing, it's just a blood test. I don't know how someone's said, Oh, I'm interested in this. I'd love to get a blood test. I'm guessing right now, it's probably not readily available. You just can't call your doctor and get a blood test for this, but I'd imagine relatively soon you probably could probably take a lot of. Testing for this, or am I wrong to think? Nah, they usually take six months or a year to like really make sure their test is, could this be accessible soon? Do you think? Yeah,
Stephen Kissler:I don't actually know. And I don't know what sorts of resources it takes to actually run the test either. And so one of the big sort of principles within within clinical medicine is that you really only test for something when it will change the. The way that you intervene, the way that your clinical course. And part of that is because you don't want to be testing everybody for everything because we just don't, we just can't, we just don't have the resources for that. And especially with something like this. So I think that may be possible. That may be a reality, but I think that practically speaking it's unlikely that you'll be able to just phone up your doctor and ask Hey, can I see if I'm immune to COVID chances are they're lonely run it. And people who they think are at high risk and potentially working a job where they're going to be exposed a lot and have co-morbidities are of high age so that they can determine whether that person needs to protect themselves in some way beyond what they've already been protected against. So I think that that's probably the more likely reality but
Matt Boettger:we'll see. Okay. Makes sense. Good. So now I heard about another vaccine coming up. I know, I think maybe you were looking some stuff up, but Novavax a couple of articles, the dark horse COVID-19 vaccine. I'm not sure why dark horse, but nonetheless, it's in a couple of articles, but it sounds like this is really promising because up to this point, we've had Moderna and Pfizer, these heavy hitters and then AstraZeneca and then Johnson and Johnson, not such a heavy hitter, but nonetheless very effective. It sounds like Novavax would be when it's, I don't know how close it is being approved. It sounds like it's on the horizon. It's the next one that'll be made available probably. And it's efficacy is on the order of Medina. And Pfizer, any talk about this in your neck of the woods, or is this something that's relatively new on your horizon as well?
Stephen Kissler:Yeah, so this is actually relatively new on my horizon as well. I think in part, because thankfully now we actually do have sort of an array of approved vaccines that are available now and that's what we badly need. We just need to get these things in people's arms at the moment. Now I need to look more deeply, I admittedly have not really looked much at the Novavax technology or sort of what what distinguishes it from those around it. But I think that that'll be really important because again, especially as we're thinking about, as we really want to push to get. The world vaccinated as much as we can, different constraints and different places will make different vaccines more or less appealing depending on the cost, depending on the storage constraints depending on the shelf, stability, all of these different things. And so depending on what niche this particular vaccine holds, it could be a really important player as we continue to roll vaccines out worldwide. But that said, right now I think that part of the reason it hasn't crossed my radar is because we're thinking so much about just like how do we get, Pfizer Madrona, AstraZeneca, Johnson, and Johnson administered, distributed and that's really sort of like the big push right now. But it'll be interesting to see as we get more data on this one as well.
Matt Boettger:Great. Now this article, you thought it was relatively humorous, excuse me. So this article, I found this from Fox news and I was curious because I wondered. It's what extent this might be a realistic criteria or measurement. This article is swollen. Lymph nodes. Following COVID-19 vaccination could mean you already had virus study suggests. So what's up with this. Is this a possibility that be true?
Stephen Kissler:Yeah. Yeah. So I think this is really interesting. So just to run a little statistics experiment if you're living in the United States and you get the vaccine and you stub your toe that afternoon, you have a one in three chance of having had COVID before you got the vaccine, right. That's crazy had 33% chance of having COVID because, but that's that's the thing is that no matter what happens, you have a one in three chance. It basically, we think that probably a third of people in the United States have been infected with COVID at some point up to this point in the pandemic. Now I'm saying that a little bit facetiously because there is I do think that there's something important that this study is saying. So what makes a swollen lymph node different than a step to T? There's a mechanistic reason to believe that your lymph nodes are responsible. They're like where many of your immune cells are produced and processed. And so in some ways a swollen lymph node is an indicator that your immune system is working. And and so if you have a swollen lymph node that suggests that your immune system is doing something, furthermore this is similar to the way in which generally people have reported having more severe side effects after their second dose because their immune system has been primed by the first dose. And then the second dose comes in and sort of like gives you the two punch on the one, two punch and gives you that, that full on immune response. Now, if you've had COVID previously, you've basically already primed your immune system. And so then when you get the vaccine, you're going to feel that in certain ways. And so there, it may well be true that that there's a higher rate of people reporting swollen lymph nodes who have had previous COVID infection. But I can also guarantee you that there are people who have not had COVID infection who are also reporting swollen lymph nodes, because that's just the way your immune system works. When you get a vaccine. Probably you're going to get swollen lymph nodes. And that may be related to a previous infection. It may be a higher risk if you have a previous infection, but the direction of causality doesn't really work out very well. I think that, maybe previous infection plus vaccine equals swollen lymph nodes, but vaccine plus swollen lymph nodes does not necessarily equal previous infection. One is contained within the other, but not vice versa. So if you have to make some notes after you get the vaccine, maybe you did have COVID. But maybe not. And I don't think that it's a very good indicator. And I wouldn't hang my hat on it. That's
Matt Boettger:good to know. Cause it, my wife has a swollen lymph nodes when she had it. And didn't even think about that because I'll put this in the show notes and a nice little podcast to Cody. And COVID Stephen Iran that for a second episode with John and he only has two episodes, but the first episode, it was about some biologists. And they taught me a lot about the lymph nodes and bit how basically they call it like a dojo that it was like a dojo to train fighters, to do their job. And so then I just took that metaphor and ran with it. I'm like, clearly, if you get the vaccine, dude, you're ramping up your dojo. You're training fighters. So the chance of you having some swollen lymph nodes makes me think they're doing their job. The dojo is full and they're all getting their black belts so that they can kick some butt. If they see it. That's right. That's exactly it. Yeah. Good. All right, there we go. With that one. It's a checkout decoding covet, a a couple of great episodes. And Stephen was awesome on that on episode two. So check it up on the show notes. Okay. We gotta wind this up. We're getting a little long. So we're going to skip a couple of things and go into, let me see, Oh, let's end with this fully vaccinated. People don't need to wear masks outdoors unless in a crowd shot. This is from the CDC. Let everybody know that. At least there's been an update on that for exposure. I'll put this in the show notes, a couple, a few scientists weigh in about outside masking and when to do it when to not. And obviously it's pretty self-explanatory. If you're, it was a nice little criteria, it said basically outdoors social some spacing and then wearing masks. And he said, basically said, you want to have those three. If you can get two of those three, you're doing great. So outdoors. If you got some distance, Hey, go get him. You're good. Otherwise, maybe be safe, still wear a mask, right? We're still in an out of this pandemic, especially worldwide for sure. Okay. I think that's all for now. There was a couple other things I think I wanted to chat about, but I don't see it Amelia. I know it's but we'll get to it next week. Cause we'll be back. All right. Again, if you can leave a review, do it on pandemic podcast or not pending, but guys on Apple podcasts we'd love that support us patrion.com/pandemic podcast as well as one-time Venmo paid bell all in the show notes and yes, email us matter, live in the real.com. If you're interested in having a special episode once a month about a book review that Stephen Mark and I reflect upon and how we integrate in her own life is a way to help us continue this to go and go strongly. Okay. Hope everyone has a wonderful week. We will see you guys all next Monday. Take care and bye-bye.