December 13, 2021 • 40 mins
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Things Discussed on Episode:
- Did Covid-19 Cause Flu Strain to Go Extinct?
- Expert made eerily prescient prediction about Covid. See his new prediction
- Why Are We Still Isolating Vaccinated People for 10 Days?
- Success of COVID antiviral pills hinges on speedy, accurate tests
- We Know a Lot More About Omicron Now - The Atlantic
- Pfizer says booster shot of its vaccine protects against omicron variant
- What makes boosters more effective than the first two Covid jabs?
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 hospital and the face
of these crises.
My name is Matt Boettger and I'mjoined not with four, three
other people.
If those of you who are going towatch this, actually, there was
two other places for two of thepeople that we're not going to
have on today, but I'm with myone good friend, Dr.
Stephen Kissler, anepidemiologist, the Harvard
school of public health.
Good morning to you.
(00:20):
It's good to see again,
Stephen Kissler (00:20):
buddy.
Good morning.
Matt Boettger (00:23):
Oh man.
Well, you know, if you hear abunch of buzzy and sound my
background, I apologize today.
This is not normally the case.
It is now December things areactually starting to cool down.
And my wife just told me she'sfreezing upstairs.
So there's none negotiating onthe heater being on right now
and I'm in the basement.
So I'll do my best to filter itout.
But I got to put my prioritiesfirst and put you guys second.
(00:43):
So that's the way it is.
It's been two weeks.
Last time we talked, you know,Omicron was like relatively new.
We were talking about, Hey, howwas Thanksgiving?
And it was great.
And well, you know, you're,while you're having your meal,
you saw all these news, likepercolated about Omicron.
And it came on fast and quickand it was unknown and we were
like, nervous about it.
And what could it be?
It sounds like within two weekswe got a fair about of news.
(01:07):
Now, granted things could changepivot at any point in time, but
we got a good amount of news totalk about an update about the
Omicron, which seems.
Generally, it's pretty goodnews, but we'll talk about that
in a moment before we get going,the normal stuff.
If you're listening, it's yourfirst time listening.
Welcome to the show.
If you're not, and you'velistened to us for a while and
you haven't left a review,please do so.
(01:27):
It'd be great.
It really helps us leaves us,inspires us to keep this going.
We just got another one inNovember 29th is the day our
last one aired from DCB, J C NJ.
All right.
That's that's that?
That's his, her name I've beenlistening to throughout the
pandemic and I've been remiss.
I have been remiss is notleaving a review, right?
So it has been fascinated tohear an epidemiologist SKUs.
(01:50):
What he's learned about a novelvirus in real time.
It has also been reassuring toreceive useful actual advice on
living, living life and managingrisk during the most significant
global crisis of my lifetime,the information is delivered
clearly and without the hysteriasensationalism we get in the
headlines.
The format, a conversationbetween a lay person.
That's me an expert is gazeKatie to never drive as we head
(02:14):
into Omicron winter, which Ilike that.
Oh, Cod winter.
It seems like we just, it was,seems like it was just Delta
summer.
I looked at tinny to rely on thepodcasts that stayed in.
And take reasonable steps tokeep myself and my partner safe
and healthy.
Thank you so much for that
Stephen Kissler (02:27):
review.
Yeah, that's great.
Really appreciate that.
It's I'm glad that somebodyenjoys learning about this on
the fly with me, becausesometimes I feel like I'm
stumbling around in the dark.
So
Matt Boettger (02:37):
I feel, I feel like we need to get email
addresses to be like, you knowhow when you go into like, okay,
I didn't even get this Stephen,but you go to a graduation
ceremony and somebody gives atalk.
There's a Tim honorary doctorateyou're given, right.
All these honorary doctorates,like for listening to you, we
should give like a littlecertificate of honorary
doctorates to everybody wholistens because just listening
(02:57):
to you and getting our owneducated.
Understanding of what's goingon.
So thank you, buddy.
So, oh yeah, you can support usfinancially.
patrion.com/pandemic podcast.
Little as$5 a month goes a longway.
It helps a lot.
And as well as one time gifts,PayPal, Venmo, all in the show
notes.
I think that's all the goodnews.
(03:17):
Get into a few things.
First thing before we get intoCOVID, every once in a while
other things fall in the newsnow eventually cover, it's going
to go from a pandemic to anendemic and the news is not
going to be so sensationalizedand we'll move.
Hopefully this podcast continuedgoing maybe every other week and
do other topics, that kind ofstuff.
So it's good to kind of getfamiliar with other things as
well.
Stephen, you're an expert in theflu, right?
(03:39):
Because this is kind of likeyour, your whole PhD and every
once in while we, we see thisstuff, resurfacing, its ugly
head.
This one is interesting.
I saw this article, Satan didCOVID 19 cause flu strain to go
extinct.
So I read a little bit moreabout this.
This is a guest, the influenza BYamagata lineage.
I don't know anything aboutthis.
I just get my flu vaccine.
(03:59):
Call it.
Good.
What is this?
I know how much do you knowabout this?
What does this mean?
And my biggest question is,okay.
I didn't even know how manylineages, so there's four
apparently.
Right?
So maybe, maybe we're down tothree.
Does this make vaccines easierand more effective down the
road?
If we knock out one
Stephen Kissler (04:17):
lineage?
Yeah.
So, I think that the, thepotential extinction of this
particular influence of B strainis it's interesting on a couple
of different levels.
So to take a step back There area lot of different varieties of
the flu that circulate that wecan the ones that currently
circulate or at least havecirculated up until recent
(04:38):
memory can sort of be split intofour large classes.
And they are two types ofinfluenza, a, which are somewhat
closely related to each other.
And two types of influenza B,which are a bit more distantly
related.
From a, they sort of clusteredtogether.
And the designations of thesethings largely have to do with
how the virus looks on itssurface and therefore how our
immune system responds to it.
(04:59):
Someone that a there's the AAslash H one N one.
So you'll remember the 2009swine flu pandemic was an H one
N one variety.
So this is pretty much adescendant of that.
And then there's also an a Hthree and two strain, which
would circulating prior to thepandemic in that.
And that the 2009 pandemicdidn't manage to displace which
was interesting because in mostprevious pandemics, the, the
(05:21):
previously circulating strainhas been displaced, but now we
have this sort of coast,circulation of two eight
strains, and also to be strains.
So the bee Victoria and the beeYamagata strains that that are
sort of.
To the a H one N one and the Hthree N two.
So I think that the one that youhad mentioned was this B
Yamagata.
(05:43):
Flu strain.
So when we get vaccinatedagainst the flu, we often get
vaccinated against multiplestrains of flu at once.
So up until recently, it wasusually a tri Vaillant flu
vaccine, which was usuallyagainst two types, both of the,
a types and one of the B types.
More recently there have been aquadrivalent flu vaccines that
have been protective against allfour varieties.
But now there's this questionof, you know, are we going to
(06:05):
see this this flu B straincontinue to circulate.
With the non-pharmaceuticalinterventions and with whatever
else led to the reduction in flucases, it seems like we haven't
really seen much of a resurgenceof this particular flu B strain.
While we have seen circulationof the others around the world.
So we think that this flustring, if it were around would
(06:25):
have the opportunity to spread,but we haven't seen it yet.
So there's a possibility that itmay have gone extinct, which is
interesting.
So I do think that it would helpwith vaccine formulation.
It would mean.
You know, be able to go back toa tri Vaillant flu vaccine,
which would make it a little biteasier to produce it would make
it so that you know, there arefewer chances for an a mismatch
(06:46):
between the vaccine and thething that's currently
circulating to cause moredisease.
I do think that the games wouldbe.
Marginal.
In my understanding the most ofthe flu that we see is due to
the flu a stream.
So H one N one N H three and twoare the things that really tends
to cause a lot of the disease.
The B strains do cause quite abit of disease as well, but
(07:06):
really the, the A1C seemed to bethe ones that are sort of the
most robust spreaders.
And so while it would behelpful, I do still think that
the other strains may well justsort of fill in that.
That's provided by the absenceof this other strain, but
definitely for the sake ofproducing vaccines more quickly
and more effectively, I do thinkthat it's a, it would be.
Matt Boettger (07:25):
Great.
I kind of assumed that I'm inAustralia, went missing all of a
sudden, I'm guessing it'sprobably not the strongest one
available right now.
So it's not going to be thatmuch of a difference, but Hey,
it's like a little supplementgives us a little bit of boost.
Okay.
Helpful information.
Let's get into the COVID stuff.
Now, before we get into Omicron,which is kind of a big topic,
there's a few other things Icame across in the past few.
(07:46):
So we we've talked about Dr.
Ostroff and how respected he is.
And he's been back in the newsagain because of his prediction,
like 18 months ago or whateverit was he predicted within 18
months or so about 800,000deaths in the U S and crazily.
He's almost like spot on.
He might, we're not even atquite the 18 month mark, maybe
we were a few weeks away andwe're probably about 7,000 short
(08:07):
from that prediction.
So he's back in the surface, inthe limelight of the news.
And one of the things that hementioned, and now I just wanted
to throw it to you to accepteven what this means.
And it was a short blurb on avideo.
And he talked about thedistinctive, the distinction
between two types of surges.
Recently, we know, we know theIndia surge and we're all avail,
or we are really, we don't last,last summer, we talked about
(08:28):
this and how it was asignificant spike went really,
really high, but then itplummeted quite quickly.
Once it reached its spot.
And then there's the otherversion, which is kind of UK, I
guess, which is experiencing,which is again, a spike, maybe a
slight.
And then maybe then resurrectits ugly head and then
continuing like this, a spikefor a long period of time.
(08:50):
Now he had juxtapose this withthe U S saying this summer, the
Southern us seemed to representthe India version.
And now we're seeing which I wasunaware.
The Northern part of the U S isexperiencing kind of UK version.
This is that kind of spike andthen sustainable.
Now maybe you can help parsethis.
What does this mean?
(09:11):
Is, is, is there a way tounderstand this and predict
this?
You know, my, my, my thing is,oh, it's just, again, I'm a lay
person.
So I'm like, oh, it's justsimply a matter of time where,
you know, in the Southern it wasall Delta.
Right.
But in the now when theNorthern's heading well, it's
Delta now Omicron.
And so maybe that's the reasonwhy it's simple as that, or
maybe it's more complicated.
So what does this mean for usand for people who are listening
(09:33):
about these types of.
Stephen Kissler (09:35):
Yeah.
So, I love this question becauseit gets at a lot of sort of
fundamentals of infectiousdisease transmission.
It also uncovers a lot of whatwe don't really know.
So, so this is this is actuallyan area that we in, in, in my
research group are beginning tolook at in some detail to try to
understand sort of what leads tothese pretty different
experiences with the virusacross different places.
(09:57):
And.
How long will it take places tosort of synchronize in their
experience or will they ever,because if we go back to the
example of flu most of the U Sfor example, and really
basically temperate regionsacross the globe are pretty well
synchronized where we have ourflu outbreaks during the
wintertime.
And there's a little bit ofvariation in timing, but nothing
(10:20):
like what we've been seeing withthe experience of, you know,
these major surges followed byhuge declines relative to sort
of this sustained degree oftransmission.
I think there could be a coupleof things going on, you know,
the, the first and most obviouselement that we don't really
have a clear sense of how tomeasure it, how to account for
just.
Differences in human behavior.
(10:41):
And so we know for sure that youknow, in, in the Southeastern
United States the indoor seasontends to be the summer, whereas
in the Northeastern us, it tendsto be the winter.
And so, when people spend timeindoors versus outdoors and what
the relative fraction of timethey spend indoors versus
outdoors could play some role inthis.
And that could help to explainsome of the differences between
(11:03):
The differences in theexperience of the virus in
places with different sorts ofclimates.
Some of it may have to do withunderlying immunity and the
degree to which things likenon-pharmaceutical interventions
have been put in place.
So, I've been trying to think ofa good analogy for this, but you
know, you, you can imagine thatYou know, I'm, I'm trying to
(11:24):
think of something like, almostlike when you're bouncing a
basketball, right?
Like if you if you throw it atthe ground, it'll keep bouncing.
For awhile.
Whereas if you sort of graduallydrop it to the ground, it's
going to take a much longer timeto hit the ground, but it'll
just sort of like gradually getthere.
And one of the things that youcan see with infectious disease
dynamics potentially that couldbe going on here is that in
places that suffer a reallymajor surge they basically
(11:47):
synchronize the immunity ofeverybody in that population.
And so then as immunity wanes,That basically everybody sort of
has the same degree of immunityand you could reach this point
where all of a sudden there canbe this new explosive outbreak,
whereas in a place that has abuildup of immunity, that's much
more gradual.
You may end up with sort of thisasynchrony between people and
their immunity.
And so because of that, there'ssort of these people who can get
(12:09):
reinfected at different pointsin time, but it's just sort of
this much more gradual kind oftransition to an endemic virus.
So that could be part of it too.
And one of the things we'retrying to ask with our, with our
research is, is to what extentcould each of these things we
contributing to these differentsorts of trajectories that we
see in different.
Hmm.
Matt Boettger (12:28):
Okay.
That's helpful.
Yeah.
Yeah.
Cause I was unaware of that.
I know Colorado, we're stillkind of slowly coming out of our
surge has been kind of a littlebit ongoing and not quite as
fast as a plummet, moresustainable for us.
It's it's I think it's harderbecause it, you know, again,
it's the environmental,environmental parts of, of our
state where generally we've beenhaving a pretty warm fall.
(12:50):
So we've been outside more isstarting to cool off.
So I could see us having agreater sustained.
Levels now.
Totally random.
I have Fred thrust in the shownotes, but Polis our governor.
Totally.
I didn't even, I didn't eventell you this.
This is a bolt.
I don't know if you saw it in anews.
He made a bold statement.
Maybe not bold, but he was justlike, it was good.
I think where he, you know,we're seeing a surge of the, of,
(13:12):
of, of the virus here and, andhe just kind of said, look, I'm
not gonna do any more state ofemergencies I'm done with these.
Like, he's like, Everybody's hada time to get the vaccine by
now.
It's been long overdue.
Now.
Boozers like, you know,basically if you don't want the
vaccine, then you're playingthat game.
Now.
It's like, there's been wideavailability, right.
And we've had them all over theplace.
We've you can get them atSafeway.
(13:32):
You can get grocery stores, youcan get them at, at clinics.
You can go to outdoor events.
We've did our best to make themwidely available the whole
state.
Now it's to the point where.
I'm wiping my hands clean.
I'm no more state of emergenciesnow, local levels.
They can do whatever they want,feel free, you know, port about
counties.
They can do whatever they want,but as a state level, that part
is done and it got a lot ofpress and over the past couple
(13:53):
of days, and you know, myintuition is felt like that's
probably a good, a good decisionat this point in time, you know,
it's, it's now just like, if youchose not to get the vaccine,
now he told him knowledges, ofcourse you can get breakthroughs
with the vaccine, but it is muchmore rare.
He said, this isn't about.
And our hostels right now, Ithink only 16% between 13 and
16% of those hospitalized arevaccinated.
(14:16):
Right.
So we're talking about theoverwhelming population run
backs.
So, so we're seeing thesustainability right now and now
things are starting to cool off.
You can hear my heater in thebackground, right.
That people are going to moreindoors, so I could see it then
continuing a little bit longerin those kinds of things.
So, yeah, that's helpful.
Okay.
It's let's continue on.
One thing I wanted, we talkedabout, and this might be a short
conversation.
I saw this Atlantic and notquite sure why they posted this
(14:39):
article because to me it'shelped.
She seemed really relativelyeasy answer said, why are we
still isolated vaccinated peoplefor 10 days?
I just had a friend who, who isvaccinated got COVID and, you
know, asked to be quarantinedfor 10 days.
I haven't really thought muchabout this.
I'm like, okay.
Yeah.
You know, because even thoughI've heard things.
Oh, and you're vaccinated.
(15:00):
You can shed the virus quicker.
You're contagious less.
So that makes sense of being,being quarantined for less.
But we also hear that there arepeople who remain contagious
for, so I'm just assuming wejust say 10 days because Hey,
some people are stillcontagious, but is there, is
this more nuanced than I'mactually thinking?
Is this something that the otherdiscussion like, Hey, we should,
(15:20):
we should knock this down forpeople who are battling.
Stephen Kissler (15:23):
Yeah, I think, you know, I think you're right,
but like, from, from what I'veseen, you know, we've, we've
done some work that suggeststhat that people who are
vaccinated may clear the viruson, on average more quickly, but
you're right.
Like there there will be somenumber of people who still
retain the virus and are stillinfectious for a number of days.
And sort of that tenant.
Sort of captures the range whenwe expect people to be
(15:46):
potentially infectious toothers.
I didn't get to read thearticle, but I I w I would
actually maybe even go a stepfurther and say, you know, why
are we isolating anyone for 10days at baseline in, because
what I think we should be doingis.
Using tests to spring peoplefrom isolation.
So I do think some people willneed to be isolated for 10 days
(16:07):
or even more if they continue totest positive on a rapid antigen
test which indicates that theymay be infectious.
But I do think that we couldprobably spring a lot of people
vaccinated or not from theirisolation period.
If they have a sequence ofnegative, rapid antigen tests,
suggesting that they're pasttheir infectious period.
And so I think that there areways where we can be.
(16:29):
Smarter about this, using thetools that we have available to
reduce the amount of time thatpeople are in isolation and
isolating is pretty disruptive.
You know, it's like, I thinkwhen we, you know, when we think
about it, like, you know, okay,like 10 days you get COVID or
whatever, you know, like, butBut, you know, for family, with
kids, I for anybody, like whenyou actually think about like
(16:50):
being stuck in your house for 10days, like it's not fun,
especially if you're likefeeling okay.
And and so it is important forreducing spread, but I do think
that there are a lot of thingswe could do given the technology
we have available to reduce theisolation period to only the
span of time that it needs.
Great.
Matt Boettger (17:06):
Well, that's a perfect segue because we're
going to continue thisdiscussion right now with that
in light of the holiday travel,you said you just did a Q and a
live Q and a about holidaytraveling.
The reason why I think it's theperfect segue is I'm guessing
these tests might be part of theequation for good holiday
travel, because so maybe firsttalk about like what you talked
about and how to prepare forholiday travel.
(17:27):
Do it safely, be able to seeyour friends and family.
And I want you to dovetail thiswith what we just talked about.
That if for instance, you do getCOVID right.
How could you use antigen teststo then best conclude that
you're okay to go out.
Cause we know they're notperfectly effective.
So do you couple them with otherthings, do you do two every
other day?
And then we get to natives.
(17:47):
How do you, how does thatformula fit into like check off
the box?
Hey, I just got COVID it's 10days before Christmas.
I'm able I'm I'm okay to see my
Stephen Kissler (17:55):
grandparents.
Yeah.
Yeah, so.
The taking the first bit aboutsort of, how can we think about
holiday travel and gatheringsthis year?
In my advice, even in thecontext of Omicron is pretty
similar to what I've said forholiday gatherings before, which
is sort of in this order, youknow, get vaccinated and get
(18:16):
boosted if you're able Then Ithink a lot about ventilation,
make sure that windows arecracked.
Fans are on, maybe even have aair filter with a HEPA filter in
it.
If if that's within your meansand leaf blower, maybe a leaf
blower turn on that leaf blower.
Yeah, that's right.
Why not?
And yeah, and then take rapidtest before.
So one of the things that Ididn't realize until this week,
(18:38):
but it might be useful for anumber of our listeners who are
out in Colorado that apparently.
The state makes rapid testsavailable for free that you can
get repeatedly.
So I thought originally this wasjust a one-time thing, but I do
think that you can get basicallyfour boxes of the avid by next.
Now is I think every week orevery other week, you have to go
on online and sort of fill out aform.
(19:00):
So it's a little bit of a pain.
But it takes about 10 minutes toget you know, like four boxes of
rapid tests every week.
And I think that that's, youknow, that that's what we should
be doing everywhere.
Matt Boettger (19:10):
I did that.
It's great.
Like, I, I, I, it's a littlecomplicated cause I signed up me
and I thought I was doing myfamily, but I guess each in a
person, each individual personhas to sign up.
So if you have kids, you signthem up.
So I just signed myself up, gottwo boxes right away, and then
I'll send the rest kids.
I'll put another six boxes andkeep them coming.
So it's pretty great.
Great, awesome thing to have on
Stephen Kissler (19:30):
hand.
Yeah, it's wonderful.
Yeah.
Yeah, no, I think, that's,that's great.
And so, you know, now is thetime if you haven't gotten them
yet, you know, get some of theserapid tests and take them before
your gatherings take them beforeyou.
And you know, I, at this pointto travel, I think, I think you
need a negative test within 24hours.
And so the rapid tests arereally helpful for that kind of
thing.
(19:51):
And I think that all of thosethings even in the context of
Omicron can go a long waytowards keeping us all safe.
I think that, you know, Omicronis definitely coming.
We're starting to see increasesin the proportion of cases that
are Omicron, especially here inthe Northeast.
It will spread across thecountry.
My hope is that here in the U Swe w that the, the major OMA
Crohn's surges we'll wait untiljust after the holidays to
(20:14):
really get rolling.
But right now we still have alot of Delta around to, you
know, it's like, oh, Macron isnot the only thing to be
concerned about at the moment.
We've got a lot of Deltaspreading at the moment to But
whether it's still to OromaCron, all of these things do
seem to be helpful towardspreventing spread.
So, so that's, that's what Iwould suggest now, if you do get
COVID I think that you know,certainly, you know, continuing
to test to see when you testnegative repeatedly, I wouldn't
(20:37):
to spring yourself fromquarantine.
I wouldn't trust a singlenegative test.
I would probably trust twonegative rapid tests three even
better.
And so, you know, that's, that'salready a lot of tests, but, but
mainly what I would say is just,just talk to your doctor because
at this point, you know, they'llbe able to, to guide you through
your own particular situationand that there's so much nuance.
(20:58):
And that has to do not onlywith, you know, your own medical
condition, but the people youmight end up seeing and the
amount of spread that'shappening in your community at
baseline.
So I don't think that there'sany sort of hard and fast rule
that I can give to everyone thatwill apply on all of their
situations.
But I do think.
Between all of the conversationsthat we've had on this podcast
(21:18):
about rapid tests and sort of,The role that they play, that
they don't give you certaintyeither way, but that they do
increase the odds of, you know,your actual scenario lining up
with what the test is tellingyou.
And and so hopefully between allof those discussions, you know,
people will be able to interpretthe results of their tests in a
way that is is useful forwhatever, whatever context
(21:40):
they're in this holidays.
Matt Boettger (21:42):
Great.
And you helped me because wewere wondering if we had, you
know, just being safe before wesee my mother-in-law couple
weeks ago.
And he suggested which washelpful because obviously those
engine tests aren't a hundredpercent and never will be nor
the PCR ones, but take not onlytwo different tests, if you
can't from two differentmanufacturers, just a.
To help that that'll help aswell to continue to increase
(22:03):
your odds of having the rightconclusion.
So that was helpful.
You really want go out your wayby two different versions and
then you can, it just, justhelps even more to feel a little
bit, a little bit better aboutthe conclusion.
So I know Alma Crohn's on our,on our minds.
One more thing, because this isrelated to the engine.
We didn't talk about this twoweeks ago.
The antiviral pill is coming outfor COVID is a super exciting,
(22:27):
because gosh, it's just areminder.
Like something about like 80some percent prevention of, of
hospitalizations.
It's, it's, you know, it's onthe verge of like, like the
vaccine, right.
But except for you already, youget COVID first.
And it, and it makes you betterquicker.
This is exciting.
Maybe come out in January.
I'm not sure who it will beavailable for how readily
available it'll be.
(22:48):
But this hinges again on thesame thing, because kind of like
that Tamiflu for the flu, Ithink same thing had to take it
pretty closely right after youhave symptoms.
Otherwise it's not nearly aseffective.
Same for this.
I like this pill.
I think it's, it's a marker.
I'm not sure what it is, whichone it is that it's, that it's
coming out.
But
Stephen Kissler (23:04):
there's there are two we can get into that in
a moment.
Okay.
Yeah,
Matt Boettger (23:08):
but then, yeah, but I think it's within six days
or five or six days of symptoms,you have to take it otherwise
not nearly effective.
So you've got to have thesethings on hand ladies quick, or
be able to get a PCR test reallyquickly.
If you want to take this, thesepills and really lessen the
symptoms.
So Carrie, you can fill in theblanks.
Yeah.
Stephen Kissler (23:25):
Great.
Yeah.
Yeah, so.
To my knowledge there are theresort of two of these antiviral
pills that are coming out.
So there's one that's producedby Merck.
And one that's produced byPfizer.
So the interim results fromMerck were looking pretty
promising, but actually they'retheir conclusions from the final
trial where.
Okay, but not as good, maybethat it was like 30% effective
against hospitalizations, butthe Pfizer one is looking much
(23:47):
better.
I think that may be the one thatyou're referring to here where
it is like on the order of 80 to90% effective against preventing
hospitalizations, which isincredible.
I think it's, it's really worthtaking a step back that like
with both.
Like pharmaceutical drugs andvaccines, like something that
can reduce your risk ofhospitalization or death by that
much is like, that's prettyamazing.
(24:11):
And so, I think it's, it'swonderful that we, that we have
these things.
The available and we'll havethem coming online very soon,
but, but you're right.
The, the, the difficulty as withTamiflu is that you need to know
if you've been infected prettyearly on because you need to
start taking the drug within acouple of days after really
after infection.
(24:32):
And yeah, basically the sooneryou get on them, the better
chance they have to work.
So, so that really just, again,just underscores the need for
testing and for it makes it allthe more important to do the
sorts of things that we've beenhoping for, that, you know,
people might test themselveswith a rapid antigen test
frequently so that they canknow.
And and so I do think that, youknow, again if you do start
(24:54):
showing symptoms, get tested asquickly as you can.
And and that will really help tonot only guide your own
behavior, but now to guide whatsort of treatment you might get.
Matt Boettger (25:03):
Yeah.
Yeah.
I This is where it gets alsojust crazy complicated because
like COVID symptoms, colds, RSV,flu is like, they all have the
same kind of symptoms.
So.
You know, you could have thesniffles for a day, it could be
allergies.
And like, you know, at 1250 apop for an antigen test, unless
he got a big budget, it's hardto like, okay.
(25:23):
Oh, you know, I fill in a littleSteph folders, probably just get
checked, you know, do Andrewtests.
I just, I'm just hoping he seemsto come down like another 80%
where, you know, you can takethese and then quickly be able
to.
You know, start tickets likethis, just to be on it's an
insurance policy.
And by the way, I got boosted onfront Thursday.
So I've got my booster, Madonnaand pre-fill and pretty excited
about it.
Didn't really affect me much.
I know it laid you out Stephen,but it didn't do too much for
(25:45):
me.
I felt a little fatigue, but I'mnot fully, still hasn't fully
wrapped up my system, but I'mfeeling good about the next
step.
That's great.
Okay.
So finally, let's get intoOmicron.
So just spew the beans, Stephen,like where are we at with
Omicron?
Is it as bad as we thought it'swas going to be.
Is it less, what do we know?
Sounds like we know a lot moreinformation than we did two
weeks.
Stephen Kissler (26:06):
Yeah, definitely.
We, we've learned a lot in theselast two weeks which is great.
There is still a lot left tolearn but we're in a much better
spot in terms of what we knowabout the virus and about this
particular variant now than wewere when we first started
talking about it.
So, as I mentioned the lasttime, I think I mentioned the
last time there was sort of thisorder of events where we were
going to first learn aboutantibody neutralism.
(26:29):
And then the next thing we willlearn about is transmissibility.
And the last thing we wouldlearn about is severity.
So, a lot of the big news latelyhas come from the immune
response, the, the neutralizingability of our antibodies
against the virus.
And as expected, the virus doesa really good job of getting
around our immune response.
The mutations that it has reallyjust helps, it helps to disguise
(26:50):
it from our antibodies Butthere've been a couple of, of
reasonably promising studiesthat suggest that getting a
booster dose, whether you'vebeen previously infected or had
a previous set of doses have anyof the vaccines that the booster
does can go a really long waytowards preventing you basically
for giving you protectionagainst the Macron variant.
Even though the booster dose isstill the same old vaccine that
(27:13):
we'd had for months, which isgreat news.
Now there's some variation fromstudy to study and just how much
that.
Gives you.
So, there was a study fromPfizer that suggested that the
booster dose basically restoresyour neutralizing antibody
levels, meaning that, you know,the ability of your immune
system to recognize andessentially eradicate the virus
back up to levels of two dosesagainst the.
(27:35):
Founding SARS cov two strings.
Now there are a number of otherstudies that are not quite as
rosy as that that suggests thatthe Omicron will still take a
hit in booster, neutralizingactivity.
But that definitely getting abooster is much better than not
having a booster.
So, so that story seems to befairly consistent.
The other important thing tonote is that most of the
(27:56):
information that we have so faron the immune response against
Omicron has to do with theseneutralizing antibodies.
So it's this one particular armof our immune response that
recognizes the virus andprevents it from binding to
cells.
But of course that's, there area lot of other elements of our
immune response that are harderto make.
And that we think actuallyprobably play an even larger
(28:16):
role in preventing againstsymptomatic disease,
hospitalization, and death.
And usually those arms of theimmune system are more broadly
protective.
They're able to identify a widerrange of variants than these
specific neutralizing.
That's sort of attached to thesevery precise pieces of the viral
surface.
And so I think that there's alot of reason to hope that our
(28:37):
protection against symptomaticdisease and especially
hospitalization and death givenprevious immunity, either
through infection and orvaccination will still hold
relatively strongly against theOmicron variant.
But that again is something thatwe're, we're still on the early
stages of gathering information.
So, another thing sotransmissibility, so we know
that OMA chronic can spread likewildfire.
(28:58):
We know that it's taking offthat took off not only in South
Africa, but that it's beentaking off in the UK and we've
started to see surgeons here inthe Northeastern us.
So it's definitely it's comingand it is spreading and it is
spreading well.
There's still some uncertaintyas to what exactly is behind its
increased transmissibility.
So.
Basically the two possibilitiesis first that by getting around
our immune system, it's able toinfect people into spread more
(29:20):
easily, even in people with somelevel of protection.
Or second to that is just moreinherently contagious that it's
able to bind to ourselves alittle bit more easily there.
You know, part of the questionis like, to what extent does it
matter?
It does matter some becauseWhichever one of those things
that is, will change the waythat the virus behaves in
different populations withdifferent degrees of immunity,
with different types of immunitywho have had different
(29:42):
experiences with differentvariants.
So I do think it's an importantquestion, but but it's pretty
clear at this point that Omicronwill be able to spread very
rapid.
Just about anywhere it goes.
And so sort of in thetransmissibility box there,
there's a big old check thatit's it is definitely more
transmissible.
And and so that's going to besomething we're going to have to
deal with in the coming months,for sure.
And so the big question now is,is severity.
(30:04):
And I think that At this point,we would probably know if
Omicron was catastrophic moresevere than previous variants,
but I don't think we're at apoint where we can conclusively
say whether it is equally orless severe than things that
have come before it.
So again, there had been someearly reports suggesting that
some clinical cases of Omicronwere not as severe.
(30:26):
But that can be confounded byall sorts of different things,
whether it's, you know, that ittook off in younger age groups
first, or it happened to takeoff in a previously vaccinated,
an Indianized population.
And so that the underlyingimmunity was protecting those
people from being as severe asthe disease might have been in
previous waves.
And then one of the other thingsthat sort of been spread around
(30:47):
is.
Basically just comparing casesversus hospitalizations in this
surge relative to cases versushospitalizations in previous
searches and saying like, oh,well, you know, it's, there,
there is a lower fraction ofhospitalizations to cases at
this point in the surge thanthere were in previous surges.
But the issue there is thatOmicron is so much more
transmissible that we're seeinga much sharper rise in cases.
(31:10):
And so it might not be.
There are fewer hospitalizationsper case.
It's just that there are so manymore cases.
So early on that the peoplehaven't had a chance to get sick
yet.
And so, so I think we're stillat the very early stages of
understanding the severity of aMacron.
And I'm, I'm, I'm not asoptimistic as some have been
about the potential for Omicronto be less severe.
(31:30):
But I am grateful that itdoesn't seem.
You know, much, much more severethan things that we've seen
previously.
So, so that's something we'regoing to have to continue to
watch pretty closely.
And the last thing to note withthis is that as, as one of my
colleagues, bill Hanna recentlysaid even the common cold would
be catastrophic if everybody gotit at exactly the same time.
Because you know, the commoncold does cause
(31:51):
hospitalizations.
It causes pneumonia in older agegroups.
If everybody got it within thesame two weeks, like that would
cause a huge burden on ourhealth system.
And it would be a public healthevent of, you know,
unprecedented scale.
And so even if we end up with anolder crown variant, that is no
more severe than the commoncold, if it's able to infect the
world within an order of acouple of weeks, it's still
going to be something we'regoing to have to contend with on
(32:13):
a large scale.
So, So I think that really justunderscores the need for
boosters for thinking aboutmasking when in indoor spaces
and, you know, thinking aboutall of these plans, we talked
about with our holidaygatherings we got to have all
our tools on the table to helpus against this coming surge.
Matt Boettger (32:30):
And so helpful.
Okay.
The two things, number one, thisis what you were saying two
weeks ago, how quick news isprobably bad news, right?
So like, you know, if it wascatastrophic, I would probably
hear really quickly on they go,man, this is crazy, crazy.
So this good news, it may not bequite as catastrophic.
The other thing I kinda remindme of like, it's like me with
like, hands-on stuff.
Like I'm a tech guy.
I, I lo I literally load theworking on my house, like on any
(32:54):
level, even if it's hanging apicture frame on the.
I will delay it as long as Ican.
Cause I do not wanna get thehammer and nail.
Cause I figured take me eighthours to figure out how to level
this thing.
Right.
So it's kinda like when I get myhands and try to work on
something, right?
The more I work on in the housethat actually the more
complicated it becomes and themore problematic in the more fix
(33:14):
it, it has to become.
So it used to be a smallproblem.
Usually when I address it, nowit's a much bigger problem
because now it's the originalproblem.
Now my problem on top of itadded on there's more holes in
the wall.
Now we have to putty because Imissed a bunch of places.
And now I say this tongue incheek, Stephen, because this is
clearly not what I'm saying.
It's like, oh, I miss the goodold days.
The end of the pandemic whenlife was simple, right.
Were, oh, it was just apandemic, but now it's like,
(33:36):
it's so much better, but it'smore complicated because now we
have vaccines and boosters.
And how does that mix and matchand how, and so it's just, I
don't know how you guys dealwith this stuff as an
epidemiologist, as, as thingsunfolded, like, okay, now we
have 18,000 more variables we'vegot to look at and figure out
how that works.
Again, I'm grateful me.
I'm grateful your life.
It makes way more complicated.
Stephen Kissler (33:55):
Yes, it does.
But and that's, that's, that'swhy we do what we do.
Matt Boettger (33:59):
So the, the last thing then I think the last
thing I'll say is it's still onthis.
So this idea of, okay, we talkedabout this off the year.
And this is where I'm reading alot of the news of what you're
just saying how, oh, Hey, thegood news about the boosters.
It seems though that it'sskyrockets the antibodies so
intensely that it sh it seemslike it's covering the Omicron
variant.
So when I keep reading this, Iget confused because what you've
(34:21):
taught me and like I said, causeit sounds like, oh, well it's
all about antibodies.
Response in general, I justvomit antibodies and you're good
to go.
If that's the case, then anyvaccine would take care of
anything.
If you could just go and getantibodies rubbed up, but it's
not the case.
Right?
So this is where it seems reallycomplicated from that it's the
same old vaccine it's Reverendabout because of this, because
the antibody response, it seemslike it's going to cover the
(34:43):
Omicron, which is highlymutated.
Do you see where I'm like, I seethis, I see a disconnect in, can
you help us fill in the gaps ofthat?
Can't be the full.
Stephen Kissler (34:53):
Yeah, totally.
So, our immune system, thedifferent arms of our immune
system very in large part basedon how specific their vision is
for a a given virus.
So there there's some parts ofour immune.
The, the antibodies that wenormally think of that have
these very precise molecularconfigurations that allow them
(35:15):
to detect very precisestructures on the surface of a
virus.
And so those antibodies arereally good at seeing exactly
when you've been infected with.
Really closely related tosomething you've been infected
with previously or have beenvaccinated against.
But they can get easily duped bythese small changes on the
surface of the virus and sort ofrender them unable to bind to
(35:36):
the virus and unable to preventthe virus from infecting
ourselves.
But then there are differentparts of our immune system that
sort of like.
Get the gist of the virus, butthey don't, you know, they're,
they're not necessarily sospecific.
And because of that, it can takethem a longer time to respond.
It takes them a little whilelonger.
They sort of have to sit backand consider the virus for a
while and say like, is this, isthis something we should be
(35:56):
concerned about or not?
And then, and then ultimately,you know, if it's the virus
starts to increase in as moreother parts of the immune
response, start to get revvedup, they're like, okay.
Yeah, this is, this is somethingthat we really need to be
worried about to attack and torespond to.
And so they're the.
You can sort of think of them asa little bit slower.
But also able to be a little bitmore flexible in their response
(36:17):
able to identify sort of widerranges of virus.
And then there are other partsof our immune response that are
just totally they basically justprotect you against everything.
They're like, I don't know whatit is, but we're just going to
like go out there and just like,try to eat up whatever we see
that doesn't look like me.
And and so, so all of thesedifferent things are in play
now.
Vaccines are.
(36:37):
Really good at eliciting veryspecific types of antibody
responses and especially asingle dose of a vaccine is
really good at getting thesesort of like highly specific
antibodies revved up and sort ofstored away in your memory.
One of the ways that I like tothink about vaccination, I I
think that, you know, we talkabout immune memory as sort of a
metaphor for how the immunesystem works.
(36:58):
But I think.
You know, I've, I've found thatmetaphor to be incredibly rich
because I think that it thinkingabout the immune system as
something that has a memoryreally does go a long way
towards helping us understandwhat the immune system is doing.
So one of the ways that I liketo think of a vaccine is like,
so you have this like reallycomplicated image, this picture
(37:19):
that you're being shown, it'sjust basically a picture of the
virus, but you could imagineanything and what the vaccine
does.
It flashes that picture beforethe immune system's eyes very
briefly.
And so it gives us this likequick moment to say like, okay,
this is what the virus lookslike.
And with two doses of thevaccine, we essentially got two
very rapid flashes of that.
But if you were shown like areally quick image you know, you
(37:39):
would see a couple of sort ofgeneral characteristics of the.
You might really notice onespecific detail and if it were
flashed before your eyes reallyquickly, you'd probably pinpoint
on that exact same spot twice,because whatever you noticed
first, your eyes would betrained to what it had seen.
Now, if instead, you had beenflashed that image twice, and
then six months later, I came upto you and flashed to that same
(38:00):
image.
Again, you'd probably focus on adifferent part because your mind
has had time to sort of process.
And it wouldn't remember thefact that it got sort of so
distracted by this one piece ofthe viral surface, but instead
it will notice some otherfeature about the picture that
it didn't see before.
And that's the value of thesevaccines that are spaced out
over longer periods of time,because as your immune system
(38:20):
gets these flashes of exposureto the virus, and as they're
spaced out over longer periodsof time, it allows your immune
system to sort of mature.
In the meantime and to forget,which is also a really important
part of the immune response sothat when it gets wrapped back
up, it can notice a differentpart of the virus.
And so essentially what we'redoing is we're trying to sort of
give it these images of thevirus from different angles
(38:41):
which also happens when you getinfected.
And so because of that, it sortof builds up this sort of entire
repertoire of protection againstdifferent pieces of the.
And so they're still veryspecific to SARS.
COVID two, I'm just ramping upantibodies.
As, as, as such.
It doesn't really give us muchprotection against things that
aren't SARS cov two, for thesame reason that a flu vaccine
(39:01):
doesn't protect us againstCOVID-19.
But nevertheless, you know,getting these repeated exposures
will help us over time tobroaden our immune response,
even against things that ourimmune system hasn't seen
before, as long as they'resufficiently closely related.
Matt Boettger (39:15):
That's great.
And you hit the nail on thehead.
I really felt super educated.
I think I earned my honorarydoctorate again.
Thank you, Stephen.
Stephen Kissler (39:23):
Appreciate it.
I hope I hitting the nail on thehead.
I didn't make too many holes inyour wall that you have to fill
up with pipe until you're waytoo
Matt Boettger (39:29):
late for that man Swiss cheese in this house.
So, great.
That's perfect.
We'll end there.
I appreciate Stephen.
We'll be back again in twoweeks.
Again, if you could not leave areview, please do so inspires
us.
He wants support uspatrion.com/pandemic podcast for
monthly subscriptions, as wellas one-time gifts through PayPal
then Mo all in the show notes.
If you wanna get ahold of us, ifyou have questions for us, Matt
(39:51):
at living.
Tom, I will forward them on toStephen and mark.
I know mark has been hereforever.
He's been busy, busy, busy, butwe hope to get them on sometime,
at least one time soon.
And if you wanna get ahold ofStephen, you can do follow him
on Twitter, which is.
S T E P H E N K I S S L E R.
And I think that's it for thisepisode.
(40:11):
Thank you all for listening.
And we'll see you guys, I thinkafter Christmas now.
So if those of you who celebrateChristmas, Merry Christmas,
happy holidays, happy Hanukkah.
All the holidays.
Have a wonderful season.
Take care.
We'll see you guys in two weeks.
You're listening to the pandemic podcast.
We equip you to live the mostreal life hospital and the face
of these crises.
My name is Matt Boettger and I'mjoined not with four, three
other people.
If those of you who are going towatch this, actually, there was
two other places for two of thepeople that we're not going to
have on today, but I'm with myone good friend, Dr.
Stephen Kissler, anepidemiologist, the Harvard
school of public health.
Good morning to you.
(00:20):
It's good to see again,
Stephen Kissler (00:20):
buddy.
Good morning.
Matt Boettger (00:23):
Oh man.
Well, you know, if you hear abunch of buzzy and sound my
background, I apologize today.
This is not normally the case.
It is now December things areactually starting to cool down.
And my wife just told me she'sfreezing upstairs.
So there's none negotiating onthe heater being on right now
and I'm in the basement.
So I'll do my best to filter itout.
But I got to put my prioritiesfirst and put you guys second.
(00:43):
So that's the way it is.
It's been two weeks.
Last time we talked, you know,Omicron was like relatively new.
We were talking about, Hey, howwas Thanksgiving?
And it was great.
And well, you know, you're,while you're having your meal,
you saw all these news, likepercolated about Omicron.
And it came on fast and quickand it was unknown and we were
like, nervous about it.
And what could it be?
It sounds like within two weekswe got a fair about of news.
(01:07):
Now, granted things could changepivot at any point in time, but
we got a good amount of news totalk about an update about the
Omicron, which seems.
Generally, it's pretty goodnews, but we'll talk about that
in a moment before we get going,the normal stuff.
If you're listening, it's yourfirst time listening.
Welcome to the show.
If you're not, and you'velistened to us for a while and
you haven't left a review,please do so.
(01:27):
It'd be great.
It really helps us leaves us,inspires us to keep this going.
We just got another one inNovember 29th is the day our
last one aired from DCB, J C NJ.
All right.
That's that's that?
That's his, her name I've beenlistening to throughout the
pandemic and I've been remiss.
I have been remiss is notleaving a review, right?
So it has been fascinated tohear an epidemiologist SKUs.
(01:50):
What he's learned about a novelvirus in real time.
It has also been reassuring toreceive useful actual advice on
living, living life and managingrisk during the most significant
global crisis of my lifetime,the information is delivered
clearly and without the hysteriasensationalism we get in the
headlines.
The format, a conversationbetween a lay person.
That's me an expert is gazeKatie to never drive as we head
(02:14):
into Omicron winter, which Ilike that.
Oh, Cod winter.
It seems like we just, it was,seems like it was just Delta
summer.
I looked at tinny to rely on thepodcasts that stayed in.
And take reasonable steps tokeep myself and my partner safe
and healthy.
Thank you so much for that
Stephen Kissler (02:27):
review.
Yeah, that's great.
Really appreciate that.
It's I'm glad that somebodyenjoys learning about this on
the fly with me, becausesometimes I feel like I'm
stumbling around in the dark.
So
Matt Boettger (02:37):
I feel, I feel like we need to get email
addresses to be like, you knowhow when you go into like, okay,
I didn't even get this Stephen,but you go to a graduation
ceremony and somebody gives atalk.
There's a Tim honorary doctorateyou're given, right.
All these honorary doctorates,like for listening to you, we
should give like a littlecertificate of honorary
doctorates to everybody wholistens because just listening
(02:57):
to you and getting our owneducated.
Understanding of what's goingon.
So thank you, buddy.
So, oh yeah, you can support usfinancially.
patrion.com/pandemic podcast.
Little as$5 a month goes a longway.
It helps a lot.
And as well as one time gifts,PayPal, Venmo, all in the show
notes.
I think that's all the goodnews.
(03:17):
Get into a few things.
First thing before we get intoCOVID, every once in a while
other things fall in the newsnow eventually cover, it's going
to go from a pandemic to anendemic and the news is not
going to be so sensationalizedand we'll move.
Hopefully this podcast continuedgoing maybe every other week and
do other topics, that kind ofstuff.
So it's good to kind of getfamiliar with other things as
well.
Stephen, you're an expert in theflu, right?
(03:39):
Because this is kind of likeyour, your whole PhD and every
once in while we, we see thisstuff, resurfacing, its ugly
head.
This one is interesting.
I saw this article, Satan didCOVID 19 cause flu strain to go
extinct.
So I read a little bit moreabout this.
This is a guest, the influenza BYamagata lineage.
I don't know anything aboutthis.
I just get my flu vaccine.
(03:59):
Call it.
Good.
What is this?
I know how much do you knowabout this?
What does this mean?
And my biggest question is,okay.
I didn't even know how manylineages, so there's four
apparently.
Right?
So maybe, maybe we're down tothree.
Does this make vaccines easierand more effective down the
road?
If we knock out one
Stephen Kissler (04:17):
lineage?
Yeah.
So, I think that the, thepotential extinction of this
particular influence of B strainis it's interesting on a couple
of different levels.
So to take a step back There area lot of different varieties of
the flu that circulate that wecan the ones that currently
circulate or at least havecirculated up until recent
(04:38):
memory can sort of be split intofour large classes.
And they are two types ofinfluenza, a, which are somewhat
closely related to each other.
And two types of influenza B,which are a bit more distantly
related.
From a, they sort of clusteredtogether.
And the designations of thesethings largely have to do with
how the virus looks on itssurface and therefore how our
immune system responds to it.
(04:59):
Someone that a there's the AAslash H one N one.
So you'll remember the 2009swine flu pandemic was an H one
N one variety.
So this is pretty much adescendant of that.
And then there's also an a Hthree and two strain, which
would circulating prior to thepandemic in that.
And that the 2009 pandemicdidn't manage to displace which
was interesting because in mostprevious pandemics, the, the
(05:21):
previously circulating strainhas been displaced, but now we
have this sort of coast,circulation of two eight
strains, and also to be strains.
So the bee Victoria and the beeYamagata strains that that are
sort of.
To the a H one N one and the Hthree N two.
So I think that the one that youhad mentioned was this B
Yamagata.
(05:43):
Flu strain.
So when we get vaccinatedagainst the flu, we often get
vaccinated against multiplestrains of flu at once.
So up until recently, it wasusually a tri Vaillant flu
vaccine, which was usuallyagainst two types, both of the,
a types and one of the B types.
More recently there have been aquadrivalent flu vaccines that
have been protective against allfour varieties.
But now there's this questionof, you know, are we going to
(06:05):
see this this flu B straincontinue to circulate.
With the non-pharmaceuticalinterventions and with whatever
else led to the reduction in flucases, it seems like we haven't
really seen much of a resurgenceof this particular flu B strain.
While we have seen circulationof the others around the world.
So we think that this flustring, if it were around would
(06:25):
have the opportunity to spread,but we haven't seen it yet.
So there's a possibility that itmay have gone extinct, which is
interesting.
So I do think that it would helpwith vaccine formulation.
It would mean.
You know, be able to go back toa tri Vaillant flu vaccine,
which would make it a little biteasier to produce it would make
it so that you know, there arefewer chances for an a mismatch
(06:46):
between the vaccine and thething that's currently
circulating to cause moredisease.
I do think that the games wouldbe.
Marginal.
In my understanding the most ofthe flu that we see is due to
the flu a stream.
So H one N one N H three and twoare the things that really tends
to cause a lot of the disease.
The B strains do cause quite abit of disease as well, but
(07:06):
really the, the A1C seemed to bethe ones that are sort of the
most robust spreaders.
And so while it would behelpful, I do still think that
the other strains may well justsort of fill in that.
That's provided by the absenceof this other strain, but
definitely for the sake ofproducing vaccines more quickly
and more effectively, I do thinkthat it's a, it would be.
Matt Boettger (07:25):
Great.
I kind of assumed that I'm inAustralia, went missing all of a
sudden, I'm guessing it'sprobably not the strongest one
available right now.
So it's not going to be thatmuch of a difference, but Hey,
it's like a little supplementgives us a little bit of boost.
Okay.
Helpful information.
Let's get into the COVID stuff.
Now, before we get into Omicron,which is kind of a big topic,
there's a few other things Icame across in the past few.
(07:46):
So we we've talked about Dr.
Ostroff and how respected he is.
And he's been back in the newsagain because of his prediction,
like 18 months ago or whateverit was he predicted within 18
months or so about 800,000deaths in the U S and crazily.
He's almost like spot on.
He might, we're not even atquite the 18 month mark, maybe
we were a few weeks away andwe're probably about 7,000 short
(08:07):
from that prediction.
So he's back in the surface, inthe limelight of the news.
And one of the things that hementioned, and now I just wanted
to throw it to you to accepteven what this means.
And it was a short blurb on avideo.
And he talked about thedistinctive, the distinction
between two types of surges.
Recently, we know, we know theIndia surge and we're all avail,
or we are really, we don't last,last summer, we talked about
(08:28):
this and how it was asignificant spike went really,
really high, but then itplummeted quite quickly.
Once it reached its spot.
And then there's the otherversion, which is kind of UK, I
guess, which is experiencing,which is again, a spike, maybe a
slight.
And then maybe then resurrectits ugly head and then
continuing like this, a spikefor a long period of time.
(08:50):
Now he had juxtapose this withthe U S saying this summer, the
Southern us seemed to representthe India version.
And now we're seeing which I wasunaware.
The Northern part of the U S isexperiencing kind of UK version.
This is that kind of spike andthen sustainable.
Now maybe you can help parsethis.
What does this mean?
(09:11):
Is, is, is there a way tounderstand this and predict
this?
You know, my, my, my thing is,oh, it's just, again, I'm a lay
person.
So I'm like, oh, it's justsimply a matter of time where,
you know, in the Southern it wasall Delta.
Right.
But in the now when theNorthern's heading well, it's
Delta now Omicron.
And so maybe that's the reasonwhy it's simple as that, or
maybe it's more complicated.
So what does this mean for usand for people who are listening
(09:33):
about these types of.
Stephen Kissler (09:35):
Yeah.
So, I love this question becauseit gets at a lot of sort of
fundamentals of infectiousdisease transmission.
It also uncovers a lot of whatwe don't really know.
So, so this is this is actuallyan area that we in, in, in my
research group are beginning tolook at in some detail to try to
understand sort of what leads tothese pretty different
experiences with the virusacross different places.
(09:57):
And.
How long will it take places tosort of synchronize in their
experience or will they ever,because if we go back to the
example of flu most of the U Sfor example, and really
basically temperate regionsacross the globe are pretty well
synchronized where we have ourflu outbreaks during the
wintertime.
And there's a little bit ofvariation in timing, but nothing
(10:20):
like what we've been seeing withthe experience of, you know,
these major surges followed byhuge declines relative to sort
of this sustained degree oftransmission.
I think there could be a coupleof things going on, you know,
the, the first and most obviouselement that we don't really
have a clear sense of how tomeasure it, how to account for
just.
Differences in human behavior.
(10:41):
And so we know for sure that youknow, in, in the Southeastern
United States the indoor seasontends to be the summer, whereas
in the Northeastern us, it tendsto be the winter.
And so, when people spend timeindoors versus outdoors and what
the relative fraction of timethey spend indoors versus
outdoors could play some role inthis.
And that could help to explainsome of the differences between
(11:03):
The differences in theexperience of the virus in
places with different sorts ofclimates.
Some of it may have to do withunderlying immunity and the
degree to which things likenon-pharmaceutical interventions
have been put in place.
So, I've been trying to think ofa good analogy for this, but you
know, you, you can imagine thatYou know, I'm, I'm trying to
(11:24):
think of something like, almostlike when you're bouncing a
basketball, right?
Like if you if you throw it atthe ground, it'll keep bouncing.
For awhile.
Whereas if you sort of graduallydrop it to the ground, it's
going to take a much longer timeto hit the ground, but it'll
just sort of like gradually getthere.
And one of the things that youcan see with infectious disease
dynamics potentially that couldbe going on here is that in
places that suffer a reallymajor surge they basically
(11:47):
synchronize the immunity ofeverybody in that population.
And so then as immunity wanes,That basically everybody sort of
has the same degree of immunityand you could reach this point
where all of a sudden there canbe this new explosive outbreak,
whereas in a place that has abuildup of immunity, that's much
more gradual.
You may end up with sort of thisasynchrony between people and
their immunity.
And so because of that, there'ssort of these people who can get
(12:09):
reinfected at different pointsin time, but it's just sort of
this much more gradual kind oftransition to an endemic virus.
So that could be part of it too.
And one of the things we'retrying to ask with our, with our
research is, is to what extentcould each of these things we
contributing to these differentsorts of trajectories that we
see in different.
Hmm.
Matt Boettger (12:28):
Okay.
That's helpful.
Yeah.
Yeah.
Cause I was unaware of that.
I know Colorado, we're stillkind of slowly coming out of our
surge has been kind of a littlebit ongoing and not quite as
fast as a plummet, moresustainable for us.
It's it's I think it's harderbecause it, you know, again,
it's the environmental,environmental parts of, of our
state where generally we've beenhaving a pretty warm fall.
(12:50):
So we've been outside more isstarting to cool off.
So I could see us having agreater sustained.
Levels now.
Totally random.
I have Fred thrust in the shownotes, but Polis our governor.
Totally.
I didn't even, I didn't eventell you this.
This is a bolt.
I don't know if you saw it in anews.
He made a bold statement.
Maybe not bold, but he was justlike, it was good.
I think where he, you know,we're seeing a surge of the, of,
(13:12):
of, of the virus here and, andhe just kind of said, look, I'm
not gonna do any more state ofemergencies I'm done with these.
Like, he's like, Everybody's hada time to get the vaccine by
now.
It's been long overdue.
Now.
Boozers like, you know,basically if you don't want the
vaccine, then you're playingthat game.
Now.
It's like, there's been wideavailability, right.
And we've had them all over theplace.
We've you can get them atSafeway.
(13:32):
You can get grocery stores, youcan get them at, at clinics.
You can go to outdoor events.
We've did our best to make themwidely available the whole
state.
Now it's to the point where.
I'm wiping my hands clean.
I'm no more state of emergenciesnow, local levels.
They can do whatever they want,feel free, you know, port about
counties.
They can do whatever they want,but as a state level, that part
is done and it got a lot ofpress and over the past couple
(13:53):
of days, and you know, myintuition is felt like that's
probably a good, a good decisionat this point in time, you know,
it's, it's now just like, if youchose not to get the vaccine,
now he told him knowledges, ofcourse you can get breakthroughs
with the vaccine, but it is muchmore rare.
He said, this isn't about.
And our hostels right now, Ithink only 16% between 13 and
16% of those hospitalized arevaccinated.
(14:16):
Right.
So we're talking about theoverwhelming population run
backs.
So, so we're seeing thesustainability right now and now
things are starting to cool off.
You can hear my heater in thebackground, right.
That people are going to moreindoors, so I could see it then
continuing a little bit longerin those kinds of things.
So, yeah, that's helpful.
Okay.
It's let's continue on.
One thing I wanted, we talkedabout, and this might be a short
conversation.
I saw this Atlantic and notquite sure why they posted this
(14:39):
article because to me it'shelped.
She seemed really relativelyeasy answer said, why are we
still isolated vaccinated peoplefor 10 days?
I just had a friend who, who isvaccinated got COVID and, you
know, asked to be quarantinedfor 10 days.
I haven't really thought muchabout this.
I'm like, okay.
Yeah.
You know, because even thoughI've heard things.
Oh, and you're vaccinated.
(15:00):
You can shed the virus quicker.
You're contagious less.
So that makes sense of being,being quarantined for less.
But we also hear that there arepeople who remain contagious
for, so I'm just assuming wejust say 10 days because Hey,
some people are stillcontagious, but is there, is
this more nuanced than I'mactually thinking?
Is this something that the otherdiscussion like, Hey, we should,
(15:20):
we should knock this down forpeople who are battling.
Stephen Kissler (15:23):
Yeah, I think, you know, I think you're right,
but like, from, from what I'veseen, you know, we've, we've
done some work that suggeststhat that people who are
vaccinated may clear the viruson, on average more quickly, but
you're right.
Like there there will be somenumber of people who still
retain the virus and are stillinfectious for a number of days.
And sort of that tenant.
Sort of captures the range whenwe expect people to be
(15:46):
potentially infectious toothers.
I didn't get to read thearticle, but I I w I would
actually maybe even go a stepfurther and say, you know, why
are we isolating anyone for 10days at baseline in, because
what I think we should be doingis.
Using tests to spring peoplefrom isolation.
So I do think some people willneed to be isolated for 10 days
(16:07):
or even more if they continue totest positive on a rapid antigen
test which indicates that theymay be infectious.
But I do think that we couldprobably spring a lot of people
vaccinated or not from theirisolation period.
If they have a sequence ofnegative, rapid antigen tests,
suggesting that they're pasttheir infectious period.
And so I think that there areways where we can be.
(16:29):
Smarter about this, using thetools that we have available to
reduce the amount of time thatpeople are in isolation and
isolating is pretty disruptive.
You know, it's like, I thinkwhen we, you know, when we think
about it, like, you know, okay,like 10 days you get COVID or
whatever, you know, like, butBut, you know, for family, with
kids, I for anybody, like whenyou actually think about like
(16:50):
being stuck in your house for 10days, like it's not fun,
especially if you're likefeeling okay.
And and so it is important forreducing spread, but I do think
that there are a lot of thingswe could do given the technology
we have available to reduce theisolation period to only the
span of time that it needs.
Great.
Matt Boettger (17:06):
Well, that's a perfect segue because we're
going to continue thisdiscussion right now with that
in light of the holiday travel,you said you just did a Q and a
live Q and a about holidaytraveling.
The reason why I think it's theperfect segue is I'm guessing
these tests might be part of theequation for good holiday
travel, because so maybe firsttalk about like what you talked
about and how to prepare forholiday travel.
(17:27):
Do it safely, be able to seeyour friends and family.
And I want you to dovetail thiswith what we just talked about.
That if for instance, you do getCOVID right.
How could you use antigen teststo then best conclude that
you're okay to go out.
Cause we know they're notperfectly effective.
So do you couple them with otherthings, do you do two every
other day?
And then we get to natives.
(17:47):
How do you, how does thatformula fit into like check off
the box?
Hey, I just got COVID it's 10days before Christmas.
I'm able I'm I'm okay to see my
Stephen Kissler (17:55):
grandparents.
Yeah.
Yeah, so.
The taking the first bit aboutsort of, how can we think about
holiday travel and gatheringsthis year?
In my advice, even in thecontext of Omicron is pretty
similar to what I've said forholiday gatherings before, which
is sort of in this order, youknow, get vaccinated and get
(18:16):
boosted if you're able Then Ithink a lot about ventilation,
make sure that windows arecracked.
Fans are on, maybe even have aair filter with a HEPA filter in
it.
If if that's within your meansand leaf blower, maybe a leaf
blower turn on that leaf blower.
Yeah, that's right.
Why not?
And yeah, and then take rapidtest before.
So one of the things that Ididn't realize until this week,
(18:38):
but it might be useful for anumber of our listeners who are
out in Colorado that apparently.
The state makes rapid testsavailable for free that you can
get repeatedly.
So I thought originally this wasjust a one-time thing, but I do
think that you can get basicallyfour boxes of the avid by next.
Now is I think every week orevery other week, you have to go
on online and sort of fill out aform.
(19:00):
So it's a little bit of a pain.
But it takes about 10 minutes toget you know, like four boxes of
rapid tests every week.
And I think that that's, youknow, that that's what we should
be doing everywhere.
Matt Boettger (19:10):
I did that.
It's great.
Like, I, I, I, it's a littlecomplicated cause I signed up me
and I thought I was doing myfamily, but I guess each in a
person, each individual personhas to sign up.
So if you have kids, you signthem up.
So I just signed myself up, gottwo boxes right away, and then
I'll send the rest kids.
I'll put another six boxes andkeep them coming.
So it's pretty great.
Great, awesome thing to have on
Stephen Kissler (19:30):
hand.
Yeah, it's wonderful.
Yeah.
Yeah, no, I think, that's,that's great.
And so, you know, now is thetime if you haven't gotten them
yet, you know, get some of theserapid tests and take them before
your gatherings take them beforeyou.
And you know, I, at this pointto travel, I think, I think you
need a negative test within 24hours.
And so the rapid tests arereally helpful for that kind of
thing.
(19:51):
And I think that all of thosethings even in the context of
Omicron can go a long waytowards keeping us all safe.
I think that, you know, Omicronis definitely coming.
We're starting to see increasesin the proportion of cases that
are Omicron, especially here inthe Northeast.
It will spread across thecountry.
My hope is that here in the U Swe w that the, the major OMA
Crohn's surges we'll wait untiljust after the holidays to
(20:14):
really get rolling.
But right now we still have alot of Delta around to, you
know, it's like, oh, Macron isnot the only thing to be
concerned about at the moment.
We've got a lot of Deltaspreading at the moment to But
whether it's still to OromaCron, all of these things do
seem to be helpful towardspreventing spread.
So, so that's, that's what Iwould suggest now, if you do get
COVID I think that you know,certainly, you know, continuing
to test to see when you testnegative repeatedly, I wouldn't
(20:37):
to spring yourself fromquarantine.
I wouldn't trust a singlenegative test.
I would probably trust twonegative rapid tests three even
better.
And so, you know, that's, that'salready a lot of tests, but, but
mainly what I would say is just,just talk to your doctor because
at this point, you know, they'llbe able to, to guide you through
your own particular situationand that there's so much nuance.
(20:58):
And that has to do not onlywith, you know, your own medical
condition, but the people youmight end up seeing and the
amount of spread that'shappening in your community at
baseline.
So I don't think that there'sany sort of hard and fast rule
that I can give to everyone thatwill apply on all of their
situations.
But I do think.
Between all of the conversationsthat we've had on this podcast
(21:18):
about rapid tests and sort of,The role that they play, that
they don't give you certaintyeither way, but that they do
increase the odds of, you know,your actual scenario lining up
with what the test is tellingyou.
And and so hopefully between allof those discussions, you know,
people will be able to interpretthe results of their tests in a
way that is is useful forwhatever, whatever context
(21:40):
they're in this holidays.
Matt Boettger (21:42):
Great.
And you helped me because wewere wondering if we had, you
know, just being safe before wesee my mother-in-law couple
weeks ago.
And he suggested which washelpful because obviously those
engine tests aren't a hundredpercent and never will be nor
the PCR ones, but take not onlytwo different tests, if you
can't from two differentmanufacturers, just a.
To help that that'll help aswell to continue to increase
(22:03):
your odds of having the rightconclusion.
So that was helpful.
You really want go out your wayby two different versions and
then you can, it just, justhelps even more to feel a little
bit, a little bit better aboutthe conclusion.
So I know Alma Crohn's on our,on our minds.
One more thing, because this isrelated to the engine.
We didn't talk about this twoweeks ago.
The antiviral pill is coming outfor COVID is a super exciting,
(22:27):
because gosh, it's just areminder.
Like something about like 80some percent prevention of, of
hospitalizations.
It's, it's, you know, it's onthe verge of like, like the
vaccine, right.
But except for you already, youget COVID first.
And it, and it makes you betterquicker.
This is exciting.
Maybe come out in January.
I'm not sure who it will beavailable for how readily
available it'll be.
(22:48):
But this hinges again on thesame thing, because kind of like
that Tamiflu for the flu, Ithink same thing had to take it
pretty closely right after youhave symptoms.
Otherwise it's not nearly aseffective.
Same for this.
I like this pill.
I think it's, it's a marker.
I'm not sure what it is, whichone it is that it's, that it's
coming out.
But
Stephen Kissler (23:04):
there's there are two we can get into that in
a moment.
Okay.
Yeah,
Matt Boettger (23:08):
but then, yeah, but I think it's within six days
or five or six days of symptoms,you have to take it otherwise
not nearly effective.
So you've got to have thesethings on hand ladies quick, or
be able to get a PCR test reallyquickly.
If you want to take this, thesepills and really lessen the
symptoms.
So Carrie, you can fill in theblanks.
Yeah.
Stephen Kissler (23:25):
Great.
Yeah.
Yeah, so.
To my knowledge there are theresort of two of these antiviral
pills that are coming out.
So there's one that's producedby Merck.
And one that's produced byPfizer.
So the interim results fromMerck were looking pretty
promising, but actually they'retheir conclusions from the final
trial where.
Okay, but not as good, maybethat it was like 30% effective
against hospitalizations, butthe Pfizer one is looking much
(23:47):
better.
I think that may be the one thatyou're referring to here where
it is like on the order of 80 to90% effective against preventing
hospitalizations, which isincredible.
I think it's, it's really worthtaking a step back that like
with both.
Like pharmaceutical drugs andvaccines, like something that
can reduce your risk ofhospitalization or death by that
much is like, that's prettyamazing.
(24:11):
And so, I think it's, it'swonderful that we, that we have
these things.
The available and we'll havethem coming online very soon,
but, but you're right.
The, the, the difficulty as withTamiflu is that you need to know
if you've been infected prettyearly on because you need to
start taking the drug within acouple of days after really
after infection.
(24:32):
And yeah, basically the sooneryou get on them, the better
chance they have to work.
So, so that really just, again,just underscores the need for
testing and for it makes it allthe more important to do the
sorts of things that we've beenhoping for, that, you know,
people might test themselveswith a rapid antigen test
frequently so that they canknow.
And and so I do think that, youknow, again if you do start
(24:54):
showing symptoms, get tested asquickly as you can.
And and that will really help tonot only guide your own
behavior, but now to guide whatsort of treatment you might get.
Matt Boettger (25:03):
Yeah.
Yeah.
I This is where it gets alsojust crazy complicated because
like COVID symptoms, colds, RSV,flu is like, they all have the
same kind of symptoms.
So.
You know, you could have thesniffles for a day, it could be
allergies.
And like, you know, at 1250 apop for an antigen test, unless
he got a big budget, it's hardto like, okay.
(25:23):
Oh, you know, I fill in a littleSteph folders, probably just get
checked, you know, do Andrewtests.
I just, I'm just hoping he seemsto come down like another 80%
where, you know, you can takethese and then quickly be able
to.
You know, start tickets likethis, just to be on it's an
insurance policy.
And by the way, I got boosted onfront Thursday.
So I've got my booster, Madonnaand pre-fill and pretty excited
about it.
Didn't really affect me much.
I know it laid you out Stephen,but it didn't do too much for
(25:45):
me.
I felt a little fatigue, but I'mnot fully, still hasn't fully
wrapped up my system, but I'mfeeling good about the next
step.
That's great.
Okay.
So finally, let's get intoOmicron.
So just spew the beans, Stephen,like where are we at with
Omicron?
Is it as bad as we thought it'swas going to be.
Is it less, what do we know?
Sounds like we know a lot moreinformation than we did two
weeks.
Stephen Kissler (26:06):
Yeah, definitely.
We, we've learned a lot in theselast two weeks which is great.
There is still a lot left tolearn but we're in a much better
spot in terms of what we knowabout the virus and about this
particular variant now than wewere when we first started
talking about it.
So, as I mentioned the lasttime, I think I mentioned the
last time there was sort of thisorder of events where we were
going to first learn aboutantibody neutralism.
(26:29):
And then the next thing we willlearn about is transmissibility.
And the last thing we wouldlearn about is severity.
So, a lot of the big news latelyhas come from the immune
response, the, the neutralizingability of our antibodies
against the virus.
And as expected, the virus doesa really good job of getting
around our immune response.
The mutations that it has reallyjust helps, it helps to disguise
(26:50):
it from our antibodies Butthere've been a couple of, of
reasonably promising studiesthat suggest that getting a
booster dose, whether you'vebeen previously infected or had
a previous set of doses have anyof the vaccines that the booster
does can go a really long waytowards preventing you basically
for giving you protectionagainst the Macron variant.
Even though the booster dose isstill the same old vaccine that
(27:13):
we'd had for months, which isgreat news.
Now there's some variation fromstudy to study and just how much
that.
Gives you.
So, there was a study fromPfizer that suggested that the
booster dose basically restoresyour neutralizing antibody
levels, meaning that, you know,the ability of your immune
system to recognize andessentially eradicate the virus
back up to levels of two dosesagainst the.
(27:35):
Founding SARS cov two strings.
Now there are a number of otherstudies that are not quite as
rosy as that that suggests thatthe Omicron will still take a
hit in booster, neutralizingactivity.
But that definitely getting abooster is much better than not
having a booster.
So, so that story seems to befairly consistent.
The other important thing tonote is that most of the
(27:56):
information that we have so faron the immune response against
Omicron has to do with theseneutralizing antibodies.
So it's this one particular armof our immune response that
recognizes the virus andprevents it from binding to
cells.
But of course that's, there area lot of other elements of our
immune response that are harderto make.
And that we think actuallyprobably play an even larger
(28:16):
role in preventing againstsymptomatic disease,
hospitalization, and death.
And usually those arms of theimmune system are more broadly
protective.
They're able to identify a widerrange of variants than these
specific neutralizing.
That's sort of attached to thesevery precise pieces of the viral
surface.
And so I think that there's alot of reason to hope that our
(28:37):
protection against symptomaticdisease and especially
hospitalization and death givenprevious immunity, either
through infection and orvaccination will still hold
relatively strongly against theOmicron variant.
But that again is something thatwe're, we're still on the early
stages of gathering information.
So, another thing sotransmissibility, so we know
that OMA chronic can spread likewildfire.
(28:58):
We know that it's taking offthat took off not only in South
Africa, but that it's beentaking off in the UK and we've
started to see surgeons here inthe Northeastern us.
So it's definitely it's comingand it is spreading and it is
spreading well.
There's still some uncertaintyas to what exactly is behind its
increased transmissibility.
So.
Basically the two possibilitiesis first that by getting around
our immune system, it's able toinfect people into spread more
(29:20):
easily, even in people with somelevel of protection.
Or second to that is just moreinherently contagious that it's
able to bind to ourselves alittle bit more easily there.
You know, part of the questionis like, to what extent does it
matter?
It does matter some becauseWhichever one of those things
that is, will change the waythat the virus behaves in
different populations withdifferent degrees of immunity,
with different types of immunitywho have had different
(29:42):
experiences with differentvariants.
So I do think it's an importantquestion, but but it's pretty
clear at this point that Omicronwill be able to spread very
rapid.
Just about anywhere it goes.
And so sort of in thetransmissibility box there,
there's a big old check thatit's it is definitely more
transmissible.
And and so that's going to besomething we're going to have to
deal with in the coming months,for sure.
And so the big question now is,is severity.
(30:04):
And I think that At this point,we would probably know if
Omicron was catastrophic moresevere than previous variants,
but I don't think we're at apoint where we can conclusively
say whether it is equally orless severe than things that
have come before it.
So again, there had been someearly reports suggesting that
some clinical cases of Omicronwere not as severe.
(30:26):
But that can be confounded byall sorts of different things,
whether it's, you know, that ittook off in younger age groups
first, or it happened to takeoff in a previously vaccinated,
an Indianized population.
And so that the underlyingimmunity was protecting those
people from being as severe asthe disease might have been in
previous waves.
And then one of the other thingsthat sort of been spread around
(30:47):
is.
Basically just comparing casesversus hospitalizations in this
surge relative to cases versushospitalizations in previous
searches and saying like, oh,well, you know, it's, there,
there is a lower fraction ofhospitalizations to cases at
this point in the surge thanthere were in previous surges.
But the issue there is thatOmicron is so much more
transmissible that we're seeinga much sharper rise in cases.
(31:10):
And so it might not be.
There are fewer hospitalizationsper case.
It's just that there are so manymore cases.
So early on that the peoplehaven't had a chance to get sick
yet.
And so, so I think we're stillat the very early stages of
understanding the severity of aMacron.
And I'm, I'm, I'm not asoptimistic as some have been
about the potential for Omicronto be less severe.
(31:30):
But I am grateful that itdoesn't seem.
You know, much, much more severethan things that we've seen
previously.
So, so that's something we'regoing to have to continue to
watch pretty closely.
And the last thing to note withthis is that as, as one of my
colleagues, bill Hanna recentlysaid even the common cold would
be catastrophic if everybody gotit at exactly the same time.
Because you know, the commoncold does cause
(31:51):
hospitalizations.
It causes pneumonia in older agegroups.
If everybody got it within thesame two weeks, like that would
cause a huge burden on ourhealth system.
And it would be a public healthevent of, you know,
unprecedented scale.
And so even if we end up with anolder crown variant, that is no
more severe than the commoncold, if it's able to infect the
world within an order of acouple of weeks, it's still
going to be something we'regoing to have to contend with on
(32:13):
a large scale.
So, So I think that really justunderscores the need for
boosters for thinking aboutmasking when in indoor spaces
and, you know, thinking aboutall of these plans, we talked
about with our holidaygatherings we got to have all
our tools on the table to helpus against this coming surge.
Matt Boettger (32:30):
And so helpful.
Okay.
The two things, number one, thisis what you were saying two
weeks ago, how quick news isprobably bad news, right?
So like, you know, if it wascatastrophic, I would probably
hear really quickly on they go,man, this is crazy, crazy.
So this good news, it may not bequite as catastrophic.
The other thing I kinda remindme of like, it's like me with
like, hands-on stuff.
Like I'm a tech guy.
I, I lo I literally load theworking on my house, like on any
(32:54):
level, even if it's hanging apicture frame on the.
I will delay it as long as Ican.
Cause I do not wanna get thehammer and nail.
Cause I figured take me eighthours to figure out how to level
this thing.
Right.
So it's kinda like when I get myhands and try to work on
something, right?
The more I work on in the housethat actually the more
complicated it becomes and themore problematic in the more fix
(33:14):
it, it has to become.
So it used to be a smallproblem.
Usually when I address it, nowit's a much bigger problem
because now it's the originalproblem.
Now my problem on top of itadded on there's more holes in
the wall.
Now we have to putty because Imissed a bunch of places.
And now I say this tongue incheek, Stephen, because this is
clearly not what I'm saying.
It's like, oh, I miss the goodold days.
The end of the pandemic whenlife was simple, right.
Were, oh, it was just apandemic, but now it's like,
(33:36):
it's so much better, but it'smore complicated because now we
have vaccines and boosters.
And how does that mix and matchand how, and so it's just, I
don't know how you guys dealwith this stuff as an
epidemiologist, as, as thingsunfolded, like, okay, now we
have 18,000 more variables we'vegot to look at and figure out
how that works.
Again, I'm grateful me.
I'm grateful your life.
It makes way more complicated.
Stephen Kissler (33:55):
Yes, it does.
But and that's, that's, that'swhy we do what we do.
Matt Boettger (33:59):
So the, the last thing then I think the last
thing I'll say is it's still onthis.
So this idea of, okay, we talkedabout this off the year.
And this is where I'm reading alot of the news of what you're
just saying how, oh, Hey, thegood news about the boosters.
It seems though that it'sskyrockets the antibodies so
intensely that it sh it seemslike it's covering the Omicron
variant.
So when I keep reading this, Iget confused because what you've
(34:21):
taught me and like I said, causeit sounds like, oh, well it's
all about antibodies.
Response in general, I justvomit antibodies and you're good
to go.
If that's the case, then anyvaccine would take care of
anything.
If you could just go and getantibodies rubbed up, but it's
not the case.
Right?
So this is where it seems reallycomplicated from that it's the
same old vaccine it's Reverendabout because of this, because
the antibody response, it seemslike it's going to cover the
(34:43):
Omicron, which is highlymutated.
Do you see where I'm like, I seethis, I see a disconnect in, can
you help us fill in the gaps ofthat?
Can't be the full.
Stephen Kissler (34:53):
Yeah, totally.
So, our immune system, thedifferent arms of our immune
system very in large part basedon how specific their vision is
for a a given virus.
So there there's some parts ofour immune.
The, the antibodies that wenormally think of that have
these very precise molecularconfigurations that allow them
(35:15):
to detect very precisestructures on the surface of a
virus.
And so those antibodies arereally good at seeing exactly
when you've been infected with.
Really closely related tosomething you've been infected
with previously or have beenvaccinated against.
But they can get easily duped bythese small changes on the
surface of the virus and sort ofrender them unable to bind to
(35:36):
the virus and unable to preventthe virus from infecting
ourselves.
But then there are differentparts of our immune system that
sort of like.
Get the gist of the virus, butthey don't, you know, they're,
they're not necessarily sospecific.
And because of that, it can takethem a longer time to respond.
It takes them a little whilelonger.
They sort of have to sit backand consider the virus for a
while and say like, is this, isthis something we should be
(35:56):
concerned about or not?
And then, and then ultimately,you know, if it's the virus
starts to increase in as moreother parts of the immune
response, start to get revvedup, they're like, okay.
Yeah, this is, this is somethingthat we really need to be
worried about to attack and torespond to.
And so they're the.
You can sort of think of them asa little bit slower.
But also able to be a little bitmore flexible in their response
(36:17):
able to identify sort of widerranges of virus.
And then there are other partsof our immune response that are
just totally they basically justprotect you against everything.
They're like, I don't know whatit is, but we're just going to
like go out there and just like,try to eat up whatever we see
that doesn't look like me.
And and so, so all of thesedifferent things are in play
now.
Vaccines are.
(36:37):
Really good at eliciting veryspecific types of antibody
responses and especially asingle dose of a vaccine is
really good at getting thesesort of like highly specific
antibodies revved up and sort ofstored away in your memory.
One of the ways that I like tothink about vaccination, I I
think that, you know, we talkabout immune memory as sort of a
metaphor for how the immunesystem works.
(36:58):
But I think.
You know, I've, I've found thatmetaphor to be incredibly rich
because I think that it thinkingabout the immune system as
something that has a memoryreally does go a long way
towards helping us understandwhat the immune system is doing.
So one of the ways that I liketo think of a vaccine is like,
so you have this like reallycomplicated image, this picture
(37:19):
that you're being shown, it'sjust basically a picture of the
virus, but you could imagineanything and what the vaccine
does.
It flashes that picture beforethe immune system's eyes very
briefly.
And so it gives us this likequick moment to say like, okay,
this is what the virus lookslike.
And with two doses of thevaccine, we essentially got two
very rapid flashes of that.
But if you were shown like areally quick image you know, you
(37:39):
would see a couple of sort ofgeneral characteristics of the.
You might really notice onespecific detail and if it were
flashed before your eyes reallyquickly, you'd probably pinpoint
on that exact same spot twice,because whatever you noticed
first, your eyes would betrained to what it had seen.
Now, if instead, you had beenflashed that image twice, and
then six months later, I came upto you and flashed to that same
(38:00):
image.
Again, you'd probably focus on adifferent part because your mind
has had time to sort of process.
And it wouldn't remember thefact that it got sort of so
distracted by this one piece ofthe viral surface, but instead
it will notice some otherfeature about the picture that
it didn't see before.
And that's the value of thesevaccines that are spaced out
over longer periods of time,because as your immune system
(38:20):
gets these flashes of exposureto the virus, and as they're
spaced out over longer periodsof time, it allows your immune
system to sort of mature.
In the meantime and to forget,which is also a really important
part of the immune response sothat when it gets wrapped back
up, it can notice a differentpart of the virus.
And so essentially what we'redoing is we're trying to sort of
give it these images of thevirus from different angles
(38:41):
which also happens when you getinfected.
And so because of that, it sortof builds up this sort of entire
repertoire of protection againstdifferent pieces of the.
And so they're still veryspecific to SARS.
COVID two, I'm just ramping upantibodies.
As, as, as such.
It doesn't really give us muchprotection against things that
aren't SARS cov two, for thesame reason that a flu vaccine
(39:01):
doesn't protect us againstCOVID-19.
But nevertheless, you know,getting these repeated exposures
will help us over time tobroaden our immune response,
even against things that ourimmune system hasn't seen
before, as long as they'resufficiently closely related.
Matt Boettger (39:15):
That's great.
And you hit the nail on thehead.
I really felt super educated.
I think I earned my honorarydoctorate again.
Thank you, Stephen.
Stephen Kissler (39:23):
Appreciate it.
I hope I hitting the nail on thehead.
I didn't make too many holes inyour wall that you have to fill
up with pipe until you're waytoo
Matt Boettger (39:29):
late for that man Swiss cheese in this house.
So, great.
That's perfect.
We'll end there.
I appreciate Stephen.
We'll be back again in twoweeks.
Again, if you could not leave areview, please do so inspires
us.
He wants support uspatrion.com/pandemic podcast for
monthly subscriptions, as wellas one-time gifts through PayPal
then Mo all in the show notes.
If you wanna get ahold of us, ifyou have questions for us, Matt
(39:51):
at living.
Tom, I will forward them on toStephen and mark.
I know mark has been hereforever.
He's been busy, busy, busy, butwe hope to get them on sometime,
at least one time soon.
And if you wanna get ahold ofStephen, you can do follow him
on Twitter, which is.
S T E P H E N K I S S L E R.
And I think that's it for thisepisode.
(40:11):
Thank you all for listening.
And we'll see you guys, I thinkafter Christmas now.
So if those of you who celebrateChristmas, Merry Christmas,
happy holidays, happy Hanukkah.
All the holidays.
Have a wonderful season.
Take care.
We'll see you guys in two weeks.
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