August 23, 2021 • 38 mins
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Things Discussed on Episode:
- Study Shows Covid-19 Can Be Detected In A Single Asymptomatic Person Through Wastewater Surveillance
- As Children's COVID Cases Surge, There's Another Virus On The Rise
- Don’t Panic, But Breakthrough Cases May Be a Bigger Problem Than You’ve Been Told Current public-health messaging may understate the scale and risk.
- Claim that Pfizer COVID-19 vaccine is 42% effective leaves out key details
- Delta Has Changed the Pandemic Risk Calculus
- Moderna vaccine gives bigger antibody boost than Pfizer in elderly, say researchers
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.
Ooh, I'm winded.
Sorry.
I came home from the basement.
My name is Matt Boettger and I'mjoined with my one good friend,
Dr.
Stephen Kissler andepidemiologist at the Harvard
school of public health.
How are you?
Fine, sir.
Stephen Kissler (00:16):
Hey, I'm doing all right, man.
How are you doing, doing
Matt Boettger (00:19):
well, apparently I need exercise cause we were
getting ready to record.
And the door to the basementupstairs is open.
And I could hear my boysscreaming and jumping wildly.
And so I wanted to solve that.
So I ran upstairs to quickcloset.
And now after five seconds ofmoving, I'm absolutely winded
and I need to take a nap
Stephen Kissler (00:38):
and we all need a nap at this point.
You know, anybody who'slistening to this, who's like
trying to decide betweenlistening to the podcasts and
taking a nap, take the napfirst.
Matt Boettger (00:45):
Hey, you know what?
We might even been a loyal tosleep right with our sweet,
sweet talk.
Right.
So if you're having a tough day,Plug us plug us in your ears and
you'll fall fast asleep and haveCOVID dreams, which I don't know
if that's a dream or anightmare.
Oh, well, thanks for joiningeverybody.
We're glad to be back.
We took a break last week andthere was a reason for that
because, well, Dr.
Mark, like usual couldn't joinus.
(01:07):
And Steve.
Was going crazy with some Deltaresearch.
And so he was burning themidnight oil.
I thought it's only good for us,us listeners to give him some
time and to do what he doesbest, which is great news for us
this week, which means we get tochat about what he has found.
Talk about this pre-pub thatmight be going out today, or as
(01:30):
he's letting me know before weget to that, let's do the basic
stuff.
That is number one.
Please leave a review.
I was going to do both of them,but I didn't have time to
snapshot.
And maybe I am, maybe I can pullit up really quickly, but we
have one from J K G U H C D F.
That's a really profound namefive stars.
I learned so much from thispodcast.
(01:51):
I look forward to every episodeand usually listen to them more
than once, because they are somuch information to absorb.
Thanks for all you do.
You're absolutely welcome.
It's my pleasure.
I learned so much every time I'mout here.
Cause I'm the one with all thequestions and I get them
answered.
I'm the lucky person in thispodcast, another one from Renee
bird and I'm going to 10th.
(02:11):
This is the best podcast outthere on the pandemic.
The three hosts are intelligentand well-spoken the discussions
are based on science and reallife experience.
I'm a registered nurse.
Therefore, what I mostespecially appreciate.
Is that the information is notdumbed down or scripted.
There's very little politicalopinion expressed.
It is clear.
The topics are well-researchedkeep up the great work gentlemen
Marine from Philly Marine.
(02:31):
Thank you so much.
There's more she says on here.
But thank you so much for makingthat review.
It's so helpful.
So if anybody else can please doit, keeps us going.
It keeps us motivated.
Not so much me, it motivates me,but Stephen and mark, the ones
that do the heavy lifting, itkeeps them lifted up and
Stephen Kissler (02:45):
strong.
Yeah, I appreciate that.
Matt Boettger (02:47):
And if you can support us in other ways,$5 as
little as$5 a month at Pennpatrion.com/podcast or one-time
donation, Venmo, PayPal, all inthe show notes.
We'd love to have your financialsupport to keep this going.
And I think that's all the goodstuff.
So let's get right into this.
Steve and I have a handful ofquestions and it's been two
weeks now and I've seen a numberof a number of headlines pop up
(03:11):
that just, I wanted to discusswith you.
But it sounds like from what wetalked about before we got on,
we might be able to get most ofthe address through your pre-pop
they were talking about, solet's go straight into this.
We didn't get you last week.
There's a reason for it sharelike what's going on, what
motivated this research and whatkind of things he has found.
Stephen Kissler (03:28):
Yeah.
So this is sort of versionnumber three of a ongoing study
that we've been working on.
So this is.
A study, that's been following acohort of individuals and
they've been tested for COVIDvery regularly as, as often as
we can, we're doing it everyday.
And this is with what we callquantitative PCR tests.
(03:52):
So when you get tested for COVIDnormally unless it's one of the
rapid tests you're gettingtested with PCR.
And one of the benefits of thatis What that gives back is that
actually, it doesn't just giveyou a positive or negative, but
it actually gives you this senseof how much virus is in your
body.
Now, when you yourself gettested, you usually only get
that positive or negativeresult, but on the backend,
there's this continuous.
(04:12):
Yeah.
That tells you basically howmuch, how much virus was in the
sample.
So since we've been followingthis cohort of people over time
and they're getting testedwhether or not they're sick,
whether or not they're showingsymptoms inevitably some of them
do get infected.
And what you get to see withthat is you see out of the
entire trajectory of the viralload in their body over time.
(04:35):
So you can see it basically whatit looks like.
Is it okay?
It sort of looks like thislittle triangle where it just
sort of goes up and then itreaches a peak and then comes
back down and then sort of,sometimes you get these sort of
low level positives that sort oflinger for a while when your
body's sort of spitting outviral fragments as it's
recovering, but by and large,it's basically actually this
really remarkably simpleincrease in decrease in viral
(04:57):
load as the virus sort of takesoff in your body.
And then as your immune systemtakes over and fights it off.
So why is that important?
One of the things that allows usto do is to look at how those,
what we call viral loadtrajectories differ between
people.
And so one of the things we'vebeen looking at is how they
differ between differentvariants.
(05:18):
So looking at the alpha variant,the Delta variance, the previous
variance and looking at how itdiffers between vaccinated and
unvaccinated people.
No.
Why does that matter?
Well, if we have anunderstanding of how these viral
trajectories look we can get asense for how long the infection
lasts, which has implicationsfor how long people need to
quarantine.
(05:39):
We can get a sense of if peoplewho are infected with different
virus, Produce more virus, whichmight mean that they're more
infectious.
We can get a sense of ifvaccinated people clear the
virus more quickly, which wouldgive us a sense of why
vaccinated people might not beas transmissible as unvaccinated
people.
So all of these things sort ofunderpin a lot of our
understanding of, of what drivesthe spread of COVID-19 and what
(06:02):
we can do to prevent it betterin a sort of finer and finer
categories of people.
So, what did we find?
Well, I mean, as I mentioned,the main axes that we've been
looking at this on are comparingalpha Delta and sort of non
variants of concern and thencomparing vaccinated and
unvaccinated.
(06:22):
So one of the things that wefound was that there's actually
not a lot of difference betweenthe variants in these viral
trajectories.
So, whether you're infected withalpha Delta or non variants,
according to the data that wehave.
You basically produce similaramounts of virus and similar
amounts of time.
And you clear it basicallyequally quickly.
(06:43):
Now that contrasts with somerecent findings, you know, there
was that study that we talkedabout a little while ago that
said, you know, people who areinfected with Delta or a
thousand times, you know, theyproduce a thousand times more
virus.
Okay.
The more we dig into that study,the more I am not totally
convinced that that's the case.
There've been a lot of otherstudies that suggest that the
peak viral loads are similar.
(07:04):
Not many have reproduced thatsort of orders of magnitude
higher viral concentrations.
Okay.
So, and this happens all thetime in science, you know, it
depends on how you analyze thedata.
It depends on where the data'scoming from.
And that's why it's reallyimportant to have a lot of
different studies looking atthis from different angles so
that we can reach some kind ofconsensus.
Yeah.
So that's what we're aiming todo with this piece is sort of
(07:24):
reach some kind of consensushere.
So, okay.
So we find that the variantshave similar viral trajectories
within how, how do we accountfor the fact that alpha it was
more infectious than that Deltais even more infectious than
that.
Yeah.
Well, one of the key things thatseems to be in play here is that
it actually probably hassomething to do biologically
(07:45):
with the virus itself and howhow strongly it binds to our
mucosal cells basically.
So what are those?
Yeah.
Yeah, exactly.
It's like, what gives you asnotty nose?
And so, basically the virusesfirst point of entry into our
bodies.
And so, so it can probably bindmore strongly to those, which
(08:05):
makes it more infectious.
And so even though you'reproducing the same amount of
virus, that means that it takesless virus to create an
infection.
And so that's one of the placesthat we get the difference in
infectiousness.
Now the other thing is that withthese viral load trajectories,
we've been measuring them fromthe notes from nasal swabs, but
(08:26):
you know, the human body is apretty complex multifaceted
place.
So just because you have similarviral trajectories in the nose
does not mean that you havesimilar vial or trajectories in
the throat or in the lungs or indifferent parts of the body.
So one of the things that mightbe happening is that you know,
you might be producing.
Equal amounts of virus in thenose, but maybe it's actually
the amount of virus in yourlungs.
(08:47):
That's most important fortransmitting.
That's just not something thatwe had access to.
So motivates a lot of otherstudies.
Now the other axis that we werelooking at this on was people
who were vaccinated versusunvaccinated and there, we
actually do see a pretty clearsignature that.
Both groups of people producesimilar amounts of virus, but
vaccinated people clear thevirus more quickly.
(09:08):
And that's consistent with acouple of other studies as well
that have come out recently,which, you know, suggests that
you're probably not asinfectious for as long.
When you get the vaccine.
Now, one of the things wecouldn't measure, but that
another study has recently comeout with us.
That also, it seems like invaccinated people, even though
you're producing the same amountof measurable viral fragments,
basically through this PCR testwhen you're vaccinated, less of
(09:31):
that virus is viable.
Less of it is able to create aninfection at another person.
So even though you're sort oflike spitting out as much viral
genetic fragments, When you'revaccinated, that means that your
immune system is doing a betterjob at sort of chopping up the
virus and making it so that itcan't go on to transmit to other
people.
Which is a good thing as well.
So both of those things areprobably contributing to reduced
(09:52):
infectiousness from vaccinatedpeople too.
So that's all good news.
That's great.
Yeah.
So that's, that's basically whatwe found.
And those are some of thefindings that we're trying to
grapple with and figure out, youknow, what do they mean now?
What do we do with that?
Matt Boettger (10:04):
Yeah.
The first thing I thought ofwhen you were talking about the
viral loads, you said thatrelatively the same amount, but
it seems as though that maybeit's, you know, they're not
quite as bad.
The first image I had was like1990s, Mike Tyson's punch out
we're out if he has any playedthat.
But like where you're, you're,you're boxing the dude.
And then when he starts to tourtwirling around in circles,
(10:25):
before he drops as if like, youknow, they're getting, just
getting beaten with the vaccineand it kind of come out, but
they're like dazed and confused.
They're all bruised.
And there's like one in randomlydon't even know what they're
doing.
So, so it's a possibility that,okay, you have the same viral
load, but it's not viable,meaning that it's just not quite
as effective.
Yeah.
Or to build in fact of thepeople.
That's.
That's awesome.
(10:45):
Yeah.
Was there anything that youfound related to?
Okay, so all this data came out.
It's like a combination seemedlike the UK study, the CDC
talking about, okay.
Same viral load, but it'sshorter period of time.
So it still benefits us.
Was there any innovation you didin the study or maybe anecdotal
along with the research aboutdemographics of people?
Does it affect any other.
(11:06):
Have a tendency to affect adifferent demographic.
Like I'm thinking of childrenlike usual because my kids are
still in vaccinated.
Is there anything related or isthis still seem to be, it's the
same kind of reality, but justdifferent kinds of ways it's
transferred.
Stephen Kissler (11:21):
Yeah.
So this is you know, I thinkthis, this is actually a good
entryway into sort of how how dowe learn about these things as
epidemiologists in the firstplace?
Yeah, so, the short answer isthat we still don't know.
It's, there's, you know, We havedefinitely seen, you know,
record hospitalizations amongkids in places where Delta is
(11:42):
surging.
But again, there are twopossible explanations for that.
One of them is that Delta, youknow, as such is just more
pathogenic in kids than previousvariants.
Or, you know, again, kids aremuch more likely to be
unvaccinated because the vaccinehasn't been approved in young
kids.
And so maybe what we're seeingis just the relative benefit of
(12:04):
vaccination in older age groups.
So when you compare what'shappening in kids to the older
age groups, it looks like kidsare being a lot more severely
infected, but really what we'reseeing in kids is what we would
be seeing across the board,which is a terrifying thought
with Delta.
If we weren't, you know, if, ifthere wasn't this reality of
vaccination And the, the, youknow, the incredibly
unsatisfying answer is that weare not sure yet.
(12:28):
Part of the difficulty is that,you know, and this is the
eternal struggle in epidemiologyis that we can really only
observe, you know, our, ourpresent moment.
And we can't really go back and,you know, say in the exact same
circumstances that alpha wasspreading however many months
ago.
Compare that to somebody who wasinfected with Delta instead.
(12:50):
What's the difference inprobability that those two
people would have you know,ended up in the hospital or, you
know, depending on their agegroup, because you know, so much
has changed.
We're, you know, whether it's,you know, differences in
restrictions, you know, anddistancing differences and
masking variation in vaccinationrates, you know, the variant
itself, whether or not schoolsare in session, all of these
things are profoundly changingthe environment in which it's
(13:12):
spreading, which makes it reallydifficult to disentangle these
things.
So, Thinking, you know, as astatistician, you know, the way
that we usually approach thesethings is that and you know,
this, this runs deeper thanstatistics too, but yeah, we, we
usually prefer the simplestexplanation, sort of the, the
explanation that, you know,nothing has changed until
(13:34):
there's evidence to.
Suggest otherwise.
So that's the idea of the nullhypothesis.
If you go back to your stats, 10 1 courses, right?
So, you know, it's kind of thisarbitrary concept, but you know,
practically speaking, what itmeans is that our null
hypothesis here is that Delta ismore infectious across the
board.
And we know for sure that that'sthe case.
And then the question is, isthat sufficient to explain
(13:57):
everything that we're seeing andit might be, it's going to take
a lot more evidence to suggestthat it's both more infectious
and.
Has different, you know,pathogenicity profiles in
different age groups.
Because so far what we're seeingis, is consistent with increased
infectiousness across the board.
There could be other things inplay, but we just don't have
the, the strength of theevidence that we would need to
(14:18):
overturn that sort of nohypothesis.
Okay.
Matt Boettger (14:22):
You know, going back to number one, it's just,
it's just still kind of a scarything for us.
Cause we just to try and figureout what, what should we do as
chill, you know, with our kids.
And it's hard when you say youdon't know because it's,
school's in session now,thankfully we're homeschooling
another year and that helps alittle bit, but we have a
wedding to go to in a couple ofweeks and we know all three of
them are unvaccinated and justin, so this kind of gets to the
(14:43):
other thing.
So my kids are unvaccinated.
Millions of kids run backstagewere obviously younger.
Like my six, five and three,your best course of defense is
to wear a mask.
Right.
That's what I can do.
Right.
And social distancing rent.
If you're, if you have to go outright and wash your hands and
all that.
So playing devil's advocatehere, in the sense of, in light
(15:04):
of your study that you guysfound like potentially that
roughly the same viral loadDelta alpha, but maybe one of
the situations is that it's the,the quality of the virus that's
actually causing the infectionand not necessarily quantity.
Now, when I'm thinking in myhead going back and reverse
engineering, why were masks?
It was because it was thequantity, the focus was on
(15:26):
quantity.
And so that a mass helps reducethat.
Cause it's, it's not perfect.
But now if it's now quality,maybe then it seems like it's a
possibility of the mass may notbe quite as still effective,
right?
No matter what, it's not like,it's like, it's, it's still
protecting you, but it seemslike Delta can chip away.
At the effectivity of the mask.
(15:46):
So a little bit, if it is thequality, if safe would just, if
it just, I mean, I'mexaggerating here, but if it
just takes one particle toinfect you, which again, that's
not what Stephen's saying.
Just, just theorizing then it,it can get in sneak in and then
bam, my kids are infected.
Right.
Is that, is that a possiblescenario that could be likely in
Delta and causing part of thesurgeon even.
(16:07):
I get it.
It's a different ball game.
This summer, people are out thepool.
People are kind of forgettingthis pandemic.
People are being a little more,so there's that whole behavioral
issue, but even us who are beingprotected with masks could we
could be even more vulnerablewith masks.
Stephen Kissler (16:21):
Yeah.
I mean, I think that that's oneof the really important things
with Delta is that it has sortof chipped away at All of the
precautions that we normallytake now that as you rightly say
it hasn't eliminated them.
Masking is still helpful becauseyou know, it's not a single
viral particle that's going toinfect you.
And so if you imagine that amask reduces the amount of virus
(16:44):
that you spread out into theworld, by some, you know, by
some percentage, you're stillreducing that percentage, you
know?
And, and so it's going to reducethe probability of infection by
that same amount.
It's just.
Delta's infectiousness hasramped up that much more to
ultimately, you know, again, therule of thumb that I usually use
is we think that Delta'sprobably about twice as
(17:05):
infectious as the original SARScov two that we've been dealing
with and probably, you know, oneand a half times more infectious
than alpha, so that I'vebasically been, you know,
dividing all of my precautionsby two now, basically that you
know, that the amount of timethat I feel comfortable
spending.
Reduced by about that much.
It's the amount of protectionthat I assume that I'm getting
(17:26):
from my mask and that.
Principally that I'm giving toother people by wearing my mask
is reduced by about that much.
If I'm infected, I'm likely toinfect about twice as many
people as I would have infected,you know, 12 months ago.
And so that's kind of the ruleof thumb and that sort of helps
me to get a sense of agencyaround this, where it's like,
you know, it's, it's not that ithelps to avoid this sense of
(17:46):
panic that like, oh gosh, youknow, we're back at square one,
nothing works.
Everything is, you know,everything is awful.
And, and it's true, you know,Delta is, is a very formidable
virus, you know, it is, it'sincredibly infectious.
And and, and we need to live inthat reality, but I think that
it's it's still true that likeall of the things that we've
been doing are still effective.
We just have to be on top ofthem a little bit more than we
(18:08):
were.
Yeah.
Matt Boettger (18:09):
It's been hard.
I know I met, I was talking to afriend slash acquaintance the
other day.
I could tell where he sat, youknow, with his, you know, COVID
and the political situation.
And it was just so hard to take.
And I'm like, it's, the evidenceseems overwhelming.
But then when you get thingslike, this is where I think it
becomes a difficult reality.
(18:30):
One of the articles I read washow the media isn't necessarily
portraying the gravity ofbreakthroughs.
The possibility, because we'retrying to constantly advance the
cause of like, no, get thevaccine, get the vaccine.
And no, you know, Stephen,you've always been great at
being in the middle of like, no,the vaccines absolutely
indispensable and there'sbreakthroughs annually, but it's
it's you got to.
(18:50):
Now you hear people aboutbreakthroughs.
And so I read articles fromfriends who are conspiracy
theorists and see even the mediagrieves that the vaccines
pointless.
I'm like, oh my gosh, this isjust like mind boggling to me
that it can take something likea headlight and clearly didn't
read it and not extrapolate itand hold these things, intention
that they're absolutelyindispensable, you know,
thankfully, you know, go, wejust, I just, before we recorded
(19:12):
Stephen, I told you that the Ft,I got a tweet, a tweet saying
FDA grants, full approval of thePfizer vaccines.
My hope.
I mean, this is a big daybecause I know I've had a
handful of people in my smallnetworks.
Just say, look, I'm not takingthe vaccine.
Not because they're likeconspiracy theorist, but they
just want to wait until FDAapproval.
That's their check mark.
(19:32):
And they're okay.
So my hope is that this is goingto unlock a wave of people to
start taking the vaccine becausewe've realized, and I'm going to
have another question to you injust a second, because this is
going to be a flip side of whatI'm just about ready to say,
because we're seeing that themajority.
Of infections are in places bywhich vaccine rates are just
incredibly low, right?
Missouri, Arkansas, Florida,Mississippi all these, all these
(19:57):
places, you know, I know Oregonsuffering tremendously right
now, but a lot of those pocketsare in low vaccinated places.
So all the more to help peoplesee the truth to get vaccinated.
But here's the outlier.
Maybe we need to circle back tothis about Israel, right?
Israel is just like, they arethe poster child of vaccine.
And from what I'm gathering,they're suffering a surge.
(20:19):
And you know, and maybe you canhelp explain it my guess, maybe
they were early adopters to thevaccine.
Could it be waiting a littlebit?
And so it's among your guys'discussions.
How do you guys make sense ofthat when we're here today and
Hey, you know, Arkansas, thereason why you're not you're
you're, you're, you're you're sohigh is because you're, you
know, a lot of it's becauseyou're in vaccinated.
Stephen Kissler (20:39):
Yeah.
I mean, as, as you know, I've,I've been really trying to stay
away from it.
Drawing too much of a causallink between the young, this
particular geographic locationis getting hit hard at this
particular time because of X, Y,or Z.
Because I think that that reallyLOLs us into this false sense of
security, you know, where I'msitting up here.
(21:01):
Boston, Massachusetts.
And I think, you know, there's,you can get caught in this sense
of like, oh, well, what'shappening there because
vaccination rates are low and itcould never happen here.
And we have fallen into thattrap way too many times, this
pandemic for that to be, youknow, it's just, it's illogical,
you know?
And like, like you said, youknow, we have, we have cases
surging in Israel.
Thankfully, the vaccine islargely providing a lot of
(21:23):
protection against severedisease and death.
You know, that, that remains thetruth.
And that's the key.
There is evidence, you know,it's as you said, the early
adopters, and so probably someof that protection is waning.
Part of the difficulty is that,you know, Since, since the
vaccines were prioritized in thehighest risk groups, those are
also the people who have thelowest levels of immunity at
(21:44):
this point from the waiting.
So they're the most likely ifthe vaccine protection has waned
to end up in the hospital.
And so we're seeing anadditional boost from that and
why some of these breakthroughinfections are probably
additionally severe becauseamong vaccinated.
The people with the lowestlevels of immunity are likely to
be the ones who were originallyat most risk of severe disease.
(22:06):
So we're sort of in that weirdsituation right now as well.
But again, I think the criticalthing is that like, you know, we
are going to continue to seesurges potentially major surges
in places that have highvaccination rates.
And nobody, you know, nobody canconsider themselves, you know,
totally immune or totally, youknow, safe from like this.
(22:28):
This pandemic is not, it's notover.
I, you know, it's like, and itwould be, I know, right.
And that, you know, it kills meto say that, right.
Like I, I want it to be done sobadly.
And that's, you know, that'swhat we've been busting our
tails to try to do.
But the reality is, is like itwill continue to spread.
And I think what Israel, thedata from Israel show is that,
(22:49):
you know, even with highvaccination rates, we're going
to continue to see surges incases.
And we're going to have tofigure out how to deal with it.
Again, you know, surgeries andcases no longer mean exactly
what they did before because ofthe protection from the vaccine
against severe disease anddeath.
So, so we're going to have tostart to get used to seeing
surges and cases and maybereduce our level of alarm at
that because they won'ttranslate into the severe
(23:11):
outcomes at the same rate asthey were before.
But yeah, I mean, I think that,you know, part of the reason
we're seeing an early surge inthe Southeastern us is because,
you know, lower vaccinationrates generally, you know, but
it's also a lot warmer there.
So people are spending a lotmore time indoors.
That's going to change, youknow, in a lot of the rest of
the country, our indoor seasonis coming up here in the fall
and in the winter.
So I totally expected anothersurge up here, you know?
(23:33):
And so there's this real dangerin sort of this Smugness that we
can get that like, oh yeah.
Well, you know, they're, they'resuffering because they, you
know, whatever don't have, youknow, aren't getting vaccinated
and it's their fault.
And it's like, no, no, this isnot that we've been, we've been
down this road too many timesbefore.
And it's, it's counterproductiveand it it'll catch us.
Flat-footed and we're, it's justnot good.
Matt Boettger (23:56):
Yeah, and I, and now I want to get into it before
I get into it.
I want to talk about the waning,right?
This idea of waning and the ideaof this, the rise of talking
about boosters, right.
I've seen a lot of headlinespromoting boosters.
I've also seen a lot ofheadlines and epidemiologists
have a second opinion.
Thankfully, I've got you onhere, so we can talk about
whether you think before we dothat, just to clarify to
(24:17):
everyone.
Cause I see this often over andover again.
We know that the vaccine isn'tas effective as it was at the
very beginning, when it comes tothe Delta variant and people
throw around that 43% as if it'slike some dramatic, terrible
number in that you have like a40, you know, you have like a
57% chance.
Having something bad happened toyou, but just I qualification
(24:39):
that 43% is only aboutinfection, right?
It's just the infection, right?
The still hospitalizationsthey're in the upper, upper
seventies, eighties and onward.
Right.
That it's pretty high.
So it's, it's still very highpercentage that protects us from
that, which we're actuallytrying to stay away from.
So I wanted to make that clause.
I want to go now straight intothis idea of waning, right?
(25:01):
We're seeing, I'm hearing thisidea that about it's about the
eight month mark.
I'm not sure people are gettingthis and maybe I need to be
corrected.
People are saying, oh, it lookslike about eight months.
Now.
It depends on what you'retalking about.
Pfizer, Madonna.
I have no idea that there mightbe a sense of winning beginning
to surface.
And so there is this desire forbooster.
Of course.
Now I'm thinking about mymother-in-law and does she,
(25:22):
should she get one in October,in November?
That's one thing, pragmaticallyspeaking.
I saw, I didn't show it to you,Stephen, and maybe you did see
it it's like futurism website orwhatever.
I don't know what it was, soprobably probably not credible,
but it should have mapped.
And I don't know where theyasked information from, but they
showed like first and secondshot.
And then, you know, how you getimmunity pretty high in that
(25:42):
second shot after a while.
And then it begins to tail.
Like we would assume, I don'tknow how many months or years,
but then they had this idea.
That I don't know where thisevidence came from, but the
third one, the booster justskyrocketed way above, even the
second shot of immunity.
That there's a sense by which itreally does a good job at third
one.
So that made me all the more,want to give it my
mother-in-law.
(26:03):
But again, where do you guysstand in?
In light of, Hey, Israel mightbe this, but boosts her.
Should we be offering these?
Should we be starting to getthem?
What do you guys consider?
Stephen Kissler (26:14):
Over there.
Yeah.
So yeah, I mean, it's it's stillunclear.
It's, it's becoming.
More and more, yeah, I would saythat we're sort of converging on
the idea that that a third dosewould would be helpful that it
does sort of skyrocket yourimmunity and gives you longer
lasting in unity overall.
(26:34):
And this, you know, this, thismakes sense.
Like we kind of, there are a lotof vaccines that we get 2, 3, 4
doses of, you know, when we'reyoung kids and it, it requires.
Those repeated, repeatedexposures for our body to
finally amount a permanentresponse to to whatever it is.
So, so it really, you know,we're talking about boosters,
(26:56):
but another way that you canthink about it is just as you
know, we're trying to sort offine tune what the standard
vaccination course should be forSARS cov.
Now one of the places where someof this data is coming from is
that a number of differentcountries have varied the amount
of time that they place betweentheir first and their second
(27:17):
doses.
So for example, in the UK, whenthe alpha variant was really
starting to take off, theyreally prioritize getting people
their first dose.
And so for many people, ratherthan having, you know, a three
or four week window betweentheir first and second dose,
many people have closer to a 12week window.
And some of the evidence comingback as suggesting that actually
that longer window is providingmore durable immunity to those
(27:39):
people.
That that immunity seems to belonger lasting.
So that suggests that actually,maybe we should wait a little
bit longer between the doses andmaybe even give a third dose,
you know, 12 weeks 36 weeksafter, you know, our last dose.
And that, that time sort ofallows our immune system to.
Go through all the processesthat it needs to go through to
Mount a really good memory tothis virus.
(28:00):
And it's tricky because this,this various from pathogen to
pathogen, you know, the way thatour immune system interacts with
different pathogens is sodifferent.
Like, it just it's so specificto each one.
So we kind of have to figurethis out on the fly.
And that's what we're doingright now.
Now the other big issue, whilethere are two big issues, you
know, so we're talking about.
(28:21):
Third dose second dose.
You know, what about all thepeople who have gotten Johnson
and Johnson and, you know,different, you know, vaccines,
you know, what do we do there?
And I think that's another bigquestion, you know, do you boost
with an MRI and a vaccine?
Do you, you know, what how doesthis work?
And I think that that's a reallyimportant question, too.
And for anyone who's gotten theJ and J vaccine, you know, We're
working on this hard too.
(28:42):
So I know that there's like alot of conversation about, you
know, Madonna and Pfizer and doyou get a third dose?
And like, it's like, you know, alot of people are feeling left
out in this cause like, youknow, I didn't get you either,
you know, and I've only gottenone dose of anything, you know,
what do I do?
For as far as I know, you know,the guidance isn't totally clear
yet, but but we're working onit.
So hang tight
Matt Boettger (29:01):
comes to dosages and the booster, you know, my,
you know, I've been hearing thatmaterial.
Excuse me, he looks slightlymore effective with the Delta
variant and it's kind of it's,you know, now you really get a
taste of this Stephen where backin April and may was all about
Pfizer at the Atlantic.
Of course.
Atlantic.
I'm just in love with eitherjust their titles of themselves.
(29:21):
They must do very good job atgetting really good titles cause
their titles suck me in everytime.
But you know, talking about howthe Pfizer gang is over in this
idea, that back in the spring,there was the Pfizer gang.
Like the Pfizer was the premierstamp of approval.
Right, right.
If you're a Pfizer, like you,you are good.
And now we're seeing that Pfizerisn't quite as effective with a
Delta compared to now theModerna.
So just goes to show.
(29:43):
It really doesn't matter whatyou get because you can't
predict the future future.
And it could be like five monthsfrom now it's AstraZeneca or J
and J that's actually knockingit right off the slate.
So you just don't know sendingsomething I'm like, okay, well,
all I can go is with mybaseline.
What I know.
Was my mother-in-law McKay.
You know, I want to kind offight for her to get to cross
(30:04):
over the barrier.
She had Pfizer and you know, getthe, get a booster that's
Madonna, right.
That kinda stuff to help, helpget, get it, get her along the
way.
So these are all theconsiderations I'm working on
and seeing, you know, my kidsand not being unvaccinated in a
wedding coming up in a few weeksand seeing the increase of yeah,
COVID sure.
But we're talking off the recordthat RSV.
It's kind of raising its uglyhead.
(30:25):
Right.
And, and, and it it's, it'scausing a threat to young young
kids who, I don't know how muchI would imagine it has to be.
Super rare, like getting thecombo kick in the butt, where
they get COVID and RSV andthat's causing some problems
when you have to.
So, you know, really, I guess myPSA and I'm just here.
I am just a layman.
I know nothing about this, butI'm just taking my advice from
(30:48):
things I've read and interpretedmy interpreter interpolation
from mark and Stephen.
And, and that is like reallyfocused on, you know, this is
another winter to really focuson the boys getting a flu
vaccine.
Yeah.
You know, and then when, when,and if the vaccine comes
available for for young ins toreally, to, to go for that,
(31:08):
because the last thing I wantis, you know, we talked about
this last year of having thepotential combo of getting the
flu and COVID at the same time,I think that can, that
potentially can cause a wreck.
So, so just, just that considerthat as where we get in the
fall, all those kinds of things.
Yeah.
Any last words for you?
Anything to,
Stephen Kissler (31:26):
oh yeah.
Just, you know, circling back tothe third dose thing.
I mean, I know one thing wehaven't really touched on, at
least on this episode is likethe issue with a vaccine equity
too, around the world.
And I think that that's a hugeissue we have to play into too.
You know, we've been talkingmainly about the epidemiology of
it and probably ideally, youknow, everyone will have
multiple doses of a highlyeffective, safe vaccine, but.
(31:47):
Yeah, there are so many placesaround the world where, you
know, vaccination rates areunder 1%, you know?
And so then the question islike, does it make sense to be
giving relatively healthy 30year olds in the United States,
a third dose of Pfizer Medina.
When they're 80 year olds, youknow, all over the rest of the
world who haven't gottenanything yet.
And I think that that's a reallycritically important question
and something that we have toweigh.
(32:07):
So that was just, just a littleaddendum.
I wanted to put into what we'vebeen talking about to make sure
it didn't get lost.
Matt Boettger (32:13):
I'm glad you said that one thing I'm going to end
on.
Totally random.
We talked about this.
I think it's fascinating.
Last fall, see, university ofColorado where I worked.
I worked.
At the Colorado, but I worked onthat campus and they did I don't
know if all universities didthis or not.
I, I feel like they one of thefirst, but they did the
wastewater testing.
Right.
(32:33):
And so all the dorms and theycould, they could really easily
determine whether there was anoutbreak in the dorm and lock it
down.
It seemed very effective.
I heard it's like costaffordable, that kind of stuff.
And so there was an article thatjust came out, just proving the
effectiveness down to the pointof even houses, individual
housing units could determine.
And that's a powerful realityand you know, I'm, I'm so gung
ho with technology, Stephen, Idon't really sometimes think of
(32:54):
the ethics behind it.
I'm like yes, technology suite,but you were talking about how
this could be a great new as anepidemiologist.
This sounds great, but thiscould be a slippery slope and
cause some concerns for people,you know, and it's a privacy.
Stephen Kissler (33:07):
Totally.
Yeah.
So I think that, I mean, what Iwant to start with is just like
the possibility of wastewatersurveillance for COVID and for
other pathogens is you know, thepotential is huge.
It's great because it's it, itis the most passive of passive
surveillance that you could do,you know?
And.
And so, you know, it doesn'trequire anything of the people
who might be infected orinfectious.
(33:27):
You're literally just monitoringsewage for traces of the virus.
And you can get pretty good,pretty good pictures of if an
outbreak is happening in a givenlocation, your rights, you know,
see you as a really, in manyways, a pioneer in this
technology, you know, we're ableto detect outbreaks in dorms
before anybody came down withsymptoms and Yeah, that's great.
(33:48):
That really revolutionizes ourability to manage infectious
diseases like this.
I think we're going to see a lotmore of these kinds of things as
we move on forward.
Now, one could envision a futurein which you have a little, you
know, a little virus monitorthat's sitting, you know, at the
sewage outflow of everyhousehold in the United States.
And so then it gives, you know,a little ping to whoever's in
the house and you know, so itwas like somebody, you know,
(34:09):
might be infected and, you know,we recommend, you know, here are
the different resources you haveand the different precautions
you might want to take.
And on the one hand, that's agreat, you know, that, that
gives you a lot of power and youknow, you can, you can figure
out what to do with thatinformation.
But I mean, this gets back tothe age old question in public
health is like, how, how do youdo surveillance?
Well, how do you do itanonymously?
How do you do it in a way thatdoesn't infringe on people's
(34:31):
privacy and freedom and in a waythat I, you know, ideally can't
get easily corrupted, you know,like, Yeah, I think that that,
that could end up being also aslippery slope.
If you have information on thelevel of individual households
or even individual people, youknow that in times of crisis,
that might make a lot of sense.
You know, sometimes we needthose kinds of responses, but as
a constant sort of surveillance,you know, could be great.
(34:54):
But I could also see it being alittle bit dangerous in the
sense that it, my eight.
Provided, you know, depending onwho has access to that
information, it could lead toall sorts of stigma or you know,
restriction of basic rights.
And and you know, I, I, I'malways trying to look ahead to,
you know, we have No, this is,this is a respiratory virus that
we've been dealing with for awhile.
(35:15):
And so now, you know, it's like,okay, COVID, we've been, we're
used to living in a world whereCOVID is spreading.
And so it's kind of hard toimagine, you know, this really
being twisted, but you can alsoimagine like a year ago,
especially when tensions werereally high around.
That could have led to some realbacklash, you know, imagine your
neighbors find out you haveCOVID or something.
And yeah, and I imagine thatit's, you know, different kind
(35:36):
of disease that spreads in adifferent route, you know, all
of the stigma around HIV oraround, you know, whatever, like
what if it was something else?
What if what if it was a diseasethat, you know, like HIV was
highly correlated with?
Especially when it was firstspreading with sexual
orientation and you weren't outto people, you know, who you
were in your neighborhood, or,you know, like all of these
(35:56):
things, the questions and thecomplications layer upon one
another in a way that sort ofblows my mind.
So the technology is hugely,hugely promising.
And I think we, as with any newtechnology, we have to be very,
very mindful about how we use itin a way that is maximally.
Effective and has the minimumchance of really backfiring.
Matt Boettger (36:19):
Yeah.
Well, you just summed that upagain, once again, it's
complicated, right?
Because we're dealing with humanbeings and it's, it's the, you
know, efficiency is, is, is oneparticular thread.
But it is definitely.
Not the only thread.
So thanks for sharing yourthoughts on that.
I appreciate it.
I think we'll end there.
Those of you who are listening,thank you so much for joining us
(36:41):
this week.
And again, we strive to do thisevery single week whenever we
can.
And if we don't, there's usuallya big reason because we want to
be available as much aspossible, particularly during
this time of Delta and who knowswhat will be next in the next 6,
8, 9, 10 months buy one piece ofsolace and I'll send us one more
real your way, Stephen, beforewe end.
(37:02):
Response.
I heard that with thisparticular kind of virus, like
all viruses, it can be likethis, a lot of mutations, but
eventually it stabilizes downthe road and it's like, this
isn't expected to be like thisforever.
That at some point in time, it'sgoing to mature and find a more
routine method of, of mutation.
Is that something that, that isa hopeful.
(37:24):
Anecdote to
Stephen Kissler (37:24):
and on.
Yes, I think so.
And I, I think, I think that'slikely, eventually it will sort
of explore the space ofdifferent mutations that it can
have and it'll find it kind ofprobably reach its happy
equilibrium.
That's that's what I expect.
And so yeah, we got some morework to do yet before that, but
but I think there is hope.
Okay.
Matt Boettger (37:42):
Great.
Thank you.
We'll end on that.
It's a nice piece of hope.
Thank you all for tuning in.
If you wanna support uspatrion.com/pandemic podcasts,
one-time gift PayPal, Venmo allin the show notes.
Please give us a review.
You can email me,matt@livingthereal.com.
Send us some good wishes.
What's going on in your neck ofthe woods, Bruce.
I'm thinking of you in Australiaright now.
Just kind of hearing a lot ofstuff going on right now.
So I'd love to hear what's goingon in your neck of the woods.
(38:04):
Have a wonderful week.
We'll see you all next week.
Take care end.
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible in the face
of these crises.
Ooh, I'm winded.
Sorry.
I came home from the basement.
My name is Matt Boettger and I'mjoined with my one good friend,
Dr.
Stephen Kissler andepidemiologist at the Harvard
school of public health.
How are you?
Fine, sir.
Stephen Kissler (00:16):
Hey, I'm doing all right, man.
How are you doing, doing
Matt Boettger (00:19):
well, apparently I need exercise cause we were
getting ready to record.
And the door to the basementupstairs is open.
And I could hear my boysscreaming and jumping wildly.
And so I wanted to solve that.
So I ran upstairs to quickcloset.
And now after five seconds ofmoving, I'm absolutely winded
and I need to take a nap
Stephen Kissler (00:38):
and we all need a nap at this point.
You know, anybody who'slistening to this, who's like
trying to decide betweenlistening to the podcasts and
taking a nap, take the napfirst.
Matt Boettger (00:45):
Hey, you know what?
We might even been a loyal tosleep right with our sweet,
sweet talk.
Right.
So if you're having a tough day,Plug us plug us in your ears and
you'll fall fast asleep and haveCOVID dreams, which I don't know
if that's a dream or anightmare.
Oh, well, thanks for joiningeverybody.
We're glad to be back.
We took a break last week andthere was a reason for that
because, well, Dr.
Mark, like usual couldn't joinus.
(01:07):
And Steve.
Was going crazy with some Deltaresearch.
And so he was burning themidnight oil.
I thought it's only good for us,us listeners to give him some
time and to do what he doesbest, which is great news for us
this week, which means we get tochat about what he has found.
Talk about this pre-pub thatmight be going out today, or as
(01:30):
he's letting me know before weget to that, let's do the basic
stuff.
That is number one.
Please leave a review.
I was going to do both of them,but I didn't have time to
snapshot.
And maybe I am, maybe I can pullit up really quickly, but we
have one from J K G U H C D F.
That's a really profound namefive stars.
I learned so much from thispodcast.
(01:51):
I look forward to every episodeand usually listen to them more
than once, because they are somuch information to absorb.
Thanks for all you do.
You're absolutely welcome.
It's my pleasure.
I learned so much every time I'mout here.
Cause I'm the one with all thequestions and I get them
answered.
I'm the lucky person in thispodcast, another one from Renee
bird and I'm going to 10th.
(02:11):
This is the best podcast outthere on the pandemic.
The three hosts are intelligentand well-spoken the discussions
are based on science and reallife experience.
I'm a registered nurse.
Therefore, what I mostespecially appreciate.
Is that the information is notdumbed down or scripted.
There's very little politicalopinion expressed.
It is clear.
The topics are well-researchedkeep up the great work gentlemen
Marine from Philly Marine.
(02:31):
Thank you so much.
There's more she says on here.
But thank you so much for makingthat review.
It's so helpful.
So if anybody else can please doit, keeps us going.
It keeps us motivated.
Not so much me, it motivates me,but Stephen and mark, the ones
that do the heavy lifting, itkeeps them lifted up and
Stephen Kissler (02:45):
strong.
Yeah, I appreciate that.
Matt Boettger (02:47):
And if you can support us in other ways,$5 as
little as$5 a month at Pennpatrion.com/podcast or one-time
donation, Venmo, PayPal, all inthe show notes.
We'd love to have your financialsupport to keep this going.
And I think that's all the goodstuff.
So let's get right into this.
Steve and I have a handful ofquestions and it's been two
weeks now and I've seen a numberof a number of headlines pop up
(03:11):
that just, I wanted to discusswith you.
But it sounds like from what wetalked about before we got on,
we might be able to get most ofthe address through your pre-pop
they were talking about, solet's go straight into this.
We didn't get you last week.
There's a reason for it sharelike what's going on, what
motivated this research and whatkind of things he has found.
Stephen Kissler (03:28):
Yeah.
So this is sort of versionnumber three of a ongoing study
that we've been working on.
So this is.
A study, that's been following acohort of individuals and
they've been tested for COVIDvery regularly as, as often as
we can, we're doing it everyday.
And this is with what we callquantitative PCR tests.
(03:52):
So when you get tested for COVIDnormally unless it's one of the
rapid tests you're gettingtested with PCR.
And one of the benefits of thatis What that gives back is that
actually, it doesn't just giveyou a positive or negative, but
it actually gives you this senseof how much virus is in your
body.
Now, when you yourself gettested, you usually only get
that positive or negativeresult, but on the backend,
there's this continuous.
(04:12):
Yeah.
That tells you basically howmuch, how much virus was in the
sample.
So since we've been followingthis cohort of people over time
and they're getting testedwhether or not they're sick,
whether or not they're showingsymptoms inevitably some of them
do get infected.
And what you get to see withthat is you see out of the
entire trajectory of the viralload in their body over time.
(04:35):
So you can see it basically whatit looks like.
Is it okay?
It sort of looks like thislittle triangle where it just
sort of goes up and then itreaches a peak and then comes
back down and then sort of,sometimes you get these sort of
low level positives that sort oflinger for a while when your
body's sort of spitting outviral fragments as it's
recovering, but by and large,it's basically actually this
really remarkably simpleincrease in decrease in viral
(04:57):
load as the virus sort of takesoff in your body.
And then as your immune systemtakes over and fights it off.
So why is that important?
One of the things that allows usto do is to look at how those,
what we call viral loadtrajectories differ between
people.
And so one of the things we'vebeen looking at is how they
differ between differentvariants.
(05:18):
So looking at the alpha variant,the Delta variance, the previous
variance and looking at how itdiffers between vaccinated and
unvaccinated people.
No.
Why does that matter?
Well, if we have anunderstanding of how these viral
trajectories look we can get asense for how long the infection
lasts, which has implicationsfor how long people need to
quarantine.
(05:39):
We can get a sense of if peoplewho are infected with different
virus, Produce more virus, whichmight mean that they're more
infectious.
We can get a sense of ifvaccinated people clear the
virus more quickly, which wouldgive us a sense of why
vaccinated people might not beas transmissible as unvaccinated
people.
So all of these things sort ofunderpin a lot of our
understanding of, of what drivesthe spread of COVID-19 and what
(06:02):
we can do to prevent it betterin a sort of finer and finer
categories of people.
So, what did we find?
Well, I mean, as I mentioned,the main axes that we've been
looking at this on are comparingalpha Delta and sort of non
variants of concern and thencomparing vaccinated and
unvaccinated.
(06:22):
So one of the things that wefound was that there's actually
not a lot of difference betweenthe variants in these viral
trajectories.
So, whether you're infected withalpha Delta or non variants,
according to the data that wehave.
You basically produce similaramounts of virus and similar
amounts of time.
And you clear it basicallyequally quickly.
(06:43):
Now that contrasts with somerecent findings, you know, there
was that study that we talkedabout a little while ago that
said, you know, people who areinfected with Delta or a
thousand times, you know, theyproduce a thousand times more
virus.
Okay.
The more we dig into that study,the more I am not totally
convinced that that's the case.
There've been a lot of otherstudies that suggest that the
peak viral loads are similar.
(07:04):
Not many have reproduced thatsort of orders of magnitude
higher viral concentrations.
Okay.
So, and this happens all thetime in science, you know, it
depends on how you analyze thedata.
It depends on where the data'scoming from.
And that's why it's reallyimportant to have a lot of
different studies looking atthis from different angles so
that we can reach some kind ofconsensus.
Yeah.
So that's what we're aiming todo with this piece is sort of
(07:24):
reach some kind of consensushere.
So, okay.
So we find that the variantshave similar viral trajectories
within how, how do we accountfor the fact that alpha it was
more infectious than that Deltais even more infectious than
that.
Yeah.
Well, one of the key things thatseems to be in play here is that
it actually probably hassomething to do biologically
(07:45):
with the virus itself and howhow strongly it binds to our
mucosal cells basically.
So what are those?
Yeah.
Yeah, exactly.
It's like, what gives you asnotty nose?
And so, basically the virusesfirst point of entry into our
bodies.
And so, so it can probably bindmore strongly to those, which
(08:05):
makes it more infectious.
And so even though you'reproducing the same amount of
virus, that means that it takesless virus to create an
infection.
And so that's one of the placesthat we get the difference in
infectiousness.
Now the other thing is that withthese viral load trajectories,
we've been measuring them fromthe notes from nasal swabs, but
(08:26):
you know, the human body is apretty complex multifaceted
place.
So just because you have similarviral trajectories in the nose
does not mean that you havesimilar vial or trajectories in
the throat or in the lungs or indifferent parts of the body.
So one of the things that mightbe happening is that you know,
you might be producing.
Equal amounts of virus in thenose, but maybe it's actually
the amount of virus in yourlungs.
(08:47):
That's most important fortransmitting.
That's just not something thatwe had access to.
So motivates a lot of otherstudies.
Now the other axis that we werelooking at this on was people
who were vaccinated versusunvaccinated and there, we
actually do see a pretty clearsignature that.
Both groups of people producesimilar amounts of virus, but
vaccinated people clear thevirus more quickly.
(09:08):
And that's consistent with acouple of other studies as well
that have come out recently,which, you know, suggests that
you're probably not asinfectious for as long.
When you get the vaccine.
Now, one of the things wecouldn't measure, but that
another study has recently comeout with us.
That also, it seems like invaccinated people, even though
you're producing the same amountof measurable viral fragments,
basically through this PCR testwhen you're vaccinated, less of
(09:31):
that virus is viable.
Less of it is able to create aninfection at another person.
So even though you're sort oflike spitting out as much viral
genetic fragments, When you'revaccinated, that means that your
immune system is doing a betterjob at sort of chopping up the
virus and making it so that itcan't go on to transmit to other
people.
Which is a good thing as well.
So both of those things areprobably contributing to reduced
(09:52):
infectiousness from vaccinatedpeople too.
So that's all good news.
That's great.
Yeah.
So that's, that's basically whatwe found.
And those are some of thefindings that we're trying to
grapple with and figure out, youknow, what do they mean now?
What do we do with that?
Matt Boettger (10:04):
Yeah.
The first thing I thought ofwhen you were talking about the
viral loads, you said thatrelatively the same amount, but
it seems as though that maybeit's, you know, they're not
quite as bad.
The first image I had was like1990s, Mike Tyson's punch out
we're out if he has any playedthat.
But like where you're, you're,you're boxing the dude.
And then when he starts to tourtwirling around in circles,
(10:25):
before he drops as if like, youknow, they're getting, just
getting beaten with the vaccineand it kind of come out, but
they're like dazed and confused.
They're all bruised.
And there's like one in randomlydon't even know what they're
doing.
So, so it's a possibility that,okay, you have the same viral
load, but it's not viable,meaning that it's just not quite
as effective.
Yeah.
Or to build in fact of thepeople.
That's.
That's awesome.
(10:45):
Yeah.
Was there anything that youfound related to?
Okay, so all this data came out.
It's like a combination seemedlike the UK study, the CDC
talking about, okay.
Same viral load, but it'sshorter period of time.
So it still benefits us.
Was there any innovation you didin the study or maybe anecdotal
along with the research aboutdemographics of people?
Does it affect any other.
(11:06):
Have a tendency to affect adifferent demographic.
Like I'm thinking of childrenlike usual because my kids are
still in vaccinated.
Is there anything related or isthis still seem to be, it's the
same kind of reality, but justdifferent kinds of ways it's
transferred.
Stephen Kissler (11:21):
Yeah.
So this is you know, I thinkthis, this is actually a good
entryway into sort of how how dowe learn about these things as
epidemiologists in the firstplace?
Yeah, so, the short answer isthat we still don't know.
It's, there's, you know, We havedefinitely seen, you know,
record hospitalizations amongkids in places where Delta is
(11:42):
surging.
But again, there are twopossible explanations for that.
One of them is that Delta, youknow, as such is just more
pathogenic in kids than previousvariants.
Or, you know, again, kids aremuch more likely to be
unvaccinated because the vaccinehasn't been approved in young
kids.
And so maybe what we're seeingis just the relative benefit of
(12:04):
vaccination in older age groups.
So when you compare what'shappening in kids to the older
age groups, it looks like kidsare being a lot more severely
infected, but really what we'reseeing in kids is what we would
be seeing across the board,which is a terrifying thought
with Delta.
If we weren't, you know, if, ifthere wasn't this reality of
vaccination And the, the, youknow, the incredibly
unsatisfying answer is that weare not sure yet.
(12:28):
Part of the difficulty is that,you know, and this is the
eternal struggle in epidemiologyis that we can really only
observe, you know, our, ourpresent moment.
And we can't really go back and,you know, say in the exact same
circumstances that alpha wasspreading however many months
ago.
Compare that to somebody who wasinfected with Delta instead.
(12:50):
What's the difference inprobability that those two
people would have you know,ended up in the hospital or, you
know, depending on their agegroup, because you know, so much
has changed.
We're, you know, whether it's,you know, differences in
restrictions, you know, anddistancing differences and
masking variation in vaccinationrates, you know, the variant
itself, whether or not schoolsare in session, all of these
things are profoundly changingthe environment in which it's
(13:12):
spreading, which makes it reallydifficult to disentangle these
things.
So, Thinking, you know, as astatistician, you know, the way
that we usually approach thesethings is that and you know,
this, this runs deeper thanstatistics too, but yeah, we, we
usually prefer the simplestexplanation, sort of the, the
explanation that, you know,nothing has changed until
(13:34):
there's evidence to.
Suggest otherwise.
So that's the idea of the nullhypothesis.
If you go back to your stats, 10 1 courses, right?
So, you know, it's kind of thisarbitrary concept, but you know,
practically speaking, what itmeans is that our null
hypothesis here is that Delta ismore infectious across the
board.
And we know for sure that that'sthe case.
And then the question is, isthat sufficient to explain
(13:57):
everything that we're seeing andit might be, it's going to take
a lot more evidence to suggestthat it's both more infectious
and.
Has different, you know,pathogenicity profiles in
different age groups.
Because so far what we're seeingis, is consistent with increased
infectiousness across the board.
There could be other things inplay, but we just don't have
the, the strength of theevidence that we would need to
(14:18):
overturn that sort of nohypothesis.
Okay.
Matt Boettger (14:22):
You know, going back to number one, it's just,
it's just still kind of a scarything for us.
Cause we just to try and figureout what, what should we do as
chill, you know, with our kids.
And it's hard when you say youdon't know because it's,
school's in session now,thankfully we're homeschooling
another year and that helps alittle bit, but we have a
wedding to go to in a couple ofweeks and we know all three of
them are unvaccinated and justin, so this kind of gets to the
(14:43):
other thing.
So my kids are unvaccinated.
Millions of kids run backstagewere obviously younger.
Like my six, five and three,your best course of defense is
to wear a mask.
Right.
That's what I can do.
Right.
And social distancing rent.
If you're, if you have to go outright and wash your hands and
all that.
So playing devil's advocatehere, in the sense of, in light
(15:04):
of your study that you guysfound like potentially that
roughly the same viral loadDelta alpha, but maybe one of
the situations is that it's the,the quality of the virus that's
actually causing the infectionand not necessarily quantity.
Now, when I'm thinking in myhead going back and reverse
engineering, why were masks?
It was because it was thequantity, the focus was on
(15:26):
quantity.
And so that a mass helps reducethat.
Cause it's, it's not perfect.
But now if it's now quality,maybe then it seems like it's a
possibility of the mass may notbe quite as still effective,
right?
No matter what, it's not like,it's like, it's, it's still
protecting you, but it seemslike Delta can chip away.
At the effectivity of the mask.
(15:46):
So a little bit, if it is thequality, if safe would just, if
it just, I mean, I'mexaggerating here, but if it
just takes one particle toinfect you, which again, that's
not what Stephen's saying.
Just, just theorizing then it,it can get in sneak in and then
bam, my kids are infected.
Right.
Is that, is that a possiblescenario that could be likely in
Delta and causing part of thesurgeon even.
(16:07):
I get it.
It's a different ball game.
This summer, people are out thepool.
People are kind of forgettingthis pandemic.
People are being a little more,so there's that whole behavioral
issue, but even us who are beingprotected with masks could we
could be even more vulnerablewith masks.
Stephen Kissler (16:21):
Yeah.
I mean, I think that that's oneof the really important things
with Delta is that it has sortof chipped away at All of the
precautions that we normallytake now that as you rightly say
it hasn't eliminated them.
Masking is still helpful becauseyou know, it's not a single
viral particle that's going toinfect you.
And so if you imagine that amask reduces the amount of virus
(16:44):
that you spread out into theworld, by some, you know, by
some percentage, you're stillreducing that percentage, you
know?
And, and so it's going to reducethe probability of infection by
that same amount.
It's just.
Delta's infectiousness hasramped up that much more to
ultimately, you know, again, therule of thumb that I usually use
is we think that Delta'sprobably about twice as
(17:05):
infectious as the original SARScov two that we've been dealing
with and probably, you know, oneand a half times more infectious
than alpha, so that I'vebasically been, you know,
dividing all of my precautionsby two now, basically that you
know, that the amount of timethat I feel comfortable
spending.
Reduced by about that much.
It's the amount of protectionthat I assume that I'm getting
(17:26):
from my mask and that.
Principally that I'm giving toother people by wearing my mask
is reduced by about that much.
If I'm infected, I'm likely toinfect about twice as many
people as I would have infected,you know, 12 months ago.
And so that's kind of the ruleof thumb and that sort of helps
me to get a sense of agencyaround this, where it's like,
you know, it's, it's not that ithelps to avoid this sense of
(17:46):
panic that like, oh gosh, youknow, we're back at square one,
nothing works.
Everything is, you know,everything is awful.
And, and it's true, you know,Delta is, is a very formidable
virus, you know, it is, it'sincredibly infectious.
And and, and we need to live inthat reality, but I think that
it's it's still true that likeall of the things that we've
been doing are still effective.
We just have to be on top ofthem a little bit more than we
(18:08):
were.
Yeah.
Matt Boettger (18:09):
It's been hard.
I know I met, I was talking to afriend slash acquaintance the
other day.
I could tell where he sat, youknow, with his, you know, COVID
and the political situation.
And it was just so hard to take.
And I'm like, it's, the evidenceseems overwhelming.
But then when you get thingslike, this is where I think it
becomes a difficult reality.
(18:30):
One of the articles I read washow the media isn't necessarily
portraying the gravity ofbreakthroughs.
The possibility, because we'retrying to constantly advance the
cause of like, no, get thevaccine, get the vaccine.
And no, you know, Stephen,you've always been great at
being in the middle of like, no,the vaccines absolutely
indispensable and there'sbreakthroughs annually, but it's
it's you got to.
(18:50):
Now you hear people aboutbreakthroughs.
And so I read articles fromfriends who are conspiracy
theorists and see even the mediagrieves that the vaccines
pointless.
I'm like, oh my gosh, this isjust like mind boggling to me
that it can take something likea headlight and clearly didn't
read it and not extrapolate itand hold these things, intention
that they're absolutelyindispensable, you know,
thankfully, you know, go, wejust, I just, before we recorded
(19:12):
Stephen, I told you that the Ft,I got a tweet, a tweet saying
FDA grants, full approval of thePfizer vaccines.
My hope.
I mean, this is a big daybecause I know I've had a
handful of people in my smallnetworks.
Just say, look, I'm not takingthe vaccine.
Not because they're likeconspiracy theorist, but they
just want to wait until FDAapproval.
That's their check mark.
(19:32):
And they're okay.
So my hope is that this is goingto unlock a wave of people to
start taking the vaccine becausewe've realized, and I'm going to
have another question to you injust a second, because this is
going to be a flip side of whatI'm just about ready to say,
because we're seeing that themajority.
Of infections are in places bywhich vaccine rates are just
incredibly low, right?
Missouri, Arkansas, Florida,Mississippi all these, all these
(19:57):
places, you know, I know Oregonsuffering tremendously right
now, but a lot of those pocketsare in low vaccinated places.
So all the more to help peoplesee the truth to get vaccinated.
But here's the outlier.
Maybe we need to circle back tothis about Israel, right?
Israel is just like, they arethe poster child of vaccine.
And from what I'm gathering,they're suffering a surge.
(20:19):
And you know, and maybe you canhelp explain it my guess, maybe
they were early adopters to thevaccine.
Could it be waiting a littlebit?
And so it's among your guys'discussions.
How do you guys make sense ofthat when we're here today and
Hey, you know, Arkansas, thereason why you're not you're
you're, you're, you're you're sohigh is because you're, you
know, a lot of it's becauseyou're in vaccinated.
Stephen Kissler (20:39):
Yeah.
I mean, as, as you know, I've,I've been really trying to stay
away from it.
Drawing too much of a causallink between the young, this
particular geographic locationis getting hit hard at this
particular time because of X, Y,or Z.
Because I think that that reallyLOLs us into this false sense of
security, you know, where I'msitting up here.
(21:01):
Boston, Massachusetts.
And I think, you know, there's,you can get caught in this sense
of like, oh, well, what'shappening there because
vaccination rates are low and itcould never happen here.
And we have fallen into thattrap way too many times, this
pandemic for that to be, youknow, it's just, it's illogical,
you know?
And like, like you said, youknow, we have, we have cases
surging in Israel.
Thankfully, the vaccine islargely providing a lot of
(21:23):
protection against severedisease and death.
You know, that, that remains thetruth.
And that's the key.
There is evidence, you know,it's as you said, the early
adopters, and so probably someof that protection is waning.
Part of the difficulty is that,you know, Since, since the
vaccines were prioritized in thehighest risk groups, those are
also the people who have thelowest levels of immunity at
(21:44):
this point from the waiting.
So they're the most likely ifthe vaccine protection has waned
to end up in the hospital.
And so we're seeing anadditional boost from that and
why some of these breakthroughinfections are probably
additionally severe becauseamong vaccinated.
The people with the lowestlevels of immunity are likely to
be the ones who were originallyat most risk of severe disease.
(22:06):
So we're sort of in that weirdsituation right now as well.
But again, I think the criticalthing is that like, you know, we
are going to continue to seesurges potentially major surges
in places that have highvaccination rates.
And nobody, you know, nobody canconsider themselves, you know,
totally immune or totally, youknow, safe from like this.
(22:28):
This pandemic is not, it's notover.
I, you know, it's like, and itwould be, I know, right.
And that, you know, it kills meto say that, right.
Like I, I want it to be done sobadly.
And that's, you know, that'swhat we've been busting our
tails to try to do.
But the reality is, is like itwill continue to spread.
And I think what Israel, thedata from Israel show is that,
(22:49):
you know, even with highvaccination rates, we're going
to continue to see surges incases.
And we're going to have tofigure out how to deal with it.
Again, you know, surgeries andcases no longer mean exactly
what they did before because ofthe protection from the vaccine
against severe disease anddeath.
So, so we're going to have tostart to get used to seeing
surges and cases and maybereduce our level of alarm at
that because they won'ttranslate into the severe
(23:11):
outcomes at the same rate asthey were before.
But yeah, I mean, I think that,you know, part of the reason
we're seeing an early surge inthe Southeastern us is because,
you know, lower vaccinationrates generally, you know, but
it's also a lot warmer there.
So people are spending a lotmore time indoors.
That's going to change, youknow, in a lot of the rest of
the country, our indoor seasonis coming up here in the fall
and in the winter.
So I totally expected anothersurge up here, you know?
(23:33):
And so there's this real dangerin sort of this Smugness that we
can get that like, oh yeah.
Well, you know, they're, they'resuffering because they, you
know, whatever don't have, youknow, aren't getting vaccinated
and it's their fault.
And it's like, no, no, this isnot that we've been, we've been
down this road too many timesbefore.
And it's, it's counterproductiveand it it'll catch us.
Flat-footed and we're, it's justnot good.
Matt Boettger (23:56):
Yeah, and I, and now I want to get into it before
I get into it.
I want to talk about the waning,right?
This idea of waning and the ideaof this, the rise of talking
about boosters, right.
I've seen a lot of headlinespromoting boosters.
I've also seen a lot ofheadlines and epidemiologists
have a second opinion.
Thankfully, I've got you onhere, so we can talk about
whether you think before we dothat, just to clarify to
(24:17):
everyone.
Cause I see this often over andover again.
We know that the vaccine isn'tas effective as it was at the
very beginning, when it comes tothe Delta variant and people
throw around that 43% as if it'slike some dramatic, terrible
number in that you have like a40, you know, you have like a
57% chance.
Having something bad happened toyou, but just I qualification
(24:39):
that 43% is only aboutinfection, right?
It's just the infection, right?
The still hospitalizationsthey're in the upper, upper
seventies, eighties and onward.
Right.
That it's pretty high.
So it's, it's still very highpercentage that protects us from
that, which we're actuallytrying to stay away from.
So I wanted to make that clause.
I want to go now straight intothis idea of waning, right?
(25:01):
We're seeing, I'm hearing thisidea that about it's about the
eight month mark.
I'm not sure people are gettingthis and maybe I need to be
corrected.
People are saying, oh, it lookslike about eight months.
Now.
It depends on what you'retalking about.
Pfizer, Madonna.
I have no idea that there mightbe a sense of winning beginning
to surface.
And so there is this desire forbooster.
Of course.
Now I'm thinking about mymother-in-law and does she,
(25:22):
should she get one in October,in November?
That's one thing, pragmaticallyspeaking.
I saw, I didn't show it to you,Stephen, and maybe you did see
it it's like futurism website orwhatever.
I don't know what it was, soprobably probably not credible,
but it should have mapped.
And I don't know where theyasked information from, but they
showed like first and secondshot.
And then, you know, how you getimmunity pretty high in that
(25:42):
second shot after a while.
And then it begins to tail.
Like we would assume, I don'tknow how many months or years,
but then they had this idea.
That I don't know where thisevidence came from, but the
third one, the booster justskyrocketed way above, even the
second shot of immunity.
That there's a sense by which itreally does a good job at third
one.
So that made me all the more,want to give it my
mother-in-law.
(26:03):
But again, where do you guysstand in?
In light of, Hey, Israel mightbe this, but boosts her.
Should we be offering these?
Should we be starting to getthem?
What do you guys consider?
Stephen Kissler (26:14):
Over there.
Yeah.
So yeah, I mean, it's it's stillunclear.
It's, it's becoming.
More and more, yeah, I would saythat we're sort of converging on
the idea that that a third dosewould would be helpful that it
does sort of skyrocket yourimmunity and gives you longer
lasting in unity overall.
(26:34):
And this, you know, this, thismakes sense.
Like we kind of, there are a lotof vaccines that we get 2, 3, 4
doses of, you know, when we'reyoung kids and it, it requires.
Those repeated, repeatedexposures for our body to
finally amount a permanentresponse to to whatever it is.
So, so it really, you know,we're talking about boosters,
(26:56):
but another way that you canthink about it is just as you
know, we're trying to sort offine tune what the standard
vaccination course should be forSARS cov.
Now one of the places where someof this data is coming from is
that a number of differentcountries have varied the amount
of time that they place betweentheir first and their second
(27:17):
doses.
So for example, in the UK, whenthe alpha variant was really
starting to take off, theyreally prioritize getting people
their first dose.
And so for many people, ratherthan having, you know, a three
or four week window betweentheir first and second dose,
many people have closer to a 12week window.
And some of the evidence comingback as suggesting that actually
that longer window is providingmore durable immunity to those
(27:39):
people.
That that immunity seems to belonger lasting.
So that suggests that actually,maybe we should wait a little
bit longer between the doses andmaybe even give a third dose,
you know, 12 weeks 36 weeksafter, you know, our last dose.
And that, that time sort ofallows our immune system to.
Go through all the processesthat it needs to go through to
Mount a really good memory tothis virus.
(28:00):
And it's tricky because this,this various from pathogen to
pathogen, you know, the way thatour immune system interacts with
different pathogens is sodifferent.
Like, it just it's so specificto each one.
So we kind of have to figurethis out on the fly.
And that's what we're doingright now.
Now the other big issue, whilethere are two big issues, you
know, so we're talking about.
(28:21):
Third dose second dose.
You know, what about all thepeople who have gotten Johnson
and Johnson and, you know,different, you know, vaccines,
you know, what do we do there?
And I think that's another bigquestion, you know, do you boost
with an MRI and a vaccine?
Do you, you know, what how doesthis work?
And I think that that's a reallyimportant question, too.
And for anyone who's gotten theJ and J vaccine, you know, We're
working on this hard too.
(28:42):
So I know that there's like alot of conversation about, you
know, Madonna and Pfizer and doyou get a third dose?
And like, it's like, you know, alot of people are feeling left
out in this cause like, youknow, I didn't get you either,
you know, and I've only gottenone dose of anything, you know,
what do I do?
For as far as I know, you know,the guidance isn't totally clear
yet, but but we're working onit.
So hang tight
Matt Boettger (29:01):
comes to dosages and the booster, you know, my,
you know, I've been hearing thatmaterial.
Excuse me, he looks slightlymore effective with the Delta
variant and it's kind of it's,you know, now you really get a
taste of this Stephen where backin April and may was all about
Pfizer at the Atlantic.
Of course.
Atlantic.
I'm just in love with eitherjust their titles of themselves.
(29:21):
They must do very good job atgetting really good titles cause
their titles suck me in everytime.
But you know, talking about howthe Pfizer gang is over in this
idea, that back in the spring,there was the Pfizer gang.
Like the Pfizer was the premierstamp of approval.
Right, right.
If you're a Pfizer, like you,you are good.
And now we're seeing that Pfizerisn't quite as effective with a
Delta compared to now theModerna.
So just goes to show.
(29:43):
It really doesn't matter whatyou get because you can't
predict the future future.
And it could be like five monthsfrom now it's AstraZeneca or J
and J that's actually knockingit right off the slate.
So you just don't know sendingsomething I'm like, okay, well,
all I can go is with mybaseline.
What I know.
Was my mother-in-law McKay.
You know, I want to kind offight for her to get to cross
(30:04):
over the barrier.
She had Pfizer and you know, getthe, get a booster that's
Madonna, right.
That kinda stuff to help, helpget, get it, get her along the
way.
So these are all theconsiderations I'm working on
and seeing, you know, my kidsand not being unvaccinated in a
wedding coming up in a few weeksand seeing the increase of yeah,
COVID sure.
But we're talking off the recordthat RSV.
It's kind of raising its uglyhead.
(30:25):
Right.
And, and, and it it's, it'scausing a threat to young young
kids who, I don't know how muchI would imagine it has to be.
Super rare, like getting thecombo kick in the butt, where
they get COVID and RSV andthat's causing some problems
when you have to.
So, you know, really, I guess myPSA and I'm just here.
I am just a layman.
I know nothing about this, butI'm just taking my advice from
(30:48):
things I've read and interpretedmy interpreter interpolation
from mark and Stephen.
And, and that is like reallyfocused on, you know, this is
another winter to really focuson the boys getting a flu
vaccine.
Yeah.
You know, and then when, when,and if the vaccine comes
available for for young ins toreally, to, to go for that,
(31:08):
because the last thing I wantis, you know, we talked about
this last year of having thepotential combo of getting the
flu and COVID at the same time,I think that can, that
potentially can cause a wreck.
So, so just, just that considerthat as where we get in the
fall, all those kinds of things.
Yeah.
Any last words for you?
Anything to,
Stephen Kissler (31:26):
oh yeah.
Just, you know, circling back tothe third dose thing.
I mean, I know one thing wehaven't really touched on, at
least on this episode is likethe issue with a vaccine equity
too, around the world.
And I think that that's a hugeissue we have to play into too.
You know, we've been talkingmainly about the epidemiology of
it and probably ideally, youknow, everyone will have
multiple doses of a highlyeffective, safe vaccine, but.
(31:47):
Yeah, there are so many placesaround the world where, you
know, vaccination rates areunder 1%, you know?
And so then the question islike, does it make sense to be
giving relatively healthy 30year olds in the United States,
a third dose of Pfizer Medina.
When they're 80 year olds, youknow, all over the rest of the
world who haven't gottenanything yet.
And I think that that's a reallycritically important question
and something that we have toweigh.
(32:07):
So that was just, just a littleaddendum.
I wanted to put into what we'vebeen talking about to make sure
it didn't get lost.
Matt Boettger (32:13):
I'm glad you said that one thing I'm going to end
on.
Totally random.
We talked about this.
I think it's fascinating.
Last fall, see, university ofColorado where I worked.
I worked.
At the Colorado, but I worked onthat campus and they did I don't
know if all universities didthis or not.
I, I feel like they one of thefirst, but they did the
wastewater testing.
Right.
(32:33):
And so all the dorms and theycould, they could really easily
determine whether there was anoutbreak in the dorm and lock it
down.
It seemed very effective.
I heard it's like costaffordable, that kind of stuff.
And so there was an article thatjust came out, just proving the
effectiveness down to the pointof even houses, individual
housing units could determine.
And that's a powerful realityand you know, I'm, I'm so gung
ho with technology, Stephen, Idon't really sometimes think of
(32:54):
the ethics behind it.
I'm like yes, technology suite,but you were talking about how
this could be a great new as anepidemiologist.
This sounds great, but thiscould be a slippery slope and
cause some concerns for people,you know, and it's a privacy.
Stephen Kissler (33:07):
Totally.
Yeah.
So I think that, I mean, what Iwant to start with is just like
the possibility of wastewatersurveillance for COVID and for
other pathogens is you know, thepotential is huge.
It's great because it's it, itis the most passive of passive
surveillance that you could do,you know?
And.
And so, you know, it doesn'trequire anything of the people
who might be infected orinfectious.
(33:27):
You're literally just monitoringsewage for traces of the virus.
And you can get pretty good,pretty good pictures of if an
outbreak is happening in a givenlocation, your rights, you know,
see you as a really, in manyways, a pioneer in this
technology, you know, we're ableto detect outbreaks in dorms
before anybody came down withsymptoms and Yeah, that's great.
(33:48):
That really revolutionizes ourability to manage infectious
diseases like this.
I think we're going to see a lotmore of these kinds of things as
we move on forward.
Now, one could envision a futurein which you have a little, you
know, a little virus monitorthat's sitting, you know, at the
sewage outflow of everyhousehold in the United States.
And so then it gives, you know,a little ping to whoever's in
the house and you know, so itwas like somebody, you know,
(34:09):
might be infected and, you know,we recommend, you know, here are
the different resources you haveand the different precautions
you might want to take.
And on the one hand, that's agreat, you know, that, that
gives you a lot of power and youknow, you can, you can figure
out what to do with thatinformation.
But I mean, this gets back tothe age old question in public
health is like, how, how do youdo surveillance?
Well, how do you do itanonymously?
How do you do it in a way thatdoesn't infringe on people's
(34:31):
privacy and freedom and in a waythat I, you know, ideally can't
get easily corrupted, you know,like, Yeah, I think that that,
that could end up being also aslippery slope.
If you have information on thelevel of individual households
or even individual people, youknow that in times of crisis,
that might make a lot of sense.
You know, sometimes we needthose kinds of responses, but as
a constant sort of surveillance,you know, could be great.
(34:54):
But I could also see it being alittle bit dangerous in the
sense that it, my eight.
Provided, you know, depending onwho has access to that
information, it could lead toall sorts of stigma or you know,
restriction of basic rights.
And and you know, I, I, I'malways trying to look ahead to,
you know, we have No, this is,this is a respiratory virus that
we've been dealing with for awhile.
(35:15):
And so now, you know, it's like,okay, COVID, we've been, we're
used to living in a world whereCOVID is spreading.
And so it's kind of hard toimagine, you know, this really
being twisted, but you can alsoimagine like a year ago,
especially when tensions werereally high around.
That could have led to some realbacklash, you know, imagine your
neighbors find out you haveCOVID or something.
And yeah, and I imagine thatit's, you know, different kind
(35:36):
of disease that spreads in adifferent route, you know, all
of the stigma around HIV oraround, you know, whatever, like
what if it was something else?
What if what if it was a diseasethat, you know, like HIV was
highly correlated with?
Especially when it was firstspreading with sexual
orientation and you weren't outto people, you know, who you
were in your neighborhood, or,you know, like all of these
(35:56):
things, the questions and thecomplications layer upon one
another in a way that sort ofblows my mind.
So the technology is hugely,hugely promising.
And I think we, as with any newtechnology, we have to be very,
very mindful about how we use itin a way that is maximally.
Effective and has the minimumchance of really backfiring.
Matt Boettger (36:19):
Yeah.
Well, you just summed that upagain, once again, it's
complicated, right?
Because we're dealing with humanbeings and it's, it's the, you
know, efficiency is, is, is oneparticular thread.
But it is definitely.
Not the only thread.
So thanks for sharing yourthoughts on that.
I appreciate it.
I think we'll end there.
Those of you who are listening,thank you so much for joining us
(36:41):
this week.
And again, we strive to do thisevery single week whenever we
can.
And if we don't, there's usuallya big reason because we want to
be available as much aspossible, particularly during
this time of Delta and who knowswhat will be next in the next 6,
8, 9, 10 months buy one piece ofsolace and I'll send us one more
real your way, Stephen, beforewe end.
(37:02):
Response.
I heard that with thisparticular kind of virus, like
all viruses, it can be likethis, a lot of mutations, but
eventually it stabilizes downthe road and it's like, this
isn't expected to be like thisforever.
That at some point in time, it'sgoing to mature and find a more
routine method of, of mutation.
Is that something that, that isa hopeful.
(37:24):
Anecdote to
Stephen Kissler (37:24):
and on.
Yes, I think so.
And I, I think, I think that'slikely, eventually it will sort
of explore the space ofdifferent mutations that it can
have and it'll find it kind ofprobably reach its happy
equilibrium.
That's that's what I expect.
And so yeah, we got some morework to do yet before that, but
but I think there is hope.
Okay.
Matt Boettger (37:42):
Great.
Thank you.
We'll end on that.
It's a nice piece of hope.
Thank you all for tuning in.
If you wanna support uspatrion.com/pandemic podcasts,
one-time gift PayPal, Venmo allin the show notes.
Please give us a review.
You can email me,matt@livingthereal.com.
Send us some good wishes.
What's going on in your neck ofthe woods, Bruce.
I'm thinking of you in Australiaright now.
Just kind of hearing a lot ofstuff going on right now.
So I'd love to hear what's goingon in your neck of the woods.
(38:04):
Have a wonderful week.
We'll see you all next week.
Take care end.
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