Can you Rate and Give us a Review in Apple Podcasts?
- Please go to Pandemic on Apple Podcasts to leave a review. Thank you!
Please consider financially supporting us for the monthly upkeep and helping hand off some of the editing responsibilities. You can give a one-time donation or become a Patreon member for as little as $5 a month. See the links below. Thank you!
- Give a one-time gift through Venmo at @mattboettger
- Give a one-time gift through PayPal here.
- Give monthly (as little as $5 a month) on our Patreon Page.
Things Discussed on Episode:
- Getting Back to Normal Is Only Possible Until You Test Positive
- Dr. Gottlieb: Coronavirus Pandemic Could End in U.S. in January
- How you’ll know when Covid-19 has gone from “pandemic” to “endemic”
- Colorado hospitals on edge amid renewed COVID surge, staffing shortages
- COVID booster shots allowed for all adults in California, Colorado and New Mexico
- covidestim · COVID-19 nowcasting
- How Easily Can Vaccinated People Spread COVID?
- Great Image of How Reduce Airborne Illness In Our House
- Should you go to Thanksgiving dinner with your unvaccinated uncle? Experts help make the decision
Mark as Played
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.
And the face, these crises.
My name is Matt Boettger.
I'm joined with my one goodfriend once again, Dr.
Stephen Kissler, anepidemiologist at the Harvard
school of public health.
Good morning.
Fine, sir.
How are
Stephen Kissler (00:14):
you doing?
Hello?
I'm doing all right.
How are you
Matt Boettger (00:16):
doing?
I'm doing pretty darn good.
Fall is still doing, doing wellfor us here in Colorado.
It hasn't snowed yet when yousay super cold cold days.
So, I do hear that winter.
Might be a chilly day, but I'mloving it.
I'm loving it.
So
Stephen Kissler (00:33):
how's your weather?
You know, we finally got fallhere too.
It was a lot later than itusually is, but yeah, the leaves
are gorgeous this time of year.
So, yeah, but I'm glad you guyshave been getting a good one.
I know that sometimes fall lastabout two minutes out there.
So
Matt Boettger (00:47):
it does.
And we, the older I get, like Isaid, the warmer, I like it.
It's I'll I'll take it.
I'll take it.
So we have some great stuff tochat about today.
Before we get started, we gotthe usual stuff.
If you can leave a review,please do.
It's so helpful.
It inspires us, keeps us go andyou get an apple podcast or some
other place as well.
(01:07):
You can do them.
I have no idea what it is aswell as you wanna support us,
please do it.
Helps us keep this going andkeep the lights on that is
patrion.com/pandemic podcast, orjust a one-time gift PayPal.
Then Mo those are all in theshow notes.
Speaking of reviews, there was areview.
So here's the deal.
People who listened to us acrossthe waters and different
(01:28):
countries.
We don't really see them becauseI think apple like put silos
around different countries andtheir reviews.
So we don't see them.
So I found one.
From Canada.
She basically emailed medirectly.
Let me know that I probably didnot see the review left a
wonderful long comment.
I have yet to send it to markand Steve and I will, but here
(01:50):
is a big thing.
I take full responsibility ifthat's from Canada.
And I just don't talk about, wedon't talk about Canada that
much.
And there's been times by whichCanada was suffering on a level,
very different than the us andprobably.
It's own guidance and Icompletely blew it in failed.
And I apologize cause I'm theone who brings up the news
articles and you know what?
(02:11):
I just didn't do it in a week.
We definitely want to drawattention particularly to our
neighbors, you know, all aroundthe world to, to, to where we
can do this, but at least ourneighbors to help them out.
So I apologize.
Thank you for still listening tous and giving us a second chance
and we'll, we'll keep that moregreatly on the radar.
And also here's a great thing.
I only have so many hours in theday.
This is just kind of a passionproject for me that if you are
(02:34):
in a different part or adifferent country, and there's
something going on, if youemail.
Matt@livingthereel.com and kindof say, Hey, this is going on.
Can you give it some attentionon your next podcast?
That makes my life about athousand times easier and I will
definitely bring it to thesurface.
So here's a tipmatt@livingthereel.com.
(02:54):
Okay.
I think that's all the goodstuff let's get rolling.
So, let's start with this.
This is an easy one.
Stephen, I'm going to plantthis.
I read this article thismorning.
I had a breakthrough COVID.
But this is the article.
It was a logistical nightmarefrom the Atlantic.
And I loved it.
It was by a gentleman whoactually was part of the whole
John Hopkins project with thetray, the tracking of COVID.
(03:16):
So Amanda takes it incrediblyseriously.
The reason why I highlight thisarticle, Stephen for the
listeners is because not tocreate a fear factor, but just
to the complexity of actuallygetting COVID because this guy
took every precaution was goingto go to a wedding and chose not
to at the last minute, went intothe wedding, into a new Orleans
or an N 95 mask in the airport.
But of course went mask list tothe actual wedding because
(03:37):
everybody was vaccinated, eventhough we know breakthrough
cases have been.
It gets covered when he getshome.
That's not actually the worstpart because yeah, he was sick,
no big deal.
He got over it, but he justexplained the logistical
nightmare of having now hiskids, having to stay home now,
having his wife, having to stayhome now in quarantine now
having to contact all the peoplehe had remote contact with,
(03:58):
right?
Because he took a PCR test andan antigen test over and over
and over, and it was kind ofnegative, negative, negative.
And then finally he startedgetting the sniffle.
And then just when you thought,okay, there's no way I've had so
many tests and then bampositive.
Right?
So it's just the idea of like,I'm just trying to throw this
out here that we're all in thistogether.
And man alive is thiscomplicated.
(04:19):
It's not just about my own danghealth.
It's about.
80 double hockey sticks forother people around me.
Right,
Stephen Kissler (04:27):
right.
Yeah.
That's, that's exactly it.
I really enjoyed that articletoo.
And I think that it reallybrings up something that a lot
of us have been feeling andthinking, or at least know
somebody who's been through asituation kind of like this.
No, there, there are two thingsthat come up for me with this
with this particular article.
And one of them is that thatreally struck me as interesting
(04:48):
is that, so this the author ofthis article is very well versed
in COVID-19 knows an awful lotabout the pathogenesis of the
disease, about the way itprogresses.
One of the interesting things tome is that he nearly stopped
taking his tests.
Before you would expect to turnpositive on a rapid antigen
test.
So, in the sense, you know, thearticle was saying that like,
(05:09):
you know, I'm really glad I tookthat last test on day five or
whatever, because it finallyturned positive and it's like,
of course, because that's,that's usually the amount of
time that it takes you to turnpositive.
So I think that there's sort ofone word of caution here, which
is.
You can test negative after apotential exposure for a couple
of days.
And that's, that's kind ofexpected because this virus
takes a while to ramp up in yoursystem.
(05:31):
So if you decide to do somethingsimilar, if you're going to take
frequent tests after you've hadpotentially some kind of
exposure, I would say, try to doso for at least a week.
And in this case, you know, ifyou have a limited number of
tests, I think he might've beenbetter off taking one every
other.
For eight days, rather thantaking one every day for four
days and then stopping aftergetting four negatives.
(05:53):
And so just, just sort of a bitof practical guidance for these
kinds of things.
If, if you decide that you'regoing to do something similar,
because I think that's, youknow, it's really important.
We have the tests now, butthere's, there's this real lack
of information about how to usethem.
And so I think that this is oneof those key things that now
that there are enough tests todo multiple tests after an
exposure we need to thinkcarefully about how to use them.
(06:15):
And then there's the secondpoint, which I think is really
the topic of the article itself,which is, you know, what happens
when you test positive?
There's one of my colleagues.
Somewhat crassly that taking aCOVID test to sort of like
picking your nose where you haveto have a plan for what you do
with what you find.
And so, and so that's not to saythat you shouldn't be taking the
test, but you should have a planfor what to do once you figure
(06:38):
out what you find.
And so a lot of us assume thatwe'll test negative, but then we
test positive and all of asudden our life is thrown into
chaos and rightly so, but itdoesn't.
A little bit of thought, youknow, what does happen when we
test positive?
Do we have the plans in place?
When that happens.
And I think that this, you know,this is part of this shift
towards having, COVID be a partof our day-to-day lives, where
(07:01):
you know, we take all sorts ofprecautions against all sorts of
different, rare, but possibleevents, you know, we've All of
us do or should have a tornadoplan and a fire plan.
And you know, like what happensin the event that our smoke
alarm starts going off and wesmell smoke in our apartment.
You know, that thankfully ithasn't ever happened to me, but
I've thought through what Iwould do so that, you know, when
(07:23):
something like that, I'll knowwhat to do.
And I think that this is nodifferent.
It's a COVID is still relativelynew.
So not all of us have thoughtthrough that, but I think it's
worth having our COVID testpositive plan for ourselves and
our families because it canhappen at any.
Matt Boettger (07:37):
That's great, Stephen, and that's kind of what
he concluded.
Like he didn't think that thewhole process of what happens
when he gets, when he, when hegets the positive result.
Now full credit goes to his wifeon this because it's his wife
that pushed the things that lastengine test.
And it turned out positive.
Now, a couple of questions.
Now I'm out of the loop.
I'm in the house.
First of all, are the air.
These antigen tests clearlyreadily accessible.
(08:00):
Now I haven't bought one yet.
And I know what eight months agowe talked about them being like
$25, a just one test.
Are they much cheaper now or arethey going down in price?
Are they accessible for theregular
Stephen Kissler (08:11):
person?
So.
Accessible as far as I know.
So I actually just went to theWalgreens here in Brookline,
Massachusetts the other day, andthey had a shelf full of Binaca
nows and I bought two boxes, sofour tasks.
But you're right.
Those two boxes ran me almost$50, which is running in my mind
a crime.
You know, it's like, it blows mymind.
(08:32):
Just, you know, gosh, we'vetalked about this in other
episodes, so we don't have torehash old territory.
So they're they're accessible inthe fact that you can pick up a
box and hold it, but whether ornot you can actually afford to
buy the thing is a wholedifferent story.
So I think that that's an areawhere.
You know, I I don't, I don'thave any political influence
whatsoever, but I think that,you know, if, if we could find a
(08:53):
way to subsidize these tests inany way and distribute them more
proactively, like that would beso great.
But we're not doing that.
So they are, you know, if youhave the means they are
accessible, please do.
If you're able to have them onhand, this is also really
helpful for things likeThanksgiving, which I think
we'll talk about in a littlewhile.
Yeah, but yeah the, the cost isstill too high.
(09:14):
I hope it will come down intime, but that's what we got to
deal with right now.
Matt Boettger (09:19):
It came up.
I'm sure this exists out here.
Well, I know it exists, but Ifeel like we need to create like
a little cheat sheet of a planof like what to do.
When you turn it, when you, whenyou get a positive result or
what, or when you were fearfulof, of being exposed to COVID,
we've talked about a lot andwe've had some great in-depth
discussion, especially early onlike last March, 2020.
We were really trying to figureout how to do this.
(09:41):
But even me, it's like, I, we dothis every couple of weeks, but
I don't have a plan.
I'm probably because I havethree little boys that keep me
so occupied.
It's just so crazy to even thinkabout it.
I'm just trying to be insurvival mode, but it might even
be nice to have like a smallchecklist or.
Stephen Kissler (09:54):
Yeah, I, you know, not that I know of.
And I think, you know, this,this might be a nice little
point of homework for ourlisteners.
I'd be actually reallyinterested to, for people to
think through this withthemselves and their families.
And if you're willing, you know,let us know what you come up
with because, you know, I, I'man epidemiologist.
I, I think about these things alot, but I also, you know, just
have my own context.
(10:14):
And mark has, you know, youngkids, but I don't.
And so a lot of the intuitionbehind sort of what this would
actually mean for people indifferent life stages for people
with different familystructures, for people who are
caretakers for people, withdifferent jobs, you know, there
are all sorts of things that Ican try to consider, but I'll,
you know, it totally failthinking about all the different
cases.
So I'd actually be really,really interested to see what
(10:35):
people come up with if theythink through this.
So.
Send some along.
Maybe we can bring up some ofthe greatest hits the next
couple of weeks.
Matt Boettger (10:42):
That's awesome.
Okay.
You heard this, everyone.
Who's listening.
We're going to crowdsource this.
So let's domatt@livingthereal.com.
L I V I N G R E a l.com the inthe middle.
So I brought that into real, Ididn't know how to do my own
living the real.com.
Check it out.
The link will be in the shownotes.
My email send us your plan.
If you have one and we'llcrowdsource this, it'd be
(11:03):
awesome to see these.
Now, Stephen, you mentioned howwe've gone from a pandemic and
trying to think about how welive with this.
There was an article about thisidea of question of when does it
move from a pandemic to anendemic, can you help guide us
as conversation of what is anendemic and how is it from a
pandemic?
And are we close to that or noteven close to that?
Stephen Kissler (11:24):
Yeah.
So.
The difference between apandemic and an endemic in some
cases is an arbitrary choice.
So the unsatisfying answer, wecan think about this on a lot of
different levels.
So I think probably the mostscientific way to think about it
is that a pandemic illness likeCOVID-19 becomes an endemic
illness.
(11:44):
Once it finally settles intosomething like a consistent
long-term pattern.
So that's why we don't normallythink of seasonal flu outbreaks
as a pandemic disease, eventhough flu spreads around the
world on every continent everyyear.
So in some senses it is apandemic, but it's settled into
this very regular, fairlypredictable pattern.
(12:05):
And so it's helpful to have adifferent term for that kind of
thing.
So it's steady, it's regular.
So for flu, we have seasonal,you know, annual, usually
wintertime outbreaks intemperate regions of the globe.
And so I think the expectationis that we'll probably have
something similar for COVIDwhere we'll have this
fluctuation in cases probablyhigher during the wintertime in
(12:26):
temperate parts of the globe.
And once it sort of settles intosomething that is more
predictable or at least moresimilar to other respiratory
illnesses, we can say that it'stransitioned into its endemic
state.
But I think there's still somequestions to answer there.
And this is, this is actuallysomething that we're beginning
to look into right now in ourmodeling and sort of what does
this off-ramp to some extentlook like I'm so sorry.
(12:50):
Kofi two is it is a respiratoryvirus.
It's a coronavirus.
We have other Corona virusesaround, but it is also kind of
odd.
It's it's very infectious.
The Delta variant is.
Super infectious relative to alot of the other respiratory
pathogens that we have around.
And my hunch is that it might beinfectious enough that unlike
(13:12):
flu, where we see very, very lowlevels of transmission over the
summer and much highertransmission over the winter,
it's possible that We mayactually see sort of sustained
transmission over the summersand probably increased
transmission of the winters.
But it might be a lot more sortof constant over the course of
the year, just because theseasonal effects doesn't really
(13:34):
have as much power againstsomething that's so contagious.
But we haven't crunched thenumbers yet to see sort of how
likely that is, but that's,that's something that we're
working on now.
So all that is to say that thereare sort of some ways to get an
intuitive sense for how thetransition from pandemic to
endemic looks.
But really ultimately it comesdown to sort of a semantic
choice for when we've decidedthat that we're going to start
(13:58):
changing our treatment ofCOVID-19 like a Sort of a
one-off crisis to treating it,like something that we're living
with for the long-term.
Yeah.
Matt Boettger (14:07):
Now curious, going back to way back March,
2000 with your famouspublication, right?
Sorry, everyone that everyone'sreading, everybody was reading.
Now you gave different models,you know, did one of those fit
this particular scene or wasthis one of these where like, oh
my gosh, this was now withDelta.
This kind of threw off some ofthe modeling of what we see now,
(14:29):
kind of the next, I don't evenknow if your model went beyond,
you know, four or five
Stephen Kissler (14:35):
know.
Yeah.
So, so the first part of themodel did go out about five
years and and actually sort ofthe last and what we thought was
going to be the most plausiblesituation.
It turned out be a pretty goodreflection of what we're seeing
right now, where we sort of havethis sporadic transmission for
roughly two years.
And then after two years, it'slikely going to settle into sort
of a more seasonal kind ofwinter.
(14:57):
Thing.
But Delta did really throw awrench into this thing.
You know, when we were buildingthat model, we were thinking of
things with a reproductionnumber of three, or like heaven
forbid maybe up to four.
Now Delta is easily up to six,you know?
And so, it's like far moreinfectious than frankly I ever
expected this virus to become.
And so despite the fact that ourproject.
I have held relatively accurateup to this point.
(15:21):
I do think we need to rerun thenumbers for Delta.
And so that's, that's thesituation we're in now.
Yeah.
Matt Boettger (15:27):
Now, speaking of which, now this, this other
article, I don't know if say thename Dr.
Gottlieb or leave or whatever.
He in this article sayscoronavirus pandemic could end
in the U S in January.
That was a startling title,especially now we're in talking
about it in the second being inColorado right now, where cases
are just really high.
And mid November is seeing thepandemic ending early January
(15:50):
seems unfeasible to me in mystate right now.
What do you think of thatarticle?
And what's being talked about ofthe pandemic.
Ending relatively soon in the US particularly.
Stephen Kissler (16:03):
Yeah.
So, full disclosure, I haven'tread Dr.
Gottlieb's article on, on this,but really I think that like
the, the answer can be sort ofyes and no, where, I could see
it making sense for practicalpurposes to say roughly around
January, I would actually put ita little bit later, but maybe by
the end of the, you know, byearly spring to say that we're
okay, we're out of this pandemicperiod, and we're now treating,
(16:25):
COVID-19 like an endemicillness, but I think that really
has a lot more to do about ourorientation towards the virus
than about something inherentabout the virus and its spread.
Now there's, there's somecaveats to that in the sense
that you know, by that point,Many people, at least in the U S
We'll probably have gotten abooster vaccines if they would
(16:46):
like them.
Many other people will have beenexposed multiple times.
So by that point, we also willhave built up a decent amount of
population immunity that willprobably protect us from having
the same sorts of surgeries onhospitals that we've seen.
And in fact are currently seeingin places like Colorado,
unfortunately So, so I thinkthat that is largely what's
behind it is that there's sortof this two-fold sense that
(17:09):
first population immunity willlikely protect us from the high
rates of hospitalizations anddeaths that we've been seeing.
Although there will still bethose things to contend with
just maybe not at the same rateand second, that it will
probably make sense for us toshift our own orientation
towards the virus, towards theselong-term sustainable things
that will help us live with thevirus rather than sort of these
more acute measures.
That made a lot more sense whenwe were thinking about a
(17:31):
short-term crisis, but not whenwe were thinking about sort of
our longterm.
Matt Boettger (17:35):
Great.
Great.
Well, let's talk about Coloradonow because we're kind of
segwaying into this.
So Colorado, the hospitals arereally getting to the point of
being nearly overloaded.
The last I checked, there was anarticle about over 90% occupied
in many hospitals.
I wish.
To chime in, sent him a textlast night.
Don't think he's been on theCOVID rounds too recently, but
(17:56):
he did mention on the texts thatthere were constantly talking
about what to do when they getto the threshold and what are
the, what are the differentoptions alternatives?
So this is definitely somethingin the forefront of even Mark's
mind right now.
So thoughts and prayers forColorado, the hospitals and all
the care workers there.
We really appreciate it.
Now, one of the things I want tochat with you about is governor
Polis.
One of three states because ofour crisis right now, because of
(18:18):
what's going on and because ofthe infection, really getting
out of control in many areas.
And this is where I want you totalk about what you talked
about, me off the air about thisother website and how it's
connected and seeing the Chinesewaves being percolated in
different places and where they,where they started.
But first, before you get intothat first mentioned, Governor
Polis gave this emergency orderof offering boosters to everyone
(18:43):
18 and over only three stateshave done this think California
and Colorado.
And I don't even know what thethird one is.
He may know.
First of all, what do you thinkabout that?
It's kind of going against, Iguess, FDA and CDC guidelines.
I know this is probably like afourth down in punt and to, to
help our, our state.
What do you think about that?
And then just talk about howyou're seeing.
Your perspective, a lot of ourcrisis in light of the history
(19:05):
of the kind that this, this,this, this fourth wave or
whatever number we're on at thispoint in time.
Stephen Kissler (19:10):
I have no clue.
Yeah, I know.
Yeah, so I think that this, thismakes a lot of sense.
There's, there's thisinteresting thing.
With infectious diseases likeCOVID-19 where preventive
measures, interventions Itmatters an awful lot when you
use them.
And so right now, you know,Colorado is in this sort of
state of emerging.
(19:30):
I don't know.
I don't know if I want to callit crisis, but definitely, you
know, there's, they're thinkingabout crisis measures at
hospitals, you know, they'retrying to figure out where to
put people because there are somany people coming into the
hospital.
So, So I think that it, it makesan awful lot of sense to respond
to that.
And and one of the best ways wecan do that is by recommending
vaccination.
So we know for sure that boosterdoses can increase a person's
(19:53):
antibody levels hugely in theshort term, and also cause them
to be more sustainable.
And we're coming into a time ofyear.
Would we know respiratorydiseases are a lot harder to
manage anyway.
We know that Colorado's casesare increasing.
And in fact, cases around thecountry in many places are
increasing.
And so, you know, now is thetime if we wait too long to do
this, we will have sort ofmissed the boat.
And a lot of those infectionsthat could have been prevented
(20:15):
will have already occurred.
So I think that there's a lot oflatitude, especially given all
of the evidence about the safetyand efficacy of these things.
You know, the reason theyhaven't been recommended yet is
not.
We don't think they'renecessarily safe and effective
for everyone.
Otherwise we wouldn't be givingthem to the more vulnerable
groups already.
It's just that we want to makesure we have the doses for those
people.
But in places where cases arereally surging, we really want
to build up population levelimmunity as much as we can.
(20:38):
So, you know, so definitelythoughts, prayers, masks, and
vaccines altogether, please.
That's, that's what we need forour healthcare workers right
now, especially in places wherecases are rising now.
So there's this interestingpoint where like, okay, so, so
we're in Colorado right now.
Cases are spiking.
Y what's going on there.
You know, in fact, you know,there've been a lot of reports
(20:58):
about Vermont, which is the mosthighly vaccinated state in I
think they're the most highlyvaccinated state in the country.
And certainly in the lower 48.
And there's seeing a major spikein cases right now, too.
So, you know, what, what giftsSo, so let's take a step back.
And so I guess it's kind ofStorytime now, but you know, so
we've been hearing an awful lotof recent months about cases in
(21:21):
the Southeastern us.
We've been talking a lot aboutFlorida, about Louisiana,
Alabama, Missouri.
And there was this really hotbed of cases, especially in
July, August sort of leadinginto September in those states.
And there were a lot of, there'sa lot of commentary that frankly
made me pretty uncomfortablesaying like, ah, you know,
vaccination rates are so low,these states are sort of seeing
the outcome of, you know, lowvaccination rates and open
(21:44):
communities.
And, you know, this is sort ofthe way that things are, you
know, that that's, that's theconsequence of these decisions
that these places have made and,you know, yes.
Yes.
Like, of course the moresusceptible people there are in
the population, the more likelyyou're going to have cases,
Florida has the especiallydifficult problem.
If that their average age isjust a lot higher than the rest
(22:04):
of the country.
There's a lot of older peopleliving in Florida.
And so by nature, they havehigher risk of people going to
the hospital.
And it's true that that many ofthe Southern states have had
sort of more open policies andless masking than many other
places, but that's, there's thisreal, real danger in making an
observation and then providing apost hoc explanation for it as
(22:28):
if it were, you could sort of.
In for a causal relationshipbetween X and Y in this really
nice, nice, neat way.
And what this is getting at isthat, so I've been spending a
lot of time with this brilliantwebsite.
That's called COVID estem.org.
That's COVID E S T I M dotOregon.
Maybe we can at, in our shownotes.
Yeah.
(22:48):
And so essentially what it is isit's a team of researchers who
are doing what we call anepidemiology.
Now casting.
So we know about forecasting.
So you can forecast the weather.
You can look slightly into thefuture to sort of understand
what's happening, but in thecontext of COVID.
Just looking at rock casecounts, doesn't actually give
you a super accurate picture ofwhat's going on.
(23:09):
You need to apply some amount ofinterpolation and mathematical
analysis to account fordifferences in testing rates and
for differences in behavior toactually infer what's underneath
the surface.
How many cases are actuallythere given the cases that we
observe?
And that's the question that nowcasting aims to answer.
And so what this group has doneis they've done now casting at
(23:29):
the county level.
Across the United States sincethe beginning of 2020.
And so what you can see isthere's this, this nice figure
where there's this timeline witha little bar that you can sort
of scrub back and forth, and youcan see these waves of infection
spreading around the country.
And one of the really remarkablethings to me about this is that
you can see these very clearwaves.
(23:50):
They look like ripples in waterthat are spreading and
especially these things happenin the winter.
So last year, We have this veryclear ripple of COVID-19
infection that started basicallyin the Dakotas and spread
outward.
So that was really where ourwinter wave got started.
And there was just this veryclear wave of spread this
winter.
It looks like we have the samesort of ripple phenomenon, but
(24:12):
it got started in theSoutheastern states.
And now it's just spreadingacross the entire.
Now, this sort of phenomenon isnot unique to COVID-19 either.
This was, this was actually thesubject of my PhD dissertation,
where we were looking at exactlythe same kind of spread patterns
for the 2009 H one N one flupandemic.
So this seems to be the case forespecially transmissible
(24:33):
wintertime, respiratory viruseswhere we've seen this phenomenon
happen again.
And again.
And so the difficulty here isthat at any given point in time,
you can apply this post hocexplanation for why this given
community is suffering highcases at this given point in
time.
But really, I think that that's,that's a pretty sort of narrow
sighted explanation because itdoesn't account for the fact
(24:54):
that infectious diseases spreadand respiratory infectious
diseases like COVID-19 spread inthis really curious geographic
way, such that anywhere that hashigh cases now, Yeah, it may
well be that it's just theirturn.
It may well be that Delta wasjust introduced into the
Southeastern states earlier, andmaybe it was able to gain a
foothold easier because of someof these things.
(25:15):
But now, you know, we're in thiscontext where a lot of people
were saying, you know, okay,well, it's, it's vaccination
rates and it's, it's opensocieties, but now how can we
reconcile that with what'shappening in Vermont, for
example.
And the fact is that part of itis just that it just took that
much time for the disease tospread that.
Now, all of that is not to saythat the vaccines are not
effective because one of thereally good things about Vermont
(25:36):
is that these cases are nottranslating into
hospitalizations and deaths atnearly the rate that they have
in many other communities thathave lower vaccination rates.
So definitely vaccines arepreventing a lot of the worst
outcomes from the virus, butthere's still an awful lot of
spread.
And I think that that's a reallyimportant thing to bring up
because.
It just gets at this complexityof that we really just can't
(25:58):
draw these clean, clearnarratives of why a given place
has high cases at any givenpoint in time, because this is
just the, this whole situationis just far too complex for that
kind of simple.
Excellent.
Matt Boettger (26:11):
That was great.
That was incredibly helpful.
Yeah.
That's, it's kinda like one ofthose things where it, so it
just, it's incredibly infectiousdisease.
It's going to land somewhere andit's going to be in this spread.
It doesn't mean that wearingmasks and, you know, distancing
when you need to is not always,it's a pointless operation.
It's incredibly important.
And it's just that when thesethings happen, how much do you
(26:32):
want it to flare up?
Do you want it to just overcomeit and golf and entire state, or
just maybe, hopefully.
Have some collateral damage andwe can have some level of
helping this thing.
So thanks for that.
And we'll put that in the shownotes as well.
This leads to the next issue.
Would you kind of already talkedabout this and this is the idea
of, okay, so Colorado is aperfect example.
(26:53):
We're in kind of this mode bywhich we're in, we're seeing a
highly increase in infectionsand infection and
hospitalizations.
And so the response.
Let's get a booster.
Right.
And then you have these wave ofarticles saying here and there
that vaccines aren't anydifferent when it comes to the
spread.
Of the virus then beingunvaccinated.
(27:15):
Now there's lots of research onboth sides.
This article really helped me.
And I want you to talk aboutthis because it was probably two
or three episodes where youtalked about this and a little
bit more detailed to help usout.
So you can make, pull from thatand bring this in.
And I'm going to go back andsays how easily can vaccinated
people spread.
COVID-19.
(27:36):
And so there was a lot of greatthings about this, this article,
but basically what it startedwith is that there are a number
of articles that show inresearch that show that, okay.
It seems as though vaccinatedpeople and unvaccinated people
may have the same viral load.
So then, then the logicalconclusion is okay, well then
they spread it.
(27:57):
The same, but we see evidence.
It's not the case that, thatunvaccinated people in vaccines
differ that there are still,even if they do have the same
viral load that vaccine peoplestill spread it less.
Can you help in light of whatyou talked about a few weeks
ago, helped bring this into fullfocus of why that might be.
Yeah.
Stephen Kissler (28:15):
Yeah, so this was something that I, and, you
know, my close colleagues hadbeen thinking about a lot.
And in fact, our, our study isone of the ones that documented
those equal viral loads betweenvaccinated and unvaccinated
individuals.
So, so here's the way that Iunderstand it.
Right?
So there, there are multiplethings that have to happen for
SARS.
COVID two to spread from personto person.
So imagine.
(28:37):
One of whom has the possibilityto spread to another, but
currently neither of them areinfected.
So person a and person B.
So for a person, a spreadperson, B person, a first has to
get infected.
They then have to interact withperson B while they're producing
enough virus to infect them.
And the virus that person theyhave met has to be healthy
(28:58):
enough to infect a person B ithas to sort of be.
You know, high octane, SARS, covtwo, it doesn't want to be
living along, you know?
And so all of those things needto be in place.
And the good thing is thatvaccination helps reduce at
least, I dunno, how many of thethings that I said, but I'm
going to say that there werefour, it helps at least three of
(29:19):
the four things that I meant tomention just then.
So I'll, I'll go through that.
Right.
So, so first vaccinationdefinitely reduces the
probability that you getinfected in the first.
Which is great.
And that's one that I thinkdoesn't receive nearly enough
attention because we can reallyonly look at transmission
between people who are alreadyinfected.
But the fact is that vaccinatedpeople are a lot less likely to
get infected in the first place.
(29:40):
And so that is sort of the firstfirst barrier that goes a long
way towards reducing spreadamong vaccinated.
But vaccinated people do getinfected.
You know, there are plenty ofbreakthrough infections that are
happening, especially withDelta.
And as I mentioned, you know,our study and many others
suggested that people who arevaccinated can produce just as
much virus as people who areunvaccinated.
(30:02):
So what does that mean?
Well, first it looks like peoplewho are vaccinated clear the
virus more quickly, so they'reprobably not producing that
level of virus for quite aslong.
So that means that They're lesslikely to come into contact with
another person when they'reproducing that high level of
virus than if you wereunvaccinated.
So that reduces the probabilityof onward spread, just because
there's a shorter window of timewhen you're capable of spreading
(30:24):
the virus.
In addition to that, there'vebeen other studies that suggest
that in vaccinated people, thevirus that they do produce is
less viable.
It's less likely to spread anonward infection because.
Either it's coded in antibodiesor it's already sort of like
broken down.
I think the important thing topoint here, point out here is
that usually when we'remeasuring amounts of virus in a
(30:45):
person who's been infected,we're not actually measuring
amounts of virus.
We're measuring copies of viralRNA.
And so.
What can happen is that theimmune system can be effectively
attacking the virus, whichbasically means, you know,
chopping it up into littlepieces, but there's still going
to be that viral RNA, thatgenetic code circulating in your
body that is correlated to theamount of virus that was there,
(31:08):
but isn't there anymore becauseyour immune system is giving
this effective response.
And so we can say there'ssimilar amounts of virus, but
really what we're saying is thatthere are similar amounts of
viral genetic material in your.
And just because there's similaramounts of viral genetic
material doesn't mean thatthere's the same amount of
viable virus and that'ssomething that's been pretty
well established that if youactually look at whether or not
that virus is able to groweither in culture, in the lab or
(31:33):
to cause onward infection, it's,it's substantially less likely.
In a vaccinated person then inan unvaccinated person.
So there are all of thesethroughout the pandemic.
We've been talking about theselayers of protection, right
about distancing and masking andventilation and vaccination, and
you know, all of these otherthings.
And the nice thing aboutvaccination is that it is in
itself, this multi-layerapproach towards preventing
(31:55):
onward transmission.
So at each stage, it sort ofintroduces this extra barrier
for virus to spread and thatmakes it so that vaccinated
people are less.
Of course, they can still spreadthe virus.
We see that all the time, butdefinitely at a lower rate than
unvaccinated people for all ofthese reasons.
Great.
Matt Boettger (32:12):
That was awesome.
So succinct, incredibly helpful.
And let's get in then let's landthe plane with Thanksgiving
because this is probably on themind.
This is related and.
Are my family vaccinated and howwhat's the chance of having a
breakthrough of coming.
But before we get there, I wantto share, I'll put the link in
the show notes.
I copied this image, so you'regoing to get it like a link.
That's my own link to see it.
(32:33):
But I'm going to come back tothis in a couple of weeks.
It was a great image ofbasically how airborne illnesses
can be prevented in our home,which I think is something we're
thinking about when it comes tothe holidays or having people
over, because I've been justthinking about this for over a
year now, off and on about like,how can you measure to what
extent your house is healthy.
(32:54):
As bad as much as you can see,clearly the caveat is there's no
way to have a hundred percentfree error and transmission
inside of a house, right.
Or even outside, but within yourcontrol, is there a way you can
measure?
And I loved this image and youcan speak to it briefly as well
about this idea of like, Ididn't know that an easy measure
(33:14):
is CO2 level.
So if you have something tomeasure your CO2 level in the
house, that there is a, there isa correlation between the level
of CO2 and the amount of inhaledare particles of somebody else's
exhalation, right?
And the more you can reduce theCO2 level, the closer you get to
(33:35):
outdoor air, which makes ithealthier.
So this is ice to me.
I love this image.
It's helpful as we prepare forthings.
To think about whether you havesomething like this can measure
about how to achieve somethingin like an outdoor air ether.
You're going to have a largeamount of people in your house
who may or may not beunvaccinated.
So is that this CO2 level, agood measurement for helping to
(33:56):
see whether the house is alittle more conducive?
Stephen Kissler (34:01):
Yes.
Yeah.
Yeah, exactly.
I think that, you know, CO2 isreally the the best, the best
measurement that we haveavailable for measuring
Recirculated air in an indoorspace.
And you know, people inindustrial design and home
design, I've been doing thisfor, for a very long time.
And it's really been picking upthrough in a public health
perspective with researcherslike Joseph Allen here at the
(34:23):
school of public health.
Who's, who's really sort ofthinking about how do we make
our built spaces healthier.
And so he's been thinking anawful lot about these kinds of
things.
So I think this is, this isgreat, you know, CO2 levels
really do help us give a senseof, you know, how.
Eh, how much air is beingrebreathe within an indoor
(34:44):
space.
And so, you know, if, if youhappen to have some sort of CO2
meter it can, it can help yousee, you know, how, how your
indoor air is beingresearch-related.
And I think, you know, Iwouldn't necessarily recommend
everyone to go out and buythemselves a CO2 meter before.
But yeah, I think that like,keeping this in mind that like,
you know, that that's sort ofthe target, you want your indoor
air to be like outdoor air tothe extent that you can.
(35:07):
And and I think that that's areally good target for
ventilating, and we know we cando that by cracking windows by
about six inches.
I know it can be chilly in someplaces, but it really does go a
long way towards clearing thatair out.
And that seems to be one of thesingle most important
interviews.
That really makes spaces a lotmore safe together.
For for Thanksgiving, I'vereally been recommending that
people you know, first, if youcan take a rapid test in the
(35:29):
morning of before you see peopleand second crack your windows by
six inches.
And I think if you do those twothings, you're going to really
reduce the odds that there's amajor outbreak among the people
who you may be hosting in yourhome.
Now one caveat with the CO2measurement is that you know, a
lot of people I know havepurchased these HEPA air
purifiers.
And so they have you know, the,the things that sort of clean
(35:50):
the indoor air those thingsaren't going to remove CO2 from
your air, but they will removethe droplets and the particles
that contain SARS.
COVID two virus.
So.
If you have one of those thingsrunning, your CO2 levels might
increase and that might bealarming.
But that doesn't mean that thosethings aren't doing their job
because they're doing somethingdifferent.
And so that's why the CO2 levelsare a good proxy, but they're
not, they're not perfect forunderstanding exactly how much
(36:13):
virus containing air orpotentially virus containing air
is circulating in yourhousehold, but it's still.
Matt Boettger (36:19):
Sure great.
That's helping yet.
We just started getting a coupleof air purifiers ourselves in
our house just to have on hand,just in general distill we have
people over.
We can have it on.
It's definitely not going to bea cure all, but just, just a,
and they're not that expensive.
I'm surprised you can get a HEPAfilter for a hundred bucks that
can really do a great job for adecent little room.
So,
Stephen Kissler (36:37):
I think you mentioned there too, you know,
as.
As a Colorado native, anotherthing that these things can
really help with is wildfiresmoke.
So, if you buy these filters forCOVID, you'll be able to use
them in the summer to, for, andfor cleaning your air as well.
So, it's a good purchase.
Yeah.
I feel
Matt Boettger (36:53):
like that probably rings on the ears
about, about everybody in theWestern us, just given, given,
given this past summer how badit's been.
Great.
Thank you for that.
That was so, we talked about theThanksgiving, you know, this is
like a hard decision because Iknow friends and family, there's
invitations being put on, it'llput all over, you know, what
would you say to someone who'slike, okay, you got the invite
(37:14):
from aunt somebody, or unclesomebody or grandma, like, by
the way, you know, Somebodycoming over and they're
unvaccinated, or they're flyingin from X, Y, and Z.
They're going to be unvaccinatedand they're going to be unmasked
and feel free to come over.
If you want to.
And these tricky situations,what do you propose in these?
I know this is probably a bombput on you because it's a very
(37:36):
gray, gray area, but what do youkind of begin to propose in
these difficult situations?
Stephen Kissler (37:41):
Yeah, I think that it.
The way that I like to thinkabout it as in terms of a risk
budget.
And so, you know, it's easy toget into this mindset of saying,
you know, this behavior is safeand this behavior is unsafe.
So, you know, I will onlyinteract with people who are
vaccinated or I'll only interactwith unvaccinated people indoors
when everyone is masked.
(38:01):
And that's, you know, that'sadmirable.
But I think that we can be alittle bit more flexible with
ourselves.
So depending on, you know, yourunderlying risks your own
vaccination status and to thepeople who you regularly
interact with I think thatthere's this opportunity to
think about risk on sort of aweekly or even a monthly basis
and say that like, you know, I,for example, I don't have a lot
(38:26):
of close encounters with peopleindoors.
I just haven't been doing thatmuch.
And I haven't really missed alot of the things where I used
to do that.
I have, you know, I, Idefinitely am having, you know,
so I, you know, I've been goingto church and so their
encounters with people indoors,wild masks, we still have a mask
mandate here in Brookline.
(38:46):
And so that's part of what we'vebeen doing.
I go into the office sometimesagain, everybody has masked
there and vaccinated And soessentially, you know, from my
point of view, I'm, I'm living apretty, pretty cautious life.
And so essentially what thatdoes is in my risk budget, that
can kind of buy me a little bitof slack, where for a day, for
example, on Thanksgiving, Imight be able to interact with
(39:07):
relatives who are unmasked andVAX unvaccinated, and who have
been traveling because I've beensort of counteracting that risk
in so many ways over thedifferent parts of my money.
And so, you know, it's, it's notperfect, but I think it is a
helpful way of sort of thinkingabout how to be a little bit
more flexible with ourselves andto recognize that there are some
times, you know, these one-offthings where the ability to have
(39:29):
community and to be with peoplein a setting where there are
fewer barriers to ourcommunication.
It can be really helpful.
It can be really valuable,especially on days like
Thanksgiving.
And so I think that there areways where we can sort of step a
little bit outside of thesestrict boundaries that we've set
for ourselves in our ownbehavior and recognize that we
can be a little bit lenient withourselves.
(39:50):
Again, to the extent that wefeel.
Safe.
So again, you know, the thingsthat can sort of complicate
this, of course, as if youyourself are immunocompromised,
or if you're caring for a veryelderly relative or something
like this, I think that thatforces you to sort of, you know,
maybe you have a smaller riskbudget then.
But you know, that that budgetis just something we all have to
sort of assess for our.
But I think really what I wantto communicate here is that
(40:10):
there's the possibility to besort of lenient with our
behavior and to use differentrules at different times while
still sort of under thisumbrella of sort of this overall
sense of how much risk I'mspending.
Matt Boettger (40:21):
That's great.
That's really helpful.
Now I'm going to go back tobooster for a second because I
didn't didn't which is, again,we mentioned Colorado is one of
the few states that can have abooster.
So this is probably a luxuryquestion given that this, this
podcast is all around the world.
People listen to it and maybesomebody who's not even not even
accessing.
First I know.
So I feel really awkward havingthis conversation, but we do
have the opportunity to have abooster.
(40:43):
Now, the question is when do Iget it?
Because it's like, I'm clearlyover the six month window.
So technically I'm available,but there's decisions that are
going into my, in my mind.
I'm like, okay, so I can get itnow.
And then I feel good, right?
That there is a surge going onright now.
The winter seasons on the risesounds like a good time.
But what if we decide to go on avacation in June or something
(41:06):
like that, and you know, that'slike another six months away and
should we like balance this actof waiting a little bit longer?
Just so that, to ensure thatthat booster is still has its
prime for our vacation in June,even though I would imagine it
to be a different ball game,unless there's another variant,
of course, that comes out, youknow, back in June.
Should I get it now?
How do I weigh this?
But then.
(41:26):
Make this even more complicated,you even mentioned Stephen way
back when that after a while,there is a chance by which you
get these boosters and it startshaving longer, longer longevity
because everything's starting toequalize and you know, the virus
starting to find its stability.
The number of boosters isstarting to really create a
stability within your ownimmunology.
And so now you just don't needthose boosters as much, you
know, so lot of all of this isthis something that I should
(41:48):
wait on.
We're just getting now, do youthink?
Stephen Kissler (41:52):
Yeah, I think that you know, my sense is that
it's probably not going tomatter too much either way.
And so, and part of that is justbecause it's while we have a
pretty good sense how the, thetiming of the immune response on
average, across largepopulations, When you try to
understand that for any singleperson, it's really hard.
(42:14):
People can be all over the shopand how quickly they develop a
response, how durable thatresponse is, how high that
response is.
And so, you know, we can, we cansort of adjust our strategy to
give us the best chance to havethe highest degree of immunity
at a given time in the future.
But as far from a guarantee thatthat your own immunity will
necessarily be maximized at anypoint in the future.
(42:37):
But I think the most importantthing here to consider is that
so first I expect the boosterdose to have much longer lasting
and unity than the first twodoses that we got of the MRN.
Simply because the really mostlybecause of the distance, that
how much time has passed thatoftentimes spacing out vaccine
doses for whatever reason, theimmunologists can tell you the
(42:59):
reason, but I can't, but eitherway we know for sure that
spacing out doses does help giveyou a longer lasting immunity in
most cases.
And so I expect that to be thecase for these boosters as well.
So translating what we knowabout second dose of know.
To booster immunity in terms ofthe timing, probably just
doesn't really pan out for me.
The most important thing is thatif you have the opportunity to
(43:21):
get boosted to do so before youexpect there to be high levels
of transmission in your owncommunity.
And so, for places in manyplaces across the U S you know,
that means trying to getyourself boosted if you're
eligible Really now, you know,as soon as you can, because
we're, we're coming into thewintertime respiratory illness
season.
And so, you know, there's,there's a decent chance that,
you know, by the time you go onyour trip in the spring or, you
(43:43):
know, early.
Okay.
Suppose we've got to be prettylow anyway.
And so, you know, you'll, you'llhave the high level of immunity,
but actually you'll havepotentially a lower risk
traveling than you do, going tothe grocery store here, you
know, during, you know rightnow.
And so, so I think that bearingthose two things in mind is
really important.
(44:03):
So yeah, but that said, youknow, if you wait a couple of
weeks, Probably won't hurt thatmuch either.
You've already gotten two dosesof the vaccine, getting your
booster will definitely help.
But I think that's sort of why Iwould say that.
You know, don't, don't wait asuper long time, but if it makes
me feel a little bit better towait a couple of weeks, I
wouldn't fuck you.
Good, great, great.
Matt Boettger (44:25):
I will.
I'm excited to get it.
Thanks Stephen.
So I think the last thing we'lljust touch on briefly is, I
don't know if we mentioned thisbecause it was two weeks ago.
And if the kiddos were availablefor their vaccine officially,
then it might've been right onthe cusp.
I forgot, but it's out.
I don't know if you've heardanything about it lately.
haven't seen a lot of Facebookphotos of my friends and they're
getting their kids vaccinatedand it's been awesome.
(44:45):
And I'm excited about thisopportunity for my own, for my
own boys.
And any updates on how that'sfairing or anything on your end
of it's been going well andwhether anything has been
Stephen Kissler (44:56):
side effects.
Yeah.
It seems like they're rollingout, which is great.
I have not heard, you know, sortof consistent with the fact that
kids tend to have fewer diseaseeffects from COVID-19.
It also seems that there, youknow, dealing with the shot
better than, than many of us oldfogies.
And so, I got flattened by mysecond dose for a good day.
(45:16):
And so, yeah, so I think thatit's, it seems to be pretty well
tolerated.
I haven't really heard any, anyissues.
You know, that's not to say thatthere haven't been, you know,
like certainly there areallergies.
You know, all of the things thathave gone along with, along with
vaccination, but those so farseem to be at very, very, very,
very, very, very low rates.
And so I'm really excited to seethis, especially now, you know,
we've, we're coming into theholiday season.
(45:37):
And I think that having a lot ofkids vaccinated can be really
helpful towards keeping everyonesafer from the spread of
COVID-19.
Matt Boettger (45:46):
Yep.
Absolutely.
We're all for this and hope wecan get the kiddos vaccinated.
Obviously the risk for them isincredibly low, but like we
said, we're all in this togetherto keep the variance down to
hopefully zero.
That'd be wonderful.
And to keep those who are immunecompromised, healthy, and safe.
Thank you all for listening tothis episode of the pandemic
podcast.
Again, if you leave a review,please do at apple podcasts, we
(46:06):
greatly appreciate that.
As well as.
Give me an email,matt@livingthereal.com.
If you have questions about yourcountry, wherever that we're
missing, we're ignorant of sendus an email.
We'll look into it.
We'll bring it up in the nextepisode.
And as well, if you can supportus patrion.com/pandemic
podcasts,$5 a month or soone-time donation, Venmo,
PayPal, all in the show notes,have a wonderful week.
(46:28):
We'll see you, I guess, afterThanksgiving break for the U S
so have a wonderfulThanksgiving, Stephen, and we'll
see you guys or.
All really, really soon takecare and.
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible.
And the face, these crises.
My name is Matt Boettger.
I'm joined with my one goodfriend once again, Dr.
Stephen Kissler, anepidemiologist at the Harvard
school of public health.
Good morning.
Fine, sir.
How are
Stephen Kissler (00:14):
you doing?
Hello?
I'm doing all right.
How are you
Matt Boettger (00:16):
doing?
I'm doing pretty darn good.
Fall is still doing, doing wellfor us here in Colorado.
It hasn't snowed yet when yousay super cold cold days.
So, I do hear that winter.
Might be a chilly day, but I'mloving it.
I'm loving it.
So
Stephen Kissler (00:33):
how's your weather?
You know, we finally got fallhere too.
It was a lot later than itusually is, but yeah, the leaves
are gorgeous this time of year.
So, yeah, but I'm glad you guyshave been getting a good one.
I know that sometimes fall lastabout two minutes out there.
So
Matt Boettger (00:47):
it does.
And we, the older I get, like Isaid, the warmer, I like it.
It's I'll I'll take it.
I'll take it.
So we have some great stuff tochat about today.
Before we get started, we gotthe usual stuff.
If you can leave a review,please do.
It's so helpful.
It inspires us, keeps us go andyou get an apple podcast or some
other place as well.
(01:07):
You can do them.
I have no idea what it is aswell as you wanna support us,
please do it.
Helps us keep this going andkeep the lights on that is
patrion.com/pandemic podcast, orjust a one-time gift PayPal.
Then Mo those are all in theshow notes.
Speaking of reviews, there was areview.
So here's the deal.
People who listened to us acrossthe waters and different
(01:28):
countries.
We don't really see them becauseI think apple like put silos
around different countries andtheir reviews.
So we don't see them.
So I found one.
From Canada.
She basically emailed medirectly.
Let me know that I probably didnot see the review left a
wonderful long comment.
I have yet to send it to markand Steve and I will, but here
(01:50):
is a big thing.
I take full responsibility ifthat's from Canada.
And I just don't talk about, wedon't talk about Canada that
much.
And there's been times by whichCanada was suffering on a level,
very different than the us andprobably.
It's own guidance and Icompletely blew it in failed.
And I apologize cause I'm theone who brings up the news
articles and you know what?
(02:11):
I just didn't do it in a week.
We definitely want to drawattention particularly to our
neighbors, you know, all aroundthe world to, to, to where we
can do this, but at least ourneighbors to help them out.
So I apologize.
Thank you for still listening tous and giving us a second chance
and we'll, we'll keep that moregreatly on the radar.
And also here's a great thing.
I only have so many hours in theday.
This is just kind of a passionproject for me that if you are
(02:34):
in a different part or adifferent country, and there's
something going on, if youemail.
Matt@livingthereel.com and kindof say, Hey, this is going on.
Can you give it some attentionon your next podcast?
That makes my life about athousand times easier and I will
definitely bring it to thesurface.
So here's a tipmatt@livingthereel.com.
(02:54):
Okay.
I think that's all the goodstuff let's get rolling.
So, let's start with this.
This is an easy one.
Stephen, I'm going to plantthis.
I read this article thismorning.
I had a breakthrough COVID.
But this is the article.
It was a logistical nightmarefrom the Atlantic.
And I loved it.
It was by a gentleman whoactually was part of the whole
John Hopkins project with thetray, the tracking of COVID.
(03:16):
So Amanda takes it incrediblyseriously.
The reason why I highlight thisarticle, Stephen for the
listeners is because not tocreate a fear factor, but just
to the complexity of actuallygetting COVID because this guy
took every precaution was goingto go to a wedding and chose not
to at the last minute, went intothe wedding, into a new Orleans
or an N 95 mask in the airport.
But of course went mask list tothe actual wedding because
(03:37):
everybody was vaccinated, eventhough we know breakthrough
cases have been.
It gets covered when he getshome.
That's not actually the worstpart because yeah, he was sick,
no big deal.
He got over it, but he justexplained the logistical
nightmare of having now hiskids, having to stay home now,
having his wife, having to stayhome now in quarantine now
having to contact all the peoplehe had remote contact with,
(03:58):
right?
Because he took a PCR test andan antigen test over and over
and over, and it was kind ofnegative, negative, negative.
And then finally he startedgetting the sniffle.
And then just when you thought,okay, there's no way I've had so
many tests and then bampositive.
Right?
So it's just the idea of like,I'm just trying to throw this
out here that we're all in thistogether.
And man alive is thiscomplicated.
(04:19):
It's not just about my own danghealth.
It's about.
80 double hockey sticks forother people around me.
Right,
Stephen Kissler (04:27):
right.
Yeah.
That's, that's exactly it.
I really enjoyed that articletoo.
And I think that it reallybrings up something that a lot
of us have been feeling andthinking, or at least know
somebody who's been through asituation kind of like this.
No, there, there are two thingsthat come up for me with this
with this particular article.
And one of them is that thatreally struck me as interesting
(04:48):
is that, so this the author ofthis article is very well versed
in COVID-19 knows an awful lotabout the pathogenesis of the
disease, about the way itprogresses.
One of the interesting things tome is that he nearly stopped
taking his tests.
Before you would expect to turnpositive on a rapid antigen
test.
So, in the sense, you know, thearticle was saying that like,
(05:09):
you know, I'm really glad I tookthat last test on day five or
whatever, because it finallyturned positive and it's like,
of course, because that's,that's usually the amount of
time that it takes you to turnpositive.
So I think that there's sort ofone word of caution here, which
is.
You can test negative after apotential exposure for a couple
of days.
And that's, that's kind ofexpected because this virus
takes a while to ramp up in yoursystem.
(05:31):
So if you decide to do somethingsimilar, if you're going to take
frequent tests after you've hadpotentially some kind of
exposure, I would say, try to doso for at least a week.
And in this case, you know, ifyou have a limited number of
tests, I think he might've beenbetter off taking one every
other.
For eight days, rather thantaking one every day for four
days and then stopping aftergetting four negatives.
(05:53):
And so just, just sort of a bitof practical guidance for these
kinds of things.
If, if you decide that you'regoing to do something similar,
because I think that's, youknow, it's really important.
We have the tests now, butthere's, there's this real lack
of information about how to usethem.
And so I think that this is oneof those key things that now
that there are enough tests todo multiple tests after an
exposure we need to thinkcarefully about how to use them.
(06:15):
And then there's the secondpoint, which I think is really
the topic of the article itself,which is, you know, what happens
when you test positive?
There's one of my colleagues.
Somewhat crassly that taking aCOVID test to sort of like
picking your nose where you haveto have a plan for what you do
with what you find.
And so, and so that's not to saythat you shouldn't be taking the
test, but you should have a planfor what to do once you figure
(06:38):
out what you find.
And so a lot of us assume thatwe'll test negative, but then we
test positive and all of asudden our life is thrown into
chaos and rightly so, but itdoesn't.
A little bit of thought, youknow, what does happen when we
test positive?
Do we have the plans in place?
When that happens.
And I think that this, you know,this is part of this shift
towards having, COVID be a partof our day-to-day lives, where
(07:01):
you know, we take all sorts ofprecautions against all sorts of
different, rare, but possibleevents, you know, we've All of
us do or should have a tornadoplan and a fire plan.
And you know, like what happensin the event that our smoke
alarm starts going off and wesmell smoke in our apartment.
You know, that thankfully ithasn't ever happened to me, but
I've thought through what Iwould do so that, you know, when
(07:23):
something like that, I'll knowwhat to do.
And I think that this is nodifferent.
It's a COVID is still relativelynew.
So not all of us have thoughtthrough that, but I think it's
worth having our COVID testpositive plan for ourselves and
our families because it canhappen at any.
Matt Boettger (07:37):
That's great, Stephen, and that's kind of what
he concluded.
Like he didn't think that thewhole process of what happens
when he gets, when he, when hegets the positive result.
Now full credit goes to his wifeon this because it's his wife
that pushed the things that lastengine test.
And it turned out positive.
Now, a couple of questions.
Now I'm out of the loop.
I'm in the house.
First of all, are the air.
These antigen tests clearlyreadily accessible.
(08:00):
Now I haven't bought one yet.
And I know what eight months agowe talked about them being like
$25, a just one test.
Are they much cheaper now or arethey going down in price?
Are they accessible for theregular
Stephen Kissler (08:11):
person?
So.
Accessible as far as I know.
So I actually just went to theWalgreens here in Brookline,
Massachusetts the other day, andthey had a shelf full of Binaca
nows and I bought two boxes, sofour tasks.
But you're right.
Those two boxes ran me almost$50, which is running in my mind
a crime.
You know, it's like, it blows mymind.
(08:32):
Just, you know, gosh, we'vetalked about this in other
episodes, so we don't have torehash old territory.
So they're they're accessible inthe fact that you can pick up a
box and hold it, but whether ornot you can actually afford to
buy the thing is a wholedifferent story.
So I think that that's an areawhere.
You know, I I don't, I don'thave any political influence
whatsoever, but I think that,you know, if, if we could find a
(08:53):
way to subsidize these tests inany way and distribute them more
proactively, like that would beso great.
But we're not doing that.
So they are, you know, if youhave the means they are
accessible, please do.
If you're able to have them onhand, this is also really
helpful for things likeThanksgiving, which I think
we'll talk about in a littlewhile.
Yeah, but yeah the, the cost isstill too high.
(09:14):
I hope it will come down intime, but that's what we got to
deal with right now.
Matt Boettger (09:19):
It came up.
I'm sure this exists out here.
Well, I know it exists, but Ifeel like we need to create like
a little cheat sheet of a planof like what to do.
When you turn it, when you, whenyou get a positive result or
what, or when you were fearfulof, of being exposed to COVID,
we've talked about a lot andwe've had some great in-depth
discussion, especially early onlike last March, 2020.
We were really trying to figureout how to do this.
(09:41):
But even me, it's like, I, we dothis every couple of weeks, but
I don't have a plan.
I'm probably because I havethree little boys that keep me
so occupied.
It's just so crazy to even thinkabout it.
I'm just trying to be insurvival mode, but it might even
be nice to have like a smallchecklist or.
Stephen Kissler (09:54):
Yeah, I, you know, not that I know of.
And I think, you know, this,this might be a nice little
point of homework for ourlisteners.
I'd be actually reallyinterested to, for people to
think through this withthemselves and their families.
And if you're willing, you know,let us know what you come up
with because, you know, I, I'man epidemiologist.
I, I think about these things alot, but I also, you know, just
have my own context.
(10:14):
And mark has, you know, youngkids, but I don't.
And so a lot of the intuitionbehind sort of what this would
actually mean for people indifferent life stages for people
with different familystructures, for people who are
caretakers for people, withdifferent jobs, you know, there
are all sorts of things that Ican try to consider, but I'll,
you know, it totally failthinking about all the different
cases.
So I'd actually be really,really interested to see what
(10:35):
people come up with if theythink through this.
So.
Send some along.
Maybe we can bring up some ofthe greatest hits the next
couple of weeks.
Matt Boettger (10:42):
That's awesome.
Okay.
You heard this, everyone.
Who's listening.
We're going to crowdsource this.
So let's domatt@livingthereal.com.
L I V I N G R E a l.com the inthe middle.
So I brought that into real, Ididn't know how to do my own
living the real.com.
Check it out.
The link will be in the shownotes.
My email send us your plan.
If you have one and we'llcrowdsource this, it'd be
(11:03):
awesome to see these.
Now, Stephen, you mentioned howwe've gone from a pandemic and
trying to think about how welive with this.
There was an article about thisidea of question of when does it
move from a pandemic to anendemic, can you help guide us
as conversation of what is anendemic and how is it from a
pandemic?
And are we close to that or noteven close to that?
Stephen Kissler (11:24):
Yeah.
So.
The difference between apandemic and an endemic in some
cases is an arbitrary choice.
So the unsatisfying answer, wecan think about this on a lot of
different levels.
So I think probably the mostscientific way to think about it
is that a pandemic illness likeCOVID-19 becomes an endemic
illness.
(11:44):
Once it finally settles intosomething like a consistent
long-term pattern.
So that's why we don't normallythink of seasonal flu outbreaks
as a pandemic disease, eventhough flu spreads around the
world on every continent everyyear.
So in some senses it is apandemic, but it's settled into
this very regular, fairlypredictable pattern.
(12:05):
And so it's helpful to have adifferent term for that kind of
thing.
So it's steady, it's regular.
So for flu, we have seasonal,you know, annual, usually
wintertime outbreaks intemperate regions of the globe.
And so I think the expectationis that we'll probably have
something similar for COVIDwhere we'll have this
fluctuation in cases probablyhigher during the wintertime in
(12:26):
temperate parts of the globe.
And once it sort of settles intosomething that is more
predictable or at least moresimilar to other respiratory
illnesses, we can say that it'stransitioned into its endemic
state.
But I think there's still somequestions to answer there.
And this is, this is actuallysomething that we're beginning
to look into right now in ourmodeling and sort of what does
this off-ramp to some extentlook like I'm so sorry.
(12:50):
Kofi two is it is a respiratoryvirus.
It's a coronavirus.
We have other Corona virusesaround, but it is also kind of
odd.
It's it's very infectious.
The Delta variant is.
Super infectious relative to alot of the other respiratory
pathogens that we have around.
And my hunch is that it might beinfectious enough that unlike
(13:12):
flu, where we see very, very lowlevels of transmission over the
summer and much highertransmission over the winter,
it's possible that We mayactually see sort of sustained
transmission over the summersand probably increased
transmission of the winters.
But it might be a lot more sortof constant over the course of
the year, just because theseasonal effects doesn't really
(13:34):
have as much power againstsomething that's so contagious.
But we haven't crunched thenumbers yet to see sort of how
likely that is, but that's,that's something that we're
working on now.
So all that is to say that thereare sort of some ways to get an
intuitive sense for how thetransition from pandemic to
endemic looks.
But really ultimately it comesdown to sort of a semantic
choice for when we've decidedthat that we're going to start
(13:58):
changing our treatment ofCOVID-19 like a Sort of a
one-off crisis to treating it,like something that we're living
with for the long-term.
Yeah.
Matt Boettger (14:07):
Now curious, going back to way back March,
2000 with your famouspublication, right?
Sorry, everyone that everyone'sreading, everybody was reading.
Now you gave different models,you know, did one of those fit
this particular scene or wasthis one of these where like, oh
my gosh, this was now withDelta.
This kind of threw off some ofthe modeling of what we see now,
(14:29):
kind of the next, I don't evenknow if your model went beyond,
you know, four or five
Stephen Kissler (14:35):
know.
Yeah.
So, so the first part of themodel did go out about five
years and and actually sort ofthe last and what we thought was
going to be the most plausiblesituation.
It turned out be a pretty goodreflection of what we're seeing
right now, where we sort of havethis sporadic transmission for
roughly two years.
And then after two years, it'slikely going to settle into sort
of a more seasonal kind ofwinter.
(14:57):
Thing.
But Delta did really throw awrench into this thing.
You know, when we were buildingthat model, we were thinking of
things with a reproductionnumber of three, or like heaven
forbid maybe up to four.
Now Delta is easily up to six,you know?
And so, it's like far moreinfectious than frankly I ever
expected this virus to become.
And so despite the fact that ourproject.
I have held relatively accurateup to this point.
(15:21):
I do think we need to rerun thenumbers for Delta.
And so that's, that's thesituation we're in now.
Yeah.
Matt Boettger (15:27):
Now, speaking of which, now this, this other
article, I don't know if say thename Dr.
Gottlieb or leave or whatever.
He in this article sayscoronavirus pandemic could end
in the U S in January.
That was a startling title,especially now we're in talking
about it in the second being inColorado right now, where cases
are just really high.
And mid November is seeing thepandemic ending early January
(15:50):
seems unfeasible to me in mystate right now.
What do you think of thatarticle?
And what's being talked about ofthe pandemic.
Ending relatively soon in the US particularly.
Stephen Kissler (16:03):
Yeah.
So, full disclosure, I haven'tread Dr.
Gottlieb's article on, on this,but really I think that like
the, the answer can be sort ofyes and no, where, I could see
it making sense for practicalpurposes to say roughly around
January, I would actually put ita little bit later, but maybe by
the end of the, you know, byearly spring to say that we're
okay, we're out of this pandemicperiod, and we're now treating,
(16:25):
COVID-19 like an endemicillness, but I think that really
has a lot more to do about ourorientation towards the virus
than about something inherentabout the virus and its spread.
Now there's, there's somecaveats to that in the sense
that you know, by that point,Many people, at least in the U S
We'll probably have gotten abooster vaccines if they would
(16:46):
like them.
Many other people will have beenexposed multiple times.
So by that point, we also willhave built up a decent amount of
population immunity that willprobably protect us from having
the same sorts of surgeries onhospitals that we've seen.
And in fact are currently seeingin places like Colorado,
unfortunately So, so I thinkthat that is largely what's
behind it is that there's sortof this two-fold sense that
(17:09):
first population immunity willlikely protect us from the high
rates of hospitalizations anddeaths that we've been seeing.
Although there will still bethose things to contend with
just maybe not at the same rateand second, that it will
probably make sense for us toshift our own orientation
towards the virus, towards theselong-term sustainable things
that will help us live with thevirus rather than sort of these
more acute measures.
That made a lot more sense whenwe were thinking about a
(17:31):
short-term crisis, but not whenwe were thinking about sort of
our longterm.
Matt Boettger (17:35):
Great.
Great.
Well, let's talk about Coloradonow because we're kind of
segwaying into this.
So Colorado, the hospitals arereally getting to the point of
being nearly overloaded.
The last I checked, there was anarticle about over 90% occupied
in many hospitals.
I wish.
To chime in, sent him a textlast night.
Don't think he's been on theCOVID rounds too recently, but
(17:56):
he did mention on the texts thatthere were constantly talking
about what to do when they getto the threshold and what are
the, what are the differentoptions alternatives?
So this is definitely somethingin the forefront of even Mark's
mind right now.
So thoughts and prayers forColorado, the hospitals and all
the care workers there.
We really appreciate it.
Now, one of the things I want tochat with you about is governor
Polis.
One of three states because ofour crisis right now, because of
(18:18):
what's going on and because ofthe infection, really getting
out of control in many areas.
And this is where I want you totalk about what you talked
about, me off the air about thisother website and how it's
connected and seeing the Chinesewaves being percolated in
different places and where they,where they started.
But first, before you get intothat first mentioned, Governor
Polis gave this emergency orderof offering boosters to everyone
(18:43):
18 and over only three stateshave done this think California
and Colorado.
And I don't even know what thethird one is.
He may know.
First of all, what do you thinkabout that?
It's kind of going against, Iguess, FDA and CDC guidelines.
I know this is probably like afourth down in punt and to, to
help our, our state.
What do you think about that?
And then just talk about howyou're seeing.
Your perspective, a lot of ourcrisis in light of the history
(19:05):
of the kind that this, this,this, this fourth wave or
whatever number we're on at thispoint in time.
Stephen Kissler (19:10):
I have no clue.
Yeah, I know.
Yeah, so I think that this, thismakes a lot of sense.
There's, there's thisinteresting thing.
With infectious diseases likeCOVID-19 where preventive
measures, interventions Itmatters an awful lot when you
use them.
And so right now, you know,Colorado is in this sort of
state of emerging.
(19:30):
I don't know.
I don't know if I want to callit crisis, but definitely, you
know, there's, they're thinkingabout crisis measures at
hospitals, you know, they'retrying to figure out where to
put people because there are somany people coming into the
hospital.
So, So I think that it, it makesan awful lot of sense to respond
to that.
And and one of the best ways wecan do that is by recommending
vaccination.
So we know for sure that boosterdoses can increase a person's
(19:53):
antibody levels hugely in theshort term, and also cause them
to be more sustainable.
And we're coming into a time ofyear.
Would we know respiratorydiseases are a lot harder to
manage anyway.
We know that Colorado's casesare increasing.
And in fact, cases around thecountry in many places are
increasing.
And so, you know, now is thetime if we wait too long to do
this, we will have sort ofmissed the boat.
And a lot of those infectionsthat could have been prevented
(20:15):
will have already occurred.
So I think that there's a lot oflatitude, especially given all
of the evidence about the safetyand efficacy of these things.
You know, the reason theyhaven't been recommended yet is
not.
We don't think they'renecessarily safe and effective
for everyone.
Otherwise we wouldn't be givingthem to the more vulnerable
groups already.
It's just that we want to makesure we have the doses for those
people.
But in places where cases arereally surging, we really want
to build up population levelimmunity as much as we can.
(20:38):
So, you know, so definitelythoughts, prayers, masks, and
vaccines altogether, please.
That's, that's what we need forour healthcare workers right
now, especially in places wherecases are rising now.
So there's this interestingpoint where like, okay, so, so
we're in Colorado right now.
Cases are spiking.
Y what's going on there.
You know, in fact, you know,there've been a lot of reports
(20:58):
about Vermont, which is the mosthighly vaccinated state in I
think they're the most highlyvaccinated state in the country.
And certainly in the lower 48.
And there's seeing a major spikein cases right now, too.
So, you know, what, what giftsSo, so let's take a step back.
And so I guess it's kind ofStorytime now, but you know, so
we've been hearing an awful lotof recent months about cases in
(21:21):
the Southeastern us.
We've been talking a lot aboutFlorida, about Louisiana,
Alabama, Missouri.
And there was this really hotbed of cases, especially in
July, August sort of leadinginto September in those states.
And there were a lot of, there'sa lot of commentary that frankly
made me pretty uncomfortablesaying like, ah, you know,
vaccination rates are so low,these states are sort of seeing
the outcome of, you know, lowvaccination rates and open
(21:44):
communities.
And, you know, this is sort ofthe way that things are, you
know, that that's, that's theconsequence of these decisions
that these places have made and,you know, yes.
Yes.
Like, of course the moresusceptible people there are in
the population, the more likelyyou're going to have cases,
Florida has the especiallydifficult problem.
If that their average age isjust a lot higher than the rest
(22:04):
of the country.
There's a lot of older peopleliving in Florida.
And so by nature, they havehigher risk of people going to
the hospital.
And it's true that that many ofthe Southern states have had
sort of more open policies andless masking than many other
places, but that's, there's thisreal, real danger in making an
observation and then providing apost hoc explanation for it as
(22:28):
if it were, you could sort of.
In for a causal relationshipbetween X and Y in this really
nice, nice, neat way.
And what this is getting at isthat, so I've been spending a
lot of time with this brilliantwebsite.
That's called COVID estem.org.
That's COVID E S T I M dotOregon.
Maybe we can at, in our shownotes.
Yeah.
(22:48):
And so essentially what it is isit's a team of researchers who
are doing what we call anepidemiology.
Now casting.
So we know about forecasting.
So you can forecast the weather.
You can look slightly into thefuture to sort of understand
what's happening, but in thecontext of COVID.
Just looking at rock casecounts, doesn't actually give
you a super accurate picture ofwhat's going on.
(23:09):
You need to apply some amount ofinterpolation and mathematical
analysis to account fordifferences in testing rates and
for differences in behavior toactually infer what's underneath
the surface.
How many cases are actuallythere given the cases that we
observe?
And that's the question that nowcasting aims to answer.
And so what this group has doneis they've done now casting at
(23:29):
the county level.
Across the United States sincethe beginning of 2020.
And so what you can see isthere's this, this nice figure
where there's this timeline witha little bar that you can sort
of scrub back and forth, and youcan see these waves of infection
spreading around the country.
And one of the really remarkablethings to me about this is that
you can see these very clearwaves.
(23:50):
They look like ripples in waterthat are spreading and
especially these things happenin the winter.
So last year, We have this veryclear ripple of COVID-19
infection that started basicallyin the Dakotas and spread
outward.
So that was really where ourwinter wave got started.
And there was just this veryclear wave of spread this
winter.
It looks like we have the samesort of ripple phenomenon, but
(24:12):
it got started in theSoutheastern states.
And now it's just spreadingacross the entire.
Now, this sort of phenomenon isnot unique to COVID-19 either.
This was, this was actually thesubject of my PhD dissertation,
where we were looking at exactlythe same kind of spread patterns
for the 2009 H one N one flupandemic.
So this seems to be the case forespecially transmissible
(24:33):
wintertime, respiratory viruseswhere we've seen this phenomenon
happen again.
And again.
And so the difficulty here isthat at any given point in time,
you can apply this post hocexplanation for why this given
community is suffering highcases at this given point in
time.
But really, I think that that's,that's a pretty sort of narrow
sighted explanation because itdoesn't account for the fact
(24:54):
that infectious diseases spreadand respiratory infectious
diseases like COVID-19 spread inthis really curious geographic
way, such that anywhere that hashigh cases now, Yeah, it may
well be that it's just theirturn.
It may well be that Delta wasjust introduced into the
Southeastern states earlier, andmaybe it was able to gain a
foothold easier because of someof these things.
(25:15):
But now, you know, we're in thiscontext where a lot of people
were saying, you know, okay,well, it's, it's vaccination
rates and it's, it's opensocieties, but now how can we
reconcile that with what'shappening in Vermont, for
example.
And the fact is that part of itis just that it just took that
much time for the disease tospread that.
Now, all of that is not to saythat the vaccines are not
effective because one of thereally good things about Vermont
(25:36):
is that these cases are nottranslating into
hospitalizations and deaths atnearly the rate that they have
in many other communities thathave lower vaccination rates.
So definitely vaccines arepreventing a lot of the worst
outcomes from the virus, butthere's still an awful lot of
spread.
And I think that that's a reallyimportant thing to bring up
because.
It just gets at this complexityof that we really just can't
(25:58):
draw these clean, clearnarratives of why a given place
has high cases at any givenpoint in time, because this is
just the, this whole situationis just far too complex for that
kind of simple.
Excellent.
Matt Boettger (26:11):
That was great.
That was incredibly helpful.
Yeah.
That's, it's kinda like one ofthose things where it, so it
just, it's incredibly infectiousdisease.
It's going to land somewhere andit's going to be in this spread.
It doesn't mean that wearingmasks and, you know, distancing
when you need to is not always,it's a pointless operation.
It's incredibly important.
And it's just that when thesethings happen, how much do you
(26:32):
want it to flare up?
Do you want it to just overcomeit and golf and entire state, or
just maybe, hopefully.
Have some collateral damage andwe can have some level of
helping this thing.
So thanks for that.
And we'll put that in the shownotes as well.
This leads to the next issue.
Would you kind of already talkedabout this and this is the idea
of, okay, so Colorado is aperfect example.
(26:53):
We're in kind of this mode bywhich we're in, we're seeing a
highly increase in infectionsand infection and
hospitalizations.
And so the response.
Let's get a booster.
Right.
And then you have these wave ofarticles saying here and there
that vaccines aren't anydifferent when it comes to the
spread.
Of the virus then beingunvaccinated.
(27:15):
Now there's lots of research onboth sides.
This article really helped me.
And I want you to talk aboutthis because it was probably two
or three episodes where youtalked about this and a little
bit more detailed to help usout.
So you can make, pull from thatand bring this in.
And I'm going to go back andsays how easily can vaccinated
people spread.
COVID-19.
(27:36):
And so there was a lot of greatthings about this, this article,
but basically what it startedwith is that there are a number
of articles that show inresearch that show that, okay.
It seems as though vaccinatedpeople and unvaccinated people
may have the same viral load.
So then, then the logicalconclusion is okay, well then
they spread it.
(27:57):
The same, but we see evidence.
It's not the case that, thatunvaccinated people in vaccines
differ that there are still,even if they do have the same
viral load that vaccine peoplestill spread it less.
Can you help in light of whatyou talked about a few weeks
ago, helped bring this into fullfocus of why that might be.
Yeah.
Stephen Kissler (28:15):
Yeah, so this was something that I, and, you
know, my close colleagues hadbeen thinking about a lot.
And in fact, our, our study isone of the ones that documented
those equal viral loads betweenvaccinated and unvaccinated
individuals.
So, so here's the way that Iunderstand it.
Right?
So there, there are multiplethings that have to happen for
SARS.
COVID two to spread from personto person.
So imagine.
(28:37):
One of whom has the possibilityto spread to another, but
currently neither of them areinfected.
So person a and person B.
So for a person, a spreadperson, B person, a first has to
get infected.
They then have to interact withperson B while they're producing
enough virus to infect them.
And the virus that person theyhave met has to be healthy
(28:58):
enough to infect a person B ithas to sort of be.
You know, high octane, SARS, covtwo, it doesn't want to be
living along, you know?
And so all of those things needto be in place.
And the good thing is thatvaccination helps reduce at
least, I dunno, how many of thethings that I said, but I'm
going to say that there werefour, it helps at least three of
(29:19):
the four things that I meant tomention just then.
So I'll, I'll go through that.
Right.
So, so first vaccinationdefinitely reduces the
probability that you getinfected in the first.
Which is great.
And that's one that I thinkdoesn't receive nearly enough
attention because we can reallyonly look at transmission
between people who are alreadyinfected.
But the fact is that vaccinatedpeople are a lot less likely to
get infected in the first place.
(29:40):
And so that is sort of the firstfirst barrier that goes a long
way towards reducing spreadamong vaccinated.
But vaccinated people do getinfected.
You know, there are plenty ofbreakthrough infections that are
happening, especially withDelta.
And as I mentioned, you know,our study and many others
suggested that people who arevaccinated can produce just as
much virus as people who areunvaccinated.
(30:02):
So what does that mean?
Well, first it looks like peoplewho are vaccinated clear the
virus more quickly, so they'reprobably not producing that
level of virus for quite aslong.
So that means that They're lesslikely to come into contact with
another person when they'reproducing that high level of
virus than if you wereunvaccinated.
So that reduces the probabilityof onward spread, just because
there's a shorter window of timewhen you're capable of spreading
(30:24):
the virus.
In addition to that, there'vebeen other studies that suggest
that in vaccinated people, thevirus that they do produce is
less viable.
It's less likely to spread anonward infection because.
Either it's coded in antibodiesor it's already sort of like
broken down.
I think the important thing topoint here, point out here is
that usually when we'remeasuring amounts of virus in a
(30:45):
person who's been infected,we're not actually measuring
amounts of virus.
We're measuring copies of viralRNA.
And so.
What can happen is that theimmune system can be effectively
attacking the virus, whichbasically means, you know,
chopping it up into littlepieces, but there's still going
to be that viral RNA, thatgenetic code circulating in your
body that is correlated to theamount of virus that was there,
(31:08):
but isn't there anymore becauseyour immune system is giving
this effective response.
And so we can say there'ssimilar amounts of virus, but
really what we're saying is thatthere are similar amounts of
viral genetic material in your.
And just because there's similaramounts of viral genetic
material doesn't mean thatthere's the same amount of
viable virus and that'ssomething that's been pretty
well established that if youactually look at whether or not
that virus is able to groweither in culture, in the lab or
(31:33):
to cause onward infection, it's,it's substantially less likely.
In a vaccinated person then inan unvaccinated person.
So there are all of thesethroughout the pandemic.
We've been talking about theselayers of protection, right
about distancing and masking andventilation and vaccination, and
you know, all of these otherthings.
And the nice thing aboutvaccination is that it is in
itself, this multi-layerapproach towards preventing
(31:55):
onward transmission.
So at each stage, it sort ofintroduces this extra barrier
for virus to spread and thatmakes it so that vaccinated
people are less.
Of course, they can still spreadthe virus.
We see that all the time, butdefinitely at a lower rate than
unvaccinated people for all ofthese reasons.
Great.
Matt Boettger (32:12):
That was awesome.
So succinct, incredibly helpful.
And let's get in then let's landthe plane with Thanksgiving
because this is probably on themind.
This is related and.
Are my family vaccinated and howwhat's the chance of having a
breakthrough of coming.
But before we get there, I wantto share, I'll put the link in
the show notes.
I copied this image, so you'regoing to get it like a link.
That's my own link to see it.
(32:33):
But I'm going to come back tothis in a couple of weeks.
It was a great image ofbasically how airborne illnesses
can be prevented in our home,which I think is something we're
thinking about when it comes tothe holidays or having people
over, because I've been justthinking about this for over a
year now, off and on about like,how can you measure to what
extent your house is healthy.
(32:54):
As bad as much as you can see,clearly the caveat is there's no
way to have a hundred percentfree error and transmission
inside of a house, right.
Or even outside, but within yourcontrol, is there a way you can
measure?
And I loved this image and youcan speak to it briefly as well
about this idea of like, Ididn't know that an easy measure
(33:14):
is CO2 level.
So if you have something tomeasure your CO2 level in the
house, that there is a, there isa correlation between the level
of CO2 and the amount of inhaledare particles of somebody else's
exhalation, right?
And the more you can reduce theCO2 level, the closer you get to
(33:35):
outdoor air, which makes ithealthier.
So this is ice to me.
I love this image.
It's helpful as we prepare forthings.
To think about whether you havesomething like this can measure
about how to achieve somethingin like an outdoor air ether.
You're going to have a largeamount of people in your house
who may or may not beunvaccinated.
So is that this CO2 level, agood measurement for helping to
(33:56):
see whether the house is alittle more conducive?
Stephen Kissler (34:01):
Yes.
Yeah.
Yeah, exactly.
I think that, you know, CO2 isreally the the best, the best
measurement that we haveavailable for measuring
Recirculated air in an indoorspace.
And you know, people inindustrial design and home
design, I've been doing thisfor, for a very long time.
And it's really been picking upthrough in a public health
perspective with researcherslike Joseph Allen here at the
(34:23):
school of public health.
Who's, who's really sort ofthinking about how do we make
our built spaces healthier.
And so he's been thinking anawful lot about these kinds of
things.
So I think this is, this isgreat, you know, CO2 levels
really do help us give a senseof, you know, how.
Eh, how much air is beingrebreathe within an indoor
(34:44):
space.
And so, you know, if, if youhappen to have some sort of CO2
meter it can, it can help yousee, you know, how, how your
indoor air is beingresearch-related.
And I think, you know, Iwouldn't necessarily recommend
everyone to go out and buythemselves a CO2 meter before.
But yeah, I think that like,keeping this in mind that like,
you know, that that's sort ofthe target, you want your indoor
air to be like outdoor air tothe extent that you can.
(35:07):
And and I think that that's areally good target for
ventilating, and we know we cando that by cracking windows by
about six inches.
I know it can be chilly in someplaces, but it really does go a
long way towards clearing thatair out.
And that seems to be one of thesingle most important
interviews.
That really makes spaces a lotmore safe together.
For for Thanksgiving, I'vereally been recommending that
people you know, first, if youcan take a rapid test in the
(35:29):
morning of before you see peopleand second crack your windows by
six inches.
And I think if you do those twothings, you're going to really
reduce the odds that there's amajor outbreak among the people
who you may be hosting in yourhome.
Now one caveat with the CO2measurement is that you know, a
lot of people I know havepurchased these HEPA air
purifiers.
And so they have you know, the,the things that sort of clean
(35:50):
the indoor air those thingsaren't going to remove CO2 from
your air, but they will removethe droplets and the particles
that contain SARS.
COVID two virus.
So.
If you have one of those thingsrunning, your CO2 levels might
increase and that might bealarming.
But that doesn't mean that thosethings aren't doing their job
because they're doing somethingdifferent.
And so that's why the CO2 levelsare a good proxy, but they're
not, they're not perfect forunderstanding exactly how much
(36:13):
virus containing air orpotentially virus containing air
is circulating in yourhousehold, but it's still.
Matt Boettger (36:19):
Sure great.
That's helping yet.
We just started getting a coupleof air purifiers ourselves in
our house just to have on hand,just in general distill we have
people over.
We can have it on.
It's definitely not going to bea cure all, but just, just a,
and they're not that expensive.
I'm surprised you can get a HEPAfilter for a hundred bucks that
can really do a great job for adecent little room.
So,
Stephen Kissler (36:37):
I think you mentioned there too, you know,
as.
As a Colorado native, anotherthing that these things can
really help with is wildfiresmoke.
So, if you buy these filters forCOVID, you'll be able to use
them in the summer to, for, andfor cleaning your air as well.
So, it's a good purchase.
Yeah.
I feel
Matt Boettger (36:53):
like that probably rings on the ears
about, about everybody in theWestern us, just given, given,
given this past summer how badit's been.
Great.
Thank you for that.
That was so, we talked about theThanksgiving, you know, this is
like a hard decision because Iknow friends and family, there's
invitations being put on, it'llput all over, you know, what
would you say to someone who'slike, okay, you got the invite
(37:14):
from aunt somebody, or unclesomebody or grandma, like, by
the way, you know, Somebodycoming over and they're
unvaccinated, or they're flyingin from X, Y, and Z.
They're going to be unvaccinatedand they're going to be unmasked
and feel free to come over.
If you want to.
And these tricky situations,what do you propose in these?
I know this is probably a bombput on you because it's a very
(37:36):
gray, gray area, but what do youkind of begin to propose in
these difficult situations?
Stephen Kissler (37:41):
Yeah, I think that it.
The way that I like to thinkabout it as in terms of a risk
budget.
And so, you know, it's easy toget into this mindset of saying,
you know, this behavior is safeand this behavior is unsafe.
So, you know, I will onlyinteract with people who are
vaccinated or I'll only interactwith unvaccinated people indoors
when everyone is masked.
(38:01):
And that's, you know, that'sadmirable.
But I think that we can be alittle bit more flexible with
ourselves.
So depending on, you know, yourunderlying risks your own
vaccination status and to thepeople who you regularly
interact with I think thatthere's this opportunity to
think about risk on sort of aweekly or even a monthly basis
and say that like, you know, I,for example, I don't have a lot
(38:26):
of close encounters with peopleindoors.
I just haven't been doing thatmuch.
And I haven't really missed alot of the things where I used
to do that.
I have, you know, I, Idefinitely am having, you know,
so I, you know, I've been goingto church and so their
encounters with people indoors,wild masks, we still have a mask
mandate here in Brookline.
(38:46):
And so that's part of what we'vebeen doing.
I go into the office sometimesagain, everybody has masked
there and vaccinated And soessentially, you know, from my
point of view, I'm, I'm living apretty, pretty cautious life.
And so essentially what thatdoes is in my risk budget, that
can kind of buy me a little bitof slack, where for a day, for
example, on Thanksgiving, Imight be able to interact with
(39:07):
relatives who are unmasked andVAX unvaccinated, and who have
been traveling because I've beensort of counteracting that risk
in so many ways over thedifferent parts of my money.
And so, you know, it's, it's notperfect, but I think it is a
helpful way of sort of thinkingabout how to be a little bit
more flexible with ourselves andto recognize that there are some
times, you know, these one-offthings where the ability to have
(39:29):
community and to be with peoplein a setting where there are
fewer barriers to ourcommunication.
It can be really helpful.
It can be really valuable,especially on days like
Thanksgiving.
And so I think that there areways where we can sort of step a
little bit outside of thesestrict boundaries that we've set
for ourselves in our ownbehavior and recognize that we
can be a little bit lenient withourselves.
(39:50):
Again, to the extent that wefeel.
Safe.
So again, you know, the thingsthat can sort of complicate
this, of course, as if youyourself are immunocompromised,
or if you're caring for a veryelderly relative or something
like this, I think that thatforces you to sort of, you know,
maybe you have a smaller riskbudget then.
But you know, that that budgetis just something we all have to
sort of assess for our.
But I think really what I wantto communicate here is that
(40:10):
there's the possibility to besort of lenient with our
behavior and to use differentrules at different times while
still sort of under thisumbrella of sort of this overall
sense of how much risk I'mspending.
Matt Boettger (40:21):
That's great.
That's really helpful.
Now I'm going to go back tobooster for a second because I
didn't didn't which is, again,we mentioned Colorado is one of
the few states that can have abooster.
So this is probably a luxuryquestion given that this, this
podcast is all around the world.
People listen to it and maybesomebody who's not even not even
accessing.
First I know.
So I feel really awkward havingthis conversation, but we do
have the opportunity to have abooster.
(40:43):
Now, the question is when do Iget it?
Because it's like, I'm clearlyover the six month window.
So technically I'm available,but there's decisions that are
going into my, in my mind.
I'm like, okay, so I can get itnow.
And then I feel good, right?
That there is a surge going onright now.
The winter seasons on the risesounds like a good time.
But what if we decide to go on avacation in June or something
(41:06):
like that, and you know, that'slike another six months away and
should we like balance this actof waiting a little bit longer?
Just so that, to ensure thatthat booster is still has its
prime for our vacation in June,even though I would imagine it
to be a different ball game,unless there's another variant,
of course, that comes out, youknow, back in June.
Should I get it now?
How do I weigh this?
But then.
(41:26):
Make this even more complicated,you even mentioned Stephen way
back when that after a while,there is a chance by which you
get these boosters and it startshaving longer, longer longevity
because everything's starting toequalize and you know, the virus
starting to find its stability.
The number of boosters isstarting to really create a
stability within your ownimmunology.
And so now you just don't needthose boosters as much, you
know, so lot of all of this isthis something that I should
(41:48):
wait on.
We're just getting now, do youthink?
Stephen Kissler (41:52):
Yeah, I think that you know, my sense is that
it's probably not going tomatter too much either way.
And so, and part of that is justbecause it's while we have a
pretty good sense how the, thetiming of the immune response on
average, across largepopulations, When you try to
understand that for any singleperson, it's really hard.
(42:14):
People can be all over the shopand how quickly they develop a
response, how durable thatresponse is, how high that
response is.
And so, you know, we can, we cansort of adjust our strategy to
give us the best chance to havethe highest degree of immunity
at a given time in the future.
But as far from a guarantee thatthat your own immunity will
necessarily be maximized at anypoint in the future.
(42:37):
But I think the most importantthing here to consider is that
so first I expect the boosterdose to have much longer lasting
and unity than the first twodoses that we got of the MRN.
Simply because the really mostlybecause of the distance, that
how much time has passed thatoftentimes spacing out vaccine
doses for whatever reason, theimmunologists can tell you the
(42:59):
reason, but I can't, but eitherway we know for sure that
spacing out doses does help giveyou a longer lasting immunity in
most cases.
And so I expect that to be thecase for these boosters as well.
So translating what we knowabout second dose of know.
To booster immunity in terms ofthe timing, probably just
doesn't really pan out for me.
The most important thing is thatif you have the opportunity to
(43:21):
get boosted to do so before youexpect there to be high levels
of transmission in your owncommunity.
And so, for places in manyplaces across the U S you know,
that means trying to getyourself boosted if you're
eligible Really now, you know,as soon as you can, because
we're, we're coming into thewintertime respiratory illness
season.
And so, you know, there's,there's a decent chance that,
you know, by the time you go onyour trip in the spring or, you
(43:43):
know, early.
Okay.
Suppose we've got to be prettylow anyway.
And so, you know, you'll, you'llhave the high level of immunity,
but actually you'll havepotentially a lower risk
traveling than you do, going tothe grocery store here, you
know, during, you know rightnow.
And so, so I think that bearingthose two things in mind is
really important.
(44:03):
So yeah, but that said, youknow, if you wait a couple of
weeks, Probably won't hurt thatmuch either.
You've already gotten two dosesof the vaccine, getting your
booster will definitely help.
But I think that's sort of why Iwould say that.
You know, don't, don't wait asuper long time, but if it makes
me feel a little bit better towait a couple of weeks, I
wouldn't fuck you.
Good, great, great.
Matt Boettger (44:25):
I will.
I'm excited to get it.
Thanks Stephen.
So I think the last thing we'lljust touch on briefly is, I
don't know if we mentioned thisbecause it was two weeks ago.
And if the kiddos were availablefor their vaccine officially,
then it might've been right onthe cusp.
I forgot, but it's out.
I don't know if you've heardanything about it lately.
haven't seen a lot of Facebookphotos of my friends and they're
getting their kids vaccinatedand it's been awesome.
(44:45):
And I'm excited about thisopportunity for my own, for my
own boys.
And any updates on how that'sfairing or anything on your end
of it's been going well andwhether anything has been
Stephen Kissler (44:56):
side effects.
Yeah.
It seems like they're rollingout, which is great.
I have not heard, you know, sortof consistent with the fact that
kids tend to have fewer diseaseeffects from COVID-19.
It also seems that there, youknow, dealing with the shot
better than, than many of us oldfogies.
And so, I got flattened by mysecond dose for a good day.
(45:16):
And so, yeah, so I think thatit's, it seems to be pretty well
tolerated.
I haven't really heard any, anyissues.
You know, that's not to say thatthere haven't been, you know,
like certainly there areallergies.
You know, all of the things thathave gone along with, along with
vaccination, but those so farseem to be at very, very, very,
very, very, very low rates.
And so I'm really excited to seethis, especially now, you know,
we've, we're coming into theholiday season.
(45:37):
And I think that having a lot ofkids vaccinated can be really
helpful towards keeping everyonesafer from the spread of
COVID-19.
Matt Boettger (45:46):
Yep.
Absolutely.
We're all for this and hope wecan get the kiddos vaccinated.
Obviously the risk for them isincredibly low, but like we
said, we're all in this togetherto keep the variance down to
hopefully zero.
That'd be wonderful.
And to keep those who are immunecompromised, healthy, and safe.
Thank you all for listening tothis episode of the pandemic
podcast.
Again, if you leave a review,please do at apple podcasts, we
(46:06):
greatly appreciate that.
As well as.
Give me an email,matt@livingthereal.com.
If you have questions about yourcountry, wherever that we're
missing, we're ignorant of sendus an email.
We'll look into it.
We'll bring it up in the nextepisode.
And as well, if you can supportus patrion.com/pandemic
podcasts,$5 a month or soone-time donation, Venmo,
PayPal, all in the show notes,have a wonderful week.
(46:28):
We'll see you, I guess, afterThanksgiving break for the U S
so have a wonderfulThanksgiving, Stephen, and we'll
see you guys or.
All really, really soon takecare and.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
The Clay Travis and Buck Sexton Show
The Clay Travis and Buck Sexton Show. Clay Travis and Buck Sexton tackle the biggest stories in news, politics and current events with intelligence and humor. From the border crisis, to the madness of cancel culture and far-left missteps, Clay and Buck guide listeners through the latest headlines and hot topics with fun and entertaining conversations and opinions.