August 10, 2021 • 36 mins
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Things Discussed on Episode:
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 in the face
of these crises.
My name's Matt Boettger and I'mjoined with not one but two good
friends.
Dr.
Stephen Kissler andepidemiologist, the Harvard
school of public health and Dr.
Mark Kissler, a doctor at theuniversity of Colorado.
Hello, U2.
How is it going?
(00:20):
Good to see you, buddy.
Mark Kissler (00:22):
Thanks.
Yeah, it's good to be back.
It is.
It's good
Matt Boettger (00:24):
to have you back.
It's good to have you back.
And Stephen, good to see you asalways a, Hey, you guys, miss
men, a few words, which isusually not the best people to
slate for a podcast.
Mark Kissler (00:42):
What are the many reasons really
Matt Boettger (00:45):
it's us.
It's like, it's like, yeah,anyway, I'm not even going to go
there, but anyway, nonetheless,it's great to have you guys
there's a lot to talk about.
I mean, some of it's kind of thesame old stuff from last week,
it's the Delta and all this kindof frightening stuff with the
surge and all these infections.
And.
But I think we're gonna startwith mark and just a couple of
minutes, because since wehaven't had him for a few weeks
and mark, you just got off thecoast, the rounds.
(01:08):
So I think you have a prettyunique perspective that we
haven't been able to give to ourlisteners for quite a few weeks,
if not months.
Cause even, even when you wereback with us a few weeks ago, I
don't think you were on theCOVID team at that point in
time.
And so maybe you were, I don'tremember.
So we'll talk about that in justa second, but before.
Before we get started just acouple small, normal things.
(01:28):
If you can support us, wegreatly appreciate that.
Greatly appreciate thatpatrion.com/pandemic podcast as
little as$5 a month.
Cause along the way, or just aone-time donation, Venmo,
PayPal.
Those are all in the show notesand get them right there.
And please, please leave areview.
It encourages us.
It keeps us going.
We like to read them ourselvesand we'd like to read them on
(01:50):
the podcast as well.
So please do that if you can.
And if you wanna reach out tous, let us know how you are
doing.
If you have questions for us,Matt, at living the real.com and
I promised to forward those onto mark and Stephen.
So let's get going, mark.
I want to give you the floorright away, because this is our
second take because we've hadsome technical technical issues.
(02:11):
It's we kind of surprise.
They're really surprised mark on
Mark Kissler (02:15):
chronic chronic listeners are gonna be shocked,
Matt Boettger (02:19):
becomes complicated.
So mark, why don't you go aheadand just kind of tell us what's
been going on at the hospitaland how that's been kind of.
How you've been dealing withthat psychologically,
emotionally, and just as, as ateam in the hospital as well.
Mark Kissler (02:33):
Yeah.
I mean, I think I have a lot ofthoughts.
It was, it was quite a week andI, I, I'm sensitive to the fact
that you know, there's so manythings sort of swirling around,
you know, as I leave the COVIDteam this week.
There's a little bit ofdisappointment and a little bit
of frustration.
I really don't want ournarrative on this show or our
(02:55):
narrative, you know, in generalto be one of perpetual crisis.
You know, like here comes here,comes another crisis here comes
this.
Here's what you need to worryabout.
Everybody's got to stay supersafe, you know?
And has never really been thegoal of, you know, what I want
to communicate.
Ideally, we're, you know, we'rejust talking about what's going
on, but I have to say, you know,here we are you know, August,
(03:17):
2021 and w and we're starting tosee some of the same patterns
that we were seeing last, youknow, last fall With some very
distinct differences.
And the, the biggest difference.
And I think the thing that ifI'm completely honest is really
affecting sort of morale and thesense of what, you know, what
we're doing in the hospitals,that a significant portion of
(03:39):
the morbidity that we're seeinga significant portion of the
severe disease.
Okay.
It feels preventable at thispoint in a way that it didn't
earlier in the pandemic.
And you know, and I think I'mYou know, as we've talked about
it, you know, I am sensitive towant to be sensitive to sort of
all the reasons why there'scomplexity hesitancy around
these vaccines and at the sametime, the subjective experience
(04:01):
of being in the hospital andseeing preventable disease over
and over and over again, andseeing it begin to increase, you
know, being on the COVID team amonth ago and having us have a
real low, you know, slump andpatients feeling like we're
getting back into thecommunities.
And then to feel right now as ifwe might be on the verge of, you
know, needing to do somedistancing again at the
(04:23):
communities, you know, and thisand that, and perpetually, you
know, having the sameconversations over and over and
over again.
And while there's differentvariations, you know, different
reasons for not getting thevaccine and different that
they're there.
Wishing for a, sort of aninternal consistency amongst
those narratives.
(04:43):
And it's just not, there's justa tremendous amount of
fragmentation that seems to meto be really expressing at the
core.
What is kind of this feeling,you know, this uneasy uneasiness
that I'm not at least in, inwhat I've encountered, hasn't
born up to the kind of rationalscrutiny that I.
You know, to, to make a reallyserious decision that affects
one's own health one's family'shealth and the community's
(05:06):
health.
Does that make sense?
Am I talking around this toomuch?
That at the end of the day, I'm,I'm frustrated, I'm tired.
And so are a lot of mycolleagues and I don't think
that it's just frustration atother people, you know, or just
frustration, apt people who aredon't have the vaccine.
It's a little bit of frustrationat the S the situation and yeah.
And, you know, seeing this youknow, yet again, you know, here
(05:28):
we are 18 months in.
And, but also feeling a littlebit like a puzzlement is how do
we get, how do we get some moretraction?
You know, how do we get a littlebit more more of this
conversation out to communitieswho, who need it, because in
some ways it feels like maybewe're just talking to people who
agree.
Matt Boettger (05:44):
Yeah.
I, I'm glad you bring this upmark.
Cause I don't even know how to.
You know, talk about thiswithout, you know, I know
everybody has their own way,they're processing these things,
but throw it to you, Stephen,like, I would imagine this is
somewhat of a discussion pieceamong your colleagues and what's
going on like how do we, you getthe message out of, or what's
(06:06):
broken and what's going on bywhich.
It seems so obvious now with,well, over 90% of the people
coming to the hospital beingunvaccinated, does it go, that's
just the case, right?
So for your own selfpreservation, you know, you just
want to compare to the, youknow, what the side effects of
getting vaccinated.
It's not even, it's not even noteven close.
So like, is there a talk aboutamong you guys right now?
(06:29):
Like what, what on earth do wedo to help people?
Yeah, she does see it, thesafety
Stephen Kissler (06:35):
of it.
I mean, it's yeah.
It's, it's such a.
Yeah, it's a complex and nuancedissue.
I mean, I know that a number ofmonths ago we had one of Mark's
colleagues on who's an expert invaccine hesitancy.
So there are people who devotetheir entire research careers to
understanding exactly thisphenomenon.
But I mean, Mark was speakingabout as well that this is also
(06:59):
really a moving target.
And the thing that constitutesvaccine hesitancy can look
different in different places atdifferent times in different
people, depending on thevaccine, depending on the
political climate, depending on,you know, all sorts of different
things, depending on theperception of risk And so that
makes it really hard to studyand to understand vaccine
hesitancy as such.
(07:20):
I think that there are somecommon themes that run
throughout these differentaspects of vaccine hesitancy
that have you know, really Beena consistent part of the public
health dialogue over the last,you know, even decades.
But really, I mean, the, the,the way that vaccine hesitancy
looks has changed the people whoare prone to vaccine hesitancy
as it to some degree shifted insome ways And and so, I mean,
(07:44):
just, just for an example, youknow, one of the big issues with
vaccine hesitancy for themeasles vaccine prior to the
COVID pandemic was generallysort of very well off.
Families in California whoweren't vaccinating their kids.
And it was sort of associatedwith you know, almost this sort
of, if we're, if we're lookingat the political spectrum, it
was sort of on the far left, insome sense, if we're speaking in
(08:07):
very broad strokes that likevaccine hesitancy was the
greatest problem.
And that seems to sort of beshifting and swaying as, as time
goes.
And I think really what that'sgetting to is that the political
spectrum is really not a goodyardstick for measuring whether
or not a person is going to bevaccine hesitant.
And I think that's one of my bigfrustrations about the
conversation right now is thatit sort of digs into this
(08:28):
broader discussion about whatdoes it mean to be vaccine
hesitant this lens that we seemto apply to everything about
left and right.
Red and blue, whatever.
It doesn't seem to hold up here.
Totally.
There, there are trends forsure, but those trends aren't
consistent over time.
And so there's something elsegoing on here that we really
need to understand that itdoesn't just boil down to
(08:49):
political preference.
And so I think that's the thingthat is interesting to me.
And that's the thing that'sstill remains a big, a big
mystery.
It would be potentiallyinteresting to, you know, talk
about some of the specificelements of vaccine has a
tendency that we've talked aboutor that I've heard arise.
That includes No, the ethics ofreceiving the vaccine, the
ethics about the ways in whichit was.
(09:10):
Developed and produced thesafety profile as well as, you
know, different degrees of, ofmisinformation about past
vaccines and their effects on aperson's longterm health and
these kinds of things.
So I think there are all ofthese different sort of aspects
to it, and it might be valuableat some point to dig into each
of those objections at somepoint.
But I think also one of thethings that mark was talking
(09:31):
about is that it, that that canbe valuable, but, but I also
don't know if that's.
Issue here.
I think that there's, there'ssomething about ticking off each
of these arguments that that'sstill wouldn't necessarily be
sufficient to convince a personwho is vaccine hesitant to then
receive a vaccine.
So there's something even deepergoing on here.
That, that I don't claim tounderstand, certainly.
(09:53):
People are thinking a lot about,but it would be interesting to
discuss with you guys.
Mark Kissler (09:57):
Yeah.
And I think, you know, thankyou.
I would love to hear and justkind of sit in on an episode
where we go through some of themajor, you know, I know that
there's been some some of thisdone and in the broader media
too, about like engaging indialogue with people who haven't
gotten the vaccine and what aretheir reasons.
And there's actually.
Lot of different reasons and alot of different motivations and
(10:17):
kind of going through maybe someof the big ones of that and
discussing.
Those affect different people inour communities and families,
you know, all over the board.
On the other hand, I don't wantto harp too much on some level.
I think, yeah, I think that thisvaccine hesitancy issue is maybe
a second layer to that.
There's underneath that.
There's a bigger conversationaround trust of, of the medical
(10:39):
system and like what's going onthere.
And I think there's somedefinitely, definitely some
valid critiques about the waythat, you know, medicine.
Has seen too to overreach incertain ways you know, with
certain communities anddifferent historical locations.
And I think there's a lot of afeeling of that, you know, I've,
I've read some interestingarticles that are coming.
They're sort of framing thepandemic.
(11:00):
And what I'm saying, being up tohere is the sense that you know,
we, I think we can focus onvaccine hesitancy as, as a
phenomenon in itself, but Ithink there's another phenomenon
that that's nested within, whichis how.
What do we think about therelationship between medicine,
science, society, and culture?
That's a very big question,right?
(11:21):
But I've seen some interestingarticles that, that have sort of
framed the shutdowns of the lastyear and recommendations of
public health experts as a S asa certain sort of power grab,
you know, that there's this,there's this medical industrial
machine that saw the pandemic asa chance to exert control.
Over society or to like broaden,you know, the reach of these,
(11:43):
these forces that want I don'tknow.
I don't know exactly understandwhat these hidden motivations
are.
The people are, are feeling and,and it seems to paint medicine
and you know, in is a little.
Organized and I think it reallyis.
And so I, I do agree.
I mean, I think there are waysthat medicine can be, you know,
like I like the word totalizing,are you familiar with that term
(12:05):
or that idea that, that thereare ways of thinking about kind
of medicine and science thatsort of take all elements of
human existence and put it underthis frame.
And in that way, that kind of.
You know, I think there's good.
There's, there's good.
You know, we've got to be ableto think outside of, you know,
purely kind of a utilitariancalculus of like, what's going
to give the most number of lifeyears, you know, there's other
(12:28):
goods, we've talked about this amillion times, right.
And there's ways that, that apurely kind of medical
scientific frame might flattenother elements of human
existence, you know?
Goodness relationship, thingslike that, but I'm not convinced
that this, this, this pandemicto me seems to be a different
case.
You know, a lot of people Ithink are framing this as like,
(12:48):
this is a lot more of the sameand that there's this kind of
systematic overreach.
And from the inside, that's nothow it feels, you know?
And, and it's hard for me to notat this point, start to take
some of those argumentspersonally.
It's hard for me to not start tofeel as if this, you know, this
perpetual, like, you know, oh,they, you know, big, big
(13:12):
government, big medicine.
They want us, they want tocontrol us.
They want to take away ourfreedoms.
You know, when I, and mycolleagues have been putting our
families at risk for the last 18months, you know, and, and not
to be overdramatic.
You know, particularly at thebeginning of the pandemic, when
we didn't have a clue about whatwas going on, but we knew that
this was real.
(13:33):
You know, and, and that we're,you know, and we're still
engaging in the same, samething.
And so much of this ispreventable, you know?
It's hard for me to not takesome of these, these arguments
deeply personally, you know, andsay, that's not what's going on.
You know, this is not a bigpower grab.
This is a deep misunderstandingabout what we're trying to do.
(13:55):
And, and it's a misunderstandingthat has affects on people's
lives.
Matt Boettger (14:00):
I don't know.
I mean, this is, I'm glad you'resaying this mark.
I've been feeling for you andfor doctors and nurses all
around the country.
I remember a kind of goes backto.
They said to me, one of mymemories is like maybe last
April or when we were talking, Iwas talking to a friend of mine
too, was dismissing hospitalsbeing overloaded in saying, oh
(14:21):
my gosh, I know all thesepeople, these nurses, doctors,
they're saying there's nothinggoing on in the hospitals.
This is all just conspiracytheory.
And, you know, Stephen, youbroke it down for us to explain,
this is the complexity of thesituation where like, you're
right, depending on whathospital you go in, it may be
full and it may be not, butdoesn't matter.
Does it change the fact thatthere are a lot of hospital
overrun and doctors and nursesbeing, putting their lives at
(14:44):
stake, being exhausted, can'teven care for the patients that
are non-covered related and it'stapping the system.
I feel like it's kind of this,this whole thing all over again
and hearing your voice mark.
I think I'm hoping it helps liketo realize that there are real
people, real doctors, realnurses in hospitals sacrificing
their families too.
(15:04):
And it's different, right?
I mean, last fall.
It was scary and the future wasunknown, but there was like,
there was a, there was a lack ofcontrol in some sense.
Now there's like really a largesense of advocacy and, and, and
it's not being used, which makesit all the more like, Kind of
(15:25):
goes back to Abraham and he'stalked about how, if there's one
thing we learned from thispandemic is that we will,
hopefully we'll realize we're,we're way more connected than
we'd like to give credit for.
And that anybody's decision todo something.
Not to make a grave, but needsto have consideration of who
would impacts theirs.
And I think that that's been thegreatest thing that you guys
have been doing for us.
(15:46):
And for me, particularly aboutwhen it comes to the vaccine,
it's not just my own health.
It's a, it's a bigger picturethat I had to put in
consideration.
Mark Kissler (15:53):
Right.
Yeah.
It's amazing to me how much.
And I don't know why I'msurprised at this, but I.
It helped much their anecdotal,this anecdotal evidence for this
personal experience continues tomatter for people.
So I have, you know, I care fora lot of folks in the hospital
who are like, man, if I onlyknew if I, if I had only known,
you know, I would have gottenthe vaccine.
(16:14):
And it's just surprising to mebecause it's not as if this
information is not available.
And, and similarly, you know,there's the, the conversations
around like, oh, well now, nowI'm going to take it seriously.
Or now I'm going to, you know,now, now I understand I guess
I'm not convinced that it needsto come to that point, that you
need to experience it in yourown body.
(16:35):
In your own family, you know,and, and the shame of that,
right, of course, is that whobore the brunt of so much of
this early in the pandemic orthese communities that are
hidden away that are not, youknow, not as mainstreamed or,
you know, or vulnerable in otherways.
And, and now all of a sudden.
The realization is hittingcommunities that had been
(16:56):
previously more sheltered fromthe effects of the pandemic.
And it just seems to me thatsuch a shame to not be able to
enter into the experience, youknow, the real experience of of
other people in our communitiesand to change our behavior as a
result of that, you know, and Irecognize that there's, there's
so many layers and I'm sure thatI'm oversimplifying and I'm
(17:16):
speaking out of my own, youknow, limited experiences.
And you know, not arguingnecessarily, but it's more
valid, et cetera, et cetera, butit's very hard.
It's just very hard for me to,to dismiss what I've seen my own
anecdotal evidence, what I'veseen with my own eyes for the
last 18 months.
And but I don't think thatthat's, that there's like some,
(17:37):
I have privileged access in thesense that I work in a hospital,
you know, but it's not a secret.
Matt Boettger (17:43):
I mean, I I'm, yeah.
I'm, I'm, I'm speechless.
I don't even know how, you know,where, where I've worked in the
past and the hesitancies.
And I, I can't explain it.
I don't understand it.
And it's frustrating to
Mark Kissler (17:56):
know it.
Yeah.
And I don't want to, and I thinkmaybe we can pivot a little bit,
cause I don't want to just give,give vent to my own.
But part of the reason that Iwanted to be sure to come on
today though, you know, it'sjust to speak a little bit out
of the, the, the.
The run of the experience ofbeing on the words yet again,
you know, and, and and, andreally kind of attesting testing
(18:16):
to this very significantdifference in the morale and how
it feels.
And that I think has felt kindof across the board at least in
my conversations and just sortof the general air and, and, you
know, we take care of people allthe time.
Very rightfully so.
All of us, you know, all of ourdiseases, every disease that you
(18:37):
and I, and everybody's going toget has some relationship to
choices we've made to ourindividual genetic makeup, where
we, where we grow up and thenthings we do, you know, things
we do to ourselves.
That's, you know, that that'sjust the fact of life.
So I'm not, it's not as if I,you know, I think that anybody
deserves different care, youknow, as a result of choices
(18:59):
they made, that's, that's veryfundamental that it doesn't
matter, you know?
And that, but, but at the sametime I don't know.
There's, it's just I can reallysympathize in some ways with
some of the doctors in, youknow, in fiction that I've
encountered in books, you know,over the years who have, who,
who get this certain kind ofworld weary.
(19:21):
And it's, it's very pragmatic,you know, it's, it's a very
like, and I recognize thelimitations of a suit of a super
pragmatic outlook, you know,because sometimes we need our
idealists and we need our, youknow, big idea think thinkers
and stuff.
But man, I really sympathizewith that and just feeling,
Matt Boettger (19:37):
You know, doing a slight pivot but still on the
same theme, like given what'sgoing on and what you've
experienced, how have thingschanged for you mark?
Like now living this new kind ofsurge scene at the hospital.
Clearly the idea of Lord havemercy.
Please get vaccinate.
That's clearly at the, at theforefront of your mind, are
there other things by which, youknow, you're now at, you're a
(19:59):
family man, right.
And you have kids going toschool.
And how are things been changingfor you if at all, as you see
this new surge coming on four,has your lifestyle changed a
little bit or how school and theinterest of school coming,
coming along?
How are things changing for youin that
Mark Kissler (20:15):
area?
Yeah, so you're, you're kind ofasking about how does this
affect kids going back to schooland things like that.
So we're getting our kids.
My youngest is going back.
This week he went, he went backand the big news here is that he
is no longer a napper at school.
And so he was a napperpreviously, and now he's a
worker.
This is why this sort of thing.
And which means that he cruiseson through nap time and crash is
(20:39):
hard when he gets home.
He was so tired.
So tired last night.
Yeah, I know.
It's really cute.
But We were fortunate in thesense that we were able to do a
significant amount of in-personschools.
I'm worried about how thisschool year is going to be.
I think, I think it might be alittle bit of a disaster because
of how prevalent this Deltavariant and how, how
(21:00):
transmissible it is.
And so if we shut down classesevery time somebody gets.
And I think, and this isanother, you know, complexity
because if every, if for thefamilies who are able to be
vaccinated having an index casewithin the classroom is not that
huge of a deal necessarily.
And I'm wondering if it's worthit to education and continuity
(21:22):
to shut down an entire classroomof kids.
You know what I mean?
I think there's there'sconversation.
I, I'm not the public healthexpert in the room here, so I'm
not.
Go out, but, but at the sametime, it feels a little bit from
an educational standpoint, youknow, we saw the ways that
educational disparities widenedmassively over the course of the
last year.
And so then going into anotherschool year and feeling like we
(21:45):
might be lining up for the samething again is a little bit
daunting.
And so, you know, I felt very,very fortunate both with our
school community and our abilityto kind of shuffle and move
things around.
You know, help our kids kind ofcontinue to, to do, do stuff.
But not everybody has thatflexibility.
A lot of people are working twojobs at this school.
You know, a lot of, a lot offamilies at the school, we go to
(22:06):
have a lot of just differentconstraints and shutting down
school and keeping kids home isa very different prospect for
them.
And so yet again, you know, herewe are at, at another kind of
semi semi reversible or somelike something we have control
over in terms of how do weprotect communities.
School or school-relatedexposures.
And I don't know, I don't knowwhat's going to happen, you
(22:27):
know,
Matt Boettger (22:28):
and I mean, I'm curious for you mark, and then
we can ask questions for Stephenas well, but I'm sure parents
are out there are worried insome level as well of like
taking their kids and going toschool with a Delta.
Okay.
With your experience.
I think it's good.
Just to hear from you arc oflike, how do you feel feeling
with that and taking your kids,kids
Mark Kissler (22:45):
school and, yeah, I dunno.
It's always been much on my mindthis year.
And I think even though we knowthat the, that the severe
diseases.
Young kids is not near what itis in adults.
It's always been something thathas, I just have wanted to be
extra careful about.
And I've seen news articlesabout like, you know, now
(23:06):
children's hospitals are seeingmore cases and we're seeing a
lot more kids getting it, comingdown with it.
I dunno.
And this is another instancewhere I really don't want to be
alarmist and say like, oh, it'sa crisis.
We got to stop everything.
You know, cause kids are gettingsick now.
And you know, here we are in theworld's on fire.
And so I, but at the same time,I think, you know, it makes us
(23:28):
think, you know, and think aboutways that that, that our actions
are just here, you know, whothey are affecting real people
again.
Yep.
I don't think, I, I don't know.
I'd be interested to hearStephen's opinion on, you know,
if kind of what this means interms of overall burden of
disease in, you know, in, inpediatric populations and things
(23:49):
like that on the whole, I don'tfeel panicked about Delta.
And my kids you know, I don'tfeel as if it's, it materially
changes a lot of things, youknow, I think that some common
sense masking here and there youknow, common sense kind of being
judicious about where we go andwhat we do but not being, you
know, over scrupulous about it.
Is it that's going to be thestate of our lives through much
(24:12):
of 20, 23.
If we believe what the gentlemanon the left here has written,
you know, in the past.
And so that's fine, you know,that's fine.
To me, I'm more concerned.
I think about some of thesebigger picture implications and
the ways that we might react andoverreact to increasing cases in
different pockets among kids.
Matt Boettger (24:34):
Yep.
Stephen, anything to say aboutthat?
Of like, I mean, here's thething, like I see the same
thing, increase hospitalizationwith children, this kind of
stuff.
And like our, all of our podcastepisodes, I feel like Stephen,
you can give insight to this,but it's probably just
complicated because there's somany nuances to, to different
culture.
Now we have vaccinated parentswith unvaccinated children
dragging their children toplaces probably it's summer
(24:57):
it's.
I mean, there's just.
It's it's, it's, it's aradically different Plainfield
than last August, likeradically.
So seen 48% of children, youknow, maybe getting infected of
the, of those who'd be infected,not hospitalized, not
hospitalized, but just infected.
I'd imagine it's the complexityof this mixed bag of vaccinating
and vaccines in summertime,right?
Stephen Kissler (25:17):
Or, yeah, exactly.
As far as we can tell.
That's the story.
It's, it's really interestingbecause my, many of my
colleagues are, are sort ofsplit on, you know, what we
should be doing about schools.
And to what extent we can safelyreopen them.
I, I tend to fall in line morewith The ones who sort of seem
(25:39):
to be also in line with whatmark was saying, which is that
there, there are at this point,some very common sense measures
that we can take to keep schoolspretty safe.
Certainly the risk of severeacute disease in young kids is
much lower than it is foradults.
And that is not to minimize thefact that there is, there are
absolutely risks to kidsassociated with this virus, for
(25:59):
sure.
And I think we need to, I mean,we, we need to remain mindful of
those.
It, the situation now isdifferent than it was.
Six 12 months ago a case nolonger means the same thing that
it did then because vaccinationrates are much higher.
The odds that a kid will spreaddisease to older family members
(26:20):
is lower assuming that thosepeople are vaccinated.
And, and so I think that we'rereally, you know, the playing
field is.
Shifting layered on top of thefact that, you know, we, we know
a lot more about masking.
We know a lot more aboutventilation and the importance
of that.
We, we have a much better senseof sort of how to.
Control COVID in thesesituations.
So, and, and as mark was saying,you know, closing schools is, is
(26:43):
a massive disruption.
It's you know, it, it, there,there are also public health
implications for that too.
That, that are very long lastingin the sense of more vulnerable
populations falling behind intheir education of adults who
are working multiple jobs, notbeing able to take care of their
kids.
You know, there's, they're huge,huge issue.
That we should be addressing onthe side as well.
You know, we should be thinkingabout, you know, how do we
(27:04):
provide childcare for familieswho need it who can't afford it?
You know, these things are alsopublic health issues that we
need to be thinking about.
But in the meantime, you know,we don't have those structures
in place.
And so, so I think that it's,you know, it's, it's a complex
landscape, but I do think thatyou know, shutting everything
down for a single case in aschool probably doesn't make
sense anymore.
(27:25):
If there's a major outbreak,then we can maybe start thinking
about that for sure.
But I think that, you know,schooling is so incredibly
important.
And I think that we do know howto really improve our odds at
keeping that safe that we canjust sort of move forward, even,
even in the context of Delta.
One last sort of point that Iwanted to add to that is, you
know, you're talking aboutrising hospitalizations and
young kids, and there's been alot of talk about, you know,
(27:46):
does this mean that the virus ismore severe.
For young kids It's really hardto disentangle, but the same
narrative was arising with thealpha variant B 1 1 7 earlier,
too.
And as far as I can tell, all ofthe patterns are consistent with
it just being mortar infectiousacross the board.
And so when that happens, you'regoing to expect to see more
infections across allpopulations.
(28:08):
But now with the differential invaccination, between older kids,
between older adults and youngkids who aren't vaccinated, we
expect the relative proportion.
If people end up in the hospitalwith young kids to rise and we
expect the overall number torise just because it's so much
more infectious.
So everything that I'm seeing isconsistent with just the Delta
being more infectious and notnecessarily being like targeting
(28:29):
kids, particularly.
And so I think that's allconsistent with mark was saying
too, is that it's worth it.
Okay.
Yeah, wearing masks in grocerystores and sort of being mindful
of how many, how many peoplewere seeing and how much time
we're spending in doors withother people.
The Delta is more infectious.
And I think that that's reallythe bottom line is that we're
just dealing with the virus.
That's the same thing we've beendealing with.
It is more transmissible forsure.
(28:50):
And that causes issues, but not,not time to panic about it
suddenly, you know, changing itsentire age profile in terms of
who it's infecting and who it'scausing more severe disease in,
I think
Matt Boettger (29:02):
it.
Go back to Mark's point andjust, just shows you the
complexity of all this, youknow, I, and every day I'm in
the news looking at what's,what's the highlights.
What can we talk about thisweek?
What's going on?
And I see these highlights oflike, you know, six-year-old,
seven-year-old hospitalized,right?
I'll get these like headlines.
Right.
And it's even hard for me, hardfor me to be like, oh, is that
propaganda?
(29:23):
Or is that a real, like, youknow what I mean?
Like, like, are you, how are youtrying to make it worse than it
is to get people, to preparethem, to take the, and so I, you
know, there's some level, somelevel of empathy, those people
who I also has headlines oflike, oh, you know, a 45 year
old man, 50 year old manregrets, not getting the
vaccine.
He's done.
He's in the ICU.
It's a headline.
It's powerful.
(29:44):
But I wonder sometimes like,okay, why did, why is that
there?
Is it, is it there to persuadepeople?
You know, is it an outlier?
It just makes thingscomplicated.
Right.
And it's like, it makes it, thenI feel like it's a political
issue and I'm on this side ofthe pandemic.
Like I'm on this side, likeit's, so it's just, the media
makes it really hard.
Even messes with my head.
(30:04):
This is why I have to be withyou guys every Monday or Tuesday
now, so I can get clear.
So, one thing I had a transitionto, cause I think this is
really, really.
And this is likemiscommunication
misunderstanding.
And I was going to go straightto this because it's the, the
Rogan show, right?
Where is it at here?
Joe Rogan is getting thiscompletely wrong.
As the title, put this in theshow notes, it says the
(30:25):
scientist who conducted thevaccine study.
So I want to give the floor toyou, Stephen.
Cause you just.
Saw a talk with this, this readfellow who Rogan took is like a
2004 15 vaccine study.
And basically to put it in aquick synopsis, for all those
who are listening, who hasn'tread, haven't read or listened
to Joe Rogan, he, Joe Rogan usedthis vaccine study to suggest
(30:48):
that those were getting thevaccine may be actually
harboring environments for thevaccine to create multiple
variants and make our lifeIndian worse.
That's the conclusion that JoeRogan is making from this
vaccine study, the scientisthimself says, Gerald got all
wrong.
Stephen, you want to help giveus some clarification of what
this site, the, this, this,whatever this study was.
(31:10):
And what's the real implication,how it's related or unrelated to
the COVID vaccines.
Stephen Kissler (31:16):
Yeah.
So this is this study was by acolleague named Andrew Reed.
And who was it?
Very highly respected you know,in the field, but also by me
personally I think he's donereally great work and he's very
clear I had about the findingsof his studies.
And, and I think that actuallythe, so the, I was recently in a
workshop in which he.
(31:37):
Spoke about this exact studythat Joe Rogan was talking
about.
And, and I think that was reallyexemplary of how he was able to
dive into the nuance of thestudy.
I mean, he was, he was veryclear about the fact that, so,
so let's give some background tothis study, right.
So, so first of all, this is astudy that was done in chickens.
Okay.
And so chickens get infectedwith viruses like humans.
(31:58):
They have immune systems like wedo their immune systems differ
from ours.
And but we were looking, theywere looking at a vaccine that
prevented severe disease anddeath from a virus that infects
chickens no critically, youknow, they, they ran this study.
They were looking at thisvaccine and they did find that
concurrent with vaccinations,some new variants of the virus
(32:21):
emerged.
That were both moretransmissible and, and I think
slightly more clinically,clinically severe, I don't know
if chickens have clinics, butso, but either way, so, but the
important thing about this isthere is really two things.
So first of all, the vaccine hadno effect on transport.
So if you have a vaccine thatcan reduce the severity of
(32:42):
illness and provides, you know,some testing against the
progression of illness, butprovides no protection against
transmission, then sometimes youcan get new variants that
emerged that that do some ofthese strange things.
But the most important findingabout all of this is that the.
Vaccinated chickens were stillprotected against severe disease
(33:06):
and illness.
Even from the variants, eventhough their risk increased with
the variants, that risk wasstill much lower than the risk
that the chickens that wereunvaccinated were facing.
And so in some ways that's veryconsistent with what we're
seeing with COVID is we areseeing new variants emerge.
But still the risk thatvaccinated people face from
these variants is much lowerthan the risk that unvaccinated
(33:27):
people face from the variants.
Now there comes, the issue of isgetting vaccinated, driving the
development of these variants.
There've been a lot of sort ofstudies around this and, and I
think that there's, there's someconfusion because it's.
It is, it is, you know, the,there it is true that
intermediate rates of immunityin a population under certain
(33:48):
circumstances can contribute tothe evolution of new variants
that are more transmissible.
And sometimes that are moresevere, but really what the
virus wants to do is to be ableto spread more easily it's yeah.
Necessarily trying to becomemore severe.
And I know I'm speaking as ifI'm giving this virus agency,
but that's, you know, roughlyspeaking sort of, you know, we
can talk about the evolutionarythings that lead to that.
(34:10):
But, but the key thing here too,is that If that happens with
natural infection.
I mean, it's, it's not thatbeing vaccinated is going to be
any worse than getting infectedwith COVID that both of those
things are going to select frommore infectious variants.
And so actually the best thingyou can do is, is get
vaccinated.
Even better at preventinginfection and severe disease
than a natural infection withCOVID because that actually
(34:32):
pushes us towards the edge whereit keeps the viral population
much lower and it gives, itgives it fewer chances to
evolve.
That's very clear that's that?
That's true in the chickenstudy.
That's true in human studiesthat we've, that we've conducted
in the modeling studies that,you know, It's not vaccination
per se.
That's, that's selecting forthese variants.
It's just the fact that there'sintermediate rates of immunity
in the population that canselect for the variants and the
(34:56):
best way to prevent that is toget vaccinated, frankly.
And, and that's, that's been avery consistent finding across
many different studies withdifferent approaches.
And so it's, you know, itprevents disease.
It prevents the virus frommutating and evolving in the
ways that we don't want it.
To the extent that we're able,especially with vaccines, like
the ones we have for COVID thatdo prevent infection.
(35:16):
So
Matt Boettger (35:17):
great.
No, thanks.
Thanks for bringing light tothat.
I really appreciate that.
You know, I think that might getto the end.
Any last words for you guysbefore we wrap this up and we're
good.
Well, thank you all forlistening.
Mark, thanks for coming on andjust telling us like what's
going on in your world and howyou're processing this.
And I really hope for those whoare listening to share this
particular episode, because Ithink more than anything, it's
one thing to hear it from CNN.
(35:37):
It's one thing to hear it fromFox or whatever, but to hear it
from just somebody who is juston a podcast, this is their
profession.
This is what they'reexperiencing to help people who
are unvaccinated, who arehesitant.
Don't really know what to do,just to hear a bigger picture of
the story that, you know, like,like, like mark said, that we
don't get to see it's a maybeunfortunate privilege that mark
(35:57):
has to able to see and hope toencourage other people, to take
the leap, get vaccinated andhelp reduce this so that we can
live a more, more normal life.
Hope you guys have a wonderfulweek, take care, and we'll see
you guys next Monday.
Bye-bye.
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible in the face
of these crises.
My name's Matt Boettger and I'mjoined with not one but two good
friends.
Dr.
Stephen Kissler andepidemiologist, the Harvard
school of public health and Dr.
Mark Kissler, a doctor at theuniversity of Colorado.
Hello, U2.
How is it going?
(00:20):
Good to see you, buddy.
Mark Kissler (00:22):
Thanks.
Yeah, it's good to be back.
It is.
It's good
Matt Boettger (00:24):
to have you back.
It's good to have you back.
And Stephen, good to see you asalways a, Hey, you guys, miss
men, a few words, which isusually not the best people to
slate for a podcast.
Mark Kissler (00:42):
What are the many reasons really
Matt Boettger (00:45):
it's us.
It's like, it's like, yeah,anyway, I'm not even going to go
there, but anyway, nonetheless,it's great to have you guys
there's a lot to talk about.
I mean, some of it's kind of thesame old stuff from last week,
it's the Delta and all this kindof frightening stuff with the
surge and all these infections.
And.
But I think we're gonna startwith mark and just a couple of
minutes, because since wehaven't had him for a few weeks
and mark, you just got off thecoast, the rounds.
(01:08):
So I think you have a prettyunique perspective that we
haven't been able to give to ourlisteners for quite a few weeks,
if not months.
Cause even, even when you wereback with us a few weeks ago, I
don't think you were on theCOVID team at that point in
time.
And so maybe you were, I don'tremember.
So we'll talk about that in justa second, but before.
Before we get started just acouple small, normal things.
(01:28):
If you can support us, wegreatly appreciate that.
Greatly appreciate thatpatrion.com/pandemic podcast as
little as$5 a month.
Cause along the way, or just aone-time donation, Venmo,
PayPal.
Those are all in the show notesand get them right there.
And please, please leave areview.
It encourages us.
It keeps us going.
We like to read them ourselvesand we'd like to read them on
(01:50):
the podcast as well.
So please do that if you can.
And if you wanna reach out tous, let us know how you are
doing.
If you have questions for us,Matt, at living the real.com and
I promised to forward those onto mark and Stephen.
So let's get going, mark.
I want to give you the floorright away, because this is our
second take because we've hadsome technical technical issues.
(02:11):
It's we kind of surprise.
They're really surprised mark on
Mark Kissler (02:15):
chronic chronic listeners are gonna be shocked,
Matt Boettger (02:19):
becomes complicated.
So mark, why don't you go aheadand just kind of tell us what's
been going on at the hospitaland how that's been kind of.
How you've been dealing withthat psychologically,
emotionally, and just as, as ateam in the hospital as well.
Mark Kissler (02:33):
Yeah.
I mean, I think I have a lot ofthoughts.
It was, it was quite a week andI, I, I'm sensitive to the fact
that you know, there's so manythings sort of swirling around,
you know, as I leave the COVIDteam this week.
There's a little bit ofdisappointment and a little bit
of frustration.
I really don't want ournarrative on this show or our
(02:55):
narrative, you know, in generalto be one of perpetual crisis.
You know, like here comes here,comes another crisis here comes
this.
Here's what you need to worryabout.
Everybody's got to stay supersafe, you know?
And has never really been thegoal of, you know, what I want
to communicate.
Ideally, we're, you know, we'rejust talking about what's going
on, but I have to say, you know,here we are you know, August,
(03:17):
2021 and w and we're starting tosee some of the same patterns
that we were seeing last, youknow, last fall With some very
distinct differences.
And the, the biggest difference.
And I think the thing that ifI'm completely honest is really
affecting sort of morale and thesense of what, you know, what
we're doing in the hospitals,that a significant portion of
(03:39):
the morbidity that we're seeinga significant portion of the
severe disease.
Okay.
It feels preventable at thispoint in a way that it didn't
earlier in the pandemic.
And you know, and I think I'mYou know, as we've talked about
it, you know, I am sensitive towant to be sensitive to sort of
all the reasons why there'scomplexity hesitancy around
these vaccines and at the sametime, the subjective experience
(04:01):
of being in the hospital andseeing preventable disease over
and over and over again, andseeing it begin to increase, you
know, being on the COVID team amonth ago and having us have a
real low, you know, slump andpatients feeling like we're
getting back into thecommunities.
And then to feel right now as ifwe might be on the verge of, you
know, needing to do somedistancing again at the
(04:23):
communities, you know, and thisand that, and perpetually, you
know, having the sameconversations over and over and
over again.
And while there's differentvariations, you know, different
reasons for not getting thevaccine and different that
they're there.
Wishing for a, sort of aninternal consistency amongst
those narratives.
(04:43):
And it's just not, there's justa tremendous amount of
fragmentation that seems to meto be really expressing at the
core.
What is kind of this feeling,you know, this uneasy uneasiness
that I'm not at least in, inwhat I've encountered, hasn't
born up to the kind of rationalscrutiny that I.
You know, to, to make a reallyserious decision that affects
one's own health one's family'shealth and the community's
(05:06):
health.
Does that make sense?
Am I talking around this toomuch?
That at the end of the day, I'm,I'm frustrated, I'm tired.
And so are a lot of mycolleagues and I don't think
that it's just frustration atother people, you know, or just
frustration, apt people who aredon't have the vaccine.
It's a little bit of frustrationat the S the situation and yeah.
And, you know, seeing this youknow, yet again, you know, here
(05:28):
we are 18 months in.
And, but also feeling a littlebit like a puzzlement is how do
we get, how do we get some moretraction?
You know, how do we get a littlebit more more of this
conversation out to communitieswho, who need it, because in
some ways it feels like maybewe're just talking to people who
agree.
Matt Boettger (05:44):
Yeah.
I, I'm glad you bring this upmark.
Cause I don't even know how to.
You know, talk about thiswithout, you know, I know
everybody has their own way,they're processing these things,
but throw it to you, Stephen,like, I would imagine this is
somewhat of a discussion pieceamong your colleagues and what's
going on like how do we, you getthe message out of, or what's
(06:06):
broken and what's going on bywhich.
It seems so obvious now with,well, over 90% of the people
coming to the hospital beingunvaccinated, does it go, that's
just the case, right?
So for your own selfpreservation, you know, you just
want to compare to the, youknow, what the side effects of
getting vaccinated.
It's not even, it's not even noteven close.
So like, is there a talk aboutamong you guys right now?
(06:29):
Like what, what on earth do wedo to help people?
Yeah, she does see it, thesafety
Stephen Kissler (06:35):
of it.
I mean, it's yeah.
It's, it's such a.
Yeah, it's a complex and nuancedissue.
I mean, I know that a number ofmonths ago we had one of Mark's
colleagues on who's an expert invaccine hesitancy.
So there are people who devotetheir entire research careers to
understanding exactly thisphenomenon.
But I mean, Mark was speakingabout as well that this is also
(06:59):
really a moving target.
And the thing that constitutesvaccine hesitancy can look
different in different places atdifferent times in different
people, depending on thevaccine, depending on the
political climate, depending on,you know, all sorts of different
things, depending on theperception of risk And so that
makes it really hard to studyand to understand vaccine
hesitancy as such.
(07:20):
I think that there are somecommon themes that run
throughout these differentaspects of vaccine hesitancy
that have you know, really Beena consistent part of the public
health dialogue over the last,you know, even decades.
But really, I mean, the, the,the way that vaccine hesitancy
looks has changed the people whoare prone to vaccine hesitancy
as it to some degree shifted insome ways And and so, I mean,
(07:44):
just, just for an example, youknow, one of the big issues with
vaccine hesitancy for themeasles vaccine prior to the
COVID pandemic was generallysort of very well off.
Families in California whoweren't vaccinating their kids.
And it was sort of associatedwith you know, almost this sort
of, if we're, if we're lookingat the political spectrum, it
was sort of on the far left, insome sense, if we're speaking in
(08:07):
very broad strokes that likevaccine hesitancy was the
greatest problem.
And that seems to sort of beshifting and swaying as, as time
goes.
And I think really what that'sgetting to is that the political
spectrum is really not a goodyardstick for measuring whether
or not a person is going to bevaccine hesitant.
And I think that's one of my bigfrustrations about the
conversation right now is thatit sort of digs into this
(08:28):
broader discussion about whatdoes it mean to be vaccine
hesitant this lens that we seemto apply to everything about
left and right.
Red and blue, whatever.
It doesn't seem to hold up here.
Totally.
There, there are trends forsure, but those trends aren't
consistent over time.
And so there's something elsegoing on here that we really
need to understand that itdoesn't just boil down to
(08:49):
political preference.
And so I think that's the thingthat is interesting to me.
And that's the thing that'sstill remains a big, a big
mystery.
It would be potentiallyinteresting to, you know, talk
about some of the specificelements of vaccine has a
tendency that we've talked aboutor that I've heard arise.
That includes No, the ethics ofreceiving the vaccine, the
ethics about the ways in whichit was.
(09:10):
Developed and produced thesafety profile as well as, you
know, different degrees of, ofmisinformation about past
vaccines and their effects on aperson's longterm health and
these kinds of things.
So I think there are all ofthese different sort of aspects
to it, and it might be valuableat some point to dig into each
of those objections at somepoint.
But I think also one of thethings that mark was talking
(09:31):
about is that it, that that canbe valuable, but, but I also
don't know if that's.
Issue here.
I think that there's, there'ssomething about ticking off each
of these arguments that that'sstill wouldn't necessarily be
sufficient to convince a personwho is vaccine hesitant to then
receive a vaccine.
So there's something even deepergoing on here.
That, that I don't claim tounderstand, certainly.
(09:53):
People are thinking a lot about,but it would be interesting to
discuss with you guys.
Mark Kissler (09:57):
Yeah.
And I think, you know, thankyou.
I would love to hear and justkind of sit in on an episode
where we go through some of themajor, you know, I know that
there's been some some of thisdone and in the broader media
too, about like engaging indialogue with people who haven't
gotten the vaccine and what aretheir reasons.
And there's actually.
Lot of different reasons and alot of different motivations and
(10:17):
kind of going through maybe someof the big ones of that and
discussing.
Those affect different people inour communities and families,
you know, all over the board.
On the other hand, I don't wantto harp too much on some level.
I think, yeah, I think that thisvaccine hesitancy issue is maybe
a second layer to that.
There's underneath that.
There's a bigger conversationaround trust of, of the medical
(10:39):
system and like what's going onthere.
And I think there's somedefinitely, definitely some
valid critiques about the waythat, you know, medicine.
Has seen too to overreach incertain ways you know, with
certain communities anddifferent historical locations.
And I think there's a lot of afeeling of that, you know, I've,
I've read some interestingarticles that are coming.
They're sort of framing thepandemic.
(11:00):
And what I'm saying, being up tohere is the sense that you know,
we, I think we can focus onvaccine hesitancy as, as a
phenomenon in itself, but Ithink there's another phenomenon
that that's nested within, whichis how.
What do we think about therelationship between medicine,
science, society, and culture?
That's a very big question,right?
(11:21):
But I've seen some interestingarticles that, that have sort of
framed the shutdowns of the lastyear and recommendations of
public health experts as a S asa certain sort of power grab,
you know, that there's this,there's this medical industrial
machine that saw the pandemic asa chance to exert control.
Over society or to like broaden,you know, the reach of these,
(11:43):
these forces that want I don'tknow.
I don't know exactly understandwhat these hidden motivations
are.
The people are, are feeling and,and it seems to paint medicine
and you know, in is a little.
Organized and I think it reallyis.
And so I, I do agree.
I mean, I think there are waysthat medicine can be, you know,
like I like the word totalizing,are you familiar with that term
(12:05):
or that idea that, that thereare ways of thinking about kind
of medicine and science thatsort of take all elements of
human existence and put it underthis frame.
And in that way, that kind of.
You know, I think there's good.
There's, there's good.
You know, we've got to be ableto think outside of, you know,
purely kind of a utilitariancalculus of like, what's going
to give the most number of lifeyears, you know, there's other
(12:28):
goods, we've talked about this amillion times, right.
And there's ways that, that apurely kind of medical
scientific frame might flattenother elements of human
existence, you know?
Goodness relationship, thingslike that, but I'm not convinced
that this, this, this pandemicto me seems to be a different
case.
You know, a lot of people Ithink are framing this as like,
(12:48):
this is a lot more of the sameand that there's this kind of
systematic overreach.
And from the inside, that's nothow it feels, you know?
And, and it's hard for me to notat this point, start to take
some of those argumentspersonally.
It's hard for me to not start tofeel as if this, you know, this
perpetual, like, you know, oh,they, you know, big, big
(13:12):
government, big medicine.
They want us, they want tocontrol us.
They want to take away ourfreedoms.
You know, when I, and mycolleagues have been putting our
families at risk for the last 18months, you know, and, and not
to be overdramatic.
You know, particularly at thebeginning of the pandemic, when
we didn't have a clue about whatwas going on, but we knew that
this was real.
(13:33):
You know, and, and that we're,you know, and we're still
engaging in the same, samething.
And so much of this ispreventable, you know?
It's hard for me to not takesome of these, these arguments
deeply personally, you know, andsay, that's not what's going on.
You know, this is not a bigpower grab.
This is a deep misunderstandingabout what we're trying to do.
(13:55):
And, and it's a misunderstandingthat has affects on people's
lives.
Matt Boettger (14:00):
I don't know.
I mean, this is, I'm glad you'resaying this mark.
I've been feeling for you andfor doctors and nurses all
around the country.
I remember a kind of goes backto.
They said to me, one of mymemories is like maybe last
April or when we were talking, Iwas talking to a friend of mine
too, was dismissing hospitalsbeing overloaded in saying, oh
(14:21):
my gosh, I know all thesepeople, these nurses, doctors,
they're saying there's nothinggoing on in the hospitals.
This is all just conspiracytheory.
And, you know, Stephen, youbroke it down for us to explain,
this is the complexity of thesituation where like, you're
right, depending on whathospital you go in, it may be
full and it may be not, butdoesn't matter.
Does it change the fact thatthere are a lot of hospital
overrun and doctors and nursesbeing, putting their lives at
(14:44):
stake, being exhausted, can'teven care for the patients that
are non-covered related and it'stapping the system.
I feel like it's kind of this,this whole thing all over again
and hearing your voice mark.
I think I'm hoping it helps liketo realize that there are real
people, real doctors, realnurses in hospitals sacrificing
their families too.
(15:04):
And it's different, right?
I mean, last fall.
It was scary and the future wasunknown, but there was like,
there was a, there was a lack ofcontrol in some sense.
Now there's like really a largesense of advocacy and, and, and
it's not being used, which makesit all the more like, Kind of
(15:25):
goes back to Abraham and he'stalked about how, if there's one
thing we learned from thispandemic is that we will,
hopefully we'll realize we're,we're way more connected than
we'd like to give credit for.
And that anybody's decision todo something.
Not to make a grave, but needsto have consideration of who
would impacts theirs.
And I think that that's been thegreatest thing that you guys
have been doing for us.
(15:46):
And for me, particularly aboutwhen it comes to the vaccine,
it's not just my own health.
It's a, it's a bigger picturethat I had to put in
consideration.
Mark Kissler (15:53):
Right.
Yeah.
It's amazing to me how much.
And I don't know why I'msurprised at this, but I.
It helped much their anecdotal,this anecdotal evidence for this
personal experience continues tomatter for people.
So I have, you know, I care fora lot of folks in the hospital
who are like, man, if I onlyknew if I, if I had only known,
you know, I would have gottenthe vaccine.
(16:14):
And it's just surprising to mebecause it's not as if this
information is not available.
And, and similarly, you know,there's the, the conversations
around like, oh, well now, nowI'm going to take it seriously.
Or now I'm going to, you know,now, now I understand I guess
I'm not convinced that it needsto come to that point, that you
need to experience it in yourown body.
(16:35):
In your own family, you know,and, and the shame of that,
right, of course, is that whobore the brunt of so much of
this early in the pandemic orthese communities that are
hidden away that are not, youknow, not as mainstreamed or,
you know, or vulnerable in otherways.
And, and now all of a sudden.
The realization is hittingcommunities that had been
(16:56):
previously more sheltered fromthe effects of the pandemic.
And it just seems to me thatsuch a shame to not be able to
enter into the experience, youknow, the real experience of of
other people in our communitiesand to change our behavior as a
result of that, you know, and Irecognize that there's, there's
so many layers and I'm sure thatI'm oversimplifying and I'm
(17:16):
speaking out of my own, youknow, limited experiences.
And you know, not arguingnecessarily, but it's more
valid, et cetera, et cetera, butit's very hard.
It's just very hard for me to,to dismiss what I've seen my own
anecdotal evidence, what I'veseen with my own eyes for the
last 18 months.
And but I don't think thatthat's, that there's like some,
(17:37):
I have privileged access in thesense that I work in a hospital,
you know, but it's not a secret.
Matt Boettger (17:43):
I mean, I I'm, yeah.
I'm, I'm, I'm speechless.
I don't even know how, you know,where, where I've worked in the
past and the hesitancies.
And I, I can't explain it.
I don't understand it.
And it's frustrating to
Mark Kissler (17:56):
know it.
Yeah.
And I don't want to, and I thinkmaybe we can pivot a little bit,
cause I don't want to just give,give vent to my own.
But part of the reason that Iwanted to be sure to come on
today though, you know, it'sjust to speak a little bit out
of the, the, the.
The run of the experience ofbeing on the words yet again,
you know, and, and and, andreally kind of attesting testing
(18:16):
to this very significantdifference in the morale and how
it feels.
And that I think has felt kindof across the board at least in
my conversations and just sortof the general air and, and, you
know, we take care of people allthe time.
Very rightfully so.
All of us, you know, all of ourdiseases, every disease that you
(18:37):
and I, and everybody's going toget has some relationship to
choices we've made to ourindividual genetic makeup, where
we, where we grow up and thenthings we do, you know, things
we do to ourselves.
That's, you know, that that'sjust the fact of life.
So I'm not, it's not as if I,you know, I think that anybody
deserves different care, youknow, as a result of choices
(18:59):
they made, that's, that's veryfundamental that it doesn't
matter, you know?
And that, but, but at the sametime I don't know.
There's, it's just I can reallysympathize in some ways with
some of the doctors in, youknow, in fiction that I've
encountered in books, you know,over the years who have, who,
who get this certain kind ofworld weary.
(19:21):
And it's, it's very pragmatic,you know, it's, it's a very
like, and I recognize thelimitations of a suit of a super
pragmatic outlook, you know,because sometimes we need our
idealists and we need our, youknow, big idea think thinkers
and stuff.
But man, I really sympathizewith that and just feeling,
Matt Boettger (19:37):
You know, doing a slight pivot but still on the
same theme, like given what'sgoing on and what you've
experienced, how have thingschanged for you mark?
Like now living this new kind ofsurge scene at the hospital.
Clearly the idea of Lord havemercy.
Please get vaccinate.
That's clearly at the, at theforefront of your mind, are
there other things by which, youknow, you're now at, you're a
(19:59):
family man, right.
And you have kids going toschool.
And how are things been changingfor you if at all, as you see
this new surge coming on four,has your lifestyle changed a
little bit or how school and theinterest of school coming,
coming along?
How are things changing for youin that
Mark Kissler (20:15):
area?
Yeah, so you're, you're kind ofasking about how does this
affect kids going back to schooland things like that.
So we're getting our kids.
My youngest is going back.
This week he went, he went backand the big news here is that he
is no longer a napper at school.
And so he was a napperpreviously, and now he's a
worker.
This is why this sort of thing.
And which means that he cruiseson through nap time and crash is
(20:39):
hard when he gets home.
He was so tired.
So tired last night.
Yeah, I know.
It's really cute.
But We were fortunate in thesense that we were able to do a
significant amount of in-personschools.
I'm worried about how thisschool year is going to be.
I think, I think it might be alittle bit of a disaster because
of how prevalent this Deltavariant and how, how
(21:00):
transmissible it is.
And so if we shut down classesevery time somebody gets.
And I think, and this isanother, you know, complexity
because if every, if for thefamilies who are able to be
vaccinated having an index casewithin the classroom is not that
huge of a deal necessarily.
And I'm wondering if it's worthit to education and continuity
(21:22):
to shut down an entire classroomof kids.
You know what I mean?
I think there's there'sconversation.
I, I'm not the public healthexpert in the room here, so I'm
not.
Go out, but, but at the sametime, it feels a little bit from
an educational standpoint, youknow, we saw the ways that
educational disparities widenedmassively over the course of the
last year.
And so then going into anotherschool year and feeling like we
(21:45):
might be lining up for the samething again is a little bit
daunting.
And so, you know, I felt very,very fortunate both with our
school community and our abilityto kind of shuffle and move
things around.
You know, help our kids kind ofcontinue to, to do, do stuff.
But not everybody has thatflexibility.
A lot of people are working twojobs at this school.
You know, a lot of, a lot offamilies at the school, we go to
(22:06):
have a lot of just differentconstraints and shutting down
school and keeping kids home isa very different prospect for
them.
And so yet again, you know, herewe are at, at another kind of
semi semi reversible or somelike something we have control
over in terms of how do weprotect communities.
School or school-relatedexposures.
And I don't know, I don't knowwhat's going to happen, you
(22:27):
know,
Matt Boettger (22:28):
and I mean, I'm curious for you mark, and then
we can ask questions for Stephenas well, but I'm sure parents
are out there are worried insome level as well of like
taking their kids and going toschool with a Delta.
Okay.
With your experience.
I think it's good.
Just to hear from you arc oflike, how do you feel feeling
with that and taking your kids,kids
Mark Kissler (22:45):
school and, yeah, I dunno.
It's always been much on my mindthis year.
And I think even though we knowthat the, that the severe
diseases.
Young kids is not near what itis in adults.
It's always been something thathas, I just have wanted to be
extra careful about.
And I've seen news articlesabout like, you know, now
(23:06):
children's hospitals are seeingmore cases and we're seeing a
lot more kids getting it, comingdown with it.
I dunno.
And this is another instancewhere I really don't want to be
alarmist and say like, oh, it'sa crisis.
We got to stop everything.
You know, cause kids are gettingsick now.
And you know, here we are in theworld's on fire.
And so I, but at the same time,I think, you know, it makes us
(23:28):
think, you know, and think aboutways that that, that our actions
are just here, you know, whothey are affecting real people
again.
Yep.
I don't think, I, I don't know.
I'd be interested to hearStephen's opinion on, you know,
if kind of what this means interms of overall burden of
disease in, you know, in, inpediatric populations and things
(23:49):
like that on the whole, I don'tfeel panicked about Delta.
And my kids you know, I don'tfeel as if it's, it materially
changes a lot of things, youknow, I think that some common
sense masking here and there youknow, common sense kind of being
judicious about where we go andwhat we do but not being, you
know, over scrupulous about it.
Is it that's going to be thestate of our lives through much
(24:12):
of 20, 23.
If we believe what the gentlemanon the left here has written,
you know, in the past.
And so that's fine, you know,that's fine.
To me, I'm more concerned.
I think about some of thesebigger picture implications and
the ways that we might react andoverreact to increasing cases in
different pockets among kids.
Matt Boettger (24:34):
Yep.
Stephen, anything to say aboutthat?
Of like, I mean, here's thething, like I see the same
thing, increase hospitalizationwith children, this kind of
stuff.
And like our, all of our podcastepisodes, I feel like Stephen,
you can give insight to this,but it's probably just
complicated because there's somany nuances to, to different
culture.
Now we have vaccinated parentswith unvaccinated children
dragging their children toplaces probably it's summer
(24:57):
it's.
I mean, there's just.
It's it's, it's, it's aradically different Plainfield
than last August, likeradically.
So seen 48% of children, youknow, maybe getting infected of
the, of those who'd be infected,not hospitalized, not
hospitalized, but just infected.
I'd imagine it's the complexityof this mixed bag of vaccinating
and vaccines in summertime,right?
Stephen Kissler (25:17):
Or, yeah, exactly.
As far as we can tell.
That's the story.
It's, it's really interestingbecause my, many of my
colleagues are, are sort ofsplit on, you know, what we
should be doing about schools.
And to what extent we can safelyreopen them.
I, I tend to fall in line morewith The ones who sort of seem
(25:39):
to be also in line with whatmark was saying, which is that
there, there are at this point,some very common sense measures
that we can take to keep schoolspretty safe.
Certainly the risk of severeacute disease in young kids is
much lower than it is foradults.
And that is not to minimize thefact that there is, there are
absolutely risks to kidsassociated with this virus, for
(25:59):
sure.
And I think we need to, I mean,we, we need to remain mindful of
those.
It, the situation now isdifferent than it was.
Six 12 months ago a case nolonger means the same thing that
it did then because vaccinationrates are much higher.
The odds that a kid will spreaddisease to older family members
(26:20):
is lower assuming that thosepeople are vaccinated.
And, and so I think that we'rereally, you know, the playing
field is.
Shifting layered on top of thefact that, you know, we, we know
a lot more about masking.
We know a lot more aboutventilation and the importance
of that.
We, we have a much better senseof sort of how to.
Control COVID in thesesituations.
So, and, and as mark was saying,you know, closing schools is, is
(26:43):
a massive disruption.
It's you know, it, it, there,there are also public health
implications for that too.
That, that are very long lastingin the sense of more vulnerable
populations falling behind intheir education of adults who
are working multiple jobs, notbeing able to take care of their
kids.
You know, there's, they're huge,huge issue.
That we should be addressing onthe side as well.
You know, we should be thinkingabout, you know, how do we
(27:04):
provide childcare for familieswho need it who can't afford it?
You know, these things are alsopublic health issues that we
need to be thinking about.
But in the meantime, you know,we don't have those structures
in place.
And so, so I think that it's,you know, it's, it's a complex
landscape, but I do think thatyou know, shutting everything
down for a single case in aschool probably doesn't make
sense anymore.
(27:25):
If there's a major outbreak,then we can maybe start thinking
about that for sure.
But I think that, you know,schooling is so incredibly
important.
And I think that we do know howto really improve our odds at
keeping that safe that we canjust sort of move forward, even,
even in the context of Delta.
One last sort of point that Iwanted to add to that is, you
know, you're talking aboutrising hospitalizations and
young kids, and there's been alot of talk about, you know,
(27:46):
does this mean that the virus ismore severe.
For young kids It's really hardto disentangle, but the same
narrative was arising with thealpha variant B 1 1 7 earlier,
too.
And as far as I can tell, all ofthe patterns are consistent with
it just being mortar infectiousacross the board.
And so when that happens, you'regoing to expect to see more
infections across allpopulations.
(28:08):
But now with the differential invaccination, between older kids,
between older adults and youngkids who aren't vaccinated, we
expect the relative proportion.
If people end up in the hospitalwith young kids to rise and we
expect the overall number torise just because it's so much
more infectious.
So everything that I'm seeing isconsistent with just the Delta
being more infectious and notnecessarily being like targeting
(28:29):
kids, particularly.
And so I think that's allconsistent with mark was saying
too, is that it's worth it.
Okay.
Yeah, wearing masks in grocerystores and sort of being mindful
of how many, how many peoplewere seeing and how much time
we're spending in doors withother people.
The Delta is more infectious.
And I think that that's reallythe bottom line is that we're
just dealing with the virus.
That's the same thing we've beendealing with.
It is more transmissible forsure.
(28:50):
And that causes issues, but not,not time to panic about it
suddenly, you know, changing itsentire age profile in terms of
who it's infecting and who it'scausing more severe disease in,
I think
Matt Boettger (29:02):
it.
Go back to Mark's point andjust, just shows you the
complexity of all this, youknow, I, and every day I'm in
the news looking at what's,what's the highlights.
What can we talk about thisweek?
What's going on?
And I see these highlights oflike, you know, six-year-old,
seven-year-old hospitalized,right?
I'll get these like headlines.
Right.
And it's even hard for me, hardfor me to be like, oh, is that
propaganda?
(29:23):
Or is that a real, like, youknow what I mean?
Like, like, are you, how are youtrying to make it worse than it
is to get people, to preparethem, to take the, and so I, you
know, there's some level, somelevel of empathy, those people
who I also has headlines oflike, oh, you know, a 45 year
old man, 50 year old manregrets, not getting the
vaccine.
He's done.
He's in the ICU.
It's a headline.
It's powerful.
(29:44):
But I wonder sometimes like,okay, why did, why is that
there?
Is it, is it there to persuadepeople?
You know, is it an outlier?
It just makes thingscomplicated.
Right.
And it's like, it makes it, thenI feel like it's a political
issue and I'm on this side ofthe pandemic.
Like I'm on this side, likeit's, so it's just, the media
makes it really hard.
Even messes with my head.
(30:04):
This is why I have to be withyou guys every Monday or Tuesday
now, so I can get clear.
So, one thing I had a transitionto, cause I think this is
really, really.
And this is likemiscommunication
misunderstanding.
And I was going to go straightto this because it's the, the
Rogan show, right?
Where is it at here?
Joe Rogan is getting thiscompletely wrong.
As the title, put this in theshow notes, it says the
(30:25):
scientist who conducted thevaccine study.
So I want to give the floor toyou, Stephen.
Cause you just.
Saw a talk with this, this readfellow who Rogan took is like a
2004 15 vaccine study.
And basically to put it in aquick synopsis, for all those
who are listening, who hasn'tread, haven't read or listened
to Joe Rogan, he, Joe Rogan usedthis vaccine study to suggest
(30:48):
that those were getting thevaccine may be actually
harboring environments for thevaccine to create multiple
variants and make our lifeIndian worse.
That's the conclusion that JoeRogan is making from this
vaccine study, the scientisthimself says, Gerald got all
wrong.
Stephen, you want to help giveus some clarification of what
this site, the, this, this,whatever this study was.
(31:10):
And what's the real implication,how it's related or unrelated to
the COVID vaccines.
Stephen Kissler (31:16):
Yeah.
So this is this study was by acolleague named Andrew Reed.
And who was it?
Very highly respected you know,in the field, but also by me
personally I think he's donereally great work and he's very
clear I had about the findingsof his studies.
And, and I think that actuallythe, so the, I was recently in a
workshop in which he.
(31:37):
Spoke about this exact studythat Joe Rogan was talking
about.
And, and I think that was reallyexemplary of how he was able to
dive into the nuance of thestudy.
I mean, he was, he was veryclear about the fact that, so,
so let's give some background tothis study, right.
So, so first of all, this is astudy that was done in chickens.
Okay.
And so chickens get infectedwith viruses like humans.
(31:58):
They have immune systems like wedo their immune systems differ
from ours.
And but we were looking, theywere looking at a vaccine that
prevented severe disease anddeath from a virus that infects
chickens no critically, youknow, they, they ran this study.
They were looking at thisvaccine and they did find that
concurrent with vaccinations,some new variants of the virus
(32:21):
emerged.
That were both moretransmissible and, and I think
slightly more clinically,clinically severe, I don't know
if chickens have clinics, butso, but either way, so, but the
important thing about this isthere is really two things.
So first of all, the vaccine hadno effect on transport.
So if you have a vaccine thatcan reduce the severity of
(32:42):
illness and provides, you know,some testing against the
progression of illness, butprovides no protection against
transmission, then sometimes youcan get new variants that
emerged that that do some ofthese strange things.
But the most important findingabout all of this is that the.
Vaccinated chickens were stillprotected against severe disease
(33:06):
and illness.
Even from the variants, eventhough their risk increased with
the variants, that risk wasstill much lower than the risk
that the chickens that wereunvaccinated were facing.
And so in some ways that's veryconsistent with what we're
seeing with COVID is we areseeing new variants emerge.
But still the risk thatvaccinated people face from
these variants is much lowerthan the risk that unvaccinated
(33:27):
people face from the variants.
Now there comes, the issue of isgetting vaccinated, driving the
development of these variants.
There've been a lot of sort ofstudies around this and, and I
think that there's, there's someconfusion because it's.
It is, it is, you know, the,there it is true that
intermediate rates of immunityin a population under certain
(33:48):
circumstances can contribute tothe evolution of new variants
that are more transmissible.
And sometimes that are moresevere, but really what the
virus wants to do is to be ableto spread more easily it's yeah.
Necessarily trying to becomemore severe.
And I know I'm speaking as ifI'm giving this virus agency,
but that's, you know, roughlyspeaking sort of, you know, we
can talk about the evolutionarythings that lead to that.
(34:10):
But, but the key thing here too,is that If that happens with
natural infection.
I mean, it's, it's not thatbeing vaccinated is going to be
any worse than getting infectedwith COVID that both of those
things are going to select frommore infectious variants.
And so actually the best thingyou can do is, is get
vaccinated.
Even better at preventinginfection and severe disease
than a natural infection withCOVID because that actually
(34:32):
pushes us towards the edge whereit keeps the viral population
much lower and it gives, itgives it fewer chances to
evolve.
That's very clear that's that?
That's true in the chickenstudy.
That's true in human studiesthat we've, that we've conducted
in the modeling studies that,you know, It's not vaccination
per se.
That's, that's selecting forthese variants.
It's just the fact that there'sintermediate rates of immunity
in the population that canselect for the variants and the
(34:56):
best way to prevent that is toget vaccinated, frankly.
And, and that's, that's been avery consistent finding across
many different studies withdifferent approaches.
And so it's, you know, itprevents disease.
It prevents the virus frommutating and evolving in the
ways that we don't want it.
To the extent that we're able,especially with vaccines, like
the ones we have for COVID thatdo prevent infection.
(35:16):
So
Matt Boettger (35:17):
great.
No, thanks.
Thanks for bringing light tothat.
I really appreciate that.
You know, I think that might getto the end.
Any last words for you guysbefore we wrap this up and we're
good.
Well, thank you all forlistening.
Mark, thanks for coming on andjust telling us like what's
going on in your world and howyou're processing this.
And I really hope for those whoare listening to share this
particular episode, because Ithink more than anything, it's
one thing to hear it from CNN.
(35:37):
It's one thing to hear it fromFox or whatever, but to hear it
from just somebody who is juston a podcast, this is their
profession.
This is what they'reexperiencing to help people who
are unvaccinated, who arehesitant.
Don't really know what to do,just to hear a bigger picture of
the story that, you know, like,like, like mark said, that we
don't get to see it's a maybeunfortunate privilege that mark
(35:57):
has to able to see and hope toencourage other people, to take
the leap, get vaccinated andhelp reduce this so that we can
live a more, more normal life.
Hope you guys have a wonderfulweek, take care, and we'll see
you guys next Monday.
Bye-bye.
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