January 10, 2022 • 42 mins
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Matt Boettger (00:00):
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible in the face
of these crises.
My name is Matt Boettger and I'mjoined.
I took forever to find this guyhe's been gone forever and hunt.
Stephen Dr.
Stephen kisser andepidemiologist Harvard school of
public health.
How are you doing
Stephen Kissler (00:14):
buddy?
Matt Boettger (00:16):
Doing good.
It's I don't know what to say.
Like Merry Christmas, happy newyear, blah, blah, blah.
We've went through a coupleholidays, right?
Yeah.
Stephen Kissler (00:23):
Happy new COVID wave.
Yeah,
Matt Boettger (00:26):
exactly.
So many exciting new things.
One that you don't want to surfon.
That's right.
No.
We're back where we apologize.
Usually it's every two weeks andwe never told you we just kinda
stopped.
And probably because it's theholidays and we were selling
Christmas new years.
I don't know if I mentioned thisto everyone who's listening.
Stephen probably knows a littlebit, but in our household, it is
(00:47):
literally a wave.
Of holiday stuff that almostmakes me tired to the point of,
I mean, utter exhaustion.
So we had our anniversary onDecember 18th and of course we
had Christmas.
Then my oldest son was born onChristmas day and then we had
new year's day.
Then my youngest son was born onJanuary 3rd.
So we had his birthday and thenwe had my wife's birthday in
(01:09):
next week and during the 17th,and then we had my son's
birthday on January 20th.
So it's a lot and it's.
It's a lot of partying.
It's a lot of budgeting thatneeds to be done better for next
year.
And then on top of that, he's,you know, Stephen, my son, my
youngest son, two days after hisbirthday had to go to the
hospital.
That was totally my fault.
(01:30):
I was vacuuming.
Our our playroom ratheraggressively, if you anybody
knows me, I do things veryquickly cause I wanna get these
done.
And I was swinging the handle,like crazy vacuuming the carpet
and I had no idea was behind me.
I just drilled him in the head.
Cut, open his head.
I feel really bad.
With the hospital.
We were a little nervous withduring the surge and but we were
(01:50):
extra cautious.
I called Stephen like at 10:45PM at his time at night.
That's the privilege of beinghis friend, I guess.
And, and, and, and crossingboundaries, asking him any tips
before I go in the hospital.
But yeah.
Yeah.
So as you know, it was a lotgoing on and you had some
holiday fun too.
You did some traveling, right?
Yeah,
Stephen Kissler (02:08):
that's right.
Made it out to Florida to seeAllie's family and also out to
Colorado briefly.
So, yeah, it was, it was good.
It was really nice to get, tosee some family over the
holidays for sure.
I bet.
Matt Boettger (02:18):
I mean, you are isolated because you had from
your family, you don't have anyfamily up there in Boston.
Yeah.
Stephen Kissler (02:23):
Neither of us really have family up in this
area.
So, yeah.
Matt Boettger (02:26):
So I'm glad you were able to get out and see
some family and we're back innow.
So we've got a lot to talkabout.
We'll see how much time we have.
The normal stuff, right.
Please relieve review.
We got a review just a coupledays ago.
No, Stephen.
He didn't.
If he saw it from J a E O T,this podcast has kept me
grounded and informed.
I'm grateful that Matt researchhas the right questions to ask
and that Dr.
(02:46):
Kisser Lee lends his time andknowledge to give listeners his
expertise.
I know that what I'm hearing isa latest and best information as
we know it at this moment.
Thank you.
So, yep.
That's good.
More welcome.
Super excited to get these thesereviews.
So please, if you want to leavea review, it inspires us and it
keeps this podcast in front ofmind and many people on all the
(03:08):
big directories, as well as youwant to support us
patrion.com/pandemic podcasts.
Those$5 a month can help us keepthis going or just a one-time
gift, PayPal, Venmo.
You can get all of that.
In the show notes.
Okay.
So let's get going.
We already talked about AlmaCron.
He back in way back, I feel likeforever ago in December 13th.
And it was kind of being to rearits ugly head and boy, oh boy.
(03:32):
Does it rear its ugly head?
I can't believe when I see thecharts of this, it's just like,
I feel like it's like an error,like miss some data errors.
So like nothing spikes thatintensely.
So I think before I get into thenitty gritty details of
everything.
Why don't you just give us alittle kind of surveillance of
like what you've been seeingwhat's been going on with
Omicron?
How does it compare to otherones?
(03:53):
I mean, now we probably haveplenty of data to get a good
analysis of where we're at andwhere might we be going in the
next two weeks?
Stephen Kissler (04:00):
Yeah.
Yeah.
So.
Holy goodness, this this variantis infectious.
It is yeah.
It's eh, so, so there's, I mean,there's a couple of things in
play, and I think that we spokeabout some of these things in
previous conversations as well,but we've gotten a lot more
certainty around.
Sort of what is OMA crowns,shtick.
(04:20):
So, is it more infectious?
Inherently?
Yes.
It seems to be even moretransmissible than Delta, even
after you account for priorimmunity.
And even if you account for sortof changes in behavior and such,
so it's ramped up infectiousnessagain by twofold threefold, plus
you layer on top the immune.
Evasion where it can and we'lltalk more about that in a
(04:41):
moment, but it's, it's able tocause breakthrough infections
like mat it's infecting a lot ofpeople who have been vaccinated
who have been previouslyinfected.
It's just able, able to do thatbecause of all of its mutations.
And so that contributes to itsapparent infectiousness as well,
because if it's more infectiousat baseline and if it's able to
get around our immunity and youknow, Generally, you know,
(05:04):
people are I mean, like we justsaid, I, I traveled to this year
to see family.
I didn't do that last year.
And I imagine that that probablymaps to a lot of other people as
well.
So our behaviors are differenttoo.
And so part of like, all ofthose things together are
leading to this sort of hockeystick pattern of cases that
we're seeing in the U S and, andacross the globe.
So yeah, so there's, there's amajor surge of Omicron To add on
(05:25):
top of all of that.
We are currently smack dab inthe middle of peak coronavirus
transmission season, right?
Like first two weeks of Januaryis when the other common cold
Corona viruses spike.
Every year.
And so this is the mostdifficult time to control the
spread of a coronavirus.
Plus we have this new variantand all of these other things
(05:46):
sort of layered on top of it.
And so that's, that's causing ahuge surge in cases.
And unfortunately, I mean,that's, that's also leading to a
pretty big surge inhospitalizations right now, too.
We haven't seen as much of anuptick in deaths right now,
thankfully.
But but I expect that to follow.
And even though on a case bycase basis, McCrumb really does
seem to be less severe thanDelta, especially in the people
(06:07):
who are vaccinated.
They're just the sheer number ofcases is enough to really really
cause a lot of.
Matt Boettger (06:13):
Yeah.
You know, I think they're justthought of, I couldn't get in my
head.
He said, hockey stick.
I'm like Neil.
I'm like, can we just blame allthis?
And Canada
Stephen Kissler (06:21):
Porter person who wrote a review, asked us to
mention Canada and other onetime we mentioned them
Matt Boettger (06:28):
totally out
Stephen Kissler (06:29):
of context.
This is not his fault.
Matt Boettger (06:32):
I want to make sure I'm just joking, everybody.
That is this fear joke.
But yeah, this is exactly, youknow, one of the things that.
How do you see this?
When it comes to booster?
You said vaccine, there arebreakthrough cases.
I haven't got a chance to see,you know, clearly I would
imagine, you know, there's apretty decent amount of
breakthrough with people who donot have the booster.
I have the booster.
(06:53):
Do we see now roughly how manybreakthrough cases happen with
the booster?
Is it still pretty significant?
Is it pretty well protected?
Where is that on the spectrumfor the
Stephen Kissler (07:02):
Omicron?
Yes.
So we're, we're still learningabout that because it's And
there was.
There's a lot of reasons that ittakes some time to collect those
kinds of data, but people whoare boosted are still getting
breakthrough infections, forsure.
Every, every exposure that youget to the viral surface
proteins, whether it's through avaccination or through a
(07:22):
previous infection reduces theodds that a new infection will
actually take hold.
So, we, we do, from what I cantell, we're seeing reduced rates
of infections in people who areboosted versus people who.
But Omicron can absolutely causebreakthrough infections and
people who are boosted as well.
And I think the real upshot ofthat is that people who are
boosted have a lot of very goodprotection against severe
(07:43):
disease.
And so that's still the verygood news boosting really sort
of brings your immunity fromsort of a personal health
perspective, right back up inline to where it was previously
with two doses.
So that's, that's the good news,but it does seem like infections
can happen.
Maybe not as well if you'reboosting.
This thing's pretty infectious.
Matt Boettger (07:58):
Yeah.
I can imagine when it gets tothe other question, this is
contextual.
So I mentioned that my youngestson had to go to the hospital to
get glue, thankfully, not institches now, before we did
that, we called ourpediatrician.
And this is where I think it'scomplicated because I hear from
so many people just consult yourpediatrician and just consult
your doctor about, you know,vaccine, blah, blah, blah, how
it relates.
I feel like that's evencomplicated because.
(08:21):
I was on the phone with him.
He happened to be on call and wewere talking about, should we
take him to the hospital?
He's got a pretty good cut.
We really don't want to go tothe hospital if we don't have
to, because we still have somemore holidays to celebrate all
these complexities.
And so he was like, oh, I thinkhe should probably take him in.
And then that's when my wifewanted me to ask, like, ask him
about.
You know, the flu vaccine andthe COVID vaccine and what he
thinks about that.
Right.
(08:41):
And we trust our pediatrician.
He's great.
We love him to death.
And I was really confused abouthis answer.
And I wanted to throw this toyou and all of our listeners, I
would imagine I'm not the onlyone who's getting these kinds of
mixed signals at times.
And that he was kind ofinitially saying right away.
Yes.
I would say a hundred percentget the flu vaccine for your
child.
It's a very dangerous, I highlyrecommend it.
You really should be getting.
(09:02):
And there's even times in acouple of years past where you
kind of almost alluded to that.
If you're not going to get yourCOVID, you're not going to get
your kid the flu vaccine thenprobably just don't take them
out much during the winter.
Right.
Just keep them inside.
So he's really PR pro pro fluvaccine.
Great.
Then I asked about the COVIDone, right?
And then he's he was like, ah,no, you know, don't give them
the code vaccine doesn't reallydo anything for kids, especially
(09:23):
with Omicron.
Right.
It's just like a common cold, nobig deal.
And he was very dismissive ofit.
I was a little perplexed by hisanswer.
I'm like, it's.
Overly simplistic.
Yes.
To the flu.
Absolutely.
There's no hesitation, no way onthe colored vaccines, because it
really doesn't affect kiddos.
Don't worry about it.
We only give it to the kids whoobviously are diabetic or obese
(09:44):
or have those kinds of issues.
Right.
We give them to them for sure.
Right.
But if you're.
No need to get it.
So I looked up some stats onflew in, you know, not to scare
anybody, but you know, kidsdeaths and that kind of stuff.
And like 2019 was like thelatest, probably good statistic.
It'd be like 543 kiddos,unfortunately passed away in
2019.
And something like 476 kiddoshave passed away in two years
(10:07):
for COVID.
Right.
So the numbers are about half,right.
But then again, those are lownumbers.
And then, you know, I see in thecomplexity of the flu vaccine,
not being that effective rightthis year, it kind of missed the
mark, but it actually is reallygood for preventing
hospitalizations.
It's just that you missed them.
I get infected.
So seeing all of them, like itdoesn't seem that black and
(10:27):
white, I'm the wondering, isthis more of a political
decision than a scientificdecision?
I would imagine people who arepro fluid.
Pro COVID where do you land inall this kind of things?
Because I'm hearing this from apediatrician and it's informed
us.
I'm like, ah, this doesn't ring.
Stephen Kissler (10:43):
Yeah.
Yeah.
It's I find it sort ofperplexing too, because in my
mind, I mean, for a long time,I've sort of, I think that a
reasonable rule of thumb is thatfor for children under the age
of 12, I think the flu is areasonable.
Proxy for the severity of COVIDas well.
(11:04):
And it, and, and you just citedthat statistic as well of the
number of of deaths related toflu versus related to COVID.
And those are, I mean, those arepretty similar numbers.
That of course glosses over, youknow, a lot of other
Uncertainties, including, youknow, there are things that flu
can cause that are not death,but that can be sort of longer
term complications as withCOVID.
There are issues with long COVIDand young kids as well.
(11:25):
It's w we it's, it's hard toreally quantify those things.
We're still learning about a lotof those things, but as the
first rule of.
I think that the risk on a perperson basis is pretty similar
for young kids between flu andCOVID.
And in, in many ways I actuallysee flu as sometimes even at
greater risk for kids under theage of six, especially.
(11:46):
And so, but, but I think thatthey're roughly the roughly in
line with each other.
So if.
If I were to meet someone whois, you know, thinks that the
flu vaccine is worth getting, Iwould also imagine that they
would think that the COVIDvaccine is worth getting and
vice versa, but it sort ofpuzzles me why there would be a
very clear split between the twothat just doesn't make a lot of
(12:07):
sense to me.
And I'm yeah.
I'm glad you
Matt Boettger (12:09):
see that.
So those of you who havereceived that similar
information, maybe get a secondopinion because I feel like,
yeah, I felt the same thing.
I'm like, ah, you know, if theflu vaccine is good for the kid
and prevented it, I wouldimagine the code's vaccine.
And again, like you said earlieroff the air, I mean, it's, it's
also not, not takingconsideration at this point in
time.
The transmission of flu issubstantially less than the
transmission of COVID right now.
(12:30):
Right?
So that's a whole differentvariable that makes, can make it
more severe in its own level aswell.
And that gets back to anotherquestion, Stephen, again,
kiddos, cause I have kiddos andI'm always thinking of my kiddos
is a few weeks ago there was anarticle about hospitalization
for kiddos is increasingsubstantially because of
Omicron.
And then maybe two weeks later,I see another qualification of
this.
Where do we stand withhospitalizations and kiddos?
(12:53):
Is it kind of, this seems to besomething that might be slightly
more aggressive towards kids oris this something that you've
helped us before?
Is that it's just the nature ofthe transmission that makes it
look as if.
Bigger.
Stephen Kissler (13:06):
Yeah.
So, so both of those things andone more.
So first of all, you know, ofcourse kids are less likely to
be vaccinated and boosted atthis point.
And so there's differences inimmunity there.
There's a lot of spread andkids, especially from schools
right now.
And so, so the, just the rawcase counts, we expect to be
high in kids right now.
And the other thing is thatthere is, especially in, in
(13:29):
certain parts of the countryright here in Massachusetts, we
have a major Omicron surge rightnow.
But we actually saw this inSouth Africa too, which is that
not everyone who is in thehospital.
With a positive COVID test isthere for COVID.
Since the rates of Omicron areso high, I mean like this low in
case I haven't emphasized thatenough, this thing is incredibly
infectious, right?
(13:49):
There are a lot of people whocurrently have crown infections
in the United States.
As a matter of course now whenyou go to the hospital,
generally you get a COVID testor at least you're screened
somehow for COVID.
And so in many places, those endup in the hospitalization
statistics, even though thehospitalization was not for
COVID itself.
Now that doesn't mean thathospitalizations aren't spiking.
(14:10):
I mean, COVID is bringing peopleto the hospital.
Omicron is bringing people tothe hospital, but some fraction
of those cases is also going tobe counts of people who have
tested positive for COVID whilein the hospital, but are not.
Because of COVID and I thinkthat'll probably especially be a
complicating factor for youngkids because there'll be going
to the hospital and there are alot less likely to be in the
(14:32):
hospital for COVID, but there'sa lot of COVID in young kids
right now.
And so I think that that mightbe one of the confounders here
as well.
So, so really we're thinkingabout these hospitalizations
statistics, especially in kidswith a grain of salt definitely.
I mean, definitely COVID canbring a kid to the hospital.
Flu can bring a kid to thehospital for sure.
But some of the spike that we'reseeing is incidental.
Yeah.
Matt Boettger (14:52):
And another thing they putting consideration, I
don't know if you said thisStephen, or if I read this, so
it should be credit to you thenI apologize.
I have no idea, but somethingabout how, even if the common
cold received this kind ofintensity, there'd be just so
many hospitalizations of that.
I mean, it's the, it's theenormity of the influx of
infections.
That's, that's overwhelming thehospital, even if, even if it
(15:13):
homo Cron general.
It's a common cold.
This could just wipe outhospitalization, hospitals
really quickly and theirresources just because it
spreads
Stephen Kissler (15:19):
so fast.
Yeah.
Matt Boettger (15:21):
So that lead me to his question, which I kind of
may lead the jury to my ownanswer.
And that is, should I just getOMA chronic, get it over with
like, there's these mixedsignals of like these, you know,
one, one article from both ofthe Atlantic boosted, God
Omicron, you still might not besuper immune.
You know, in my mind I wastalking to my wife.
What's the possible, I mean, nothaving a COVID party of course,
(15:42):
but like saying, okay, we're notgoing to shelter in place for
three months.
We're still going to go out and,you know, wear a mask.
But if we get it, wouldn't thatmaybe be a good time because OMA
Crohn's generally not toodangerous.
And if we're boosted and we getOmicron, and if the next variant
comes at raise its ugly head andit's worse, maybe we have, we
have an extra insurance policyof, of, of weathering the storm
(16:02):
until the next booster.
Should we go ahead and allow itor.
Not, you know, this article issuggested maybe not, but then a
previous article by the Atlanticmentioned, well, there's
T-cells.
And, and because of those thatmight actually help you with the
next variant, where do you standin this kind of like Alma Cron
dance of it gets just a commoncold.
Let's just get this sucker andbuild my immunity versus maybe,
(16:23):
you know, balance that.
Stephen Kissler (16:26):
Yeah.
So, I mean, I think sort of.
Bringing this into the contextof the previous conversation.
You know, the biggest thingthat, you know, the thing that's
on the forefront of my mind nowis trying not to get Omicron
right now because I don't wantthat, even though it does seem
to be like, I'd probably bebetter off if I had gotten
(16:46):
infected with Omicron than if Ihad gotten infected with Delta
right now, given my vaccinationstatus and so on.
Breakthrough in the chronicinfections can still hurt quite
a bit.
I mean, when we talk about mildinfections, that doesn't
necessarily mean the sniffles,you know, you could be, you
could be coughing up a lung fora good week or two and feel
pretty fatigued and that's stillconsidered a mild infection.
Right.
Matt Boettger (17:05):
That's good.
And that's going to say reallyfast.
Cause my wife was like I said,oh, it's just mild.
Like, well, all my friends arehaving it.
And they were like in bed, likejust like coffin and they don't
want to go to bed, but that'snot modeling like what.
Their definition of mild is, islike comparative to a hospital
where you're on a ventilator,
Stephen Kissler (17:19):
right.
Is exactly, I think it getsworth.
And this was illuminating for metoo, that like these, these
classifications of, of mild,severe, et cetera, are, are made
by generally by clinicians, bypeople who are in the hospital
who really see the severe cases.
Right.
So if you're, you know, sick inbed and feel like you've gotten
hit by a train.
That doesn't feel mild to me,but if you, you know, if you
(17:41):
have somebody who's treatingpatients in the ICU, see is
here, they're going to shrugtheir shoulders and be like,
yeah, it'd be all right.
You know, smiled.
So it's all a matter ofperspective too.
And so, you know, and, andbecause of that, you know, Could
lead me to need some type ofmedical care right now, even if
I don't end up in the hospital.
And that's kind of what I'mtrying to avoid at this point
(18:01):
which I think it's, it's worthnoting that that's very
different than what I was tryingto avoid this time.
Last year, when the thought ofgetting infected.
Also from a personal standpoint,and from the standpoint of
exposing people around me, therewas just a lot of risk there
that vaccination has done a lotto blunt.
And so right now, really my onthe forefront of my mind is.
(18:24):
Trying to keep our healthcaresystem from really getting
overwhelmed.
And thinking about it from apersonal perspective, too,
right?
Like I'm talking about ourhealthcare system, but like,
this is my brother we're talkingabout.
Right.
Like, I, I, I, we're trying tokeep these people who are
keeping us healthy from gettingso burned out and, you know,
having to work over to.
And you know, people are leavinghealthcare positions in droves
right now because of just howawful of a situation this has
(18:48):
been.
And, and that's, you know, thatthat's who that's, who we're
doing it for.
And so maybe it'll, maybe it'shelpful to talk about Sort of
the precautions that I'm takingright now.
So I'm vaccinated, I'm boosted.
I got my booster in November andI am not indoor dining.
We've decided to, to put that onhold for now.
But we're still, you know,getting takeout from local
restaurants to.
(19:08):
Both try to support them.
And because I get sick of my owncooking and I I've transitioned
to wearing mainly kn 95 masks.
When I'm going indoors withplaces where there are other
people's different going groceryshopping, for example, I'll,
I'll put on a, on 95.
And, but I'm still going groceryshopping.
Maybe not as frequently as I, asI was or try to get some
deliveries and such, but I I'mhappy to go into a grocery
(19:29):
store.
And so part of that is sort offeeding into, I think, what you
had been getting at with yourprevious question, which is that
like, I don't want to getOmicron right now.
This wouldn't be a particularlygood time for me to be laid out
in bed for a week and a half.
But I'm also a lot lessconcerned, like.
Given the, the raw statistics,it's, it's pretty unlikely that
I would end up in the hospitalwith it.
(19:50):
And so I'm not locked down tothe degree that I was this time
last year.
Everybody has their own riskcalculus, which has to do with
their own level of risks thatthey're willing to tolerate with
their own personal situation,their health situation, the
people they might be taking careof.
So it's really hard to sort ofgive recommendations that are
applicable across the board.
But that's sort of the way thatI've been approaching it.
Matt Boettger (20:08):
Great.
And let's hit the Canaanite and95 masks.
I, myself moved towards that.
I had kind of just a regularmask and about Thanksgiving,
first week of December, I movedto permanently to the K N 95
mask, but I'm a dude.
I wear the same thing.
I have it in my pocket.
I pulled it out.
I had the same thing for thepast month.
Is it okay?
I mean, it's not green, it'sstill looking the same color.
(20:30):
Right.
So that's good.
It's good for me, but like, am Iokay?
I mean, Now that we're moving tothese kinds of, okay.
Cloth mass, back in the day, youjust throw them in the wash or
wash and reuse them.
No big deal.
Now I've got these kn 95 maskand I'm just too lazy and I
might have it for three yearsand just not even do anything
with it, still use it.
When can I reuse these?
What's the best kind of, how doyou approach your canine by mass
(20:51):
replacing it or keeping it, doyou have any, any tips for us
who are just like.
I'm not being super cautiouswith my mask.
Oh yeah.
Stephen Kissler (20:58):
It was I was going to say pay attention to
how it smells, but then again,if you get COVID
Matt Boettger (21:04):
that doesn't the front of the mask and if it
tastes really bad and then goahead and note that that's not
the one.
Stephen Kissler (21:09):
No, don't do that.
I mean, yeah.
So I think that like, generally,you know, it, it, it seems to be
okay to reuse these masks for,for a number of, of, of uses.
I, ah, Yeah, it depends a lot onsort of like how long you're
using it as well.
I'm I tend to fall on the sideof like, if I pull something out
of the fridge and it smells alittle bit funky, I'm like, I'm
(21:30):
going to pitch it rather thanunit.
I'm pretty cautious with thatkind of thing.
You're an epidemiologist.
Yeah, exactly.
So I I tended to change out myprobably every like five to
seven days or so.
And and, and also, you know,bearing in mind that like, I'm
usually only wearing them forlike quick trips out.
Right.
I'm not, I'm not like wearingthis all day long.
If I had to wear a K on 95 allday, I'd probably be changing it
(21:50):
daily.
And so, and, and a lot of thatis just because it's like a.
I don't know, like it's just,just helps to keep it fresh.
So, yeah, I, I it's, I don'tknow if there's like solid data
on this, but I do know thatlike, that it seems like.
You can reuse them, especiallyif they're not, if they haven't
gotten wet, if they haven'tgotten soiled in any way they,
(22:11):
they hold up their protectionover time.
But you also don't want to bebreathing in your own gunk too
much.
So,
Matt Boettger (22:16):
yeah.
I hear hear that.
Yeah.
And I had saw a couple articlesin the same thing that you can
reuse them for a while, and itdepends on how long you use
them, use them all day then, butyou can normally use them maybe
for a few weeks and just.
If you just use them kind ofsporadically right here and
there and small Smuckers, butjust keep them.
I think I read which I don't do.
They're like, don't put it inyour pocket.
Don't just put your purse.
Don't just hang it on your ear.
(22:37):
Put it in like a, a paper bag.
Or if you do a plastic ziplockbag, don't zip it up all the
way.
Cause the moisture can thencondensate that kind of stuff.
So just make sure to take thoseprecautions.
I learned a couple of things.
I'll put a, put one of those inthe show notes as well about
that.
One of the other things I wantto talk about is a number of
articles have been about withOmicron being this kind of
beginning of the end, thatbecause of this, I've heard even
(23:01):
things like, oh, this could bethe first time where there
actually might be a, some senseof herd immunity, because it's
just so intense.
I don't even know what thatmeans and let a variance that
kind of stuff.
I feel like it's a meaningless.
But like, I, you know, Alma conmay be the harbinger of the end.
That's the one I hear Omicroncase they're hitting highs, but
new Delta may put end in sight.
Omicron could potentially hastenthe COVID pandemics end.
(23:21):
So all these things about theend right now, the apocalyptic,
like the entire.
Stephen Kissler (23:28):
Yeah, I was going to say, you know, I've for
my entire life, I've always beena little bit skeptical of the
people who, you know, say theend is near.
And so, I think that applies onevery level.
And but that said, you know, Ithink that what w what it is, I
do think that there actually maybe some truth to that where At
this point, a lot of people whohave been who have, who are
(23:48):
going to get vaccinated, havealready been vaccinated.
Omicron is probably gonna affectjust about everybody, you know,
especially if they haven't beenvaccinated yet.
And so that's going to give,essentially everybody.
Almost everyone, some degree ofexposure to SARS COVID two which
should feed forward into somedegree of protection from severe
disease and illness.
And so I do think that there's,there's some reason to hope that
(24:12):
because the monochrome wave isso intense, that future waves
will be blunted to some extentbecause our immune systems will
have gotten one more exposure tothis thing.
I'm hopeful for that.
But you know, epidemics arefamously elusive when it comes
to defining beginnings and ends.
You know, it's as, as with thegreat apocalyptic poem, it's not
going to end with a bang, but awhimper.
(24:33):
You know, we're just going toslowly transition into this
period of time where ourperception of the virus is going
to change.
The severity of the virus isgoing to change and thoroughly
isn't going to be the switchthat happens with the Omicron
variant, but it's going to besort of one more.
Interests us towards thatendemic phase where we're going
to be dealing with COVID as acommonly circulating illness for
a long time.
And so I do think, you know, oneof the actually really good
(24:56):
strokes of fortune, as far as Ican tell with this virus so far,
is that it does seem like.
Multiple exposures tends toincrease the breadth, the level
and the duration of yourimmunity.
That's not always true for allpathogens.
Sometimes repeated exposures getworse with time.
Sometimes they don't do much atall.
So, in some ways we got luckywith this one that, that
actually our immune system doesbuild up over time with it.
(25:18):
That's usually the case, butit's not a guarantee, but it
seems to be the case with SARSCOVID two.
So I think we're just sort ofgetting closer and closer to
that base.
Matt Boettger (25:25):
Okay.
Now, speaking of a baseline inthe transition, the CDC changed
their policy for isolation,which seems to be another kind
of transitionary point for usfrom, I think it was 10 days to
now five days.
So a couple things I want you torespond to.
Number one, what do you thinkabout this?
This is now five day thing.
Is it a good policy?
And the second big thing I wantyou to at this time?
(25:48):
Excuse me.
The second thing I really wantyou to talk about is I was
thinking about this, like, okay,I was reading about this policy
change and the why behind it,and then there's some science
behind it.
And I get that, but I feel likethis is another example of
science.
Using supply and demand to maketheir decision.
I think this is an importantthing that I want you to just
talk about for a little bit,because to me, this is one Elmo
(26:10):
by which it becomes fodder forconspiracy theories.
So I have three examples hereback in the day, early in 2000,
right?
In 2020 in spring, when it firstcame out, Fowchee started
talking about how cloth maskswere first.
You first don't worry aboutcloth masks, not at all.
And then, then it was just clothmasks and then cloth masks.
And part of this, like aconfusion, I felt part of it at
(26:33):
least was the idea that thehospitals weren't getting the
necessary resources they need.
So a policy became like, oh,just use Claus pass.
Right.
Because they're just aseffective.
And then in the end we realizedthey're not just as effective.
And so then we want to likeblame them as being like wrong
or some kind of conspiracything.
Because in the end, I'm thinkingthey're not only being
scientists, they're using supplyand demand to make their
(26:54):
decisions.
And the second example is theisolation period, right?
This one changes down to fivedays.
Part of it might be in science,but part of it also, because
everybody was homesick you lastweek and people have to work.
And so we have to change thissupply and demand like, oh crap,
let's change the five days now,is it?
Because 10 days wasn't really anumber in that we're just making
up crap.
(27:15):
No, it's because it was really.
But now there's a new problemthat we have to address.
We have to change the numberbecause of a greater problem.
And then the third one, we'lltalk about it a little bit.
As I'm seeing this now istesting like the, the the
over-the-counter testing first,it was like, just test, test,
test now, like, oh, don't askdon't test.
If you're asymptomatic don'ttest because we're writing the
shortages on.
So you're seeing these likescientific explorations and then
(27:38):
presenting us a model of what todo, and then it kind of changes.
Partly because of supply anddemand, I think because we had
to thank consideration, but it'snot because science is wrong or
it's conspiracy theories becauseit's just one other variable
that needs to be considered forpublic policy.
Can you wrap your inner weave,all those into this, this
particular question.
Stephen Kissler (27:55):
Right.
So, so regarding the CDCguidelines, like you said,
they've, they've reduced theisolation period of five days
and critically that, that, thatapplies if you are no longer
symptomatic and they ask thatyou continue to wear a mask
pretty diligently for, for thefull 10 day period.
Now that said people canabsolutely be infectious for
more than five days after.
After a after detection.
(28:16):
And so there's there's a riskhere.
I think you're right.
That essentially what they'retrying to do is to balance the
need for people to work and tosort of return to their more
normal lives with the risk ofcontinuing infection.
I think it's a really difficultcall to make the.
The policy that I would hope foris a test to move out of
(28:42):
isolation.
Because that'll spring somepeople from isolation after
three days and it'll spring somepeople out from isolation after
seven days.
But but that's going to be a lotmore relevant metric for whether
or not you're likely to spreadinfection to others.
And, and so.
This would be the way to go.
People can be infectious for upto seven to 10 days, for sure.
Or at least seven to 10 daysafter their, their detection.
(29:03):
And so I do think that, youknow, we need to be mindful of
the fact that this update to theguidelines is posing some degree
of risk of onward spread.
And I think that, you know, Thatthat the right policy is not to
re increase it to 10 days.
It's to use the technology thatwe now have available to make
better decisions and morepersonalized decisions based on
whether or not you actually areinfectious.
Yeah, that gets, that gets tothe question about testing now,
(29:24):
too.
Right?
So there's been a lot of this,this questions about, you know,
should we be tests doingasymptomatic testing as much as
we have them?
So I think there are a couple oflayers to this as well.
So the, the question aboutshortages of tests, I mean, it's
kind of true, but I really don'tthink that individuals should be
shouldering that burden, right.
Are, are frankly it's, it's theMachinery of government and
(29:46):
manufacturing that is failed ushere.
You know, it's, we, we shouldhave these tests in much greater
supply than we do.
And and so now it's sort ofbeing, you know, asking
individuals to say like, oh, weneed to conserve these things.
It's like, well, yes, but like,Well, why, why, why we had to
conserve them for the entirepandemic?
You know, it's, it's a littlebit crazy.
(30:06):
But that said, you know, we arein the situation that we're in.
And so maybe, I don't know, I,for the sake of, of of, of Like
maintaining our supply chains.
I really can't get behind tothis argument of like testing
less.
I think if you need to get atest, you should, you should get
a test.
And, and our, our supply chainsneed to sort of find a way to,
(30:27):
to keep up with that one way oranother.
That said, so there's also beena lot of questions about rapid
antigen testing with respect tothe Omer crown variant.
And it really does seem like,the rapid tests.
Don't seem to be able to pick upthe Omicron variant as well in
the early stages of infection asthey used to be able to.
And so it seems like people areable to be infectious prior to
(30:47):
turning positive with a rapidtest, for example, whereas
previously there was a reallytight correlation where if
you're positive on an enginetest, you're infectious, and if
you're not positive, you're notinfectious.
That correlation is sort ofgetting broken up a little bit.
And part of that might be due tothe way that Omicron causes.
It seems like there's a lot moresort of like, Throat based
symptoms with Omicron and thatit might sort of reside in the
(31:10):
throat a little bit more than itresides in sort of the anterior
narrows on the, on the front ofthe nose.
And so part of it is maybe noteven that the test is not good,
but actually the swab itself ishaving some issues picking up
the.
Nope.
There've been some videoscirculating and one of them I
think, is actually useful fromthe United Kingdom.
What is it?
The UK HSA, the health securityagency in the UK where they
(31:31):
actually walk you through thesteps of taking a combined
throat and nose swab.
And there are some tests in theUK that actually are approved
and call for that, but there aresome people who have been.
Yeah, maybe we should try to dothis with rapid antigen tests
and see if they that increasestheir positivity.
So there's not a lot of cleardata on that, but full
disclosure, I've swapped mythroat with a Binance now and
then swapped my nostrils aswell.
(31:52):
When I was taking some rapidtests recently made me gag a
little bit.
It wasn't particularly pleasant,but but you know, like, and it
was a little bit gross stick ina swab that had just been down
my throat up.
I know it was too, but like allfor the sake of science and for
the sake of trying to preventthe spread of.
Spread of COVID Lord have mercy.
And so, yeah, so I mean, ifyou're interested in looking at
(32:13):
some of those videos that areout there, I would recommend the
one from the UK HSA becausethat's, that's generated by
their public health agency andreally goes, walks through the
steps of giving yourself athroat swab, full disclosure,
not approved by the FDA.
This is not like on the package,you know, like.
And so, yeah.
If you do that, recognize thatyou're deviating from the
recommended protocol of thesetests, and that comes with all
of the standard, you know,whatevers that come along with
(32:35):
that, I'm not a lawyer.
I am an epidemiologist, so sorryfor the vagueness here.
But that said, you know, thatthat does seem to be a feature
of Omicron potentially thatthere might be differences and
where it resides in our system.
And that could change the waythat tests respond to it as
well.
Okay.
Matt Boettger (32:49):
Yeah.
And I heard about this.
I mean, well, I mean, from mywife, there's just been weird,
weird things happen.
I mean, we have people gettingCOVID all over the place.
I mean, every meeting I have isvirtual over half of those
people in the meeting haveactively COVID, but we were
hearing like, oh yeah, thisfamily got covered the whole
family, but we didn't get COVIDbut we got sick.
Cause we could, we took anengine test and it said we
weren't, we weren't positive,but we're like, I'm sure it's
(33:10):
probably covered if the wholefamily's covered.
And you got sick too.
And he had.
Chances are, I mean, it's not,yeah.
It's just a, maybe a bad, badtest.
Right.
So great.
That's helpful.
Anything on the whole supply anddemand thing, like immediately,
like, is it part of like thekind of, I mean, this is where
I, it's hard for me tounderstand, like as a, as an
epidemiologist, your peer on thescience side of this things, and
(33:31):
then there's public policy,which then takes all of this
stuff that you provided and thensomebody else filters it to
provide the best possibledecision for the sake of.
Right.
Yeah.
A government or society.
Stephen Kissler (33:44):
Yeah.
I think, you know, th th thosethings definitely come into
play.
And it's like on all sorts ofdifferent levels.
Right.
So there's like, there's thescience, there's the policy is
sort of like supply and demand.
There's the question of justsort of like, what level of risk
are we willing to sustain as apopulation, as a society, and
sort of all of those thingsfactor into the decisions.
Now, my hope would be that like,as these policies change, that
(34:04):
we.
I have very clear informationabout sort of what's behind
those changes.
And to what extent it is supplyand demand, at what extent it
is, you know, Hey, we'reactually going to begin to
accept this degree of spread,recognizing that the science
suggests that we can stillspread COVID after these five
days.
But you know, we're going to saythat like there's so much COVID
circulating anyway, that wedon't think this is going to add
(34:24):
substantially to an individualperson's risk of acquiring COVID
given how much is out there atthe moment.
And so, you know, veryprincipled, various sort of like
clear.
Rationale for the changes inguidelines, because absolutely
all of these factors.
Feed into what the guidelinesare.
And I think that the real issueis that a lot of times it hasn't
been clear what thosemotivations have been
(34:45):
throughout.
And I think that if we can beclear on those things and we can
really hopefully avoid a lot ofthe skepticism, that's been
leveled towards the.
Matt Boettger (34:53):
That's great.
I think that's a perfect answeryet.
I think that sometimes I feellike it is being clouded or like
not being addressed at theforefront, which then makes it
feel like somebody's hidingsomething and it's not intended
to just make it been great.
You know, just how it'spresented.
Okay.
So let's get to the next thing.
So we talked about this.
There is a new variant, right?
Well, who knows?
There's probably tons ofvariants out there, but there's
new variant.
That's hitting the press as a,recently from Cyprus.
(35:13):
So a shout out to our, our, oneof our Cypress friends out
there.
Not the best of news, but.
You and talk about this as itwas it called the Delta crown or
something like that.
I know it's like
Stephen Kissler (35:23):
a little bit ridiculous, right?
Like, so we have Delta plus fora little while, and now it's
like OMA, Delta, flu Macron orwhatever.
And it's like, yeah, so, so,right.
So, so this one that I think wecan actually probably like,
well, let me take a step back.
Right?
So, so there's, there has beensome suggestion that the COVID
that starts Coby to the viruscan do something that we call
(35:43):
genetic recombination.
So basically when you getinfected with two different
stereoscopy, two variants intheory, they could switch some
little parts of their genome andgenerate this sort of hybrid
variant.
So in theory, that's true.
It's been sort of observed.
Some small, relatively isolatedinstances.
But then this really hit thenews with the Delta Cron variant
(36:04):
that I think they're talkingabout now, from what I can tell,
this is probably an issue withlaboratory contamination.
So oftentimes what happens iswhen you're doing sequencing.
You'll have swabs that pick upDNA, that you then run through a
sequencer.
And if at any point in theprocess that swab gets
contaminated with anothervariant that's circulating,
(36:25):
where if you're doing a labthat's processing SARS, cov two
sequences, you've probably gotsome Delta in there and some of
them are crown.
You can end up with a sequencethat looks like a hybrid between
the two, even though that's notactually the thing that you
isolated in the first place.
Part of the reason we think thatthis is likely an issue of
contamination is also becausein, from, from my understanding
in the genetic sequences thathave been tagged as these hybrid
(36:47):
variants, there are also a lotof other parts of the genome
that are.
Essentially what we callreversions to the reference
sequence.
So whenever you're doing asequence Normally you start from
a reference sequence.
So sort of a basic SARS COVIDtwo genome.
And then what your actualsequencer is doing is trying to
figure out where your particularsample differs from that.
(37:09):
And if you have low certainty incertain areas, it just reverts
to that reference sequence.
And if it does that a lot oftimes, that's an indication that
actually you don't really have agood sample in the first place.
And so because of the number ofcalls to the reference sequence
that this, that these particularDelta.
Sequences have had there's mybest guess is that there's some
sort of laboratory sequencingcontamination going on here and
(37:31):
not an actual bonafide newrecombination variants sort of
circulating right now.
Matt Boettger (37:35):
Okay, great.
Here's a helpful, it'sfascinating how I feel like, you
know, our names went from anapple S kind of like Delta plus
to now.
I think it feels like it's likeWWF restaurant Delta crop right
now.
We're now we're now we're inthe, we're in the spotlight,
some heavy, heavy lifting here.
Okay.
That's.
We you know, some good news,right?
President Biden to promise tothink this year, January.
(37:56):
So it's beginning the enginetest, rolling out free tests to
500 like 500 million boxes orwhatever to give out.
I just, I'm just so happy withColorado because I get boxes.
It's just amazing how generousColorado has been with every
week.
You could get two boxes if youwant to.
I think twice a week.
So up to four boxes a week, ifyou want to, if you need.
(38:16):
Free delivered to your, to yourdoorstep.
So, also crowdsourcing everyone.
Here's my question.
I have a cane in 95 mask that Isometimes can't even see out.
Cause I wear glasses.
Does anybody have a K N 95 massthat they purchased that is rock
solid.
And he feel like, man, I wearglasses and I don't get the fog.
Now I know I can put fog stuffon my glasses.
(38:37):
I don't want to deal with it.
I just want a good canine fiveglass.
If anybody has one.
That they want to recommendmad@livingthereal.com.
I'd love to get one, a legitone.
I'm looking for one preferablynot, not pink and roses, just
the normal color.
That's what, that one that wehad, all the suit.
We know the, we talked aboutthat the Pfizer 50 authorizes
the Pfizer is antiviral pill.
We said that might be out now,but probably in.
(38:58):
The
Stephen Kissler (38:58):
low circulation, I think it's
probably being mainly used rightnow for people who are at high
risk of severe disease.
So with, with multiplecomorbidities and, and such,
but, you know, hopefully it willbe more and more available as.
Okay.
Matt Boettger (39:10):
Great.
Last few things is quick.
Awesome.
Put a bookmark on this.
I tell this, I told this to you,Steve and I saw this interesting
article, a punish shadows.
New COVID vaccine from Texascould be a global game changer.
It was really interesting.
Again, you hear some of thepolitics.
Initially, these, this couplehad been working on for decades
and prison.
Too, I think some big leagues tobe a part of the vaccine early
on, but wasn't adopted becauseit wasn't innovative enough.
(39:31):
It's kind of an old schoolmethod, but some private
companies invested in it's asuper cheap, pretty effective,
90% effective for the original80% with Delta.
We don't know about Omicron yet,that kind of stuff, but we're,
it's like a dollar, a buck, 50per dose.
So this is like a game changerfor a global vaccine.
So I'll put in the show notes,read about it.
My last question to you, it justcrazy to think about.
(39:52):
Israel has studied fourthdosages.
This is Cray Cray.
I'm like, man, I feel like we, Ithought we're going to go to a
restaurant that you're going tohave, like, you know, I'll have
the lobster and I'll have adose.
Right.
So w w w you know, I knowearlier on, we were talking
about how the third dose couldbe like this linchpin to keep us
for a while, a lot longer thanthe first and second dose.
(40:13):
Where do you see before we endthis?
Now with this fourth dose, maybeendless dosages coming about, oh
boy.
Stephen Kissler (40:19):
I mean, I hope it's not endless dosages,
especially if they all make mefeel the way that the last one
or two did.
You know, so, but so I'm gladthey're studying it and it's the
right place to study it becausethey're one of the most highly
vaccinated populations in theworld at the moment.
It, it does bear studying.
And so I think that it makessense that they're, that they're
looking into it for sure.
I have not, I know.
(40:39):
Well, we'll see, we'll, we'llsee what they find.
But it seems to me that if, ifthe two doses plus a, you know,
a six month followup booster ofan MRI and a vaccine is able to
provide as much protectionagainst hospitalization and
death, even from.
Oh, McCrone, which is a prettyheavily mutated virus.
I think that that's, you know,that, that might be good enough,
(41:02):
you know, at, at some point, youknow, we could you know, you can
vaccinate to kingdom come, butthe, at some point I imagine
we'll reach a point ofdiminishing returns.
Now that depends a lot on, onthe extent to which starts be to
continues to mutate.
We could enter a cycle whereit's like a flu shot, where we
have to get one every year.
I do think that's possible.
But but it's still far from aguarantee.
(41:23):
And I I'm, I'm still feelingpretty good about the protection
that I've gotten from mybooster.
And so, I'm hoping that'llthat'll last me.
Matt Boettger (41:30):
Okay.
Good.
Well, man, it's good to hangwith you forever.
Yeah, it's awesome.
Well, Hey, if you guys want toreach out to us and
mad@livingthereal.com email me,I will always forward on to
Stephen and mark.
I know mark has been hereforever.
It'll be a while before he isback.
He is inundated with a lot ofresponsibilities right now, but
I know he sends his thoughts andloves to all you guys out there.
We're listening.
Thank you for listening.
(41:50):
If you wanna support uspatrion.com/pandemic podcast,$5
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We really appreciate that.
Please leave a review.
If you want to check out Steve,and you can do that on Twitter.
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I've been following all thepeople you follow.
I've been learning a lot of realtime.
Good stuff with the people youfollow Stephen.
(42:11):
So S T E P H E N K I S S L E R.
Check him out.
You can subscribe to his feed.
You can do that on Twitter andyou'll get a lot of great
real-time information there.
Thanks for listening.
We are back to our regularepisodes until further ado.
Every two weeks have a wonderfulweek.
We'll see you guys in a coupletake care and bye-bye.
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible in the face
of these crises.
My name is Matt Boettger and I'mjoined.
I took forever to find this guyhe's been gone forever and hunt.
Stephen Dr.
Stephen kisser andepidemiologist Harvard school of
public health.
How are you doing
Stephen Kissler (00:14):
buddy?
Matt Boettger (00:16):
Doing good.
It's I don't know what to say.
Like Merry Christmas, happy newyear, blah, blah, blah.
We've went through a coupleholidays, right?
Yeah.
Stephen Kissler (00:23):
Happy new COVID wave.
Yeah,
Matt Boettger (00:26):
exactly.
So many exciting new things.
One that you don't want to surfon.
That's right.
No.
We're back where we apologize.
Usually it's every two weeks andwe never told you we just kinda
stopped.
And probably because it's theholidays and we were selling
Christmas new years.
I don't know if I mentioned thisto everyone who's listening.
Stephen probably knows a littlebit, but in our household, it is
(00:47):
literally a wave.
Of holiday stuff that almostmakes me tired to the point of,
I mean, utter exhaustion.
So we had our anniversary onDecember 18th and of course we
had Christmas.
Then my oldest son was born onChristmas day and then we had
new year's day.
Then my youngest son was born onJanuary 3rd.
So we had his birthday and thenwe had my wife's birthday in
(01:09):
next week and during the 17th,and then we had my son's
birthday on January 20th.
So it's a lot and it's.
It's a lot of partying.
It's a lot of budgeting thatneeds to be done better for next
year.
And then on top of that, he's,you know, Stephen, my son, my
youngest son, two days after hisbirthday had to go to the
hospital.
That was totally my fault.
(01:30):
I was vacuuming.
Our our playroom ratheraggressively, if you anybody
knows me, I do things veryquickly cause I wanna get these
done.
And I was swinging the handle,like crazy vacuuming the carpet
and I had no idea was behind me.
I just drilled him in the head.
Cut, open his head.
I feel really bad.
With the hospital.
We were a little nervous withduring the surge and but we were
(01:50):
extra cautious.
I called Stephen like at 10:45PM at his time at night.
That's the privilege of beinghis friend, I guess.
And, and, and, and crossingboundaries, asking him any tips
before I go in the hospital.
But yeah.
Yeah.
So as you know, it was a lotgoing on and you had some
holiday fun too.
You did some traveling, right?
Yeah,
Stephen Kissler (02:08):
that's right.
Made it out to Florida to seeAllie's family and also out to
Colorado briefly.
So, yeah, it was, it was good.
It was really nice to get, tosee some family over the
holidays for sure.
I bet.
Matt Boettger (02:18):
I mean, you are isolated because you had from
your family, you don't have anyfamily up there in Boston.
Yeah.
Stephen Kissler (02:23):
Neither of us really have family up in this
area.
So, yeah.
Matt Boettger (02:26):
So I'm glad you were able to get out and see
some family and we're back innow.
So we've got a lot to talkabout.
We'll see how much time we have.
The normal stuff, right.
Please relieve review.
We got a review just a coupledays ago.
No, Stephen.
He didn't.
If he saw it from J a E O T,this podcast has kept me
grounded and informed.
I'm grateful that Matt researchhas the right questions to ask
and that Dr.
(02:46):
Kisser Lee lends his time andknowledge to give listeners his
expertise.
I know that what I'm hearing isa latest and best information as
we know it at this moment.
Thank you.
So, yep.
That's good.
More welcome.
Super excited to get these thesereviews.
So please, if you want to leavea review, it inspires us and it
keeps this podcast in front ofmind and many people on all the
(03:08):
big directories, as well as youwant to support us
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Those$5 a month can help us keepthis going or just a one-time
gift, PayPal, Venmo.
You can get all of that.
In the show notes.
Okay.
So let's get going.
We already talked about AlmaCron.
He back in way back, I feel likeforever ago in December 13th.
And it was kind of being to rearits ugly head and boy, oh boy.
(03:32):
Does it rear its ugly head?
I can't believe when I see thecharts of this, it's just like,
I feel like it's like an error,like miss some data errors.
So like nothing spikes thatintensely.
So I think before I get into thenitty gritty details of
everything.
Why don't you just give us alittle kind of surveillance of
like what you've been seeingwhat's been going on with
Omicron?
How does it compare to otherones?
(03:53):
I mean, now we probably haveplenty of data to get a good
analysis of where we're at andwhere might we be going in the
next two weeks?
Stephen Kissler (04:00):
Yeah.
Yeah.
So.
Holy goodness, this this variantis infectious.
It is yeah.
It's eh, so, so there's, I mean,there's a couple of things in
play, and I think that we spokeabout some of these things in
previous conversations as well,but we've gotten a lot more
certainty around.
Sort of what is OMA crowns,shtick.
(04:20):
So, is it more infectious?
Inherently?
Yes.
It seems to be even moretransmissible than Delta, even
after you account for priorimmunity.
And even if you account for sortof changes in behavior and such,
so it's ramped up infectiousnessagain by twofold threefold, plus
you layer on top the immune.
Evasion where it can and we'lltalk more about that in a
(04:41):
moment, but it's, it's able tocause breakthrough infections
like mat it's infecting a lot ofpeople who have been vaccinated
who have been previouslyinfected.
It's just able, able to do thatbecause of all of its mutations.
And so that contributes to itsapparent infectiousness as well,
because if it's more infectiousat baseline and if it's able to
get around our immunity and youknow, Generally, you know,
(05:04):
people are I mean, like we justsaid, I, I traveled to this year
to see family.
I didn't do that last year.
And I imagine that that probablymaps to a lot of other people as
well.
So our behaviors are differenttoo.
And so part of like, all ofthose things together are
leading to this sort of hockeystick pattern of cases that
we're seeing in the U S and, andacross the globe.
So yeah, so there's, there's amajor surge of Omicron To add on
(05:25):
top of all of that.
We are currently smack dab inthe middle of peak coronavirus
transmission season, right?
Like first two weeks of Januaryis when the other common cold
Corona viruses spike.
Every year.
And so this is the mostdifficult time to control the
spread of a coronavirus.
Plus we have this new variantand all of these other things
(05:46):
sort of layered on top of it.
And so that's, that's causing ahuge surge in cases.
And unfortunately, I mean,that's, that's also leading to a
pretty big surge inhospitalizations right now, too.
We haven't seen as much of anuptick in deaths right now,
thankfully.
But but I expect that to follow.
And even though on a case bycase basis, McCrumb really does
seem to be less severe thanDelta, especially in the people
(06:07):
who are vaccinated.
They're just the sheer number ofcases is enough to really really
cause a lot of.
Matt Boettger (06:13):
Yeah.
You know, I think they're justthought of, I couldn't get in my
head.
He said, hockey stick.
I'm like Neil.
I'm like, can we just blame allthis?
And Canada
Stephen Kissler (06:21):
Porter person who wrote a review, asked us to
mention Canada and other onetime we mentioned them
Matt Boettger (06:28):
totally out
Stephen Kissler (06:29):
of context.
This is not his fault.
Matt Boettger (06:32):
I want to make sure I'm just joking, everybody.
That is this fear joke.
But yeah, this is exactly, youknow, one of the things that.
How do you see this?
When it comes to booster?
You said vaccine, there arebreakthrough cases.
I haven't got a chance to see,you know, clearly I would
imagine, you know, there's apretty decent amount of
breakthrough with people who donot have the booster.
I have the booster.
(06:53):
Do we see now roughly how manybreakthrough cases happen with
the booster?
Is it still pretty significant?
Is it pretty well protected?
Where is that on the spectrumfor the
Stephen Kissler (07:02):
Omicron?
Yes.
So we're, we're still learningabout that because it's And
there was.
There's a lot of reasons that ittakes some time to collect those
kinds of data, but people whoare boosted are still getting
breakthrough infections, forsure.
Every, every exposure that youget to the viral surface
proteins, whether it's through avaccination or through a
(07:22):
previous infection reduces theodds that a new infection will
actually take hold.
So, we, we do, from what I cantell, we're seeing reduced rates
of infections in people who areboosted versus people who.
But Omicron can absolutely causebreakthrough infections and
people who are boosted as well.
And I think the real upshot ofthat is that people who are
boosted have a lot of very goodprotection against severe
(07:43):
disease.
And so that's still the verygood news boosting really sort
of brings your immunity fromsort of a personal health
perspective, right back up inline to where it was previously
with two doses.
So that's, that's the good news,but it does seem like infections
can happen.
Maybe not as well if you'reboosting.
This thing's pretty infectious.
Matt Boettger (07:58):
Yeah.
I can imagine when it gets tothe other question, this is
contextual.
So I mentioned that my youngestson had to go to the hospital to
get glue, thankfully, not institches now, before we did
that, we called ourpediatrician.
And this is where I think it'scomplicated because I hear from
so many people just consult yourpediatrician and just consult
your doctor about, you know,vaccine, blah, blah, blah, how
it relates.
I feel like that's evencomplicated because.
(08:21):
I was on the phone with him.
He happened to be on call and wewere talking about, should we
take him to the hospital?
He's got a pretty good cut.
We really don't want to go tothe hospital if we don't have
to, because we still have somemore holidays to celebrate all
these complexities.
And so he was like, oh, I thinkhe should probably take him in.
And then that's when my wifewanted me to ask, like, ask him
about.
You know, the flu vaccine andthe COVID vaccine and what he
thinks about that.
Right.
(08:41):
And we trust our pediatrician.
He's great.
We love him to death.
And I was really confused abouthis answer.
And I wanted to throw this toyou and all of our listeners, I
would imagine I'm not the onlyone who's getting these kinds of
mixed signals at times.
And that he was kind ofinitially saying right away.
Yes.
I would say a hundred percentget the flu vaccine for your
child.
It's a very dangerous, I highlyrecommend it.
You really should be getting.
(09:02):
And there's even times in acouple of years past where you
kind of almost alluded to that.
If you're not going to get yourCOVID, you're not going to get
your kid the flu vaccine thenprobably just don't take them
out much during the winter.
Right.
Just keep them inside.
So he's really PR pro pro fluvaccine.
Great.
Then I asked about the COVIDone, right?
And then he's he was like, ah,no, you know, don't give them
the code vaccine doesn't reallydo anything for kids, especially
(09:23):
with Omicron.
Right.
It's just like a common cold, nobig deal.
And he was very dismissive ofit.
I was a little perplexed by hisanswer.
I'm like, it's.
Overly simplistic.
Yes.
To the flu.
Absolutely.
There's no hesitation, no way onthe colored vaccines, because it
really doesn't affect kiddos.
Don't worry about it.
We only give it to the kids whoobviously are diabetic or obese
(09:44):
or have those kinds of issues.
Right.
We give them to them for sure.
Right.
But if you're.
No need to get it.
So I looked up some stats onflew in, you know, not to scare
anybody, but you know, kidsdeaths and that kind of stuff.
And like 2019 was like thelatest, probably good statistic.
It'd be like 543 kiddos,unfortunately passed away in
2019.
And something like 476 kiddoshave passed away in two years
(10:07):
for COVID.
Right.
So the numbers are about half,right.
But then again, those are lownumbers.
And then, you know, I see in thecomplexity of the flu vaccine,
not being that effective rightthis year, it kind of missed the
mark, but it actually is reallygood for preventing
hospitalizations.
It's just that you missed them.
I get infected.
So seeing all of them, like itdoesn't seem that black and
(10:27):
white, I'm the wondering, isthis more of a political
decision than a scientificdecision?
I would imagine people who arepro fluid.
Pro COVID where do you land inall this kind of things?
Because I'm hearing this from apediatrician and it's informed
us.
I'm like, ah, this doesn't ring.
Stephen Kissler (10:43):
Yeah.
Yeah.
It's I find it sort ofperplexing too, because in my
mind, I mean, for a long time,I've sort of, I think that a
reasonable rule of thumb is thatfor for children under the age
of 12, I think the flu is areasonable.
Proxy for the severity of COVIDas well.
(11:04):
And it, and, and you just citedthat statistic as well of the
number of of deaths related toflu versus related to COVID.
And those are, I mean, those arepretty similar numbers.
That of course glosses over, youknow, a lot of other
Uncertainties, including, youknow, there are things that flu
can cause that are not death,but that can be sort of longer
term complications as withCOVID.
There are issues with long COVIDand young kids as well.
(11:25):
It's w we it's, it's hard toreally quantify those things.
We're still learning about a lotof those things, but as the
first rule of.
I think that the risk on a perperson basis is pretty similar
for young kids between flu andCOVID.
And in, in many ways I actuallysee flu as sometimes even at
greater risk for kids under theage of six, especially.
(11:46):
And so, but, but I think thatthey're roughly the roughly in
line with each other.
So if.
If I were to meet someone whois, you know, thinks that the
flu vaccine is worth getting, Iwould also imagine that they
would think that the COVIDvaccine is worth getting and
vice versa, but it sort ofpuzzles me why there would be a
very clear split between the twothat just doesn't make a lot of
(12:07):
sense to me.
And I'm yeah.
I'm glad you
Matt Boettger (12:09):
see that.
So those of you who havereceived that similar
information, maybe get a secondopinion because I feel like,
yeah, I felt the same thing.
I'm like, ah, you know, if theflu vaccine is good for the kid
and prevented it, I wouldimagine the code's vaccine.
And again, like you said earlieroff the air, I mean, it's, it's
also not, not takingconsideration at this point in
time.
The transmission of flu issubstantially less than the
transmission of COVID right now.
(12:30):
Right?
So that's a whole differentvariable that makes, can make it
more severe in its own level aswell.
And that gets back to anotherquestion, Stephen, again,
kiddos, cause I have kiddos andI'm always thinking of my kiddos
is a few weeks ago there was anarticle about hospitalization
for kiddos is increasingsubstantially because of
Omicron.
And then maybe two weeks later,I see another qualification of
this.
Where do we stand withhospitalizations and kiddos?
(12:53):
Is it kind of, this seems to besomething that might be slightly
more aggressive towards kids oris this something that you've
helped us before?
Is that it's just the nature ofthe transmission that makes it
look as if.
Bigger.
Stephen Kissler (13:06):
Yeah.
So, so both of those things andone more.
So first of all, you know, ofcourse kids are less likely to
be vaccinated and boosted atthis point.
And so there's differences inimmunity there.
There's a lot of spread andkids, especially from schools
right now.
And so, so the, just the rawcase counts, we expect to be
high in kids right now.
And the other thing is thatthere is, especially in, in
(13:29):
certain parts of the countryright here in Massachusetts, we
have a major Omicron surge rightnow.
But we actually saw this inSouth Africa too, which is that
not everyone who is in thehospital.
With a positive COVID test isthere for COVID.
Since the rates of Omicron areso high, I mean like this low in
case I haven't emphasized thatenough, this thing is incredibly
infectious, right?
(13:49):
There are a lot of people whocurrently have crown infections
in the United States.
As a matter of course now whenyou go to the hospital,
generally you get a COVID testor at least you're screened
somehow for COVID.
And so in many places, those endup in the hospitalization
statistics, even though thehospitalization was not for
COVID itself.
Now that doesn't mean thathospitalizations aren't spiking.
(14:10):
I mean, COVID is bringing peopleto the hospital.
Omicron is bringing people tothe hospital, but some fraction
of those cases is also going tobe counts of people who have
tested positive for COVID whilein the hospital, but are not.
Because of COVID and I thinkthat'll probably especially be a
complicating factor for youngkids because there'll be going
to the hospital and there are alot less likely to be in the
(14:32):
hospital for COVID, but there'sa lot of COVID in young kids
right now.
And so I think that that mightbe one of the confounders here
as well.
So, so really we're thinkingabout these hospitalizations
statistics, especially in kidswith a grain of salt definitely.
I mean, definitely COVID canbring a kid to the hospital.
Flu can bring a kid to thehospital for sure.
But some of the spike that we'reseeing is incidental.
Yeah.
Matt Boettger (14:52):
And another thing they putting consideration, I
don't know if you said thisStephen, or if I read this, so
it should be credit to you thenI apologize.
I have no idea, but somethingabout how, even if the common
cold received this kind ofintensity, there'd be just so
many hospitalizations of that.
I mean, it's the, it's theenormity of the influx of
infections.
That's, that's overwhelming thehospital, even if, even if it
(15:13):
homo Cron general.
It's a common cold.
This could just wipe outhospitalization, hospitals
really quickly and theirresources just because it
spreads
Stephen Kissler (15:19):
so fast.
Yeah.
Matt Boettger (15:21):
So that lead me to his question, which I kind of
may lead the jury to my ownanswer.
And that is, should I just getOMA chronic, get it over with
like, there's these mixedsignals of like these, you know,
one, one article from both ofthe Atlantic boosted, God
Omicron, you still might not besuper immune.
You know, in my mind I wastalking to my wife.
What's the possible, I mean, nothaving a COVID party of course,
(15:42):
but like saying, okay, we're notgoing to shelter in place for
three months.
We're still going to go out and,you know, wear a mask.
But if we get it, wouldn't thatmaybe be a good time because OMA
Crohn's generally not toodangerous.
And if we're boosted and we getOmicron, and if the next variant
comes at raise its ugly head andit's worse, maybe we have, we
have an extra insurance policyof, of, of weathering the storm
(16:02):
until the next booster.
Should we go ahead and allow itor.
Not, you know, this article issuggested maybe not, but then a
previous article by the Atlanticmentioned, well, there's
T-cells.
And, and because of those thatmight actually help you with the
next variant, where do you standin this kind of like Alma Cron
dance of it gets just a commoncold.
Let's just get this sucker andbuild my immunity versus maybe,
(16:23):
you know, balance that.
Stephen Kissler (16:26):
Yeah.
So, I mean, I think sort of.
Bringing this into the contextof the previous conversation.
You know, the biggest thingthat, you know, the thing that's
on the forefront of my mind nowis trying not to get Omicron
right now because I don't wantthat, even though it does seem
to be like, I'd probably bebetter off if I had gotten
(16:46):
infected with Omicron than if Ihad gotten infected with Delta
right now, given my vaccinationstatus and so on.
Breakthrough in the chronicinfections can still hurt quite
a bit.
I mean, when we talk about mildinfections, that doesn't
necessarily mean the sniffles,you know, you could be, you
could be coughing up a lung fora good week or two and feel
pretty fatigued and that's stillconsidered a mild infection.
Right.
Matt Boettger (17:05):
That's good.
And that's going to say reallyfast.
Cause my wife was like I said,oh, it's just mild.
Like, well, all my friends arehaving it.
And they were like in bed, likejust like coffin and they don't
want to go to bed, but that'snot modeling like what.
Their definition of mild is, islike comparative to a hospital
where you're on a ventilator,
Stephen Kissler (17:19):
right.
Is exactly, I think it getsworth.
And this was illuminating for metoo, that like these, these
classifications of, of mild,severe, et cetera, are, are made
by generally by clinicians, bypeople who are in the hospital
who really see the severe cases.
Right.
So if you're, you know, sick inbed and feel like you've gotten
hit by a train.
That doesn't feel mild to me,but if you, you know, if you
(17:41):
have somebody who's treatingpatients in the ICU, see is
here, they're going to shrugtheir shoulders and be like,
yeah, it'd be all right.
You know, smiled.
So it's all a matter ofperspective too.
And so, you know, and, andbecause of that, you know, Could
lead me to need some type ofmedical care right now, even if
I don't end up in the hospital.
And that's kind of what I'mtrying to avoid at this point
(18:01):
which I think it's, it's worthnoting that that's very
different than what I was tryingto avoid this time.
Last year, when the thought ofgetting infected.
Also from a personal standpoint,and from the standpoint of
exposing people around me, therewas just a lot of risk there
that vaccination has done a lotto blunt.
And so right now, really my onthe forefront of my mind is.
(18:24):
Trying to keep our healthcaresystem from really getting
overwhelmed.
And thinking about it from apersonal perspective, too,
right?
Like I'm talking about ourhealthcare system, but like,
this is my brother we're talkingabout.
Right.
Like, I, I, I, we're trying tokeep these people who are
keeping us healthy from gettingso burned out and, you know,
having to work over to.
And you know, people are leavinghealthcare positions in droves
right now because of just howawful of a situation this has
(18:48):
been.
And, and that's, you know, thatthat's who that's, who we're
doing it for.
And so maybe it'll, maybe it'shelpful to talk about Sort of
the precautions that I'm takingright now.
So I'm vaccinated, I'm boosted.
I got my booster in November andI am not indoor dining.
We've decided to, to put that onhold for now.
But we're still, you know,getting takeout from local
restaurants to.
(19:08):
Both try to support them.
And because I get sick of my owncooking and I I've transitioned
to wearing mainly kn 95 masks.
When I'm going indoors withplaces where there are other
people's different going groceryshopping, for example, I'll,
I'll put on a, on 95.
And, but I'm still going groceryshopping.
Maybe not as frequently as I, asI was or try to get some
deliveries and such, but I I'mhappy to go into a grocery
(19:29):
store.
And so part of that is sort offeeding into, I think, what you
had been getting at with yourprevious question, which is that
like, I don't want to getOmicron right now.
This wouldn't be a particularlygood time for me to be laid out
in bed for a week and a half.
But I'm also a lot lessconcerned, like.
Given the, the raw statistics,it's, it's pretty unlikely that
I would end up in the hospitalwith it.
(19:50):
And so I'm not locked down tothe degree that I was this time
last year.
Everybody has their own riskcalculus, which has to do with
their own level of risks thatthey're willing to tolerate with
their own personal situation,their health situation, the
people they might be taking careof.
So it's really hard to sort ofgive recommendations that are
applicable across the board.
But that's sort of the way thatI've been approaching it.
Matt Boettger (20:08):
Great.
And let's hit the Canaanite and95 masks.
I, myself moved towards that.
I had kind of just a regularmask and about Thanksgiving,
first week of December, I movedto permanently to the K N 95
mask, but I'm a dude.
I wear the same thing.
I have it in my pocket.
I pulled it out.
I had the same thing for thepast month.
Is it okay?
I mean, it's not green, it'sstill looking the same color.
(20:30):
Right.
So that's good.
It's good for me, but like, am Iokay?
I mean, Now that we're moving tothese kinds of, okay.
Cloth mass, back in the day, youjust throw them in the wash or
wash and reuse them.
No big deal.
Now I've got these kn 95 maskand I'm just too lazy and I
might have it for three yearsand just not even do anything
with it, still use it.
When can I reuse these?
What's the best kind of, how doyou approach your canine by mass
(20:51):
replacing it or keeping it, doyou have any, any tips for us
who are just like.
I'm not being super cautiouswith my mask.
Oh yeah.
Stephen Kissler (20:58):
It was I was going to say pay attention to
how it smells, but then again,if you get COVID
Matt Boettger (21:04):
that doesn't the front of the mask and if it
tastes really bad and then goahead and note that that's not
the one.
Stephen Kissler (21:09):
No, don't do that.
I mean, yeah.
So I think that like, generally,you know, it, it, it seems to be
okay to reuse these masks for,for a number of, of, of uses.
I, ah, Yeah, it depends a lot onsort of like how long you're
using it as well.
I'm I tend to fall on the sideof like, if I pull something out
of the fridge and it smells alittle bit funky, I'm like, I'm
(21:30):
going to pitch it rather thanunit.
I'm pretty cautious with thatkind of thing.
You're an epidemiologist.
Yeah, exactly.
So I I tended to change out myprobably every like five to
seven days or so.
And and, and also, you know,bearing in mind that like, I'm
usually only wearing them forlike quick trips out.
Right.
I'm not, I'm not like wearingthis all day long.
If I had to wear a K on 95 allday, I'd probably be changing it
(21:50):
daily.
And so, and, and a lot of thatis just because it's like a.
I don't know, like it's just,just helps to keep it fresh.
So, yeah, I, I it's, I don'tknow if there's like solid data
on this, but I do know thatlike, that it seems like.
You can reuse them, especiallyif they're not, if they haven't
gotten wet, if they haven'tgotten soiled in any way they,
(22:11):
they hold up their protectionover time.
But you also don't want to bebreathing in your own gunk too
much.
So,
Matt Boettger (22:16):
yeah.
I hear hear that.
Yeah.
And I had saw a couple articlesin the same thing that you can
reuse them for a while, and itdepends on how long you use
them, use them all day then, butyou can normally use them maybe
for a few weeks and just.
If you just use them kind ofsporadically right here and
there and small Smuckers, butjust keep them.
I think I read which I don't do.
They're like, don't put it inyour pocket.
Don't just put your purse.
Don't just hang it on your ear.
(22:37):
Put it in like a, a paper bag.
Or if you do a plastic ziplockbag, don't zip it up all the
way.
Cause the moisture can thencondensate that kind of stuff.
So just make sure to take thoseprecautions.
I learned a couple of things.
I'll put a, put one of those inthe show notes as well about
that.
One of the other things I wantto talk about is a number of
articles have been about withOmicron being this kind of
beginning of the end, thatbecause of this, I've heard even
(23:01):
things like, oh, this could bethe first time where there
actually might be a, some senseof herd immunity, because it's
just so intense.
I don't even know what thatmeans and let a variance that
kind of stuff.
I feel like it's a meaningless.
But like, I, you know, Alma conmay be the harbinger of the end.
That's the one I hear Omicroncase they're hitting highs, but
new Delta may put end in sight.
Omicron could potentially hastenthe COVID pandemics end.
(23:21):
So all these things about theend right now, the apocalyptic,
like the entire.
Stephen Kissler (23:28):
Yeah, I was going to say, you know, I've for
my entire life, I've always beena little bit skeptical of the
people who, you know, say theend is near.
And so, I think that applies onevery level.
And but that said, you know, Ithink that what w what it is, I
do think that there actually maybe some truth to that where At
this point, a lot of people whohave been who have, who are
(23:48):
going to get vaccinated, havealready been vaccinated.
Omicron is probably gonna affectjust about everybody, you know,
especially if they haven't beenvaccinated yet.
And so that's going to give,essentially everybody.
Almost everyone, some degree ofexposure to SARS COVID two which
should feed forward into somedegree of protection from severe
disease and illness.
And so I do think that there's,there's some reason to hope that
(24:12):
because the monochrome wave isso intense, that future waves
will be blunted to some extentbecause our immune systems will
have gotten one more exposure tothis thing.
I'm hopeful for that.
But you know, epidemics arefamously elusive when it comes
to defining beginnings and ends.
You know, it's as, as with thegreat apocalyptic poem, it's not
going to end with a bang, but awhimper.
(24:33):
You know, we're just going toslowly transition into this
period of time where ourperception of the virus is going
to change.
The severity of the virus isgoing to change and thoroughly
isn't going to be the switchthat happens with the Omicron
variant, but it's going to besort of one more.
Interests us towards thatendemic phase where we're going
to be dealing with COVID as acommonly circulating illness for
a long time.
And so I do think, you know, oneof the actually really good
(24:56):
strokes of fortune, as far as Ican tell with this virus so far,
is that it does seem like.
Multiple exposures tends toincrease the breadth, the level
and the duration of yourimmunity.
That's not always true for allpathogens.
Sometimes repeated exposures getworse with time.
Sometimes they don't do much atall.
So, in some ways we got luckywith this one that, that
actually our immune system doesbuild up over time with it.
(25:18):
That's usually the case, butit's not a guarantee, but it
seems to be the case with SARSCOVID two.
So I think we're just sort ofgetting closer and closer to
that base.
Matt Boettger (25:25):
Okay.
Now, speaking of a baseline inthe transition, the CDC changed
their policy for isolation,which seems to be another kind
of transitionary point for usfrom, I think it was 10 days to
now five days.
So a couple things I want you torespond to.
Number one, what do you thinkabout this?
This is now five day thing.
Is it a good policy?
And the second big thing I wantyou to at this time?
(25:48):
Excuse me.
The second thing I really wantyou to talk about is I was
thinking about this, like, okay,I was reading about this policy
change and the why behind it,and then there's some science
behind it.
And I get that, but I feel likethis is another example of
science.
Using supply and demand to maketheir decision.
I think this is an importantthing that I want you to just
talk about for a little bit,because to me, this is one Elmo
(26:10):
by which it becomes fodder forconspiracy theories.
So I have three examples hereback in the day, early in 2000,
right?
In 2020 in spring, when it firstcame out, Fowchee started
talking about how cloth maskswere first.
You first don't worry aboutcloth masks, not at all.
And then, then it was just clothmasks and then cloth masks.
And part of this, like aconfusion, I felt part of it at
(26:33):
least was the idea that thehospitals weren't getting the
necessary resources they need.
So a policy became like, oh,just use Claus pass.
Right.
Because they're just aseffective.
And then in the end we realizedthey're not just as effective.
And so then we want to likeblame them as being like wrong
or some kind of conspiracything.
Because in the end, I'm thinkingthey're not only being
scientists, they're using supplyand demand to make their
(26:54):
decisions.
And the second example is theisolation period, right?
This one changes down to fivedays.
Part of it might be in science,but part of it also, because
everybody was homesick you lastweek and people have to work.
And so we have to change thissupply and demand like, oh crap,
let's change the five days now,is it?
Because 10 days wasn't really anumber in that we're just making
up crap.
(27:15):
No, it's because it was really.
But now there's a new problemthat we have to address.
We have to change the numberbecause of a greater problem.
And then the third one, we'lltalk about it a little bit.
As I'm seeing this now istesting like the, the the
over-the-counter testing first,it was like, just test, test,
test now, like, oh, don't askdon't test.
If you're asymptomatic don'ttest because we're writing the
shortages on.
So you're seeing these likescientific explorations and then
(27:38):
presenting us a model of what todo, and then it kind of changes.
Partly because of supply anddemand, I think because we had
to thank consideration, but it'snot because science is wrong or
it's conspiracy theories becauseit's just one other variable
that needs to be considered forpublic policy.
Can you wrap your inner weave,all those into this, this
particular question.
Stephen Kissler (27:55):
Right.
So, so regarding the CDCguidelines, like you said,
they've, they've reduced theisolation period of five days
and critically that, that, thatapplies if you are no longer
symptomatic and they ask thatyou continue to wear a mask
pretty diligently for, for thefull 10 day period.
Now that said people canabsolutely be infectious for
more than five days after.
After a after detection.
(28:16):
And so there's there's a riskhere.
I think you're right.
That essentially what they'retrying to do is to balance the
need for people to work and tosort of return to their more
normal lives with the risk ofcontinuing infection.
I think it's a really difficultcall to make the.
The policy that I would hope foris a test to move out of
(28:42):
isolation.
Because that'll spring somepeople from isolation after
three days and it'll spring somepeople out from isolation after
seven days.
But but that's going to be a lotmore relevant metric for whether
or not you're likely to spreadinfection to others.
And, and so.
This would be the way to go.
People can be infectious for upto seven to 10 days, for sure.
Or at least seven to 10 daysafter their, their detection.
(29:03):
And so I do think that, youknow, we need to be mindful of
the fact that this update to theguidelines is posing some degree
of risk of onward spread.
And I think that, you know, Thatthat the right policy is not to
re increase it to 10 days.
It's to use the technology thatwe now have available to make
better decisions and morepersonalized decisions based on
whether or not you actually areinfectious.
Yeah, that gets, that gets tothe question about testing now,
(29:24):
too.
Right?
So there's been a lot of this,this questions about, you know,
should we be tests doingasymptomatic testing as much as
we have them?
So I think there are a couple oflayers to this as well.
So the, the question aboutshortages of tests, I mean, it's
kind of true, but I really don'tthink that individuals should be
shouldering that burden, right.
Are, are frankly it's, it's theMachinery of government and
(29:46):
manufacturing that is failed ushere.
You know, it's, we, we shouldhave these tests in much greater
supply than we do.
And and so now it's sort ofbeing, you know, asking
individuals to say like, oh, weneed to conserve these things.
It's like, well, yes, but like,Well, why, why, why we had to
conserve them for the entirepandemic?
You know, it's, it's a littlebit crazy.
(30:06):
But that said, you know, we arein the situation that we're in.
And so maybe, I don't know, I,for the sake of, of of, of Like
maintaining our supply chains.
I really can't get behind tothis argument of like testing
less.
I think if you need to get atest, you should, you should get
a test.
And, and our, our supply chainsneed to sort of find a way to,
(30:27):
to keep up with that one way oranother.
That said, so there's also beena lot of questions about rapid
antigen testing with respect tothe Omer crown variant.
And it really does seem like,the rapid tests.
Don't seem to be able to pick upthe Omicron variant as well in
the early stages of infection asthey used to be able to.
And so it seems like people areable to be infectious prior to
(30:47):
turning positive with a rapidtest, for example, whereas
previously there was a reallytight correlation where if
you're positive on an enginetest, you're infectious, and if
you're not positive, you're notinfectious.
That correlation is sort ofgetting broken up a little bit.
And part of that might be due tothe way that Omicron causes.
It seems like there's a lot moresort of like, Throat based
symptoms with Omicron and thatit might sort of reside in the
(31:10):
throat a little bit more than itresides in sort of the anterior
narrows on the, on the front ofthe nose.
And so part of it is maybe noteven that the test is not good,
but actually the swab itself ishaving some issues picking up
the.
Nope.
There've been some videoscirculating and one of them I
think, is actually useful fromthe United Kingdom.
What is it?
The UK HSA, the health securityagency in the UK where they
(31:31):
actually walk you through thesteps of taking a combined
throat and nose swab.
And there are some tests in theUK that actually are approved
and call for that, but there aresome people who have been.
Yeah, maybe we should try to dothis with rapid antigen tests
and see if they that increasestheir positivity.
So there's not a lot of cleardata on that, but full
disclosure, I've swapped mythroat with a Binance now and
then swapped my nostrils aswell.
(31:52):
When I was taking some rapidtests recently made me gag a
little bit.
It wasn't particularly pleasant,but but you know, like, and it
was a little bit gross stick ina swab that had just been down
my throat up.
I know it was too, but like allfor the sake of science and for
the sake of trying to preventthe spread of.
Spread of COVID Lord have mercy.
And so, yeah, so I mean, ifyou're interested in looking at
(32:13):
some of those videos that areout there, I would recommend the
one from the UK HSA becausethat's, that's generated by
their public health agency andreally goes, walks through the
steps of giving yourself athroat swab, full disclosure,
not approved by the FDA.
This is not like on the package,you know, like.
And so, yeah.
If you do that, recognize thatyou're deviating from the
recommended protocol of thesetests, and that comes with all
of the standard, you know,whatevers that come along with
(32:35):
that, I'm not a lawyer.
I am an epidemiologist, so sorryfor the vagueness here.
But that said, you know, thatthat does seem to be a feature
of Omicron potentially thatthere might be differences and
where it resides in our system.
And that could change the waythat tests respond to it as
well.
Okay.
Matt Boettger (32:49):
Yeah.
And I heard about this.
I mean, well, I mean, from mywife, there's just been weird,
weird things happen.
I mean, we have people gettingCOVID all over the place.
I mean, every meeting I have isvirtual over half of those
people in the meeting haveactively COVID, but we were
hearing like, oh yeah, thisfamily got covered the whole
family, but we didn't get COVIDbut we got sick.
Cause we could, we took anengine test and it said we
weren't, we weren't positive,but we're like, I'm sure it's
(33:10):
probably covered if the wholefamily's covered.
And you got sick too.
And he had.
Chances are, I mean, it's not,yeah.
It's just a, maybe a bad, badtest.
Right.
So great.
That's helpful.
Anything on the whole supply anddemand thing, like immediately,
like, is it part of like thekind of, I mean, this is where
I, it's hard for me tounderstand, like as a, as an
epidemiologist, your peer on thescience side of this things, and
(33:31):
then there's public policy,which then takes all of this
stuff that you provided and thensomebody else filters it to
provide the best possibledecision for the sake of.
Right.
Yeah.
A government or society.
Stephen Kissler (33:44):
Yeah.
I think, you know, th th thosethings definitely come into
play.
And it's like on all sorts ofdifferent levels.
Right.
So there's like, there's thescience, there's the policy is
sort of like supply and demand.
There's the question of justsort of like, what level of risk
are we willing to sustain as apopulation, as a society, and
sort of all of those thingsfactor into the decisions.
Now, my hope would be that like,as these policies change, that
(34:04):
we.
I have very clear informationabout sort of what's behind
those changes.
And to what extent it is supplyand demand, at what extent it
is, you know, Hey, we'reactually going to begin to
accept this degree of spread,recognizing that the science
suggests that we can stillspread COVID after these five
days.
But you know, we're going to saythat like there's so much COVID
circulating anyway, that wedon't think this is going to add
(34:24):
substantially to an individualperson's risk of acquiring COVID
given how much is out there atthe moment.
And so, you know, veryprincipled, various sort of like
clear.
Rationale for the changes inguidelines, because absolutely
all of these factors.
Feed into what the guidelinesare.
And I think that the real issueis that a lot of times it hasn't
been clear what thosemotivations have been
(34:45):
throughout.
And I think that if we can beclear on those things and we can
really hopefully avoid a lot ofthe skepticism, that's been
leveled towards the.
Matt Boettger (34:53):
That's great.
I think that's a perfect answeryet.
I think that sometimes I feellike it is being clouded or like
not being addressed at theforefront, which then makes it
feel like somebody's hidingsomething and it's not intended
to just make it been great.
You know, just how it'spresented.
Okay.
So let's get to the next thing.
So we talked about this.
There is a new variant, right?
Well, who knows?
There's probably tons ofvariants out there, but there's
new variant.
That's hitting the press as a,recently from Cyprus.
(35:13):
So a shout out to our, our, oneof our Cypress friends out
there.
Not the best of news, but.
You and talk about this as itwas it called the Delta crown or
something like that.
I know it's like
Stephen Kissler (35:23):
a little bit ridiculous, right?
Like, so we have Delta plus fora little while, and now it's
like OMA, Delta, flu Macron orwhatever.
And it's like, yeah, so, so,right.
So, so this one that I think wecan actually probably like,
well, let me take a step back.
Right?
So, so there's, there has beensome suggestion that the COVID
that starts Coby to the viruscan do something that we call
(35:43):
genetic recombination.
So basically when you getinfected with two different
stereoscopy, two variants intheory, they could switch some
little parts of their genome andgenerate this sort of hybrid
variant.
So in theory, that's true.
It's been sort of observed.
Some small, relatively isolatedinstances.
But then this really hit thenews with the Delta Cron variant
(36:04):
that I think they're talkingabout now, from what I can tell,
this is probably an issue withlaboratory contamination.
So oftentimes what happens iswhen you're doing sequencing.
You'll have swabs that pick upDNA, that you then run through a
sequencer.
And if at any point in theprocess that swab gets
contaminated with anothervariant that's circulating,
(36:25):
where if you're doing a labthat's processing SARS, cov two
sequences, you've probably gotsome Delta in there and some of
them are crown.
You can end up with a sequencethat looks like a hybrid between
the two, even though that's notactually the thing that you
isolated in the first place.
Part of the reason we think thatthis is likely an issue of
contamination is also becausein, from, from my understanding
in the genetic sequences thathave been tagged as these hybrid
(36:47):
variants, there are also a lotof other parts of the genome
that are.
Essentially what we callreversions to the reference
sequence.
So whenever you're doing asequence Normally you start from
a reference sequence.
So sort of a basic SARS COVIDtwo genome.
And then what your actualsequencer is doing is trying to
figure out where your particularsample differs from that.
(37:09):
And if you have low certainty incertain areas, it just reverts
to that reference sequence.
And if it does that a lot oftimes, that's an indication that
actually you don't really have agood sample in the first place.
And so because of the number ofcalls to the reference sequence
that this, that these particularDelta.
Sequences have had there's mybest guess is that there's some
sort of laboratory sequencingcontamination going on here and
(37:31):
not an actual bonafide newrecombination variants sort of
circulating right now.
Matt Boettger (37:35):
Okay, great.
Here's a helpful, it'sfascinating how I feel like, you
know, our names went from anapple S kind of like Delta plus
to now.
I think it feels like it's likeWWF restaurant Delta crop right
now.
We're now we're now we're inthe, we're in the spotlight,
some heavy, heavy lifting here.
Okay.
That's.
We you know, some good news,right?
President Biden to promise tothink this year, January.
(37:56):
So it's beginning the enginetest, rolling out free tests to
500 like 500 million boxes orwhatever to give out.
I just, I'm just so happy withColorado because I get boxes.
It's just amazing how generousColorado has been with every
week.
You could get two boxes if youwant to.
I think twice a week.
So up to four boxes a week, ifyou want to, if you need.
(38:16):
Free delivered to your, to yourdoorstep.
So, also crowdsourcing everyone.
Here's my question.
I have a cane in 95 mask that Isometimes can't even see out.
Cause I wear glasses.
Does anybody have a K N 95 massthat they purchased that is rock
solid.
And he feel like, man, I wearglasses and I don't get the fog.
Now I know I can put fog stuffon my glasses.
(38:37):
I don't want to deal with it.
I just want a good canine fiveglass.
If anybody has one.
That they want to recommendmad@livingthereal.com.
I'd love to get one, a legitone.
I'm looking for one preferablynot, not pink and roses, just
the normal color.
That's what, that one that wehad, all the suit.
We know the, we talked aboutthat the Pfizer 50 authorizes
the Pfizer is antiviral pill.
We said that might be out now,but probably in.
(38:58):
The
Stephen Kissler (38:58):
low circulation, I think it's
probably being mainly used rightnow for people who are at high
risk of severe disease.
So with, with multiplecomorbidities and, and such,
but, you know, hopefully it willbe more and more available as.
Okay.
Matt Boettger (39:10):
Great.
Last few things is quick.
Awesome.
Put a bookmark on this.
I tell this, I told this to you,Steve and I saw this interesting
article, a punish shadows.
New COVID vaccine from Texascould be a global game changer.
It was really interesting.
Again, you hear some of thepolitics.
Initially, these, this couplehad been working on for decades
and prison.
Too, I think some big leagues tobe a part of the vaccine early
on, but wasn't adopted becauseit wasn't innovative enough.
(39:31):
It's kind of an old schoolmethod, but some private
companies invested in it's asuper cheap, pretty effective,
90% effective for the original80% with Delta.
We don't know about Omicron yet,that kind of stuff, but we're,
it's like a dollar, a buck, 50per dose.
So this is like a game changerfor a global vaccine.
So I'll put in the show notes,read about it.
My last question to you, it justcrazy to think about.
(39:52):
Israel has studied fourthdosages.
This is Cray Cray.
I'm like, man, I feel like we, Ithought we're going to go to a
restaurant that you're going tohave, like, you know, I'll have
the lobster and I'll have adose.
Right.
So w w w you know, I knowearlier on, we were talking
about how the third dose couldbe like this linchpin to keep us
for a while, a lot longer thanthe first and second dose.
(40:13):
Where do you see before we endthis?
Now with this fourth dose, maybeendless dosages coming about, oh
boy.
Stephen Kissler (40:19):
I mean, I hope it's not endless dosages,
especially if they all make mefeel the way that the last one
or two did.
You know, so, but so I'm gladthey're studying it and it's the
right place to study it becausethey're one of the most highly
vaccinated populations in theworld at the moment.
It, it does bear studying.
And so I think that it makessense that they're, that they're
looking into it for sure.
I have not, I know.
(40:39):
Well, we'll see, we'll, we'llsee what they find.
But it seems to me that if, ifthe two doses plus a, you know,
a six month followup booster ofan MRI and a vaccine is able to
provide as much protectionagainst hospitalization and
death, even from.
Oh, McCrone, which is a prettyheavily mutated virus.
I think that that's, you know,that, that might be good enough,
(41:02):
you know, at, at some point, youknow, we could you know, you can
vaccinate to kingdom come, butthe, at some point I imagine
we'll reach a point ofdiminishing returns.
Now that depends a lot on, onthe extent to which starts be to
continues to mutate.
We could enter a cycle whereit's like a flu shot, where we
have to get one every year.
I do think that's possible.
But but it's still far from aguarantee.
(41:23):
And I I'm, I'm still feelingpretty good about the protection
that I've gotten from mybooster.
And so, I'm hoping that'llthat'll last me.
Matt Boettger (41:30):
Okay.
Good.
Well, man, it's good to hangwith you forever.
Yeah, it's awesome.
Well, Hey, if you guys want toreach out to us and
mad@livingthereal.com email me,I will always forward on to
Stephen and mark.
I know mark has been hereforever.
It'll be a while before he isback.
He is inundated with a lot ofresponsibilities right now, but
I know he sends his thoughts andloves to all you guys out there.
We're listening.
Thank you for listening.
(41:50):
If you wanna support uspatrion.com/pandemic podcast,$5
a month or a one-time.
PayPal, Venmo.
We really appreciate that.
Please leave a review.
If you want to check out Steve,and you can do that on Twitter.
I'm in following him more andmore and more lately, I had you
on Twitter, but I didn't reallyfollow you that much, but lately
I've been following all thepeople you follow.
I've been learning a lot of realtime.
Good stuff with the people youfollow Stephen.
(42:11):
So S T E P H E N K I S S L E R.
Check him out.
You can subscribe to his feed.
You can do that on Twitter andyou'll get a lot of great
real-time information there.
Thanks for listening.
We are back to our regularepisodes until further ado.
Every two weeks have a wonderfulweek.
We'll see you guys in a coupletake care and bye-bye.
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