August 2, 2021 • 34 mins
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Things Discussed on Episode:
- U.S. Vaccinations Ramp Up With Shots Passing 700,000 for Four Straight Days
- Pfizer Covid-19 Vaccine Is Less Effective Against Delta Infections but Still Prevents Serious Illness, Israel Study Suggests
- Some COVID hot spots see increase in vaccinations; Massachusetts outbreak shows 'vaccines are working': Live COVID-19 updates
- MA Outbreak of 900 COVID Cases Leads to Only 7 Hospitalizations: 'The Vaccines Are Working'
- 21 of 29 People Test Positive for COVID-19 After Oregon Family Reunion—13 Fully Vaccinated
- Should you be wearing a mask again? Here’s a map of the Covid hot spots subject to the CDC’s new guidance
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 week
with you to live the most reallife possible.
Face to face.
My name is Matt and I'm joinedwith my one good friend, Dr.
Steven Kissler, a epidemiologistat the Harvard school of public
health.
How are you doing this?
Fine, wonderful August Monday.
Crazy
Stephen Kissler (00:17):
there actually.
No, it's it's cool enough.
It's almost, there've been theseweird days lately where it
almost starting to feel likefall which has really thrown me
for a loop.
I know, I know.
I know.
It's like, it's crazy, but it's,it's one of those days today and
I, yeah, it's nice.
It's comfortable, but it's alsogot a weird.
Matt Boettger (00:33):
Kind of weird.
Well, that'll be in that mightbe a really a good theme for
today's episode, weird stuffcoming on, but I know, I know my
wife can not stay here.
After the 4th of July, when allthe, like the back to school
sales begin because she's like,it's not school time yet.
It's not fall time yet.
Don't, don't put that in myface.
I want to do it the summer show.
So we saw a couple of leaveslook like a little foolish here
(00:56):
in the premature.
We're like, no, no, no, come on.
Hold strong in the late fall.
So, man, to the hard problems ofthe U S.
There is a lot going on thisweek.
And before we get into that, thenormal stuff.
So please leave a review.
We've got a couple have beengreat.
It inspires us.
You can go on apple podcasts,leave one.
(01:18):
We really appreciate it.
We'd love for your supportfinancial support in any way
possible to keep this going, tohelp us keep the lights on as
little as$5 a month atpatrion.com/pandemic podcast, or
just one time gift to PayPal,Venmo all in the show notes.
You can grab it right then andthere.
So let's get into it.
(01:39):
Steven.
We were kind of chatting beforewe were rolling.
We were, I was asking you whatwhat's been going on.
You're like, oh man, it's beencrazy week.
And it depends on what it couldbe thematic to our podcast, or
it could be, it'll be a crazyweek in general for you.
But this one seems to be verymuch right in line with what we
talk about.
And so let's just tip off.
What's been going on in yourworld.
What's been kind of put on yourlap and what do you guys seen
(02:01):
over there with this past week?
There's been a lot of weirdstuff going on and some big news
cycles that have been thrown inmy face a couple of times even
against kind of what we talkabout.
So.
Take it
Stephen Kissler (02:11):
away on this.
Yeah, totally.
It's it's, it's been an eventfulweek for sure.
So, I mean, I think, you know,the big thing is we have the CDC
stating new mass recommendationsfor basically everyone who's
indoors whether or not you'revaccinated, especially if you
are in a area of hightransmission They did that
citing some evidence that thatthe Delta variant in particular
(02:33):
may be transmissible amongpeople who were vaccinated.
Then a couple of days later,they Released a report on the
data that they have based thoserecommendations off of which
primarily was this a cluster ofinfections in Provincetown which
is a town here in Massachusetts.
So it's just up the road.
And Yeah, and we can, I thinkwe'll probably spend some time
(02:55):
getting into all the detailsthere, but it's been really
interesting because there's, youknow, there's been the CDC
itself, updating guidelines, andthere's been the response from
all across the spectrum as towhether or not they should have
done that and how they shouldhave done that.
And you know, that hasn'tnecessarily fallen into the
traditional camps where, youknow, some people who have been
generally supportive of recentCDC measures have been more
(03:16):
critical and vice versa And thenin addition to it all, you know,
just the question of, you know,whether it's founded, whether,
whether this makes sense to doit, how they did it, whether it
made sense to update theguidelines before releasing the
data, or if they should havedone it in the reverse order.
And then all of the new cyclesthat have come off of that,
where there have been articles,reporting, you know, bits and
(03:36):
fragments of this reportheadlines that don't really
reflect what's in the articles,but then, you know, cause a lot
of concern and confusion aroundwhat's actually happening.
But it also makes sense becausewe're all a little bit confused
and trying to figure out what's.
So, so it's just been a a busyweek to be an epidemiologist.
Matt Boettger (03:56):
Yeah.
I know.
Just when, what, two weeks agoyou were telling me, oh, you
know, we, things have beenslowing down and, you know, our
focus is finally being kind ofswitched from, so COVID focused
like right, right
Stephen Kissler (04:08):
back in it again.
Yeah.
Matt Boettger (04:10):
Yeah, totally.
So let's jump into this becausethis has been concerning me.
And I have another question thatI've talked to you about.
We'll kind of we'll maybe comeback and circle back with that
question, but this Provincetownthing has really kind of made me
a little uneasy if it, becausenumber one, I didn't even know
about it until somebody did aFacebook post to somebody.
I don't know.
Don't consider a friend, a verylarge conspiracy theorist
(04:34):
throwing it in kind of thepublic's face.
Like, see, this is just, youknow, basically if you can get
the gist of it, In Stephen, youcan get all the dot, the I's and
cross the T's and this kind ofstuff.
But basically that there was alarge amount of infections in
like 77% of them or 73%,something like that in the
seventies.
Those who were infected wereactually people who were
vaccinated.
(04:54):
So the majority of people duringthis timeframe, like on July
7th, the 14th or something themajority of them who were
infected were actuallyvaccinated people, which should
just, was it alarming becauseand we might try to figure out
ways by which this could bepossible.
And then I just read anotherone.
This was, I think this morningor yesterday then it's just,
okay.
Now two of these is reallymaking me kind of a little
(05:16):
nervous of what's going on.
There was 21 of 29 people, thetested who tested positive for
COVID-19 after Oregon familyreunion.
So there was 21 of 29.
That's one thing and another.
13 of those were vaccinatedpeople, right?
So that's, that's, that's that'sagain, another one that seems to
(05:36):
at some level kind to ring trueto the province.
So, what are you guys talkingabout?
What's going on?
Is this a sign that thevaccinations are having a
difficult time working or is itactually creating a more havoc
with infections?
What's how you're trying to makesense of this.
Stephen Kissler (05:54):
Oh boy.
Yeah.
So, There's a lot of differentfactors there that are playing
into this and I'll try to tickdown them one by one.
So, so first let's, let's maybefocus on Provincetown and sort
of thinking about the context,what happened there?
What we know, what we don'tknow, what we're still trying to
figure out.
So, first of all, the, theoutbreak, a cluster of
(06:15):
infections in Provincetown islargely traceable back to the
4th of July weekend.
And Provincetown is a placewhere a lot of people in the
Boston metropolitan area, andeven across new England go on
the 4th of July.
It's like a very big destinationfor July 4th.
So a lot of people there, a lotof people.
In close proximity with eachother it was raining that whole
(06:37):
weekend.
So a lot of people who might'vespent time outdoors were driven
indoors.
So a lot of opportunities forspread many, many opportunities
for spread.
So, So that's one thing.
So, so if you were to expect acluster of COVID cases anywhere
in the country, over the July4th weekend you know, I, I might
well put my money onProvincetown, you know, maybe
I'm biased being a Massachusettsit's resident right now, but but
(07:00):
it makes, it makes some sensethat there was a cluster there.
No I'm still sort of siftingthrough the data on this, but I
know there've been A number oftweets by Shaw, for example
who's a very well-renownedepidemiologist and a doctor.
And and he's been one of thethings that he cited is that,
you know, we've had this clusterof cases, which has been
(07:22):
alarming, but also it seems likethat In his words, it's, it's
largely sort of fizzled outwhere you would expect if a big
cluster of Delta cases emergedin an unvaccinated population
that it would just skyrocket.
But actually, you know, here inMassachusetts, thankfully we
have very high vaccination ratesand it seems like that might've
helped sort of tamp down thefire which is good news.
(07:43):
So that's all there.
But I think it's worth sort ofdigging into some of this a
little bit further because youknow, I think that a lot of
people remain sort of confusedand uncertain about sort of how
to make all of the differentpieces line up.
And, and frankly, I'm, I'm stillworking on this too.
You know, we, as epidemiologistsare trying to make sense of all
(08:04):
of the data that's coming outand trying to sort of reconcile
everything with each other,because it seems like it's
giving us sort of a very mixedpicture.
So, you know, on one of those,the things that people have
found most alarming is that andthis was the subject of a lot of
the headlines in the immediateaftermath of the outbreak or at
least of, of this report thatwas published by the CDC which
(08:26):
is that an estimated 75% of thecases were in vaccinated.
Okay.
So what does that mean?
You know, that, that almostmakes, it sounds like the
vaccines were actively harmingyou in a way, right?
Because because you actuallyhaven't, you know, more than 50%
of the cases that you observerand people who are vaccinated.
So it's not a, it's notnecessarily that simple it's.
(08:49):
So one of the thoughtexperiments that I like to do is
that, you know, imagine, imagineyou have a community where you
have a hundred percentvaccination rates, but we know
the vaccines are not a hundredpercent effective at stopping
infection.
So you do have a cluster ofcases there.
What fraction of those cases aregoing to be in vaccinated.
Oh, a hundred percent of themare going to be in vaccinated
people.
Right?
(09:10):
So if we, if we, if you have aplace with very high vaccination
rates, you naturally expectgreater and greater proportions
of those cases to belong tovaccinated people.
So that's not necessarilysurprising that we're, that we
see a lot of cases amongvaccinated people, because if
there is an outbreak and theoutbreak occurs in a highly
vaccinated community, then youexpect a lot of those cases to
(09:33):
be in vaccinated people.
One of the things that you know,certainly I'm still trying to
sort out here is that you know,here in Massachusetts we have we
do have pretty high vaccinationrates and it's, you know, on the
order of, you know, for peopleover the age of 18, it's about
75% vaccination rates.
So.
If you assume that the peoplewho have been sort of infected
(09:54):
in this cluster so far werereflective of that 75%, then it
is a little bit odd that wewould see, you know, 75% of the
cases being vaccinated, peoplein a place with 75% vaccination
rates, because that wouldsuggest that maybe actually the
vaccine is providing lessprotection against infection
than we initially thought.
You would expect that number tobe skewed a little bit where
(10:14):
there would be at least fewerpeople, fewer cases in the
vaccinated population than theunvaccinated population,
relative to the baselinevaccination rates.
So that then gets into theissues with so there are a
couple of different ways that wecould explain that potentially.
So one of them is that maybeamongst the people who have been
infected so far actuallyvaccination rates are much
higher than the state.
(10:36):
That would make sense here inthe Boston metropolitan area,
vaccination rates are actuallyquite a bit higher than the
Massachusetts average.
So maybe they were actually, youknow, if vaccination rates were
90, 95%, then that 75% no longerbecomes as surprised.
There could be a bias in caseascertainment where people who
are vaccinated might be morelikely to comply with public
(10:57):
health officials might be morelikely to report their cases,
things like that.
And so that might also bias caseascertainment towards vaccinated
people.
And so those are all things thatwe're looking into.
But of course we can't throw outthe fact that we might've
learned something new about theDelta variant here too, or about
some descendant of it where Youknow, it's it does seem like the
Delta variants you know, we'veknown for sure that it's
(11:18):
extremely infectious.
And and I think that we weregoing to talk in a little while
about some of the data comingout from Israel too, that
suggests that you know, it mightbe chipping away at some level
of the vaccine protection aswell, especially protection
against infection, even if itremains pretty effective against
severe disease.
So, you know, as the Deltavariant continues to spread
We're learning a lot more aboutit.
(11:39):
And I think the big questionabout this outbreak is that, you
know, what, what exactly is ittelling us?
The trick, when we see sort of asingle big outbreak like this is
that there are all of thesedifferent axes in play where
there's behavior during theoutbreak there's behavior, after
the outbreak, there are a lot ofuncertainties as to sort of what
the baseline situation was interms of vaccination rates and
who was there.
What their age distribution was.
(12:00):
And then we layer on top of it,the fact that we're dealing with
a relatively new variant thatwe're still trying to learn
about.
So there's, there's a lot ofuncertainty here.
And so I think really what Iwant to emphasize is that I I've
even been frustrated with someof the ways, you know, not only
the media has been portrayingthis, but even, you know, even,
even other epidemiologists andexperts in the field or at least
tangential experts you know,people who have.
(12:24):
Sort of weighed in, onepidemiology over the course of
this thing, but might not havesort of the full grounding and
epidemiology or even people whodo who I think are trying to,
you know, in good faith toexplain their perspective on
what's happening.
But I think that what that cangloss over.
This is a really complexsituation and it's okay to be
confused.
(12:45):
I am a little bit confused andI'm, I'm personally, I'm sort of
suspending my judgment as tosort of what's happening in
this, in this outbreak.
And I don't, you know, I don'twant to say that to, you know,
so alarm or concern that, youknow, we have this like crazy
new variant on our hands, butbut I do think.
It's prudent in this case to saythat, you know, there's, this is
a new, important piece ofinformation that we've gotten
in.
(13:06):
It's a little bit difficult tosquare all the corners on it, to
figure out what exactly is goingon.
That it's still, you know,highly probable.
That this was just Delta beingDelta.
And that it was in a veryanomalous situation in a sort of
strange community in the sensethat, you know, Massachusetts
has high vaccination rates andwe don't really know who was
there, but that said, you know,we're going to have to see sort
(13:27):
of how this plays out in thenext few weeks and months to
sort of see what to try todisentangle some of these
different factors.
So, you know, I, I love to beable to.
Explain things clearly andconcisely and to sort of help
people sift through all of the,the difficulty here.
And, and I think we'll continueto in the coming weeks for sure,
but, but I think really what Iwant to say right now is that
(13:47):
this is it it's complex.
And and yeah, so it, it makessense to yeah, to be paying
attention to all of this and toTo not necessarily have a, have
a clear place to stand yet.
Yeah,
Matt Boettger (14:03):
no.
I mean, first of all, thanks.
I mean, thank you for yourhonesty.
I mean, technology that youdon't really know what's going
on and kind of giving us all theright to be able to feel the
same thing.
If an epi epidemiologists ofHarvard school, public it can be
perplexed and we have the rightto be perplexed as well.
And no, I feel like we have toeither go on one side or the
other where there's the one sideby which I'm seeing that they're
using the, the, theMassachusetts study to prove
(14:26):
conspiracy theories.
And there's the other side,which I think is more, I think,
I think more, more pronouncedand, and maybe in some sense can
be a little bit more dangerousbecause I think it's so much
easier to dismiss.
The conspiracy theories, I guessdepends on what camp you're,
you're a part of.
Right.
But then there's the other sidewhich I'm seeing is this, this
almost even I read it the pastweek, a lot of articles I felt
as if they're going above andbeyond to justify that this is
(14:49):
normal.
This is okay.
This is to be.
And I get that, but I felt likethere was a little sense of
artificial reassurance being,say, like, yeah.
And, and thank you for justsaying like, look, both sides
might be kind of erring on theside of like trying to like
defend their position.
Right.
And this is just a perplexed,this is a perplexing case.
And so I wanna, I want to kindof encapsulate this again.
(15:11):
So I wanna like give a potentialreason why this might be
happening and then reopen a newdoor with you.
Have another level of complexitythat you should.
Off the air.
So you just mentioned that studyfrom Israel that I saw, I sent
it to you, Stephen, the wallstreet journal.
I'll put it in the show notesand it talks about how, you
know, before all this happened,you know, when, when the vaccine
(15:31):
Pfizer Madrona rolled out, itwas 95, 90 4%.
You know, effective againstinfection, right.
And that was an incredible rate.
And we're really excited aboutthat.
And this study presents itselfsane because the Delta variant,
I'm guessing, I'm assuming, andmaybe all the variants together
that Israel has shown that the,the, the particularly, I didn't
(15:51):
see which one it was.
This is Pfizer is 39% effectiveat reducing the risk of
infection.
Right.
30 that's a huge dramatic jump.
And then 40% effective atreducing the risk of symptomatic
disease.
So this may feel like we'regetting a little nervous going
to scare.
I mean, the good news is that'sstill the same level of the
vaccine was 91% effective atpreventing severe illness, which
(16:14):
you were talking about.
So I could see this.
As making sense a little bit.
In my mind, you kind of gavethe, some of these situations
with Provincetown, you know, mebeing vaccinated, I'm more
willing to go out and quote riskand go do normal things.
Right.
Because I'm vaccinated.
So I feel like almost like a, asa Malcolm Gladwell, the tipping
point is there, like this liketipping point, you're like.
When, when the vaccine is 95%effective against infection,
(16:39):
people going out and doingthings, once they're vaccinated,
probably doesn't have a dramaticchange on infection, but at some
point in time, when it getswhittled away, 90, 85, 70, 60
fifth, there's a tipping pointby which okay.
Now between the combination of,of behavior and it's reduced,
defectiveness did like, almostlike a just a flood water.
(17:00):
Right.
When it comes to infection openup, I'm assuming that could
probably make sense of some ofthis.
Is that what you were thinking
Stephen Kissler (17:06):
as well?
Yeah, totally.
So, to sort of break some ofthat open and just just to be
sort of totally precise with mywords here.
So the the early, you know, the,the trials for the Pfizer and
Maduro Nevada the reportedefficacy is that 94, 90 5% was
the efficacy against symptomaticdisease.
Not necessarily againstinfection.
So the efficacy againstinfection was probably somewhat
(17:28):
lower on the order of 70 to 80%.
But nevertheless what you say,you know, is true that these
data coming from Israel are Arereally important because as you
know, as, as you said, it seemslike the, the efficacy against
both infection and symptomaticillness are, is reduced to
around 40% in the data set thatthey're looking at.
(17:49):
So either way that's, that's adrop-off from from what we had
been observing before.
No.
This study as the authors werevery upfront about, and also the
article in the wall streetjournal is very up front about
is that it's preliminary, it'srelatively small group has not
been peer reviewed.
You know, we still need a lot ofchecks and balances on this
(18:09):
before we can really concludeanything for sure about this.
But you know, that said it doesalso kind of align with the.
Increasing reports of vaccinatedpeople coming down with a
symptomatic disease in the faceof the Delta.
And so these numbers are goingto absolutely shift over time,
as we learn more about the Deltafurthermore, you know, there's
(18:30):
not only are we learning moreabout the Delta, but we're also
learning more about the vaccinesthemselves.
So one of the things that wasbrought up in this article and
that I think we need to continuethinking about is that It's very
well possible.
And in fact, probable thatimmunity wanes over time.
This is a pretty well-documentedphenomenon that happens with
other coronaviruses.
(18:51):
It happens with flu.
It happens with many differentinfectious diseases.
Where are the strength of ourimmunity can decline over time.
Part of the reason, the way thePfizer and Madrona shots are in
a two dose series is to sort ofhelp shore up that decline to
try to keep it higher forlonger.
But a lot of the talk aboutintroducing potentially a third
dose into that sequence isbecause maybe, maybe we need it
(19:12):
to maintain those levels ofprotect.
You know, that's notunprecedented.
There are a lot of vaccines thatwe get, especially as kids where
we have a three or four doseseries.
And the entire purpose of thatis because it takes that many
doses for our immune response togo up to a durable level and
protect us for life.
That way may well be true forfor COVID-19 as well.
(19:32):
Israel of course has extremelyhigh vaccination rates.
But also, you know, they werevery quick to the draw.
And so many of the people whohave been vaccinated there have
been vaccinated for a while.
So some of this might reflectthe Delta variance.
Some of it might also reflectwaning immunity from the vaccine
over time.
And so once again, there's a lotof these different factors in
(19:53):
play that we can't quitedisentangle until we observe.
These kinds of studies indifferent populations at
different times so that we canfigure out, you know, what
exactly is contributing to whatso absolutely important
information.
It's just not totally clear whatto do with it yet.
Yeah,
Matt Boettger (20:10):
no, that's awesome.
That's great.
So let's add a level ofcomplexity to this because,
okay, so you added anotheradditional level complexity,
understanding the situation.
We talked about, how, ah, youknow, it kind of makes sense if,
if right, if these preliminary,the studies are correct and
there's a, it's now only 40%effective on maybe S you know,
symptomatic disease and peopleare being a little bit more
(20:31):
risky, so we can see these largeamounts, however you mentioned.
And I didn't, I didn't even knowthat.
Before we started the podcastthat Florida is seeing a pretty
significant uptick inhospitalization.
So that's like another level,you know, so seeing Pfizer being
at 91% effective now, I'm notsure what it was beforehand.
If it was like 95 or 96, Idon't, when it comes to that
(20:53):
level, that seems maybe like, I,that that's a hard narrative
that I'm not being able toexplain right now in light of
the efficacy.
Of of Pfizer Medina and you weretelling me.
Florida is a place that'sgenerally well vaccinated.
So you maybe wouldn't reallyexpect to have such an uptick.
So do you wanna talk about whatyou've seen with Florida and how
(21:14):
that's causing a whole maybe,and maybe in their mess of
complexity and perplexity aswell?
Stephen Kissler (21:19):
Yeah, so exactly.
So, you know, we're, we'restarting to see pretty
substantial increases in casesin a number of states,
particularly Florida, and someof the.
Southern Midwestern states likeFlorida, Louisiana Arkansas,
Missouri have recently had amongthe highest per capita case
counts in the country.
As you mentioned, you know, sosome of those states have
(21:40):
relatively low vaccinationrates.
And so we might not beparticularly surprised, but
actually, you know, Florida hashad it.
Has decently high vaccinationrates, you know, especially
relative to their surroundingcommunity and and even relative
to the national average.
So, so Florida is an interestingcase in this, in this sense
where you have relatively highvaccination rates and we do have
(22:02):
cases that are increasing prettyquickly and probably most
concerningly, you know,hospitalizations are rising
there as well.
And so it's again, sort of.
Trying to make sense of this.
So, it's once again, there are acouple of things that could be
in play.
So.
As as before.
So Florida was one of the fewstates in the country that had a
(22:23):
larger summer surge last yearthan their winter surge.
And we think that some of thatmight have to do with the fact
that You know, up here inMassachusetts and certainly in
Colorado, we think about summeras the time that you spend
outdoors and winter is the timethat you spend indoors, but
that's kind of flipped therewhere, you know, it gets so hot
in the summer that you spendmore time indoors.
(22:43):
And the winter is actually whenit's pretty pleasant to be, you
know, hanging out in Florida.
And so, you know, some of thisstuff.
Could be behaviorally driven.
We do expect cases to risearound this time of year if it
reflects it all, what happenedlast year?
Particularly in Florida, butalso in some of the other
Southern states.
But I think again, you know, thething that we're trying to
reconcile here is that thetrajectory of Hospitalizations
(23:06):
in Florida is seems to differfrom the trajectory of at least
the relationship between casesand deaths, for example, that we
saw in the UK.
So I think one of the thingsthat we talked about last week
was this really remarkabledifference.
In the previous two waves in theUK where they had their winter,
sorry.
And then they've had this morerecent summer surge that was
really driven by the Deltavariant, where in the winter you
(23:29):
can sort of calculate the factorof cases that lead to deaths.
And then in this most recentsearch really in the post
vaccination period, that thattrend sort of broke apart where
there were far fewer deaths percase.
That seems to be totally as aresult of vaccine coverage,
which is great.
And so, you know, I was.
Expecting to see something muchlike that here.
(23:50):
It may well still play outbecause it's still too soon to
sort of carry cases forward intomortality data.
We haven't really had this surgeof Delta long enough for it to
really cause an uptick in deathsif it's, if it's going to do so,
but we're definitely seeing arise in hospitalizations.
So, one of the questions that'sremaining here you know, I.
(24:10):
I wasn't able to get, I wasn'table to find data on
hospitalizations in the UK,which is really what I would
want to be able to compare tohere.
Part of the question is, youknow, the vaccine can provide
protection at many differentstages of illness.
It can prevent you from gettinginfected.
It can prevent you from gettingsymptoms that can prevent you
from going to the hospital thatcan prevent you from going to
the credit clinic, criticalcare, and it can prevent you
from dying.
(24:30):
It's not really clear, you know,what is the efficacy of the
vaccine at each of those stages?
So it may, well, you know, theremay well still be people going
to hospital, but it might bedoing a very good job at
preventing people from dying.
Even if they do end up needingcare in the hostel.
I think it's still sort of toosoon to see if, you know,
hopefully you know, the we'llstill see cases spike, but
actually the, the deaths wereremained very low especially in
(24:54):
places with high vaccinecoverage.
But we're again, in this superunsatisfying position where it's
kind of too soon to tell whatexactly.
That's going to look like I'm,I'm hopeful.
I'm hopeful that that we willstill see far fewer deaths per
case in this search than we didbefore.
And I think that, you know,looking at some of the
experience of other countriesaround the world with the Delta
variant, there's good reason tobelieve that that will be true,
(25:16):
but I think it's something we'regoing to have to watch very
closely, because if that doesnot turn out to be the case,
then that's, you know, anotherthing we're going to have to
figure out, you know, what isgoing on there.
Is it a difference in.
Is it a difference in ourbehavior?
Is it a difference in, you know,the time that it's taken between
when we've gotten the shot andwhen we've gotten infected, all
(25:36):
of these things are in play andwe're going to have to put all
of those on the table when we'resort of reconciling the
different experiences that we'vehad with this particular variant
of the virus all around theworld.
Okay,
Matt Boettger (25:46):
that's helpful.
And just a quick caveat.
It's one of our Facebook,private groups that ALO hello
back.
I don't know who you are becauseI don't think you hit the accept
button to know who it actuallyis.
But it's one of our members fromthe, our private support group.
So thank you for watching.
It's awesome to have a couple ofyears right now.
Let's continue on to a questionI had.
(26:07):
Is, it's not quite as relevantas it was maybe last week, but
still kind of relevant.
I mentioned this to you becauseI was like thinking in my head,
Adam, okay, last week we said,Hey infections are or going up.
But hospitalizations are stillreally low.
And we we also kind of saw thatat that point in time, we were
saying, oh, 99 send to thepeople who are being infected
were, were unvaccinated and only10% were vaccinated.
(26:30):
And so then my mind is initiallyit doesn't really make sense
because.
If 90% of the people have beeninfected yet hospitalizations
are low.
Then you think they'll only belike a 10% decrease because of
in fact, you know, because ofthose who were being infected
are vaccinated.
It took me a few minutes to kindof reverse engineer that.
And I thought, oh, you know,cause some of our listeners
could be struggling in the sameway.
Like that doesn't make sense.
(26:51):
And I want to throw this back toyou.
Just make sure that my mentalgymnastics were obviously
correct that.
Okay.
So it is the fact that eventhough.
Only 10% of the people had leftat that point in time.
Right.
We don't know now because we'vegot some new studies showing up
right last week.
We're we're vaccinated, but it'sthe, it's the very nature of the
population of the vaccinationbecause before the vaccination.
(27:13):
Everyone was susceptiblewhatsoever, including the immune
compromise.
Those who had cormobidities allthese kinds of things.
And of course those people whosigned up for the vaccine,
probably the majority of them,those early adopters were those
who were at the greatest risk.
So that population pool has beentaken away largely.
Is that how those statisticskind of make, make sense?
Stephen Kissler (27:32):
Exactly.
So, I mean, and that's one ofthe things for sure is, you
know, vaccination rates areespecially much higher amongst
people over the age of 65 whoare much more likely to go to
hospital.
In the first place.
And so we have this wholegradient where, you know, if we
just look at the averagevaccination rates and we look at
average vaccine efficacy, we canreally miss a lot of the picture
because we've so far done a verygood job of protecting the
(27:53):
people who are most likely to goto hospital in the first place.
So, which is a good thing.
Yeah.
Matt Boettger (27:58):
Great.
So let's let's land here becausewhat we talked about, all the,
the, the, the true stuff, thestats, the data we've
acknowledged, there's a, there'sa large sense of perplexity
going on.
So what do we do with this?
Like, how do we land this plane?
Because the CDC has given ussome guidelines, right?
It's it's up to states to imposethat or not impose that.
So here we are individualslistening to this, maybe a
(28:20):
little concerned of.
Coming down the pipeline nextweek or three.
How do you feel like we shouldbe engaging on level of prudence
when we're saying, Hey, theconspiracy theorists clearly we
think are way off the mark.
And we even say those people aretrying to radically confirm that
everything is normal.
Don't worry.
All is going to plan.
(28:40):
Might be a little bit toointense that we need to hold
this middle ground.
What does that mean for us goingforward in my day to day,
grocery shopping, going out,seeing friends, should I change
on any level or modify mybehavior because of this time of
complexity?
Stephen Kissler (28:55):
Yeah.
I mean, I think that there's,you know, a number of different
principles that we, we need toput in play here where you know,
one of them is the, you know,the principle of prudence or
caution where, you know, we're,we're not sure what's w w how
exactly.
Yeah.
Or if substantially the game haschanged against the virus
(29:16):
there's some evidence to suggestthat it might have.
But I wanted to bring up, youknow, on the other hand, it, it
remains true that at, you know,as you said, the, the great
majority of people who are beingadmitted to hospital with COVID
are un-vaccinated so.
That's another piece of evidencethat we have to square on the
other side of the camp whereit's like, it does seem pretty
clear that certainly beingvaccinated reduces your odds of
(29:37):
going to the hospital on thisvery large scale.
So, if you're not vaccinatedyet, it does still make sense to
get vaccinated.
That's remains the best, youknow, the best tool that we know
of that we have available forpreventing the most severe
outcomes from COVID and evenreducing its spread.
I think that continuing to wearmasks while indoors whenever
possible, it makes a lot ofsense.
(29:59):
That was something that I'vemore or less kept up throughout
all of the changing guidance.
But I think especially now itmakes sense because.
This, you know, if Delta isgoing to continue to spread,
it's mainly going to bespreading in indoor crowded
spaces.
So, trying to reduce yourexposure to large crowds, trying
to reduce certainly yourunmasked exposure indoors makes
an awful lot of sense,especially if you're in a place
(30:20):
where cases are are spiking,right.
I do think that it makes a lotof sense to, you know, pay
attention to the local to thelocal COVID weather where that
can really adjust our behavior.
Because you know, certainly inplaces with a lot of spread, I
would, I would, I would urge amuch higher degree of caution.
Whereas in places where casesare remaining relatively low, I
think that, you know, not a lotreally needs to change at the
(30:41):
moment.
We should continue payingattention to the data that's
coming in, sort of suspendingour judgment about what's
happening and informingourselves as much as possible.
But in places where cases aren'tactively searching, I don't
think that I would recommendmuch of a shift in behavior at
the moment.
But it's all totally contextual.
It's all sort of, associatedwith what your own risk budget
is.
And and so the best I can do issay, you know, I'm generally
(31:04):
wearing a mask indoors.
I, you know, still going to thegrocery store, but haven't
really been indoor dining asmuch.
Outdoor dining is wonderfulright now in this part of the
country, you know, so,supporting local businesses you
know, a lot of people are havingtrouble making it through this
thing.
So like, you know, recognizingthat, like we have a formidable
Infectious disease on our hands.
And we all need to make itthrough this and all of the
(31:25):
different ways we can.
So I feel like I'm bringing up alot of things that we were
talking about way back at thebeginning of 2020, but this
sense of like, to the extentthat we're able to, you know,
maintaining our solidarityrecognizing that some of our
actions willing to change, butnot allowing that to really
drive wedges between us, butinstead to make sure that we're
taking care of each other.
And and.
You know, living our lives tothe extent that we're able.
(31:47):
But also recognizing that theremay be.
Necessary adjustments coming up.
Matt Boettger (31:51):
Yeah.
Great.
I love it.
You know, I'll put this in theshow notes as an an article,
just talking about the CDCrecommendation and they're kind
of tears, which seems a littleabstract, but they break it down
to basically I can read thearticle.
I could be flubbing this andSteven can agree, but you know,
basically between 50 and ahundred cases per a hundred
thousand, I think that'sconsidered like the, the high
(32:11):
level.
And then above a hundred isconsidered even higher.
Those areas are, you know,recommend that you wear a mask
endorsed even in fascinated.
And then there's the positivityrate, which I forgot what it
was, but it's in the article andthat's a great way to kind of
memorize those and use that as akind of a baseline and just
check your COVID weather.
Right.
I think, what do you use Steven?
It was, it was like some of theNew York times or New York
(32:32):
something.
The great one that you can justcheck.
Stephen Kissler (32:34):
Yeah, so exactly.
I mean, I think the New Yorktimes does a good job with data
visualization.
And so a lot of their maps areopenly accessible, even if you
don't have a subscription.
And so, yeah, so I've been, I'vebeen relying on on at least
their data visualizations, quitea bit to sort of, do this, but I
think the CDC is now actuallyproviding some of these maps now
as well, which is, which isgood.
Great.
Matt Boettger (32:55):
So check that we can put that link in the show
notes.
And finally, just in, on a bitof good news, because of all the
Delta variant, there's been asurge in vaccinations, which has
been great just to see a lot ofpeople tipping over I think
700,000 at some point in timefor four straight days this has
been great.
So that's good news hopefulnews.
And for those of you are.
Please consider it.
That is a safe way, and it is agreat way to protect yourself
(33:17):
and the people around you, whichis mutually important, so, and
help and share this podcast withother people.
If they're hesitant, or ifthey're just having a tough
time, make that decision Stephenand mark do an incredible job of
just, just showing why it'simportant and that it's safe.
So, share this podcast withpeople.
You think you may need it.
Thank you all.
For listening once again, if youwant to support us anywhere,
(33:39):
anywhere that'spatrion.com/pandemic podcast,$5
a month, as well as one time,Venmo, PayPal in the show notes.
And if you want to get ahold ofus or just send a comment or let
us know what's going on in yourworld, matt@livingthereal.com
and I will send that on toSteven and mark have a wonderful
week.
You guys we'll see you guys nextMonday, take care and bye-bye.
You're listening to the pandemic podcast week
with you to live the most reallife possible.
Face to face.
My name is Matt and I'm joinedwith my one good friend, Dr.
Steven Kissler, a epidemiologistat the Harvard school of public
health.
How are you doing this?
Fine, wonderful August Monday.
Crazy
Stephen Kissler (00:17):
there actually.
No, it's it's cool enough.
It's almost, there've been theseweird days lately where it
almost starting to feel likefall which has really thrown me
for a loop.
I know, I know.
I know.
It's like, it's crazy, but it's,it's one of those days today and
I, yeah, it's nice.
It's comfortable, but it's alsogot a weird.
Matt Boettger (00:33):
Kind of weird.
Well, that'll be in that mightbe a really a good theme for
today's episode, weird stuffcoming on, but I know, I know my
wife can not stay here.
After the 4th of July, when allthe, like the back to school
sales begin because she's like,it's not school time yet.
It's not fall time yet.
Don't, don't put that in myface.
I want to do it the summer show.
So we saw a couple of leaveslook like a little foolish here
(00:56):
in the premature.
We're like, no, no, no, come on.
Hold strong in the late fall.
So, man, to the hard problems ofthe U S.
There is a lot going on thisweek.
And before we get into that, thenormal stuff.
So please leave a review.
We've got a couple have beengreat.
It inspires us.
You can go on apple podcasts,leave one.
(01:18):
We really appreciate it.
We'd love for your supportfinancial support in any way
possible to keep this going, tohelp us keep the lights on as
little as$5 a month atpatrion.com/pandemic podcast, or
just one time gift to PayPal,Venmo all in the show notes.
You can grab it right then andthere.
So let's get into it.
(01:39):
Steven.
We were kind of chatting beforewe were rolling.
We were, I was asking you whatwhat's been going on.
You're like, oh man, it's beencrazy week.
And it depends on what it couldbe thematic to our podcast, or
it could be, it'll be a crazyweek in general for you.
But this one seems to be verymuch right in line with what we
talk about.
And so let's just tip off.
What's been going on in yourworld.
What's been kind of put on yourlap and what do you guys seen
(02:01):
over there with this past week?
There's been a lot of weirdstuff going on and some big news
cycles that have been thrown inmy face a couple of times even
against kind of what we talkabout.
So.
Take it
Stephen Kissler (02:11):
away on this.
Yeah, totally.
It's it's, it's been an eventfulweek for sure.
So, I mean, I think, you know,the big thing is we have the CDC
stating new mass recommendationsfor basically everyone who's
indoors whether or not you'revaccinated, especially if you
are in a area of hightransmission They did that
citing some evidence that thatthe Delta variant in particular
(02:33):
may be transmissible amongpeople who were vaccinated.
Then a couple of days later,they Released a report on the
data that they have based thoserecommendations off of which
primarily was this a cluster ofinfections in Provincetown which
is a town here in Massachusetts.
So it's just up the road.
And Yeah, and we can, I thinkwe'll probably spend some time
(02:55):
getting into all the detailsthere, but it's been really
interesting because there's, youknow, there's been the CDC
itself, updating guidelines, andthere's been the response from
all across the spectrum as towhether or not they should have
done that and how they shouldhave done that.
And you know, that hasn'tnecessarily fallen into the
traditional camps where, youknow, some people who have been
generally supportive of recentCDC measures have been more
(03:16):
critical and vice versa And thenin addition to it all, you know,
just the question of, you know,whether it's founded, whether,
whether this makes sense to doit, how they did it, whether it
made sense to update theguidelines before releasing the
data, or if they should havedone it in the reverse order.
And then all of the new cyclesthat have come off of that,
where there have been articles,reporting, you know, bits and
(03:36):
fragments of this reportheadlines that don't really
reflect what's in the articles,but then, you know, cause a lot
of concern and confusion aroundwhat's actually happening.
But it also makes sense becausewe're all a little bit confused
and trying to figure out what's.
So, so it's just been a a busyweek to be an epidemiologist.
Matt Boettger (03:56):
Yeah.
I know.
Just when, what, two weeks agoyou were telling me, oh, you
know, we, things have beenslowing down and, you know, our
focus is finally being kind ofswitched from, so COVID focused
like right, right
Stephen Kissler (04:08):
back in it again.
Yeah.
Matt Boettger (04:10):
Yeah, totally.
So let's jump into this becausethis has been concerning me.
And I have another question thatI've talked to you about.
We'll kind of we'll maybe comeback and circle back with that
question, but this Provincetownthing has really kind of made me
a little uneasy if it, becausenumber one, I didn't even know
about it until somebody did aFacebook post to somebody.
I don't know.
Don't consider a friend, a verylarge conspiracy theorist
(04:34):
throwing it in kind of thepublic's face.
Like, see, this is just, youknow, basically if you can get
the gist of it, In Stephen, youcan get all the dot, the I's and
cross the T's and this kind ofstuff.
But basically that there was alarge amount of infections in
like 77% of them or 73%,something like that in the
seventies.
Those who were infected wereactually people who were
vaccinated.
(04:54):
So the majority of people duringthis timeframe, like on July
7th, the 14th or something themajority of them who were
infected were actuallyvaccinated people, which should
just, was it alarming becauseand we might try to figure out
ways by which this could bepossible.
And then I just read anotherone.
This was, I think this morningor yesterday then it's just,
okay.
Now two of these is reallymaking me kind of a little
(05:16):
nervous of what's going on.
There was 21 of 29 people, thetested who tested positive for
COVID-19 after Oregon familyreunion.
So there was 21 of 29.
That's one thing and another.
13 of those were vaccinatedpeople, right?
So that's, that's, that's that'sagain, another one that seems to
(05:36):
at some level kind to ring trueto the province.
So, what are you guys talkingabout?
What's going on?
Is this a sign that thevaccinations are having a
difficult time working or is itactually creating a more havoc
with infections?
What's how you're trying to makesense of this.
Stephen Kissler (05:54):
Oh boy.
Yeah.
So, There's a lot of differentfactors there that are playing
into this and I'll try to tickdown them one by one.
So, so first let's, let's maybefocus on Provincetown and sort
of thinking about the context,what happened there?
What we know, what we don'tknow, what we're still trying to
figure out.
So, first of all, the, theoutbreak, a cluster of
(06:15):
infections in Provincetown islargely traceable back to the
4th of July weekend.
And Provincetown is a placewhere a lot of people in the
Boston metropolitan area, andeven across new England go on
the 4th of July.
It's like a very big destinationfor July 4th.
So a lot of people there, a lotof people.
In close proximity with eachother it was raining that whole
(06:37):
weekend.
So a lot of people who might'vespent time outdoors were driven
indoors.
So a lot of opportunities forspread many, many opportunities
for spread.
So, So that's one thing.
So, so if you were to expect acluster of COVID cases anywhere
in the country, over the July4th weekend you know, I, I might
well put my money onProvincetown, you know, maybe
I'm biased being a Massachusettsit's resident right now, but but
(07:00):
it makes, it makes some sensethat there was a cluster there.
No I'm still sort of siftingthrough the data on this, but I
know there've been A number oftweets by Shaw, for example
who's a very well-renownedepidemiologist and a doctor.
And and he's been one of thethings that he cited is that,
you know, we've had this clusterof cases, which has been
(07:22):
alarming, but also it seems likethat In his words, it's, it's
largely sort of fizzled outwhere you would expect if a big
cluster of Delta cases emergedin an unvaccinated population
that it would just skyrocket.
But actually, you know, here inMassachusetts, thankfully we
have very high vaccination ratesand it seems like that might've
helped sort of tamp down thefire which is good news.
(07:43):
So that's all there.
But I think it's worth sort ofdigging into some of this a
little bit further because youknow, I think that a lot of
people remain sort of confusedand uncertain about sort of how
to make all of the differentpieces line up.
And, and frankly, I'm, I'm stillworking on this too.
You know, we, as epidemiologistsare trying to make sense of all
(08:04):
of the data that's coming outand trying to sort of reconcile
everything with each other,because it seems like it's
giving us sort of a very mixedpicture.
So, you know, on one of those,the things that people have
found most alarming is that andthis was the subject of a lot of
the headlines in the immediateaftermath of the outbreak or at
least of, of this report thatwas published by the CDC which
(08:26):
is that an estimated 75% of thecases were in vaccinated.
Okay.
So what does that mean?
You know, that, that almostmakes, it sounds like the
vaccines were actively harmingyou in a way, right?
Because because you actuallyhaven't, you know, more than 50%
of the cases that you observerand people who are vaccinated.
So it's not a, it's notnecessarily that simple it's.
(08:49):
So one of the thoughtexperiments that I like to do is
that, you know, imagine, imagineyou have a community where you
have a hundred percentvaccination rates, but we know
the vaccines are not a hundredpercent effective at stopping
infection.
So you do have a cluster ofcases there.
What fraction of those cases aregoing to be in vaccinated.
Oh, a hundred percent of themare going to be in vaccinated
people.
Right?
(09:10):
So if we, if we, if you have aplace with very high vaccination
rates, you naturally expectgreater and greater proportions
of those cases to belong tovaccinated people.
So that's not necessarilysurprising that we're, that we
see a lot of cases amongvaccinated people, because if
there is an outbreak and theoutbreak occurs in a highly
vaccinated community, then youexpect a lot of those cases to
(09:33):
be in vaccinated people.
One of the things that you know,certainly I'm still trying to
sort out here is that you know,here in Massachusetts we have we
do have pretty high vaccinationrates and it's, you know, on the
order of, you know, for peopleover the age of 18, it's about
75% vaccination rates.
So.
If you assume that the peoplewho have been sort of infected
(09:54):
in this cluster so far werereflective of that 75%, then it
is a little bit odd that wewould see, you know, 75% of the
cases being vaccinated, peoplein a place with 75% vaccination
rates, because that wouldsuggest that maybe actually the
vaccine is providing lessprotection against infection
than we initially thought.
You would expect that number tobe skewed a little bit where
(10:14):
there would be at least fewerpeople, fewer cases in the
vaccinated population than theunvaccinated population,
relative to the baselinevaccination rates.
So that then gets into theissues with so there are a
couple of different ways that wecould explain that potentially.
So one of them is that maybeamongst the people who have been
infected so far actuallyvaccination rates are much
higher than the state.
(10:36):
That would make sense here inthe Boston metropolitan area,
vaccination rates are actuallyquite a bit higher than the
Massachusetts average.
So maybe they were actually, youknow, if vaccination rates were
90, 95%, then that 75% no longerbecomes as surprised.
There could be a bias in caseascertainment where people who
are vaccinated might be morelikely to comply with public
(10:57):
health officials might be morelikely to report their cases,
things like that.
And so that might also bias caseascertainment towards vaccinated
people.
And so those are all things thatwe're looking into.
But of course we can't throw outthe fact that we might've
learned something new about theDelta variant here too, or about
some descendant of it where Youknow, it's it does seem like the
Delta variants you know, we'veknown for sure that it's
(11:18):
extremely infectious.
And and I think that we weregoing to talk in a little while
about some of the data comingout from Israel too, that
suggests that you know, it mightbe chipping away at some level
of the vaccine protection aswell, especially protection
against infection, even if itremains pretty effective against
severe disease.
So, you know, as the Deltavariant continues to spread
We're learning a lot more aboutit.
(11:39):
And I think the big questionabout this outbreak is that, you
know, what, what exactly is ittelling us?
The trick, when we see sort of asingle big outbreak like this is
that there are all of thesedifferent axes in play where
there's behavior during theoutbreak there's behavior, after
the outbreak, there are a lot ofuncertainties as to sort of what
the baseline situation was interms of vaccination rates and
who was there.
What their age distribution was.
(12:00):
And then we layer on top of it,the fact that we're dealing with
a relatively new variant thatwe're still trying to learn
about.
So there's, there's a lot ofuncertainty here.
And so I think really what Iwant to emphasize is that I I've
even been frustrated with someof the ways, you know, not only
the media has been portrayingthis, but even, you know, even,
even other epidemiologists andexperts in the field or at least
tangential experts you know,people who have.
(12:24):
Sort of weighed in, onepidemiology over the course of
this thing, but might not havesort of the full grounding and
epidemiology or even people whodo who I think are trying to,
you know, in good faith toexplain their perspective on
what's happening.
But I think that what that cangloss over.
This is a really complexsituation and it's okay to be
confused.
(12:45):
I am a little bit confused andI'm, I'm personally, I'm sort of
suspending my judgment as tosort of what's happening in
this, in this outbreak.
And I don't, you know, I don'twant to say that to, you know,
so alarm or concern that, youknow, we have this like crazy
new variant on our hands, butbut I do think.
It's prudent in this case to saythat, you know, there's, this is
a new, important piece ofinformation that we've gotten
in.
(13:06):
It's a little bit difficult tosquare all the corners on it, to
figure out what exactly is goingon.
That it's still, you know,highly probable.
That this was just Delta beingDelta.
And that it was in a veryanomalous situation in a sort of
strange community in the sensethat, you know, Massachusetts
has high vaccination rates andwe don't really know who was
there, but that said, you know,we're going to have to see sort
(13:27):
of how this plays out in thenext few weeks and months to
sort of see what to try todisentangle some of these
different factors.
So, you know, I, I love to beable to.
Explain things clearly andconcisely and to sort of help
people sift through all of the,the difficulty here.
And, and I think we'll continueto in the coming weeks for sure,
but, but I think really what Iwant to say right now is that
(13:47):
this is it it's complex.
And and yeah, so it, it makessense to yeah, to be paying
attention to all of this and toTo not necessarily have a, have
a clear place to stand yet.
Yeah,
Matt Boettger (14:03):
no.
I mean, first of all, thanks.
I mean, thank you for yourhonesty.
I mean, technology that youdon't really know what's going
on and kind of giving us all theright to be able to feel the
same thing.
If an epi epidemiologists ofHarvard school, public it can be
perplexed and we have the rightto be perplexed as well.
And no, I feel like we have toeither go on one side or the
other where there's the one sideby which I'm seeing that they're
using the, the, theMassachusetts study to prove
(14:26):
conspiracy theories.
And there's the other side,which I think is more, I think,
I think more, more pronouncedand, and maybe in some sense can
be a little bit more dangerousbecause I think it's so much
easier to dismiss.
The conspiracy theories, I guessdepends on what camp you're,
you're a part of.
Right.
But then there's the other sidewhich I'm seeing is this, this
almost even I read it the pastweek, a lot of articles I felt
as if they're going above andbeyond to justify that this is
(14:49):
normal.
This is okay.
This is to be.
And I get that, but I felt likethere was a little sense of
artificial reassurance being,say, like, yeah.
And, and thank you for justsaying like, look, both sides
might be kind of erring on theside of like trying to like
defend their position.
Right.
And this is just a perplexed,this is a perplexing case.
And so I wanna, I want to kindof encapsulate this again.
(15:11):
So I wanna like give a potentialreason why this might be
happening and then reopen a newdoor with you.
Have another level of complexitythat you should.
Off the air.
So you just mentioned that studyfrom Israel that I saw, I sent
it to you, Stephen, the wallstreet journal.
I'll put it in the show notesand it talks about how, you
know, before all this happened,you know, when, when the vaccine
(15:31):
Pfizer Madrona rolled out, itwas 95, 90 4%.
You know, effective againstinfection, right.
And that was an incredible rate.
And we're really excited aboutthat.
And this study presents itselfsane because the Delta variant,
I'm guessing, I'm assuming, andmaybe all the variants together
that Israel has shown that the,the, the particularly, I didn't
(15:51):
see which one it was.
This is Pfizer is 39% effectiveat reducing the risk of
infection.
Right.
30 that's a huge dramatic jump.
And then 40% effective atreducing the risk of symptomatic
disease.
So this may feel like we'regetting a little nervous going
to scare.
I mean, the good news is that'sstill the same level of the
vaccine was 91% effective atpreventing severe illness, which
(16:14):
you were talking about.
So I could see this.
As making sense a little bit.
In my mind, you kind of gavethe, some of these situations
with Provincetown, you know, mebeing vaccinated, I'm more
willing to go out and quote riskand go do normal things.
Right.
Because I'm vaccinated.
So I feel like almost like a, asa Malcolm Gladwell, the tipping
point is there, like this liketipping point, you're like.
When, when the vaccine is 95%effective against infection,
(16:39):
people going out and doingthings, once they're vaccinated,
probably doesn't have a dramaticchange on infection, but at some
point in time, when it getswhittled away, 90, 85, 70, 60
fifth, there's a tipping pointby which okay.
Now between the combination of,of behavior and it's reduced,
defectiveness did like, almostlike a just a flood water.
(17:00):
Right.
When it comes to infection openup, I'm assuming that could
probably make sense of some ofthis.
Is that what you were thinking
Stephen Kissler (17:06):
as well?
Yeah, totally.
So, to sort of break some ofthat open and just just to be
sort of totally precise with mywords here.
So the the early, you know, the,the trials for the Pfizer and
Maduro Nevada the reportedefficacy is that 94, 90 5% was
the efficacy against symptomaticdisease.
Not necessarily againstinfection.
So the efficacy againstinfection was probably somewhat
(17:28):
lower on the order of 70 to 80%.
But nevertheless what you say,you know, is true that these
data coming from Israel are Arereally important because as you
know, as, as you said, it seemslike the, the efficacy against
both infection and symptomaticillness are, is reduced to
around 40% in the data set thatthey're looking at.
(17:49):
So either way that's, that's adrop-off from from what we had
been observing before.
No.
This study as the authors werevery upfront about, and also the
article in the wall streetjournal is very up front about
is that it's preliminary, it'srelatively small group has not
been peer reviewed.
You know, we still need a lot ofchecks and balances on this
(18:09):
before we can really concludeanything for sure about this.
But you know, that said it doesalso kind of align with the.
Increasing reports of vaccinatedpeople coming down with a
symptomatic disease in the faceof the Delta.
And so these numbers are goingto absolutely shift over time,
as we learn more about the Deltafurthermore, you know, there's
(18:30):
not only are we learning moreabout the Delta, but we're also
learning more about the vaccinesthemselves.
So one of the things that wasbrought up in this article and
that I think we need to continuethinking about is that It's very
well possible.
And in fact, probable thatimmunity wanes over time.
This is a pretty well-documentedphenomenon that happens with
other coronaviruses.
(18:51):
It happens with flu.
It happens with many differentinfectious diseases.
Where are the strength of ourimmunity can decline over time.
Part of the reason, the way thePfizer and Madrona shots are in
a two dose series is to sort ofhelp shore up that decline to
try to keep it higher forlonger.
But a lot of the talk aboutintroducing potentially a third
dose into that sequence isbecause maybe, maybe we need it
(19:12):
to maintain those levels ofprotect.
You know, that's notunprecedented.
There are a lot of vaccines thatwe get, especially as kids where
we have a three or four doseseries.
And the entire purpose of thatis because it takes that many
doses for our immune response togo up to a durable level and
protect us for life.
That way may well be true forfor COVID-19 as well.
(19:32):
Israel of course has extremelyhigh vaccination rates.
But also, you know, they werevery quick to the draw.
And so many of the people whohave been vaccinated there have
been vaccinated for a while.
So some of this might reflectthe Delta variance.
Some of it might also reflectwaning immunity from the vaccine
over time.
And so once again, there's a lotof these different factors in
(19:53):
play that we can't quitedisentangle until we observe.
These kinds of studies indifferent populations at
different times so that we canfigure out, you know, what
exactly is contributing to whatso absolutely important
information.
It's just not totally clear whatto do with it yet.
Yeah,
Matt Boettger (20:10):
no, that's awesome.
That's great.
So let's add a level ofcomplexity to this because,
okay, so you added anotheradditional level complexity,
understanding the situation.
We talked about, how, ah, youknow, it kind of makes sense if,
if right, if these preliminary,the studies are correct and
there's a, it's now only 40%effective on maybe S you know,
symptomatic disease and peopleare being a little bit more
(20:31):
risky, so we can see these largeamounts, however you mentioned.
And I didn't, I didn't even knowthat.
Before we started the podcastthat Florida is seeing a pretty
significant uptick inhospitalization.
So that's like another level,you know, so seeing Pfizer being
at 91% effective now, I'm notsure what it was beforehand.
If it was like 95 or 96, Idon't, when it comes to that
(20:53):
level, that seems maybe like, I,that that's a hard narrative
that I'm not being able toexplain right now in light of
the efficacy.
Of of Pfizer Medina and you weretelling me.
Florida is a place that'sgenerally well vaccinated.
So you maybe wouldn't reallyexpect to have such an uptick.
So do you wanna talk about whatyou've seen with Florida and how
(21:14):
that's causing a whole maybe,and maybe in their mess of
complexity and perplexity aswell?
Stephen Kissler (21:19):
Yeah, so exactly.
So, you know, we're, we'restarting to see pretty
substantial increases in casesin a number of states,
particularly Florida, and someof the.
Southern Midwestern states likeFlorida, Louisiana Arkansas,
Missouri have recently had amongthe highest per capita case
counts in the country.
As you mentioned, you know, sosome of those states have
(21:40):
relatively low vaccinationrates.
And so we might not beparticularly surprised, but
actually, you know, Florida hashad it.
Has decently high vaccinationrates, you know, especially
relative to their surroundingcommunity and and even relative
to the national average.
So, so Florida is an interestingcase in this, in this sense
where you have relatively highvaccination rates and we do have
(22:02):
cases that are increasing prettyquickly and probably most
concerningly, you know,hospitalizations are rising
there as well.
And so it's again, sort of.
Trying to make sense of this.
So, it's once again, there are acouple of things that could be
in play.
So.
As as before.
So Florida was one of the fewstates in the country that had a
(22:23):
larger summer surge last yearthan their winter surge.
And we think that some of thatmight have to do with the fact
that You know, up here inMassachusetts and certainly in
Colorado, we think about summeras the time that you spend
outdoors and winter is the timethat you spend indoors, but
that's kind of flipped therewhere, you know, it gets so hot
in the summer that you spendmore time indoors.
(22:43):
And the winter is actually whenit's pretty pleasant to be, you
know, hanging out in Florida.
And so, you know, some of thisstuff.
Could be behaviorally driven.
We do expect cases to risearound this time of year if it
reflects it all, what happenedlast year?
Particularly in Florida, butalso in some of the other
Southern states.
But I think again, you know, thething that we're trying to
reconcile here is that thetrajectory of Hospitalizations
(23:06):
in Florida is seems to differfrom the trajectory of at least
the relationship between casesand deaths, for example, that we
saw in the UK.
So I think one of the thingsthat we talked about last week
was this really remarkabledifference.
In the previous two waves in theUK where they had their winter,
sorry.
And then they've had this morerecent summer surge that was
really driven by the Deltavariant, where in the winter you
(23:29):
can sort of calculate the factorof cases that lead to deaths.
And then in this most recentsearch really in the post
vaccination period, that thattrend sort of broke apart where
there were far fewer deaths percase.
That seems to be totally as aresult of vaccine coverage,
which is great.
And so, you know, I was.
Expecting to see something muchlike that here.
(23:50):
It may well still play outbecause it's still too soon to
sort of carry cases forward intomortality data.
We haven't really had this surgeof Delta long enough for it to
really cause an uptick in deathsif it's, if it's going to do so,
but we're definitely seeing arise in hospitalizations.
So, one of the questions that'sremaining here you know, I.
(24:10):
I wasn't able to get, I wasn'table to find data on
hospitalizations in the UK,which is really what I would
want to be able to compare tohere.
Part of the question is, youknow, the vaccine can provide
protection at many differentstages of illness.
It can prevent you from gettinginfected.
It can prevent you from gettingsymptoms that can prevent you
from going to the hospital thatcan prevent you from going to
the credit clinic, criticalcare, and it can prevent you
from dying.
(24:30):
It's not really clear, you know,what is the efficacy of the
vaccine at each of those stages?
So it may, well, you know, theremay well still be people going
to hospital, but it might bedoing a very good job at
preventing people from dying.
Even if they do end up needingcare in the hostel.
I think it's still sort of toosoon to see if, you know,
hopefully you know, the we'llstill see cases spike, but
actually the, the deaths wereremained very low especially in
(24:54):
places with high vaccinecoverage.
But we're again, in this superunsatisfying position where it's
kind of too soon to tell whatexactly.
That's going to look like I'm,I'm hopeful.
I'm hopeful that that we willstill see far fewer deaths per
case in this search than we didbefore.
And I think that, you know,looking at some of the
experience of other countriesaround the world with the Delta
variant, there's good reason tobelieve that that will be true,
(25:16):
but I think it's something we'regoing to have to watch very
closely, because if that doesnot turn out to be the case,
then that's, you know, anotherthing we're going to have to
figure out, you know, what isgoing on there.
Is it a difference in.
Is it a difference in ourbehavior?
Is it a difference in, you know,the time that it's taken between
when we've gotten the shot andwhen we've gotten infected, all
(25:36):
of these things are in play andwe're going to have to put all
of those on the table when we'resort of reconciling the
different experiences that we'vehad with this particular variant
of the virus all around theworld.
Okay,
Matt Boettger (25:46):
that's helpful.
And just a quick caveat.
It's one of our Facebook,private groups that ALO hello
back.
I don't know who you are becauseI don't think you hit the accept
button to know who it actuallyis.
But it's one of our members fromthe, our private support group.
So thank you for watching.
It's awesome to have a couple ofyears right now.
Let's continue on to a questionI had.
(26:07):
Is, it's not quite as relevantas it was maybe last week, but
still kind of relevant.
I mentioned this to you becauseI was like thinking in my head,
Adam, okay, last week we said,Hey infections are or going up.
But hospitalizations are stillreally low.
And we we also kind of saw thatat that point in time, we were
saying, oh, 99 send to thepeople who are being infected
were, were unvaccinated and only10% were vaccinated.
(26:30):
And so then my mind is initiallyit doesn't really make sense
because.
If 90% of the people have beeninfected yet hospitalizations
are low.
Then you think they'll only belike a 10% decrease because of
in fact, you know, because ofthose who were being infected
are vaccinated.
It took me a few minutes to kindof reverse engineer that.
And I thought, oh, you know,cause some of our listeners
could be struggling in the sameway.
Like that doesn't make sense.
(26:51):
And I want to throw this back toyou.
Just make sure that my mentalgymnastics were obviously
correct that.
Okay.
So it is the fact that eventhough.
Only 10% of the people had leftat that point in time.
Right.
We don't know now because we'vegot some new studies showing up
right last week.
We're we're vaccinated, but it'sthe, it's the very nature of the
population of the vaccinationbecause before the vaccination.
(27:13):
Everyone was susceptiblewhatsoever, including the immune
compromise.
Those who had cormobidities allthese kinds of things.
And of course those people whosigned up for the vaccine,
probably the majority of them,those early adopters were those
who were at the greatest risk.
So that population pool has beentaken away largely.
Is that how those statisticskind of make, make sense?
Stephen Kissler (27:32):
Exactly.
So, I mean, and that's one ofthe things for sure is, you
know, vaccination rates areespecially much higher amongst
people over the age of 65 whoare much more likely to go to
hospital.
In the first place.
And so we have this wholegradient where, you know, if we
just look at the averagevaccination rates and we look at
average vaccine efficacy, we canreally miss a lot of the picture
because we've so far done a verygood job of protecting the
(27:53):
people who are most likely to goto hospital in the first place.
So, which is a good thing.
Yeah.
Matt Boettger (27:58):
Great.
So let's let's land here becausewhat we talked about, all the,
the, the, the true stuff, thestats, the data we've
acknowledged, there's a, there'sa large sense of perplexity
going on.
So what do we do with this?
Like, how do we land this plane?
Because the CDC has given ussome guidelines, right?
It's it's up to states to imposethat or not impose that.
So here we are individualslistening to this, maybe a
(28:20):
little concerned of.
Coming down the pipeline nextweek or three.
How do you feel like we shouldbe engaging on level of prudence
when we're saying, Hey, theconspiracy theorists clearly we
think are way off the mark.
And we even say those people aretrying to radically confirm that
everything is normal.
Don't worry.
All is going to plan.
(28:40):
Might be a little bit toointense that we need to hold
this middle ground.
What does that mean for us goingforward in my day to day,
grocery shopping, going out,seeing friends, should I change
on any level or modify mybehavior because of this time of
complexity?
Stephen Kissler (28:55):
Yeah.
I mean, I think that there's,you know, a number of different
principles that we, we need toput in play here where you know,
one of them is the, you know,the principle of prudence or
caution where, you know, we're,we're not sure what's w w how
exactly.
Yeah.
Or if substantially the game haschanged against the virus
(29:16):
there's some evidence to suggestthat it might have.
But I wanted to bring up, youknow, on the other hand, it, it
remains true that at, you know,as you said, the, the great
majority of people who are beingadmitted to hospital with COVID
are un-vaccinated so.
That's another piece of evidencethat we have to square on the
other side of the camp whereit's like, it does seem pretty
clear that certainly beingvaccinated reduces your odds of
(29:37):
going to the hospital on thisvery large scale.
So, if you're not vaccinatedyet, it does still make sense to
get vaccinated.
That's remains the best, youknow, the best tool that we know
of that we have available forpreventing the most severe
outcomes from COVID and evenreducing its spread.
I think that continuing to wearmasks while indoors whenever
possible, it makes a lot ofsense.
(29:59):
That was something that I'vemore or less kept up throughout
all of the changing guidance.
But I think especially now itmakes sense because.
This, you know, if Delta isgoing to continue to spread,
it's mainly going to bespreading in indoor crowded
spaces.
So, trying to reduce yourexposure to large crowds, trying
to reduce certainly yourunmasked exposure indoors makes
an awful lot of sense,especially if you're in a place
(30:20):
where cases are are spiking,right.
I do think that it makes a lotof sense to, you know, pay
attention to the local to thelocal COVID weather where that
can really adjust our behavior.
Because you know, certainly inplaces with a lot of spread, I
would, I would, I would urge amuch higher degree of caution.
Whereas in places where casesare remaining relatively low, I
think that, you know, not a lotreally needs to change at the
(30:41):
moment.
We should continue payingattention to the data that's
coming in, sort of suspendingour judgment about what's
happening and informingourselves as much as possible.
But in places where cases aren'tactively searching, I don't
think that I would recommendmuch of a shift in behavior at
the moment.
But it's all totally contextual.
It's all sort of, associatedwith what your own risk budget
is.
And and so the best I can do issay, you know, I'm generally
(31:04):
wearing a mask indoors.
I, you know, still going to thegrocery store, but haven't
really been indoor dining asmuch.
Outdoor dining is wonderfulright now in this part of the
country, you know, so,supporting local businesses you
know, a lot of people are havingtrouble making it through this
thing.
So like, you know, recognizingthat, like we have a formidable
Infectious disease on our hands.
And we all need to make itthrough this and all of the
(31:25):
different ways we can.
So I feel like I'm bringing up alot of things that we were
talking about way back at thebeginning of 2020, but this
sense of like, to the extentthat we're able to, you know,
maintaining our solidarityrecognizing that some of our
actions willing to change, butnot allowing that to really
drive wedges between us, butinstead to make sure that we're
taking care of each other.
And and.
You know, living our lives tothe extent that we're able.
(31:47):
But also recognizing that theremay be.
Necessary adjustments coming up.
Matt Boettger (31:51):
Yeah.
Great.
I love it.
You know, I'll put this in theshow notes as an an article,
just talking about the CDCrecommendation and they're kind
of tears, which seems a littleabstract, but they break it down
to basically I can read thearticle.
I could be flubbing this andSteven can agree, but you know,
basically between 50 and ahundred cases per a hundred
thousand, I think that'sconsidered like the, the high
(32:11):
level.
And then above a hundred isconsidered even higher.
Those areas are, you know,recommend that you wear a mask
endorsed even in fascinated.
And then there's the positivityrate, which I forgot what it
was, but it's in the article andthat's a great way to kind of
memorize those and use that as akind of a baseline and just
check your COVID weather.
Right.
I think, what do you use Steven?
It was, it was like some of theNew York times or New York
(32:32):
something.
The great one that you can justcheck.
Stephen Kissler (32:34):
Yeah, so exactly.
I mean, I think the New Yorktimes does a good job with data
visualization.
And so a lot of their maps areopenly accessible, even if you
don't have a subscription.
And so, yeah, so I've been, I'vebeen relying on on at least
their data visualizations, quitea bit to sort of, do this, but I
think the CDC is now actuallyproviding some of these maps now
as well, which is, which isgood.
Great.
Matt Boettger (32:55):
So check that we can put that link in the show
notes.
And finally, just in, on a bitof good news, because of all the
Delta variant, there's been asurge in vaccinations, which has
been great just to see a lot ofpeople tipping over I think
700,000 at some point in timefor four straight days this has
been great.
So that's good news hopefulnews.
And for those of you are.
Please consider it.
That is a safe way, and it is agreat way to protect yourself
(33:17):
and the people around you, whichis mutually important, so, and
help and share this podcast withother people.
If they're hesitant, or ifthey're just having a tough
time, make that decision Stephenand mark do an incredible job of
just, just showing why it'simportant and that it's safe.
So, share this podcast withpeople.
You think you may need it.
Thank you all.
For listening once again, if youwant to support us anywhere,
(33:39):
anywhere that'spatrion.com/pandemic podcast,$5
a month, as well as one time,Venmo, PayPal in the show notes.
And if you want to get ahold ofus or just send a comment or let
us know what's going on in yourworld, matt@livingthereal.com
and I will send that on toSteven and mark have a wonderful
week.
You guys we'll see you guys nextMonday, take care and bye-bye.
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