October 18, 2021 • 46 mins
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Things Discussed on Episode:
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Matt Boettger (00:00):
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible in the face
of these crises.
My name is Matt Boettger and I'mjoined with my good
friend, Dr.
Stephen Kissler.
And if you actually watch this video, I
tell, I forgot to get rid of theother empty face or Dr.
Mark Kissler.
Who's not here whatsoever.
So we're going to move thatright like this.
So we're over with just the twoof us.
So, Stephen, I've got you on.
(00:21):
Good to see.
Yeah,
Stephen Kissler (00:23):
it's good to see you too.
Matt Boettger (00:24):
It's a, how's the weather in Boston.
Can I do the normal, like acliche?
Stephen Kissler (00:29):
I know.
Yeah, it's a it's cool enough.
Allie and I got to go out andsee some of the leaves this past
weekend, which was great.
Took a drive up through Westernmass in the Southern part of New
Hampshire.
And it's great.
This is, this is a special timeof year
Matt Boettger (00:42):
now.
Are there any tips in that for,so those of us who are those of
you who are listening, who arekind of up in the Northeast
daily tips for great places tosee tree, because it has here in
Colorado, it's an as you wellknow, it's not all over.
You've got to go drive to findthe Aspen leaves and there's
certain hotspots.
Is it similar or is it justeverywhere?
They're just a matter of whereyou go.
Stephen Kissler (01:03):
Yeah.
It's most places are good, atleast at some point that there's
this like gradient from north tosouth.
So it gets really good, like wayup north first and then it's
coming down.
So here in Boston, actually,most things are still green.
We're gonna have little bits ofcolor.
So, so it was part of why weended up driving up north.
So there's there's a highway inNew Hampshire.
That's in the white mountains.
That's absolutely beautiful.
(01:23):
So that's where we ended updriving them.
If you're really into thisVermont publishes a weekly
foliage report and it's thisnewsletter it's, even if you're
not living up here in theNortheast, it's the most
charming thing you can imagine.
So if you need a little bit asfalse spirit in your inbox every
week the Vermont department oftourism gives you a detailed
update of where exactly to seethe leaves in their state.
(01:44):
It's just wonderful.
So we're going to go out of ourway in your life and
Matt Boettger (01:48):
put that in the show notes, because that sounds
awesome.
It's awesome.
Now better yet is if they havean Instagram feed, so I can be
inspired every day by thefoliage of of New Hampshire will
be great.
Yeah.
We'll work on that.
I'm sure with all your extrafree time.
Well, good.
I'm glad we could connect.
Again, this Monday morning, kindof get back on a regular
schedule of on Mondays.
(02:09):
A few things are normal stuff.
You could leave a review.
We haven't had one in a littlewhile.
We've had a couple more fivestars.
It was great, but no comments.
So leave a comment, inspires usto keep us going.
If you can support us.
We'd love that as little as$5 amonth at patrion.com/pandemic
podcast, you can see it in theshow notes or just a one-time
(02:29):
gift, PayPal, Venmo again, allin the show notes.
So Stephen it's been a couple ofweeks just shy under a couple of
weeks since we were on aWednesday.
And I've been perusing the news.
And as you well knows, it's,it's a slow, which is kind of a,
I guess, maybe a good sign.
Maybe you can fill me in it'sit's, it's, it's slow right now
in the news on the pandemic andCOVID-19 and maybe part of it is
(02:53):
I honestly, to be fulldisclosure, I had.
Quite as invested in checkingthe news every single day, a lot
of things on my other life thatkind of preoccupy me.
But I want to get with youbecause you've mentioned there's
been a couple of things thatyou've been seeing that's been
surfacing.
Can you give us an update on thetwo things you talked about?
He was the vaccine, theboosters, and then any variant
(03:14):
information that we need to be,to be known.
Stephen Kissler (03:17):
Yeah.
So, and I think first of all, Iwant to kind of echo the, the
feeling that you have, where itreally does feel like there's No
less than the news.
And, you know, I also have beensort of like checking my usual
dashboards a little bit lessfrequently.
And and I think that that's, youknow, that's something that a
lot of people I've spoken withhave been sharing as well.
And, and in large part, I dothink that's, that's a good
(03:38):
thing we have seen largely youknow, declines in cases across
the year.
For the most part, which is,which is great.
And so, and it really, you know,the question is we're, we're
coming into this winter seasonand there's a lot of uncertainty
as to what's going to happenwith COVID with flu.
What do we need to do to beprepared for those things?
And I think we'll probably getinto each of those things one by
one over the course of thisepisode, but you know, some of
(04:01):
the, the major things that havecome across my radar over the
last.
Two weeks or so as first ofcourse, the FDA approvals of
boosters or third doses, or insome cases, second doses for
those who've received the J andJ.
And and so the, for the vaccinesthat have been approved in the U
S so the Pfizer, the Medina andthe J and J additional doses are
(04:22):
now approved.
And so there's a matter ofsupply trying to figure out, you
know, how.
To get doses to those who needthem.
There'll be some time that ittakes to ramp up.
And right now I think that whilethey have been approved, I think
they're currently recommendedfor people over the age of 65
and those who are working inhigh contact settings.
So healthcare workers, teacherspeople who are at high risk of
(04:45):
in fact, So I think this is allreally good news.
One of the questions that I'vegotten about these is that we're
so far, the guidelines all haveto do with getting an additional
dose of whatever you've alreadygotten one or two doses of.
And there's also been a lot ofresearch that's come out that is
still in the early stages, but Ithink is really maturing
quickly.
Mixing and matching and lookingat, you know, what is the best
(05:08):
dose to follow up and given yourprevious dose?
There are no clear cutguidelines on that yet, but in
the same way that we got a lotof information, I think it was
this past week on third doses.
I expect over the next couple ofweeks for there to be some more
information about mixing vaccinetypes as well.
And there's a lot of really It'sdifficult to there, there are a
(05:29):
lot of layers of difficulty withus because the trials of those
who have received differentvaccine doses are there are
fewer of them because of vaccinecompany is not going to
administer another.
The vaccine to their owncohorts.
So you know, a lot of theinitial information we got is
from Pfizer or from Medina.
Whereas now we have to rely onthese more independent agencies
(05:49):
who are running their ownstudies for people who have
gotten different types ofvaccines.
So that's part of the reason whythe information is a little bit
slower to come out, but it'scoming.
And generally from what I'veseen certain combinations of
doses do seem to be performingpretty well in terms of the
duration and level of antibodyresponse.
And we've seen that to someextent in the UK too, where
simply because of supply issuesand the need to vaccinate people
(06:11):
quickly, many people got anAstraZeneca dose first, and then
that was followed by a Pfizerdose.
And those people seem to havefared pretty well.
So that's where some of ourinformation is coming from as
well.
Keep the eye, keep an eye outfor that kind of information
coming up.
So, so the vaccination is reallysort of one of the big areas of
news that I've seen.
The other really is just sort ofbeen emerging over the last day
or two.
And this has to do with the AOIfor variants, which is a sub
(06:33):
lineage of the Delta variant.
And there've been somesubstantial increases of this
particular variant that we'veseen in particular, in the.
I think part of that, part ofthe reason we've been seeing
those increases there is again,because the UK is surveillance
is unbelievable.
And so it's not to say that it'sthe only place where a sub
lineage of Delta might be takinghold.
But they've been able to detectit and to identify the fact that
(06:56):
this Is a somewhat mutatedversion of the original Delta
that we've been seeing spread.
So again, it's still too earlyto say if the mutations that
we've seen in this new variantare sufficient to give it.
Some escape from immunity orincreased transmissibility.
It does seem to be spreading alittle bit more rapidly than
(07:16):
other variants of Delta that,that came before it.
And so I think there is reasonto believe that it might be
either somewhat more infectiousor able to get around some level
of.
But it also doesn't seem likeit's the orders of magnitude
difference.
Like we saw going from alpha toDelta, if it is it's maybe a
little bit more fit, a littlebit more able to spread.
But I don't think fromeverything that I've seen so far
(07:38):
and from all the commentary thatI've seen from my colleagues we
may see this additional variancesort of starting to.
Represent more and more cases.
But it doesn't seem like it'sgoing to be nearly like what we
saw with the transition fromalpha to Delta.
So that's, you know, that's,that's good news, but it's also
something that we're going to bewatching closely.
We've spoken about this topic somany times about you know, just
the difficulties of figuring outwhat makes a variant a variant.
(08:01):
And is it just getting lucky oris it actually, you know,
genetically biologically betterin some way.
And how does that depend on theplace in which it's spreading
and the population.
All of those are still, youknow, those same questions.
I'll still hold here too.
And that's why we're stilluncertain as to really what
exactly is going on with thisthing.
But it's something we'rewatching closely.
Great.
Matt Boettger (08:20):
Well, a couple of follow-ups in this, so I'll go
reverse.
Where, what the most, the topicyou just mentioned right now,
and that is a variance.
It seems as though now, maybethis is because Delta is just a
dominant force.
But it seems as though, like thevariants have kind of, been
tapering off a little bit.
And for those of you who mightbe hearing the background, my
(08:41):
son's kids screaming in thebackground.
Sorry.
It just happens.
It's part of the life of the, ofthe household.
So it seems like the variantsare kind of tapering off.
Is this amongst the colleagueswho you're talking to.
Is there a sense by which it'sstarting to stabilize or is it
more of a, just Delta is justsuch a dominant force that
there's just no other chance.
And it's still like, where doyou guys find yourselves and
(09:04):
kind of landing on those areasof like, is it stabilizing or we
find ourselves maybe the nextsix months, this is going to be
kind of really being a taper offor is it just nothing has a
competed quite yet.
We're just waiting for it.
A new dominant variant.
Stephen Kissler (09:18):
Yeah.
You know, it's, it's really hardto say famously when one tries
to make predictions aboutbiology one has always proved
wrong.
And so, so it's hard to say, butyou are right.
The rate at which we've seen newvariants emerging and spreading
and sort of taking over hasdeclined.
And that is largely becauseDelta is just so contagious.
(09:40):
It's really hard to superchargesomething past something that is
already so supercharged.
And uh, you know, part of thereason for that is I imagine
because you know, there, thereare some constraints on
Respiratory pathogens that usecertain strategies to infect
ourselves.
So COVID 19, the SARS cov twovirus uses these ACE two
(10:01):
receptors in our epithelialcells to attach and then bind
and then enter into ourselves.
And you can get better andbetter at that, but ultimately
they're there.
We expect there to be some limitthat just biologically speaking,
you can only be.
So sticky and you can onlybecome, you know, so fast at
invading cells.
And that you know, you canexplore this evolutionary space,
(10:21):
basically you can mutate andspread and that sort of
optimizes one part of thisequation, but then at some point
you just can't really optimizeit that much more.
So, so I think that that may bepartly why we haven't been
seeing anything emerging pastthe Delta.
So it's kind of both, both ofthose things that you said.
So first, you know, Delta isalready so infectious.
And second, because the virusmay maybe starting to exhaust
(10:45):
some of that what we callevolutionary space it's ability
to sort of explore thesedifferent strategies that make
it more and more infectious.
But of course, you know, basicinfectiousness is just one part
of the equation.
People I think are rightlyconcerned about right now is
also the ability to evadeimmunity and virus can do that
in a lot.
Generally speaking, there are alot more ways to do that, partly
(11:06):
because Are if for anyone who's,you know, seen either actual
microscopic images of the SARS,cov two virus, or even just a
cartoon versions of it, it'ssort of this circle looking
thing with these spikes stickingout of the top.
That's the name?
The Corona virus stands for thecrown or the Corona that
surrounds the virus, which arethese spike proteins that are so
infectious or that are so.
(11:28):
Much responsible for theinfectiousness of the virus.
So these, these spikes help thevirus attached to ourselves, but
they're also the first thingthat our immune system is
exposed to.
And our immune system doesn'talways recognize the bits that
are most important for the virusis actual function.
Sometimes the virus will justdisplay things on these spikes
and it can change those to trickour immune system, basically.
(11:52):
And, and this is a very commonthing with.
So this is why we need fluvaccines every year.
This is why flu can infect usyear after year after year,
because it's essentially likethe virus is the same, but it's
like, it's changing its outfit.
And so it has this, you know,wide range of you know, coats
and hats and sunglasses that canput on so that our immune system
doesn't quite recognize it aswell.
And so those things don'tactually disrupt the function of
(12:13):
the.
You know, the virus itself isstill the same, but the thing
that it looks like to our immunesystem is a little bit
different.
And so I think that's what wemay start to see here, where we
have the, you know, sort ofthis, this Delta base of the
SARS cov two virus, but thevariants can now sort of lead to
these subtle shifts.
And I expect this might bewhat's happening with this new
AOI for variant is that it'sfound sort of a different coat
(12:34):
to put on.
And our immune system can'tquite recognize it as well as
our response.
And I think that that issomething that we might see.
For a long, long period of time.
And so if we start to seeCOVID-19 or the SARS cov, two
virus coming into the seasonalcirculation, something that
looks a lot like flu, I thinkthat this might be part of
what's behind it is that it justsort of keeps changing its
outfit from year to year.
(12:55):
And that's something we'reprobably never going to totally
be able to get ahead
Matt Boettger (12:57):
of.
Okay.
That's helpful.
I mean, I never really made thedistinction between.
The variant and maybe it's aleveling off and its ability to
kind of only be so efficient.
And that is a separate dimensionto evading the immunity.
I always saw them as beingone-to-one like once it kind of
plateaus out.
So, so is it for its immunity,its ability to skip immunity,
(13:18):
but those are two separatevariables you're saying, and
that you could actually leveloff, but instill in her infinite
amount of like hats and coatsthroughout the lifetime of its
of its existence.
Right.
Okay.
Alright, great.
And then the other question thenis dealing with this, the
vaccines and the boosters.
Right?
Well, now that we have James Jand J and, and Madrona being
(13:39):
available for boosters, youknow, I'm kinda thinking, first
of all, I saw Fowchee saysomething about, oh, this is
good news.
You know, we could now mix andmatch.
And so is it not quite availableto mix and match yet?
Are you just saying this is kindof the radar?
Or could I go into a Walgreensand get my little menu and be
like, Hey, do I want to today?
Do I want the modern, I don'twant the Pfizer.
Do I want the Jane.
Or do they, I mean, this may bebeyond what you know right now.
(14:02):
Or when you go in, do I have toshow them my card and say, oh,
you had the Pfizer's you'regoing to get the Pfizer again.
Or do I, am I going to have asay, you know, right.
Even right now on grant, I'm not65 rollers.
I wouldn't get one right now.
Whatever, say to actually changeit up by one to two at this
point in time.
Stephen Kissler (14:17):
Yeah.
So I think my understanding isthat if you you know, Walk into
a drug store.
They go to your local CVS thatif you are truthful about your
vaccination history, then, andyou say that you need a booster,
then they will give you a doseof whatever it is that you've
gotten before.
(14:37):
So it's not yet approved for fora person to mix and match.
That said a lot of, I do knowthat people have.
And and I do think that thatrequires you to not be truthful
about what you've alreadyreceived.
So there, you know, so that'sthat's in play there.
But but that's one of the reallyinteresting things about, you
know, the way that we'vestructured our vaccination
(14:57):
system for COVID-19 here in theU S is that there's really,
there's really not a lot ofoversight.
Generally people haven't reallybeen necessarily registered with
individually identifyinginformation.
So the.
We can clearly track exactlywho's received which doses.
And even if we are, then it'sactually very easy to sort of
subvert that system.
So these are not things that Iwould recommend at the moment I
(15:19):
think that, you know, the, theFDA exists for a reason and the
oversight is, is, is good.
But I do know that it's, it'spossible to do that.
But not neither recommended nornor you know, within the
boundaries of what has beenapproved.
So, so, so that's, you know,that is all, that's all Yeah,
(15:39):
that's all there that said, Imean, I know that.
So from, from, just to sort ofgive a gloss over the research,
I think I already mentionedthis, but it does seem like,
especially for people who havereceived and adenovirus type
vaccine as their first dose.
So something like the J and Jand the AstraZeneca, and then
have followed that with an MRIand a vaccine.
Generally it's been welltolerated.
Generally.
They've gotten very good immuneresponses that have far
(16:00):
surpassed the initial dose ofthe adenovirus vaccine they've
gotten in the first place.
So, it's not something I canrecommend at this point, but
again, this, these are thestudies that I'm pointing to
that I think we'll start to heara lot more about very soon.
Great.
Okay, great.
Matt Boettger (16:11):
Okay.
So let's switch gears for asecond.
I'm going to go back.
I know probably like every fourto six, maybe eight weeks now,
since we're every other week wementioned the flu and then
another, another article cameout from the Atlantic.
About the flu, which kind ofsparked my interest of the idea
that the concept that maybe isthe flu gone, like, are, is this
kind of like not gone below?
(16:33):
For years and years and years,we've kind of just a defaulted.
The fact that's always going toexist.
That's always going to dominateduring the winter that we're
going to have tens of thousandsof deaths, you know, all these
things.
And so we get the flu vaccine.
Now, then last year happens andwe have this freakish episode by
which we have almost zero flucases.
(16:54):
And so now we're wondering, youknow, maybe in August and July,
I was one, Hey, it's going to bea bad flu season because now I'm
thinking.
You know, not so great thoughtsof like, okay, well, you know,
we had a whole year where itdidn't surface and now it's been
underground building, you know,Dr.
Evil like this, this next year,it's going to be just atrocious.
Right?
They've they've had more time tothink about what they're going
(17:15):
to do and it's going to be wayworse.
And now I'm starting to wonder,you know, because of habitual
changes, because now that.
You know, the pandemics going toan endemic where it's like,
it's, it's going to live with usforever.
So we're slowly changing ourhabits.
You know, like of course we, youknow, no more lockdowns, that
kind of stuff, but you know,like things like working
remotely for a couple of weeksor, you know, having school go
(17:36):
remote for one week at a timeduring high, you know, high
outbreaks or wearing masks hereand there.
So all these random things washyour hands more, just having a
little bit extra space betweenpeople at the grocery store.
That's not even that much, youknow, all these have a
significant impact.
Could it be the case that likethis whole flu thing is just
like going to be behind us forthe rest of our lives, as long
as we continue down this path.
Stephen Kissler (17:58):
Yeah.
It's, it's pretty amazing to me.
I mean, I think that whathappened to the flu last year,
it was just mind blowing,absolutely mind blowing, because
flu has just been such a, as yousaid, it's such a regular part
of our experience know certainlyfor our entire lifetimes and for
as long as you know, any of uscan remember And it is a
(18:21):
remarkable thing that globally,we basically saw no flu last
year.
You know, it wasn't absolutelyzero, but it was historically
low and basically everywherethat collects flu related data.
Which is unbelievable.
So I think, I mean the firstthing, and I think, you know,
this is, this is what you weretalking about already, but it,
it really did cause us to take astep back and be like, wow,
(18:44):
like.
There are things that we can dothat we didn't realize would
have this level of impact.
And it is forcing us to think alittle bit differently about
infection control.
I think you're right, that thereare things that we took for
granted that now we're startingto think, well, do we, do we
have to and you know, like yousaid, that's not to say that
(19:06):
we're going to.
Impose all of the restrictionsthat we imposed last year, so
that we're living in a flu zeroworld for the rest of our lives.
But but it is a really importantTestament to the fact that like
these non-pharmaceuticalinterventions.
Do something, you know, theyreally, they do something and we
(19:26):
can use them in, you know, to,to reduce the burden of flu and
other respiratory diseases.
And and I think we really needto think critically about how,
how best to do that while, youknow, while maintaining all of
the other benefits of living ina social society, you know, that
we have So, so I think it's,it's going to be a really
(19:46):
exciting and interesting time tothink about what's what's going
to happen with the fleet now.
So part of the question is, youknow what, what's in store for
us this year, next year, andover the next five, 10 years.
And there's been a lot ofspeculations that after the near
eraser of the flu season lastyear That there could be a very
strong season this year.
And that's in large part due toour own immune systems, not so
(20:08):
much the virus itself, but thefact that because essentially
nobody was exposed to it lastyear that sort of timer on our
immune systems that gets weakerand weaker over time is not
going to have gotten thatreminder that it usually.
Annually or every couple ofyears.
And so that means there's goingto be a lot more people running
around who are not as protectedas they usually are.
So the flu is going to be ableto spread more easily, might be
(20:29):
more intense for the people whodo get infected because that
immune response might havedeclined to some extent.
And so I think that's been oneof the big concerns.
But there are, you know, thereare some counter.
To this too.
So there was, we should put thison the show notes as well, but
there was recently this writeupfrom a couple of my colleagues
from the UK including my PhDsupervisor, Julia Gaga, who has
(20:52):
done she spent her careerworking on flu and its
transmission dynamics.
And and she's far from convincedthat this coming flu season is
going to be.
The, you know, this big, bad,scary flu season, it could be.
I think there's reason tobelieve that it could be.
But one of the other reallyinteresting things about
essentially driving flu cases tonear zero is that we don't
really know how long it's goingto take for it to rebound.
(21:14):
Usually the flu Sort of spreadsfrom the Northern to Southern
hemisphere.
And so even though in the uphere, you know, we're in the
United United States right now,I'm in the Northern hemisphere.
We have our flu season duringNovember, December, January time
of year.
I'm in the Southern hemisphere.
It's June, July, August becausethat's their winter.
(21:35):
And so even though the flu isvery periodic.
In our own experience, there'sactually usually a decent amount
of flu circulating everywhere inthe world at some point.
And so one of the reallyinteresting things about the
COVID pandemic.
Essentially stopped to thatpattern.
And you can sort of, you cansort of think of this.
You could sort of think of thisas a pendulum in a way, right?
(21:56):
Where if you have a pendulumthat's swinging to keep it
swinging, all you really need todo is just sort of poke it a
little bit.
Right.
And, and if you just give it theslight little push, once it
reaches sort of the top, thenit'll keep swinging for a very
long period.
But if you stop that pendulum,if there's this bowling ball at
the end of the string, it takesa lot of effort to get it back
to the point where it's swingingback and forth like that year
(22:17):
after year after year.
And so, so we could be in ascenario like that for flute,
where it might actually takesome time for it to get ramped
up, back to speed.
I don't know for sure if that'sgoing to be the case, but I
think it's a really interestingidea.
They've, they've actually donesome formal modeling work to
suggest that this might be thecase.
And before the pandemic a lot ofthis work was done pre COVID 19.
So it was really this sort oftheoretical study that was like
(22:38):
in the night deal world.
If we could just stop flu for ayear.
What would happen.
And now all of a sudden we'reliving in that world, which is
pretty crazy.
So we're going to actually beable to see and test whether
these projections turn out to betrue.
So, all of that is a long way ofsaying that I have no idea
what's going to happen thisyear.
And and I think it'll be reallyinteresting to see what happens
over the next couple of years.
I think that.
(22:59):
My hunch is that you know, theflu flu does spread pretty well.
And so I, I I'm, I'm actuallyscheduled to get my flu.
This afternoon.
And so I'm planning to do that,especially because I do, I do
expect this year to have flucirculation.
And I think that it could be,even though it's not guaranteed
to be bad, I think that there'senough of a chance that I'm
(23:19):
definitely going to doeverything I can to protect
myself and the people around meby getting vaccinated.
I'm probably going to be wearinga mask pretty fastidiously all
winter long.
When I'm in indoor spaces withothers who are not part of my
normal pod.
And so, so that's, that's howI'm going to approach it.
But I do think that it's, it'sworth noting that We don't know
for
Matt Boettger (23:38):
sure.
Yeah.
Yeah.
Yeah.
There's one thing I learned inphysics and I know nothing about
physics.
I took a class in college and Ithought, I was like, oh, you
know what, I'm going to lovephysics.
And I realized, I hated itbecause it was just too
complicated for me.
But there's one thing I learnedand that was the friction
coefficient.
And that was like, that was likethe one thing that stick with me
because it was like, oh, thiswas like a life lesson.
(24:00):
And what you just did wherethere's this a coefficient of
friction, right.
Where we know that whensomething is not moving.
It takes so much inertia to getit to move, but once you get a
going right, it's so much easierto keep it moving.
And that's why I was thinkingabout the Fleming.
To what extent did we, you know,like you just said it stopped
and how much more momentum youhave to exert to get it to go
again.
And this is like a life lessonfor everybody.
This is where like, not to go ona tangent and I will, I'll spend
(24:22):
less than 15 seconds on this.
I hope.
And then.
That goals are really, reallycool.
They actually don't get the workdone.
You know, it's, it's the habits,right?
It's the tactics that, you know,instead of putting the one thing
down a day to do, to actuallythink of a recurring 15, 20, 30
minutes of doing an area of yourlife that you want to look
forward to so that you keepdoing it to build momentum to
(24:44):
where it becomes easier, right?
Just like habit formation.
So, taking this example of theflu and hope.
Th the end result will beexactly that, right.
It just takes too much inertiaand we're going to have a a slow
percolating flu season, butyeah, that's one good news.
Second.
Good news is guys get on somegood habits, get some good
tactics in and build, get rid ofthat friction coefficient.
(25:04):
So that to
Stephen Kissler (25:05):
make life a little bit simpler.
I think that's to turn your 15second tangent into a 32nd one.
I think, I think that that'sreally timely, you know?
I, I was, I was just having aconversation the other day with
Allie about how yeah, just, justhow strange this, this year has
been in sort of this it's sortof this.
Appendix to the crisis wherewe're still sort of living in
crisis, but also it's, it's likedifferent and I've, I've
(25:27):
personally found it really hardto get and maintain momentum
really this entire year it'sfelt like.
And so I, I really appreciatethat cause it's, it's true.
It's sort of like science,reflecting life, reflecting all
of these different sorts ofthings.
And I don't know.
It's I think it's a messagethat.
We could all stance to hereright now.
Yeah,
Matt Boettger (25:45):
I agree.
I spent a lot of time thisweekend working on my own life.
I felt the same thing.
Like I'm trying to get momentumin my life a little more and do
some more stuff.
And when I set goals out,sometimes they feel daunting and
so scheduling out my day andjust make even 15 minute blocks
to do something that I haven'tdone for a while and do it every
day.
And then you find yourself 30,you know, 30 days down and
feeling like, oh, this is oncewas a hard thing.
(26:06):
And now you want to do 30minutes an hour.
And so.
Really encouraged people.
If you haven't done anything fora long time, because of just the
pandemic or just life orwhatever, then just seriously
blocked 10 to 15 minutes.
And just commit to it every day,five to six days a week, close
up shop for that 15 minutes.
You're gonna find yourself in adifferent place, 60, 30 days
from now feeling better aboutyourself and all that jazz.
(26:28):
So that's our life lesson fortoday, but, you know, continuing
on with the flu for a second,now that we talked about this
off.
The the recording.
But I really curious this ideaof where you kind of reflected a
little bit Stephen and myself,for sure.
This idea of pandemic fatigueand just exhaustion and then not
building momentum.
And then I was thinking, youknow, okay, I'm going to be
vulnerable here.
(26:49):
Like I'm not the greatest impactin the world.
My wife is she, she really canfeel for the world deeply.
Right.
I don't have quite thatsensitivity.
And it's something that I wantto cultivate in my life.
The pandemic did not help meStephen.
Right.
Because I feel even moreexhausted.
I feel a little bit apathetictowards people, full disclosure,
(27:09):
but I'm working on this.
So my curiosity is, have you hadany research or no.
Talk to anybody about like theflu pandemic of whatever 19, 18,
whatever it was that after theentire thing.
So-called ended after the nextcrises where people are like
whatever.
I just don't care.
I can't do it anymore.
I mean, is there kind of like,any kind of studies on what, how
we deal with this crisisafterwards and how we engage the
(27:33):
next crisis?
Cause you know, a little, alittle careful and like, you
know, next price for the guy orwhatever.
And then it becomes actually aworst scenario because we're
like, I'm just exhausted.
Is there any kind of researchabout this, of like how we
behave?
Stephen Kissler (27:45):
Yeah, there is, and it's, it's a body of work
that I'm not super familiarwith, but that I I'm just
beginning to dig into.
I have another set of colleaguesfrom the UK who who sort of work
on the, on the social scienceside of epidemics and of major
crises.
But especially infectiousdisease related crises.
(28:06):
So there's there's thiswonderful in a way maybe
wonderfully morbid, but I thinkthey're super interesting
research group over there calledcrash.
And this is at the university ofCambridge and the acronym stands
for the center or, no, sorry.
It's not.
It's Cesar C E S E R for theit's the center for the study of
existential risk.
And so they collect a bunch ofpeople together who are
(28:26):
basically studying existentialrisks as such.
So that includes pandemicpathogens and global warming and
artificial intelligence takingover the world.
And, you know, all of thesedifferent kinds of things and
thinking about these things as,as such but also thinking about
them very broadly.
Not only the scientific sides,but also the social sides.
And so.
A lot of their seminars areposted online.
(28:49):
So if anybody is got a one ofthese slightly apocalyptic
streaks like ideas sure.
Feel free to take a look atthis.
And I, and it's actually reallyinteresting and can be
illuminating towards these,these kinds of things.
So, so the research is out thereand but I think that.
Th this pandemic is really goingto spur a lot more of it and
I'll be interested to see whatcomes of it.
But I think that for me, one ofthe most interesting places to
(29:12):
look at this, that I think thatwe all have some amount of
access to is to look at how arthas changed over time.
And to some extent, both art andphilosophy, but I think art is
in some ways, a little bit moreimmediately accessible in a way.
And one of the things that hasalways really struck me is the
shift in art that took placefrom the late 18 hundreds, early
(29:35):
19 hundreds to the 1930s,forties, fifties, up until the
present day.
I'm a.
Musician.
So I've, I've played the violinfor a long time.
So my first point of access tothis was through classical
music.
And you can see this really hugeshift from sort of the classical
period and You know, enteringinto the romantic period of
(29:57):
music where oftentimes there arethese very lush melodies and it
was very creative andspontaneous, but also had this
very like clear internalstructure.
It it, it broke from tradition,but still like had this very
strong tie to the tradition ofclassical music up until that
point.
And then you hit world war oneand world war II.
And also of course, the, the1918 flu pandemic laid over the
(30:20):
top of this and music becomesreally different.
It, it loses a lot of its senseof internal structure and
coherence and fidelity to atradition.
It tries to express things indifferent ways.
And it becomes a lot moreimpressionistic.
It becomes a lot more it drawson instruments that one would
(30:41):
never necessarily think of as aninstrument.
So a lot of modern music pieceshave, you know, there are people
banging on pots and pans, ormaybe you've recorded a
rainstorm.
Features at some point in thispiece of music famously Phillip
glass writes this piece of threeminutes of silence and that's
all it is literally, it's justthree minutes of silence and it
he's composed of this piece.
Right.
And so, and there's this reallyinteresting sort of anti
(31:03):
structuralist movement in art.
And I think we can see that invisual art as well, you go to
any sort of art museum and theart, you know, before the 1920s
is vastly different from the artthat came out of.
And I think that that'sexpressing something about a
response to crisis that in a waywe're still living through.
I think that the it's, it's easyto forget just what an upheaval
(31:25):
the early part of the 20thcentury was, and the fact that.
Even though, you know, we'vebeen talking during the pandemic
about returning to normal lifeto regular life.
I think we forget that we've forthe past decades, we've, we've
been living in a post-crisisworld.
And we're still living, youknow, we're now living in a post
post crisis crisis world where,you know, there's, some of these
(31:47):
crises are layering on top ofeach other, but but I can't say
that the world we were living inbefore.
Normal, you know, to the extentthat anything ever has been
normal.
And in some ways, like we'vestill been trying to respond and
grapple with this, this majorcrisis that that sort of ushered
in the 20th century.
So I think that there'll be alot of interesting work, sort of
(32:07):
doing some comparative.
And analysis of the art andpoetry and music that comes out
of the post COVID world to thesame sorts of things that came
out of the post world war one,world war two world where all of
it is responding to each other.
And, and I think it'll be reallyinteresting to just see what
happens there, because as yousaid and my interpretation of a
(32:27):
lot of that art is that there isthe sense of Artists sort of
pushing the boundaries of of, ofthe assertion that I can do
whatever I want and, and call itart.
And that's not, that's not todiminish any of this.
I think that that's actually areally remarkably artistic
distillation of what's happeningor where it's like, really
pushing the boundaries of what'spossible to be called art.
(32:48):
And that's really interestingquestion.
And, but I do think that in someart there's also this Almost
nihilist streak to where there'sthe sense of almost playing with
the idea of structure andmeaning, and sort of using art
as a vessel to say that thosethings don't actually exist in
any sort of substantive way, butI don't think that that's a
necessary corollary of livingthrough a crisis either.
(33:09):
I think that crises can haveboth.
Obliterate our sense of meaningor they can intensify it.
And this seems to be embodiedeven in your personal sphere, in
the responses that you and yourwife have potentially felt as
well.
And then I think that many of ushave felt with our friends
where, where some of us havebeen tempted.
To hopelessness and a sense oflack of meaning and this feeling
(33:31):
of, of real despondence in theworld and its state and others
have been really spurred toaction and charity and love for
the other and solidarity from.
You know, people who may havenever really considered these
things or may have only done soon a theoretical level before
the pandemic.
And it's really interestingbecause we have all of these
little internal responses thatare going to be integrated and
(33:51):
emerge as this culturalphenomenon.
And I have no idea where thatneedle is going to land.
But it's going to be reallyinteresting to see, and that
that's one of the things thatI'm really excited to pay
attention to over the nextyears.
That's
Matt Boettger (34:03):
great.
You know, now this is beyond mypay.
Stephen and all these arelistening, but I've always felt,
or not always felt.
I felt recently in the past fewyears, like music and art at
least made for me, I'll statejust for me and maybe not.
So prescription is a descriptivereality and film is a
prescriptive reality.
It wouldn't mean by that is likefor me, music helps me feel my
(34:24):
current circumstances.
That's that that's that there'sa play that for that reason or
the field to do more, describeof what's going on in my life.
Whereas film.
Is more prescriptive,prescriptive, like how I want to
be.
So w I think about this, I hadthis philosophy that like, like
in calm seasons in America, inthe U S right when things are
(34:45):
relatively stable, Not like thispast year, maybe, maybe when I
was growing up in the ninetiesand things were like, cool.
And grunge was all over theplace.
Right?
So that, that the movies forliving for me, I would get like,
I, you know, I it's chill.
It's relaxed.
So the movies were.
Hydroma high conflict, all thestuff to reflect the opposite of
(35:06):
what I was feeling in somesense, like to cultivate motion
because my life was so Alexadays a call.
Right.
But then in high conflict, highsituation, at least I can feel
in the pandemic.
Right.
The last thing I wanted to watchis high drama.
I wanted funny humor, relaxed,hopeful, inspiring, right.
I'm looking for something.
On the opposite end, right.
(35:26):
That whatever I'm in.
And I'm just, I'm just curiousif I wonder if that's how even
sometimes filmography isactually done, like you're in
it, maybe in a war time, you'retrying to put out films that
actually inspire and uplift andare lighthearted.
And during calm times you getwar scenes.
So it to like evoke that emotionthat you're not really feeling.
Totally up.
So I might pay grade, but that'show I feel anyway about when it
(35:48):
comes about how art and film,and maybe at least maybe that's
not how it's actually produced,but that's how I digest it.
At least in those.
Thanks for sharing that, Steve.
And I appreciate that.
That that's some really greatinsight.
I think we're going to end hereone small thing, cause it's only
takes a minute.
I saw this mark talked about ittwo weeks ago.
We talked about the Japanarticle that I, that, that I had
(36:09):
given him that was probablypublished a year ago.
This one came out recentlyagain, which, which is, I think
quite, just ironic stating thesame thing.
Japan becomes a surpriseovernight COVID success story,
right?
July, August, September, they'rebeing slammed.
Maybe partly because of theOlympics, probably because they
had low vaccination rates.
And then out of nowhere, they'rere the, the cases just
(36:32):
plummeted.
Once again, Japan has just beencoming this shine light of being
able to deal with COVID and theyhaven't been dealt, you know,
not through lockdowns.
Granted, we, as I shared withyou back in July, it was like
10% vaccination rate for Japan.
Now, as of October, I think it's75%.
So I'm guessing that's a littlebit of a game changer when it
comes to dealing with infectiousdisease.
But do you have any, anythoughts before we close up on
(36:54):
that particular story aboutJapan being this shining beacon
of hope for dealing with theinfectious disease, like COVID
outside without having to dothat.
Stephen Kissler (37:01):
Yeah, and I think it's, it's really
inspiring and amazing andimpressive.
And at the same time, mysteriousand confounding, and I, you
know, it's really hard to knowwhat this is what's happening
here.
I think that one of the areasthat I'm also really interested
in digging into in the comingyears is just, how do we make
sense of the vast.
(37:21):
That in, in how differentcountries responded and in how
they fared in terms of their,you know, the pandemic, because
it it's clear that certaininterventions did have certain
effects, but it's also clearthat there's not this perfect
one-to-one correspondence.
And I think part of that isbecause of how everyone is so
interconnected.
But I also think a big part ofit probably has to do with these
(37:41):
really subtle unmeasurable or atleast so far on measured, but
very difficult to measureelements.
Play into infectious diseasecontrol as well.
So one of the points I oftenlike to bring up is that you
know, we often look at massmandates and lockdowns as these,
you know, interventions.
But if you actually look at howpeople behaved during and around
(38:02):
those times, people werechanging their behavior long
before any sort of lockdown forwhat was horrible.
And meanwhile, people were alsochanging their behavior in the
opposite direction long beforethose lockdowns were actually
lifted.
And and so there's this reallysort of porous divide between,
you know, the things that we canmeasure, the things that we can
identify as this is thebeginning of a new thing.
And.
The actual underlying thingsthat, that affect the spread of
(38:26):
disease.
So w you mentioned thevaccination rate, so first and
foremost, yeah.
That's, that is a huge change invaccination rates in a very
short period of time andincreasing the number of people
who are vaccinated.
We'll go a very long way towardsreducing the number of cases
that are around and preventingpeople from getting really sick
in the first place, which alsoreally helps to bring the
(38:46):
observed case counts down.
But to me, one of the even morestriking things about that is
that they were able to do that,that, that, that in Japan, in
this very free society that.
There was that fast, a vaccineuptake once they become once
they became available.
And so what that suggests to meis that there's this really
(39:07):
interesting.
Culture as well, that isamenable to being vaccinated and
to doing so very quickly whenthere arises a need.
And so that I, I can't help, butwonder sort of what other small
scale decisions are being madeon a minute to minute basis for
people who are making choices toprotect themselves and other
people in a way that makes it sothat there's this emergent
(39:28):
qualities such that Japan hasactually fared much better than
many other countries in waysthat are really difficult to
measure.
Take place in this fear ofpolicy and have these grand
scale interventions that were soattracted to in the Western
world.
But in fact is probably anentirely different implicit
cultural philosophy of contagionand of cultural responsibility
(39:49):
and of hygiene and of all ofthese other things that that are
a lot more nebulous, a lot lesshard to pin down or a lot harder
to pin down.
Probably play a profound role inhow COVID actually behaves at a
given place.
So, yeah, so that's, that'sanother very complex way of
saying the same thing I alwayssay, which is that I don't know.
But but that that's, that's,that's where my thoughts are
(40:09):
sort of pointing.
Yep.
That's great.
Matt Boettger (40:11):
Yeah.
You know, there's so many thingsI want to say with this.
I don't want to keep us too muchlonger, but.
Number one.
I saw an article in the Atlanticabout, you know, the U S and the
dine sense of the pursuit of thecommon.
Good.
I don't want to make that atrite reality.
I know it gets becomescomplicated, but I do see that
as a general trend and that's,it's always been the case for
the U S because we come out of arebellion, a particular abelian
of being.
Dominated.
(40:32):
Right.
And w and so, per sir, thepursuit of individual freedom
has always been a hallmarktrait, which is a wonderful
trait, right.
But when it's a clips to notaccentuated and complimented by
the pursuit of the common good,it becomes a very difficult
reality and self-centered, andbecomes hard for everyone.
Now I have to ask this question,even though it was on the
docket, we didn't get through.
(40:52):
It's a loaded question again,and it probably takes a lot of
time, but you mentioned it kindof at hand, when you said how,
Hey, Japan, free society do allthe stuff that, you know, just
it's a cultural reality, butthen we have the U S we have
vaccine mandates, right?
It's a different, a differentreality, right?
We're trying to enforce thislaw.
And I wanted to ask at the verybeginning, like if you could,
without being political, if youcould rate your response to the
(41:14):
white house currently, notthrough necessarily public
policy or like, but as ascientist, like, you know,
trying to do the best to bringabout the best laws and guidance
how would you grade it in lightof, you know, this, this crazy
reality of trying to getmandates and get people
vaccinated?
Where do you sit in?
Stephen Kissler (41:32):
Oh boy, it's, it's super complex.
And I think that, you know, it'stying into the discussion that
we were just having is that youknow, the white house is, you
know, in, and our, ourgovernment and political system
more broadly is certainly anelement of the response, but
also is not the end all be allof the response and that You
(41:53):
know, we can think about thewhite houses or, or like our
government, you know, I thinkit's easy to think of it as sort
of this almost like this, thishead that is dictating the
motions and movements of thebody, but in many ways, Politics
and government is, is, is anemergent quality of this culture
that we already have.
And so any, any grade that Ipass on our, our current
(42:15):
government or our governmentmore broadly is also a
reflection of the culture thatwe live in and, you know, the
individual decisions that we allmake as well.
So it's, it's really difficult.
I don't think that I can givelike a you know, a specific
rating, but that I can sort ofhighlight some of the things
that both This administrationand the previous administration
have done well and have donepoorly from a scientific
epidemiological perspective.
(42:35):
So, I mean, coming into thepandemic, I think that I was, I
was extremely frustrated at theslowness at which testing was
encouraged and made available.
I think we we were unbelievablyslow in, in improving our
resources for testing.
And I think that we put Yeah, itjust really just put too much
single-minded faith intodeveloping a vaccine.
There was really poor messagingabout responsibility for one
(42:58):
another.
And the really just likecommunicating this very clear
sense that we were in a very badsituation, which as
epidemiologists, we were allpretty certain about.
But but it was never reallyclearly communicated, but on the
flip side, by, by putting somuch emphasis on a vaccine, A
lot of the work that theprevious administration did
really helped us to get vaccinesas quickly as we did which was a
(43:21):
surprise to me and to many of mycolleagues that they, you know,
came about so quickly.
And of course that's not.
Just the administration that isalso, you know, the scientists,
we were also poised with MRNtechnology that has, you know,
the research that has been doneover the past decades.
So does not, you know, certainlynot the single handed success of
the administration, but also,you know, a lot of the funding
that the administration pouredinto that.
(43:43):
Did help produce in particular,the Pfizer vaccine.
Right.
And and that's been one of themajor success stories of the
pandemic now transitioning intothe current administration.
I do think that the messaginghas been a lot more on point
with with, you know, what, whatis needed for Just mounting a
rational public health responseon a, on a large perspective.
But honestly the testing hasstill been slow.
(44:04):
I say it's really nuts.
And you know, finally, you know,just recently there was this
announcement that theadministration was going to put
a lot more funding into rapidtests, which I'm thankful for.
It's great.
So hopefully we will be able topick up rapid tests a lot more
easily.
It'll be cheaper.
But good gracious.
Like how did it take this long?
And and so I think that therehave been you know, a lot of, a
(44:25):
lot of promises that I wasexcited for that have taken a
long time to come to fruition.
I do think that one of thethings that this administration
has also done well is.
Making vaccines rapidly andwidely available and really
ramping up our vaccinationefforts, especially early on.
But of course, we've, we've hita bit of a wall there too.
And now there's this reallysticky question as to how, how
to encourage vaccination.
And that then becomes a questionthat is no longer a scientific
(44:47):
and one that I don't know how toanswer.
'cause you know, there has beena lot of movements towards
vaccine mandates and I don'tknow if that's the right option.
I think that that really getsinto, you know, I think that
increasing vaccination rates is,is something that we ought to be
focusing on as much as possible,but how we do that is gets into
so many really sticky areas ofculture and freedom and social
(45:08):
science and all of these thingsthat I don't even begin to know
how to comment on.
So, So it's mixed, it's mixedthroughout.
And boy we're going to have alot of work to do in the coming
years to figure out how tostreamline all of this stuff.
The next time one of thesethings comes around.
Absolutely.
Matt Boettger (45:23):
Thanks for sharing Stephen.
That's good, good insights andfair analysis.
Thank you guys for listening.
We'll be back every two weeks.
If you want to leave a review,please do apple podcasts.
There's probably another placeyou can do that as well.
Love to see them support uspatrion.com/pandemic podcasts.
One-time gift Venmo, PayPal onthe show notes.
If you're gonna get ahold of uson Twitter, S T E P H E N K I S
(45:45):
S L E R.
And by the way, I read anarticle the other day that said
that most of this whole.
Like scientific discourse wasdone through Twitter.
Like all the big leagues likethat.
That's probably the main placeswhere, which they, you could see
it unfold, not on Instagram.
So if you want to go on aTwitter and kind of see all the
latest going on, you can
(46:06):
also follow Stephen as well.
And a, sorry, you can hear a ghost in the
background because my doorbelljust rang and it's a Halloween
one.
Sorry about that, guys.
The boys are out playing withthe doorbell.
But so you can, or you can emailus matt@livingthereal.com and
give us a little note, let usknow how you're doing, what's
going on and how we continue tosupport you have a wonderful
week.
I'll see you guys in two weeks,take care and bye-bye.
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible in the face
of these crises.
My name is Matt Boettger and I'mjoined with my good
friend, Dr.
Stephen Kissler.
And if you actually watch this video, I
tell, I forgot to get rid of theother empty face or Dr.
Mark Kissler.
Who's not here whatsoever.
So we're going to move thatright like this.
So we're over with just the twoof us.
So, Stephen, I've got you on.
(00:21):
Good to see.
Yeah,
Stephen Kissler (00:23):
it's good to see you too.
Matt Boettger (00:24):
It's a, how's the weather in Boston.
Can I do the normal, like acliche?
Stephen Kissler (00:29):
I know.
Yeah, it's a it's cool enough.
Allie and I got to go out andsee some of the leaves this past
weekend, which was great.
Took a drive up through Westernmass in the Southern part of New
Hampshire.
And it's great.
This is, this is a special timeof year
Matt Boettger (00:42):
now.
Are there any tips in that for,so those of us who are those of
you who are listening, who arekind of up in the Northeast
daily tips for great places tosee tree, because it has here in
Colorado, it's an as you wellknow, it's not all over.
You've got to go drive to findthe Aspen leaves and there's
certain hotspots.
Is it similar or is it justeverywhere?
They're just a matter of whereyou go.
Stephen Kissler (01:03):
Yeah.
It's most places are good, atleast at some point that there's
this like gradient from north tosouth.
So it gets really good, like wayup north first and then it's
coming down.
So here in Boston, actually,most things are still green.
We're gonna have little bits ofcolor.
So, so it was part of why weended up driving up north.
So there's there's a highway inNew Hampshire.
That's in the white mountains.
That's absolutely beautiful.
(01:23):
So that's where we ended updriving them.
If you're really into thisVermont publishes a weekly
foliage report and it's thisnewsletter it's, even if you're
not living up here in theNortheast, it's the most
charming thing you can imagine.
So if you need a little bit asfalse spirit in your inbox every
week the Vermont department oftourism gives you a detailed
update of where exactly to seethe leaves in their state.
(01:44):
It's just wonderful.
So we're going to go out of ourway in your life and
Matt Boettger (01:48):
put that in the show notes, because that sounds
awesome.
It's awesome.
Now better yet is if they havean Instagram feed, so I can be
inspired every day by thefoliage of of New Hampshire will
be great.
Yeah.
We'll work on that.
I'm sure with all your extrafree time.
Well, good.
I'm glad we could connect.
Again, this Monday morning, kindof get back on a regular
schedule of on Mondays.
(02:09):
A few things are normal stuff.
You could leave a review.
We haven't had one in a littlewhile.
We've had a couple more fivestars.
It was great, but no comments.
So leave a comment, inspires usto keep us going.
If you can support us.
We'd love that as little as$5 amonth at patrion.com/pandemic
podcast, you can see it in theshow notes or just a one-time
(02:29):
gift, PayPal, Venmo again, allin the show notes.
So Stephen it's been a couple ofweeks just shy under a couple of
weeks since we were on aWednesday.
And I've been perusing the news.
And as you well knows, it's,it's a slow, which is kind of a,
I guess, maybe a good sign.
Maybe you can fill me in it'sit's, it's, it's slow right now
in the news on the pandemic andCOVID-19 and maybe part of it is
(02:53):
I honestly, to be fulldisclosure, I had.
Quite as invested in checkingthe news every single day, a lot
of things on my other life thatkind of preoccupy me.
But I want to get with youbecause you've mentioned there's
been a couple of things thatyou've been seeing that's been
surfacing.
Can you give us an update on thetwo things you talked about?
He was the vaccine, theboosters, and then any variant
(03:14):
information that we need to be,to be known.
Stephen Kissler (03:17):
Yeah.
So, and I think first of all, Iwant to kind of echo the, the
feeling that you have, where itreally does feel like there's No
less than the news.
And, you know, I also have beensort of like checking my usual
dashboards a little bit lessfrequently.
And and I think that that's, youknow, that's something that a
lot of people I've spoken withhave been sharing as well.
And, and in large part, I dothink that's, that's a good
(03:38):
thing we have seen largely youknow, declines in cases across
the year.
For the most part, which is,which is great.
And so, and it really, you know,the question is we're, we're
coming into this winter seasonand there's a lot of uncertainty
as to what's going to happenwith COVID with flu.
What do we need to do to beprepared for those things?
And I think we'll probably getinto each of those things one by
one over the course of thisepisode, but you know, some of
(04:01):
the, the major things that havecome across my radar over the
last.
Two weeks or so as first ofcourse, the FDA approvals of
boosters or third doses, or insome cases, second doses for
those who've received the J andJ.
And and so the, for the vaccinesthat have been approved in the U
S so the Pfizer, the Medina andthe J and J additional doses are
(04:22):
now approved.
And so there's a matter ofsupply trying to figure out, you
know, how.
To get doses to those who needthem.
There'll be some time that ittakes to ramp up.
And right now I think that whilethey have been approved, I think
they're currently recommendedfor people over the age of 65
and those who are working inhigh contact settings.
So healthcare workers, teacherspeople who are at high risk of
(04:45):
in fact, So I think this is allreally good news.
One of the questions that I'vegotten about these is that we're
so far, the guidelines all haveto do with getting an additional
dose of whatever you've alreadygotten one or two doses of.
And there's also been a lot ofresearch that's come out that is
still in the early stages, but Ithink is really maturing
quickly.
Mixing and matching and lookingat, you know, what is the best
(05:08):
dose to follow up and given yourprevious dose?
There are no clear cutguidelines on that yet, but in
the same way that we got a lotof information, I think it was
this past week on third doses.
I expect over the next couple ofweeks for there to be some more
information about mixing vaccinetypes as well.
And there's a lot of really It'sdifficult to there, there are a
(05:29):
lot of layers of difficulty withus because the trials of those
who have received differentvaccine doses are there are
fewer of them because of vaccinecompany is not going to
administer another.
The vaccine to their owncohorts.
So you know, a lot of theinitial information we got is
from Pfizer or from Medina.
Whereas now we have to rely onthese more independent agencies
(05:49):
who are running their ownstudies for people who have
gotten different types ofvaccines.
So that's part of the reason whythe information is a little bit
slower to come out, but it'scoming.
And generally from what I'veseen certain combinations of
doses do seem to be performingpretty well in terms of the
duration and level of antibodyresponse.
And we've seen that to someextent in the UK too, where
simply because of supply issuesand the need to vaccinate people
(06:11):
quickly, many people got anAstraZeneca dose first, and then
that was followed by a Pfizerdose.
And those people seem to havefared pretty well.
So that's where some of ourinformation is coming from as
well.
Keep the eye, keep an eye outfor that kind of information
coming up.
So, so the vaccination is reallysort of one of the big areas of
news that I've seen.
The other really is just sort ofbeen emerging over the last day
or two.
And this has to do with the AOIfor variants, which is a sub
(06:33):
lineage of the Delta variant.
And there've been somesubstantial increases of this
particular variant that we'veseen in particular, in the.
I think part of that, part ofthe reason we've been seeing
those increases there is again,because the UK is surveillance
is unbelievable.
And so it's not to say that it'sthe only place where a sub
lineage of Delta might be takinghold.
But they've been able to detectit and to identify the fact that
(06:56):
this Is a somewhat mutatedversion of the original Delta
that we've been seeing spread.
So again, it's still too earlyto say if the mutations that
we've seen in this new variantare sufficient to give it.
Some escape from immunity orincreased transmissibility.
It does seem to be spreading alittle bit more rapidly than
(07:16):
other variants of Delta that,that came before it.
And so I think there is reasonto believe that it might be
either somewhat more infectiousor able to get around some level
of.
But it also doesn't seem likeit's the orders of magnitude
difference.
Like we saw going from alpha toDelta, if it is it's maybe a
little bit more fit, a littlebit more able to spread.
But I don't think fromeverything that I've seen so far
(07:38):
and from all the commentary thatI've seen from my colleagues we
may see this additional variancesort of starting to.
Represent more and more cases.
But it doesn't seem like it'sgoing to be nearly like what we
saw with the transition fromalpha to Delta.
So that's, you know, that's,that's good news, but it's also
something that we're going to bewatching closely.
We've spoken about this topic somany times about you know, just
the difficulties of figuring outwhat makes a variant a variant.
(08:01):
And is it just getting lucky oris it actually, you know,
genetically biologically betterin some way.
And how does that depend on theplace in which it's spreading
and the population.
All of those are still, youknow, those same questions.
I'll still hold here too.
And that's why we're stilluncertain as to really what
exactly is going on with thisthing.
But it's something we'rewatching closely.
Great.
Matt Boettger (08:20):
Well, a couple of follow-ups in this, so I'll go
reverse.
Where, what the most, the topicyou just mentioned right now,
and that is a variance.
It seems as though now, maybethis is because Delta is just a
dominant force.
But it seems as though, like thevariants have kind of, been
tapering off a little bit.
And for those of you who mightbe hearing the background, my
(08:41):
son's kids screaming in thebackground.
Sorry.
It just happens.
It's part of the life of the, ofthe household.
So it seems like the variantsare kind of tapering off.
Is this amongst the colleagueswho you're talking to.
Is there a sense by which it'sstarting to stabilize or is it
more of a, just Delta is justsuch a dominant force that
there's just no other chance.
And it's still like, where doyou guys find yourselves and
(09:04):
kind of landing on those areasof like, is it stabilizing or we
find ourselves maybe the nextsix months, this is going to be
kind of really being a taper offor is it just nothing has a
competed quite yet.
We're just waiting for it.
A new dominant variant.
Stephen Kissler (09:18):
Yeah.
You know, it's, it's really hardto say famously when one tries
to make predictions aboutbiology one has always proved
wrong.
And so, so it's hard to say, butyou are right.
The rate at which we've seen newvariants emerging and spreading
and sort of taking over hasdeclined.
And that is largely becauseDelta is just so contagious.
(09:40):
It's really hard to superchargesomething past something that is
already so supercharged.
And uh, you know, part of thereason for that is I imagine
because you know, there, thereare some constraints on
Respiratory pathogens that usecertain strategies to infect
ourselves.
So COVID 19, the SARS cov twovirus uses these ACE two
(10:01):
receptors in our epithelialcells to attach and then bind
and then enter into ourselves.
And you can get better andbetter at that, but ultimately
they're there.
We expect there to be some limitthat just biologically speaking,
you can only be.
So sticky and you can onlybecome, you know, so fast at
invading cells.
And that you know, you canexplore this evolutionary space,
(10:21):
basically you can mutate andspread and that sort of
optimizes one part of thisequation, but then at some point
you just can't really optimizeit that much more.
So, so I think that that may bepartly why we haven't been
seeing anything emerging pastthe Delta.
So it's kind of both, both ofthose things that you said.
So first, you know, Delta isalready so infectious.
And second, because the virusmay maybe starting to exhaust
(10:45):
some of that what we callevolutionary space it's ability
to sort of explore thesedifferent strategies that make
it more and more infectious.
But of course, you know, basicinfectiousness is just one part
of the equation.
People I think are rightlyconcerned about right now is
also the ability to evadeimmunity and virus can do that
in a lot.
Generally speaking, there are alot more ways to do that, partly
(11:06):
because Are if for anyone who's,you know, seen either actual
microscopic images of the SARS,cov two virus, or even just a
cartoon versions of it, it'ssort of this circle looking
thing with these spikes stickingout of the top.
That's the name?
The Corona virus stands for thecrown or the Corona that
surrounds the virus, which arethese spike proteins that are so
infectious or that are so.
(11:28):
Much responsible for theinfectiousness of the virus.
So these, these spikes help thevirus attached to ourselves, but
they're also the first thingthat our immune system is
exposed to.
And our immune system doesn'talways recognize the bits that
are most important for the virusis actual function.
Sometimes the virus will justdisplay things on these spikes
and it can change those to trickour immune system, basically.
(11:52):
And, and this is a very commonthing with.
So this is why we need fluvaccines every year.
This is why flu can infect usyear after year after year,
because it's essentially likethe virus is the same, but it's
like, it's changing its outfit.
And so it has this, you know,wide range of you know, coats
and hats and sunglasses that canput on so that our immune system
doesn't quite recognize it aswell.
And so those things don'tactually disrupt the function of
(12:13):
the.
You know, the virus itself isstill the same, but the thing
that it looks like to our immunesystem is a little bit
different.
And so I think that's what wemay start to see here, where we
have the, you know, sort ofthis, this Delta base of the
SARS cov two virus, but thevariants can now sort of lead to
these subtle shifts.
And I expect this might bewhat's happening with this new
AOI for variant is that it'sfound sort of a different coat
(12:34):
to put on.
And our immune system can'tquite recognize it as well as
our response.
And I think that that issomething that we might see.
For a long, long period of time.
And so if we start to seeCOVID-19 or the SARS cov, two
virus coming into the seasonalcirculation, something that
looks a lot like flu, I thinkthat this might be part of
what's behind it is that it justsort of keeps changing its
outfit from year to year.
(12:55):
And that's something we'reprobably never going to totally
be able to get ahead
Matt Boettger (12:57):
of.
Okay.
That's helpful.
I mean, I never really made thedistinction between.
The variant and maybe it's aleveling off and its ability to
kind of only be so efficient.
And that is a separate dimensionto evading the immunity.
I always saw them as beingone-to-one like once it kind of
plateaus out.
So, so is it for its immunity,its ability to skip immunity,
(13:18):
but those are two separatevariables you're saying, and
that you could actually leveloff, but instill in her infinite
amount of like hats and coatsthroughout the lifetime of its
of its existence.
Right.
Okay.
Alright, great.
And then the other question thenis dealing with this, the
vaccines and the boosters.
Right?
Well, now that we have James Jand J and, and Madrona being
(13:39):
available for boosters, youknow, I'm kinda thinking, first
of all, I saw Fowchee saysomething about, oh, this is
good news.
You know, we could now mix andmatch.
And so is it not quite availableto mix and match yet?
Are you just saying this is kindof the radar?
Or could I go into a Walgreensand get my little menu and be
like, Hey, do I want to today?
Do I want the modern, I don'twant the Pfizer.
Do I want the Jane.
Or do they, I mean, this may bebeyond what you know right now.
(14:02):
Or when you go in, do I have toshow them my card and say, oh,
you had the Pfizer's you'regoing to get the Pfizer again.
Or do I, am I going to have asay, you know, right.
Even right now on grant, I'm not65 rollers.
I wouldn't get one right now.
Whatever, say to actually changeit up by one to two at this
point in time.
Stephen Kissler (14:17):
Yeah.
So I think my understanding isthat if you you know, Walk into
a drug store.
They go to your local CVS thatif you are truthful about your
vaccination history, then, andyou say that you need a booster,
then they will give you a doseof whatever it is that you've
gotten before.
(14:37):
So it's not yet approved for fora person to mix and match.
That said a lot of, I do knowthat people have.
And and I do think that thatrequires you to not be truthful
about what you've alreadyreceived.
So there, you know, so that'sthat's in play there.
But but that's one of the reallyinteresting things about, you
know, the way that we'vestructured our vaccination
(14:57):
system for COVID-19 here in theU S is that there's really,
there's really not a lot ofoversight.
Generally people haven't reallybeen necessarily registered with
individually identifyinginformation.
So the.
We can clearly track exactlywho's received which doses.
And even if we are, then it'sactually very easy to sort of
subvert that system.
So these are not things that Iwould recommend at the moment I
(15:19):
think that, you know, the, theFDA exists for a reason and the
oversight is, is, is good.
But I do know that it's, it'spossible to do that.
But not neither recommended nornor you know, within the
boundaries of what has beenapproved.
So, so, so that's, you know,that is all, that's all Yeah,
(15:39):
that's all there that said, Imean, I know that.
So from, from, just to sort ofgive a gloss over the research,
I think I already mentionedthis, but it does seem like,
especially for people who havereceived and adenovirus type
vaccine as their first dose.
So something like the J and Jand the AstraZeneca, and then
have followed that with an MRIand a vaccine.
Generally it's been welltolerated.
Generally.
They've gotten very good immuneresponses that have far
(16:00):
surpassed the initial dose ofthe adenovirus vaccine they've
gotten in the first place.
So, it's not something I canrecommend at this point, but
again, this, these are thestudies that I'm pointing to
that I think we'll start to heara lot more about very soon.
Great.
Okay, great.
Matt Boettger (16:11):
Okay.
So let's switch gears for asecond.
I'm going to go back.
I know probably like every fourto six, maybe eight weeks now,
since we're every other week wementioned the flu and then
another, another article cameout from the Atlantic.
About the flu, which kind ofsparked my interest of the idea
that the concept that maybe isthe flu gone, like, are, is this
kind of like not gone below?
(16:33):
For years and years and years,we've kind of just a defaulted.
The fact that's always going toexist.
That's always going to dominateduring the winter that we're
going to have tens of thousandsof deaths, you know, all these
things.
And so we get the flu vaccine.
Now, then last year happens andwe have this freakish episode by
which we have almost zero flucases.
(16:54):
And so now we're wondering, youknow, maybe in August and July,
I was one, Hey, it's going to bea bad flu season because now I'm
thinking.
You know, not so great thoughtsof like, okay, well, you know,
we had a whole year where itdidn't surface and now it's been
underground building, you know,Dr.
Evil like this, this next year,it's going to be just atrocious.
Right?
They've they've had more time tothink about what they're going
(17:15):
to do and it's going to be wayworse.
And now I'm starting to wonder,you know, because of habitual
changes, because now that.
You know, the pandemics going toan endemic where it's like,
it's, it's going to live with usforever.
So we're slowly changing ourhabits.
You know, like of course we, youknow, no more lockdowns, that
kind of stuff, but you know,like things like working
remotely for a couple of weeksor, you know, having school go
(17:36):
remote for one week at a timeduring high, you know, high
outbreaks or wearing masks hereand there.
So all these random things washyour hands more, just having a
little bit extra space betweenpeople at the grocery store.
That's not even that much, youknow, all these have a
significant impact.
Could it be the case that likethis whole flu thing is just
like going to be behind us forthe rest of our lives, as long
as we continue down this path.
Stephen Kissler (17:58):
Yeah.
It's, it's pretty amazing to me.
I mean, I think that whathappened to the flu last year,
it was just mind blowing,absolutely mind blowing, because
flu has just been such a, as yousaid, it's such a regular part
of our experience know certainlyfor our entire lifetimes and for
as long as you know, any of uscan remember And it is a
(18:21):
remarkable thing that globally,we basically saw no flu last
year.
You know, it wasn't absolutelyzero, but it was historically
low and basically everywherethat collects flu related data.
Which is unbelievable.
So I think, I mean the firstthing, and I think, you know,
this is, this is what you weretalking about already, but it,
it really did cause us to take astep back and be like, wow,
(18:44):
like.
There are things that we can dothat we didn't realize would
have this level of impact.
And it is forcing us to think alittle bit differently about
infection control.
I think you're right, that thereare things that we took for
granted that now we're startingto think, well, do we, do we
have to and you know, like yousaid, that's not to say that
(19:06):
we're going to.
Impose all of the restrictionsthat we imposed last year, so
that we're living in a flu zeroworld for the rest of our lives.
But but it is a really importantTestament to the fact that like
these non-pharmaceuticalinterventions.
Do something, you know, theyreally, they do something and we
(19:26):
can use them in, you know, to,to reduce the burden of flu and
other respiratory diseases.
And and I think we really needto think critically about how,
how best to do that while, youknow, while maintaining all of
the other benefits of living ina social society, you know, that
we have So, so I think it's,it's going to be a really
(19:46):
exciting and interesting time tothink about what's what's going
to happen with the fleet now.
So part of the question is, youknow what, what's in store for
us this year, next year, andover the next five, 10 years.
And there's been a lot ofspeculations that after the near
eraser of the flu season lastyear That there could be a very
strong season this year.
And that's in large part due toour own immune systems, not so
(20:08):
much the virus itself, but thefact that because essentially
nobody was exposed to it lastyear that sort of timer on our
immune systems that gets weakerand weaker over time is not
going to have gotten thatreminder that it usually.
Annually or every couple ofyears.
And so that means there's goingto be a lot more people running
around who are not as protectedas they usually are.
So the flu is going to be ableto spread more easily, might be
(20:29):
more intense for the people whodo get infected because that
immune response might havedeclined to some extent.
And so I think that's been oneof the big concerns.
But there are, you know, thereare some counter.
To this too.
So there was, we should put thison the show notes as well, but
there was recently this writeupfrom a couple of my colleagues
from the UK including my PhDsupervisor, Julia Gaga, who has
(20:52):
done she spent her careerworking on flu and its
transmission dynamics.
And and she's far from convincedthat this coming flu season is
going to be.
The, you know, this big, bad,scary flu season, it could be.
I think there's reason tobelieve that it could be.
But one of the other reallyinteresting things about
essentially driving flu cases tonear zero is that we don't
really know how long it's goingto take for it to rebound.
(21:14):
Usually the flu Sort of spreadsfrom the Northern to Southern
hemisphere.
And so even though in the uphere, you know, we're in the
United United States right now,I'm in the Northern hemisphere.
We have our flu season duringNovember, December, January time
of year.
I'm in the Southern hemisphere.
It's June, July, August becausethat's their winter.
(21:35):
And so even though the flu isvery periodic.
In our own experience, there'sactually usually a decent amount
of flu circulating everywhere inthe world at some point.
And so one of the reallyinteresting things about the
COVID pandemic.
Essentially stopped to thatpattern.
And you can sort of, you cansort of think of this.
You could sort of think of thisas a pendulum in a way, right?
(21:56):
Where if you have a pendulumthat's swinging to keep it
swinging, all you really need todo is just sort of poke it a
little bit.
Right.
And, and if you just give it theslight little push, once it
reaches sort of the top, thenit'll keep swinging for a very
long period.
But if you stop that pendulum,if there's this bowling ball at
the end of the string, it takesa lot of effort to get it back
to the point where it's swingingback and forth like that year
(22:17):
after year after year.
And so, so we could be in ascenario like that for flute,
where it might actually takesome time for it to get ramped
up, back to speed.
I don't know for sure if that'sgoing to be the case, but I
think it's a really interestingidea.
They've, they've actually donesome formal modeling work to
suggest that this might be thecase.
And before the pandemic a lot ofthis work was done pre COVID 19.
So it was really this sort oftheoretical study that was like
(22:38):
in the night deal world.
If we could just stop flu for ayear.
What would happen.
And now all of a sudden we'reliving in that world, which is
pretty crazy.
So we're going to actually beable to see and test whether
these projections turn out to betrue.
So, all of that is a long way ofsaying that I have no idea
what's going to happen thisyear.
And and I think it'll be reallyinteresting to see what happens
over the next couple of years.
I think that.
(22:59):
My hunch is that you know, theflu flu does spread pretty well.
And so I, I I'm, I'm actuallyscheduled to get my flu.
This afternoon.
And so I'm planning to do that,especially because I do, I do
expect this year to have flucirculation.
And I think that it could be,even though it's not guaranteed
to be bad, I think that there'senough of a chance that I'm
(23:19):
definitely going to doeverything I can to protect
myself and the people around meby getting vaccinated.
I'm probably going to be wearinga mask pretty fastidiously all
winter long.
When I'm in indoor spaces withothers who are not part of my
normal pod.
And so, so that's, that's howI'm going to approach it.
But I do think that it's, it'sworth noting that We don't know
for
Matt Boettger (23:38):
sure.
Yeah.
Yeah.
Yeah.
There's one thing I learned inphysics and I know nothing about
physics.
I took a class in college and Ithought, I was like, oh, you
know what, I'm going to lovephysics.
And I realized, I hated itbecause it was just too
complicated for me.
But there's one thing I learnedand that was the friction
coefficient.
And that was like, that was likethe one thing that stick with me
because it was like, oh, thiswas like a life lesson.
(24:00):
And what you just did wherethere's this a coefficient of
friction, right.
Where we know that whensomething is not moving.
It takes so much inertia to getit to move, but once you get a
going right, it's so much easierto keep it moving.
And that's why I was thinkingabout the Fleming.
To what extent did we, you know,like you just said it stopped
and how much more momentum youhave to exert to get it to go
again.
And this is like a life lessonfor everybody.
This is where like, not to go ona tangent and I will, I'll spend
(24:22):
less than 15 seconds on this.
I hope.
And then.
That goals are really, reallycool.
They actually don't get the workdone.
You know, it's, it's the habits,right?
It's the tactics that, you know,instead of putting the one thing
down a day to do, to actuallythink of a recurring 15, 20, 30
minutes of doing an area of yourlife that you want to look
forward to so that you keepdoing it to build momentum to
(24:44):
where it becomes easier, right?
Just like habit formation.
So, taking this example of theflu and hope.
Th the end result will beexactly that, right.
It just takes too much inertiaand we're going to have a a slow
percolating flu season, butyeah, that's one good news.
Second.
Good news is guys get on somegood habits, get some good
tactics in and build, get rid ofthat friction coefficient.
(25:04):
So that to
Stephen Kissler (25:05):
make life a little bit simpler.
I think that's to turn your 15second tangent into a 32nd one.
I think, I think that that'sreally timely, you know?
I, I was, I was just having aconversation the other day with
Allie about how yeah, just, justhow strange this, this year has
been in sort of this it's sortof this.
Appendix to the crisis wherewe're still sort of living in
crisis, but also it's, it's likedifferent and I've, I've
(25:27):
personally found it really hardto get and maintain momentum
really this entire year it'sfelt like.
And so I, I really appreciatethat cause it's, it's true.
It's sort of like science,reflecting life, reflecting all
of these different sorts ofthings.
And I don't know.
It's I think it's a messagethat.
We could all stance to hereright now.
Yeah,
Matt Boettger (25:45):
I agree.
I spent a lot of time thisweekend working on my own life.
I felt the same thing.
Like I'm trying to get momentumin my life a little more and do
some more stuff.
And when I set goals out,sometimes they feel daunting and
so scheduling out my day andjust make even 15 minute blocks
to do something that I haven'tdone for a while and do it every
day.
And then you find yourself 30,you know, 30 days down and
feeling like, oh, this is oncewas a hard thing.
(26:06):
And now you want to do 30minutes an hour.
And so.
Really encouraged people.
If you haven't done anything fora long time, because of just the
pandemic or just life orwhatever, then just seriously
blocked 10 to 15 minutes.
And just commit to it every day,five to six days a week, close
up shop for that 15 minutes.
You're gonna find yourself in adifferent place, 60, 30 days
from now feeling better aboutyourself and all that jazz.
(26:28):
So that's our life lesson fortoday, but, you know, continuing
on with the flu for a second,now that we talked about this
off.
The the recording.
But I really curious this ideaof where you kind of reflected a
little bit Stephen and myself,for sure.
This idea of pandemic fatigueand just exhaustion and then not
building momentum.
And then I was thinking, youknow, okay, I'm going to be
vulnerable here.
(26:49):
Like I'm not the greatest impactin the world.
My wife is she, she really canfeel for the world deeply.
Right.
I don't have quite thatsensitivity.
And it's something that I wantto cultivate in my life.
The pandemic did not help meStephen.
Right.
Because I feel even moreexhausted.
I feel a little bit apathetictowards people, full disclosure,
(27:09):
but I'm working on this.
So my curiosity is, have you hadany research or no.
Talk to anybody about like theflu pandemic of whatever 19, 18,
whatever it was that after theentire thing.
So-called ended after the nextcrises where people are like
whatever.
I just don't care.
I can't do it anymore.
I mean, is there kind of like,any kind of studies on what, how
we deal with this crisisafterwards and how we engage the
(27:33):
next crisis?
Cause you know, a little, alittle careful and like, you
know, next price for the guy orwhatever.
And then it becomes actually aworst scenario because we're
like, I'm just exhausted.
Is there any kind of researchabout this, of like how we
behave?
Stephen Kissler (27:45):
Yeah, there is, and it's, it's a body of work
that I'm not super familiarwith, but that I I'm just
beginning to dig into.
I have another set of colleaguesfrom the UK who who sort of work
on the, on the social scienceside of epidemics and of major
crises.
But especially infectiousdisease related crises.
(28:06):
So there's there's thiswonderful in a way maybe
wonderfully morbid, but I thinkthey're super interesting
research group over there calledcrash.
And this is at the university ofCambridge and the acronym stands
for the center or, no, sorry.
It's not.
It's Cesar C E S E R for theit's the center for the study of
existential risk.
And so they collect a bunch ofpeople together who are
(28:26):
basically studying existentialrisks as such.
So that includes pandemicpathogens and global warming and
artificial intelligence takingover the world.
And, you know, all of thesedifferent kinds of things and
thinking about these things as,as such but also thinking about
them very broadly.
Not only the scientific sides,but also the social sides.
And so.
A lot of their seminars areposted online.
(28:49):
So if anybody is got a one ofthese slightly apocalyptic
streaks like ideas sure.
Feel free to take a look atthis.
And I, and it's actually reallyinteresting and can be
illuminating towards these,these kinds of things.
So, so the research is out thereand but I think that.
Th this pandemic is really goingto spur a lot more of it and
I'll be interested to see whatcomes of it.
But I think that for me, one ofthe most interesting places to
(29:12):
look at this, that I think thatwe all have some amount of
access to is to look at how arthas changed over time.
And to some extent, both art andphilosophy, but I think art is
in some ways, a little bit moreimmediately accessible in a way.
And one of the things that hasalways really struck me is the
shift in art that took placefrom the late 18 hundreds, early
(29:35):
19 hundreds to the 1930s,forties, fifties, up until the
present day.
I'm a.
Musician.
So I've, I've played the violinfor a long time.
So my first point of access tothis was through classical
music.
And you can see this really hugeshift from sort of the classical
period and You know, enteringinto the romantic period of
(29:57):
music where oftentimes there arethese very lush melodies and it
was very creative andspontaneous, but also had this
very like clear internalstructure.
It it, it broke from tradition,but still like had this very
strong tie to the tradition ofclassical music up until that
point.
And then you hit world war oneand world war II.
And also of course, the, the1918 flu pandemic laid over the
(30:20):
top of this and music becomesreally different.
It, it loses a lot of its senseof internal structure and
coherence and fidelity to atradition.
It tries to express things indifferent ways.
And it becomes a lot moreimpressionistic.
It becomes a lot more it drawson instruments that one would
(30:41):
never necessarily think of as aninstrument.
So a lot of modern music pieceshave, you know, there are people
banging on pots and pans, ormaybe you've recorded a
rainstorm.
Features at some point in thispiece of music famously Phillip
glass writes this piece of threeminutes of silence and that's
all it is literally, it's justthree minutes of silence and it
he's composed of this piece.
Right.
And so, and there's this reallyinteresting sort of anti
(31:03):
structuralist movement in art.
And I think we can see that invisual art as well, you go to
any sort of art museum and theart, you know, before the 1920s
is vastly different from the artthat came out of.
And I think that that'sexpressing something about a
response to crisis that in a waywe're still living through.
I think that the it's, it's easyto forget just what an upheaval
(31:25):
the early part of the 20thcentury was, and the fact that.
Even though, you know, we'vebeen talking during the pandemic
about returning to normal lifeto regular life.
I think we forget that we've forthe past decades, we've, we've
been living in a post-crisisworld.
And we're still living, youknow, we're now living in a post
post crisis crisis world where,you know, there's, some of these
(31:47):
crises are layering on top ofeach other, but but I can't say
that the world we were living inbefore.
Normal, you know, to the extentthat anything ever has been
normal.
And in some ways, like we'vestill been trying to respond and
grapple with this, this majorcrisis that that sort of ushered
in the 20th century.
So I think that there'll be alot of interesting work, sort of
(32:07):
doing some comparative.
And analysis of the art andpoetry and music that comes out
of the post COVID world to thesame sorts of things that came
out of the post world war one,world war two world where all of
it is responding to each other.
And, and I think it'll be reallyinteresting to just see what
happens there, because as yousaid and my interpretation of a
(32:27):
lot of that art is that there isthe sense of Artists sort of
pushing the boundaries of of, ofthe assertion that I can do
whatever I want and, and call itart.
And that's not, that's not todiminish any of this.
I think that that's actually areally remarkably artistic
distillation of what's happeningor where it's like, really
pushing the boundaries of what'spossible to be called art.
(32:48):
And that's really interestingquestion.
And, but I do think that in someart there's also this Almost
nihilist streak to where there'sthe sense of almost playing with
the idea of structure andmeaning, and sort of using art
as a vessel to say that thosethings don't actually exist in
any sort of substantive way, butI don't think that that's a
necessary corollary of livingthrough a crisis either.
(33:09):
I think that crises can haveboth.
Obliterate our sense of meaningor they can intensify it.
And this seems to be embodiedeven in your personal sphere, in
the responses that you and yourwife have potentially felt as
well.
And then I think that many of ushave felt with our friends
where, where some of us havebeen tempted.
To hopelessness and a sense oflack of meaning and this feeling
(33:31):
of, of real despondence in theworld and its state and others
have been really spurred toaction and charity and love for
the other and solidarity from.
You know, people who may havenever really considered these
things or may have only done soon a theoretical level before
the pandemic.
And it's really interestingbecause we have all of these
little internal responses thatare going to be integrated and
(33:51):
emerge as this culturalphenomenon.
And I have no idea where thatneedle is going to land.
But it's going to be reallyinteresting to see, and that
that's one of the things thatI'm really excited to pay
attention to over the nextyears.
That's
Matt Boettger (34:03):
great.
You know, now this is beyond mypay.
Stephen and all these arelistening, but I've always felt,
or not always felt.
I felt recently in the past fewyears, like music and art at
least made for me, I'll statejust for me and maybe not.
So prescription is a descriptivereality and film is a
prescriptive reality.
It wouldn't mean by that is likefor me, music helps me feel my
(34:24):
current circumstances.
That's that that's that there'sa play that for that reason or
the field to do more, describeof what's going on in my life.
Whereas film.
Is more prescriptive,prescriptive, like how I want to
be.
So w I think about this, I hadthis philosophy that like, like
in calm seasons in America, inthe U S right when things are
(34:45):
relatively stable, Not like thispast year, maybe, maybe when I
was growing up in the ninetiesand things were like, cool.
And grunge was all over theplace.
Right?
So that, that the movies forliving for me, I would get like,
I, you know, I it's chill.
It's relaxed.
So the movies were.
Hydroma high conflict, all thestuff to reflect the opposite of
(35:06):
what I was feeling in somesense, like to cultivate motion
because my life was so Alexadays a call.
Right.
But then in high conflict, highsituation, at least I can feel
in the pandemic.
Right.
The last thing I wanted to watchis high drama.
I wanted funny humor, relaxed,hopeful, inspiring, right.
I'm looking for something.
On the opposite end, right.
(35:26):
That whatever I'm in.
And I'm just, I'm just curiousif I wonder if that's how even
sometimes filmography isactually done, like you're in
it, maybe in a war time, you'retrying to put out films that
actually inspire and uplift andare lighthearted.
And during calm times you getwar scenes.
So it to like evoke that emotionthat you're not really feeling.
Totally up.
So I might pay grade, but that'show I feel anyway about when it
(35:48):
comes about how art and film,and maybe at least maybe that's
not how it's actually produced,but that's how I digest it.
At least in those.
Thanks for sharing that, Steve.
And I appreciate that.
That that's some really greatinsight.
I think we're going to end hereone small thing, cause it's only
takes a minute.
I saw this mark talked about ittwo weeks ago.
We talked about the Japanarticle that I, that, that I had
(36:09):
given him that was probablypublished a year ago.
This one came out recentlyagain, which, which is, I think
quite, just ironic stating thesame thing.
Japan becomes a surpriseovernight COVID success story,
right?
July, August, September, they'rebeing slammed.
Maybe partly because of theOlympics, probably because they
had low vaccination rates.
And then out of nowhere, they'rere the, the cases just
(36:32):
plummeted.
Once again, Japan has just beencoming this shine light of being
able to deal with COVID and theyhaven't been dealt, you know,
not through lockdowns.
Granted, we, as I shared withyou back in July, it was like
10% vaccination rate for Japan.
Now, as of October, I think it's75%.
So I'm guessing that's a littlebit of a game changer when it
comes to dealing with infectiousdisease.
But do you have any, anythoughts before we close up on
(36:54):
that particular story aboutJapan being this shining beacon
of hope for dealing with theinfectious disease, like COVID
outside without having to dothat.
Stephen Kissler (37:01):
Yeah, and I think it's, it's really
inspiring and amazing andimpressive.
And at the same time, mysteriousand confounding, and I, you
know, it's really hard to knowwhat this is what's happening
here.
I think that one of the areasthat I'm also really interested
in digging into in the comingyears is just, how do we make
sense of the vast.
(37:21):
That in, in how differentcountries responded and in how
they fared in terms of their,you know, the pandemic, because
it it's clear that certaininterventions did have certain
effects, but it's also clearthat there's not this perfect
one-to-one correspondence.
And I think part of that isbecause of how everyone is so
interconnected.
But I also think a big part ofit probably has to do with these
(37:41):
really subtle unmeasurable or atleast so far on measured, but
very difficult to measureelements.
Play into infectious diseasecontrol as well.
So one of the points I oftenlike to bring up is that you
know, we often look at massmandates and lockdowns as these,
you know, interventions.
But if you actually look at howpeople behaved during and around
(38:02):
those times, people werechanging their behavior long
before any sort of lockdown forwhat was horrible.
And meanwhile, people were alsochanging their behavior in the
opposite direction long beforethose lockdowns were actually
lifted.
And and so there's this reallysort of porous divide between,
you know, the things that we canmeasure, the things that we can
identify as this is thebeginning of a new thing.
And.
The actual underlying thingsthat, that affect the spread of
(38:26):
disease.
So w you mentioned thevaccination rate, so first and
foremost, yeah.
That's, that is a huge change invaccination rates in a very
short period of time andincreasing the number of people
who are vaccinated.
We'll go a very long way towardsreducing the number of cases
that are around and preventingpeople from getting really sick
in the first place, which alsoreally helps to bring the
(38:46):
observed case counts down.
But to me, one of the even morestriking things about that is
that they were able to do that,that, that, that in Japan, in
this very free society that.
There was that fast, a vaccineuptake once they become once
they became available.
And so what that suggests to meis that there's this really
(39:07):
interesting.
Culture as well, that isamenable to being vaccinated and
to doing so very quickly whenthere arises a need.
And so that I, I can't help, butwonder sort of what other small
scale decisions are being madeon a minute to minute basis for
people who are making choices toprotect themselves and other
people in a way that makes it sothat there's this emergent
(39:28):
qualities such that Japan hasactually fared much better than
many other countries in waysthat are really difficult to
measure.
Take place in this fear ofpolicy and have these grand
scale interventions that were soattracted to in the Western
world.
But in fact is probably anentirely different implicit
cultural philosophy of contagionand of cultural responsibility
(39:49):
and of hygiene and of all ofthese other things that that are
a lot more nebulous, a lot lesshard to pin down or a lot harder
to pin down.
Probably play a profound role inhow COVID actually behaves at a
given place.
So, yeah, so that's, that'sanother very complex way of
saying the same thing I alwayssay, which is that I don't know.
But but that that's, that's,that's where my thoughts are
(40:09):
sort of pointing.
Yep.
That's great.
Matt Boettger (40:11):
Yeah.
You know, there's so many thingsI want to say with this.
I don't want to keep us too muchlonger, but.
Number one.
I saw an article in the Atlanticabout, you know, the U S and the
dine sense of the pursuit of thecommon.
Good.
I don't want to make that atrite reality.
I know it gets becomescomplicated, but I do see that
as a general trend and that's,it's always been the case for
the U S because we come out of arebellion, a particular abelian
of being.
Dominated.
(40:32):
Right.
And w and so, per sir, thepursuit of individual freedom
has always been a hallmarktrait, which is a wonderful
trait, right.
But when it's a clips to notaccentuated and complimented by
the pursuit of the common good,it becomes a very difficult
reality and self-centered, andbecomes hard for everyone.
Now I have to ask this question,even though it was on the
docket, we didn't get through.
(40:52):
It's a loaded question again,and it probably takes a lot of
time, but you mentioned it kindof at hand, when you said how,
Hey, Japan, free society do allthe stuff that, you know, just
it's a cultural reality, butthen we have the U S we have
vaccine mandates, right?
It's a different, a differentreality, right?
We're trying to enforce thislaw.
And I wanted to ask at the verybeginning, like if you could,
without being political, if youcould rate your response to the
(41:14):
white house currently, notthrough necessarily public
policy or like, but as ascientist, like, you know,
trying to do the best to bringabout the best laws and guidance
how would you grade it in lightof, you know, this, this crazy
reality of trying to getmandates and get people
vaccinated?
Where do you sit in?
Stephen Kissler (41:32):
Oh boy, it's, it's super complex.
And I think that, you know, it'stying into the discussion that
we were just having is that youknow, the white house is, you
know, in, and our, ourgovernment and political system
more broadly is certainly anelement of the response, but
also is not the end all be allof the response and that You
(41:53):
know, we can think about thewhite houses or, or like our
government, you know, I thinkit's easy to think of it as sort
of this almost like this, thishead that is dictating the
motions and movements of thebody, but in many ways, Politics
and government is, is, is anemergent quality of this culture
that we already have.
And so any, any grade that Ipass on our, our current
(42:15):
government or our governmentmore broadly is also a
reflection of the culture thatwe live in and, you know, the
individual decisions that we allmake as well.
So it's, it's really difficult.
I don't think that I can givelike a you know, a specific
rating, but that I can sort ofhighlight some of the things
that both This administrationand the previous administration
have done well and have donepoorly from a scientific
epidemiological perspective.
(42:35):
So, I mean, coming into thepandemic, I think that I was, I
was extremely frustrated at theslowness at which testing was
encouraged and made available.
I think we we were unbelievablyslow in, in improving our
resources for testing.
And I think that we put Yeah, itjust really just put too much
single-minded faith intodeveloping a vaccine.
There was really poor messagingabout responsibility for one
(42:58):
another.
And the really just likecommunicating this very clear
sense that we were in a very badsituation, which as
epidemiologists, we were allpretty certain about.
But but it was never reallyclearly communicated, but on the
flip side, by, by putting somuch emphasis on a vaccine, A
lot of the work that theprevious administration did
really helped us to get vaccinesas quickly as we did which was a
(43:21):
surprise to me and to many of mycolleagues that they, you know,
came about so quickly.
And of course that's not.
Just the administration that isalso, you know, the scientists,
we were also poised with MRNtechnology that has, you know,
the research that has been doneover the past decades.
So does not, you know, certainlynot the single handed success of
the administration, but also,you know, a lot of the funding
that the administration pouredinto that.
(43:43):
Did help produce in particular,the Pfizer vaccine.
Right.
And and that's been one of themajor success stories of the
pandemic now transitioning intothe current administration.
I do think that the messaginghas been a lot more on point
with with, you know, what, whatis needed for Just mounting a
rational public health responseon a, on a large perspective.
But honestly the testing hasstill been slow.
(44:04):
I say it's really nuts.
And you know, finally, you know,just recently there was this
announcement that theadministration was going to put
a lot more funding into rapidtests, which I'm thankful for.
It's great.
So hopefully we will be able topick up rapid tests a lot more
easily.
It'll be cheaper.
But good gracious.
Like how did it take this long?
And and so I think that therehave been you know, a lot of, a
(44:25):
lot of promises that I wasexcited for that have taken a
long time to come to fruition.
I do think that one of thethings that this administration
has also done well is.
Making vaccines rapidly andwidely available and really
ramping up our vaccinationefforts, especially early on.
But of course, we've, we've hita bit of a wall there too.
And now there's this reallysticky question as to how, how
to encourage vaccination.
And that then becomes a questionthat is no longer a scientific
(44:47):
and one that I don't know how toanswer.
'cause you know, there has beena lot of movements towards
vaccine mandates and I don'tknow if that's the right option.
I think that that really getsinto, you know, I think that
increasing vaccination rates is,is something that we ought to be
focusing on as much as possible,but how we do that is gets into
so many really sticky areas ofculture and freedom and social
(45:08):
science and all of these thingsthat I don't even begin to know
how to comment on.
So, So it's mixed, it's mixedthroughout.
And boy we're going to have alot of work to do in the coming
years to figure out how tostreamline all of this stuff.
The next time one of thesethings comes around.
Absolutely.
Matt Boettger (45:23):
Thanks for sharing Stephen.
That's good, good insights andfair analysis.
Thank you guys for listening.
We'll be back every two weeks.
If you want to leave a review,please do apple podcasts.
There's probably another placeyou can do that as well.
Love to see them support uspatrion.com/pandemic podcasts.
One-time gift Venmo, PayPal onthe show notes.
If you're gonna get ahold of uson Twitter, S T E P H E N K I S
(45:45):
S L E R.
And by the way, I read anarticle the other day that said
that most of this whole.
Like scientific discourse wasdone through Twitter.
Like all the big leagues likethat.
That's probably the main placeswhere, which they, you could see
it unfold, not on Instagram.
So if you want to go on aTwitter and kind of see all the
latest going on, you can
(46:06):
also follow Stephen as well.
And a, sorry, you can hear a ghost in the
background because my doorbelljust rang and it's a Halloween
one.
Sorry about that, guys.
The boys are out playing withthe doorbell.
But so you can, or you can emailus matt@livingthereal.com and
give us a little note, let usknow how you're doing, what's
going on and how we continue tosupport you have a wonderful
week.
I'll see you guys in two weeks,take care and bye-bye.
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