November 1, 2021 • 37 mins
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Things Discussed on Episode:
- Colorado battles fall COVID-19 resurgence, with highest hospitalization rate since December
- Why do the modellers always seem to get Covid infection rate wrong?
- Global numbers of Covid cases and deaths rise for the first time in 2 months, WHO says
- What to expect with COVID-19 vaccines for kids ages 5 to 11
- Heterologous SARS-CoV-2 Booster Vaccinations – Preliminary Report
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 my bad name.
Is Matt Boettger.
Not Becker.
That'd be what call me.
I don't even
Stephen Kissler (00:11):
know how to get dressed up for us Halloween.
Matt Boettger (00:14):
We're going to get into that in just a second.
And you're totally right, isbecause it's the day after
Halloween and they have threewild and crazy boys.
So my name is Matt Barker and Ienjoy.
With my one, a great, greatfriend, Dr.
Stephen Kissler andepidemiologist at the Harvard
school of public health.
How are you and happy?
Happy.
One day past Halloween.
Stephen Kissler (00:35):
And the happy one day past Halloween year too.
Yeah, I'm doing all right.
It was, I mean, for me it was avery uneventful Halloween here.
So did you dress up?
I did not dress up.
I dressed up in my PJ's and wentto bed.
Gosh.
Yeah, it's been a long couple ofweeks, so, yeah, I've just been
trying to catch up on some rest,which has been good.
But yeah, there were a bunch ofkiddos running around our
(00:56):
neighborhood.
There's a lot of young familiesclose by where we live.
So, lots of little goblins andmonsters running around last
night,
Matt Boettger (01:03):
which was no.
No, I don't know.
Cause I've never been to yourplace.
I have no idea.
Do they come to your doorbell orare you like in an apartment
complex where they don't?
Did you get trick or treaters ordid you just put a big sign
saying I don't wanna deal withyou.
I'm just tired.
I'm an epidemiologist.
Stephen Kissler (01:17):
Yeah.
So I live in an apartmentbuilding, so usually we don't
get trick or treaters.
We're like way up on the fourthfloor too.
So they'd have to come quite aways.
Last year we thought aboutsetting up a candy shoot out the
window, but never got that puttogether
Matt Boettger (01:31):
last city on that thing from four story could just
knock some kid out though
Stephen Kissler (01:33):
with.
That's right.
That's right.
Yeah, that was, that was part ofthe reason why we decided not
to,
Matt Boettger (01:40):
Well, okay.
Yours was uneventful.
Mine was incredibly eventful.
So I apologize if this goes inplaces it's not supposed to go
in the next 45 minutes because Ifeel absolutely hung over from.
Because I have a sweet tooth andthe boys went out in a week.
This is kind of a few times inthe year.
We just allow them to be like,okay, you can be wild and free.
(02:01):
They're pretty containedotherwise.
And so we went out, went to afew houses of friends and
family, and we told them onepiece of candy per house, but
then we got talking to friendsand we weren't monitoring.
And they took about 65 piecesand ate them like in one like 15
minutes setting, just consumingas much as they could.
And so it was a crazy.
Totally wild, totally fun.
(02:22):
And I'm exhausted.
And we, we didn't get to sleeptill probably after close to
1:00 AM.
So that's for me at 43, that isa wild night.
So
Stephen Kissler (02:29):
that's a wild night.
How did, how were COVIDprecautions?
Like what did that look like?
And odd existed?
Matt Boettger (02:34):
Yeah.
I mean, at least outside, butnobody is like, you know, if you
had a mask it's because you had,you were a goblin, not because
of anything else.
And so, it seemed like it was.
You know, our neighborhood isdoesn't have a lot of
trick-or-treaters so, and wereclose.
We were gone, but we went to onethat is just known for its
houses.
They're incredible.
And it was just packed.
I mean, just the streets werejust crammed with
(02:56):
trick-or-treaters because it isthe coolest sight to behold.
So, Yeah.
Not much, not much going on, soyeah, it's all there.
So, well you, Hey, Stephen, Idon't know if you saw this, but
we got another review.
I want to read this toeverybody.
Who's listening.
Love it.
This is from Kate Jan fromTuesday.
She says pure excellence.
I love this podcast.
(03:17):
It is so informed.
It is so informed.
While at the same time.
So relatable, the information ispresented in a clear, concise
and conversational way.
So it was easy to digest andreflect on the host, add a dash
of nuance and every now and thensome humor, I think we need to
add some more humorous Stephenamongst the informative content.
And so it's overall quiteenjoyable.
(03:38):
Some very helpful insights intothe relevant issues presented in
the time.
I really liked the last podcast.
Please do a follow-up withregards to the boosters and
mixing and matching.
As I think we would all benefitfrom your wisdom, keep living
the dream.
And I think thank you again somuch Kate for giving that.
Thanks.
It's it just makes us, itlightens our spirits.
(03:58):
I think we should go there andtalk about the mix and match and
we might just kind of go roundabout and have those towards the
end of our outline, but then shekind of set the pace for us.
Let's start with that because.
It was two weeks ago.
And I think we were suggestingthat was going to be the case,
but I think it just shortlyafter we released the episode,
then it became officially.
So we can, we can mix and match.
And so now the question is now Idon't even know, and maybe you
(04:19):
can help frame this because I amnot following as detailed as I
used to be with all the COVIDnote news, but there's boosters
out.
Right.
And so now I don't know who.
Who's available to get themright now.
And what does it mean to mix andmatch?
And since I got Pfizer back inMarch, should I be fighting for
Moderna to get a nice little,you know, accent to my booster
(04:40):
or what's going on in your guys'is like talk and discussion
there at, at, in Harvard.
Stephen Kissler (04:44):
So, I love the question and I think that these
mixing and matching of vaccinedoses.
It's a really interesting andkind of new area in a way for
for vaccine regulation.
Although, you know, it's, it isfrequently the case, you know,
there have been many times whena.
Seen has been updated orchanged.
And so there have been, youknow, people will get a couple
(05:07):
doses of one and then maybe acouple of doses of another the
most, well, I mean, clearly weget a different type of flu
vaccine every year.
And so we have a decent amountof evidence on that.
Also for any parents of young.
I guess by now they'd besomewhat older, but in 2010,
this vaccine that you get forpneumococcal disease got
updated.
And so that's another one wherekids got boosted with a
(05:29):
different vaccine than they gotoriginally.
And so there's some reallyinteresting stuff we've looked
into there.
So this isn't like a totally newlandscape, but I do think that
it's interest.
To look at, especially in thecontext of COVID.
And so, I think I'll lay outfirst, some of the some of the
key points that we need to keepstraight in our minds when we're
thinking about these boosters ora third doses.
(05:50):
And then and then talk aboutSome of the evidence that I've
seen.
Just anecdotally what some ofthe people around me have been
doing and to thinking aboutamong my colleagues.
And so hopefully we can dig intoit.
So first you know, a couple ofweeks ago we had this
announcement from the FDA thatthey were considering and then
ultimately approved and sort ofgave their blessing as safe and
effective.
(06:10):
This idea of mixing andmatching.
Different COVID vaccines.
So the official term for that isheterologous boosting.
And so, so you may see thatkicking around it.
If you're looking for more sortof, peer reviewed scientific
information, that that might bethe term that you want to search
for.
And so, yeah, so a lot of thisis based off of a couple of
(06:31):
different observational studiesand actually one sort of
prospective Study that was done,looking at how different
vaccines behaved when they wereused as a booster against the
backdrop of another vaccine.
And so maybe we can link to oneof these in the show notes, the
one that I've been sort ofrelying on the most which does.
Sort of a three by three grid.
So nine different possibilitieswhere, you know, you get J and J
(06:55):
Madonna or Pfizer as your firstdose or doses.
And then it gets boosted withone of those other three.
So you multiply the three by thethree and you get sort of all of
the different combinations.
And they looked at Efficacy.
And, and they looked at reportedside effects from each of these
things to do this really sort ofcomprehensive analysis of what
the different boosters seem todo.
Now, one caveat with that studyis that one of the big things
(07:19):
that's been in the news aboutthe Madonna and the Pfizer
vaccines is that the maternityhas seemed to be giving slightly
higher and more durable immuneresponse.
If we think that part of that isbecause the dose was bigger.
More and more data injected intoyou.
And that is changing.
So with the third dose of theMedina, I think they're going
from a hundred microgram to a50.
(07:41):
So they're basically having thedose that you got originally.
Whereas for the Pfizer, they'reall three of the same, but this
study was done with a booster ofMadrona.
That was the same size as theoriginal two.
So that's going to affect thingsa little bit too.
So the boost that you get, whatperfectly match up with the data
that we have available becausethey've adjusted to use
guidelines a little bit part ofthe reason they've done that is
(08:01):
because of what we'll talk aboutin a minute, which is that
probably with a smaller dose,you're less likely to get some
of the side effects, includingthe myocarditis.
Anyway, all of that aside theevidence for mixing and matching
the vaccines is pretty good.
It seems like mixing thevaccines tends to be at least as
good as getting the same onethat you got before.
(08:23):
It does depend a little bit onwhat you got before.
And so one of the things that Iwas most encouraged to see was
that for somebody who got aJohnson and Johnson type
vaccine, initially, if theyboosted with a Medina or a
Pfizer, then their antibodylevels came up, basically
indistinguishable to somebodywho got Pfizer.
Or Madonna first and then gotboosted with those same vaccines
(08:44):
later.
So, that was not the case.
So if a person had Johnson andJohnson originally and then got
boosted with the same, theirantibodies were not quite as
high as the person who wasboosted with Madrona or Pfizer.
So.
As far as my public healthrecommendation for people who
got a Johnson and Johnsonvaccine, or maybe you're living
abroad and you've got somethinglike the Oxford AstraZeneca
vaccine, which is very similar,I would say boost with one of
(09:06):
the marinade vaccines ifpossible.
And that will basically put youright in, right in line with the
people who got MRNs from thebeginning.
Very protective, very goodantibody levels.
And I think that's good.
No, Of course, we haven't reallybeen following the, you know, in
some places.
So in Israel, for example, we'vebeen able to follow people and
we see that their immuneresponse is pretty long after
(09:27):
they've gotten these boosters.
But I think one of theinteresting things will be to
see how mixing and matchingaffects the duration of
immunity.
And based off of what I knowabout immunology, I actually
expect that people who have.
Mix, especially people who mayhave gotten a Johnson and
Johnson first and then get anMRI and a vaccine.
I would anticipate that thosepeople may be among the people
who have the longest lastingimmunity, because it exposes
(09:50):
your body to the most diverserange of of of, of, you know,
different antigens that it'sfighting against.
Unfortunately, if you start.
Pfizer and Madrona, and then geta Johnson and Johnson.
Your antibodies don't actuallyboost as high as you would.
If you got just three Pfizerswith three modernize or two
Pfizers and a maternal and viceversa.
So I wouldn't necessarilyrecommend following up with, you
(10:12):
know, an MRA with the Johnsonand Johnson, especially if
you're in a high risk group, butif you're young and healthy and
a Johnson and Johnson isavailable I have something
different because there's achance that it may actually give
you a more diverse immuneresponse.
That wouldn't be a bad ideanecessarily.
You know, it, it, it will stillgive you a very robust boost.
(10:33):
Even if the antibody levelsinitially aren't as high as they
would be.
We don't know for sure, but itcould last longer you know,
based off of the, what we knowabout immunology that's, that's,
that's possible.
So all of that is to say that ifyou've gotten Johnson and
Johnson, I highly recommendfollowing that with an MRN, a
dose.
If you've gotten one of the MRNvaccines probably get the one
that you got originally, but youcould consider switching to the
(10:54):
other one.
And it seems basically to comeout in the wash.
And then if you've got the MRMAvaccine first.
If you're a bit of a Maverickand you really want to try
something new, go for theJohnson and Johnson it won't
hurt.
And and it could potentiallygive you longer lasting
community, but we don't have thehard evidence to back that up
yet.
But if you wanna play it safe,just get a third MRN dose and
(11:16):
you should be good
Matt Boettger (11:16):
to go now.
That's great.
That helps up talons.
And here's my follow-upquestion.
And that is, if you say, okay,we do the J and J and then we've
seen that if you fought with theMRMA man, you pushed, it puts
you kind of right on the heels.
Everybody else with say, whojust got MRN a and then if I
heard you right, that, but ifyou have an MRI, NY, and then go
(11:37):
to J and J you're not, you maynot see the same kind of.
Boost.
Why is that?
It seems such a weird thing inthe end.
They're the same thing, butorder means something
apparently.
And is there, I mean, am I goingway beyond the scope of what we
can talk about?
Like why, how can that.
Stephen Kissler (11:53):
Yeah, I, so I don't fully understand it
either.
And, and I'm not sure thatanyone does, but it, part of it
is just how our immune systemworks.
You know, there's there are allsorts of examples where both for
vaccines and for naturalinfections that your immune
system does very differentthings upon the first, second,
third, sometimes fourth, fifthexposure to a pathogen.
And and that has to do with Justwhat it's been exposed to, how
(12:16):
long it's been betweenexposures, things like that.
And it, it comes down to all ofthese little biological timers
in your body that it takes acertain amount of time for some
cells to be produced.
And then after a certain amountof time, these other cells will
die away.
And so there are these relativeconcentrations of different
chemicals in your immune systemthat basically the, the, the
precise sort of relativefrequencies of these different
(12:37):
cells and these differentsignalers in your body.
It can really affect what yourbody does when it gets exposed
to something and, and some ofthose dynamics persist for years
and years and years.
And so, so I don't, I don't knowfor sure what it is about that
that caused that.
But definitely ordered.
That's
Matt Boettger (12:55):
helpful.
That's helpful.
Okay.
I'm going to pause for a briefmoment here because there's more
so if we wanna talk about twothings I didn't mention, but if
you want to leave a review,please do so like the like Kate
did we love them have kind of,helped us, encourages us to keep
going.
If you want to support us, youcan do that at
patrion.com/pandemic podcast isa$5 a month goes a long way, or
just a one-time gift, PayPal,Venmo all in the show notes.
(13:16):
And I was talking to Stephenearlier about this, and we're
gonna get right back into thegood stuff in less than two
minutes.
There's a pre-roll and puttingout about, so if you, if you're
new to our podcast, welcome,we're excited that you're
listening and you have no ideawhat I'm about, what I'm about
to talk about.
If you're a long listener, then,you know, right.
So another one of my side thingsis I have this, this, this
(13:37):
business living the real, whereI do coaching them, developing
it.
It's been a little bit on ahiatus for a couple of months,
cause I kinda regroup throughsome life transitioning and I'm
gearing up to do some.
To the next step, the nextlevel.
And so I could love your helpright now.
So listen, the pre-roll, there'sa survey to fill out.
I'm trying, I'm looking at threedifferent groups of people.
And my curiosity among all ofour listeners, Stephen, is like,
(13:59):
who fits in?
What category if anybody fits.
Cause I, I haven't done theresearch of going into like
Spotify or apple podcasts to seewhat our demographic audience
really consists of.
And I'm excited to hear aboutthis.
So.
It really helped metremendously.
The survey will probably takeless than two minutes, maybe
even a minute.
And maybe if you're open andwilling, I could get on a 10
minute conversation, phone callwith a few of you just to
(14:20):
understand your pain points andto just to be able to
understand, see whether this isan area that I, that I could be
most useful in.
So check out the pre-roll.
If it's still going on, listento it.
If you can take the two minutes,any fit, one of these three
groups I'm looking at right now,fill out the form.
It would be greatly helpful.
Well, let's get right back intowhy you're here and that's the
pandemic and what's going on.
(14:41):
We talked about the booster andall that kind of stuff.
I saw Stephen that Colorado hasseen a resurgence.
This is the state that I'mliving in.
I kind of expected it.
It's been kind of slowlypercolating for a while.
We've been seeing hotspots allover the place.
As you always say, Stephen isutterly unpredictable.
Who's going to get what, when,where, why, how?
And so here we are.
I'm not sure why we're in thisplace.
It's the fall holidays.
(15:02):
That's part of it, I'm assuming.
Right.
And the weather's cooling off.
Cause I think part of it is thatColorado has been exceptionally
warm and we've had you rightnow.
I was just telling you, beforewe start recording Steve, and
I'm like, Hey, it's snowing.
So by the way, if you hear likepitter patters are screaming or
yelling, it is post Halloween.
There's still sugar in my boys'system.
I cannot contain it.
Good news is it started to snow.
So they ran outside, which helpswith the footprints above, above
(15:25):
me.
And we had our, I think this isour first snow, which is a
little bit, a little bit long.
Right.
So it's been warm.
So I think that's part of thereason why we've been our
numbers have been a little bitlower than other places.
Cause we've been outside andenjoying the good weather and
now it's on the cooler.
But what I want to relate thisto is an article that you've
spoken about a number of times,Stephen, in one way or another,
(15:45):
we've talked about this and thearticle says this, why do the
modelers always seem to getCOVID infection rate wrong?
And so very striking question.
The why it's related is becausethe same thing, I think it's the
same reason why.
You don't know whether Coloradois going to be hit when, where,
why, how and why, why theNortheast, why the Southwest and
who's next.
It's like, you could predictthis Stephen and you could be
(16:07):
absolutely right or absolutelywrong, but I found it and
there's this one line at thevery beginning that struck me.
And I want to use this as thekind of catapult for you to just
launch into explain why is itthat you guys are so good at
what you're doing?
But at the same time, it can beso off.
And when it comes to the futureand he says this modelers insist
that they are not makingpredictions, they are merely
(16:29):
presenting scenarios to helppoliticians make decisions, but
as hard to avoid the conclusionthat many of these have been
wide off the mark.
Right.
So taking that help usunderstand that.
Man there's been way things offthe mark, but at the same time
you're doing what you guys dobest and some of the best
(16:49):
models.
How do we kind of reconcilethese two things is like, these
are guiding, this is guidancefor us.
And just because they're widelyoff the mark doesn't mean we
just throw them out.
The baby and the bathwater,
Stephen Kissler (17:00):
right?
Yeah.
So there's a couple of differentlayers to this and I'm glad you
bring it up.
Cause this was, I mean, this isone of my favorite subjects,
right?
This is like the bread andbutter of what I do is these
models and, and thinking aboutthem and how to make them
useful.
Cause if they're not useful,then.
Might as well, get a differentjob, you know?
And so, yeah, it's so I thinkthat, right, so the different
(17:21):
layers to this, so first modelscan serve a bunch of different
purposes.
And you can get into an awfullot of trouble.
If you try to use a model thatwas built for one purpose to
tell you something that itwasn't built for.
So what do I mean by that?
Well, The different reasons thatwe might use a model is to first
(17:41):
just gain a better intuitiveunderstanding of something.
So I think of it kind ofsimilarly to like, if you, if
you're like struggling withsomething in your life, if you
were feeling, you know, some waythat you don't understand you're
just.
Kind of miffed at the world anddon't know where it's coming
from.
One of the ways that you cangain some more clarity about
(18:02):
that is by writing about it byjust like sitting, thinking
really precisely and workingthrough.
Okay.
So like what happened leading upto this point?
What are all of the, what's thescenario?
What am I thinking?
What's going through my mindright now.
And so you basically.
There, and you just think veryprecisely, very sequentially
about a problem that you'rehaving.
And just in going through thatprocess of thinking about it,
(18:23):
you can gain some clarity as tothe mechanisms that are
underneath sort of what you'refeeling.
And then you can begin to dosomething about it.
Now that doesn't necessarilymean that you can predict
forward and say exactly how I'mgoing to feel, but you can at
least have a deeperunderstanding of sort of what
the guiding principles are.
And then you can tweak somethingand then.
Sit down two weeks later andwrite something again and see
how it went.
So that's one of the things thatmodeling does for us is that
(18:44):
even aside from the output ofthe model, usually we focus a
lot of the, the, the news.
And even I, as a model, I thinkabout like what, what the model
is telling us, what are theprojections?
What are the forecasts?
But sometimes the act ofmodeling itself is sort of like
this way of writing a scientificjournal to try to more deeply
understand the problem thatwe're facing.
Matt Boettger (19:02):
Second kids coming down here.
There we go.
They're back.
Stephen Kissler (19:06):
Great.
Yeah.
So that's that's one way is tojust sort of like try to get a
better understanding of theunderlying things that, that
make a system work.
So in this case, an epidemicspread, now we can also think
about using models to Too.
And these are the words that thearticle is using to make
projections or predictions.
(19:27):
I like to use projections orforecasts.
Now there are some models someinfectious disease models that
are used for making forecasts,but a lot like making weather
forecasts, they're only accuratefor a very short period of time.
So you can make a forecast.
Maybe a week ahead, maybe twoweeks ahead.
And that's, you know, that'strue for weather and that's true
for epidemics and, and you cando, you actually can do a pretty
(19:48):
good job of that, but once youget past that, I mean, I'm not
going to trust a weatherforecast that's four weeks out
for sure.
Nor should you really be able totrust an epidemic forecast
that's four weeks out becauseintrinsically the system is just
too complex to measure that faraway.
With epidemics it's especiallydifficult because we have these
behavioral feedbacks too, thatthat responds to what the
(20:09):
epidemic is doing.
So even more so than the weatherthere are these complexities.
So I'll get back into that in amoment too, but then there's
also these questions ofprojections.
So the other thing that modelscan help us do is look maybe
further into the future and aska bunch of sort of if then
questions and in this case,rather than.
Trying to get an understandingof precisely how many cases are
(20:30):
there going to be on a given dayor within a given timeframe?
Really, what we're trying to dois to assess orders of
magnitude.
And so to say, if we make thischange, is it going to have a
big effect or a small effectrelative to this other change
that we could make?
So really we have these twopolicy decisions that we might
make and we say, okay, which oneis the best and models?
(20:50):
Well, we don't know preciselywhat this one will do, but
across all of the differentmodels that we ran, this one had
a much bigger, positive impact.
So that's probably the choicethat we should make.
We don't know exactly what it'sgoing to do, but you're a lot
more likely to do something goodif you choose this one versus
this one.
And so the issue that we oftenrun into is that we use this
last category of models that areused for making these
projections and policydecisions.
(21:11):
And then we compare them withthe actual case counts.
And while you're there, they'retotally off.
And it's like, well, yeah,because we never had the data to
make the.
Predictions, the sorts offorecasts that you're asking
them to make in the first place,these models were built for an
entirely different purpose.
And they did help make certaindecisions and in some ways, The
proof that the models did a goodthing is because the forecasts
(21:34):
were wrong.
Right?
Because that's the other thingis that the decisions that the
models are helping us make arehelping us to avoid these
scenarios that were casts arewarning us about.
And if they're successful, ourforecasts are going to be wrong.
Because, and that's differentthan the weather because we
don't, you know, or if I similaror
Matt Boettger (21:53):
similar to the weather, instead of like, it's
kinda like when you, there's abig train of warning, I'm from
the Midwest and you know, youknow, that tornadoes kill and
all of a sudden the sirens gooff, everybody goes to the
basement, there's no desk.
And you're like, see, Tunezdon't kill him.
Like, no, no, no is becausethere was a siren then everyone
to the basement.
And so they weren't out in thestreets.
Right.
Exactly.
Stephen Kissler (22:11):
Yeah.
So that's what we're in theprocess of doing is trying to
ring those sirens when theyshould be around and trying not
to ring them when theyshouldn't.
And then and so then the outcomeis this sort of thing where
yeah.
All of the forecasts andprojections are off because.
We're responding to thoseforecasts and projections and,
and trying to do something here.
So, so I think that all of thosereasons, all of those things are
reasons why, you know, there's YY you know, the modelers have
(22:34):
been wrong in air quotes.
And, and that's, you know,that's not to say that, like,
we've, we've pitched a perfectgame.
You know, a lot of these models.
Frankly been off we've wehaven't accountant counted for
things that we should haveaccounted for.
We've, you know, just based somemodels on data that turned out
to be not very reliable attimes.
You know, things can go wrong inmodeling as well.
(22:56):
So that's, you know, that's notto say that like, we've, we've
done everything right.
And the problem is just in howthey're being interpreted, but,
but really the, that, that isthe primary issue here.
And I mean, and I don't, youknow, I don't, I don't blame
people who.
Experts in this area for notnecessarily, you know, being
(23:17):
able to make these distinctionson the fly, right?
Like I've, I've been involved inmathematical modeling for years
and years and years and years.
And it's taken a lot ofexperience to get an intuitive
feel for how models differ andwhat sorts of things they can.
And can't tell us at differenttimes most of my work over this
past year, well, most of it hasbeen the modeling itself, but
second, only to that has beencommunicating how to interpret
(23:39):
the models that I built topeople who are not initially
modeling.
And that has been immenselychallenging.
So I think, you know, the bestthat I can hope to do here is to
just sort of communicate thatthere are these different
purposes that models serve.
And that that a big reason whyit seems like some of the model
outputs aren't necessarilymatching up with what actually
happened.
Are, are these different thingsthat either they weren't built
for that purpose?
(24:00):
Or they work.
Yeah,
Matt Boettger (24:01):
exactly.
No, that's really helpful.
Totally helpful.
And I mean, thank you forallowing us to understand that
epidemiology is still acredible,
Stephen Kissler (24:09):
credible.
I hope so.
Yeah.
I mean, I, I have to, yeah, I dohave a vested interest in that.
This is what I believe in anddo, but, but yeah,
Matt Boettger (24:19):
I would imagine, you know, and this is just, it
will move on just a second, but.
And I'm sure you're feeling thisas well, that this particular
pandemic at this particularpoint in time at this state in
technological advancementprobably has been, or we
probably haven't seen it quiteyet or has been, or will be an
exponential explosion of.
(24:40):
Perf more perfected,epidemiological modeling for the
future, because I'm sure thishas been like the just poster
child of like given where we'reat with our technology and then
what we, what we currently have.
But then all of a suddenrealizing, oh my gosh, where we
admitted misdirected ourinvestments in technology and
research and what we should beputting and doubling and
(25:02):
tripling down for the next one,there was a, probably just
thousands of aha moments forepidemiologists at this, at
this, in this past year, yearand a half.
Stephen Kissler (25:14):
Totally.
Yeah.
I really think that you know, Idon't want to overstate it, but
I think that, you know, fromthat this pandemic has.
Really let of spark.
And I think that the field ofepidemiology was kind of primed
already to take that spark inthe, in the sense that, you
know, we have a lot of newtechnology that gives us new
insight into where disease isspreading and who's getting
(25:36):
infected and why and how peoplemove and how people interact.
And like all of those pieceswere kind of there.
And then this crisis hits thatreally just sort of focused
everyone and Motivated all ofthese problems that we've sort
of been circling around forawhile, but there hasn't really
been this concrete nucleatingsort of factor that that really
revealed what we know and whatwe don't in, in, you know, a, a
(25:59):
real sort of.
Setting and this has done it.
So I think that, you know, we'regoing to see the reverberations
of this within epidemiology fora long time.
And I think a lot of those aregoing to spill over into
everyday life too.
I think that just public healthand especially public health
from the standpoint ofinfectious disease is just going
to be.
A feature of our existencemoving forward for awhile.
(26:22):
And it'll be really interestingto see how that, and on
Matt Boettger (26:24):
a popular level, like, I mean, not just in the
research, like, I mean now, youknow, I'm looking at this thing
called the aura ring.
Have you seen that the aura ringdied and there were three just
came out with those of you whoare like, not geeks.
I'm like, it's like, I mean, Iwouldn't have been this
intrigued by it until now, like,oh, the, you know, the
temperature and how that canactually potentially show
infection.
(26:45):
Any days in advance this, these,these technologies are now
becoming a very, you know, it'snow it's in the consumer area,
right.
Versus just in research.
So I'm excited for what thiscould be the next year or two
and further.
Yeah.
Let's continue on.
So we talked about Colorado, theresurgence, we talked about the
modeling you know, I, I noticedjust a couple days ago, the
global COVID cases are on theincline or an increase again
(27:09):
after two months of kind of alittle bit of a hiatus, so to
speak you know, I was.
Just wonder if that's anythingto do with this new variant
going on.
I know there's not a lot ofinformation on it.
This is the Delta plus which isjust such a weird thing.
I feel like this is an appleproduct Delta plus, so more leg
room, more like, oh my gosh.
(27:30):
And eat.
And there's, there seems to be,maybe you can echo back and
incorrect.
Anything.
I read a few articles.
Not much is going on when itcomes to this particular
variant, like a, I feel like,ah, you know, it's more of a
headache than like a crisis andit's, it seems to be a little
bit more contagious.
And I see a lot of like these,like almost like shrugs their
shoulders.
(27:50):
Like, I dunno what w what's whatdo you mean.
Stephen Kissler (27:54):
Well, yeah.
So one of the new pieces ofinformation, that's very good
about this is that, you know,whenever we see one of these new
variants, there's inevitably astudy that follows soon after
asking, you know, how are thevaccines holding up against it?
And the answer for this Deltaplus variant is very well,
basically just as well asthey've been holding up against
Delta.
So the really good thing aboutthat is that there had been some
(28:15):
uncertainty about whether theincreased contagiousness of this
Delta plus variant.
Was due to something intrinsicabout its transmissibility.
That's just sort of stickier aswe've talked about before.
Or if it's getting around ourimmunity, because that's another
way in a, in a very highlyimmunized population, then one
way to increase your.
(28:36):
Transmissibility is to getaround immunity, but that
doesn't seem really like themain feature here.
It just seems like it's Delta,it truly is Delta plus.
Right.
It's like Delta with a littlebit extra.
Right.
And so, and that that's it.
And it's, and it's really just alittle, you know, it is starting
to.
(28:56):
What we call displace theprevious lineages of Delta.
So where it's circulating, itsort of increases in prevalence
relative to the otherpredecessor Delta strains that
had been circulating.
And th that's a function of itsincreased contagiousness, but
but it's not so much morecontagious that it's causing
these massive new outbreaks,like we saw when the Delta first
emerged.
(29:16):
So I think that's why you'reseeing a lot of shrugs of
shoulders because.
The same old story little bit ofa tweak it's worth, you know,
those of us who spend our daysand lives, you know, with our
heads sunk deep into these datato be able to distinguish
between these things and to keeptrack of what's going on.
But by and large, it reallyhasn't changed the landscape
much.
Now that said it's you know, wecan't totally.
(29:39):
Like we are starting to seerises in cases globally.
As you've said, there are surgesin Colorado, there are different
surges across different placesin the us.
And all of that, you know, isagainst this backdrop of Delta
and Delta plus.
And so the, the increases incase.
We can't really separate fromthis variant, but they also, I
think aren't being principallycaused by the fact that there's
(30:00):
this new variant.
I think that there are otherfactors in play, including just
the virus, making it tocommunities that have lower
immunity.
And especially here in theNorthern hemisphere, starting to
get into our wintertimerespiratory illness season.
So one more plug to get your flushot if you have yet.
And so, because this is, this isthe time, right?
It's November where we'restarting to see respiratory
(30:21):
viruses going around.
This is normally when we startto see increases in other
coronaviruses anyway, so, it's,it's my expectation that we're
going to, it's going to beharder to control during this
time of year in this part of theworld.
And so we can expect to see somesurges for sure.
But I think that really, to me,it's that seasonality that is
really the main driver of whatwe're seeing.
(30:41):
Okay.
Matt Boettger (30:42):
And as we land this plane and coming back to
the vaccine, we talked about theboosters and the mix and match.
And by the way, on that one, Isaw an article about this, about
FDA, I think said this yeah.
Medina boosters Pfizer andMadrona boosters for people 40
and older.
I didn't quite understand all ofthis cause I, when I see, like,
what is the standard now?
Does that mean that anybodyforward 40 and older can get one
(31:04):
right now?
It depends on the state.
W what does this
Stephen Kissler (31:07):
mean?
Yeah.
So I have no idea.
And it seems like theseguidelines are changing by the
day.
And so I think the main thing isjust, you know, keep you keep
watching the CDC, their webpageshould lay out, you know,
whether or not you are approvedtalk to your doctor because one
of the other big sort of grabbags of people who are eligible
(31:28):
for this vaccine, or is thatpeople who are at risk of severe
outcomes from COVID.
And there's a little bit ofsubjectivity as to, you know,
who falls into that category aswell.
I think there's also a case tobe made for people who are
caretakers of people who are athigh risk.
And so I think in many casesjust talking to your doctor and
saying like, Hey, here's mysituation.
(31:49):
Would you recommend getting one?
And they can provide you somereally clear guidance as to
whether or not to get it.
I think at this point, you know,it's you know, if you really, if
you really championed at the bitto get the booster, like I think
there are ways to get it.
And by and large, I think it'sworth sort of following the CDC
guidelines because there are,you know, following the best
available evidence and thevaccine supply and trying to
(32:10):
make sure that people who needit most are getting it.
So, you know, I haven't gottenmy booster yet.
Probably will.
But it hasn't come up for my agegroup, my risk group yet.
And so I'll wait until it does.
And that's really what the CDCis in charge of doing.
I know we talked about thisbefore and the FDA is sort of in
charge of saying, you know, thisis safe and effective.
And then the CDC is in charge ofsaying, okay, this is how we're
going to do it.
(32:30):
This is how we're going to sortof roll these things out.
And so that's why the CDC isreally the group to, to watch
for these kinds of things,because they're sort of the
central.
Organizing agency around aroundthese suggestions.
So, but yeah, that said, I mean,I think that if, if you feel
that for whatever reason, youwould be better off with a
booster sooner rather than laterthan you know, first I, I would
(32:51):
really recommend just talkingwith your doctor and seeing if
there's any way to get itthrough them.
But a lot of these doses areavailable now.
And so, and especially now thatthey've been approved for anyone
who's gotten any vaccine that'sbeen approved in the U S
already, there's really nothingholding you back.
Matt Boettger (33:05):
Great.
Good news.
Okay.
What's going on?
This was kind of the kiddos.
So just recently we saw that theFDA approved ages five through
11 for the vaccine.
What does this mean?
Do you know much about what'sgoing on here with the next step
is, is the same thing wherethat's the FDA and then we're
still waiting for the CDC to seewhat, how this is going to be.
Stephen Kissler (33:24):
That's right.
Yeah.
My understanding is that we FDAgives the green light.
CDC, I don't think has yet comeout with their guidance, but I
expect that on the order ofhours, two days.
And so, keep an eye out forthat.
So, you know, once again, youknow, if if you've got a kiddo
in this age range, or if you areone yourself, how do all our
five to 11 year olds wholistened to this podcast?
I don't know if there's any outthere.
(33:45):
The I talked to yourpediatrician, but I expect these
to be approved right now.
It's just the Pfizer, as youmentioned they're waiting on
evidence for the Medina in partbecause just fewer people have
gotten it.
And so we just haven't had asmany cases to observe.
And so they're trying to watch,you know, for cases of
myocarditis and all these kindsof things to just really pin
down these numbers of.
(34:06):
Rare events that can happen inresult of vaccination, but they
really just want to know veryprecisely like what these rates
are so that we can, you know,help people through them if they
arise.
But the Pfizer has been clearedby the FDA.
I expect it to be to have theguidelines from the CDC very
soon.
And so if you, or yourcaretaking, someone in that age
range, then then I think itmakes sense to, to, to get that
(34:27):
vaccine.
It could go a really long way aswe're, as we're looking at, you
know, family gatherings over theholidays and just schools during
the wintertime respiratoryillness season it could go a
long way towards preventingoutbreaks in schools, towards
preventing kiddos, from bringinginfection home to their
families.
So epidemiologically speaking, Ithink that this could be a
really important step forward.
(34:48):
Good.
Matt Boettger (34:49):
That's good news.
And, you know, The surprise me,this article is related.
It was a why you shouldvaccinate your kids against
COVID-19 is a good article.
I'll put in the show notes.
But one thing that surprised meand I didn't, I don't know if
this is accurate or not, butmaybe you would know it was
saying COVID-19 was the sixthleading cause of death among
children ages five to 11 in2020, blah, blah, blah, has led
(35:09):
to nearly 700 deaths amongchildren.
And in a typical flu season,this is the part approximately
200 children die.
And an unacceptably high numberfor which we recommend universal
vaccination cover remains farmore deadly for children than
the flu.
Is that true?
I always thought it was the, I,the flu was always like, that
was worse for kids for when itcomes to COVID-19 or is this
(35:30):
something that sounds familiar?
No,
Stephen Kissler (35:31):
it's, it's hard.
I mean, once we get into thosenumbers, like 200 to 700 out of
the total number of kids in thatage range in the us is like
really, really, really tinynumber as it is.
And so, and one of the otherthings too, is that like, you
know, we've been really paying alot of attention to COVID.
And so there, there may well beflu deaths that weren't
(35:55):
necessarily recorded as fludeaths.
One of the other really clearthings is that, you know,
especially with young kids, thething that I think of with young
kids, Getting really severecases of flu is that often it's
not the flu, it's the secondarybacterial pneumonia that follows
on from the flu that does themost damage.
And that's really true acrossage groups, but especially for
kids who are immunocompromisedor who have asthma or who have
(36:17):
some sort of a chronic conditionthat makes them a lot more
susceptible to respiratoryillnesses.
That's, that's really what we'rethinking about.
Once we get into numbers, sortof, of that size, where we're
talking nationally about 200,700, it's hard to really draw a
hard and fast conclusions to mymind.
Those are, you know, despite thefact, you know, 700 is
(36:38):
definitely a bigger number than200, right?
Like from one perspective,that's like a three and a half
fold difference.
Like that's, that's big.
But in absolute numbers, that's.
Small as well, which is not tominimize it at all, but really
what it really, all I'm tryingto say is that yes, both COVID
and flu are, are issues forkids.
You know, we are protectingthem, makes an awful lot of
(36:59):
sense, but especially for kidsin the younger age groups, you
know, it's, they're, they're onpar with each other, for sure.
And so, Yeah, I think that's
Matt Boettger (37:08):
good.
Well, thank you for putting thatperspective.
That ends it for this episode.
Thank you all for listeningagain.
If you can leave a review, welove it.
So you can do that on applepodcasts.
If you wanna support us aslittle as$5 a month at
patrion.com/pandemic podcast,can help us keep this going or
just a one-time gift to PayPalthen Mo in the show notes, check
out that pre-roll again, pleasefill out that survey.
(37:29):
If you ha, if you fit one ofthose three categories.
Grilly appreciate any time youcan help me to focus my own next
work for living the real.
And if you would get a hold ofStephen S T E P H E N K I S S L
E R at on Twitter, or if youwant to just reach out to us via
email matt@livingthereal.com,let us know how you're doing and
(37:51):
how we can help invest to serveyou.
Hope you guys have a wonderfulweek.
We'll see you guys in two weeks,take care and.
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 my bad name.
Is Matt Boettger.
Not Becker.
That'd be what call me.
I don't even
Stephen Kissler (00:11):
know how to get dressed up for us Halloween.
Matt Boettger (00:14):
We're going to get into that in just a second.
And you're totally right, isbecause it's the day after
Halloween and they have threewild and crazy boys.
So my name is Matt Barker and Ienjoy.
With my one, a great, greatfriend, Dr.
Stephen Kissler andepidemiologist at the Harvard
school of public health.
How are you and happy?
Happy.
One day past Halloween.
Stephen Kissler (00:35):
And the happy one day past Halloween year too.
Yeah, I'm doing all right.
It was, I mean, for me it was avery uneventful Halloween here.
So did you dress up?
I did not dress up.
I dressed up in my PJ's and wentto bed.
Gosh.
Yeah, it's been a long couple ofweeks, so, yeah, I've just been
trying to catch up on some rest,which has been good.
But yeah, there were a bunch ofkiddos running around our
(00:56):
neighborhood.
There's a lot of young familiesclose by where we live.
So, lots of little goblins andmonsters running around last
night,
Matt Boettger (01:03):
which was no.
No, I don't know.
Cause I've never been to yourplace.
I have no idea.
Do they come to your doorbell orare you like in an apartment
complex where they don't?
Did you get trick or treaters ordid you just put a big sign
saying I don't wanna deal withyou.
I'm just tired.
I'm an epidemiologist.
Stephen Kissler (01:17):
Yeah.
So I live in an apartmentbuilding, so usually we don't
get trick or treaters.
We're like way up on the fourthfloor too.
So they'd have to come quite aways.
Last year we thought aboutsetting up a candy shoot out the
window, but never got that puttogether
Matt Boettger (01:31):
last city on that thing from four story could just
knock some kid out though
Stephen Kissler (01:33):
with.
That's right.
That's right.
Yeah, that was, that was part ofthe reason why we decided not
to,
Matt Boettger (01:40):
Well, okay.
Yours was uneventful.
Mine was incredibly eventful.
So I apologize if this goes inplaces it's not supposed to go
in the next 45 minutes because Ifeel absolutely hung over from.
Because I have a sweet tooth andthe boys went out in a week.
This is kind of a few times inthe year.
We just allow them to be like,okay, you can be wild and free.
(02:01):
They're pretty containedotherwise.
And so we went out, went to afew houses of friends and
family, and we told them onepiece of candy per house, but
then we got talking to friendsand we weren't monitoring.
And they took about 65 piecesand ate them like in one like 15
minutes setting, just consumingas much as they could.
And so it was a crazy.
Totally wild, totally fun.
(02:22):
And I'm exhausted.
And we, we didn't get to sleeptill probably after close to
1:00 AM.
So that's for me at 43, that isa wild night.
So
Stephen Kissler (02:29):
that's a wild night.
How did, how were COVIDprecautions?
Like what did that look like?
And odd existed?
Matt Boettger (02:34):
Yeah.
I mean, at least outside, butnobody is like, you know, if you
had a mask it's because you had,you were a goblin, not because
of anything else.
And so, it seemed like it was.
You know, our neighborhood isdoesn't have a lot of
trick-or-treaters so, and wereclose.
We were gone, but we went to onethat is just known for its
houses.
They're incredible.
And it was just packed.
I mean, just the streets werejust crammed with
(02:56):
trick-or-treaters because it isthe coolest sight to behold.
So, Yeah.
Not much, not much going on, soyeah, it's all there.
So, well you, Hey, Stephen, Idon't know if you saw this, but
we got another review.
I want to read this toeverybody.
Who's listening.
Love it.
This is from Kate Jan fromTuesday.
She says pure excellence.
I love this podcast.
(03:17):
It is so informed.
It is so informed.
While at the same time.
So relatable, the information ispresented in a clear, concise
and conversational way.
So it was easy to digest andreflect on the host, add a dash
of nuance and every now and thensome humor, I think we need to
add some more humorous Stephenamongst the informative content.
And so it's overall quiteenjoyable.
(03:38):
Some very helpful insights intothe relevant issues presented in
the time.
I really liked the last podcast.
Please do a follow-up withregards to the boosters and
mixing and matching.
As I think we would all benefitfrom your wisdom, keep living
the dream.
And I think thank you again somuch Kate for giving that.
Thanks.
It's it just makes us, itlightens our spirits.
(03:58):
I think we should go there andtalk about the mix and match and
we might just kind of go roundabout and have those towards the
end of our outline, but then shekind of set the pace for us.
Let's start with that because.
It was two weeks ago.
And I think we were suggestingthat was going to be the case,
but I think it just shortlyafter we released the episode,
then it became officially.
So we can, we can mix and match.
And so now the question is now Idon't even know, and maybe you
(04:19):
can help frame this because I amnot following as detailed as I
used to be with all the COVIDnote news, but there's boosters
out.
Right.
And so now I don't know who.
Who's available to get themright now.
And what does it mean to mix andmatch?
And since I got Pfizer back inMarch, should I be fighting for
Moderna to get a nice little,you know, accent to my booster
(04:40):
or what's going on in your guys'is like talk and discussion
there at, at, in Harvard.
Stephen Kissler (04:44):
So, I love the question and I think that these
mixing and matching of vaccinedoses.
It's a really interesting andkind of new area in a way for
for vaccine regulation.
Although, you know, it's, it isfrequently the case, you know,
there have been many times whena.
Seen has been updated orchanged.
And so there have been, youknow, people will get a couple
(05:07):
doses of one and then maybe acouple of doses of another the
most, well, I mean, clearly weget a different type of flu
vaccine every year.
And so we have a decent amountof evidence on that.
Also for any parents of young.
I guess by now they'd besomewhat older, but in 2010,
this vaccine that you get forpneumococcal disease got
updated.
And so that's another one wherekids got boosted with a
(05:29):
different vaccine than they gotoriginally.
And so there's some reallyinteresting stuff we've looked
into there.
So this isn't like a totally newlandscape, but I do think that
it's interest.
To look at, especially in thecontext of COVID.
And so, I think I'll lay outfirst, some of the some of the
key points that we need to keepstraight in our minds when we're
thinking about these boosters ora third doses.
(05:50):
And then and then talk aboutSome of the evidence that I've
seen.
Just anecdotally what some ofthe people around me have been
doing and to thinking aboutamong my colleagues.
And so hopefully we can dig intoit.
So first you know, a couple ofweeks ago we had this
announcement from the FDA thatthey were considering and then
ultimately approved and sort ofgave their blessing as safe and
effective.
(06:10):
This idea of mixing andmatching.
Different COVID vaccines.
So the official term for that isheterologous boosting.
And so, so you may see thatkicking around it.
If you're looking for more sortof, peer reviewed scientific
information, that that might bethe term that you want to search
for.
And so, yeah, so a lot of thisis based off of a couple of
(06:31):
different observational studiesand actually one sort of
prospective Study that was done,looking at how different
vaccines behaved when they wereused as a booster against the
backdrop of another vaccine.
And so maybe we can link to oneof these in the show notes, the
one that I've been sort ofrelying on the most which does.
Sort of a three by three grid.
So nine different possibilitieswhere, you know, you get J and J
(06:55):
Madonna or Pfizer as your firstdose or doses.
And then it gets boosted withone of those other three.
So you multiply the three by thethree and you get sort of all of
the different combinations.
And they looked at Efficacy.
And, and they looked at reportedside effects from each of these
things to do this really sort ofcomprehensive analysis of what
the different boosters seem todo.
Now, one caveat with that studyis that one of the big things
(07:19):
that's been in the news aboutthe Madonna and the Pfizer
vaccines is that the maternityhas seemed to be giving slightly
higher and more durable immuneresponse.
If we think that part of that isbecause the dose was bigger.
More and more data injected intoyou.
And that is changing.
So with the third dose of theMedina, I think they're going
from a hundred microgram to a50.
(07:41):
So they're basically having thedose that you got originally.
Whereas for the Pfizer, they'reall three of the same, but this
study was done with a booster ofMadrona.
That was the same size as theoriginal two.
So that's going to affect thingsa little bit too.
So the boost that you get, whatperfectly match up with the data
that we have available becausethey've adjusted to use
guidelines a little bit part ofthe reason they've done that is
(08:01):
because of what we'll talk aboutin a minute, which is that
probably with a smaller dose,you're less likely to get some
of the side effects, includingthe myocarditis.
Anyway, all of that aside theevidence for mixing and matching
the vaccines is pretty good.
It seems like mixing thevaccines tends to be at least as
good as getting the same onethat you got before.
(08:23):
It does depend a little bit onwhat you got before.
And so one of the things that Iwas most encouraged to see was
that for somebody who got aJohnson and Johnson type
vaccine, initially, if theyboosted with a Medina or a
Pfizer, then their antibodylevels came up, basically
indistinguishable to somebodywho got Pfizer.
Or Madonna first and then gotboosted with those same vaccines
(08:44):
later.
So, that was not the case.
So if a person had Johnson andJohnson originally and then got
boosted with the same, theirantibodies were not quite as
high as the person who wasboosted with Madrona or Pfizer.
So.
As far as my public healthrecommendation for people who
got a Johnson and Johnsonvaccine, or maybe you're living
abroad and you've got somethinglike the Oxford AstraZeneca
vaccine, which is very similar,I would say boost with one of
(09:06):
the marinade vaccines ifpossible.
And that will basically put youright in, right in line with the
people who got MRNs from thebeginning.
Very protective, very goodantibody levels.
And I think that's good.
No, Of course, we haven't reallybeen following the, you know, in
some places.
So in Israel, for example, we'vebeen able to follow people and
we see that their immuneresponse is pretty long after
(09:27):
they've gotten these boosters.
But I think one of theinteresting things will be to
see how mixing and matchingaffects the duration of
immunity.
And based off of what I knowabout immunology, I actually
expect that people who have.
Mix, especially people who mayhave gotten a Johnson and
Johnson first and then get anMRI and a vaccine.
I would anticipate that thosepeople may be among the people
who have the longest lastingimmunity, because it exposes
(09:50):
your body to the most diverserange of of of, of, you know,
different antigens that it'sfighting against.
Unfortunately, if you start.
Pfizer and Madrona, and then geta Johnson and Johnson.
Your antibodies don't actuallyboost as high as you would.
If you got just three Pfizerswith three modernize or two
Pfizers and a maternal and viceversa.
So I wouldn't necessarilyrecommend following up with, you
(10:12):
know, an MRA with the Johnsonand Johnson, especially if
you're in a high risk group, butif you're young and healthy and
a Johnson and Johnson isavailable I have something
different because there's achance that it may actually give
you a more diverse immuneresponse.
That wouldn't be a bad ideanecessarily.
You know, it, it, it will stillgive you a very robust boost.
(10:33):
Even if the antibody levelsinitially aren't as high as they
would be.
We don't know for sure, but itcould last longer you know,
based off of the, what we knowabout immunology that's, that's,
that's possible.
So all of that is to say that ifyou've gotten Johnson and
Johnson, I highly recommendfollowing that with an MRN, a
dose.
If you've gotten one of the MRNvaccines probably get the one
that you got originally, but youcould consider switching to the
(10:54):
other one.
And it seems basically to comeout in the wash.
And then if you've got the MRMAvaccine first.
If you're a bit of a Maverickand you really want to try
something new, go for theJohnson and Johnson it won't
hurt.
And and it could potentiallygive you longer lasting
community, but we don't have thehard evidence to back that up
yet.
But if you wanna play it safe,just get a third MRN dose and
(11:16):
you should be good
Matt Boettger (11:16):
to go now.
That's great.
That helps up talons.
And here's my follow-upquestion.
And that is, if you say, okay,we do the J and J and then we've
seen that if you fought with theMRMA man, you pushed, it puts
you kind of right on the heels.
Everybody else with say, whojust got MRN a and then if I
heard you right, that, but ifyou have an MRI, NY, and then go
(11:37):
to J and J you're not, you maynot see the same kind of.
Boost.
Why is that?
It seems such a weird thing inthe end.
They're the same thing, butorder means something
apparently.
And is there, I mean, am I goingway beyond the scope of what we
can talk about?
Like why, how can that.
Stephen Kissler (11:53):
Yeah, I, so I don't fully understand it
either.
And, and I'm not sure thatanyone does, but it, part of it
is just how our immune systemworks.
You know, there's there are allsorts of examples where both for
vaccines and for naturalinfections that your immune
system does very differentthings upon the first, second,
third, sometimes fourth, fifthexposure to a pathogen.
And and that has to do with Justwhat it's been exposed to, how
(12:16):
long it's been betweenexposures, things like that.
And it, it comes down to all ofthese little biological timers
in your body that it takes acertain amount of time for some
cells to be produced.
And then after a certain amountof time, these other cells will
die away.
And so there are these relativeconcentrations of different
chemicals in your immune systemthat basically the, the, the
precise sort of relativefrequencies of these different
(12:37):
cells and these differentsignalers in your body.
It can really affect what yourbody does when it gets exposed
to something and, and some ofthose dynamics persist for years
and years and years.
And so, so I don't, I don't knowfor sure what it is about that
that caused that.
But definitely ordered.
That's
Matt Boettger (12:55):
helpful.
That's helpful.
Okay.
I'm going to pause for a briefmoment here because there's more
so if we wanna talk about twothings I didn't mention, but if
you want to leave a review,please do so like the like Kate
did we love them have kind of,helped us, encourages us to keep
going.
If you want to support us, youcan do that at
patrion.com/pandemic podcast isa$5 a month goes a long way, or
just a one-time gift, PayPal,Venmo all in the show notes.
(13:16):
And I was talking to Stephenearlier about this, and we're
gonna get right back into thegood stuff in less than two
minutes.
There's a pre-roll and puttingout about, so if you, if you're
new to our podcast, welcome,we're excited that you're
listening and you have no ideawhat I'm about, what I'm about
to talk about.
If you're a long listener, then,you know, right.
So another one of my side thingsis I have this, this, this
(13:37):
business living the real, whereI do coaching them, developing
it.
It's been a little bit on ahiatus for a couple of months,
cause I kinda regroup throughsome life transitioning and I'm
gearing up to do some.
To the next step, the nextlevel.
And so I could love your helpright now.
So listen, the pre-roll, there'sa survey to fill out.
I'm trying, I'm looking at threedifferent groups of people.
And my curiosity among all ofour listeners, Stephen, is like,
(13:59):
who fits in?
What category if anybody fits.
Cause I, I haven't done theresearch of going into like
Spotify or apple podcasts to seewhat our demographic audience
really consists of.
And I'm excited to hear aboutthis.
So.
It really helped metremendously.
The survey will probably takeless than two minutes, maybe
even a minute.
And maybe if you're open andwilling, I could get on a 10
minute conversation, phone callwith a few of you just to
(14:20):
understand your pain points andto just to be able to
understand, see whether this isan area that I, that I could be
most useful in.
So check out the pre-roll.
If it's still going on, listento it.
If you can take the two minutes,any fit, one of these three
groups I'm looking at right now,fill out the form.
It would be greatly helpful.
Well, let's get right back intowhy you're here and that's the
pandemic and what's going on.
(14:41):
We talked about the booster andall that kind of stuff.
I saw Stephen that Colorado hasseen a resurgence.
This is the state that I'mliving in.
I kind of expected it.
It's been kind of slowlypercolating for a while.
We've been seeing hotspots allover the place.
As you always say, Stephen isutterly unpredictable.
Who's going to get what, when,where, why, how?
And so here we are.
I'm not sure why we're in thisplace.
It's the fall holidays.
(15:02):
That's part of it, I'm assuming.
Right.
And the weather's cooling off.
Cause I think part of it is thatColorado has been exceptionally
warm and we've had you rightnow.
I was just telling you, beforewe start recording Steve, and
I'm like, Hey, it's snowing.
So by the way, if you hear likepitter patters are screaming or
yelling, it is post Halloween.
There's still sugar in my boys'system.
I cannot contain it.
Good news is it started to snow.
So they ran outside, which helpswith the footprints above, above
(15:25):
me.
And we had our, I think this isour first snow, which is a
little bit, a little bit long.
Right.
So it's been warm.
So I think that's part of thereason why we've been our
numbers have been a little bitlower than other places.
Cause we've been outside andenjoying the good weather and
now it's on the cooler.
But what I want to relate thisto is an article that you've
spoken about a number of times,Stephen, in one way or another,
(15:45):
we've talked about this and thearticle says this, why do the
modelers always seem to getCOVID infection rate wrong?
And so very striking question.
The why it's related is becausethe same thing, I think it's the
same reason why.
You don't know whether Coloradois going to be hit when, where,
why, how and why, why theNortheast, why the Southwest and
who's next.
It's like, you could predictthis Stephen and you could be
(16:07):
absolutely right or absolutelywrong, but I found it and
there's this one line at thevery beginning that struck me.
And I want to use this as thekind of catapult for you to just
launch into explain why is itthat you guys are so good at
what you're doing?
But at the same time, it can beso off.
And when it comes to the futureand he says this modelers insist
that they are not makingpredictions, they are merely
(16:29):
presenting scenarios to helppoliticians make decisions, but
as hard to avoid the conclusionthat many of these have been
wide off the mark.
Right.
So taking that help usunderstand that.
Man there's been way things offthe mark, but at the same time
you're doing what you guys dobest and some of the best
(16:49):
models.
How do we kind of reconcilethese two things is like, these
are guiding, this is guidancefor us.
And just because they're widelyoff the mark doesn't mean we
just throw them out.
The baby and the bathwater,
Stephen Kissler (17:00):
right?
Yeah.
So there's a couple of differentlayers to this and I'm glad you
bring it up.
Cause this was, I mean, this isone of my favorite subjects,
right?
This is like the bread andbutter of what I do is these
models and, and thinking aboutthem and how to make them
useful.
Cause if they're not useful,then.
Might as well, get a differentjob, you know?
And so, yeah, it's so I thinkthat, right, so the different
(17:21):
layers to this, so first modelscan serve a bunch of different
purposes.
And you can get into an awfullot of trouble.
If you try to use a model thatwas built for one purpose to
tell you something that itwasn't built for.
So what do I mean by that?
Well, The different reasons thatwe might use a model is to first
(17:41):
just gain a better intuitiveunderstanding of something.
So I think of it kind ofsimilarly to like, if you, if
you're like struggling withsomething in your life, if you
were feeling, you know, some waythat you don't understand you're
just.
Kind of miffed at the world anddon't know where it's coming
from.
One of the ways that you cangain some more clarity about
(18:02):
that is by writing about it byjust like sitting, thinking
really precisely and workingthrough.
Okay.
So like what happened leading upto this point?
What are all of the, what's thescenario?
What am I thinking?
What's going through my mindright now.
And so you basically.
There, and you just think veryprecisely, very sequentially
about a problem that you'rehaving.
And just in going through thatprocess of thinking about it,
(18:23):
you can gain some clarity as tothe mechanisms that are
underneath sort of what you'refeeling.
And then you can begin to dosomething about it.
Now that doesn't necessarilymean that you can predict
forward and say exactly how I'mgoing to feel, but you can at
least have a deeperunderstanding of sort of what
the guiding principles are.
And then you can tweak somethingand then.
Sit down two weeks later andwrite something again and see
how it went.
So that's one of the things thatmodeling does for us is that
(18:44):
even aside from the output ofthe model, usually we focus a
lot of the, the, the news.
And even I, as a model, I thinkabout like what, what the model
is telling us, what are theprojections?
What are the forecasts?
But sometimes the act ofmodeling itself is sort of like
this way of writing a scientificjournal to try to more deeply
understand the problem thatwe're facing.
Matt Boettger (19:02):
Second kids coming down here.
There we go.
They're back.
Stephen Kissler (19:06):
Great.
Yeah.
So that's that's one way is tojust sort of like try to get a
better understanding of theunderlying things that, that
make a system work.
So in this case, an epidemicspread, now we can also think
about using models to Too.
And these are the words that thearticle is using to make
projections or predictions.
(19:27):
I like to use projections orforecasts.
Now there are some models someinfectious disease models that
are used for making forecasts,but a lot like making weather
forecasts, they're only accuratefor a very short period of time.
So you can make a forecast.
Maybe a week ahead, maybe twoweeks ahead.
And that's, you know, that'strue for weather and that's true
for epidemics and, and you cando, you actually can do a pretty
(19:48):
good job of that, but once youget past that, I mean, I'm not
going to trust a weatherforecast that's four weeks out
for sure.
Nor should you really be able totrust an epidemic forecast
that's four weeks out becauseintrinsically the system is just
too complex to measure that faraway.
With epidemics it's especiallydifficult because we have these
behavioral feedbacks too, thatthat responds to what the
(20:09):
epidemic is doing.
So even more so than the weatherthere are these complexities.
So I'll get back into that in amoment too, but then there's
also these questions ofprojections.
So the other thing that modelscan help us do is look maybe
further into the future and aska bunch of sort of if then
questions and in this case,rather than.
Trying to get an understandingof precisely how many cases are
(20:30):
there going to be on a given dayor within a given timeframe?
Really, what we're trying to dois to assess orders of
magnitude.
And so to say, if we make thischange, is it going to have a
big effect or a small effectrelative to this other change
that we could make?
So really we have these twopolicy decisions that we might
make and we say, okay, which oneis the best and models?
(20:50):
Well, we don't know preciselywhat this one will do, but
across all of the differentmodels that we ran, this one had
a much bigger, positive impact.
So that's probably the choicethat we should make.
We don't know exactly what it'sgoing to do, but you're a lot
more likely to do something goodif you choose this one versus
this one.
And so the issue that we oftenrun into is that we use this
last category of models that areused for making these
projections and policydecisions.
(21:11):
And then we compare them withthe actual case counts.
And while you're there, they'retotally off.
And it's like, well, yeah,because we never had the data to
make the.
Predictions, the sorts offorecasts that you're asking
them to make in the first place,these models were built for an
entirely different purpose.
And they did help make certaindecisions and in some ways, The
proof that the models did a goodthing is because the forecasts
(21:34):
were wrong.
Right?
Because that's the other thingis that the decisions that the
models are helping us make arehelping us to avoid these
scenarios that were casts arewarning us about.
And if they're successful, ourforecasts are going to be wrong.
Because, and that's differentthan the weather because we
don't, you know, or if I similaror
Matt Boettger (21:53):
similar to the weather, instead of like, it's
kinda like when you, there's abig train of warning, I'm from
the Midwest and you know, youknow, that tornadoes kill and
all of a sudden the sirens gooff, everybody goes to the
basement, there's no desk.
And you're like, see, Tunezdon't kill him.
Like, no, no, no is becausethere was a siren then everyone
to the basement.
And so they weren't out in thestreets.
Right.
Exactly.
Stephen Kissler (22:11):
Yeah.
So that's what we're in theprocess of doing is trying to
ring those sirens when theyshould be around and trying not
to ring them when theyshouldn't.
And then and so then the outcomeis this sort of thing where
yeah.
All of the forecasts andprojections are off because.
We're responding to thoseforecasts and projections and,
and trying to do something here.
So, so I think that all of thosereasons, all of those things are
reasons why, you know, there's YY you know, the modelers have
(22:34):
been wrong in air quotes.
And, and that's, you know,that's not to say that, like,
we've, we've pitched a perfectgame.
You know, a lot of these models.
Frankly been off we've wehaven't accountant counted for
things that we should haveaccounted for.
We've, you know, just based somemodels on data that turned out
to be not very reliable attimes.
You know, things can go wrong inmodeling as well.
(22:56):
So that's, you know, that's notto say that like, we've, we've
done everything right.
And the problem is just in howthey're being interpreted, but,
but really the, that, that isthe primary issue here.
And I mean, and I don't, youknow, I don't, I don't blame
people who.
Experts in this area for notnecessarily, you know, being
(23:17):
able to make these distinctionson the fly, right?
Like I've, I've been involved inmathematical modeling for years
and years and years and years.
And it's taken a lot ofexperience to get an intuitive
feel for how models differ andwhat sorts of things they can.
And can't tell us at differenttimes most of my work over this
past year, well, most of it hasbeen the modeling itself, but
second, only to that has beencommunicating how to interpret
(23:39):
the models that I built topeople who are not initially
modeling.
And that has been immenselychallenging.
So I think, you know, the bestthat I can hope to do here is to
just sort of communicate thatthere are these different
purposes that models serve.
And that that a big reason whyit seems like some of the model
outputs aren't necessarilymatching up with what actually
happened.
Are, are these different thingsthat either they weren't built
for that purpose?
(24:00):
Or they work.
Yeah,
Matt Boettger (24:01):
exactly.
No, that's really helpful.
Totally helpful.
And I mean, thank you forallowing us to understand that
epidemiology is still acredible,
Stephen Kissler (24:09):
credible.
I hope so.
Yeah.
I mean, I, I have to, yeah, I dohave a vested interest in that.
This is what I believe in anddo, but, but yeah,
Matt Boettger (24:19):
I would imagine, you know, and this is just, it
will move on just a second, but.
And I'm sure you're feeling thisas well, that this particular
pandemic at this particularpoint in time at this state in
technological advancementprobably has been, or we
probably haven't seen it quiteyet or has been, or will be an
exponential explosion of.
(24:40):
Perf more perfected,epidemiological modeling for the
future, because I'm sure thishas been like the just poster
child of like given where we'reat with our technology and then
what we, what we currently have.
But then all of a suddenrealizing, oh my gosh, where we
admitted misdirected ourinvestments in technology and
research and what we should beputting and doubling and
(25:02):
tripling down for the next one,there was a, probably just
thousands of aha moments forepidemiologists at this, at
this, in this past year, yearand a half.
Stephen Kissler (25:14):
Totally.
Yeah.
I really think that you know, Idon't want to overstate it, but
I think that, you know, fromthat this pandemic has.
Really let of spark.
And I think that the field ofepidemiology was kind of primed
already to take that spark inthe, in the sense that, you
know, we have a lot of newtechnology that gives us new
insight into where disease isspreading and who's getting
(25:36):
infected and why and how peoplemove and how people interact.
And like all of those pieceswere kind of there.
And then this crisis hits thatreally just sort of focused
everyone and Motivated all ofthese problems that we've sort
of been circling around forawhile, but there hasn't really
been this concrete nucleatingsort of factor that that really
revealed what we know and whatwe don't in, in, you know, a, a
(25:59):
real sort of.
Setting and this has done it.
So I think that, you know, we'regoing to see the reverberations
of this within epidemiology fora long time.
And I think a lot of those aregoing to spill over into
everyday life too.
I think that just public healthand especially public health
from the standpoint ofinfectious disease is just going
to be.
A feature of our existencemoving forward for awhile.
(26:22):
And it'll be really interestingto see how that, and on
Matt Boettger (26:24):
a popular level, like, I mean, not just in the
research, like, I mean now, youknow, I'm looking at this thing
called the aura ring.
Have you seen that the aura ringdied and there were three just
came out with those of you whoare like, not geeks.
I'm like, it's like, I mean, Iwouldn't have been this
intrigued by it until now, like,oh, the, you know, the
temperature and how that canactually potentially show
infection.
(26:45):
Any days in advance this, these,these technologies are now
becoming a very, you know, it'snow it's in the consumer area,
right.
Versus just in research.
So I'm excited for what thiscould be the next year or two
and further.
Yeah.
Let's continue on.
So we talked about Colorado, theresurgence, we talked about the
modeling you know, I, I noticedjust a couple days ago, the
global COVID cases are on theincline or an increase again
(27:09):
after two months of kind of alittle bit of a hiatus, so to
speak you know, I was.
Just wonder if that's anythingto do with this new variant
going on.
I know there's not a lot ofinformation on it.
This is the Delta plus which isjust such a weird thing.
I feel like this is an appleproduct Delta plus, so more leg
room, more like, oh my gosh.
(27:30):
And eat.
And there's, there seems to be,maybe you can echo back and
incorrect.
Anything.
I read a few articles.
Not much is going on when itcomes to this particular
variant, like a, I feel like,ah, you know, it's more of a
headache than like a crisis andit's, it seems to be a little
bit more contagious.
And I see a lot of like these,like almost like shrugs their
shoulders.
(27:50):
Like, I dunno what w what's whatdo you mean.
Stephen Kissler (27:54):
Well, yeah.
So one of the new pieces ofinformation, that's very good
about this is that, you know,whenever we see one of these new
variants, there's inevitably astudy that follows soon after
asking, you know, how are thevaccines holding up against it?
And the answer for this Deltaplus variant is very well,
basically just as well asthey've been holding up against
Delta.
So the really good thing aboutthat is that there had been some
(28:15):
uncertainty about whether theincreased contagiousness of this
Delta plus variant.
Was due to something intrinsicabout its transmissibility.
That's just sort of stickier aswe've talked about before.
Or if it's getting around ourimmunity, because that's another
way in a, in a very highlyimmunized population, then one
way to increase your.
(28:36):
Transmissibility is to getaround immunity, but that
doesn't seem really like themain feature here.
It just seems like it's Delta,it truly is Delta plus.
Right.
It's like Delta with a littlebit extra.
Right.
And so, and that that's it.
And it's, and it's really just alittle, you know, it is starting
to.
(28:56):
What we call displace theprevious lineages of Delta.
So where it's circulating, itsort of increases in prevalence
relative to the otherpredecessor Delta strains that
had been circulating.
And th that's a function of itsincreased contagiousness, but
but it's not so much morecontagious that it's causing
these massive new outbreaks,like we saw when the Delta first
emerged.
(29:16):
So I think that's why you'reseeing a lot of shrugs of
shoulders because.
The same old story little bit ofa tweak it's worth, you know,
those of us who spend our daysand lives, you know, with our
heads sunk deep into these datato be able to distinguish
between these things and to keeptrack of what's going on.
But by and large, it reallyhasn't changed the landscape
much.
Now that said it's you know, wecan't totally.
(29:39):
Like we are starting to seerises in cases globally.
As you've said, there are surgesin Colorado, there are different
surges across different placesin the us.
And all of that, you know, isagainst this backdrop of Delta
and Delta plus.
And so the, the increases incase.
We can't really separate fromthis variant, but they also, I
think aren't being principallycaused by the fact that there's
(30:00):
this new variant.
I think that there are otherfactors in play, including just
the virus, making it tocommunities that have lower
immunity.
And especially here in theNorthern hemisphere, starting to
get into our wintertimerespiratory illness season.
So one more plug to get your flushot if you have yet.
And so, because this is, this isthe time, right?
It's November where we'restarting to see respiratory
(30:21):
viruses going around.
This is normally when we startto see increases in other
coronaviruses anyway, so, it's,it's my expectation that we're
going to, it's going to beharder to control during this
time of year in this part of theworld.
And so we can expect to see somesurges for sure.
But I think that really, to me,it's that seasonality that is
really the main driver of whatwe're seeing.
(30:41):
Okay.
Matt Boettger (30:42):
And as we land this plane and coming back to
the vaccine, we talked about theboosters and the mix and match.
And by the way, on that one, Isaw an article about this, about
FDA, I think said this yeah.
Medina boosters Pfizer andMadrona boosters for people 40
and older.
I didn't quite understand all ofthis cause I, when I see, like,
what is the standard now?
Does that mean that anybodyforward 40 and older can get one
(31:04):
right now?
It depends on the state.
W what does this
Stephen Kissler (31:07):
mean?
Yeah.
So I have no idea.
And it seems like theseguidelines are changing by the
day.
And so I think the main thing isjust, you know, keep you keep
watching the CDC, their webpageshould lay out, you know,
whether or not you are approvedtalk to your doctor because one
of the other big sort of grabbags of people who are eligible
(31:28):
for this vaccine, or is thatpeople who are at risk of severe
outcomes from COVID.
And there's a little bit ofsubjectivity as to, you know,
who falls into that category aswell.
I think there's also a case tobe made for people who are
caretakers of people who are athigh risk.
And so I think in many casesjust talking to your doctor and
saying like, Hey, here's mysituation.
(31:49):
Would you recommend getting one?
And they can provide you somereally clear guidance as to
whether or not to get it.
I think at this point, you know,it's you know, if you really, if
you really championed at the bitto get the booster, like I think
there are ways to get it.
And by and large, I think it'sworth sort of following the CDC
guidelines because there are,you know, following the best
available evidence and thevaccine supply and trying to
(32:10):
make sure that people who needit most are getting it.
So, you know, I haven't gottenmy booster yet.
Probably will.
But it hasn't come up for my agegroup, my risk group yet.
And so I'll wait until it does.
And that's really what the CDCis in charge of doing.
I know we talked about thisbefore and the FDA is sort of in
charge of saying, you know, thisis safe and effective.
And then the CDC is in charge ofsaying, okay, this is how we're
going to do it.
(32:30):
This is how we're going to sortof roll these things out.
And so that's why the CDC isreally the group to, to watch
for these kinds of things,because they're sort of the
central.
Organizing agency around aroundthese suggestions.
So, but yeah, that said, I mean,I think that if, if you feel
that for whatever reason, youwould be better off with a
booster sooner rather than laterthan you know, first I, I would
(32:51):
really recommend just talkingwith your doctor and seeing if
there's any way to get itthrough them.
But a lot of these doses areavailable now.
And so, and especially now thatthey've been approved for anyone
who's gotten any vaccine that'sbeen approved in the U S
already, there's really nothingholding you back.
Matt Boettger (33:05):
Great.
Good news.
Okay.
What's going on?
This was kind of the kiddos.
So just recently we saw that theFDA approved ages five through
11 for the vaccine.
What does this mean?
Do you know much about what'sgoing on here with the next step
is, is the same thing wherethat's the FDA and then we're
still waiting for the CDC to seewhat, how this is going to be.
Stephen Kissler (33:24):
That's right.
Yeah.
My understanding is that we FDAgives the green light.
CDC, I don't think has yet comeout with their guidance, but I
expect that on the order ofhours, two days.
And so, keep an eye out forthat.
So, you know, once again, youknow, if if you've got a kiddo
in this age range, or if you areone yourself, how do all our
five to 11 year olds wholistened to this podcast?
I don't know if there's any outthere.
(33:45):
The I talked to yourpediatrician, but I expect these
to be approved right now.
It's just the Pfizer, as youmentioned they're waiting on
evidence for the Medina in partbecause just fewer people have
gotten it.
And so we just haven't had asmany cases to observe.
And so they're trying to watch,you know, for cases of
myocarditis and all these kindsof things to just really pin
down these numbers of.
(34:06):
Rare events that can happen inresult of vaccination, but they
really just want to know veryprecisely like what these rates
are so that we can, you know,help people through them if they
arise.
But the Pfizer has been clearedby the FDA.
I expect it to be to have theguidelines from the CDC very
soon.
And so if you, or yourcaretaking, someone in that age
range, then then I think itmakes sense to, to, to get that
(34:27):
vaccine.
It could go a really long way aswe're, as we're looking at, you
know, family gatherings over theholidays and just schools during
the wintertime respiratoryillness season it could go a
long way towards preventingoutbreaks in schools, towards
preventing kiddos, from bringinginfection home to their
families.
So epidemiologically speaking, Ithink that this could be a
really important step forward.
(34:48):
Good.
Matt Boettger (34:49):
That's good news.
And, you know, The surprise me,this article is related.
It was a why you shouldvaccinate your kids against
COVID-19 is a good article.
I'll put in the show notes.
But one thing that surprised meand I didn't, I don't know if
this is accurate or not, butmaybe you would know it was
saying COVID-19 was the sixthleading cause of death among
children ages five to 11 in2020, blah, blah, blah, has led
(35:09):
to nearly 700 deaths amongchildren.
And in a typical flu season,this is the part approximately
200 children die.
And an unacceptably high numberfor which we recommend universal
vaccination cover remains farmore deadly for children than
the flu.
Is that true?
I always thought it was the, I,the flu was always like, that
was worse for kids for when itcomes to COVID-19 or is this
(35:30):
something that sounds familiar?
No,
Stephen Kissler (35:31):
it's, it's hard.
I mean, once we get into thosenumbers, like 200 to 700 out of
the total number of kids in thatage range in the us is like
really, really, really tinynumber as it is.
And so, and one of the otherthings too, is that like, you
know, we've been really paying alot of attention to COVID.
And so there, there may well beflu deaths that weren't
(35:55):
necessarily recorded as fludeaths.
One of the other really clearthings is that, you know,
especially with young kids, thething that I think of with young
kids, Getting really severecases of flu is that often it's
not the flu, it's the secondarybacterial pneumonia that follows
on from the flu that does themost damage.
And that's really true acrossage groups, but especially for
kids who are immunocompromisedor who have asthma or who have
(36:17):
some sort of a chronic conditionthat makes them a lot more
susceptible to respiratoryillnesses.
That's, that's really what we'rethinking about.
Once we get into numbers, sortof, of that size, where we're
talking nationally about 200,700, it's hard to really draw a
hard and fast conclusions to mymind.
Those are, you know, despite thefact, you know, 700 is
(36:38):
definitely a bigger number than200, right?
Like from one perspective,that's like a three and a half
fold difference.
Like that's, that's big.
But in absolute numbers, that's.
Small as well, which is not tominimize it at all, but really
what it really, all I'm tryingto say is that yes, both COVID
and flu are, are issues forkids.
You know, we are protectingthem, makes an awful lot of
(36:59):
sense, but especially for kidsin the younger age groups, you
know, it's, they're, they're onpar with each other, for sure.
And so, Yeah, I think that's
Matt Boettger (37:08):
good.
Well, thank you for putting thatperspective.
That ends it for this episode.
Thank you all for listeningagain.
If you can leave a review, welove it.
So you can do that on applepodcasts.
If you wanna support us aslittle as$5 a month at
patrion.com/pandemic podcast,can help us keep this going or
just a one-time gift to PayPalthen Mo in the show notes, check
out that pre-roll again, pleasefill out that survey.
(37:29):
If you ha, if you fit one ofthose three categories.
Grilly appreciate any time youcan help me to focus my own next
work for living the real.
And if you would get a hold ofStephen S T E P H E N K I S S L
E R at on Twitter, or if youwant to just reach out to us via
email matt@livingthereal.com,let us know how you're doing and
(37:51):
how we can help invest to serveyou.
Hope you guys have a wonderfulweek.
We'll see you guys in two weeks,take care and.
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