July 26, 2021 • 40 mins
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Things Discussed on Episode:
- A new way to visualize the surge in Covid-19 cases in the U.S.
- Why There's a Big Difference Between a Vaccinated and Unvaccinated Person Testing Positive for COVID-19
- How concerned should we be about breakthrough coronavirus infections? One expert weighs in
- The Tokyo Olympics could be a COVID-19 “super evolutionary event”
- Coronavirus Today: Breakthrough infections break through
- Can vaccinated people get long Covid? Doctors say risk is 'very, very small'
- Mixed AstraZeneca-Pfizer shot boosts COVID antibody level - study
- U.S. life expectancy dropped by 1.5 years in 2020, driven by the pandemic - The Washington Post
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.
I'm joined with just by one goodfriend, Dr.
Stephen Kissler in Boston, thereat the Harvard school of public.
How are you doing there, buddy?
How's it going?
Oh, I'm hanging in there.
How are you doing?
Good.
You look good in blue, by theway.
For those of you were justlistening, you can't tell that.
(00:21):
I don't think I've ever seen youlook that sharp on a, on a
podcast.
So it's it's great to great tosee it on you.
Well, it's good to have a beback this week, two weeks in a
row after being gone for acouple of weeks.
And it seems like there's a lotto.
It's weird.
I feel like there's a little bitof a, I don't know, Groundhog's
day don't want to put that likekind of resurfacing last summer
(00:42):
stuff.
So I feel like we say the samething over and over, like with
like onion, but we peel theonion back and there's like a
different layer to it.
It's a little bit nuanced, butit's the same stuff.
And I think Stephen will carryus all the way through this
episode.
Obviously I'll ask all thequestions.
It's probably my mind and myheart right now, before we get
started that a couple of fewthings.
Couple of few things makes nosense by the way.
(01:04):
So just FYI, I got a few things,a couple things.
The first thing is please leavea review.
That would be awesome.
You can do that at applepodcasts.
There's other places you canleave reviews.
We just got one last week.
I have to read it.
I gave it to Stephen and markand it was awesome.
Yeah, this is from S Hayne fromThursday title, finally clear
(01:26):
science-based pandemic, and thenit goes dot, dot, dot.
I can't read that, but here'sthe actual comment.
I love it.
I've been following this podcastsince the beginning of the
podcast.
So thank you by the way.
And it's fantastic.
I'm always looking for the datawithout the bias and skewing of
information with the politicalagenda.
What I appreciate about theseguides, they give a few
different perspective yet it'ssolely focused on helping the
(01:47):
average person look at thispandemic through the lens of a
profession.
They look at the complexities.
Don't try to have an answer foreverything in our humble, as
they navigate all the news data,as it rolls in best part.
I don't even know theirpolitics.
That's pretty sweet.
Yeah.
I love that.
I just want to navigate this thebest I can, and truly want to
understand the science that'scoming in.
(02:07):
Thank you guys so much for thispodcast.
You were all great.
Thank you so much.
really appreciate that insight.
Yeah, I appreciate that.
Those are some, those are somegreat words.
Appreciate that a lot.
Yeah.
So anyway, any more reviews welove them.
We can read them as we continuealong on the episodes.
If you want to support us.
In other ways, you can do thatat patrion.com/pandemic
(02:28):
podcasts.
There's a$5 a month can go along ways to help us keep this
going, or a one-time giftthrough PayPal or Venmo all in
the show notes.
So let's get going with all thisupdate news.
And I kinda want to, I don'tknow how I'm gonna package all
of this first.
I had this Stephen and a bunchof different kinds of
subheadings in different areas,but I think we can talk about
(02:48):
this all in one big picture.
So I want to frame it as this.
So I read an article where wasthis article that says, okay.
A new way to visualize the surgein COVID-19 cases in the U S
I'll put this in the show notesfor those of you who want to
read along, please do.
So this is a great article.
There's a handful of solidarticles that came out in the
past seven days.
This one in particularly reallygot me going, because it
(03:10):
reminded me of what I mentionedto you, Stephen and mark, just
over a year ago in April ishwhen things were still crazy,
maybe may.
And I was getting all of thesepeople coming my way, who knew
that I, we started a podcast andall this kind of stuff.
And in proclaiming.
Hey, this is no different Coveis no different than the flu.
And they would show these ratesand they show how it's
different.
And look at the look at how manypeople it kills in a year for
(03:32):
the flu and look where you're atat COVID.
And so my best comparison wasokay.
It's like comparing my, my oldcrummy 2008 Nissan, four
cylinder, and just flooring itfor 10 seconds, giving it maybe
90 miles per hour and like 10seconds probably.
And then comparing it to a Teslaat second one.
And then say, look, my Nissan'sgoing 90.
(03:54):
The Tesla's going 45 in onesecond.
And clearly my Nissan is faster.
So game closed.
Right.
Then we know that wasn't truebecause at the same time, the
flu has been going for years andCA COVID was revving up.
How does this article, how doesthis article come into play the,
the new way to visualize allabout side?
Do you have acceleration thatit's one thing to see our normal
(04:16):
stuff, right?
Stephen, we see the daily casesand they're going up and we see
the chart and the going down.
But that's just one measurement.
I think the measurement, myniece on the Tesla was the
example of what you didn'treally think about is the
acceleration property and theacceleration right now.
And you can speak into this.
It's really crazy.
It's on the order of what wewere dealing with last winter.
So I am, this is what's weird.
(04:38):
Like we're, we're living a lastwinter acceleration and we're
living a life almost.
When you go out kind of pandemicfree, how do we make sense of
all this?
What's a common denominator.
What's different between them.
And back in December where wewere much more careful.
Yeah.
You know, there's a couple ofthings that have changed and I
think you're right.
That that thinking about theacceleration is really the right
(05:01):
thing to do here.
In a lot of ways, the the, thereproduction number that we've
been talking about is, is apretty good measure of, of that
acceleration rate.
Stephen Kissler (05:10):
It's not exactly that.
There's another thing, you know,the, the reproduction number we
represent with the big R, whichis the number of people who
you're expected to infect, butthat doesn't inherently have a
notion of how quickly you infectthose people.
So if you have something with areproduction number of.
You might infect those twopeople in a day, or you might
infect those two people in 10years and then of course leads
(05:32):
to a very different kind ofacceleration.
Right?
So, so, so the big arm would bethat too, but the little R is
the exponential rate of increasein cases.
And that, and that's theacceleration we're interested in
and it's related to big artbecause of course the more
people you infect, the fasteryou're going to accelerate, but
it also really matters howquickly you infect those people.
So, So where does that leave us?
(05:52):
Right.
So it's pretty clear that in alot of places, especially places
that have started to seeoutbreaks of the Delta variant,
but the acceleration is Teslastyle, right?
It's you saw that definitelywhen we saw the Delta variant
taking off in India and now inthe UK now in the U S.
But, I think especially when wewere looking at what was
happening in India, it wasunbelievable that it was like
(06:14):
the, the case counts just hitthis, you know, vertical wall.
It just went straight up veryquickly, a very fast
acceleration.
The acceleration in the UK andthe U S has not yet.
Quite that fast in part, becausewe were able to see it coming.
We saw what had happened inIndia.
We were able to sort of prepareourselves a little bit.
But it's still been very fast.
(06:34):
Like you said, it's been aboutas fast as it's been in previous
waves, which is pretty wild ifwe take a step back because You
know, this is happening in thecontext of the summer.
Whereas this virus tends to be aseasonal virus where we expect
the transmission to be strongestin the winter.
It's happening certainly in theU S and the UK in the context of
(06:54):
vaccination rates.
So, you know, vaccination ratesare certainly not anywhere near.
80 90 a hundred percent, but westill have people vaccinated.
And so that should slow thingsdown too.
And so really, I think what thisis getting at is just how
infectious this Delta variant isthat in the midst of all of
these things, we're still seeingthe spread of the Delta.
Now on the other side, of courseI am behaving very differently
(07:17):
than I was six months ago.
Many people are behaving verydifferently than they were six
months ago.
And so.
Helping the Delta along is thatgenerally where we're seeing
more people it just has moreopportunities to spread.
And so some of the increased,some of this acceleration that
we're seeing is, is inherent tothe variant.
And some of it is just due tothe changes in our behavior.
(07:38):
But those things together havereally helped us sort of see an
increase that sort of on parwith what we've seen in the
winter months.
So definitely things aredifferent than they were a few
months ago.
But with sort of all of thesechanges that are moving it in
different directions that we endup is with a scenario where the
increase in cases looks verysimilar to the way that it did
sort of in early December.
(08:00):
Before we move on, though.
I want to break that down alittle bit further, because it's
been really interesting here inthe U S because we've in many
ways sort of, lagged behind theUK by six to eight weeks or so
in a lot of instances, sort ofthe UK has seen a surge first,
and then we've seen it here inthe U S and actually our overall
epidemics have looked prettysimilar in a lot of ways with
(08:21):
the exception of that lag Whichfor those of us here in the U S
is kind of a fortunate thingbecause we can look to them to
sort of see what to expect inthe near future.
And so one of the things that Iwant to emphasize about this is
if you look at the case countsin the UK the overall surge is
finally starting to come down.
So they're starting to see in asustained decreases in the
(08:42):
number of cases, but the size ofthat surge in terms of the
number of cases was prettysimilar to the one that they saw
in December.
But if you compare the number ofdeaths that they've observed,
it's vastly lower.
And so we've been talking a lotabout delays, you know, have we
waited long enough to actuallysee that increase in deaths?
Why at this point, yes.
We would expect even the casesin the UK are coming down, we
(09:03):
would expect the dusk to stillbe increasing.
But if you compare the rawnumber of the number of deaths,
per case that we see now in theUK versus the number of deaths
per case that we were seeing atthis equivalent point in the
epidemic curve, right.
Vastly vastly lower.
And I would encourage everyoneto take a look at the data.
I was looking at the New Yorktimes portal for this, but you
can see this in a number ofdifferent locations and it's,
(09:24):
it's actually really quiteencouraging that what looks like
a very similar scenario is infact quite different.
And, and I really attribute thatto the vaccine that a lot of
people, especially the peoplewho are at most severe risk of
death.
So people who are 65 and olderVaccination rates in those
people in the UK and the U S areextremely high and we're
starting to see the benefit ofthat.
(09:45):
So that's, that's the little bitof good news.
That's sort of captured in themidst of all of this sort of
craziness.
That's great.
Now I read an article aboutthis, but how do you've talked
to, you talked about this, ohgosh, maybe three or four months
ago.
This idea of once the vaccinestarted rolling out that, are we
going to see a decouplingbetween vaccination increases in
hospitalizations?
And now we're seeing that in aprofound way, which is a huge, a
(10:07):
huge benefit to see my questionto you.
In in the past, I kind of took acenter, maybe not a solace by
any means.
So I never want to see anincrease of hospitalizations and
deaths, but like with, with the,with vaccine positive cases, you
know, early on people weregetting tested like crazy.
Now testing is kinda morphedinto less of an intensive
(10:27):
reality.
And so then I was kind of likereally putting all my, my bets
on the reality that, well, evenif.
People aren't going in to gettested.
We can still look tohospitalizations to see roughly
a proportion.
Okay.
Well, clearly there's more,there's more spread going on
because we're seeing an increaseof hospitalizations because you
can't hide that.
Right.
You got to go to the hospital,but now we don't have that
(10:48):
figure.
We're seeing an increase.
Are we, are we thinking thatmaybe there's even way more than
we think, because I wouldimagine way less people.
Then last year, or even thinkingabout getting tested at this
point in time.
So how do we factor that in, atany level or are we factoring
that in the psychology of allthat?
That's great.
So absolutely.
(11:09):
So testing rates overall aresort of declining they've sort
of plateaued to some extent.
And so yeah, we, we have alwaysbeen under counting COVID cases
and we're probably undercounting by even more.
Now.
Yeah, because fewer people aregetting tested.
And so you're right.
So, so it can be difficult tocompare the raw numbers of cases
from now to the winter, because,because we're probably under
(11:31):
counting by an even greaterdegree than we were then.
Which is interesting.
So, so I think, you know, one ofthe questions sort of implicit
in that is.
Is that a problem?
Should we be, should we betesting more?
And I, it's sort of what's,what's the purpose of testing at
this stage in the pandemic.
And I think this has been one ofthe most difficult Things to
(11:53):
sort of both communicate, butalso to sort of wrap my own mind
around is what is the purpose oftesting?
Because actually getting a testfor COVID usually serves
multiple purposes depending onwhere you get it, but even a
single test will serve multiplepurposes.
So if I am going to travel, Imight get a test before I go
just as sort of a baseline test.
(12:14):
And so that's trying to sort of,Modulate my own behavior, where
if it came back positive, then,then I would stay back.
But that same test is alsofeeding into the data where
there's somebody who had a lowprior probability of turning
positive, but I'm contributingmy negative test to that pool of
tests.
And so I woke up one morningwith a sore throat and a
headache.
I might go to get tested becauseI'm symptomatic.
(12:35):
And so then that also, you know,what I'm trying to do is to See
if I should modulate mybehavior, see if I should maybe
think about going to the doctorfor, for to, to get these things
checked out.
And also, you know, thiscontributes to the overall
surveillance of, of what's goingon with COVID in the community.
So now, you know, you've layerin vaccination where maybe if
I'm vaccinated, I'm less likelyto get tested, even if I'm
(12:58):
symptomatic.
So all of these probabilitiesare shifting underneath our
feet.
So what should we do with that?
So I think one of the reallydifficult things about this
period of time is that the wwhat COVID means both
individually and as a society isstarting to change and to a
large part that's because ofvaccination.
So, Do we need to know exactlyhow much is spreading.
(13:19):
I don't know.
I definitely do want to know howmany hospitalizations there are
with respect to COVID.
And I want to know whatproportion of those people
hospitalized with COVID arevaccinated versus unvaccinated,
because that gives us a hugeamount of information about if
COVID, if, if new variants aremaybe starting to chip away at
the protection that the vaccineprovides, but.
(13:41):
What vaccination effectivelydoes is it reduces the risk of
severe outcomes from COVIDvastly to the point where it's
basically in line with a lot ofother risks that we face with
other infectious diseases as wego about our lives.
So then does it still make senseto follow up all of those cases?
I don't know.
I have some colleagues who sayabsolutely yes.
You know, we need to befollowing up every single
breakthrough case.
We need to be testing as much aswe possibly can.
(14:04):
And then there are others andI'm starting to shift a little
bit more towards the side too,which is that, you know, testing
requires a huge amount ofresources.
At least.
Level of testing.
It takes a lot of money.
It takes a lot of time.
It takes a lot of personnel.
Are there other things that wecould be doing that would be
more effective at actuallyreducing the spread of COVID
without actually following upevery single one of these cases,
(14:24):
especially in a world in whichthe risk of hospitalization and
death, given infection fromCOVID.
Actually all that different.
If you're vaccinated from a lotof other risks that we face
day-to-day that we, that wedon't track nearly as closely,
we're still in this murky middleground where the answer is not
clear, but I think we're sort oftransitioning from one to the
other and figuring out how to dothat gracefully, I think is a
(14:46):
really difficult problem.
Yeah.
Well, two questions to follow upwith that.
The first one is you talkedabout the idea of what would it
be like if we reallocate theseresources to something else?
Prevent the spread.
Do you have an idea of what goodyou'd replace with that?
Either in particular or ingeneral?
Like, oh yeah.
Example would be let'sreallocate the reason from X to
(15:07):
Y.
Yeah.
So, a couple of things.
So one, rather than maybewidespread testing in the
population, sort ofconcentrating surveillance,
testing on schools and on placeswhere people interact very
frequently.
So instead of focusing on thewhole population focused on
places where you expect theremight be spread where you really
want to make.
(15:27):
Things don't get out of handimproving ventilation in
schools.
So, hiring consultants to comeout and help schools figure out
how to improve their HVACsystems, how to improve sort of
just education around the peoplewho are Maintaining the upkeep
of these schools too.
So, so that again, and waerosols don't build up in the
(15:47):
air and we prevent infections inplaces where people gather same
is true for restaurants and barsand things like that.
So if we could really emphasizethat and then also you know, one
thing that I've sort of beenhoping that we would do you,
that I haven't really seen a lotof it all is Helping to provide
people with effective masks.
So surgical masks or evenrespirators in places, you know,
(16:12):
for example, people who are likedriving public transit, bus
drivers the train drivers, youknow, there a lot of the masks.
Wearing are still in some cases,even homemade or, you know,
there's a lot better than wecould do.
Both for the general population,sending people a couple of masks
or and especially for people in,in, you know, high contact
(16:32):
areas.
So I think there's a lot ofreally practical things that we
can do with the same resourcesthat would really go a long way
towards interrupting spread, butwe can be a lot more targeted
because I think we're doingenough surveillance to know when
cases are ticking up in analarming.
And we don't necessarily need tosee every case to know that,
here in Massachusetts, in mostof the country cases are going
up, do we need to know exactlyby how many I'm not sure.
(16:55):
I think just the fact thatthey're going up is enough for
us to sort of start to calibratethese things and to start to
understand who needs theseinterventions, where do we,
where do we allocate theseresources?
Those are the sorts of thingsI'd like to see instead.
Yeah.
And you know, another questionwith this is this would be, I
think, a way more difficult one.
I think this is what you'regetting into and my guess is if
I get into your mind, maybethat's what you're thinking.
(17:17):
When do you normalize this?
Like you were saying we're,we're, we're at a point now
where the vaccinated, those whoare vaccinated are dealing with
a threat that's similar to otherregular viruses that we do not
have this kind of measure ofcontainment and measurement and
that kind of stuff.
What, what is there a, is therea standard by which we can
actually transition to say,okay, we've reached this moment
by which we can now I think wetalked about this last week and
(17:40):
this is going to be, I think theperennial difficulty of dealing
with a pandemic is when do youmove it from.
I'm an outlier to somethingthat's, that's actually
fabricated into the daily rhythmof life.
Like just like we don't measureflu.
Every positive case that is, is,is this, is this more of an art
than a science for this?
(18:00):
Are we when we're culturallyready?
Or is there like a metric bywhich we can look at?
Look at?
Yeah.
There's you're right.
There's a lot of, sort of,There's a lot of room for
discussion on this.
I think in the end, there'snothing that's really cut and
dry.
I think probably the best way tothink about it is to place it in
the context of other risks thatwe face every day.
And so in this case, I thinkthat flu is a reasonable, a
(18:21):
reasonable thing to do.
Part of my hesitancy in, inlooking at fluids that actually,
I think we could do a lot betterat preventing illness and deaths
from flu too.
You know, there's, as we startto compare risk from COVID to
risk from other things, we alsohave to really critically
examine as like, sh should we beaccepting this level of risk
from these other things as well?
Yeah, putting that to one sidefor now, there, there are risks
(18:44):
that we accept every day,including the risk of getting in
our car and driving down thestreet or, or of, you know, flu
every year.
And so I think that one of theways that we can start to
measure that is looking at along enough time horizon,
usually on the order of a yearand asking, you know, how many
people are dying, how manypeople are hospitalized from
each of these things.
(19:04):
On average, over the course of ayear in a particular position,
And then ask ourselves sort of,how does COVID stack up right
now?
Deaths from COVID are stillexceeding the rate of death from
COVID is still exceeding thatfrom flu, but as vaccination
increases as ideally, you know,we find better ways to manage it
during surgeries.
Hopefully that will come muchmore in line.
And then once it's sort of onpar with those other risks that
(19:27):
we've come to accept, we canthen say, okay, well now, now
it's time to sort of fold thisinto this portfolio of other
risks that we that we face everyday, every day, while also
recognizing that we can make alot of progress on these other
risks too, to improve wellbeing.
This is always reallychallenging because that risk
will change depending on.
(19:50):
Age groups, depending on thecommunity you're living in,
depending on all sorts ofdifferent things.
And so there's a real danger ofdoing too much averaging where
if we, for example, average thenumber of deaths from COVID over
the entire country, we mightreally be missing out on a huge
number of excess morbiditymortality that are that's
occurring in certain age groupsor certain communities.
(20:11):
And we need to make sure we'renot doing that.
So we need to make sure we'redoing these things sort of on,
on the local scale wheneverpossible.
But as long as we're doing thatthoughtfully, then I think,
yeah, comparing this to otherrisks that we access adapt in
our day-to-day lives as sort ofone good metric for determining
when we're ready to transitioninto this being just a reality
of our life.
Okay.
And now you just said how evenat this level, at this point in
(20:32):
time, you know, being well overa year and of the pandemic,
we're still at a place, butwhich the rates of death and
are, are much larger than, orsignificantly worse than flu and
other things in our, in our lifeas well.
Given the, the increase incases, the the accelerator of
the Delta variant.
Do you prescribe anything rightnow in generally different for,
(20:54):
for the communities right next?
So we're seeing medicalprofessionals.
I don't, I don't think the CDChas done it yet.
The medical professionalsadvocate, and even now people
wearing masks outside, even ifyou're vaccinated because of the
increase of variants.
Among in discussion there atHarvard.
Is there anything going on atthis point in time, should we
advance the level of our cautionor still maintain the CDC
(21:16):
policies of if you'revaccinated?
You're good.
Unless you're in a bigpopulation.
Yeah.
So it's I think it's, it'stricky.
So there may well be, and Ianticipate there probably will
be a time when we're going tohave to start.
Wearing masks because indoorsagain.
Certainly for unvaccinatedpeople who I think by CDC
guidelines should be wearingmasks indoors anyway, but but it
(21:37):
might make sense for vaccinatedpeople to start wearing them
inside too.
Full disclosure.
I am generally wearing a maskindoors anytime I'm indoors.
Anyway it just I just feel likeit's a small thing that I can
do.
That's an extra layer ofprotection for the people around
me.
And so in my mind, that's just atrade-off that makes an awful
lot of sense.
But especially as the cases ofDelta start to increase Those
(21:58):
kinds of things.
We'll probably have to startbringing back to some extent.
So I think it's still earlydays.
We, it, we may not need thatquite yet, but I think, you
know, stay tuned.
There's definitely somecommunities here in
Massachusetts where cases areaccelerating more quickly that
I've just as of today oryesterday, re-instated an indoor
mask mandate.
(22:18):
And And so I think it's coming,it may only be coming for
particular communities atdifferent times.
It may not be a national sort ofthing.
But I think that also makessense.
I think the story of this.
Epidemic over the next fewmonths, it's probably going to
be a very local sort of thing.
And so it makes sense to treatit as such great.
Now let's you just mentionedhow, like you, your personal
(22:39):
preference right now, as you goin, you go inside, you wear a
mask it's just free.
It's a small contribution youcan do to help keep COVID at
bay.
So let's take that and, and movethat into what the CDC was
talking about.
And there's been some criticismabout what do we measure when it
comes to breakthrough cases.
This is all the discussion.
The past week, two weeks hasbeen, we're seeing, you know,
(22:59):
maybe in June, it was 1%.
Of cases or, or are coming fromthe vaccinated people.
Now we're seeing a much biggernumber and, or at least
relatively speaking that arecoming breakthrough infections
coming through, you know, so twothings, can you help us
understand that betweenbreakthrough infections and
breakthrough disease?
Because I'm sure you've talkedabout as many, many times, but I
(23:22):
saw that distinction a couple ofdays ago.
I'm like, oh yeah, I forgotabout that.
There's a different one, two.
And then CDC, if I, if I'mgetting this correctly, has
decided at least maybe they'vechanged.
I don't know, at least there wasone point in time they wanted
to, to measure breakthroughdisease and not necessarily
breakthrough breakthroughinfections, but there's some
people say, no, we need to bemeasuring these because we don't
(23:42):
know to what extent we'retransmitting this to other
people, those who have thevaccine, maybe why that extra
level of caution for you to wearthe mask.
And it's also helpful forgenomic research to know, to
what extent is the vaccinecausing variants.
And so measuring this will behelpful for us.
And I'm guessing, you said youhad interviewed just recently
talking about this and he mayhave a different, a little bit
(24:04):
of a different flavor too, to aresponse to the criticism of the
CDC.
Yeah, exactly.
I you know, it kind of foldsinto some of what we were
talking about before with, withtesting in general.
Which is that, you know, does itmake sense for us to follow up
every single breakthroughinfection and an infection?
Breakthrough infection is anespecially difficult thing to do
(24:25):
because by definition, if it'san infection, but not a case,
you're not showing symptoms.
And so figuring out how to testthose people.
Well, you, you essentially haveto do regular testing for
everyone, always regardless ofvaccination status.
It may not be a bad idea, but,but should we be using those
resources for that or forsomething else?
So before I get too far, youasked about the distinction
(24:47):
between breakthrough infectionand breakthrough disease.
So, breakthrough infection iswhen someone who is vaccinated
becomes infected with SARS covtwo, but remains asymptomatic.
So you can become infected,which means usually in this
case, meaning that you can testpositive through a PCR test But
you don't go on to show disease.
Now, one of the really importantthings about this is that
(25:09):
oftentimes when a person who'svaccinated becomes infected they
do become infected.
They, they are able to turnpositive on PCR, but they
frequently don't even produceenough virus to infect another
person.
And so, especially in that case,it's like, okay, so the person
is not showing symptoms.
They're, they're not.
Infectious to others.
Is, is that something we reallycare about?
(25:31):
Yes.
From a research perspective, I'man epidemiologist.
I want all of the data I cansurely get, but from a practical
perspective, for somebody who'sin charge of running a national
public health agency, Iunderstand why following up
every single one of these mightnot be the top priority.
Breakthrough disease on theother hand is, is what it sounds
like where you're someone who'svaccinated who's been infected
and then has progressed to showsymptoms.
(25:53):
Now that's something that wemight want to pay some more
attention to.
I think that there's still somelatitude here for disagreement
because.
If a vaccinated person does goon to show symptoms, they're
still unlikely to have severeoutcomes from those symptoms.
And so, again, this is sort ofthe, in this paradigm of trying
to shift the risk from COVIDinto something like the risk of
(26:13):
other infectious diseases thatwe deal with all the time.
I still become symptomatic withflu with other Corona viruses as
well.
But does it make sense for everysingle one of those cases to be
tracked?
I don't know, there, there maywell be bigger fish to fry now,
breakthrough hospitalizations,breakthrough breakthrough
infections that lead to death.
Absolutely.
You know, we should be followingthose up because if we start to
(26:36):
see that the risk ofhospitalization or the risk of
death starts to edge invaccinated people closer towards
what it is in unvaccinatedpeople right now, the difference
is still vast.
But if it starts to increase,then, then that's a real cause
for alarm.
Right?
Then, then we might really havea variant on our hands and
something that we really have topay close attention to.
(26:56):
And I think that rightfullythat's why the real emphasis is
being placed on that.
It's difficult because it meansthat you can't necessarily
compare the numbers directlyfrom unvaccinated people in
vaccinated people because we'retreating them somewhat
differently.
And.
You know, in some circles that'sa real cause for alarm and
concern and allegations that,you know, we're trying to hide
(27:18):
information or to make thevaccines seem better than they
are or something like that.
And I think that it's justreally, as far as I can tell,
it's just, this is sort ofplaying out in the context of
really difficult, practicalrealities with respect to
testing.
And so I think that, you know,we can always criticize what the
CDC is doing.
But But a decision has to bemade at some point.
And I think that the decisionsthat they're making with respect
(27:40):
to this are.
Defensible.
Yeah.
And, and that's kind of wherewe're at.
So desert it's helpful becauselike, well, a couple of things,
and we probably talked aboutthis already, at least in a
roundabout way, in my mind I'mthinking, oh, I want to have a
measured because of two things.
Number one.
To what extent are AceNetasymptomatic people spreading it
and causing more spread, but youjust mentioned, you've answered
(28:01):
that.
I saw an article that kind ofrepeated what you just said,
that those who had the vaccine,even if they become
asymptomatic, They have likeroughly a 40% less viral load to
actually spread.
So this kind of goes into thequestion I wanted to ask as well
that if between Vaccinated apositive case and an
un-vaccinated positive case.
And there's, there seems to be adramatic difference.
(28:21):
You've pretty much already saidin the past 20 minutes that the
viral load is significantly lessfor those who are vaccine.
If you are now, I can seeanother reason why I would want
to be able to be.
And that is, well, you know,maybe I get it, I'm a cinematic,
but maybe I need to prepare forthe possibility of me having
long haulers.
Right.
It's like that, but it's alsoanother article I read.
(28:42):
It seems like it's really, andmaybe you can echo the same
thing.
I don't know if you've seen anyof it's really, really, really,
really, really unlikely thatpeople are going to get along
hollers from a vaccinator.
Positive case.
Has that been a similar kind ofdiscussion going on in your neck
of the woods?
Yeah, it seems to be so maybeagain, to add sort of some
(29:02):
nuance to some of this with theW with how, how infections look
between vaccinated andunvaccinated people.
You know, you're absolutelyright.
That on average, a vaccinatedperson is sort of every step of
the way less likely to progress.
So they're less likely to getinfected in the first place.
If they're infected, they'reless likely to show symptoms.
If they show symptoms, they'reless likely to produce as much
(29:22):
virus as a person who'sun-vaccinated and they're less
likely to go to the hospital.
So all of those things are sortof the vaccine sort of puts a
filter at each one of thosestages and sort of help screen
you out from getting to each ofthem.
That said, you know, one of thethings in a lot of the
conversation I've had withjournalists and even just with,
with concerned friends aboutthis, is that, you know, we're
starting to see morebreakthrough infections.
(29:42):
Personally, right?
Like I, I now know a friend of afriend who's been vaccinated and
has shown symptoms from COVIDand there's something super
alarming about this too.
Right?
Like they got vaccinated.
What the heck?
You know, am I at risk?
I've been vaccinated.
I don't want to get COVID, youknow, what, what should I do
about this?
And I think.
And this is where it's beenreally helpful to be looking at
the data all along.
(30:03):
And the sort of thinking aboutthe statistics about this is
that again, the vaccines arevery effective.
They're very helpful atpreventing each of these
progressions from one stage ofillness to the next.
But the way that I like to thinkabout it is from the very
beginning in the trials, thevaccines were 95% effective at
preventing symptoms, right?
Just very good between 90 and95% effective.
(30:25):
Basically these are for themodern and the Pfizer vaccines,
for example What that means isthat for every 20 unvaccinated
people who show symptoms, you'regoing to expect one or two
vaccinated people to show someelse.
So the ratio is about 20 to one,20 to two.
That's actually not all thatuncommon.
Now, of course, if you showsymptoms, you're less likely to
go to the hospital.
You're less likely, you know,all of these things.
(30:45):
So, so the vaccines reallyespecially protect against those
severe outcomes, but, but Ithink it's worth bearing in mind
that actually symptomaticbreakthrough cases are now.
That's surprising in some sense,too.
And so this is another reasonwhy, why following all of them
up doesn't necessarily makesense, because it doesn't imply
necessarily that there's a newvariant or that there's
something to be super alarmedabout.
(31:06):
It's just that as we've knownall along the vaccines are not a
magic bullet, but they arehelping us keep control of the
epidemic.
And so, so that's sort of.
Big sort of caveat in all ofthat.
Now we're still learning a lotabout the long haulers issue.
And I think that that's going tobe one of the most interesting
things is to see therelationship between vaccination
and long hauling.
(31:26):
There've been some anecdotalsuggestions that even people who
have suffered from COVID longhauling.
Their symptoms have some haveimproved after getting
vaccinated as well.
So like the developed COVIDbefore they were vaccinated,
they had long haulers, they gotvaccinated and the vaccine
somehow seems to havecontributed to some of those
symptoms clearing up.
Totally anecdotal.
I don't think we have any solidevidence as to if that's
(31:48):
actually the case on sort of awidespread scale.
But I do think that therelationship between vaccination
and long hauling is going to besuper important.
To my knowledge, we don't reallyknow yet.
The extent to which vaccinationprevents your odds of developing
long haulers.
I would anticipate that it ismuch lower in the sense that the
vaccine seems to protect againstevery stage of illness.
(32:09):
But one of the difficulties withthis as both that long hauling
is still not super well-defined.
And so it's difficult to saywhen exactly you have a case of
it or not.
And it also takes longer todevelop.
And so it's, we're just going toneed more time to collect those
data too.
So, I would believe those kindsof things, but I think that
we're still sort of in the earlystages of getting evidence on
(32:30):
the relationship betweenvaccination and long hauling.
Good, good.
You know, speaking of which, Ithink what adds a level of
complexity to breakthroughcases, as you mentioned, all the
different, you know, 90, 90%,95%, but then they include,
right.
Even those who've been given thefirst vaccine, but didn't follow
up and get the second vaccine.
So this is going to skewstatistics even more because we
(32:50):
know that especially thevariant.
Are a little bit strongeragainst those who chose to get
the first vaccine, but not thesecond one.
And if they get a positive caseinfection or disease, there's
still a vaccinated group, eventhough they weren't fully
vaccinated.
Right.
So they're part of that, thatlump sum is that, is that.
That's right, exactly.
Yeah.
(33:10):
Going to add some more of thestatistics as well.
So speaking of that doublevaccination, I saw this in the
news.
Just want to bring it out.
It's interesting.
Nixed, AstraZeneca and Pfizershot boost Cova antibodies up to
like six times.
So just showing now we've beentalking about this for all, you
know, six months, seven months.
About at some point in time,we're going to start seeing a
lot more of these studies andtests of mixing two different
(33:32):
types of vaccines.
To see how it increased theantibody levels.
And I think that was a greatfirst step with AstraZeneca and
the Pfizer.
Now I did see that when it comesto the variants, particularly
beta, gamma and Delta, it's notquite as big of an antibody
jump, but nonetheless, startingto see these tests to show some
good, good positives.
Okay, last thing I'm gonna talkabout before we go I brought
(33:53):
this up to you before we startrecording, and I thought it was
going to be a moot point,Stephen.
And you're like, oh, this isactually kind of interesting
concept.
So I wanted to bring up the lastweek.
We didn't have time for it, butI saw articles at a U S life
expectancy dropped by 1.5 yearsin 2020.
Right?
So this is, I think the mostsignificant drop we have had in
life expectancy.
Since when we go to war to now,I think it's not a big surprise.
(34:16):
The reason for this isparticularly COVID is, is the
hallmark reason for why thishappened when I mentioned this
to you, Steve.
And you're like, oh yeah, thiswould be a really fun topic
because of X, Y, and Z.
And explain you guys been havingsome discussion about this.
Why don't you chime in and talkabout this life expectancy?
What might be happening in thefuture and this, the craziness
and the complexities of dealingwith this kind of the stuff?
(34:38):
Yeah.
So, you know, there's so manydifferent ways that we can Look
at the impact of this pandemic.
You know, we've looked at excessmortality, we've looked at
cases, we've looked at deathsand hospitalizations over time,
cumulative specific span oftime, peak level, you know,
there's all sorts of differentways that we can measure the
impact of COVID.
And one of them are, is thisvariation in life expectancy?
(35:00):
One of the reasons people liketo use this measure is because
it's sort of a blanket measure.
Wellbeing across the population.
I before we really dive into it,I want to, you know, sort of
talk about what life expectancyis and what it is not.
So what life expectancy soundslike is how long a person is
expected to live.
If they.
(35:20):
Born on this day.
And it's not really that what itis is actually sort of what a
hypothetical, how long ahypothetical person would live.
If at every age they faced thesame risk that a person who
lived through this year faced.
So that's why the COVID pandemichas had such a big impact on
life expectancy.
It's it's not to say that now.
(35:41):
Everybody's, you know, we had acouple of years shaved off our
lives.
I do feel like I had a couple ofyears shaved off my life after
this past year.
But what it's really saying isbasically, you know, what sort
of risk did we face over thecourse of this year?
And because of all of the excessmortality from the pandemic it's
it decreased life expectancy.
Matt Boettger (36:01):
Now, one of the things that would've made this
number go up even further is ifCOVID had been much more severe
in younger people than an older.
For example, so that would havedecreased life expectancy even
more.
So it's sort of a measure thatsort of assesses risk of death
over time by different agegroups and so on.
Stephen Kissler (36:17):
So you're right.
It is still really importantthat life expectancy for this
year dropped by about a year anda half, which is more than it's
dropped since world war II.
And so, so, so there's that, so,so that's basically what it's
measuring is sort of this onemore metric of sort of.
The impact of the pandemic overthis past year now, what do we
(36:38):
expect going into the future?
Well, there's this reallyinteresting phenomenon that's
called mortality displacement,and the idea behind it is that
you know, EV everybody dies ofsomething.
But yeah.
If in a particular span of time,you're exposed to an excess
risk.
You're are no longer going todie of what you would have died
(36:59):
of you die of that other thinginstead.
So in this case, that excessrisk is COVID.
Some people have talked about itusing a word that.
Don't like, but it's likebasically like mortality
harvesting in a way where it'ssort of like COVID has sort of
collected people who would havedied from other causes, but has
made their cause of death COVIDinstead.
And in some cases, this is true,right?
A lot of, especially people whowere very old, who had lots of
(37:22):
co-morbidities like those arethe people who are most likely
to die from COVID.
And so they might have died in acouple of years from pneumonia
or from some other kind of bloodinfection, but instead they died
from cancer.
So, what does that do as we lookforward to life expectancy?
Well, this is actually a prettywell-documented phenomenon in
people who studied demographyand, you know, just sort of the
(37:43):
study of populations over time,which is that when you have one
of these, you know, reallycatastrophic events in a
population, essentially you seethis mortality displacement
phenomenon and what it does isit the people who basically.
Shorter times left for thisworld are the ones who are most
likely to succumb to whatever itwas.
And that means that theremaining population actually on
(38:05):
average has a longer span oflife ahead of them.
So what you see actually is thisrebound.
So there's this decline in lifeexpectancy, but then in the
following years, it kind ofrebounds.
And so there's this artificialincrease in life expectancy for
a couple of years, followingthese catastrophic events until
it sort of settles back intonormal.
Why is this interesting and notjust sort of like an academic
(38:26):
thing, you know?
Well, one of the ways thatpeople frequently advocate for
policy change is by quotingdifferences in life expectancy,
between racial and ethnicgroups, between demographic
groups, between geographiclocations, for example.
And we know that the pandemichas been more severe for certain
groups for especiallydisadvantaged groups lower
(38:47):
socioeconomic income, racial andethnic minorities, these sorts
of things.
The rebound is usuallyproportional to the size of the
decrease in life expectancy thatwe saw before.
So, so we run the risk of infuture years saying that, oh,
you know, actually, actuallylife has gotten a lot better for
these disadvantaged communities.
We thought that it was going tobe really bad.
We thought that, you know, theywere going to be suffering for a
(39:08):
really long period of time.
But look, their life expectancyhas actually increased and it's
increased by a factor even morethan those communities that are
better resourced.
How good are we doing?
You know, this is wonderful.
We don't have to provideresources to these communities
at nearly the rate that wethought we did, because it seems
like they're just kind of takingcare of themselves, which is not
at all the conclusion we want todraw from this.
(39:28):
Right.
Because really it's just anentirely artificial.
Rebound, it sort of comes out ofthe way that these statistics
are calculated.
So that's something we're goingto have to pay really close
attention to in the comingyears.
And so as we're thinking aboutthese life expectancy, I think
I, I sort of, I want toemphasize to not place too much
doom and gloom on the, on thedecline in life expectancy.
It's terrible, but it doesn'tmean that you personally are
(39:49):
less likely to live as long asyou were before.
Assuming you're still listening.
Podcasts, but then also in thefuture, we're going to see some
really wonky things happeningwith life expectancy.
And so it's worth sort oftempering our surprise at these
things because a lot of it justsort of falls out of the
calculations.
I can definitely see this rightin the future being used and
hijacked for media and politicalinfluence.
(40:09):
So it's good to kind of get thatsobriety right here and right
now, and also I had no idea.
About what life expectancyreally meant.
And so thank you for clarifyingthat because you think it's kind
of just self-explanatory becauseit's life expectancy, but it's
odd thing.
Like everything else.
It's a little bit complicatedand a little nuanced.
Thanks for sharing that,Stephen.
I think that'll end in wrap thisepisode up.
Thank you all for listening andthank you for all who were on
(40:32):
live or watch it and split up intwo different videos.
Sorry for the little bug andtechnical difficulty same stuff
you'd like to review.
Please leave a review on applepodcasts.
Please support us$5 a month atpatrion.com/pandemic podcasts or
Venmo, PayPal.
One-time gift all in the show.
Check out the show notes.
There's some really interestingarticles that came out this
week.
I'll put them in there for youto read and enjoy, have a
(40:54):
wonderful week, and we'll seeyou next week.
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.
I'm joined with just by one goodfriend, Dr.
Stephen Kissler in Boston, thereat the Harvard school of public.
How are you doing there, buddy?
How's it going?
Oh, I'm hanging in there.
How are you doing?
Good.
You look good in blue, by theway.
For those of you were justlistening, you can't tell that.
(00:21):
I don't think I've ever seen youlook that sharp on a, on a
podcast.
So it's it's great to great tosee it on you.
Well, it's good to have a beback this week, two weeks in a
row after being gone for acouple of weeks.
And it seems like there's a lotto.
It's weird.
I feel like there's a little bitof a, I don't know, Groundhog's
day don't want to put that likekind of resurfacing last summer
(00:42):
stuff.
So I feel like we say the samething over and over, like with
like onion, but we peel theonion back and there's like a
different layer to it.
It's a little bit nuanced, butit's the same stuff.
And I think Stephen will carryus all the way through this
episode.
Obviously I'll ask all thequestions.
It's probably my mind and myheart right now, before we get
started that a couple of fewthings.
Couple of few things makes nosense by the way.
(01:04):
So just FYI, I got a few things,a couple things.
The first thing is please leavea review.
That would be awesome.
You can do that at applepodcasts.
There's other places you canleave reviews.
We just got one last week.
I have to read it.
I gave it to Stephen and markand it was awesome.
Yeah, this is from S Hayne fromThursday title, finally clear
(01:26):
science-based pandemic, and thenit goes dot, dot, dot.
I can't read that, but here'sthe actual comment.
I love it.
I've been following this podcastsince the beginning of the
podcast.
So thank you by the way.
And it's fantastic.
I'm always looking for the datawithout the bias and skewing of
information with the politicalagenda.
What I appreciate about theseguides, they give a few
different perspective yet it'ssolely focused on helping the
(01:47):
average person look at thispandemic through the lens of a
profession.
They look at the complexities.
Don't try to have an answer foreverything in our humble, as
they navigate all the news data,as it rolls in best part.
I don't even know theirpolitics.
That's pretty sweet.
Yeah.
I love that.
I just want to navigate this thebest I can, and truly want to
understand the science that'scoming in.
(02:07):
Thank you guys so much for thispodcast.
You were all great.
Thank you so much.
really appreciate that insight.
Yeah, I appreciate that.
Those are some, those are somegreat words.
Appreciate that a lot.
Yeah.
So anyway, any more reviews welove them.
We can read them as we continuealong on the episodes.
If you want to support us.
In other ways, you can do thatat patrion.com/pandemic
(02:28):
podcasts.
There's a$5 a month can go along ways to help us keep this
going, or a one-time giftthrough PayPal or Venmo all in
the show notes.
So let's get going with all thisupdate news.
And I kinda want to, I don'tknow how I'm gonna package all
of this first.
I had this Stephen and a bunchof different kinds of
subheadings in different areas,but I think we can talk about
(02:48):
this all in one big picture.
So I want to frame it as this.
So I read an article where wasthis article that says, okay.
A new way to visualize the surgein COVID-19 cases in the U S
I'll put this in the show notesfor those of you who want to
read along, please do.
So this is a great article.
There's a handful of solidarticles that came out in the
past seven days.
This one in particularly reallygot me going, because it
(03:10):
reminded me of what I mentionedto you, Stephen and mark, just
over a year ago in April ishwhen things were still crazy,
maybe may.
And I was getting all of thesepeople coming my way, who knew
that I, we started a podcast andall this kind of stuff.
And in proclaiming.
Hey, this is no different Coveis no different than the flu.
And they would show these ratesand they show how it's
different.
And look at the look at how manypeople it kills in a year for
(03:32):
the flu and look where you're atat COVID.
And so my best comparison wasokay.
It's like comparing my, my oldcrummy 2008 Nissan, four
cylinder, and just flooring itfor 10 seconds, giving it maybe
90 miles per hour and like 10seconds probably.
And then comparing it to a Teslaat second one.
And then say, look, my Nissan'sgoing 90.
(03:54):
The Tesla's going 45 in onesecond.
And clearly my Nissan is faster.
So game closed.
Right.
Then we know that wasn't truebecause at the same time, the
flu has been going for years andCA COVID was revving up.
How does this article, how doesthis article come into play the,
the new way to visualize allabout side?
Do you have acceleration thatit's one thing to see our normal
(04:16):
stuff, right?
Stephen, we see the daily casesand they're going up and we see
the chart and the going down.
But that's just one measurement.
I think the measurement, myniece on the Tesla was the
example of what you didn'treally think about is the
acceleration property and theacceleration right now.
And you can speak into this.
It's really crazy.
It's on the order of what wewere dealing with last winter.
So I am, this is what's weird.
(04:38):
Like we're, we're living a lastwinter acceleration and we're
living a life almost.
When you go out kind of pandemicfree, how do we make sense of
all this?
What's a common denominator.
What's different between them.
And back in December where wewere much more careful.
Yeah.
You know, there's a couple ofthings that have changed and I
think you're right.
That that thinking about theacceleration is really the right
(05:01):
thing to do here.
In a lot of ways, the the, thereproduction number that we've
been talking about is, is apretty good measure of, of that
acceleration rate.
Stephen Kissler (05:10):
It's not exactly that.
There's another thing, you know,the, the reproduction number we
represent with the big R, whichis the number of people who
you're expected to infect, butthat doesn't inherently have a
notion of how quickly you infectthose people.
So if you have something with areproduction number of.
You might infect those twopeople in a day, or you might
infect those two people in 10years and then of course leads
(05:32):
to a very different kind ofacceleration.
Right?
So, so, so the big arm would bethat too, but the little R is
the exponential rate of increasein cases.
And that, and that's theacceleration we're interested in
and it's related to big artbecause of course the more
people you infect, the fasteryou're going to accelerate, but
it also really matters howquickly you infect those people.
So, So where does that leave us?
(05:52):
Right.
So it's pretty clear that in alot of places, especially places
that have started to seeoutbreaks of the Delta variant,
but the acceleration is Teslastyle, right?
It's you saw that definitelywhen we saw the Delta variant
taking off in India and now inthe UK now in the U S.
But, I think especially when wewere looking at what was
happening in India, it wasunbelievable that it was like
(06:14):
the, the case counts just hitthis, you know, vertical wall.
It just went straight up veryquickly, a very fast
acceleration.
The acceleration in the UK andthe U S has not yet.
Quite that fast in part, becausewe were able to see it coming.
We saw what had happened inIndia.
We were able to sort of prepareourselves a little bit.
But it's still been very fast.
(06:34):
Like you said, it's been aboutas fast as it's been in previous
waves, which is pretty wild ifwe take a step back because You
know, this is happening in thecontext of the summer.
Whereas this virus tends to be aseasonal virus where we expect
the transmission to be strongestin the winter.
It's happening certainly in theU S and the UK in the context of
(06:54):
vaccination rates.
So, you know, vaccination ratesare certainly not anywhere near.
80 90 a hundred percent, but westill have people vaccinated.
And so that should slow thingsdown too.
And so really, I think what thisis getting at is just how
infectious this Delta variant isthat in the midst of all of
these things, we're still seeingthe spread of the Delta.
Now on the other side, of courseI am behaving very differently
(07:17):
than I was six months ago.
Many people are behaving verydifferently than they were six
months ago.
And so.
Helping the Delta along is thatgenerally where we're seeing
more people it just has moreopportunities to spread.
And so some of the increased,some of this acceleration that
we're seeing is, is inherent tothe variant.
And some of it is just due tothe changes in our behavior.
(07:38):
But those things together havereally helped us sort of see an
increase that sort of on parwith what we've seen in the
winter months.
So definitely things aredifferent than they were a few
months ago.
But with sort of all of thesechanges that are moving it in
different directions that we endup is with a scenario where the
increase in cases looks verysimilar to the way that it did
sort of in early December.
(08:00):
Before we move on, though.
I want to break that down alittle bit further, because it's
been really interesting here inthe U S because we've in many
ways sort of, lagged behind theUK by six to eight weeks or so
in a lot of instances, sort ofthe UK has seen a surge first,
and then we've seen it here inthe U S and actually our overall
epidemics have looked prettysimilar in a lot of ways with
(08:21):
the exception of that lag Whichfor those of us here in the U S
is kind of a fortunate thingbecause we can look to them to
sort of see what to expect inthe near future.
And so one of the things that Iwant to emphasize about this is
if you look at the case countsin the UK the overall surge is
finally starting to come down.
So they're starting to see in asustained decreases in the
(08:42):
number of cases, but the size ofthat surge in terms of the
number of cases was prettysimilar to the one that they saw
in December.
But if you compare the number ofdeaths that they've observed,
it's vastly lower.
And so we've been talking a lotabout delays, you know, have we
waited long enough to actuallysee that increase in deaths?
Why at this point, yes.
We would expect even the casesin the UK are coming down, we
(09:03):
would expect the dusk to stillbe increasing.
But if you compare the rawnumber of the number of deaths,
per case that we see now in theUK versus the number of deaths
per case that we were seeing atthis equivalent point in the
epidemic curve, right.
Vastly vastly lower.
And I would encourage everyoneto take a look at the data.
I was looking at the New Yorktimes portal for this, but you
can see this in a number ofdifferent locations and it's,
(09:24):
it's actually really quiteencouraging that what looks like
a very similar scenario is infact quite different.
And, and I really attribute thatto the vaccine that a lot of
people, especially the peoplewho are at most severe risk of
death.
So people who are 65 and olderVaccination rates in those
people in the UK and the U S areextremely high and we're
starting to see the benefit ofthat.
(09:45):
So that's, that's the little bitof good news.
That's sort of captured in themidst of all of this sort of
craziness.
That's great.
Now I read an article aboutthis, but how do you've talked
to, you talked about this, ohgosh, maybe three or four months
ago.
This idea of once the vaccinestarted rolling out that, are we
going to see a decouplingbetween vaccination increases in
hospitalizations?
And now we're seeing that in aprofound way, which is a huge, a
(10:07):
huge benefit to see my questionto you.
In in the past, I kind of took acenter, maybe not a solace by
any means.
So I never want to see anincrease of hospitalizations and
deaths, but like with, with the,with vaccine positive cases, you
know, early on people weregetting tested like crazy.
Now testing is kinda morphedinto less of an intensive
(10:27):
reality.
And so then I was kind of likereally putting all my, my bets
on the reality that, well, evenif.
People aren't going in to gettested.
We can still look tohospitalizations to see roughly
a proportion.
Okay.
Well, clearly there's more,there's more spread going on
because we're seeing an increaseof hospitalizations because you
can't hide that.
Right.
You got to go to the hospital,but now we don't have that
(10:48):
figure.
We're seeing an increase.
Are we, are we thinking thatmaybe there's even way more than
we think, because I wouldimagine way less people.
Then last year, or even thinkingabout getting tested at this
point in time.
So how do we factor that in, atany level or are we factoring
that in the psychology of allthat?
That's great.
So absolutely.
(11:09):
So testing rates overall aresort of declining they've sort
of plateaued to some extent.
And so yeah, we, we have alwaysbeen under counting COVID cases
and we're probably undercounting by even more.
Now.
Yeah, because fewer people aregetting tested.
And so you're right.
So, so it can be difficult tocompare the raw numbers of cases
from now to the winter, because,because we're probably under
(11:31):
counting by an even greaterdegree than we were then.
Which is interesting.
So, so I think, you know, one ofthe questions sort of implicit
in that is.
Is that a problem?
Should we be, should we betesting more?
And I, it's sort of what's,what's the purpose of testing at
this stage in the pandemic.
And I think this has been one ofthe most difficult Things to
(11:53):
sort of both communicate, butalso to sort of wrap my own mind
around is what is the purpose oftesting?
Because actually getting a testfor COVID usually serves
multiple purposes depending onwhere you get it, but even a
single test will serve multiplepurposes.
So if I am going to travel, Imight get a test before I go
just as sort of a baseline test.
(12:14):
And so that's trying to sort of,Modulate my own behavior, where
if it came back positive, then,then I would stay back.
But that same test is alsofeeding into the data where
there's somebody who had a lowprior probability of turning
positive, but I'm contributingmy negative test to that pool of
tests.
And so I woke up one morningwith a sore throat and a
headache.
I might go to get tested becauseI'm symptomatic.
(12:35):
And so then that also, you know,what I'm trying to do is to See
if I should modulate mybehavior, see if I should maybe
think about going to the doctorfor, for to, to get these things
checked out.
And also, you know, thiscontributes to the overall
surveillance of, of what's goingon with COVID in the community.
So now, you know, you've layerin vaccination where maybe if
I'm vaccinated, I'm less likelyto get tested, even if I'm
(12:58):
symptomatic.
So all of these probabilitiesare shifting underneath our
feet.
So what should we do with that?
So I think one of the reallydifficult things about this
period of time is that the wwhat COVID means both
individually and as a society isstarting to change and to a
large part that's because ofvaccination.
So, Do we need to know exactlyhow much is spreading.
(13:19):
I don't know.
I definitely do want to know howmany hospitalizations there are
with respect to COVID.
And I want to know whatproportion of those people
hospitalized with COVID arevaccinated versus unvaccinated,
because that gives us a hugeamount of information about if
COVID, if, if new variants aremaybe starting to chip away at
the protection that the vaccineprovides, but.
(13:41):
What vaccination effectivelydoes is it reduces the risk of
severe outcomes from COVIDvastly to the point where it's
basically in line with a lot ofother risks that we face with
other infectious diseases as wego about our lives.
So then does it still make senseto follow up all of those cases?
I don't know.
I have some colleagues who sayabsolutely yes.
You know, we need to befollowing up every single
breakthrough case.
We need to be testing as much aswe possibly can.
(14:04):
And then there are others andI'm starting to shift a little
bit more towards the side too,which is that, you know, testing
requires a huge amount ofresources.
At least.
Level of testing.
It takes a lot of money.
It takes a lot of time.
It takes a lot of personnel.
Are there other things that wecould be doing that would be
more effective at actuallyreducing the spread of COVID
without actually following upevery single one of these cases,
(14:24):
especially in a world in whichthe risk of hospitalization and
death, given infection fromCOVID.
Actually all that different.
If you're vaccinated from a lotof other risks that we face
day-to-day that we, that wedon't track nearly as closely,
we're still in this murky middleground where the answer is not
clear, but I think we're sort oftransitioning from one to the
other and figuring out how to dothat gracefully, I think is a
(14:46):
really difficult problem.
Yeah.
Well, two questions to follow upwith that.
The first one is you talkedabout the idea of what would it
be like if we reallocate theseresources to something else?
Prevent the spread.
Do you have an idea of what goodyou'd replace with that?
Either in particular or ingeneral?
Like, oh yeah.
Example would be let'sreallocate the reason from X to
(15:07):
Y.
Yeah.
So, a couple of things.
So one, rather than maybewidespread testing in the
population, sort ofconcentrating surveillance,
testing on schools and on placeswhere people interact very
frequently.
So instead of focusing on thewhole population focused on
places where you expect theremight be spread where you really
want to make.
(15:27):
Things don't get out of handimproving ventilation in
schools.
So, hiring consultants to comeout and help schools figure out
how to improve their HVACsystems, how to improve sort of
just education around the peoplewho are Maintaining the upkeep
of these schools too.
So, so that again, and waerosols don't build up in the
(15:47):
air and we prevent infections inplaces where people gather same
is true for restaurants and barsand things like that.
So if we could really emphasizethat and then also you know, one
thing that I've sort of beenhoping that we would do you,
that I haven't really seen a lotof it all is Helping to provide
people with effective masks.
So surgical masks or evenrespirators in places, you know,
(16:12):
for example, people who are likedriving public transit, bus
drivers the train drivers, youknow, there a lot of the masks.
Wearing are still in some cases,even homemade or, you know,
there's a lot better than wecould do.
Both for the general population,sending people a couple of masks
or and especially for people in,in, you know, high contact
(16:32):
areas.
So I think there's a lot ofreally practical things that we
can do with the same resourcesthat would really go a long way
towards interrupting spread, butwe can be a lot more targeted
because I think we're doingenough surveillance to know when
cases are ticking up in analarming.
And we don't necessarily need tosee every case to know that,
here in Massachusetts, in mostof the country cases are going
up, do we need to know exactlyby how many I'm not sure.
(16:55):
I think just the fact thatthey're going up is enough for
us to sort of start to calibratethese things and to start to
understand who needs theseinterventions, where do we,
where do we allocate theseresources?
Those are the sorts of thingsI'd like to see instead.
Yeah.
And you know, another questionwith this is this would be, I
think, a way more difficult one.
I think this is what you'regetting into and my guess is if
I get into your mind, maybethat's what you're thinking.
(17:17):
When do you normalize this?
Like you were saying we're,we're, we're at a point now
where the vaccinated, those whoare vaccinated are dealing with
a threat that's similar to otherregular viruses that we do not
have this kind of measure ofcontainment and measurement and
that kind of stuff.
What, what is there a, is therea standard by which we can
actually transition to say,okay, we've reached this moment
by which we can now I think wetalked about this last week and
(17:40):
this is going to be, I think theperennial difficulty of dealing
with a pandemic is when do youmove it from.
I'm an outlier to somethingthat's, that's actually
fabricated into the daily rhythmof life.
Like just like we don't measureflu.
Every positive case that is, is,is this, is this more of an art
than a science for this?
(18:00):
Are we when we're culturallyready?
Or is there like a metric bywhich we can look at?
Look at?
Yeah.
There's you're right.
There's a lot of, sort of,There's a lot of room for
discussion on this.
I think in the end, there'snothing that's really cut and
dry.
I think probably the best way tothink about it is to place it in
the context of other risks thatwe face every day.
And so in this case, I thinkthat flu is a reasonable, a
(18:21):
reasonable thing to do.
Part of my hesitancy in, inlooking at fluids that actually,
I think we could do a lot betterat preventing illness and deaths
from flu too.
You know, there's, as we startto compare risk from COVID to
risk from other things, we alsohave to really critically
examine as like, sh should we beaccepting this level of risk
from these other things as well?
Yeah, putting that to one sidefor now, there, there are risks
(18:44):
that we accept every day,including the risk of getting in
our car and driving down thestreet or, or of, you know, flu
every year.
And so I think that one of theways that we can start to
measure that is looking at along enough time horizon,
usually on the order of a yearand asking, you know, how many
people are dying, how manypeople are hospitalized from
each of these things.
(19:04):
On average, over the course of ayear in a particular position,
And then ask ourselves sort of,how does COVID stack up right
now?
Deaths from COVID are stillexceeding the rate of death from
COVID is still exceeding thatfrom flu, but as vaccination
increases as ideally, you know,we find better ways to manage it
during surgeries.
Hopefully that will come muchmore in line.
And then once it's sort of onpar with those other risks that
(19:27):
we've come to accept, we canthen say, okay, well now, now
it's time to sort of fold thisinto this portfolio of other
risks that we that we face everyday, every day, while also
recognizing that we can make alot of progress on these other
risks too, to improve wellbeing.
This is always reallychallenging because that risk
will change depending on.
(19:50):
Age groups, depending on thecommunity you're living in,
depending on all sorts ofdifferent things.
And so there's a real danger ofdoing too much averaging where
if we, for example, average thenumber of deaths from COVID over
the entire country, we mightreally be missing out on a huge
number of excess morbiditymortality that are that's
occurring in certain age groupsor certain communities.
(20:11):
And we need to make sure we'renot doing that.
So we need to make sure we'redoing these things sort of on,
on the local scale wheneverpossible.
But as long as we're doing thatthoughtfully, then I think,
yeah, comparing this to otherrisks that we access adapt in
our day-to-day lives as sort ofone good metric for determining
when we're ready to transitioninto this being just a reality
of our life.
Okay.
And now you just said how evenat this level, at this point in
(20:32):
time, you know, being well overa year and of the pandemic,
we're still at a place, butwhich the rates of death and
are, are much larger than, orsignificantly worse than flu and
other things in our, in our lifeas well.
Given the, the increase incases, the the accelerator of
the Delta variant.
Do you prescribe anything rightnow in generally different for,
(20:54):
for the communities right next?
So we're seeing medicalprofessionals.
I don't, I don't think the CDChas done it yet.
The medical professionalsadvocate, and even now people
wearing masks outside, even ifyou're vaccinated because of the
increase of variants.
Among in discussion there atHarvard.
Is there anything going on atthis point in time, should we
advance the level of our cautionor still maintain the CDC
(21:16):
policies of if you'revaccinated?
You're good.
Unless you're in a bigpopulation.
Yeah.
So it's I think it's, it'stricky.
So there may well be, and Ianticipate there probably will
be a time when we're going tohave to start.
Wearing masks because indoorsagain.
Certainly for unvaccinatedpeople who I think by CDC
guidelines should be wearingmasks indoors anyway, but but it
(21:37):
might make sense for vaccinatedpeople to start wearing them
inside too.
Full disclosure.
I am generally wearing a maskindoors anytime I'm indoors.
Anyway it just I just feel likeit's a small thing that I can
do.
That's an extra layer ofprotection for the people around
me.
And so in my mind, that's just atrade-off that makes an awful
lot of sense.
But especially as the cases ofDelta start to increase Those
(21:58):
kinds of things.
We'll probably have to startbringing back to some extent.
So I think it's still earlydays.
We, it, we may not need thatquite yet, but I think, you
know, stay tuned.
There's definitely somecommunities here in
Massachusetts where cases areaccelerating more quickly that
I've just as of today oryesterday, re-instated an indoor
mask mandate.
(22:18):
And And so I think it's coming,it may only be coming for
particular communities atdifferent times.
It may not be a national sort ofthing.
But I think that also makessense.
I think the story of this.
Epidemic over the next fewmonths, it's probably going to
be a very local sort of thing.
And so it makes sense to treatit as such great.
Now let's you just mentionedhow, like you, your personal
(22:39):
preference right now, as you goin, you go inside, you wear a
mask it's just free.
It's a small contribution youcan do to help keep COVID at
bay.
So let's take that and, and movethat into what the CDC was
talking about.
And there's been some criticismabout what do we measure when it
comes to breakthrough cases.
This is all the discussion.
The past week, two weeks hasbeen, we're seeing, you know,
(22:59):
maybe in June, it was 1%.
Of cases or, or are coming fromthe vaccinated people.
Now we're seeing a much biggernumber and, or at least
relatively speaking that arecoming breakthrough infections
coming through, you know, so twothings, can you help us
understand that betweenbreakthrough infections and
breakthrough disease?
Because I'm sure you've talkedabout as many, many times, but I
(23:22):
saw that distinction a couple ofdays ago.
I'm like, oh yeah, I forgotabout that.
There's a different one, two.
And then CDC, if I, if I'mgetting this correctly, has
decided at least maybe they'vechanged.
I don't know, at least there wasone point in time they wanted
to, to measure breakthroughdisease and not necessarily
breakthrough breakthroughinfections, but there's some
people say, no, we need to bemeasuring these because we don't
(23:42):
know to what extent we'retransmitting this to other
people, those who have thevaccine, maybe why that extra
level of caution for you to wearthe mask.
And it's also helpful forgenomic research to know, to
what extent is the vaccinecausing variants.
And so measuring this will behelpful for us.
And I'm guessing, you said youhad interviewed just recently
talking about this and he mayhave a different, a little bit
(24:04):
of a different flavor too, to aresponse to the criticism of the
CDC.
Yeah, exactly.
I you know, it kind of foldsinto some of what we were
talking about before with, withtesting in general.
Which is that, you know, does itmake sense for us to follow up
every single breakthroughinfection and an infection?
Breakthrough infection is anespecially difficult thing to do
(24:25):
because by definition, if it'san infection, but not a case,
you're not showing symptoms.
And so figuring out how to testthose people.
Well, you, you essentially haveto do regular testing for
everyone, always regardless ofvaccination status.
It may not be a bad idea, but,but should we be using those
resources for that or forsomething else?
So before I get too far, youasked about the distinction
(24:47):
between breakthrough infectionand breakthrough disease.
So, breakthrough infection iswhen someone who is vaccinated
becomes infected with SARS covtwo, but remains asymptomatic.
So you can become infected,which means usually in this
case, meaning that you can testpositive through a PCR test But
you don't go on to show disease.
Now, one of the really importantthings about this is that
(25:09):
oftentimes when a person who'svaccinated becomes infected they
do become infected.
They, they are able to turnpositive on PCR, but they
frequently don't even produceenough virus to infect another
person.
And so, especially in that case,it's like, okay, so the person
is not showing symptoms.
They're, they're not.
Infectious to others.
Is, is that something we reallycare about?
(25:31):
Yes.
From a research perspective, I'man epidemiologist.
I want all of the data I cansurely get, but from a practical
perspective, for somebody who'sin charge of running a national
public health agency, Iunderstand why following up
every single one of these mightnot be the top priority.
Breakthrough disease on theother hand is, is what it sounds
like where you're someone who'svaccinated who's been infected
and then has progressed to showsymptoms.
(25:53):
Now that's something that wemight want to pay some more
attention to.
I think that there's still somelatitude here for disagreement
because.
If a vaccinated person does goon to show symptoms, they're
still unlikely to have severeoutcomes from those symptoms.
And so, again, this is sort ofthe, in this paradigm of trying
to shift the risk from COVIDinto something like the risk of
(26:13):
other infectious diseases thatwe deal with all the time.
I still become symptomatic withflu with other Corona viruses as
well.
But does it make sense for everysingle one of those cases to be
tracked?
I don't know, there, there maywell be bigger fish to fry now,
breakthrough hospitalizations,breakthrough breakthrough
infections that lead to death.
Absolutely.
You know, we should be followingthose up because if we start to
(26:36):
see that the risk ofhospitalization or the risk of
death starts to edge invaccinated people closer towards
what it is in unvaccinatedpeople right now, the difference
is still vast.
But if it starts to increase,then, then that's a real cause
for alarm.
Right?
Then, then we might really havea variant on our hands and
something that we really have topay close attention to.
(26:56):
And I think that rightfullythat's why the real emphasis is
being placed on that.
It's difficult because it meansthat you can't necessarily
compare the numbers directlyfrom unvaccinated people in
vaccinated people because we'retreating them somewhat
differently.
And.
You know, in some circles that'sa real cause for alarm and
concern and allegations that,you know, we're trying to hide
(27:18):
information or to make thevaccines seem better than they
are or something like that.
And I think that it's justreally, as far as I can tell,
it's just, this is sort ofplaying out in the context of
really difficult, practicalrealities with respect to
testing.
And so I think that, you know,we can always criticize what the
CDC is doing.
But But a decision has to bemade at some point.
And I think that the decisionsthat they're making with respect
(27:40):
to this are.
Defensible.
Yeah.
And, and that's kind of wherewe're at.
So desert it's helpful becauselike, well, a couple of things,
and we probably talked aboutthis already, at least in a
roundabout way, in my mind I'mthinking, oh, I want to have a
measured because of two things.
Number one.
To what extent are AceNetasymptomatic people spreading it
and causing more spread, but youjust mentioned, you've answered
(28:01):
that.
I saw an article that kind ofrepeated what you just said,
that those who had the vaccine,even if they become
asymptomatic, They have likeroughly a 40% less viral load to
actually spread.
So this kind of goes into thequestion I wanted to ask as well
that if between Vaccinated apositive case and an
un-vaccinated positive case.
And there's, there seems to be adramatic difference.
(28:21):
You've pretty much already saidin the past 20 minutes that the
viral load is significantly lessfor those who are vaccine.
If you are now, I can seeanother reason why I would want
to be able to be.
And that is, well, you know,maybe I get it, I'm a cinematic,
but maybe I need to prepare forthe possibility of me having
long haulers.
Right.
It's like that, but it's alsoanother article I read.
(28:42):
It seems like it's really, andmaybe you can echo the same
thing.
I don't know if you've seen anyof it's really, really, really,
really, really unlikely thatpeople are going to get along
hollers from a vaccinator.
Positive case.
Has that been a similar kind ofdiscussion going on in your neck
of the woods?
Yeah, it seems to be so maybeagain, to add sort of some
(29:02):
nuance to some of this with theW with how, how infections look
between vaccinated andunvaccinated people.
You know, you're absolutelyright.
That on average, a vaccinatedperson is sort of every step of
the way less likely to progress.
So they're less likely to getinfected in the first place.
If they're infected, they'reless likely to show symptoms.
If they show symptoms, they'reless likely to produce as much
(29:22):
virus as a person who'sun-vaccinated and they're less
likely to go to the hospital.
So all of those things are sortof the vaccine sort of puts a
filter at each one of thosestages and sort of help screen
you out from getting to each ofthem.
That said, you know, one of thethings in a lot of the
conversation I've had withjournalists and even just with,
with concerned friends aboutthis, is that, you know, we're
starting to see morebreakthrough infections.
(29:42):
Personally, right?
Like I, I now know a friend of afriend who's been vaccinated and
has shown symptoms from COVIDand there's something super
alarming about this too.
Right?
Like they got vaccinated.
What the heck?
You know, am I at risk?
I've been vaccinated.
I don't want to get COVID, youknow, what, what should I do
about this?
And I think.
And this is where it's beenreally helpful to be looking at
the data all along.
(30:03):
And the sort of thinking aboutthe statistics about this is
that again, the vaccines arevery effective.
They're very helpful atpreventing each of these
progressions from one stage ofillness to the next.
But the way that I like to thinkabout it is from the very
beginning in the trials, thevaccines were 95% effective at
preventing symptoms, right?
Just very good between 90 and95% effective.
(30:25):
Basically these are for themodern and the Pfizer vaccines,
for example What that means isthat for every 20 unvaccinated
people who show symptoms, you'regoing to expect one or two
vaccinated people to show someelse.
So the ratio is about 20 to one,20 to two.
That's actually not all thatuncommon.
Now, of course, if you showsymptoms, you're less likely to
go to the hospital.
You're less likely, you know,all of these things.
(30:45):
So, so the vaccines reallyespecially protect against those
severe outcomes, but, but Ithink it's worth bearing in mind
that actually symptomaticbreakthrough cases are now.
That's surprising in some sense,too.
And so this is another reasonwhy, why following all of them
up doesn't necessarily makesense, because it doesn't imply
necessarily that there's a newvariant or that there's
something to be super alarmedabout.
(31:06):
It's just that as we've knownall along the vaccines are not a
magic bullet, but they arehelping us keep control of the
epidemic.
And so, so that's sort of.
Big sort of caveat in all ofthat.
Now we're still learning a lotabout the long haulers issue.
And I think that that's going tobe one of the most interesting
things is to see therelationship between vaccination
and long hauling.
(31:26):
There've been some anecdotalsuggestions that even people who
have suffered from COVID longhauling.
Their symptoms have some haveimproved after getting
vaccinated as well.
So like the developed COVIDbefore they were vaccinated,
they had long haulers, they gotvaccinated and the vaccine
somehow seems to havecontributed to some of those
symptoms clearing up.
Totally anecdotal.
I don't think we have any solidevidence as to if that's
(31:48):
actually the case on sort of awidespread scale.
But I do think that therelationship between vaccination
and long hauling is going to besuper important.
To my knowledge, we don't reallyknow yet.
The extent to which vaccinationprevents your odds of developing
long haulers.
I would anticipate that it ismuch lower in the sense that the
vaccine seems to protect againstevery stage of illness.
(32:09):
But one of the difficulties withthis as both that long hauling
is still not super well-defined.
And so it's difficult to saywhen exactly you have a case of
it or not.
And it also takes longer todevelop.
And so it's, we're just going toneed more time to collect those
data too.
So, I would believe those kindsof things, but I think that
we're still sort of in the earlystages of getting evidence on
(32:30):
the relationship betweenvaccination and long hauling.
Good, good.
You know, speaking of which, Ithink what adds a level of
complexity to breakthroughcases, as you mentioned, all the
different, you know, 90, 90%,95%, but then they include,
right.
Even those who've been given thefirst vaccine, but didn't follow
up and get the second vaccine.
So this is going to skewstatistics even more because we
(32:50):
know that especially thevariant.
Are a little bit strongeragainst those who chose to get
the first vaccine, but not thesecond one.
And if they get a positive caseinfection or disease, there's
still a vaccinated group, eventhough they weren't fully
vaccinated.
Right.
So they're part of that, thatlump sum is that, is that.
That's right, exactly.
Yeah.
(33:10):
Going to add some more of thestatistics as well.
So speaking of that doublevaccination, I saw this in the
news.
Just want to bring it out.
It's interesting.
Nixed, AstraZeneca and Pfizershot boost Cova antibodies up to
like six times.
So just showing now we've beentalking about this for all, you
know, six months, seven months.
About at some point in time,we're going to start seeing a
lot more of these studies andtests of mixing two different
(33:32):
types of vaccines.
To see how it increased theantibody levels.
And I think that was a greatfirst step with AstraZeneca and
the Pfizer.
Now I did see that when it comesto the variants, particularly
beta, gamma and Delta, it's notquite as big of an antibody
jump, but nonetheless, startingto see these tests to show some
good, good positives.
Okay, last thing I'm gonna talkabout before we go I brought
(33:53):
this up to you before we startrecording, and I thought it was
going to be a moot point,Stephen.
And you're like, oh, this isactually kind of interesting
concept.
So I wanted to bring up the lastweek.
We didn't have time for it, butI saw articles at a U S life
expectancy dropped by 1.5 yearsin 2020.
Right?
So this is, I think the mostsignificant drop we have had in
life expectancy.
Since when we go to war to now,I think it's not a big surprise.
(34:16):
The reason for this isparticularly COVID is, is the
hallmark reason for why thishappened when I mentioned this
to you, Steve.
And you're like, oh yeah, thiswould be a really fun topic
because of X, Y, and Z.
And explain you guys been havingsome discussion about this.
Why don't you chime in and talkabout this life expectancy?
What might be happening in thefuture and this, the craziness
and the complexities of dealingwith this kind of the stuff?
(34:38):
Yeah.
So, you know, there's so manydifferent ways that we can Look
at the impact of this pandemic.
You know, we've looked at excessmortality, we've looked at
cases, we've looked at deathsand hospitalizations over time,
cumulative specific span oftime, peak level, you know,
there's all sorts of differentways that we can measure the
impact of COVID.
And one of them are, is thisvariation in life expectancy?
(35:00):
One of the reasons people liketo use this measure is because
it's sort of a blanket measure.
Wellbeing across the population.
I before we really dive into it,I want to, you know, sort of
talk about what life expectancyis and what it is not.
So what life expectancy soundslike is how long a person is
expected to live.
If they.
(35:20):
Born on this day.
And it's not really that what itis is actually sort of what a
hypothetical, how long ahypothetical person would live.
If at every age they faced thesame risk that a person who
lived through this year faced.
So that's why the COVID pandemichas had such a big impact on
life expectancy.
It's it's not to say that now.
(35:41):
Everybody's, you know, we had acouple of years shaved off our
lives.
I do feel like I had a couple ofyears shaved off my life after
this past year.
But what it's really saying isbasically, you know, what sort
of risk did we face over thecourse of this year?
And because of all of the excessmortality from the pandemic it's
it decreased life expectancy.
Matt Boettger (36:01):
Now, one of the things that would've made this
number go up even further is ifCOVID had been much more severe
in younger people than an older.
For example, so that would havedecreased life expectancy even
more.
So it's sort of a measure thatsort of assesses risk of death
over time by different agegroups and so on.
Stephen Kissler (36:17):
So you're right.
It is still really importantthat life expectancy for this
year dropped by about a year anda half, which is more than it's
dropped since world war II.
And so, so, so there's that, so,so that's basically what it's
measuring is sort of this onemore metric of sort of.
The impact of the pandemic overthis past year now, what do we
(36:38):
expect going into the future?
Well, there's this reallyinteresting phenomenon that's
called mortality displacement,and the idea behind it is that
you know, EV everybody dies ofsomething.
But yeah.
If in a particular span of time,you're exposed to an excess
risk.
You're are no longer going todie of what you would have died
(36:59):
of you die of that other thinginstead.
So in this case, that excessrisk is COVID.
Some people have talked about itusing a word that.
Don't like, but it's likebasically like mortality
harvesting in a way where it'ssort of like COVID has sort of
collected people who would havedied from other causes, but has
made their cause of death COVIDinstead.
And in some cases, this is true,right?
A lot of, especially people whowere very old, who had lots of
(37:22):
co-morbidities like those arethe people who are most likely
to die from COVID.
And so they might have died in acouple of years from pneumonia
or from some other kind of bloodinfection, but instead they died
from cancer.
So, what does that do as we lookforward to life expectancy?
Well, this is actually a prettywell-documented phenomenon in
people who studied demographyand, you know, just sort of the
(37:43):
study of populations over time,which is that when you have one
of these, you know, reallycatastrophic events in a
population, essentially you seethis mortality displacement
phenomenon and what it does isit the people who basically.
Shorter times left for thisworld are the ones who are most
likely to succumb to whatever itwas.
And that means that theremaining population actually on
(38:05):
average has a longer span oflife ahead of them.
So what you see actually is thisrebound.
So there's this decline in lifeexpectancy, but then in the
following years, it kind ofrebounds.
And so there's this artificialincrease in life expectancy for
a couple of years, followingthese catastrophic events until
it sort of settles back intonormal.
Why is this interesting and notjust sort of like an academic
(38:26):
thing, you know?
Well, one of the ways thatpeople frequently advocate for
policy change is by quotingdifferences in life expectancy,
between racial and ethnicgroups, between demographic
groups, between geographiclocations, for example.
And we know that the pandemichas been more severe for certain
groups for especiallydisadvantaged groups lower
(38:47):
socioeconomic income, racial andethnic minorities, these sorts
of things.
The rebound is usuallyproportional to the size of the
decrease in life expectancy thatwe saw before.
So, so we run the risk of infuture years saying that, oh,
you know, actually, actuallylife has gotten a lot better for
these disadvantaged communities.
We thought that it was going tobe really bad.
We thought that, you know, theywere going to be suffering for a
(39:08):
really long period of time.
But look, their life expectancyhas actually increased and it's
increased by a factor even morethan those communities that are
better resourced.
How good are we doing?
You know, this is wonderful.
We don't have to provideresources to these communities
at nearly the rate that wethought we did, because it seems
like they're just kind of takingcare of themselves, which is not
at all the conclusion we want todraw from this.
(39:28):
Right.
Because really it's just anentirely artificial.
Rebound, it sort of comes out ofthe way that these statistics
are calculated.
So that's something we're goingto have to pay really close
attention to in the comingyears.
And so as we're thinking aboutthese life expectancy, I think
I, I sort of, I want toemphasize to not place too much
doom and gloom on the, on thedecline in life expectancy.
It's terrible, but it doesn'tmean that you personally are
(39:49):
less likely to live as long asyou were before.
Assuming you're still listening.
Podcasts, but then also in thefuture, we're going to see some
really wonky things happeningwith life expectancy.
And so it's worth sort oftempering our surprise at these
things because a lot of it justsort of falls out of the
calculations.
I can definitely see this rightin the future being used and
hijacked for media and politicalinfluence.
(40:09):
So it's good to kind of get thatsobriety right here and right
now, and also I had no idea.
About what life expectancyreally meant.
And so thank you for clarifyingthat because you think it's kind
of just self-explanatory becauseit's life expectancy, but it's
odd thing.
Like everything else.
It's a little bit complicatedand a little nuanced.
Thanks for sharing that,Stephen.
I think that'll end in wrap thisepisode up.
Thank you all for listening andthank you for all who were on
(40:32):
live or watch it and split up intwo different videos.
Sorry for the little bug andtechnical difficulty same stuff
you'd like to review.
Please leave a review on applepodcasts.
Please support us$5 a month atpatrion.com/pandemic podcasts or
Venmo, PayPal.
One-time gift all in the show.
Check out the show notes.
There's some really interestingarticles that came out this
week.
I'll put them in there for youto read and enjoy, have a
(40:54):
wonderful week, and we'll seeyou next week.
Take care.
And bye-bye.
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