June 28, 2021 • 43 mins
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Things Discussed on Episode:
- Man believed to have longest COVID-19 infection had virus for 300 days
- COVID live updates: Delta variant can spread within '5 to 10 seconds' of exposure
- Dangerous Delta COVID-19 Variant Infecting Vaccinated Adults In Israel
- We’re Not Ready for Another Pandemic
- The mRNA Vaccines Are Extraordinary, but Novavax Is Even Better
- CDC says roughly 4,100 people have been hospitalized or died with Covid breakthrough infections after vaccination
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 is Matt Boettger and I'mjoined with once again, just by
one Kissler friend, Dr.
Stephen kisser andepidemiologist at Harvard school
of public health.
Good morning to you find, sir,how are you doing on this lovely
Monday morning?
Good
Stephen Kissler (00:17):
morning.
I'm doing pretty well.
Really hot in Boston today.
So we're just trying to keep itgoing.
Matt Boettger (00:23):
No, man, you were a, you were at the beach,
weren't you?
Stephen Kissler (00:27):
Yeah.
If, if you can call it that it'sso, new England does have things
that some people refer to asbeaches.
They're, they're pretty Rockyand the water is very cold.
But but it was nevertheless, youknow, since it is driving
distance away, it was nice tojust get out of the city for a
little bit.
Matt Boettger (00:44):
That's awesome.
Good, good, good.
My weekend was spent dealingwith sciatica.
I was telling Stephen, this hasbeen fun.
I'm 43 years old.
I'm getting old apparently.
And so now I've got some sad.
I got problem.
I didn't do anything strange orcrazy.
I just got it.
So I don't know how it happened.
And so it's been fun.
It's been a great, I just don'twant to sit down.
Don't want to lay down.
I wish I could sleep standingup.
That'd be a great, great thingto do.
(01:04):
Or like a little bat upsidedown.
So that's been mine but it'sbeen beautiful here, beautiful
weather.
And it's good to go outside withthe boys and do more things, all
that great stuff.
And I hope you guys arelistening and having a wonderful
summer as well.
And can you ready for awonderful 4th of July, for those
of you who celebrate it here inthe U S.
But let's get going here.
So a couple of things reviews,love them.
We just got another one lastweek was awesome.
(01:24):
Thank you so much.
I wanted to read that, but Iforgot to put it in the show
notes.
I'll do it next time around.
Just has I'm remembering Stephenis going to be gone next week.
So we'll probably either skip,just let you guys know ahead of
time or if I can get thiselusive, I don't know what his
name is again.
Mark Kissler.
Is that Dr.
Mark?
If I get him actually on theshow again, maybe we can, we can
have another episode, but he isone heck of a busy man.
(01:46):
This is.
If you want to support us, we'dlove it helps us just keep us
going a cup, a cup, pick a fewcents in our pockets, help to
automate things and allow us tocontinue to move this forward.
That's at patrion.com/pandemicpodcast, or one-time gift
PayPal, Venmo all in the shownotes.
So I want to start with this.
This is kind of not necessarilyCOVID related Stephen, but I
(02:08):
just want to get an idea of how.
You know, global warmingeffects, your research and
infectious disease.
Cause the reason why I'mthinking about this is I just
saw of this on the news.
Like three days ago, I was likea record temperature.
I couldn't believe like pork.
I don't know if you saw thisStephen like predicted, I don't
know if it hit it like 114degrees and Portland, Oregon,
(02:29):
and Seattle was supposed to getupwards of a hundred, which is
this is not like 10 to 15degrees is 30 to 40 degrees over
their normal highs.
And so this is got me thinkingof how does an increase in
temperature globally affect likedisease, you know, in my mind,
Does it make it worse?
Does it make it less?
(02:49):
I'm sure it's complicated.
Like everything.
Cause I'm thinking, oh, youknow, winter time and it's when
it gets really difficult for us.
And so my goal when it gets coldor maybe it gets worse and when
it gets warmer, maybe thingswill be generally better.
But is that I'm a guessingeverything is a nuance.
There's no black and white, butwhat, how do you approach this
when it comes to future disease?
Stephen Kissler (03:07):
Yeah.
So there's this is a greatquestion and something that a
lot of epidemiologists areworking on right now is the
intersection between climatechange and infectious disease.
So, I think I, you know, thereare a couple of different levels
that we can take a look at thisquestion, and I think I'll sort
of step from maybe the mostapparent ones down to some of
the, maybe more surprising onesas well.
(03:27):
So.
Of course, one of the issueswith global warming is as the
name says, you know, places getwarmer.
And so one of the things that wewe are already beginning to see
and we'll probably continue tosee is that the regions were
Yeah.
Basically the, the tropicalbands of the climate tropical
(03:49):
bands of the world that aregenerally the middle latitudes
are starting to expand outwards.
And that hasn't effect on acouple of different ways.
So first of all, Differentinfectious diseases frequently
behave differently in tropicalversus temperate parts of the
world.
So flu is the canonical examplewhere in temperate regions of
the world we see majorwintertime outbreaks of many
(04:11):
respiratory diseases whereas inthe tropical regions of the
world where seasons are not somuch spring, summer, winter,
fall, but more rainy and dry.
The, the whole.
Pattern of flu outbreaks andother respiratory illnesses is
just different.
Tends to be a lot more sporadic.
Still can be linked to theseasons, but again, the seasons
(04:32):
look very different there thanthey do, for example, up here in
Boston.
And so what we're starting tosee is, is there sort of, the
latitudes where that regionexists are starting to expand,
and it's going to be interestingto see what effect that has on
the overall seasonality ofrespiratory illnesses, the
severity of respiratoryillnesses.
Cause In, in some ways havingoutbreaks asynchronous can be
(04:52):
helpful in a way, because wheneveryone's susceptible and then
gets infected in one bigexplosive outbreak that actually
tends to cause more cases thanit does when people are sort of
getting infected at a low levelover time.
That's certainly not an argumentto say that global warming is a
good thing because we actually.
No, what some of these effectsare going to be.
One of the other things thathappens when you have this
(05:12):
expanding latitudes of sort oftropical regions, is that a lot
of the vectors that carry otherinfectious diseases that are
especially problems in tropicalareas of the world, especially
in mosquitoes.
They're starting to expand theirhabitats outward as well.
So that's part of why we wereable to see, for example, sort
of more widespread outbreaks ofZika virus a few years back
because the range where thosemosquitoes that carry that virus
(05:33):
can thrive are wider than theyused to be.
And so we're going to start tosee outbreaks of infectious
diseases like malaria, forexample, in places that haven't
seen them for many years, wewe've started to see outbreaks
of malaria in Southern Italy,for example, which had
eradicated malaria for a verylong period of time.
So this is going to start tobecome a reality.
We're going to see infectiousdiseases that certain parts of
(05:54):
the globe have not seen in avery long time start to
research.
So that's, that's one key areathat we're thinking about, but
of course know global warmingYeah, we, we think about it in
terms of warming and a place isgetting hotter, but actually,
you know, one of the biggestproblems with global warming is
not so much the increase intemperature, but the increase in
variation in the types ofweather systems that you get.
(06:15):
So you generally get strongerstorms, you get hotter hots, but
you also tend to get coldercolds as well.
And so it just makes sort of thewhole weather system a lot more
variable.
And so one of the issues theretoo, is that, of course for
season.
Infectious diseases in placeswhere that, that do remain
temperate, you might actuallysee much more severe winters and
much more severe summers, whichcould actually drive that
(06:36):
seasonality even stronger.
Um Hm.
And then.
Digging one layer deeper intothat.
One of the things that I'm mostconcerned about is that we've
definitely seen and we'rebeginning to see, and I
anticipate that we'll continueto see big increases in the
severity of tropical storms,hurricanes typhoons, cyclones,
you know, things that can reallydevastate coastal community.
(06:58):
And so, you know, one of theother big issues is that we're
going to start to see infectiousdisease crises that follow along
when these things hit short.
So a number of years back we sawthere was a major hurricane that
hit Haiti and the DominicanRepublic.
And following on from that foryears, they've been having a
really difficult timecontrolling cholera because that
affected their water treatmentsystems.
(07:19):
And so there's been this hugecolor outbreak that has been
spreading there as a result of ahurricane that, and so as we
start to see coast lands,getting flooded, different
infrastructures are going tocause you know, start to
collapse.
We're going to see peopledisplaced, which also causes
sort of the spread of pathogens.
And so there's a lot of reallybig issues that are going to
follow along from this thatinclude.
(07:41):
Diseases spread because of thechanging weather, but also
include the very humanitariancrises that are going to follow
along from global warming aswell.
So it's, it's hard to overstatehow huge of an issue this is and
how it will touch infectiousdiseases and every other part of
our lives in every way.
But yeah, it's not to be youknow, I, I feel bad starting off
the podcast on this note, itseems so bleak.
(08:02):
It is the, you know, there's, wehave a lot of lecture to sort of
get this.
Matt Boettger (08:07):
Yeah, I'm assuming Stephen did didn't do
you work much with like climatechange specialists there, or do
you kind of your own bubble?
Given that you know, what you doseems to touch almost every
dimension of reality.
Do you have like little groupsby what you kind of talk about
the future of global warming andhow people are, how best to
(08:27):
handle it?
Or how does that work for youwhen it comes to
Stephen Kissler (08:30):
collaboration?
Yeah.
I currently I'm not working withany climate scientists.
Although I've Back when I wasstudying for my PhD, I did a
little bit more.
So, many of my colleagues arefor sure.
There's a lot of crosstalkbetween climate scientists and
epidemiologists economists andepidemiologists.
That's one of the areas thatI've been sort of doing more
(08:50):
interdisciplinary collaborationbehavioral scientists and
epidemiologists.
So oftentimes, it's reallydifficult.
Have any sort of expertise inall of these rooms at once.
So frequently epidemiologistswill sort of pick one or two
that I think especially relatedto the work that we're doing
and, and try to dig into thatand develop collaboration's
(09:10):
there.
But absolutely there, you know,since climate change is such a
huge issue, there are a lot ofus who have been who have been
talking with climate scientistsand really thinking deeply about
yeah, about what these changesare going to mean for the
landscape.
Matt Boettger (09:24):
Sure.
You know, this is we're gonnachange subject now, but I feel
like it's kind of related.
I kinda, it's kinda hard to putmy finger on this, but there's
this other article and it talksabout, but it's it kind of maybe
in a metaphorical way it'srelated this man believed to
have longest COVID 19 infectionhad virus for 300 days.
So why do I think this isrelated?
Because I feel like in somesense with global warming, no
(09:45):
matter how much the world beginsto have its own ecosystem in the
end, And how it corrects itselfin the end, there is.
Dependency and responsibility onus to be able to help it be able
to not go into an extremeweather cycle or whatever.
And so the same thing for this,where this is what's fascinating
to me because this guy had itfor 300 days.
(10:07):
It was like, whoa, that'sinsane.
How did that happen?
The article, obviously rightaway.
Pop that bubble from bill, yougot freaked out about, oh my
gosh, can people just spread itfor 300 days?
No, this was just an individualperson who had a severe immune
compromised body cancer, thatkind of stuff.
So that kept the virus alive fora long period of time.
And I want you to speak in thisfor a second, because this was
(10:28):
like a revelation to me on maybeat least the current technology
that's give that's provided forus that no matter how much
medicine future technology thatwe have to have.
Bring health to someone whosick.
In the end, the buck stops withus because I realized, oh, this
person just couldn't receive thetreatment because their body,
(10:51):
the body itself, wasn't able towork with the treatment.
Like, wow.
At some level we can really putour hope in technology that it's
going to cure every disease, butat least, at least at this
moment, this is a perfect caseby which the body has to have at
least a baseline by which tonegotiate and work with the
future technology to bring abouthealth.
That just was kind of roadleverage to me the, again, going
(11:13):
back to the public healthmandates of the future
technology is great, but at thesame time, we've got to keep
ourselves as healthy, aspossible to work with technology
and not have it be kind of likea substitute for our bad
behaviors and bad.
Stephen Kissler (11:25):
Yeah.
And to be clear, like certainlybeing immunocompromised does.
Relate to necessarily badbehavior or like any person's
fault.
People are certainly born withthese conditions.
Cancer is cancer is no one'sfault.
And, and so, you know,certainly, you know, maintaining
our health.
Is a good thing to do and, andhelps, you know, not just with,
(11:47):
with the standard things ofpreventing you know, reducing
our risk of cancer and obesity.
But also then the downstreamconditions that follow along
from that, which included thatoutcomes from infectious
diseases.
So I, I do have a lot of hopefor the technologies, the
medical technologies that willdevelop in the future.
And, and that hopefully, youknow, we will find ways to help
people with who areimmunocompromised too.
(12:10):
To improve their immune systemsto, to have, you know,
immunotherapy to to findvaccines that work for them.
There's been some recent studiesthat suggest maybe a third dose
of the MRN vaccines actually doprovide a substantially higher
immunity for people who are,have certain immunocompromised
conditions.
So that might be an approach isto just sort of keep exposing
them repeatedly to to thevaccines and that, that, that
(12:32):
might help.
So I think this is a reallyactive area of research.
You're right as well, that thaton, on sort of the population
level too.
And I think we'll probably getinto this in some of the topics
that we'll talk about in a fewmoments as well, but we can we
can play so much of our trust intechnology.
And I've seen this, especiallyaround the vaccine, sort of like
seeing the vaccine as this magicbullet that will get us out of
(12:53):
the COVID problem.
And that's clearly not the case,too.
Right.
We're seeing spikes in cases, inplaces around the world and.
Again, since people arevaccinated, these rises in cases
don't matter, certainly meanwhat they meant six or eight
months ago.
They're not translating intohospitalizations and deaths at
nearly the same rate that theydid then.
So the vaccines are definitelydoing.
What they were intended to do,but they're also, you know,
(13:15):
COVID is still clearly here andthere are other things,
including, you know, basicprevention measures that are
still important alongside thevaccine.
And you're right.
You know, like in the long-termone of the things we talked
about on a previous episodes wasjust like how the United States
in particular does have reallyhigh rates of obesity, heart
disease, diabetes Some of thesethings, which are, you know, are
(13:38):
genetically linked, but are alsoto some extent behaviorly
linked.
And so, you know, what can we doto maintain a healthy society,
to the extent that we're able,if you're predisposed to
diabetes and obesity how can wehelp those people out a little
bit extra?
Because they're going to have anespecially hard time keeping
their weight down and then.
You know, make, make themespecially vulnerable to future
infectious diseases, to, youknow, how do we you know, treat,
(13:59):
treat the whole person and thewhole body and not just rely on
sort of these technologies thatcome through and save us in a
time of crisis.
I think that that's a huge, hugething that we're gonna, I have
to think about for the future ofpublic.
Yeah.
Matt Boettger (14:11):
Yeah, no, thank you for correcting my
oversimplification.
Yep.
Totally.
With the immune compromise.
That is not anybody's fault.
I'm just thinking about back inmy nineties days.
I We're trying to lose weightand there was these, these pills
you could take that actuallywould make you feel full.
So you don't have to eat.
I'm like, that's like the cheapway, right?
It's not trying to actually workand actually being healthy, but
taking some kind of chemicalpill to make you actually feel
full.
So then you don't overeat them.
(14:32):
These are the things that weneed to really work on general
health.
No, thank you for that clarity.
Okay.
So let's, let's, let's get intothis now.
So, with the Delta, the variantwe're seeing now, I last week I
saw a lot of articles about thiskind of, I a little bit of
dramatic stuff going on andmaybe not fear-mongering, but
just showing a lot of risingcases everywhere.
(14:52):
We're seeing the Delta COVID theDelta variant being really taken
over California.
Not necessarily in the sense oflike surges, but just that it's,
it's dominant.
It's now I've thought it waslike 1% now it's like 15% or
more than that.
Within California being theDelta variant, Missouri seen a
surge of the Delta.
It seems like the Delta variantscontributing to that.
(15:13):
We're seeing Africa now.
Or you said you're mentioningeven the UK is starting to see
Israel, you know, at 87%vaccinated is starting to see,
you know, quota, surge.
Now we can talk about that rightnow, or in a little bit about
how the a hundred cases thatthey've received a day.
Half of those coming fromchildren who are vaccinated, but
surprisingly the other halfLisa's one article is saying is
(15:35):
coming from vaccinated adults.
You know?
So these are these breakthroughoccurrences, you know, maybe you
can.
On all of this had one level ofwhere you see things both as the
Delta variant kind of takingover certain areas and how we're
going to continue seeing thesehops.
But also this idea of thebreakthrough hot pockets.
Oh man.
(15:56):
I'm 43.
Those were the most deliciousthing ever.
That's a, yeah, that's a gooduse of hot pockets by the way to
talk about that.
If those hot spots, right.
And as well as this Israeldealing with these a hundred
cases, 87% vaccinated.
So it's going to land on a fewand what that means for the
brain.
Stephen Kissler (16:16):
Yeah, right.
So, I think that we can sort ofthink about this on two
different levels where, youknow, one there at many
countries around the world wherevaccination rates remain very
low.
And so in those contexts, youknow, then it's there's not so
much a question as to, you know,why, you know, why, why is it
spreading there because it'ssort of the same.
Song and dance in a way whereit's like there, it just happens
(16:38):
then.
And, and we, you know, we, we dohave the Delta variant on our
hands, which is as we mentioned,I think in the last episode far
more infectious potentially isable to get around some level of
underlying immunity anyway.
And so it makes a lot of sensethat places who don't really
have much immunologicalprotection from the vaccine or
from a lot of previous spreadwould be susceptible to rises in
(16:58):
cases right now.
So that's one thing.
Then we w we certainly have theexample, places that have higher
vaccination rates as well.
The, you know, wha why is theDelta variant starting to spread
there too?
So, sort of ticking these off ww one by one, if, if we're able
I think also, as we've mentionedbefore, you know, vaccination
rates It matters a lot on, itmatters a lot, sort of what
(17:21):
geographic scale you look atthem on.
So across the United States, wehave, I think on the order of
almost 50% of people fullyvaccinated, something on that
order.
And and more than that, who havereceived at least one dose, but
of course that varies hugelyfrom community to community.
So a lot of places where we'veseen outbreaks of the Delta
variant now are still hoveringaround 15, 20% vaccination
(17:45):
rates.
And so there's still a lot ofsusceptibility there too.
And of course there's stillCOVID circulating in the
community.
Like there are still casesspreading around.
And so when it finds a placewhere it's able to.
It's going to spread.
And so that, that makes somesense, but of course, you know,
there's, as you said, there's,we are still seeing cases, even
in vaccinated people.
(18:05):
We are still seeing cases inplaces where we do have high
rates of vaccination.
And so what's going on there?
On the one hand it's, again,still, it seems like the
vaccines are working as, as wewould expect, right?
Like the, the vaccines arehighly effective, but again,
they have 95% of effectivenessagainst symptomatic disease.
Against the sort of vanillavariant, you know, pre this was
(18:29):
even pre-alpha variant that mostof the MRN vaccines were tested.
And so we will see somebreakthrough infections it's
going to chip away at thateffectiveness against
symptomatic disease.
It will chip away probably evenmore against the effectiveness
against asymptomatic disease,which was already a little bit
lower in the first place.
And so we're going to startseeing breakthrough infections.
We're going to start seeing theDelta variant takeover, even in
(18:51):
places that do have higher ratesof vaccination, including
California.
No matter what your rates ofvaccination are, the Delta will
start to displace whatever wasthere, because it's just so much
more that.
That's just the way thatevolutionary biology works.
It's, it's going to start makingit more and more of those cases,
even if it doesn't necessarilycause surges.
And that sort of brings us tothe UK, which has had a pretty
good vaccination rolloutprogram, but is starting to see
(19:14):
both, you know, the majority ofcases made up by the Delta
variant and a rise in cases inmany places.
Nope.
The UK similar to the U S has alot of heterogeneity in
vaccination rates within thecountry.
Some places are very highlyvaccinated.
Some are still have very lowrates of vaccination.
But we're starting to see risesin cases, again, I think the,
(19:34):
the main point to underscorehere is that it's not totally
unexpected, although it'ssomething that we're watching.
You know, very closely.
I want to see how this sort ofplays out, but by and large, you
know, again, people who arevaccinated are very well
protected against severedisease.
And so even if the variant isable to gain a foothold, even if
it's able to spread, it's nottranslating into
hospitalizations and deaths atnearly the rate that that
(19:57):
previous variants were in thepre vaccine era.
So, you know, this is, this iskind of something that we've
been saying for over a year now,which is that, you know, we're,
we're going, we're going to beliving with COVID for a very
long time.
And we're sort of in thisawkward transition period where
hopefully it's transitioningfrom this pandemic, awful
(20:17):
disease to something that ismore like a wintertime
respiratory virus.
And we're still going to seethese sort of surges of
infection at different times ofyear until things sort of settle
out.
It's going to take a littlewhile for that system.
Settle into its normal, youknow, pattern of, of, of
seasonal outbreaks, which iswhat I imagine will probably
happen.
(20:37):
We could be surprised it mightbe able to spread outside of the
winter and for a long time tocome, but it's, we're, we're
still in that transition period.
So, so none of what we're seeingis super alarming to me.
Although it is, you know,something we need to pay close
attention to because, you know,if we do start.
Really big rises in cases, forexample, in the UK or in Israel.
And if those do starttranslating into
(20:58):
hospitalizations and deaths,which I don't anticipate that it
will, but if it does in thatremote possibility that it does,
then, then we got some more workon our hands, you know, we've,
we've got to continue figuringthis out.
But for right now you know,watching it with curiosity, but
definitely not paying.
Matt Boettger (21:15):
Yeah.
Yeah.
Great.
And to put things in thecontext, just to say from the
CDC, if this is like 4,100cases, total so far in the U S
that have led to breakthroughsand hospitalization and, or a
death.
And now those, like, I think itwas 3,900.
Have been hospitalized in athousand, it was 3,900 were
asymptomatic and reallyunrelated to COVID-19.
(21:37):
The CDC says as well as 750fully vaccinate people have also
died.
I think most were the age ofover 65 in that situation of
those seven hundred fifty, ahundred and forty two of those
were again, asymptomatic and notreally.
Directly court, you know,correlated to covet.
So just shows how small thepercentage seems to be going
quite accurate with what wethink of between 94 to 90 and
(21:59):
88% with effective with theDelta variant, with Pfizer and
Madonna.
Stephen Kissler (22:04):
Right.
And ever since that part withall that.
Yeah, that's perfect.
I.
Amend the previous statementwhere I said that I'm not
particularly concerned and that,and that really pertains to
highly vaccinated.
I am deeply, deeply concernedabout it may happen in places
that don't have higher rates ofvaccination yet.
Because, you know, especiallywith the Delta variant, we know
that it could potentially bemore severe as well.
(22:25):
So I think this reallyunderscores the super urgency.
Sharing vaccines of getting asmany places around the globe
vaccinated as quickly aspossible, both for their own
sake, for the sake of the globalpicture.
Because again you know, and youknow, I'm, I'm sitting up here
in Massachusetts where we havevery high vaccination rates and
cases are very low right now.
So, so in that context I'm notparticularly concerned for this
local community, but we do havea massive global problem on our
(22:49):
hands.
And I just want to underscorethat and not be too blessing
about any of that.
Matt Boettger (22:52):
Yeah.
That's important.
Yeah.
But yeah you know, we weretalking about just like Africa
is that 1% vaccinated right now.
And they're seeing a pretty bigsurge in this could be really.
Destructive for Africa and a lotof these countries who don't
have the resources like we do tobe able to roll out such a
vaccinated effort across thecountry.
So let's keep going with thisDelta thing.
What do you think about this?
I read this, I read this articlekind of got me, got me really
(23:15):
interested about Delta Varian.
Can spread within five to 10seconds of exposure.
So that was like, whoa, thatfreaked me out because of
course, you know, we've talkedabout this, the, it was 10 to 15
minutes or 15 minutes ofexposure.
We've we've oh, we've evolvedthat over time that it's not 15
minutes in individualincrements, but it's a total of
15 minutes over a period of day,you know, over one day.
(23:35):
I know we in the U S really likenumbers and algorithms to know
exactly what we can do, so wecan basically go, go right to
that line and have our freedomand then not cross that line.
So is this something that's.
Quantitatively and qualitativelydifferent with a Delta.
Very, that is just so bad thatif I'm with someone for five
seconds I'm toast or help kindof part this in comparison to
(23:56):
the previous 10 to 15 minuteone.
Stephen Kissler (23:57):
Yeah.
So I think this was, this wasgreat.
So, it's so tricky because weEssentially, I think that the
danger that we have ininterpreting these numbers is
that we're sort of comparing twothings that sound similar, but I
think in fact are not.
So the 15 minute rule sort of isa question of Of average of
central tendency of roughprobabilities where for the
(24:22):
previous COVID variance, it wasa rough sense of what's safe.
Maybe 15 minutes of exposure ina room with somebody who has
COVID is Where you cross somethreshold of of likelihood of
getting of getting infected withCOVID-19, but we're then
comparing that with what I thinkis in, in this other study,
which is a lower bound, which isbasically how quickly could you
possibly get the Delta variantand it's within seconds, that,
(24:44):
that was true previously too.
Like you, you could get infectedwith COVID no matter what
variant if somebody who isactively infected.
Coughed in your face, like thatwould take right there done, you
know, like you've got onesecond.
And so, yeah.
So I think that it's one of thethings, and this was a lesson
that I'm continuing to learn,even as a trained epidemiologist
(25:04):
is just how much contextmatters.
And, and sort of what's aroundall of these statistics because
they become totallyuninterpretable unless we know
exactly where they weremeasured, how they were measured
what question they were aimingto answer.
And so.
You know, that's, that's notjust, you know, it is true that
the Delta variant is absolutelymore infectious.
And I do imagine that, you know,if you're comparing, like with
(25:25):
like situations in one roomwhere you might've gotten
infected in 15 minutes with the,with the vanilla variant, I
don't even know what to call it.
The it's it doesn't even havethat Greek letter, but it's just
like the standard coronavirus.
Right.
Maybe you'll get infected withDelta sooner.
How much sooner?
I don't know.
Maybe 15.
You know, we, we can, we canroughly work some of these
probabilities out, right?
(25:45):
If we think that Delta is maybetwice as infectious as the, as
the standard variant, maybe ittakes half the time, something
like that.
But there's some sort of weirdscaling, you know, 15 to seven
minutes maybe is probably a moreaccurate sort of comparison
there.
But of course, you know, noamount of time is perfectly
safe.
Also no amount of time is aguarantee that you'll get
infected either you could, youknow, we've absolutely had
(26:06):
people, you know, spend long,long periods of time in a room
with another person who'sactively infectious.
But if there's ventilation, ifthere's masking that might
reduce the probability ofinfection down very low.
So all of this matters hugely,definitely the Delta is more
infectious and that doestranslate into a shorter period
of time on average that it willtake for a person to become
infected with Delta.
But I don't think that it'sshifted.
(26:28):
Tens of minutes to tens ofseconds.
It's probably, you know, tens ofminutes to maybe 10 minutes.
Matt Boettger (26:36):
Great.
That's helpful.
It puts into perspective andthat that's totally right.
I It's always important to seethe context.
I forget it all the time you getthese articles, like one is the
average one is like as soon asfive to 10 seconds, which of
course that was in the old wayas well.
One small thing again, before wemove on from the Delta, even
though it kind of permeates allof our discussions in one way or
another.
There is this Delta plus veryend for those of you heard of
(26:57):
it, don't worry about it.
House, put this article in theshow notes.
It's a, I don't know any ofthis.
I'm just going to read thejargon.
There's one small mutation.
It's called the K 4 1 7 9.
And apparently that is a, anumber of other variants.
So we can know that as being aninsignificant mutation compared
to what the Delta already.
So no need to be alarmed.
If you see this in the news,it's not that signal.
(27:20):
Whatsoever.
Okay.
So if there's two articles youguys read who are listening
right now, these are the biggestarticles I want you to read.
I'm going to throw these pastStephen because the first one is
this they're both from theAtlantic.
You're probably thinking Itotally just am biased.
The Atlantic.
I don't mean to be, I justhappened to just read it and I'm
like, this is really good stuff.
I don't, I, it could, you could,it could be one it's like blind
coffee tasting tests, and I'dstill end up being with the
(27:42):
Atlantic because I just likedthe way it's written and it's as
well done.
Both of these are from theAtlantic.
I'm sorry for not beingdiversified in my articles, but
this is, are we ready foranother pandemic?
This is a must read everyone.
Please check it on the shownotes, read it, but there's so
much good stuff here aboutbasically we're not, and the
reasons why and what we couldhave learned from the previous
one.
But instead of rehashing this, Iwant to throw it to you,
(28:04):
Stephen.
And thinking about going forwardfor the next pandemic, which is
inevitable.
If there was the top threethings that we w we at least,
maybe not globally, maybe a topthing globally, and three things
in the U S that really needs tohave a fundamental change for us
to be able to appropriatelyhandle the next pandemic.
What would they be?
Stephen Kissler (28:26):
Oh boy.
It's going on three differentdays and you'll get three
different answers and that's twodifferent epidemiologists and
none of them will agree, but butI think part of that is just
because there's, there's so muchto do.
And it's hard to, it's hard tosort of prioritize, but there's,
you know, there's one of thethings that this pandemic has
really done is sort ofunderscored that something needs
to be done.
And and I think that we're sortof actively working on sort of
(28:48):
what that needs to be.
So yeah.
If I could take a stab at ananswer at this I think that one
thing is changing the way thatwe do surveillance and
communicate about aboutpotentially emerging biological
threats and that's That soundscomplicated and it's actually
even more complicated than itsounds.
Because so one of the issues isthat, you know, we we see
(29:12):
spillovers of infectiousdiseases from animals to humans.
All the time.
There's a, and actuallyspillover is probably not even
the right word for it.
We, we share infections withanimals all the time.
We, we, we acquire infectionsfrom poultry, from pigs, from
whatever.
(29:33):
But we also give them infectionsbecause there's a lot of them
you know, we flew is a greatexample where, you know, we're,
we're infecting pigs with oursor flu all the time.
And vice versa to some extent,you know, and, and the same is
true for other, you know, otherinfectious diseases and other,
other animals, other animalreservoirs.
So I think we need to doprobably more.
(29:53):
We need to understand the humananimal interface a little bit
better.
We need to understand sort ofwhat circulating in animals
what's circulating in humans.
What are the things that havepotential to spill over?
But I think that this is areally difficult problem because
not everything, not everyinfection that a human gets from
an animal.
And it's going to cause apandemic actually, you know,
the, the number is thepossibility that any given
crossover does cause a pandemicis extremely, extremely low.
(30:15):
And really all we end up seeingare these catastrophic events
where we do see a globalpandemic, but we forget that
this happens all the time.
So actually figuring out, youknow, not only what's
circulating there, what'scrossing over into humans, but
actually what are the thingsthat we actually need to be
concerned about and how do webecome concerned about them
quickly enough to do somethingabout them, but without
following up every second, Leadand completely exhausting
(30:36):
ourselves chasing our tails is areally big open problem.
And I think that's somethingthat we're going to need to
think about sort of as a globalpublic health establishment.
Okay.
But what does that mean forthose of us who are not
epidemiologists?
And for, you know, who are, youdon't want to live through
another COVID 19 But also aren'tgoing to set up some global
immunological observatory.
(30:57):
That's going to test animal, youknow, if that's true for sure.
Further antibodies.
So I think that there's I don'tknow how this works, but I think
that sort of working on figuringout how to Just emphasize the
importance of preventivemedicine is going to be really
key.
I think here in the UnitedStates, especially we have the
sense of sort of, prioritizingcrisis care over preventive
(31:19):
care.
We prefer to take a pill whenwe're sick than to do something,
to keep us from getting sick inthe first place.
And you know, that's.
That's an oversimplification,but, but certainly I think that,
that we could put more emphasison, you know, what does it mean
to keep ourselves healthy?
And what does it mean for us tobe agile, to an infectious
disease that's beginning tospread?
(31:39):
How do we build theinfrastructure to actually have
the supplies for testing?
How do we build theinfrastructure to regulate.
Tests and new diagnostics andthings that need to be rolled
out in a crisis period becauseour whole system is sort of
based off of a non-crisisperiod.
So how do we, how do we buildthe resiliency into the FDA?
How do we build the resiliencyinto our government?
(32:00):
How do we build the resiliencyinto our individual behavior so
that we can adapt to these sortsof things much more quickly?
I don't know the answers to anyof those questions.
I think I have more answers tosort of the regulatory and
government level things than Ido to the individual level
stuff.
But I think that that's that's abig, big question is like, how
do we just sort of become moreaware that these threats are
going to continue happening andhow do we as individuals sort of
(32:21):
incorporate that into our liveswithout sort of being crushed by
this reality.
But, but recognizing that youknow, in some ways, I think that
it's a corrective in the rightdirection where we can we can so
easily sort of partition illnessand sickness and death into some
corner of our lives and, andforget that we're not immortal.
And I think that this pandemichas been a real wake up call
that, that, you know, in fact weare, and actually that's been a
(32:44):
very clear realization for muchof human history, but really
we're kind of living in an oddperiod where we've been able to
kind of ignore that in, in manyways and very well resourced
countries.
So, so how do we sort ofreinforce.
This healthy notion of arephysical limits, this healthy
notion of our limited tenure oftime on this earth.
Without, you know, this is, thisis not a morbid thing.
This is actually, you know, thisis just sort of a realistic and,
(33:07):
and I think a joyful thing thathelps us to live our lives more
fully in the moment anyway.
But how do we, how do we dothat, grace?
Given all of the promise thattechnology has given all of the
ways that we've set up oursocieties to make it so that we
can basically ignore this factwhat do we do?
I don't know, but I think thatthat's, that's sort of the area
that I think we're going to needa lot of work in the coming.
Matt Boettger (33:25):
Good.
That's that that's helpful.
That's great.
Remind me, or just makes methink of just the idea of the,
the kind of like the tomorrowbias that we not only as an
individual, but obviously as asociety we're we're so prone to,
just to be in humans where meindividually, tomorrow me is
always going to be moreproductive, more.
I'll start my diet tomorrow.
I'll be more productivetomorrow.
(33:46):
I'll sleep, I'll sleep intomorrow.
I'll, you know, I'll be kinderto my spouse and my kids
tomorrow.
And then today, just because,you know, there's a laundry list
of the reasons why I just can'tbe that person that I want to be
today because of the worldaround me is just putting
pressure on me, whatever it is.
And it just has that cycle hasto stop it.
Not to go on kind of aphilosophical reality, but it
(34:08):
just restarts with theindividual, me of look, I've got
to start and I want to show mykids this as well.
Terrible at this, that no, thebest person who can do this
work, the best thing I can do isprovide the best value for
myself and the value that my, myfamily today and stop getting
this vicious cycle of waitinguntil tomorrow.
Before I do that thing a littlebit better do better today.
(34:32):
Get myself, you know, tomorrowI'll start my walks.
No, if I say that and then thatmeans I have to double my walk
today.
I'm going to go out for a walktoday.
If I get tempted down thatroute, then the consequences.
And now I have to double my walkor double my salad and not
having that piece of bread orwhatever it is because I've got
to teach myself that today isthe best day to change my life
and not tomorrow.
And then of course, that justturns into.
(34:53):
Government social.
We always want to postpone theinevitable to the future, but
we've got to start by theindividual level as well.
That's great.
Okay.
So read that article in theAtlantic.
It's so good.
Second article is, I think thisis when we're going to end on
this is big because this waslike a game changer for me as I
read this, because we've talkedso much to even about the
efficacy of the MRN, and I'vebeen pushing you to talk about
(35:15):
its nuances and it's okay.
Future and what's gonna provideand how I feel like it's going
to save the world.
And then here Atlanta comes andbust my little bubble about MRNs
saying, look there, this, thisarticle is titled Novavax is now
the best COVID 19 vaccine.
So they're basically comparingNovavax to the MRNs and just
saying, look, we are giving anunfair advantage.
(35:38):
To the MRI and a vaccine thatwe're not seeing a clear picture
at the end, they definitelyhallmark MRNs.
They know this is a greattechnology.
I'm not, they're not saying thisis bad.
There's setups.
And I want you, I want you torespond back to this.
Their set up is look, marinadebecame the premier vaccine
really by accident because.
Basically Pfizer took bio.
(35:58):
I think it's BioEnTech orwhatever it is, took that and
allowed that big corporation tohelp them move needle forward.
And they happened to be able togo through their phases during
really big outbreaks, whichallowed it to expedite.
And it was the outbreaks thatexpedited their, their MRI and a
vaccine to come to reality.
And that said, look, there werenine M RNA vaccines out there
(36:20):
only two males.
Right to the real world.
Whereas here in the Atlantic,suggesting look, 13, non Emrani
and vaccines have made itthrough trials and going through
the periods.
So it's not inherent to MRMAthat it's success, that it's
like 95% accurate.
That's not inherent to MRMA.
That's just happened to be acircumstance.
And they're looking at, Novavaxsaying no, the vaccine is a
traditional vaccine.
(36:42):
That probably has a higherpercentage because it's 90% in a
current situation.
Whereas it was closer to 96%back on the early.
The, the, the, the, the firstthe coronavirus.
So all that being said, and thebase of the article is saying,
look, Novavax is traditional.
Probably wouldn't have scared.
As many people MRMA scare a lotof people.
It was new.
It has higher side effects thanthe traditional Novavax one.
(37:06):
The Novaks is the real winner,and that we're really giving an
unfair advantage to the MRMA.
Can you speak into this?
What's what's what's mayberesonates with you and what
maybe might be new.
Stephen Kissler (37:16):
Yeah, I think, I think this is super
interesting because in someways, you know, this this sort
of commentary about the vaccineis like totally predictable and
good is essentially what the,what the Atlantic is doing is
they're getting ahead of thecurve on the hype cycle.
Are you familiar with the hypecycle?
No, it's this, it's this idea.
I look it up on Wikipedia.
It's they've got this nice sortof graph of it.
(37:38):
And it's sort of, it has theseaxes of basically enthusiasm or
expectations for technology.
It's time.
And as you move forward, youhave this new technology and it
just spikes at the verybeginning, everybody's super
excited about this newtechnology.
It's going to save the world,it's going to do everything it's
going to, you know, and then itplateaus.
And then you reach this sort oftrough of disillusionment as
(37:58):
they call it.
Or it's oh no, you know, we'vetried applying this to a new
problem and it's actually notworking and it's more
complicated than we thought.
And then actually it picks upagain and then you reach sort of
this plateau of realistic.
Appropriate use of a newtechnology, right.
Where it's it's no longer asgood as it sounds like.
Matt Boettger (38:15):
That sounds like it sounds like dating Stephen.
Stephen Kissler (38:19):
Yeah.
I guess that's true too.
Matt Boettger (38:20):
Best foot forward.
Best foot forward.
Oh.
We realize who we really are.
We're broken people and weplateau.
Okay.
We love each other for who weare now, right?
Yeah.
Stephen Kissler (38:28):
There you go.
Exactly.
It's like deep, deep,psychological realities here.
Totally.
Yeah.
So I think that this is, this ispart of what's happening here,
but I think we can break it downspecifically with respect to the
MRN vaccines and the othervaccines that we have available.
So I love this point that thearticle brought up that you just
mentioned about how had thisNovavax vaccine been trialed at
(38:54):
the same time as the MRNvaccines, it might have actually
had higher efficacy.
And so I think that what thisreally underscores is that these
numbers of efficacy.
Fixed numbers necessarily, youknow, they're like, like we were
talking about before they'recontext specific, we need to
know sort of how they weremeasured when they were
measured, why they were measuredand, you know, vaccines that are
being trialed now are generallybeing trialed against variants
(39:18):
that didn't exist six months agowhen some of the earlier
vaccines were being trialed.
And so if we're comparing like,In the current conditions.
Yeah.
They, they do seem to be prettywell on par.
Of course there's somestatistical uncertainty in here
too, you know, depending onwhich geographic communities
you're you're measuring this injust, you know, how many cases
do you actually see?
Right.
(39:39):
You're absolutely going to getsome statistical variation in
these numbers as well.
And so, my sense is that theconfidence intervals for these
efficacy rates given the currentconditions do overlap pretty
well with Novavax versus the MRNvaccines which is great.
Other things to speak into here.
So, I do still think that theMRN vaccines that Absolutely in
(40:00):
many ways, there was luckserendipity behind why they sort
of were the first ones throughthe gate and why they were so
effective.
Some of it is, does pertain tothe technology itself though,
too, in the sense that you know,the, the modern of vaccine.
And I think, I think the Pfizervaccine as well, We actually had
vials of it within days of whenthe sequence of the the
(40:23):
coronavirus was first published.
Now still had to go through lotsof testing.
Many other companies also hadvials of a coronavirus vaccine
within days of that sequencebeing posted.
But those ones didn't actuallyend up performing very well or
they had two severe side effectsor whatever.
So, but one of the greatadvantages of the MRI.
You can produce them extremelyquickly.
And so you, they can be part ofa very agile response.
(40:44):
And so that was part of thereason why they were first
through the gate.
Because just technologicallyspeaking, and this is building
off of, you know, years andyears of development of other
types of MRN technology.
We were just sort of, at thistime in history, when MRNs
vaccines, we were able toproduce them and something about
the vaccines themselves, makethem.
Easier to produce quickly thanother types of vaccine
(41:06):
technology that we haveavailable.
So that's part of why they werefirst through the gate, but in
terms of efficacy, I don't thinkthat we can necessarily.
I don't think it's necessarilytrue that MRN vaccines will
always be super effective.
That's super pathogen specific.
It could just be that COVID-19is a decently vaccine, Hubble,
pathogen and some pathogens aremore vaccine rubble.
(41:29):
And so, you know, of course thecanonical example here is HIV,
where we still don't have avaccine.
And we've been working on thatfor years and years and years.
Our marinade vaccine is going tofinally give us a vaccine for
HIV.
I hope so, but I don't thinkthere's any reason to think that
that that will necessarilychange the landscape there nor
do I think that necessarily MRNsvaccines will be more effective
(41:49):
against other pathogens that wealready have vaccines for.
I just don't know they could,and I really hope that they do.
But again, when we're thinkingof about COVID, it's this
there's the vaccine, but it'sthe vaccine pathogen interaction
that's really important to hear.
And that can totally changedepending on what the pathogen
is.
What body systems that pathogeninteracts with all of these
(42:11):
things.
So MRA, vaccines, superexciting.
There are reasons why they canbe part of this agile.
Response to emerging pathogens.
They could really revolutionizethe way that we deal with
infectious diseases, but theywon't necessarily.
And I think that's part of whatthis article was getting at.
Was that a lot of enthusiasmaround MRNs vaccines.
But I think it's worthtempering.
(42:32):
Some of that because we stillhave a lot of big challenges to
face.
And in many ways, we're, we'relucky that they were as
effective as they were againstthis particular pathogen.
Hopefully that success willtranslate into other pathogens
in the future.
But generally speaking, when wethink about medical techniques,
You know, oftentimes, you know,the, the real ringer sort of
emerges to the surface for oneinfectious disease and we think
(42:53):
it's going to cure everything.
And then we applied in adifferent context and it's like,
yeah, it's just okay.
And I think that's probably themost likely scenario is that
it'll help, but we'll see whatthe actual impact will be.
Matt Boettger (43:05):
Great.
Thanks for that, Stephen.
I think we'll end there on thatcheckout.
Novavax as well as a lot of goodstuff coming with that one,
obviously way more available tothe, to the global community
then thank you Stephen.
Now again, just to re review,please do apple podcast support
us patron.com/pandemic podcastor Venmo, PayPal.
Realize that we may not have anepisode next week.
(43:27):
If, unless I can get mark on.
The week after that I will be onvacation.
There'll be some staycations, sothere could be a one to two
weeks sabbatical, but we'llnegotiate that as time comes
forward, we are still here andwe're still going to be going
and giving you the news on thepandemic and just general
information on.
The future of healthcare anddisease and all that good stuff.
(43:48):
So stay tuned, have a wonderfulweek.
Have a great fourth if we don't,if we, if we don't come in on
that week and we'll see yousoon, take care.
And bye-bye.
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible in the face
of these crises.
My name is Matt Boettger and I'mjoined with once again, just by
one Kissler friend, Dr.
Stephen kisser andepidemiologist at Harvard school
of public health.
Good morning to you find, sir,how are you doing on this lovely
Monday morning?
Good
Stephen Kissler (00:17):
morning.
I'm doing pretty well.
Really hot in Boston today.
So we're just trying to keep itgoing.
Matt Boettger (00:23):
No, man, you were a, you were at the beach,
weren't you?
Stephen Kissler (00:27):
Yeah.
If, if you can call it that it'sso, new England does have things
that some people refer to asbeaches.
They're, they're pretty Rockyand the water is very cold.
But but it was nevertheless, youknow, since it is driving
distance away, it was nice tojust get out of the city for a
little bit.
Matt Boettger (00:44):
That's awesome.
Good, good, good.
My weekend was spent dealingwith sciatica.
I was telling Stephen, this hasbeen fun.
I'm 43 years old.
I'm getting old apparently.
And so now I've got some sad.
I got problem.
I didn't do anything strange orcrazy.
I just got it.
So I don't know how it happened.
And so it's been fun.
It's been a great, I just don'twant to sit down.
Don't want to lay down.
I wish I could sleep standingup.
That'd be a great, great thingto do.
(01:04):
Or like a little bat upsidedown.
So that's been mine but it'sbeen beautiful here, beautiful
weather.
And it's good to go outside withthe boys and do more things, all
that great stuff.
And I hope you guys arelistening and having a wonderful
summer as well.
And can you ready for awonderful 4th of July, for those
of you who celebrate it here inthe U S.
But let's get going here.
So a couple of things reviews,love them.
We just got another one lastweek was awesome.
(01:24):
Thank you so much.
I wanted to read that, but Iforgot to put it in the show
notes.
I'll do it next time around.
Just has I'm remembering Stephenis going to be gone next week.
So we'll probably either skip,just let you guys know ahead of
time or if I can get thiselusive, I don't know what his
name is again.
Mark Kissler.
Is that Dr.
Mark?
If I get him actually on theshow again, maybe we can, we can
have another episode, but he isone heck of a busy man.
(01:46):
This is.
If you want to support us, we'dlove it helps us just keep us
going a cup, a cup, pick a fewcents in our pockets, help to
automate things and allow us tocontinue to move this forward.
That's at patrion.com/pandemicpodcast, or one-time gift
PayPal, Venmo all in the shownotes.
So I want to start with this.
This is kind of not necessarilyCOVID related Stephen, but I
(02:08):
just want to get an idea of how.
You know, global warmingeffects, your research and
infectious disease.
Cause the reason why I'mthinking about this is I just
saw of this on the news.
Like three days ago, I was likea record temperature.
I couldn't believe like pork.
I don't know if you saw thisStephen like predicted, I don't
know if it hit it like 114degrees and Portland, Oregon,
(02:29):
and Seattle was supposed to getupwards of a hundred, which is
this is not like 10 to 15degrees is 30 to 40 degrees over
their normal highs.
And so this is got me thinkingof how does an increase in
temperature globally affect likedisease, you know, in my mind,
Does it make it worse?
Does it make it less?
(02:49):
I'm sure it's complicated.
Like everything.
Cause I'm thinking, oh, youknow, winter time and it's when
it gets really difficult for us.
And so my goal when it gets coldor maybe it gets worse and when
it gets warmer, maybe thingswill be generally better.
But is that I'm a guessingeverything is a nuance.
There's no black and white, butwhat, how do you approach this
when it comes to future disease?
Stephen Kissler (03:07):
Yeah.
So there's this is a greatquestion and something that a
lot of epidemiologists areworking on right now is the
intersection between climatechange and infectious disease.
So, I think I, you know, thereare a couple of different levels
that we can take a look at thisquestion, and I think I'll sort
of step from maybe the mostapparent ones down to some of
the, maybe more surprising onesas well.
(03:27):
So.
Of course, one of the issueswith global warming is as the
name says, you know, places getwarmer.
And so one of the things that wewe are already beginning to see
and we'll probably continue tosee is that the regions were
Yeah.
Basically the, the tropicalbands of the climate tropical
(03:49):
bands of the world that aregenerally the middle latitudes
are starting to expand outwards.
And that hasn't effect on acouple of different ways.
So first of all, Differentinfectious diseases frequently
behave differently in tropicalversus temperate parts of the
world.
So flu is the canonical examplewhere in temperate regions of
the world we see majorwintertime outbreaks of many
(04:11):
respiratory diseases whereas inthe tropical regions of the
world where seasons are not somuch spring, summer, winter,
fall, but more rainy and dry.
The, the whole.
Pattern of flu outbreaks andother respiratory illnesses is
just different.
Tends to be a lot more sporadic.
Still can be linked to theseasons, but again, the seasons
(04:32):
look very different there thanthey do, for example, up here in
Boston.
And so what we're starting tosee is, is there sort of, the
latitudes where that regionexists are starting to expand,
and it's going to be interestingto see what effect that has on
the overall seasonality ofrespiratory illnesses, the
severity of respiratoryillnesses.
Cause In, in some ways havingoutbreaks asynchronous can be
(04:52):
helpful in a way, because wheneveryone's susceptible and then
gets infected in one bigexplosive outbreak that actually
tends to cause more cases thanit does when people are sort of
getting infected at a low levelover time.
That's certainly not an argumentto say that global warming is a
good thing because we actually.
No, what some of these effectsare going to be.
One of the other things thathappens when you have this
(05:12):
expanding latitudes of sort oftropical regions, is that a lot
of the vectors that carry otherinfectious diseases that are
especially problems in tropicalareas of the world, especially
in mosquitoes.
They're starting to expand theirhabitats outward as well.
So that's part of why we wereable to see, for example, sort
of more widespread outbreaks ofZika virus a few years back
because the range where thosemosquitoes that carry that virus
(05:33):
can thrive are wider than theyused to be.
And so we're going to start tosee outbreaks of infectious
diseases like malaria, forexample, in places that haven't
seen them for many years, wewe've started to see outbreaks
of malaria in Southern Italy,for example, which had
eradicated malaria for a verylong period of time.
So this is going to start tobecome a reality.
We're going to see infectiousdiseases that certain parts of
(05:54):
the globe have not seen in avery long time start to
research.
So that's, that's one key areathat we're thinking about, but
of course know global warmingYeah, we, we think about it in
terms of warming and a place isgetting hotter, but actually,
you know, one of the biggestproblems with global warming is
not so much the increase intemperature, but the increase in
variation in the types ofweather systems that you get.
(06:15):
So you generally get strongerstorms, you get hotter hots, but
you also tend to get coldercolds as well.
And so it just makes sort of thewhole weather system a lot more
variable.
And so one of the issues theretoo, is that, of course for
season.
Infectious diseases in placeswhere that, that do remain
temperate, you might actuallysee much more severe winters and
much more severe summers, whichcould actually drive that
(06:36):
seasonality even stronger.
Um Hm.
And then.
Digging one layer deeper intothat.
One of the things that I'm mostconcerned about is that we've
definitely seen and we'rebeginning to see, and I
anticipate that we'll continueto see big increases in the
severity of tropical storms,hurricanes typhoons, cyclones,
you know, things that can reallydevastate coastal community.
(06:58):
And so, you know, one of theother big issues is that we're
going to start to see infectiousdisease crises that follow along
when these things hit short.
So a number of years back we sawthere was a major hurricane that
hit Haiti and the DominicanRepublic.
And following on from that foryears, they've been having a
really difficult timecontrolling cholera because that
affected their water treatmentsystems.
(07:19):
And so there's been this hugecolor outbreak that has been
spreading there as a result of ahurricane that, and so as we
start to see coast lands,getting flooded, different
infrastructures are going tocause you know, start to
collapse.
We're going to see peopledisplaced, which also causes
sort of the spread of pathogens.
And so there's a lot of reallybig issues that are going to
follow along from this thatinclude.
(07:41):
Diseases spread because of thechanging weather, but also
include the very humanitariancrises that are going to follow
along from global warming aswell.
So it's, it's hard to overstatehow huge of an issue this is and
how it will touch infectiousdiseases and every other part of
our lives in every way.
But yeah, it's not to be youknow, I, I feel bad starting off
the podcast on this note, itseems so bleak.
(08:02):
It is the, you know, there's, wehave a lot of lecture to sort of
get this.
Matt Boettger (08:07):
Yeah, I'm assuming Stephen did didn't do
you work much with like climatechange specialists there, or do
you kind of your own bubble?
Given that you know, what you doseems to touch almost every
dimension of reality.
Do you have like little groupsby what you kind of talk about
the future of global warming andhow people are, how best to
(08:27):
handle it?
Or how does that work for youwhen it comes to
Stephen Kissler (08:30):
collaboration?
Yeah.
I currently I'm not working withany climate scientists.
Although I've Back when I wasstudying for my PhD, I did a
little bit more.
So, many of my colleagues arefor sure.
There's a lot of crosstalkbetween climate scientists and
epidemiologists economists andepidemiologists.
That's one of the areas thatI've been sort of doing more
(08:50):
interdisciplinary collaborationbehavioral scientists and
epidemiologists.
So oftentimes, it's reallydifficult.
Have any sort of expertise inall of these rooms at once.
So frequently epidemiologistswill sort of pick one or two
that I think especially relatedto the work that we're doing
and, and try to dig into thatand develop collaboration's
(09:10):
there.
But absolutely there, you know,since climate change is such a
huge issue, there are a lot ofus who have been who have been
talking with climate scientistsand really thinking deeply about
yeah, about what these changesare going to mean for the
landscape.
Matt Boettger (09:24):
Sure.
You know, this is we're gonnachange subject now, but I feel
like it's kind of related.
I kinda, it's kinda hard to putmy finger on this, but there's
this other article and it talksabout, but it's it kind of maybe
in a metaphorical way it'srelated this man believed to
have longest COVID 19 infectionhad virus for 300 days.
So why do I think this isrelated?
Because I feel like in somesense with global warming, no
(09:45):
matter how much the world beginsto have its own ecosystem in the
end, And how it corrects itselfin the end, there is.
Dependency and responsibility onus to be able to help it be able
to not go into an extremeweather cycle or whatever.
And so the same thing for this,where this is what's fascinating
to me because this guy had itfor 300 days.
(10:07):
It was like, whoa, that'sinsane.
How did that happen?
The article, obviously rightaway.
Pop that bubble from bill, yougot freaked out about, oh my
gosh, can people just spread itfor 300 days?
No, this was just an individualperson who had a severe immune
compromised body cancer, thatkind of stuff.
So that kept the virus alive fora long period of time.
And I want you to speak in thisfor a second, because this was
(10:28):
like a revelation to me on maybeat least the current technology
that's give that's provided forus that no matter how much
medicine future technology thatwe have to have.
Bring health to someone whosick.
In the end, the buck stops withus because I realized, oh, this
person just couldn't receive thetreatment because their body,
(10:51):
the body itself, wasn't able towork with the treatment.
Like, wow.
At some level we can really putour hope in technology that it's
going to cure every disease, butat least, at least at this
moment, this is a perfect caseby which the body has to have at
least a baseline by which tonegotiate and work with the
future technology to bring abouthealth.
That just was kind of roadleverage to me the, again, going
(11:13):
back to the public healthmandates of the future
technology is great, but at thesame time, we've got to keep
ourselves as healthy, aspossible to work with technology
and not have it be kind of likea substitute for our bad
behaviors and bad.
Stephen Kissler (11:25):
Yeah.
And to be clear, like certainlybeing immunocompromised does.
Relate to necessarily badbehavior or like any person's
fault.
People are certainly born withthese conditions.
Cancer is cancer is no one'sfault.
And, and so, you know,certainly, you know, maintaining
our health.
Is a good thing to do and, andhelps, you know, not just with,
(11:47):
with the standard things ofpreventing you know, reducing
our risk of cancer and obesity.
But also then the downstreamconditions that follow along
from that, which included thatoutcomes from infectious
diseases.
So I, I do have a lot of hopefor the technologies, the
medical technologies that willdevelop in the future.
And, and that hopefully, youknow, we will find ways to help
people with who areimmunocompromised too.
(12:10):
To improve their immune systemsto, to have, you know,
immunotherapy to to findvaccines that work for them.
There's been some recent studiesthat suggest maybe a third dose
of the MRN vaccines actually doprovide a substantially higher
immunity for people who are,have certain immunocompromised
conditions.
So that might be an approach isto just sort of keep exposing
them repeatedly to to thevaccines and that, that, that
(12:32):
might help.
So I think this is a reallyactive area of research.
You're right as well, that thaton, on sort of the population
level too.
And I think we'll probably getinto this in some of the topics
that we'll talk about in a fewmoments as well, but we can we
can play so much of our trust intechnology.
And I've seen this, especiallyaround the vaccine, sort of like
seeing the vaccine as this magicbullet that will get us out of
(12:53):
the COVID problem.
And that's clearly not the case,too.
Right.
We're seeing spikes in cases, inplaces around the world and.
Again, since people arevaccinated, these rises in cases
don't matter, certainly meanwhat they meant six or eight
months ago.
They're not translating intohospitalizations and deaths at
nearly the same rate that theydid then.
So the vaccines are definitelydoing.
What they were intended to do,but they're also, you know,
(13:15):
COVID is still clearly here andthere are other things,
including, you know, basicprevention measures that are
still important alongside thevaccine.
And you're right.
You know, like in the long-termone of the things we talked
about on a previous episodes wasjust like how the United States
in particular does have reallyhigh rates of obesity, heart
disease, diabetes Some of thesethings, which are, you know, are
(13:38):
genetically linked, but are alsoto some extent behaviorly
linked.
And so, you know, what can we doto maintain a healthy society,
to the extent that we're able,if you're predisposed to
diabetes and obesity how can wehelp those people out a little
bit extra?
Because they're going to have anespecially hard time keeping
their weight down and then.
You know, make, make themespecially vulnerable to future
infectious diseases, to, youknow, how do we you know, treat,
(13:59):
treat the whole person and thewhole body and not just rely on
sort of these technologies thatcome through and save us in a
time of crisis.
I think that that's a huge, hugething that we're gonna, I have
to think about for the future ofpublic.
Yeah.
Matt Boettger (14:11):
Yeah, no, thank you for correcting my
oversimplification.
Yep.
Totally.
With the immune compromise.
That is not anybody's fault.
I'm just thinking about back inmy nineties days.
I We're trying to lose weightand there was these, these pills
you could take that actuallywould make you feel full.
So you don't have to eat.
I'm like, that's like the cheapway, right?
It's not trying to actually workand actually being healthy, but
taking some kind of chemicalpill to make you actually feel
full.
So then you don't overeat them.
(14:32):
These are the things that weneed to really work on general
health.
No, thank you for that clarity.
Okay.
So let's, let's, let's get intothis now.
So, with the Delta, the variantwe're seeing now, I last week I
saw a lot of articles about thiskind of, I a little bit of
dramatic stuff going on andmaybe not fear-mongering, but
just showing a lot of risingcases everywhere.
(14:52):
We're seeing the Delta COVID theDelta variant being really taken
over California.
Not necessarily in the sense oflike surges, but just that it's,
it's dominant.
It's now I've thought it waslike 1% now it's like 15% or
more than that.
Within California being theDelta variant, Missouri seen a
surge of the Delta.
It seems like the Delta variantscontributing to that.
(15:13):
We're seeing Africa now.
Or you said you're mentioningeven the UK is starting to see
Israel, you know, at 87%vaccinated is starting to see,
you know, quota, surge.
Now we can talk about that rightnow, or in a little bit about
how the a hundred cases thatthey've received a day.
Half of those coming fromchildren who are vaccinated, but
surprisingly the other halfLisa's one article is saying is
(15:35):
coming from vaccinated adults.
You know?
So these are these breakthroughoccurrences, you know, maybe you
can.
On all of this had one level ofwhere you see things both as the
Delta variant kind of takingover certain areas and how we're
going to continue seeing thesehops.
But also this idea of thebreakthrough hot pockets.
Oh man.
(15:56):
I'm 43.
Those were the most deliciousthing ever.
That's a, yeah, that's a gooduse of hot pockets by the way to
talk about that.
If those hot spots, right.
And as well as this Israeldealing with these a hundred
cases, 87% vaccinated.
So it's going to land on a fewand what that means for the
brain.
Stephen Kissler (16:16):
Yeah, right.
So, I think that we can sort ofthink about this on two
different levels where, youknow, one there at many
countries around the world wherevaccination rates remain very
low.
And so in those contexts, youknow, then it's there's not so
much a question as to, you know,why, you know, why, why is it
spreading there because it'ssort of the same.
Song and dance in a way whereit's like there, it just happens
(16:38):
then.
And, and we, you know, we, we dohave the Delta variant on our
hands, which is as we mentioned,I think in the last episode far
more infectious potentially isable to get around some level of
underlying immunity anyway.
And so it makes a lot of sensethat places who don't really
have much immunologicalprotection from the vaccine or
from a lot of previous spreadwould be susceptible to rises in
(16:58):
cases right now.
So that's one thing.
Then we w we certainly have theexample, places that have higher
vaccination rates as well.
The, you know, wha why is theDelta variant starting to spread
there too?
So, sort of ticking these off ww one by one, if, if we're able
I think also, as we've mentionedbefore, you know, vaccination
rates It matters a lot on, itmatters a lot, sort of what
(17:21):
geographic scale you look atthem on.
So across the United States, wehave, I think on the order of
almost 50% of people fullyvaccinated, something on that
order.
And and more than that, who havereceived at least one dose, but
of course that varies hugelyfrom community to community.
So a lot of places where we'veseen outbreaks of the Delta
variant now are still hoveringaround 15, 20% vaccination
(17:45):
rates.
And so there's still a lot ofsusceptibility there too.
And of course there's stillCOVID circulating in the
community.
Like there are still casesspreading around.
And so when it finds a placewhere it's able to.
It's going to spread.
And so that, that makes somesense, but of course, you know,
there's, as you said, there's,we are still seeing cases, even
in vaccinated people.
(18:05):
We are still seeing cases inplaces where we do have high
rates of vaccination.
And so what's going on there?
On the one hand it's, again,still, it seems like the
vaccines are working as, as wewould expect, right?
Like the, the vaccines arehighly effective, but again,
they have 95% of effectivenessagainst symptomatic disease.
Against the sort of vanillavariant, you know, pre this was
(18:29):
even pre-alpha variant that mostof the MRN vaccines were tested.
And so we will see somebreakthrough infections it's
going to chip away at thateffectiveness against
symptomatic disease.
It will chip away probably evenmore against the effectiveness
against asymptomatic disease,which was already a little bit
lower in the first place.
And so we're going to startseeing breakthrough infections.
We're going to start seeing theDelta variant takeover, even in
(18:51):
places that do have higher ratesof vaccination, including
California.
No matter what your rates ofvaccination are, the Delta will
start to displace whatever wasthere, because it's just so much
more that.
That's just the way thatevolutionary biology works.
It's, it's going to start makingit more and more of those cases,
even if it doesn't necessarilycause surges.
And that sort of brings us tothe UK, which has had a pretty
good vaccination rolloutprogram, but is starting to see
(19:14):
both, you know, the majority ofcases made up by the Delta
variant and a rise in cases inmany places.
Nope.
The UK similar to the U S has alot of heterogeneity in
vaccination rates within thecountry.
Some places are very highlyvaccinated.
Some are still have very lowrates of vaccination.
But we're starting to see risesin cases, again, I think the,
(19:34):
the main point to underscorehere is that it's not totally
unexpected, although it'ssomething that we're watching.
You know, very closely.
I want to see how this sort ofplays out, but by and large, you
know, again, people who arevaccinated are very well
protected against severedisease.
And so even if the variant isable to gain a foothold, even if
it's able to spread, it's nottranslating into
hospitalizations and deaths atnearly the rate that that
(19:57):
previous variants were in thepre vaccine era.
So, you know, this is, this iskind of something that we've
been saying for over a year now,which is that, you know, we're,
we're going, we're going to beliving with COVID for a very
long time.
And we're sort of in thisawkward transition period where
hopefully it's transitioningfrom this pandemic, awful
(20:17):
disease to something that ismore like a wintertime
respiratory virus.
And we're still going to seethese sort of surges of
infection at different times ofyear until things sort of settle
out.
It's going to take a littlewhile for that system.
Settle into its normal, youknow, pattern of, of, of
seasonal outbreaks, which iswhat I imagine will probably
happen.
(20:37):
We could be surprised it mightbe able to spread outside of the
winter and for a long time tocome, but it's, we're, we're
still in that transition period.
So, so none of what we're seeingis super alarming to me.
Although it is, you know,something we need to pay close
attention to because, you know,if we do start.
Really big rises in cases, forexample, in the UK or in Israel.
And if those do starttranslating into
(20:58):
hospitalizations and deaths,which I don't anticipate that it
will, but if it does in thatremote possibility that it does,
then, then we got some more workon our hands, you know, we've,
we've got to continue figuringthis out.
But for right now you know,watching it with curiosity, but
definitely not paying.
Matt Boettger (21:15):
Yeah.
Yeah.
Great.
And to put things in thecontext, just to say from the
CDC, if this is like 4,100cases, total so far in the U S
that have led to breakthroughsand hospitalization and, or a
death.
And now those, like, I think itwas 3,900.
Have been hospitalized in athousand, it was 3,900 were
asymptomatic and reallyunrelated to COVID-19.
(21:37):
The CDC says as well as 750fully vaccinate people have also
died.
I think most were the age ofover 65 in that situation of
those seven hundred fifty, ahundred and forty two of those
were again, asymptomatic and notreally.
Directly court, you know,correlated to covet.
So just shows how small thepercentage seems to be going
quite accurate with what wethink of between 94 to 90 and
(21:59):
88% with effective with theDelta variant, with Pfizer and
Madonna.
Stephen Kissler (22:04):
Right.
And ever since that part withall that.
Yeah, that's perfect.
I.
Amend the previous statementwhere I said that I'm not
particularly concerned and that,and that really pertains to
highly vaccinated.
I am deeply, deeply concernedabout it may happen in places
that don't have higher rates ofvaccination yet.
Because, you know, especiallywith the Delta variant, we know
that it could potentially bemore severe as well.
(22:25):
So I think this reallyunderscores the super urgency.
Sharing vaccines of getting asmany places around the globe
vaccinated as quickly aspossible, both for their own
sake, for the sake of the globalpicture.
Because again you know, and youknow, I'm, I'm sitting up here
in Massachusetts where we havevery high vaccination rates and
cases are very low right now.
So, so in that context I'm notparticularly concerned for this
local community, but we do havea massive global problem on our
(22:49):
hands.
And I just want to underscorethat and not be too blessing
about any of that.
Matt Boettger (22:52):
Yeah.
That's important.
Yeah.
But yeah you know, we weretalking about just like Africa
is that 1% vaccinated right now.
And they're seeing a pretty bigsurge in this could be really.
Destructive for Africa and a lotof these countries who don't
have the resources like we do tobe able to roll out such a
vaccinated effort across thecountry.
So let's keep going with thisDelta thing.
What do you think about this?
I read this, I read this articlekind of got me, got me really
(23:15):
interested about Delta Varian.
Can spread within five to 10seconds of exposure.
So that was like, whoa, thatfreaked me out because of
course, you know, we've talkedabout this, the, it was 10 to 15
minutes or 15 minutes ofexposure.
We've we've oh, we've evolvedthat over time that it's not 15
minutes in individualincrements, but it's a total of
15 minutes over a period of day,you know, over one day.
(23:35):
I know we in the U S really likenumbers and algorithms to know
exactly what we can do, so wecan basically go, go right to
that line and have our freedomand then not cross that line.
So is this something that's.
Quantitatively and qualitativelydifferent with a Delta.
Very, that is just so bad thatif I'm with someone for five
seconds I'm toast or help kindof part this in comparison to
(23:56):
the previous 10 to 15 minuteone.
Stephen Kissler (23:57):
Yeah.
So I think this was, this wasgreat.
So, it's so tricky because weEssentially, I think that the
danger that we have ininterpreting these numbers is
that we're sort of comparing twothings that sound similar, but I
think in fact are not.
So the 15 minute rule sort of isa question of Of average of
central tendency of roughprobabilities where for the
(24:22):
previous COVID variance, it wasa rough sense of what's safe.
Maybe 15 minutes of exposure ina room with somebody who has
COVID is Where you cross somethreshold of of likelihood of
getting of getting infected withCOVID-19, but we're then
comparing that with what I thinkis in, in this other study,
which is a lower bound, which isbasically how quickly could you
possibly get the Delta variantand it's within seconds, that,
(24:44):
that was true previously too.
Like you, you could get infectedwith COVID no matter what
variant if somebody who isactively infected.
Coughed in your face, like thatwould take right there done, you
know, like you've got onesecond.
And so, yeah.
So I think that it's one of thethings, and this was a lesson
that I'm continuing to learn,even as a trained epidemiologist
(25:04):
is just how much contextmatters.
And, and sort of what's aroundall of these statistics because
they become totallyuninterpretable unless we know
exactly where they weremeasured, how they were measured
what question they were aimingto answer.
And so.
You know, that's, that's notjust, you know, it is true that
the Delta variant is absolutelymore infectious.
And I do imagine that, you know,if you're comparing, like with
(25:25):
like situations in one roomwhere you might've gotten
infected in 15 minutes with the,with the vanilla variant, I
don't even know what to call it.
The it's it doesn't even havethat Greek letter, but it's just
like the standard coronavirus.
Right.
Maybe you'll get infected withDelta sooner.
How much sooner?
I don't know.
Maybe 15.
You know, we, we can, we canroughly work some of these
probabilities out, right?
(25:45):
If we think that Delta is maybetwice as infectious as the, as
the standard variant, maybe ittakes half the time, something
like that.
But there's some sort of weirdscaling, you know, 15 to seven
minutes maybe is probably a moreaccurate sort of comparison
there.
But of course, you know, noamount of time is perfectly
safe.
Also no amount of time is aguarantee that you'll get
infected either you could, youknow, we've absolutely had
(26:06):
people, you know, spend long,long periods of time in a room
with another person who'sactively infectious.
But if there's ventilation, ifthere's masking that might
reduce the probability ofinfection down very low.
So all of this matters hugely,definitely the Delta is more
infectious and that doestranslate into a shorter period
of time on average that it willtake for a person to become
infected with Delta.
But I don't think that it'sshifted.
(26:28):
Tens of minutes to tens ofseconds.
It's probably, you know, tens ofminutes to maybe 10 minutes.
Matt Boettger (26:36):
Great.
That's helpful.
It puts into perspective andthat that's totally right.
I It's always important to seethe context.
I forget it all the time you getthese articles, like one is the
average one is like as soon asfive to 10 seconds, which of
course that was in the old wayas well.
One small thing again, before wemove on from the Delta, even
though it kind of permeates allof our discussions in one way or
another.
There is this Delta plus veryend for those of you heard of
(26:57):
it, don't worry about it.
House, put this article in theshow notes.
It's a, I don't know any ofthis.
I'm just going to read thejargon.
There's one small mutation.
It's called the K 4 1 7 9.
And apparently that is a, anumber of other variants.
So we can know that as being aninsignificant mutation compared
to what the Delta already.
So no need to be alarmed.
If you see this in the news,it's not that signal.
(27:20):
Whatsoever.
Okay.
So if there's two articles youguys read who are listening
right now, these are the biggestarticles I want you to read.
I'm going to throw these pastStephen because the first one is
this they're both from theAtlantic.
You're probably thinking Itotally just am biased.
The Atlantic.
I don't mean to be, I justhappened to just read it and I'm
like, this is really good stuff.
I don't, I, it could, you could,it could be one it's like blind
coffee tasting tests, and I'dstill end up being with the
(27:42):
Atlantic because I just likedthe way it's written and it's as
well done.
Both of these are from theAtlantic.
I'm sorry for not beingdiversified in my articles, but
this is, are we ready foranother pandemic?
This is a must read everyone.
Please check it on the shownotes, read it, but there's so
much good stuff here aboutbasically we're not, and the
reasons why and what we couldhave learned from the previous
one.
But instead of rehashing this, Iwant to throw it to you,
(28:04):
Stephen.
And thinking about going forwardfor the next pandemic, which is
inevitable.
If there was the top threethings that we w we at least,
maybe not globally, maybe a topthing globally, and three things
in the U S that really needs tohave a fundamental change for us
to be able to appropriatelyhandle the next pandemic.
What would they be?
Stephen Kissler (28:26):
Oh boy.
It's going on three differentdays and you'll get three
different answers and that's twodifferent epidemiologists and
none of them will agree, but butI think part of that is just
because there's, there's so muchto do.
And it's hard to, it's hard tosort of prioritize, but there's,
you know, there's one of thethings that this pandemic has
really done is sort ofunderscored that something needs
to be done.
And and I think that we're sortof actively working on sort of
(28:48):
what that needs to be.
So yeah.
If I could take a stab at ananswer at this I think that one
thing is changing the way thatwe do surveillance and
communicate about aboutpotentially emerging biological
threats and that's That soundscomplicated and it's actually
even more complicated than itsounds.
Because so one of the issues isthat, you know, we we see
(29:12):
spillovers of infectiousdiseases from animals to humans.
All the time.
There's a, and actuallyspillover is probably not even
the right word for it.
We, we share infections withanimals all the time.
We, we, we acquire infectionsfrom poultry, from pigs, from
whatever.
(29:33):
But we also give them infectionsbecause there's a lot of them
you know, we flew is a greatexample where, you know, we're,
we're infecting pigs with oursor flu all the time.
And vice versa to some extent,you know, and, and the same is
true for other, you know, otherinfectious diseases and other,
other animals, other animalreservoirs.
So I think we need to doprobably more.
(29:53):
We need to understand the humananimal interface a little bit
better.
We need to understand sort ofwhat circulating in animals
what's circulating in humans.
What are the things that havepotential to spill over?
But I think that this is areally difficult problem because
not everything, not everyinfection that a human gets from
an animal.
And it's going to cause apandemic actually, you know,
the, the number is thepossibility that any given
crossover does cause a pandemicis extremely, extremely low.
(30:15):
And really all we end up seeingare these catastrophic events
where we do see a globalpandemic, but we forget that
this happens all the time.
So actually figuring out, youknow, not only what's
circulating there, what'scrossing over into humans, but
actually what are the thingsthat we actually need to be
concerned about and how do webecome concerned about them
quickly enough to do somethingabout them, but without
following up every second, Leadand completely exhausting
(30:36):
ourselves chasing our tails is areally big open problem.
And I think that's somethingthat we're going to need to
think about sort of as a globalpublic health establishment.
Okay.
But what does that mean forthose of us who are not
epidemiologists?
And for, you know, who are, youdon't want to live through
another COVID 19 But also aren'tgoing to set up some global
immunological observatory.
(30:57):
That's going to test animal, youknow, if that's true for sure.
Further antibodies.
So I think that there's I don'tknow how this works, but I think
that sort of working on figuringout how to Just emphasize the
importance of preventivemedicine is going to be really
key.
I think here in the UnitedStates, especially we have the
sense of sort of, prioritizingcrisis care over preventive
(31:19):
care.
We prefer to take a pill whenwe're sick than to do something,
to keep us from getting sick inthe first place.
And you know, that's.
That's an oversimplification,but, but certainly I think that,
that we could put more emphasison, you know, what does it mean
to keep ourselves healthy?
And what does it mean for us tobe agile, to an infectious
disease that's beginning tospread?
(31:39):
How do we build theinfrastructure to actually have
the supplies for testing?
How do we build theinfrastructure to regulate.
Tests and new diagnostics andthings that need to be rolled
out in a crisis period becauseour whole system is sort of
based off of a non-crisisperiod.
So how do we, how do we buildthe resiliency into the FDA?
How do we build the resiliencyinto our government?
(32:00):
How do we build the resiliencyinto our individual behavior so
that we can adapt to these sortsof things much more quickly?
I don't know the answers to anyof those questions.
I think I have more answers tosort of the regulatory and
government level things than Ido to the individual level
stuff.
But I think that that's that's abig, big question is like, how
do we just sort of become moreaware that these threats are
going to continue happening andhow do we as individuals sort of
(32:21):
incorporate that into our liveswithout sort of being crushed by
this reality.
But, but recognizing that youknow, in some ways, I think that
it's a corrective in the rightdirection where we can we can so
easily sort of partition illnessand sickness and death into some
corner of our lives and, andforget that we're not immortal.
And I think that this pandemichas been a real wake up call
that, that, you know, in fact weare, and actually that's been a
(32:44):
very clear realization for muchof human history, but really
we're kind of living in an oddperiod where we've been able to
kind of ignore that in, in manyways and very well resourced
countries.
So, so how do we sort ofreinforce.
This healthy notion of arephysical limits, this healthy
notion of our limited tenure oftime on this earth.
Without, you know, this is, thisis not a morbid thing.
This is actually, you know, thisis just sort of a realistic and,
(33:07):
and I think a joyful thing thathelps us to live our lives more
fully in the moment anyway.
But how do we, how do we dothat, grace?
Given all of the promise thattechnology has given all of the
ways that we've set up oursocieties to make it so that we
can basically ignore this factwhat do we do?
I don't know, but I think thatthat's, that's sort of the area
that I think we're going to needa lot of work in the coming.
Matt Boettger (33:25):
Good.
That's that that's helpful.
That's great.
Remind me, or just makes methink of just the idea of the,
the kind of like the tomorrowbias that we not only as an
individual, but obviously as asociety we're we're so prone to,
just to be in humans where meindividually, tomorrow me is
always going to be moreproductive, more.
I'll start my diet tomorrow.
I'll be more productivetomorrow.
(33:46):
I'll sleep, I'll sleep intomorrow.
I'll, you know, I'll be kinderto my spouse and my kids
tomorrow.
And then today, just because,you know, there's a laundry list
of the reasons why I just can'tbe that person that I want to be
today because of the worldaround me is just putting
pressure on me, whatever it is.
And it just has that cycle hasto stop it.
Not to go on kind of aphilosophical reality, but it
(34:08):
just restarts with theindividual, me of look, I've got
to start and I want to show mykids this as well.
Terrible at this, that no, thebest person who can do this
work, the best thing I can do isprovide the best value for
myself and the value that my, myfamily today and stop getting
this vicious cycle of waitinguntil tomorrow.
Before I do that thing a littlebit better do better today.
(34:32):
Get myself, you know, tomorrowI'll start my walks.
No, if I say that and then thatmeans I have to double my walk
today.
I'm going to go out for a walktoday.
If I get tempted down thatroute, then the consequences.
And now I have to double my walkor double my salad and not
having that piece of bread orwhatever it is because I've got
to teach myself that today isthe best day to change my life
and not tomorrow.
And then of course, that justturns into.
(34:53):
Government social.
We always want to postpone theinevitable to the future, but
we've got to start by theindividual level as well.
That's great.
Okay.
So read that article in theAtlantic.
It's so good.
Second article is, I think thisis when we're going to end on
this is big because this waslike a game changer for me as I
read this, because we've talkedso much to even about the
efficacy of the MRN, and I'vebeen pushing you to talk about
(35:15):
its nuances and it's okay.
Future and what's gonna provideand how I feel like it's going
to save the world.
And then here Atlanta comes andbust my little bubble about MRNs
saying, look there, this, thisarticle is titled Novavax is now
the best COVID 19 vaccine.
So they're basically comparingNovavax to the MRNs and just
saying, look, we are giving anunfair advantage.
(35:38):
To the MRI and a vaccine thatwe're not seeing a clear picture
at the end, they definitelyhallmark MRNs.
They know this is a greattechnology.
I'm not, they're not saying thisis bad.
There's setups.
And I want you, I want you torespond back to this.
Their set up is look, marinadebecame the premier vaccine
really by accident because.
Basically Pfizer took bio.
(35:58):
I think it's BioEnTech orwhatever it is, took that and
allowed that big corporation tohelp them move needle forward.
And they happened to be able togo through their phases during
really big outbreaks, whichallowed it to expedite.
And it was the outbreaks thatexpedited their, their MRI and a
vaccine to come to reality.
And that said, look, there werenine M RNA vaccines out there
(36:20):
only two males.
Right to the real world.
Whereas here in the Atlantic,suggesting look, 13, non Emrani
and vaccines have made itthrough trials and going through
the periods.
So it's not inherent to MRMAthat it's success, that it's
like 95% accurate.
That's not inherent to MRMA.
That's just happened to be acircumstance.
And they're looking at, Novavaxsaying no, the vaccine is a
traditional vaccine.
(36:42):
That probably has a higherpercentage because it's 90% in a
current situation.
Whereas it was closer to 96%back on the early.
The, the, the, the, the firstthe coronavirus.
So all that being said, and thebase of the article is saying,
look, Novavax is traditional.
Probably wouldn't have scared.
As many people MRMA scare a lotof people.
It was new.
It has higher side effects thanthe traditional Novavax one.
(37:06):
The Novaks is the real winner,and that we're really giving an
unfair advantage to the MRMA.
Can you speak into this?
What's what's what's mayberesonates with you and what
maybe might be new.
Stephen Kissler (37:16):
Yeah, I think, I think this is super
interesting because in someways, you know, this this sort
of commentary about the vaccineis like totally predictable and
good is essentially what the,what the Atlantic is doing is
they're getting ahead of thecurve on the hype cycle.
Are you familiar with the hypecycle?
No, it's this, it's this idea.
I look it up on Wikipedia.
It's they've got this nice sortof graph of it.
(37:38):
And it's sort of, it has theseaxes of basically enthusiasm or
expectations for technology.
It's time.
And as you move forward, youhave this new technology and it
just spikes at the verybeginning, everybody's super
excited about this newtechnology.
It's going to save the world,it's going to do everything it's
going to, you know, and then itplateaus.
And then you reach this sort oftrough of disillusionment as
(37:58):
they call it.
Or it's oh no, you know, we'vetried applying this to a new
problem and it's actually notworking and it's more
complicated than we thought.
And then actually it picks upagain and then you reach sort of
this plateau of realistic.
Appropriate use of a newtechnology, right.
Where it's it's no longer asgood as it sounds like.
Matt Boettger (38:15):
That sounds like it sounds like dating Stephen.
Stephen Kissler (38:19):
Yeah.
I guess that's true too.
Matt Boettger (38:20):
Best foot forward.
Best foot forward.
Oh.
We realize who we really are.
We're broken people and weplateau.
Okay.
We love each other for who weare now, right?
Yeah.
Stephen Kissler (38:28):
There you go.
Exactly.
It's like deep, deep,psychological realities here.
Totally.
Yeah.
So I think that this is, this ispart of what's happening here,
but I think we can break it downspecifically with respect to the
MRN vaccines and the othervaccines that we have available.
So I love this point that thearticle brought up that you just
mentioned about how had thisNovavax vaccine been trialed at
(38:54):
the same time as the MRNvaccines, it might have actually
had higher efficacy.
And so I think that what thisreally underscores is that these
numbers of efficacy.
Fixed numbers necessarily, youknow, they're like, like we were
talking about before they'recontext specific, we need to
know sort of how they weremeasured when they were
measured, why they were measuredand, you know, vaccines that are
being trialed now are generallybeing trialed against variants
(39:18):
that didn't exist six months agowhen some of the earlier
vaccines were being trialed.
And so if we're comparing like,In the current conditions.
Yeah.
They, they do seem to be prettywell on par.
Of course there's somestatistical uncertainty in here
too, you know, depending onwhich geographic communities
you're you're measuring this injust, you know, how many cases
do you actually see?
Right.
(39:39):
You're absolutely going to getsome statistical variation in
these numbers as well.
And so, my sense is that theconfidence intervals for these
efficacy rates given the currentconditions do overlap pretty
well with Novavax versus the MRNvaccines which is great.
Other things to speak into here.
So, I do still think that theMRN vaccines that Absolutely in
(40:00):
many ways, there was luckserendipity behind why they sort
of were the first ones throughthe gate and why they were so
effective.
Some of it is, does pertain tothe technology itself though,
too, in the sense that you know,the, the modern of vaccine.
And I think, I think the Pfizervaccine as well, We actually had
vials of it within days of whenthe sequence of the the
(40:23):
coronavirus was first published.
Now still had to go through lotsof testing.
Many other companies also hadvials of a coronavirus vaccine
within days of that sequencebeing posted.
But those ones didn't actuallyend up performing very well or
they had two severe side effectsor whatever.
So, but one of the greatadvantages of the MRI.
You can produce them extremelyquickly.
And so you, they can be part ofa very agile response.
(40:44):
And so that was part of thereason why they were first
through the gate.
Because just technologicallyspeaking, and this is building
off of, you know, years andyears of development of other
types of MRN technology.
We were just sort of, at thistime in history, when MRNs
vaccines, we were able toproduce them and something about
the vaccines themselves, makethem.
Easier to produce quickly thanother types of vaccine
(41:06):
technology that we haveavailable.
So that's part of why they werefirst through the gate, but in
terms of efficacy, I don't thinkthat we can necessarily.
I don't think it's necessarilytrue that MRN vaccines will
always be super effective.
That's super pathogen specific.
It could just be that COVID-19is a decently vaccine, Hubble,
pathogen and some pathogens aremore vaccine rubble.
(41:29):
And so, you know, of course thecanonical example here is HIV,
where we still don't have avaccine.
And we've been working on thatfor years and years and years.
Our marinade vaccine is going tofinally give us a vaccine for
HIV.
I hope so, but I don't thinkthere's any reason to think that
that that will necessarilychange the landscape there nor
do I think that necessarily MRNsvaccines will be more effective
(41:49):
against other pathogens that wealready have vaccines for.
I just don't know they could,and I really hope that they do.
But again, when we're thinkingof about COVID, it's this
there's the vaccine, but it'sthe vaccine pathogen interaction
that's really important to hear.
And that can totally changedepending on what the pathogen
is.
What body systems that pathogeninteracts with all of these
(42:11):
things.
So MRA, vaccines, superexciting.
There are reasons why they canbe part of this agile.
Response to emerging pathogens.
They could really revolutionizethe way that we deal with
infectious diseases, but theywon't necessarily.
And I think that's part of whatthis article was getting at.
Was that a lot of enthusiasmaround MRNs vaccines.
But I think it's worthtempering.
(42:32):
Some of that because we stillhave a lot of big challenges to
face.
And in many ways, we're, we'relucky that they were as
effective as they were againstthis particular pathogen.
Hopefully that success willtranslate into other pathogens
in the future.
But generally speaking, when wethink about medical techniques,
You know, oftentimes, you know,the, the real ringer sort of
emerges to the surface for oneinfectious disease and we think
(42:53):
it's going to cure everything.
And then we applied in adifferent context and it's like,
yeah, it's just okay.
And I think that's probably themost likely scenario is that
it'll help, but we'll see whatthe actual impact will be.
Matt Boettger (43:05):
Great.
Thanks for that, Stephen.
I think we'll end there on thatcheckout.
Novavax as well as a lot of goodstuff coming with that one,
obviously way more available tothe, to the global community
then thank you Stephen.
Now again, just to re review,please do apple podcast support
us patron.com/pandemic podcastor Venmo, PayPal.
Realize that we may not have anepisode next week.
(43:27):
If, unless I can get mark on.
The week after that I will be onvacation.
There'll be some staycations, sothere could be a one to two
weeks sabbatical, but we'llnegotiate that as time comes
forward, we are still here andwe're still going to be going
and giving you the news on thepandemic and just general
information on.
The future of healthcare anddisease and all that good stuff.
(43:48):
So stay tuned, have a wonderfulweek.
Have a great fourth if we don't,if we, if we don't come in on
that week and we'll see yousoon, take care.
And bye-bye.
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