October 6, 2021 • 40 mins
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Things Discussed on Episode:
- How Japan Beat Coronavirus Without Lockdowns
- No, the Unvaccinated Aren't Selfish or Ignorant. Here's Why I'm Not Vaxxed | Opinion
- Ellume recalls hundreds of thousands of home coronavirus test kits over false positive concerns
- WHO says Merck’s antiviral Covid pill is ‘certainly good news’ as it awaits data
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Matt Boettger (00:00):
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible and the face
to face crises.
My name is Matt and I'm joinedwith two buddies of mine.
This is a miracle Dr.
Mark Kissler.
Here he is at the university ofColorado hospital.
He's back.
He's.
Come out of some dark place andable to reveal the surface of
his own head for us and talk tous for a few minutes moments.
(00:23):
And then Steven, our, ourreliable steadfast guy and in
his own little apartment therein Boston epidemiologists at the
Harvard school of public health,how are you guys doing?
Mark Kissler (00:34):
Good.
It's good to see that I missedyour radio announcer voice.
It's been a while since I'veheard that.
So it was good.
It's good to hear that thismorning again,
Matt Boettger (00:42):
I'm glad that that's somebody can, can enjoy
that, man.
Well, you know, we don't have alot of time this morning because
you know, we'll start.
Steven only because that's thecontext.
And then we'll move to markbecause I want to hear what's
going on in your neck of thewoods.
But Steven, we had adjust forthose of you who are listening.
You're going to realize we'republishing this a couple of days
(01:02):
late.
Steven's been at a conferenceand in fact, he even Keven gave
a talk at this conference.
I'm actually completely in thedark of this conference.
I have no idea what's going on,what you're doing, Steven.
So can you fill me in as well asthe rest of the world about what
conference you're doing and thenwhat talk did you get?
Stephen Kissler (01:19):
Yeah.
So I have been at the virtualconference on virus dynamics
which has been hosted byinterestingly the Fred.
Oh my gosh.
I tried
Matt Boettger (01:30):
to get a ticket to that one.
Stephen Kissler (01:32):
I know it was, yeah, there were sold out, like
within five minutes.
It was crazy people all overthemselves.
Yeah, so it's, it's hosted bythe Fred Hutchinson cancer
research Institute in Washingtonand Washington state university.
So interestingly, the Fred Hutchdoes does a lot of work on
infectious diseases as well.
Because the intersection betweenthat and cancer is pretty,
hugely important.
(01:53):
And so there with this workshopthey're interested in How
viruses behave within the humanbody.
But not just SARS cov two.
A lot of this workshophistorically has been around
HIV.
And in fact, a lot of theresearch on viral dynamics in
general has been from HIV.
So we've had to adapt a lot ofthe work that they've done over
the past few decades to try tolearn what we can about Cyrus
(02:17):
Kovi too.
So, the presentation that Igave.
It was the very first one of theconference.
So, it was a little bitstressful way to set the pace.
Yeah.
Matt Boettger (02:26):
Something like that.
You probably made everybody feeljust really bad eyes.
Stephen Kissler (02:31):
It was so I spoke about And some of the
things that we've talked abouton previous episodes where we've
had some, some manuscripts thathave come out to our
collaboration with the NBA.
So where we've been doingfrequent testing in players and
staff and vendors and familymembers with the NBA.
And when we do that, we can seehow much virus people have in
their bodies, if they do becomeinfected and using that we can
(02:52):
build mathematical models tofix.
How long the infection lasts andwhether that changes depending
on which variant they'reinfected with or whether or not
they're vaccinated.
So some of the things I wastalking about in particular
where the the, the variants andthe vaccines and how they affect
how the virus behaves in ourbody.
So the vaccine really helpsclear the virus out of our
bodies more quickly.
(03:13):
But you can still produce quitea bit of virus if you do get
infected.
So that's, that's been a bigpart of the reason why some of
we've had some of these shiftingguidelines lately where now
vaccinated people that are stillrecommended to wear masks in
indoor settings and these kindsof things.
It's based off of some of thesefindings.
From measuring these viralconcentrations and people over
time.
So we were just talking aboutthose things and and the
(03:33):
conference has been reallyinteresting.
It's been really cool to hearpeople digging into some of
these questions for a lot ofdifferent angles.
Matt Boettger (03:40):
That's great.
And is this I'm guessing this isall behind like a paywall
there's no.
To access your talk down the
Stephen Kissler (03:46):
road.
Yeah.
There's there was like aconference registration that we
had to put in.
But I think that I should beable to get access to at least
at least my talk.
And so I'm hoping to post thatsomewhere after the conference
is finished.
Matt Boettger (03:59):
Great.
So those are you're listeningand you're interested once
Stephen gets it.
I'll make sure we put it intosome notes, a show notes of some
episode in Woolwich.
That's awesome.
And is it still going on,Steven?
Are you
Stephen Kissler (04:08):
done?
Yeah.
Today is the last day, so,
Matt Boettger (04:11):
yeah.
Okay, great.
Are you skipping out right now?
Just bailing out of theconference, that to deduce
podcast reserve that
Stephen Kissler (04:16):
there's a break it's actually since it's hosted
on the west coast, it's onPacific time.
So it starts at 8:30 AM theirtime, but 1130 miles.
So I've got another hour beforethe first session.
Yeah.
Matt Boettger (04:26):
Okay.
That's where the time crunchmark has had to you.
Cause we haven't heard from youfor ever.
And in fact, you know, as wewere Steven and I were meeting
every other week, you send anemail to us saying, Hey, here's
some stuff I'm going to talkabout him and hearing about
this, the hospital, talking tofriends.
So I know you've got a lot onyour mind, but I want to first
hear what's been going on a dayin the hospital since we haven't
heard anything about thatforever.
(04:48):
And then B we've been before westarted recording this, we
started talking about yourpersonal life and kids going
back to school.
I'm sure a lot of wouldappreciate what's going on in
that transition in the kiss,their family and how that's
being.
Mark Kissler (05:00):
Yeah, for sure.
So, well I can start there.
So kids are back at school.
It's a little bit of a differentflavor than the end of last
school year in that they've beentreating COVID cases just a
little bit differently and notshutting down the whole
classroom for weeks.
If there's.
Yeah, like a case in thecommunity that's related to a
kid.
And they're still doing maskingin all the classes as far as I
know as of a couple or as of aweek and a half ago or so when
(05:23):
they last reported, there's beenno outbreaks amongst the kids at
the school.
And I think, you know, from fromjust like an educational
standpoint and from aconsistency standpoint they've
been doing a really good job ofkeeping the kids in the
classroom as much as possibleand really supportive of that
ongoing.
You know, just the ongoingeducational needs of the kids.
(05:44):
So that's been good.
And you know, we feel prettywell supported as a family from
that standpoint.
What else was going on?
Hospital life is kind of statusquo right now.
And so we've been.
We've seen an uptick in the casenumbers as we've approached the
fall.
For sure.
And now we're kinda, you know,it kind of goes up and up and
down by the week.
We saw more we, our ICU had beena little bit more full.
(06:06):
And so we've been helping outthere a little bit.
And some of that is because oncepatients are so sick that they
need ICU level care.
You know, often they're on a, ona ventilator or high flow oxygen
for many days.
And so that just kind of createsa different flow for the
patients and and ourtherapeutics wise we're still
using, there's not been a lot ofbig changes.
(06:27):
So we're definitely still usingthe dexamethazone, which has the
most robust evidence formortality, but.
We're using REM desk severe youknow, which again is more it
has, less, less of a strongsignal in the mortality realm
than than our othertherapeutics, but that's
something that we've been usingin our institution.
And then we also for patientswho get very, very sick, despite
the dexamethazone we are usingthe Tocilizumab and, or the bear
(06:51):
setting of which are thosemolecular.
Kind of the monoclonalantibodies that help reduce
inflammation and cellularsignaling.
And so those, they have some youknow, there's some nuances
around who we use those for andwhen but for the most part, I
haven't seen a lot of bigtherapeutic changes you know, in
this cycle, in this latest cycleof COVID.
(07:11):
And I think there's just anunderstanding and an expectation
that as we approach the wintermonths, We are accustomed to
seeing a surge in the winterrelated to respiratory viruses
and things like that.
And so we're expecting that andthat there's going to be sort of
a concurrent increase in COVIDcases, along with her other
respiratory viruses.
So we're preparing for that froma staffing standpoint and our
(07:35):
operations team is hard at work,you know, making sure that we're
going to have enough teams totake care of all the patients
that.
Okay.
Great.
Matt Boettger (07:42):
Well, you know, before we get into some of the
questions you had from a coupleof weeks ago, there's two things
I'm taking about given whatyou're just talking about.
Hey, I'm just curious inColorado, have we seen any other
increases of like viruses orlike, you know, flu as that
starting to uptake?
Are we still kind of like onthe, you know, the delay on
that, I'm curious about howthat's gonna pan out down the
road next few months, becauseyeah.
(08:04):
We can have a big flu season or,you know, there's still a lot of
people masking obviously.
And so it might have itsbenefits once again this year.
So I think that's my firstquestion to you and I forgot my
second one, but oh yeah.
The other one was abouttreating.
And about you know, talkingabout this, we were talking
about this merch thing.
And so when does it tie thatinto the treatment, but the
first is, have you seen any flusflu, like symptoms surfacing
(08:24):
here in Colorado?
Mark Kissler (08:25):
The flu is definitely here, so we're
starting to see some cases.
And this is, you know, asexpected.
So here, you know, here we arebeginning of October sort of,
you know, beginning end and youknow, I think Steven could
probably speak moreepidemiologically.
There's also, you know, as, aswe've seen and as we know
there's going to be some complexfactors.
Intersect with influenza todetermine whether this is bad
flu season or a mild flu season.
(08:47):
And I think it's hard topredict, you know, at this point
from a clinic purely clinicalstandpoint it's more a question
of how do we.
You know, how do we prepare andget ready?
Cause we don't know exactly whatwe're going to see.
And just kind of take it as itcomes.
This Merck thing is prettyinteresting and I have, haven't
had the chance to do a deep diveon the evidence yet though
initial, at least in terms ofthe reporting on the initial
(09:09):
studies.
Quite promising for anoutpatient treatment to prevent
severe disease.
And so it's an antiviralmedication.
And it, so it would be mostlyused in the outpatient setting.
They're they're the conversationpoint or they're marketing it a
lot as sort of a Tamiflu forCOVID.
So this idea that, you know,you, you have initial symptoms
and a positive test, and thenyou can use this medication.
(09:32):
To help reduce the symptomburden, maybe shorten the
course.
And we've been using things likethere's certain you know,
monoclonal antibodies that theyuse in the outpatient setting as
well.
If, for people who are at highrisk to help reduce the symptom
burden burden, but it seems tome that this would be
potentially a big step forwardin terms of having something
that can be really widelyavailable and act on the virus
(09:53):
itself early in the.
So Steven, do you have anythoughts about that?
Yeah.
Stephen Kissler (09:57):
That's basically my understanding of it
as well.
It's one of the really excitingthings about it is that it is
like you said, Meant to beavailable at a time in the
infection that we don't reallyhave anything available for
people.
All of the therapeuticinterventions that we have are
either vaccines to prevent youfrom getting infected in the
first place or things that helpyou once you've already gotten
(10:20):
to the hospital.
And so this has been a reallysort of critical gap in our
therapeutic portfolio that wehave for COVID-19.
So it's I'm, I'm reallyencouraged by it.
It seems like from myunderstanding, the evidence of
its efficacy was so good thatthey actually stopped the trial
short because they couldn'tjustify not giving the people in
the placebo arm, the, the drugbecause it was, it seemed to be
(10:41):
so effective.
So I think that that's, that's avery good sign.
And we'll see, but I think thatit it's, it's good news.
Matt Boettger (10:47):
That's great.
Now I, you guys dropped this onme.
I had no idea.
I didn't know.
So a couple of things that maybeyou just said, and maybe I was
just tuning out and thinkingabout my next question, which I
can sometimes do.
So I apologize, but now is thisan over the counter prescription
thing that you just, is it overthe counter prescribe?
And how quickly would this beavailable?
Is it still a ways away beforeit could become to the masses?
Stephen Kissler (11:10):
I'm actually not sure about that.
I, it would be a prescriptiondrug.
So you would need to have somesort of healthcare encounter to
to get it.
But I think the, the, probablythe, the, the two hurdles
standing in the way still areFDA approval.
So they've shown the evidence ofof the efficacy, but it still
needs to be approved.
And then once, once that's done,then, then the production.
(11:31):
So it'll still be a littlewhile, but Hopefully not too
long.
Matt Boettger (11:35):
Great.
Well, I'll definitely we'll keepthat in mind.
And if I see anything in themedia about it, I'll put it in
the show notes for thisparticular episode.
So.
Mark, let's get back to you nowbecause you had some questions.
This is the, I'm glad you'rehere, mark, because I feel like,
well, I'm the most, like themost reclusive right now, I live
in a tunnel cave.
First it was Steven.
I actually worked someplace,went to a building, dealt with a
(11:58):
lot of conspiracies on a regularbasis and I no longer work
there.
And I really don't talk to verymany people that me and my wife
and my kids.
We're kind of all on the samepage on some level.
So, but you you're out in thehospital, you've been engaging a
lot of people, you know, you'vehad some, you've had some pretty
strong encounters.
So talk about that and sort offacilitate some of this kind of
(12:20):
conversation about the vaccinehesitancy and just dealing with
all these, these prescriptionsof lockdown to
Mark Kissler (12:25):
masks.
Yeah.
But I think that's good.
I agree.
I think I've been the leastreclusive of the trio here in
case.
You know, out and about both atwork and and in our, in our
community in edit, it's anopportunity for that.
I think we've had someinteresting conversations with
folks that I'm close to.
Both at work and outside of workaround a couple of specifics.
(12:46):
Things.
And so the questions that havebeen coming up at this point for
me fall in generally kind of twocategories.
And so one of, well, I'm goingto say actually three
categories, cause you brought upthe Illume home testing thing
recall.
And so that in the pre-show whenwe were talking about that, so I
want to that's kind of thing.
Number three.
Topic, number one that we'vebeen talking about a lot is our
(13:07):
vaccines yet again.
And so things getting, breakingdown some of the various reasons
for people not getting vaccinesand in particular, getting a lot
of questions about w people say,well, if I've already had COVID,
what's the utility of gettingthe vaccine and then
conversations around who does.
Who do I trust and how do I getsort of the preponderance of
evidence that the vaccine is theright thing.
(13:28):
And, you know, I think we'veseen this a lot in there's
different angles that differentmedia outlets have used to
report on vaccines.
So some have been Widelypublicized cases of young people
dying who were unvaccinated.
And that takes on a certainflavor when it's picked up by
the media that I think can be,they have, have a sense of sort
of, of a punitive or a shamingaspect that is really repellent
(13:51):
to a lot of people.
And understandably so, and thenthere's this other sense of
like, okay, how do we, how do weactually engage in reasonable
conversations about the reasonsand.
And is there a way to developsome certainty or even, you
know, marginal certainty aboutare the side effects, you know,
dangerous and how do we.
(14:12):
We are communal responsibilityanyway.
So I've been getting a lot ofongoing questions still.
Particularly as differentworkplaces have rolled out
vaccine mandates for theiremployees.
And so what I've seen is that asthe is different workplaces are
saying, okay, we're coming upagainst a deadline often that
coincides with the fall comingon and, you know, expected
surge, then people are forced tosay, okay, am I going to file
(14:37):
for an exemption?
Then, if I am on what groundsand if I'm not, what's my
relationship with my employer,am I going to leave?
Am I going to seek alternativeemployment?
Things like that.
And so it's really become realfor a lot of people in this
timeframe be, and mostly becauseof those employer mandates.
So that's thing.
Number one, that's been thetopic where a lot of things have
been sorted.
(14:58):
Topic number two has been alittle bit of conversation
around how do we evaluate how wedid with the pandemic and in
particular, how do we look atepidemia life?
Evidence looking forward andknowing that there's going to be
a point in the future in whichwe encounter in a rapidly
spreading infectious diseaseagain.
And so I think, you know, we'veexperienced where there's just a
(15:19):
lot of feelings that people havearound mandates and statements
by the CDC and things like that.
And still a tremendous amount offeeling.
There's been changing goalposts.
We don't really know what'sreal.
We don't know if these mandateswere effective.
And so what I'm interested intalking to Steven about a little
(15:39):
bit is how do we think about thequality of epidemiologic
evidence?
How do we really get a sense.
What interventions were helpful.
And what, what interventionsmight we be able to forego and
future pandemics?
And things like that.
I think it, there's, there's acertain amount of despair of
knowing that I've beenencountering people where it's
just like, There's just no wayto tell.
And particularly because wecan't do things like randomized
(16:02):
controlled trials, you know,like we do for drugs when we're
talking about these big socialinterventions.
And of course those big socialinterventions have been the
things that have really impactedpeople.
You know, in huge ways.
And then thing, number three, isthis, this question of, you
know, the at-home testing, Ithink has been really relevant
and people are trying to makewise decisions of like, can I go
to an event if everybody'svaccinated?
(16:24):
And do you test beforehand andthen with the Illume tests,
having a bunch of false positivetests, how does that change our
orientation towards hometesting?
Does it change?
Is that a blip or is that sortof a indicator of the utility of
these things to begin with?
So I think.
Those, those have been kind ofthe three topics that have been
circling around.
And then you know, just to throwone more in the mix is, is the
(16:47):
mental health burden that we'veseen.
And, and I think just as thispandemic has stretched on now
from a year to network going on,you know, almost two years and
it feels like.
We're still kind of diggingourselves out.
I do think that there's a reallysignificant burden in the
community.
People who are really sufferingfrom things other than just
infectious disease as this isgoing on.
(17:08):
So, so those are, those are the.
To concerns that people havebeen bringing to me the points
of conversation.
And I don't know, we have just afew minutes, but maybe we want
to kind of hit those, you know,1, 2, 3, 4 as we go and see what
you guys
Matt Boettger (17:21):
think.
Yeah.
Sounds good.
I'm so glad you brought thismost simple questions to the
foregrounds.
Cause we didn't have a lot oftime to adjust.
Really some surface level, justicebreaker topics.
Okay.
So maybe we should do this insomewhat of reverse, reverse
order, because I feel like a lotof time, I think the Illume
thing, the mental health, let menot quite reversed because the
(17:43):
mental health is a big, big, abig bag of something.
So let's hit, let's hit handle aloom and what that symbolizes
and then work backwards fromthere and do the Illume.
And then the question about thelockdowns from Steven.
So.
Stephen.
This is your show.
Now a glad, a great questionshere.
I will let let's talk about theOlympics that was on mine thing
(18:03):
as well.
Like, oh, is this just a blip orare we get, are we changing our
tune to maybe these aren't thebest thing it's causing more
problems.
So, any thoughts on that?
Yeah.
Stephen Kissler (18:13):
It's it's tricky, right?
It's like what we w we wantthese tests to be as accurate,
meaning as sensitive and asspecific as possible.
So we don't want falsenegatives.
We don't want false positives.
And so I think that I am still,I'm still deeply convinced that
that rapid tests like the Illumetest and especially like some of
(18:33):
the others that are available tobuy an X now.
And many of the others they havenot yet been approved in the U S
but that have been approved inmany other countries in the
world.
Can be, and should be a centralelement of our route out of this
pandemic and sort of, emergingfrom this two year long You
know, a real burden that we'veall been carrying.
I think that the, the issue hereis around how, how we use tests
(18:57):
because the tests, test doesn'texist in isolation.
A test, it gives you informationabout some specific scenario
that you're trying to learnsomething about.
So one of the things that therethat you can do to adjust for
these false positives as to.
Include a verification test,which many of the tests already
(19:17):
do.
So there are very simple ways toget around some of these issues
with false positives, falsenegatives that really enhance
the accuracy of the tests.
And the thing that we're lackingmost is not.
Good testing technology, butgood testing protocol.
People don't know how to use thetests.
People don't know when to usethe tests and the tests are very
(19:37):
good if you know those things,but in the absence of that, the
tests are useless no matter howsensitive and how specific they
are.
So that's my major frustrationis that even these tests that
have lower in this case,specificity, meaning they were
giving some false positives.
They could still be extremelyuseful.
If used in the right way.
And so, so that, that I think isthe issue.
(19:57):
We're trying to find atechnological answer to
something that is actually muchmore fundamental and in some
ways straight.
Mark Kissler (20:03):
Yeah.
And I think just to specify,it's not by used in the right
way.
It doesn't mean there's aimproper testing technique being
used, but what's what I believeyou're referring to as a sense
of understanding this concept ofwhat's my pre-test probability
you know, do I have symptoms?
What am I testing for?
Then the test characteristicsthat are inherent to the test
(20:23):
itself.
And then that those two thingsactually interact to give you a
post-test probability ofactually having COVID.
And so there's it.
And there's other ways to thinkabout that.
Like, what are the scenarios inwhich we're using these tests,
but that is that right?
That you're meaning it's notthat we don't know how to use
the tests, but it's actually, wedon't know how to
operationalize.
You know, to make decisions.
Stephen Kissler (20:45):
Exactly, exactly.
And right.
And even like, what are, whatexactly are we testing for?
So there's, there's the pre-testprobability, there's the test
itself.
And then, you know, what are,what are we going to do with
this test once, once once itcomes out, do I want to know if
I have COVID and needs to seekmedical care?
Do I want to know if I shouldsend my kid to school or not?
Do I want to know if I shouldlike show up to a family
(21:06):
gathering and all of thosethings, contextualize how you
interpret the result that youget.
And I think that we, we have apretty good sense of, of what to
do and all of those differentcases, but the communication
around it has been pretty poor,at least here in the U S.
Matt Boettger (21:20):
That's great.
That's helpful.
It can.
I I don't know if this relevantto remind me of this concept,
like habit stacking, where likeyou, you're trying to build a
good habit and as an island,it's just not sufficient.
You really can't get a goodhabit sometimes to get started,
but if you stack them with otherexisting things that actually
elevates the probability thatyou actually can develop a good
habit, I think this is like asimilar, like taking an, you
know, a rapid test in of itselfis one thing, but to stack it
(21:42):
with all the other things thathelp to surround it's context
and circumstances reallyelevated.
The effectiveness of the actualtest.
So the treated as a one pillthing, it's just not going to be
it's purpose is to be used incontext.
Right.
And so that's, that's reallyhelpful.
Thanks, Steven.
I appreciate it.
Okay, go ahead,
Mark Kissler (21:59):
mark.
Do you have, oh yeah, I was justgoing to say let's hit, let's
hit that.
The next question.
Right.
Right.
Matt Boettger (22:05):
This is a big one locked down.
Even in my little basement, youknow, it still affects me.
So when I talked to no one aboutmyself and maybe a few people
online the whole concept of, youknow, do lock downs did lock
down to work.
Did the, are the mass working?
And there's all this evidencethat would get from the media of
people who were fully mass inthe spread like wildfire or
(22:27):
people, you know, you know thatmark.
Really old article.
I sent you guys from Japan aboutthe existence of how without
lockdowns, this is how theysurvived that this was, this was
a while ago.
This was well over a year, Ithink a year ago when that
article came out, maybe less.
So just wanted to propose it oflike, you know, in mark, you can
reframe this a little more aboutjust how, how, how do we know
what's effective?
(22:47):
What's not, and how do we cometo conclusions and
epidemiologist?
Yeah.
Stephen Kissler (22:51):
Yeah.
It's, I think that it's, this isA tricky question.
And it's one that we've beengrappling with as
epidemiologists, as people whotend to deal with observational
data, as opposed to trial baseddata all the time.
But never has it been so centralto our existence as humans in
(23:12):
society.
There was a lot of debate aroundthis early in the pandemic as
well.
Where there was even a splitbetween sort of, different
groups of epidemiologists, someof whom Did not think that we
can justify things likelockdowns because we didn't have
the sort of randomizedcontrolled evidence to justify
them.
And others who were and I, I, inmany of my colleagues tended to
(23:35):
fall more into this camp, whichwas that we don't necessarily
know what the effect oflockdowns will be, but we do
know what the effect of COVID.
On a city on a community can be.
And we have sufficient reason tobelieve that this could very
well be helpful in the immediateterm.
And so based on theprecautionary principle, this is
something that we should bedoing even in the absence of
evidence.
(23:56):
And we should be collectingevidence as we go.
But now we're in a verydifferent situation where, you
know, the pandemic has beenspreading for quite a long time.
In theory, we, we do have, andshould have some evidence on
this and, and in fact, we, we dobut as far from straight.
So we can look at the examplesof some countries that have very
strict lockdowns, very strongcountermeasures.
(24:18):
And many of them have had veryfew COVID cases.
Their economies are doing verywell.
We can look to Australia, NewZealand.
For example, there was theexample of Japan.
I think we were talking aboutearlier.
Yeah, and different countrieshave fared very differently
here.
But on the other hand, you know,some we might contrast the
response in Germany versus the US which, which are actually
(24:39):
quite different.
I think Germany tended to havea.
Stricter response.
They've been a lot quicker toadopt technologies like rapid
tests and to use them in waysthat I think are very sensible.
And that has definitely helped,but also, you know, the they're
not in the situation thatAustralia and New Zealand are.
They're much closer to the percapita mortality that we have in
(24:59):
the.
Then you might expect given thedifference in the response
between the two differentplaces.
So one of the big issues here isthat just there are so many
different moving factors fromindividual culture and political
response and just sheer luck,one way or another.
And all of these differentthings sort of play into making
(25:20):
it really difficult to drawconclusions as to, you know,
what what, what is the doseresponse of a week of lockdown
to reduce COVID cases?
And that's, that's the sort ofevidence that we're, we're never
going to be able to haveperfectly.
It is something that we can,it's an evidence-based that we
can build over time.
As we look back at theexperience that we've had over
the last couple of years andbegin to disentangle it, but
(25:41):
it's, it's a messy process.
And I'm going to really.
Empathize with the frustrationthat that many people have about
you know, like there's, there'ssort of the sense of, of
futility and almost hopelessnessthat we can ever know for sure.
And I think that that's in a Iempathize with it deeply because
that's, that's sort of where myentire professional life is
situated.
I, I feel that frustration everyday.
(26:02):
And but I, I am convinced atthis point that even if the
quality of evidence that wemight have is poor relative to
something that you might have ina, in a trial, it's not nothing.
And I think that that mattersstill.
Mark Kissler (26:16):
That's good.
You know, I think a couple ofthemes come out, you know, as
I'm hearing you talk about that,I think one of them is I think
that there has been a lot offrustration amongst people who,
especially who are I think lessinclined to.
Mask mandates, vaccinationmandates locked down, things
like that.
At the use of the, thisnarrative of well science says
(26:37):
that, you know, XYZ, and I thinkthat you draw some important
nuance there where that evenwithin the scientific community,
there's some conversations goingon about how do we use these
models to inform what shall wedo?
And it would be.
It's so tough because I think alot of people feel as if they
don't have access to thescientific knowledge, the models
(26:58):
themselves, to the ability, youknow, to really parse that such
that they CA that it feels as ifthey're, they can't participate
in that conversation in arightly, because it takes
experts.
To do that.
That's why you went to schoolfor as long as you did and your,
your colleagues and continue tolearn, you know, out of school.
And then what happens.
And I think this ties to ourlast point around the vaccines
(27:21):
is that in that scenario, youknow, in which I can't
participate, you know, in.
More nuanced conversation thatreally weighs the data.
Then what I ended up trustingare local authorities and local
authorities that I'm at here orcohere to my pre-existing set of
(27:44):
beliefs to a certain degree.
Right.
And so I thought there was.
Newsweek article I'm using thiskind of by way of transition to
our vaccine point, but Matt, yousent out this, this interesting
Newsweek article about a womanwho is, you know, very highly
educated and articulate andtalked about the reasons that.
It was not vaccinated.
And you know, she, she was like,I believe that the vaccine is
(28:04):
important.
She wasn't categorically, youknow, anti-vaccine and Juan, you
know, believes in COVID andwants it to end, but laid out
her reasons.
And what I found mostinteresting, you know, I think
some of the reasons there, youcan go point by point.
And you, and I, I feel like, youknow, Somebody who you could
have a really fruitful dialoguewith and who, you know, I might
learn something from, and shemight learn something from me
(28:26):
about, you know, how do we weighthe relative risks of side
effects for instance, or how dowe understand the evidence that
she cited about people who arevaccinated still spreading COVID
you know, I think there's somereally important.
Around that.
And you know, the way that thevaccine actually reduces the
incidence of getting infected,you got to stack those
probabilities.
(28:47):
So we can talk about all thatpoint to point, but where she
ended her argument, I think isthe most illuminating thing,
which is that it was in aconversation with her physician
who she trusted.
And she didn't get thisunequivocal yes.
That you need to get vaccinated.
And so for her thatcrystallized, you know, all of
these little factors, like alittle bit.
You know, frustration about thechanging goalposts or the
(29:10):
perceived changing goalpostsfrustration about the CDCs
messaging frustration about, youknow, the government and various
ways, but then it crystallizesin this local conversation and a
local sense of who then do Itrust.
And I think that's, I don'tknow, I feel as if we're really
encountering that in a lot of ina lot of ways.
And so, you know, we, and as weknow, there's just a lot of
(29:31):
variability.
Then in these local authoritiesyou know, variability and how
valid their advices howevidence-based it is, you know,
and I think just in your one'sdesire to listen to somebody,
you know, based on a whole lotof issues that maybe don't have
anything to do with COVID.
And so that, I don't know, I,it, it seems to me when I'm
(29:52):
having these conversationsabout.
Vaccination you know, and, andsome pretty real stress that
people are experiencing relatedto work and vaccine.
That it's often coming down tothe sense of like, who's my
local authority that I can trustaround this to kind of cohere,
you know, all these vaguefeelings that I have into
(30:14):
something that's actionable.
Does that strike you guys asright?
Is that something you've beenseeing too amongst, you know,
friends or I imagine a lot of ushave kind of homogeneous work
environments are more or lesshomogeneous work environments.
Right.
Where there's a lot of.
You know, but, but I think for,for those of us who have friends
you know, our family that spanthese ideological starting
(30:36):
points, I think this has beenreally relevant.
Matt Boettger (30:39):
Yeah.
I totally agree.
I don't even think it's so muchlocal authority, but if it just
authority in general, becauselike, you know, it's so easy, it
depends on what, you know,What's kind of the, the fat of
the culture, but like, you know,if it's football, you know where
to go for your authority, itmight be ESPN or whatever it is.
Like you got your places to goto, like, where do I need to get
my information of like, what'shappening and how do I make my
(30:59):
decisions, that kind of stuff.
But when it comes to.
When it comes to a, you know, apandemic, we haven't, this
hasn't been a fad.
We don't know where to look to.
And the first thing I thoughtabout mark is like, where's like
the NCAA brackets ofepidemiology.
It's like, you know, you have,you have one side and here's the
brackets of here's one side,here's the other side.
These are all the professionalsgoing at it, talking about how
(31:20):
do we deal with the pandemic andbegin to be able to digest it in
a way.
And inform ourselves versuslike, I have no idea.
If it wasn't for a randomFacebook post by Steven in like
I, whatever it was February of2020, I would have no idea about
any of this stuff.
What an epidemiologist reallydoes.
And I've been informed by justmy lowest hanging out.
(31:43):
And for me, it's, it's not inthe forefront of my mind.
It would be okay.
A doctor's a physician.
So that's the end all be all.
What do you think I'm done?
Right.
Had no clue that there wasanother area.
Mark, you did, because you wentto school for this, right?
So, virology and vaccinology,all this stuff, I had no idea.
It's just not even in the realmof having to even find this
information.
So,
Mark Kissler (32:06):
yeah, and I think it's interesting.
Even just the idea of a bracketthere's this, we were so deeply
committed right now in inAmerica to a competitive or kind
of a conflict oriented thatthere are two sides.
Right.
And I think there's.
W one of the helpful things, Ithink that the conversation
around vaccine hesitancy isbringing up is with this
reminder that there aren't,isn't a uniform reason that
(32:29):
people are not gettingvaccinated and there's not a
uniform prejudice againstvaccine.
That it's actually is a lot youknow, there's a lot of things
going on there, but also thischaracterization that there are
two sides, we're so deeplycommitted to that.
And to these metaphors thatwe're using about.
You know, th that arefundamentally they're, they're
combat oriented metaphors.
(32:49):
And we use that in all levels ofour society right now, to sort
ourselves out, you know, andsure.
Maybe there's, I'm notsociologist or an
anthropologist.
I'm sure there's.
A lot of strong tendency to sortourselves in this way.
I found it to be extremelyunhelpful you know, over the
last year and a half two yearsand I think it would be great.
(33:11):
I, one thing I'm interested inis how do we, how do we begin
our conversations from astarting place that undercuts
that metaphor that says like,let's not figure out, let's not
sort out where we stand beforewe engage.
Let's engage.
Something real, that matters andbe really rigorous intellectual
rigorous about it.
But that's kind of, that's oftenI think, kind of pie in the sky.
(33:32):
So,
Matt Boettger (33:32):
I think in some sense it is binary, but like,
You know, for me this I oversupply it, I can be over supply
things, but like it's either inthis situation there, the
vaccine get the vaccine or notvaccine.
But then like in my mind thatbrackets is kind of a good
imagery because in, from thatthere's a narrative that plays
out and that narrative, it getsa little more complicated as you
expand out where there's,there's more, there's more
nodes, there's more things.
(33:52):
There's more complexities forreasons.
Why?
Because there's no one reasonthere's, you know, I'm not
vaccine because of.
Immune compromise, whatever, butthen it keeps going further and
further, further, and we findtons of different nuances to the
reasons why, you know, there'sthe one extreme, the
anti-vaxxers and there's the,then there's the other ones are
just like, because of concern,not having the right
information.
And there's a myriad of reasons,right.
(34:13):
Or those who who'd actually takethe vaccine.
There's tons of reasons why thatmean that as you expand outward,
that neural network becomeswider and wider and wider and
more.
You know, but, but, but it seemsas if there is some common
thread that kind of unites thosedecisions to be able to find and
discover, but I that's kind ofway, but not in combat.
Yeah.
Not in a combatitive sense.
Mark Kissler (34:34):
Yeah, yeah, yeah.
I'm aware of the time and whereeverybody Stephen's gotta be
pretty quick.
Is there something else that,that you guys wanted to chat
about or Steven that's on yourmind this week?
Thinking about this stuff.
Stephen Kissler (34:47):
Yeah, no, I think the only other thing,
like, just on that last point tojust echo that I've, I've also
experienced I've spoken with alot of people who have very
diverse and well thought outreasons why they themselves
might not have gottenvaccinated.
And it really, you know, This isone of the I think difficulties,
(35:07):
you know, again, I think aboutthis as a statistician, as an
epidemiologist, I think it'salso just a real human problem
with like, how do we, how do weavoid flattening narratives?
And it came to mind when we weretalking about the The role that
the media has played in shapingsome of the narrative around the
pandemic.
And I think mark something thatyou had mentioned earlier about
(35:30):
how there is this discussiongoing on, even amongst.
About what should we do?
And yet that somehow getsflattened and distorted as it as
it reaches people who are notscientists to make it seem like
there's this monolithic.
Scientific opinion on all thingswhich then becomes sort of more
(35:50):
of a moral statement than ascientific statement at some
point.
And I think that it's, it'sreally interesting.
I, I don't know what to do withthis, but I think that this is,
you know, this is a deep Issuein that, you know, I think both,
you know, both the, the mediaitself, but also just the
platforms with which we shareinformation can sometimes serve
to amplify single messages tothe detriment of, of more nuance
(36:12):
within those messages.
And make it seem like there is asingle reason to not get
vaccinated and that a person whois unvaccinated falls into this
very stereotypical category.
And we can, you know, thinkabout that with all sorts of
different things that havearisen during the pandemic.
One of the really interestingthings to me about this is that
there's also.
Concurrent major shift withinthe scientific community to make
(36:33):
our research and ourcommunication more and more open
and accessible.
So there's a huge open accessmovement in journals.
We, we post almost everything aspreprints.
There are many scientists, keyblogs where you can directly
access their thinking.
Many of us have been publishingop-eds in different newspapers
and magazines.
And so basically all of this wasto say that I, I don't, I don't
(36:58):
understand all of the issues.
And and, and why, you know, whysome of this flattening takes
place amidst this landscapewhere, where it should be much
easier to have direct access tothe people who have been
thinking about these things forlong before.
COVID 19 had a name So, I don'tknow what to do about this, but
I do think that that justmaintaining this, this initial
(37:20):
stance, whenever encounteringany new piece of information
that that there's probably a lotof complexity that that
underlies whatever messageyou're hearing is probably a
valuable thing.
Mark Kissler (37:31):
Yeah, I think that's great.
I think the last thing I justwanted to make another plug to
kind of go, we didn't, ofcourse, we're not going to break
down this whole.
Conversation around you know,depression, hopelessness, social
isolation that's much bigger ofa scope than I think any of us
can really tackle.
But I do think just as a, apersonal plug, if I would just
(37:53):
encourage everybody, who'slistening to check.
Folks around them and just beaware that I think there's a lot
going on underneath the surfacefor a lot of people right now.
There's a lot of, and so justjust checking on people and
making sure that we're not, youknow, perpetuating this dis you
know, whatever distancing thatwe're doing to be actually you
know, interpersonal.
(38:14):
Distancing as much as possible.
So it can, it can make a bigdifference, I think, to look in
on somebody and, and to checkin.
So I just encourage everybody tobe doing that.
That's okay
Matt Boettger (38:24):
to end this market.
Thanks.
You know, I kind of like a goodbeginning of March of 2000.
Asking people again, same thing,mark.
You're asked for the check in onpeople.
There's almost in some sense, alittle bit more nuanced where
our habit was to be really openout and doing things.
And we're being forced to beingclosed down.
Now you've been closed down fora year and a half, almost two
years.
This in the most subtle way, isthat reaching out with a context
(38:46):
of leaning into human contact,again, it's like we built a
reverse habit now it's been sointense.
Our, our initial reaction is tostay away.
And I'm not saying that if youfeel like you're conscious of
saying whatever that may be, butto encourage ourselves to reach
out connect and now fight theurge to be isolated and begin to
try to find ways to re-encounterthe world, because this is not
(39:08):
going to end at least this.
Mental cycle for a long while.
So there's, there needs to beanother rehabilitation going on.
So thanks for sharing that.
Okay.
That ends this episode.
Glad to have mark in so thankfulyou could join us and hopefully
you can be more regular.
I know there's a lot of thingsgoing on in your life.
Steven, so good to see you havea wonderful rest of your day,
(39:29):
the conference and forever theeveryone who is listening.
Thank you for listening.
Please subscribe.
If you haven't subscribed, ifyou can join us to support us
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Please leave a review.
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(39:49):
us, matt@livingthereal.com.
I will immediately forward thaton to mark and Steven, so they
can be encouraged as well andeven answer questions as they
come along.
Take care, have a wonderfulweek.
We'll see you in a couple ofweeks.
All right, bye bye-bye.
You're listening to the pandemic podcast.
We equip you to live the mostreal life possible and the face
to face crises.
My name is Matt and I'm joinedwith two buddies of mine.
This is a miracle Dr.
Mark Kissler.
Here he is at the university ofColorado hospital.
He's back.
He's.
Come out of some dark place andable to reveal the surface of
his own head for us and talk tous for a few minutes moments.
(00:23):
And then Steven, our, ourreliable steadfast guy and in
his own little apartment therein Boston epidemiologists at the
Harvard school of public health,how are you guys doing?
Mark Kissler (00:34):
Good.
It's good to see that I missedyour radio announcer voice.
It's been a while since I'veheard that.
So it was good.
It's good to hear that thismorning again,
Matt Boettger (00:42):
I'm glad that that's somebody can, can enjoy
that, man.
Well, you know, we don't have alot of time this morning because
you know, we'll start.
Steven only because that's thecontext.
And then we'll move to markbecause I want to hear what's
going on in your neck of thewoods.
But Steven, we had adjust forthose of you who are listening.
You're going to realize we'republishing this a couple of days
(01:02):
late.
Steven's been at a conferenceand in fact, he even Keven gave
a talk at this conference.
I'm actually completely in thedark of this conference.
I have no idea what's going on,what you're doing, Steven.
So can you fill me in as well asthe rest of the world about what
conference you're doing and thenwhat talk did you get?
Stephen Kissler (01:19):
Yeah.
So I have been at the virtualconference on virus dynamics
which has been hosted byinterestingly the Fred.
Oh my gosh.
I tried
Matt Boettger (01:30):
to get a ticket to that one.
Stephen Kissler (01:32):
I know it was, yeah, there were sold out, like
within five minutes.
It was crazy people all overthemselves.
Yeah, so it's, it's hosted bythe Fred Hutchinson cancer
research Institute in Washingtonand Washington state university.
So interestingly, the Fred Hutchdoes does a lot of work on
infectious diseases as well.
Because the intersection betweenthat and cancer is pretty,
hugely important.
(01:53):
And so there with this workshopthey're interested in How
viruses behave within the humanbody.
But not just SARS cov two.
A lot of this workshophistorically has been around
HIV.
And in fact, a lot of theresearch on viral dynamics in
general has been from HIV.
So we've had to adapt a lot ofthe work that they've done over
the past few decades to try tolearn what we can about Cyrus
(02:17):
Kovi too.
So, the presentation that Igave.
It was the very first one of theconference.
So, it was a little bitstressful way to set the pace.
Yeah.
Matt Boettger (02:26):
Something like that.
You probably made everybody feeljust really bad eyes.
Stephen Kissler (02:31):
It was so I spoke about And some of the
things that we've talked abouton previous episodes where we've
had some, some manuscripts thathave come out to our
collaboration with the NBA.
So where we've been doingfrequent testing in players and
staff and vendors and familymembers with the NBA.
And when we do that, we can seehow much virus people have in
their bodies, if they do becomeinfected and using that we can
(02:52):
build mathematical models tofix.
How long the infection lasts andwhether that changes depending
on which variant they'reinfected with or whether or not
they're vaccinated.
So some of the things I wastalking about in particular
where the the, the variants andthe vaccines and how they affect
how the virus behaves in ourbody.
So the vaccine really helpsclear the virus out of our
bodies more quickly.
(03:13):
But you can still produce quitea bit of virus if you do get
infected.
So that's, that's been a bigpart of the reason why some of
we've had some of these shiftingguidelines lately where now
vaccinated people that are stillrecommended to wear masks in
indoor settings and these kindsof things.
It's based off of some of thesefindings.
From measuring these viralconcentrations and people over
time.
So we were just talking aboutthose things and and the
(03:33):
conference has been reallyinteresting.
It's been really cool to hearpeople digging into some of
these questions for a lot ofdifferent angles.
Matt Boettger (03:40):
That's great.
And is this I'm guessing this isall behind like a paywall
there's no.
To access your talk down the
Stephen Kissler (03:46):
road.
Yeah.
There's there was like aconference registration that we
had to put in.
But I think that I should beable to get access to at least
at least my talk.
And so I'm hoping to post thatsomewhere after the conference
is finished.
Matt Boettger (03:59):
Great.
So those are you're listeningand you're interested once
Stephen gets it.
I'll make sure we put it intosome notes, a show notes of some
episode in Woolwich.
That's awesome.
And is it still going on,Steven?
Are you
Stephen Kissler (04:08):
done?
Yeah.
Today is the last day, so,
Matt Boettger (04:11):
yeah.
Okay, great.
Are you skipping out right now?
Just bailing out of theconference, that to deduce
podcast reserve that
Stephen Kissler (04:16):
there's a break it's actually since it's hosted
on the west coast, it's onPacific time.
So it starts at 8:30 AM theirtime, but 1130 miles.
So I've got another hour beforethe first session.
Yeah.
Matt Boettger (04:26):
Okay.
That's where the time crunchmark has had to you.
Cause we haven't heard from youfor ever.
And in fact, you know, as wewere Steven and I were meeting
every other week, you send anemail to us saying, Hey, here's
some stuff I'm going to talkabout him and hearing about
this, the hospital, talking tofriends.
So I know you've got a lot onyour mind, but I want to first
hear what's been going on a dayin the hospital since we haven't
heard anything about thatforever.
(04:48):
And then B we've been before westarted recording this, we
started talking about yourpersonal life and kids going
back to school.
I'm sure a lot of wouldappreciate what's going on in
that transition in the kiss,their family and how that's
being.
Mark Kissler (05:00):
Yeah, for sure.
So, well I can start there.
So kids are back at school.
It's a little bit of a differentflavor than the end of last
school year in that they've beentreating COVID cases just a
little bit differently and notshutting down the whole
classroom for weeks.
If there's.
Yeah, like a case in thecommunity that's related to a
kid.
And they're still doing maskingin all the classes as far as I
know as of a couple or as of aweek and a half ago or so when
(05:23):
they last reported, there's beenno outbreaks amongst the kids at
the school.
And I think, you know, from fromjust like an educational
standpoint and from aconsistency standpoint they've
been doing a really good job ofkeeping the kids in the
classroom as much as possibleand really supportive of that
ongoing.
You know, just the ongoingeducational needs of the kids.
(05:44):
So that's been good.
And you know, we feel prettywell supported as a family from
that standpoint.
What else was going on?
Hospital life is kind of statusquo right now.
And so we've been.
We've seen an uptick in the casenumbers as we've approached the
fall.
For sure.
And now we're kinda, you know,it kind of goes up and up and
down by the week.
We saw more we, our ICU had beena little bit more full.
(06:06):
And so we've been helping outthere a little bit.
And some of that is because oncepatients are so sick that they
need ICU level care.
You know, often they're on a, ona ventilator or high flow oxygen
for many days.
And so that just kind of createsa different flow for the
patients and and ourtherapeutics wise we're still
using, there's not been a lot ofbig changes.
(06:27):
So we're definitely still usingthe dexamethazone, which has the
most robust evidence formortality, but.
We're using REM desk severe youknow, which again is more it
has, less, less of a strongsignal in the mortality realm
than than our othertherapeutics, but that's
something that we've been usingin our institution.
And then we also for patientswho get very, very sick, despite
the dexamethazone we are usingthe Tocilizumab and, or the bear
(06:51):
setting of which are thosemolecular.
Kind of the monoclonalantibodies that help reduce
inflammation and cellularsignaling.
And so those, they have some youknow, there's some nuances
around who we use those for andwhen but for the most part, I
haven't seen a lot of bigtherapeutic changes you know, in
this cycle, in this latest cycleof COVID.
(07:11):
And I think there's just anunderstanding and an expectation
that as we approach the wintermonths, We are accustomed to
seeing a surge in the winterrelated to respiratory viruses
and things like that.
And so we're expecting that andthat there's going to be sort of
a concurrent increase in COVIDcases, along with her other
respiratory viruses.
So we're preparing for that froma staffing standpoint and our
(07:35):
operations team is hard at work,you know, making sure that we're
going to have enough teams totake care of all the patients
that.
Okay.
Great.
Matt Boettger (07:42):
Well, you know, before we get into some of the
questions you had from a coupleof weeks ago, there's two things
I'm taking about given whatyou're just talking about.
Hey, I'm just curious inColorado, have we seen any other
increases of like viruses orlike, you know, flu as that
starting to uptake?
Are we still kind of like onthe, you know, the delay on
that, I'm curious about howthat's gonna pan out down the
road next few months, becauseyeah.
(08:04):
We can have a big flu season or,you know, there's still a lot of
people masking obviously.
And so it might have itsbenefits once again this year.
So I think that's my firstquestion to you and I forgot my
second one, but oh yeah.
The other one was abouttreating.
And about you know, talkingabout this, we were talking
about this merch thing.
And so when does it tie thatinto the treatment, but the
first is, have you seen any flusflu, like symptoms surfacing
(08:24):
here in Colorado?
Mark Kissler (08:25):
The flu is definitely here, so we're
starting to see some cases.
And this is, you know, asexpected.
So here, you know, here we arebeginning of October sort of,
you know, beginning end and youknow, I think Steven could
probably speak moreepidemiologically.
There's also, you know, as, aswe've seen and as we know
there's going to be some complexfactors.
Intersect with influenza todetermine whether this is bad
flu season or a mild flu season.
(08:47):
And I think it's hard topredict, you know, at this point
from a clinic purely clinicalstandpoint it's more a question
of how do we.
You know, how do we prepare andget ready?
Cause we don't know exactly whatwe're going to see.
And just kind of take it as itcomes.
This Merck thing is prettyinteresting and I have, haven't
had the chance to do a deep diveon the evidence yet though
initial, at least in terms ofthe reporting on the initial
(09:09):
studies.
Quite promising for anoutpatient treatment to prevent
severe disease.
And so it's an antiviralmedication.
And it, so it would be mostlyused in the outpatient setting.
They're they're the conversationpoint or they're marketing it a
lot as sort of a Tamiflu forCOVID.
So this idea that, you know,you, you have initial symptoms
and a positive test, and thenyou can use this medication.
(09:32):
To help reduce the symptomburden, maybe shorten the
course.
And we've been using things likethere's certain you know,
monoclonal antibodies that theyuse in the outpatient setting as
well.
If, for people who are at highrisk to help reduce the symptom
burden burden, but it seems tome that this would be
potentially a big step forwardin terms of having something
that can be really widelyavailable and act on the virus
(09:53):
itself early in the.
So Steven, do you have anythoughts about that?
Yeah.
Stephen Kissler (09:57):
That's basically my understanding of it
as well.
It's one of the really excitingthings about it is that it is
like you said, Meant to beavailable at a time in the
infection that we don't reallyhave anything available for
people.
All of the therapeuticinterventions that we have are
either vaccines to prevent youfrom getting infected in the
first place or things that helpyou once you've already gotten
(10:20):
to the hospital.
And so this has been a reallysort of critical gap in our
therapeutic portfolio that wehave for COVID-19.
So it's I'm, I'm reallyencouraged by it.
It seems like from myunderstanding, the evidence of
its efficacy was so good thatthey actually stopped the trial
short because they couldn'tjustify not giving the people in
the placebo arm, the, the drugbecause it was, it seemed to be
(10:41):
so effective.
So I think that that's, that's avery good sign.
And we'll see, but I think thatit it's, it's good news.
Matt Boettger (10:47):
That's great.
Now I, you guys dropped this onme.
I had no idea.
I didn't know.
So a couple of things that maybeyou just said, and maybe I was
just tuning out and thinkingabout my next question, which I
can sometimes do.
So I apologize, but now is thisan over the counter prescription
thing that you just, is it overthe counter prescribe?
And how quickly would this beavailable?
Is it still a ways away beforeit could become to the masses?
Stephen Kissler (11:10):
I'm actually not sure about that.
I, it would be a prescriptiondrug.
So you would need to have somesort of healthcare encounter to
to get it.
But I think the, the, probablythe, the, the two hurdles
standing in the way still areFDA approval.
So they've shown the evidence ofof the efficacy, but it still
needs to be approved.
And then once, once that's done,then, then the production.
(11:31):
So it'll still be a littlewhile, but Hopefully not too
long.
Matt Boettger (11:35):
Great.
Well, I'll definitely we'll keepthat in mind.
And if I see anything in themedia about it, I'll put it in
the show notes for thisparticular episode.
So.
Mark, let's get back to you nowbecause you had some questions.
This is the, I'm glad you'rehere, mark, because I feel like,
well, I'm the most, like themost reclusive right now, I live
in a tunnel cave.
First it was Steven.
I actually worked someplace,went to a building, dealt with a
(11:58):
lot of conspiracies on a regularbasis and I no longer work
there.
And I really don't talk to verymany people that me and my wife
and my kids.
We're kind of all on the samepage on some level.
So, but you you're out in thehospital, you've been engaging a
lot of people, you know, you'vehad some, you've had some pretty
strong encounters.
So talk about that and sort offacilitate some of this kind of
(12:20):
conversation about the vaccinehesitancy and just dealing with
all these, these prescriptionsof lockdown to
Mark Kissler (12:25):
masks.
Yeah.
But I think that's good.
I agree.
I think I've been the leastreclusive of the trio here in
case.
You know, out and about both atwork and and in our, in our
community in edit, it's anopportunity for that.
I think we've had someinteresting conversations with
folks that I'm close to.
Both at work and outside of workaround a couple of specifics.
(12:46):
Things.
And so the questions that havebeen coming up at this point for
me fall in generally kind of twocategories.
And so one of, well, I'm goingto say actually three
categories, cause you brought upthe Illume home testing thing
recall.
And so that in the pre-show whenwe were talking about that, so I
want to that's kind of thing.
Number three.
Topic, number one that we'vebeen talking about a lot is our
(13:07):
vaccines yet again.
And so things getting, breakingdown some of the various reasons
for people not getting vaccinesand in particular, getting a lot
of questions about w people say,well, if I've already had COVID,
what's the utility of gettingthe vaccine and then
conversations around who does.
Who do I trust and how do I getsort of the preponderance of
evidence that the vaccine is theright thing.
(13:28):
And, you know, I think we'veseen this a lot in there's
different angles that differentmedia outlets have used to
report on vaccines.
So some have been Widelypublicized cases of young people
dying who were unvaccinated.
And that takes on a certainflavor when it's picked up by
the media that I think can be,they have, have a sense of sort
of, of a punitive or a shamingaspect that is really repellent
(13:51):
to a lot of people.
And understandably so, and thenthere's this other sense of
like, okay, how do we, how do weactually engage in reasonable
conversations about the reasonsand.
And is there a way to developsome certainty or even, you
know, marginal certainty aboutare the side effects, you know,
dangerous and how do we.
(14:12):
We are communal responsibilityanyway.
So I've been getting a lot ofongoing questions still.
Particularly as differentworkplaces have rolled out
vaccine mandates for theiremployees.
And so what I've seen is that asthe is different workplaces are
saying, okay, we're coming upagainst a deadline often that
coincides with the fall comingon and, you know, expected
surge, then people are forced tosay, okay, am I going to file
(14:37):
for an exemption?
Then, if I am on what groundsand if I'm not, what's my
relationship with my employer,am I going to leave?
Am I going to seek alternativeemployment?
Things like that.
And so it's really become realfor a lot of people in this
timeframe be, and mostly becauseof those employer mandates.
So that's thing.
Number one, that's been thetopic where a lot of things have
been sorted.
(14:58):
Topic number two has been alittle bit of conversation
around how do we evaluate how wedid with the pandemic and in
particular, how do we look atepidemia life?
Evidence looking forward andknowing that there's going to be
a point in the future in whichwe encounter in a rapidly
spreading infectious diseaseagain.
And so I think, you know, we'veexperienced where there's just a
(15:19):
lot of feelings that people havearound mandates and statements
by the CDC and things like that.
And still a tremendous amount offeeling.
There's been changing goalposts.
We don't really know what'sreal.
We don't know if these mandateswere effective.
And so what I'm interested intalking to Steven about a little
(15:39):
bit is how do we think about thequality of epidemiologic
evidence?
How do we really get a sense.
What interventions were helpful.
And what, what interventionsmight we be able to forego and
future pandemics?
And things like that.
I think it, there's, there's acertain amount of despair of
knowing that I've beenencountering people where it's
just like, There's just no wayto tell.
And particularly because wecan't do things like randomized
(16:02):
controlled trials, you know,like we do for drugs when we're
talking about these big socialinterventions.
And of course those big socialinterventions have been the
things that have really impactedpeople.
You know, in huge ways.
And then thing, number three, isthis, this question of, you
know, the at-home testing, Ithink has been really relevant
and people are trying to makewise decisions of like, can I go
to an event if everybody'svaccinated?
(16:24):
And do you test beforehand andthen with the Illume tests,
having a bunch of false positivetests, how does that change our
orientation towards hometesting?
Does it change?
Is that a blip or is that sortof a indicator of the utility of
these things to begin with?
So I think.
Those, those have been kind ofthe three topics that have been
circling around.
And then you know, just to throwone more in the mix is, is the
(16:47):
mental health burden that we'veseen.
And, and I think just as thispandemic has stretched on now
from a year to network going on,you know, almost two years and
it feels like.
We're still kind of diggingourselves out.
I do think that there's a reallysignificant burden in the
community.
People who are really sufferingfrom things other than just
infectious disease as this isgoing on.
(17:08):
So, so those are, those are the.
To concerns that people havebeen bringing to me the points
of conversation.
And I don't know, we have just afew minutes, but maybe we want
to kind of hit those, you know,1, 2, 3, 4 as we go and see what
you guys
Matt Boettger (17:21):
think.
Yeah.
Sounds good.
I'm so glad you brought thismost simple questions to the
foregrounds.
Cause we didn't have a lot oftime to adjust.
Really some surface level, justicebreaker topics.
Okay.
So maybe we should do this insomewhat of reverse, reverse
order, because I feel like a lotof time, I think the Illume
thing, the mental health, let menot quite reversed because the
(17:43):
mental health is a big, big, abig bag of something.
So let's hit, let's hit handle aloom and what that symbolizes
and then work backwards fromthere and do the Illume.
And then the question about thelockdowns from Steven.
So.
Stephen.
This is your show.
Now a glad, a great questionshere.
I will let let's talk about theOlympics that was on mine thing
(18:03):
as well.
Like, oh, is this just a blip orare we get, are we changing our
tune to maybe these aren't thebest thing it's causing more
problems.
So, any thoughts on that?
Yeah.
Stephen Kissler (18:13):
It's it's tricky, right?
It's like what we w we wantthese tests to be as accurate,
meaning as sensitive and asspecific as possible.
So we don't want falsenegatives.
We don't want false positives.
And so I think that I am still,I'm still deeply convinced that
that rapid tests like the Illumetest and especially like some of
(18:33):
the others that are available tobuy an X now.
And many of the others they havenot yet been approved in the U S
but that have been approved inmany other countries in the
world.
Can be, and should be a centralelement of our route out of this
pandemic and sort of, emergingfrom this two year long You
know, a real burden that we'veall been carrying.
I think that the, the issue hereis around how, how we use tests
(18:57):
because the tests, test doesn'texist in isolation.
A test, it gives you informationabout some specific scenario
that you're trying to learnsomething about.
So one of the things that therethat you can do to adjust for
these false positives as to.
Include a verification test,which many of the tests already
(19:17):
do.
So there are very simple ways toget around some of these issues
with false positives, falsenegatives that really enhance
the accuracy of the tests.
And the thing that we're lackingmost is not.
Good testing technology, butgood testing protocol.
People don't know how to use thetests.
People don't know when to usethe tests and the tests are very
(19:37):
good if you know those things,but in the absence of that, the
tests are useless no matter howsensitive and how specific they
are.
So that's my major frustrationis that even these tests that
have lower in this case,specificity, meaning they were
giving some false positives.
They could still be extremelyuseful.
If used in the right way.
And so, so that, that I think isthe issue.
(19:57):
We're trying to find atechnological answer to
something that is actually muchmore fundamental and in some
ways straight.
Mark Kissler (20:03):
Yeah.
And I think just to specify,it's not by used in the right
way.
It doesn't mean there's aimproper testing technique being
used, but what's what I believeyou're referring to as a sense
of understanding this concept ofwhat's my pre-test probability
you know, do I have symptoms?
What am I testing for?
Then the test characteristicsthat are inherent to the test
(20:23):
itself.
And then that those two thingsactually interact to give you a
post-test probability ofactually having COVID.
And so there's it.
And there's other ways to thinkabout that.
Like, what are the scenarios inwhich we're using these tests,
but that is that right?
That you're meaning it's notthat we don't know how to use
the tests, but it's actually, wedon't know how to
operationalize.
You know, to make decisions.
Stephen Kissler (20:45):
Exactly, exactly.
And right.
And even like, what are, whatexactly are we testing for?
So there's, there's the pre-testprobability, there's the test
itself.
And then, you know, what are,what are we going to do with
this test once, once once itcomes out, do I want to know if
I have COVID and needs to seekmedical care?
Do I want to know if I shouldsend my kid to school or not?
Do I want to know if I shouldlike show up to a family
(21:06):
gathering and all of thosethings, contextualize how you
interpret the result that youget.
And I think that we, we have apretty good sense of, of what to
do and all of those differentcases, but the communication
around it has been pretty poor,at least here in the U S.
Matt Boettger (21:20):
That's great.
That's helpful.
It can.
I I don't know if this relevantto remind me of this concept,
like habit stacking, where likeyou, you're trying to build a
good habit and as an island,it's just not sufficient.
You really can't get a goodhabit sometimes to get started,
but if you stack them with otherexisting things that actually
elevates the probability thatyou actually can develop a good
habit, I think this is like asimilar, like taking an, you
know, a rapid test in of itselfis one thing, but to stack it
(21:42):
with all the other things thathelp to surround it's context
and circumstances reallyelevated.
The effectiveness of the actualtest.
So the treated as a one pillthing, it's just not going to be
it's purpose is to be used incontext.
Right.
And so that's, that's reallyhelpful.
Thanks, Steven.
I appreciate it.
Okay, go ahead,
Mark Kissler (21:59):
mark.
Do you have, oh yeah, I was justgoing to say let's hit, let's
hit that.
The next question.
Right.
Right.
Matt Boettger (22:05):
This is a big one locked down.
Even in my little basement, youknow, it still affects me.
So when I talked to no one aboutmyself and maybe a few people
online the whole concept of, youknow, do lock downs did lock
down to work.
Did the, are the mass working?
And there's all this evidencethat would get from the media of
people who were fully mass inthe spread like wildfire or
(22:27):
people, you know, you know thatmark.
Really old article.
I sent you guys from Japan aboutthe existence of how without
lockdowns, this is how theysurvived that this was, this was
a while ago.
This was well over a year, Ithink a year ago when that
article came out, maybe less.
So just wanted to propose it oflike, you know, in mark, you can
reframe this a little more aboutjust how, how, how do we know
what's effective?
(22:47):
What's not, and how do we cometo conclusions and
epidemiologist?
Yeah.
Stephen Kissler (22:51):
Yeah.
It's, I think that it's, this isA tricky question.
And it's one that we've beengrappling with as
epidemiologists, as people whotend to deal with observational
data, as opposed to trial baseddata all the time.
But never has it been so centralto our existence as humans in
(23:12):
society.
There was a lot of debate aroundthis early in the pandemic as
well.
Where there was even a splitbetween sort of, different
groups of epidemiologists, someof whom Did not think that we
can justify things likelockdowns because we didn't have
the sort of randomizedcontrolled evidence to justify
them.
And others who were and I, I, inmany of my colleagues tended to
(23:35):
fall more into this camp, whichwas that we don't necessarily
know what the effect oflockdowns will be, but we do
know what the effect of COVID.
On a city on a community can be.
And we have sufficient reason tobelieve that this could very
well be helpful in the immediateterm.
And so based on theprecautionary principle, this is
something that we should bedoing even in the absence of
evidence.
(23:56):
And we should be collectingevidence as we go.
But now we're in a verydifferent situation where, you
know, the pandemic has beenspreading for quite a long time.
In theory, we, we do have, andshould have some evidence on
this and, and in fact, we, we dobut as far from straight.
So we can look at the examplesof some countries that have very
strict lockdowns, very strongcountermeasures.
(24:18):
And many of them have had veryfew COVID cases.
Their economies are doing verywell.
We can look to Australia, NewZealand.
For example, there was theexample of Japan.
I think we were talking aboutearlier.
Yeah, and different countrieshave fared very differently
here.
But on the other hand, you know,some we might contrast the
response in Germany versus the US which, which are actually
(24:39):
quite different.
I think Germany tended to havea.
Stricter response.
They've been a lot quicker toadopt technologies like rapid
tests and to use them in waysthat I think are very sensible.
And that has definitely helped,but also, you know, the they're
not in the situation thatAustralia and New Zealand are.
They're much closer to the percapita mortality that we have in
(24:59):
the.
Then you might expect given thedifference in the response
between the two differentplaces.
So one of the big issues here isthat just there are so many
different moving factors fromindividual culture and political
response and just sheer luck,one way or another.
And all of these differentthings sort of play into making
(25:20):
it really difficult to drawconclusions as to, you know,
what what, what is the doseresponse of a week of lockdown
to reduce COVID cases?
And that's, that's the sort ofevidence that we're, we're never
going to be able to haveperfectly.
It is something that we can,it's an evidence-based that we
can build over time.
As we look back at theexperience that we've had over
the last couple of years andbegin to disentangle it, but
(25:41):
it's, it's a messy process.
And I'm going to really.
Empathize with the frustrationthat that many people have about
you know, like there's, there'ssort of the sense of, of
futility and almost hopelessnessthat we can ever know for sure.
And I think that that's in a Iempathize with it deeply because
that's, that's sort of where myentire professional life is
situated.
I, I feel that frustration everyday.
(26:02):
And but I, I am convinced atthis point that even if the
quality of evidence that wemight have is poor relative to
something that you might have ina, in a trial, it's not nothing.
And I think that that mattersstill.
Mark Kissler (26:16):
That's good.
You know, I think a couple ofthemes come out, you know, as
I'm hearing you talk about that,I think one of them is I think
that there has been a lot offrustration amongst people who,
especially who are I think lessinclined to.
Mask mandates, vaccinationmandates locked down, things
like that.
At the use of the, thisnarrative of well science says
(26:37):
that, you know, XYZ, and I thinkthat you draw some important
nuance there where that evenwithin the scientific community,
there's some conversations goingon about how do we use these
models to inform what shall wedo?
And it would be.
It's so tough because I think alot of people feel as if they
don't have access to thescientific knowledge, the models
(26:58):
themselves, to the ability, youknow, to really parse that such
that they CA that it feels as ifthey're, they can't participate
in that conversation in arightly, because it takes
experts.
To do that.
That's why you went to schoolfor as long as you did and your,
your colleagues and continue tolearn, you know, out of school.
And then what happens.
And I think this ties to ourlast point around the vaccines
(27:21):
is that in that scenario, youknow, in which I can't
participate, you know, in.
More nuanced conversation thatreally weighs the data.
Then what I ended up trustingare local authorities and local
authorities that I'm at here orcohere to my pre-existing set of
(27:44):
beliefs to a certain degree.
Right.
And so I thought there was.
Newsweek article I'm using thiskind of by way of transition to
our vaccine point, but Matt, yousent out this, this interesting
Newsweek article about a womanwho is, you know, very highly
educated and articulate andtalked about the reasons that.
It was not vaccinated.
And you know, she, she was like,I believe that the vaccine is
(28:04):
important.
She wasn't categorically, youknow, anti-vaccine and Juan, you
know, believes in COVID andwants it to end, but laid out
her reasons.
And what I found mostinteresting, you know, I think
some of the reasons there, youcan go point by point.
And you, and I, I feel like, youknow, Somebody who you could
have a really fruitful dialoguewith and who, you know, I might
learn something from, and shemight learn something from me
(28:26):
about, you know, how do we weighthe relative risks of side
effects for instance, or how dowe understand the evidence that
she cited about people who arevaccinated still spreading COVID
you know, I think there's somereally important.
Around that.
And you know, the way that thevaccine actually reduces the
incidence of getting infected,you got to stack those
probabilities.
(28:47):
So we can talk about all thatpoint to point, but where she
ended her argument, I think isthe most illuminating thing,
which is that it was in aconversation with her physician
who she trusted.
And she didn't get thisunequivocal yes.
That you need to get vaccinated.
And so for her thatcrystallized, you know, all of
these little factors, like alittle bit.
You know, frustration about thechanging goalposts or the
(29:10):
perceived changing goalpostsfrustration about the CDCs
messaging frustration about, youknow, the government and various
ways, but then it crystallizesin this local conversation and a
local sense of who then do Itrust.
And I think that's, I don'tknow, I feel as if we're really
encountering that in a lot of ina lot of ways.
And so, you know, we, and as weknow, there's just a lot of
(29:31):
variability.
Then in these local authoritiesyou know, variability and how
valid their advices howevidence-based it is, you know,
and I think just in your one'sdesire to listen to somebody,
you know, based on a whole lotof issues that maybe don't have
anything to do with COVID.
And so that, I don't know, I,it, it seems to me when I'm
(29:52):
having these conversationsabout.
Vaccination you know, and, andsome pretty real stress that
people are experiencing relatedto work and vaccine.
That it's often coming down tothe sense of like, who's my
local authority that I can trustaround this to kind of cohere,
you know, all these vaguefeelings that I have into
(30:14):
something that's actionable.
Does that strike you guys asright?
Is that something you've beenseeing too amongst, you know,
friends or I imagine a lot of ushave kind of homogeneous work
environments are more or lesshomogeneous work environments.
Right.
Where there's a lot of.
You know, but, but I think for,for those of us who have friends
you know, our family that spanthese ideological starting
(30:36):
points, I think this has beenreally relevant.
Matt Boettger (30:39):
Yeah.
I totally agree.
I don't even think it's so muchlocal authority, but if it just
authority in general, becauselike, you know, it's so easy, it
depends on what, you know,What's kind of the, the fat of
the culture, but like, you know,if it's football, you know where
to go for your authority, itmight be ESPN or whatever it is.
Like you got your places to goto, like, where do I need to get
my information of like, what'shappening and how do I make my
(30:59):
decisions, that kind of stuff.
But when it comes to.
When it comes to a, you know, apandemic, we haven't, this
hasn't been a fad.
We don't know where to look to.
And the first thing I thoughtabout mark is like, where's like
the NCAA brackets ofepidemiology.
It's like, you know, you have,you have one side and here's the
brackets of here's one side,here's the other side.
These are all the professionalsgoing at it, talking about how
(31:20):
do we deal with the pandemic andbegin to be able to digest it in
a way.
And inform ourselves versuslike, I have no idea.
If it wasn't for a randomFacebook post by Steven in like
I, whatever it was February of2020, I would have no idea about
any of this stuff.
What an epidemiologist reallydoes.
And I've been informed by justmy lowest hanging out.
(31:43):
And for me, it's, it's not inthe forefront of my mind.
It would be okay.
A doctor's a physician.
So that's the end all be all.
What do you think I'm done?
Right.
Had no clue that there wasanother area.
Mark, you did, because you wentto school for this, right?
So, virology and vaccinology,all this stuff, I had no idea.
It's just not even in the realmof having to even find this
information.
So,
Mark Kissler (32:06):
yeah, and I think it's interesting.
Even just the idea of a bracketthere's this, we were so deeply
committed right now in inAmerica to a competitive or kind
of a conflict oriented thatthere are two sides.
Right.
And I think there's.
W one of the helpful things, Ithink that the conversation
around vaccine hesitancy isbringing up is with this
reminder that there aren't,isn't a uniform reason that
(32:29):
people are not gettingvaccinated and there's not a
uniform prejudice againstvaccine.
That it's actually is a lot youknow, there's a lot of things
going on there, but also thischaracterization that there are
two sides, we're so deeplycommitted to that.
And to these metaphors thatwe're using about.
You know, th that arefundamentally they're, they're
combat oriented metaphors.
(32:49):
And we use that in all levels ofour society right now, to sort
ourselves out, you know, andsure.
Maybe there's, I'm notsociologist or an
anthropologist.
I'm sure there's.
A lot of strong tendency to sortourselves in this way.
I found it to be extremelyunhelpful you know, over the
last year and a half two yearsand I think it would be great.
(33:11):
I, one thing I'm interested inis how do we, how do we begin
our conversations from astarting place that undercuts
that metaphor that says like,let's not figure out, let's not
sort out where we stand beforewe engage.
Let's engage.
Something real, that matters andbe really rigorous intellectual
rigorous about it.
But that's kind of, that's oftenI think, kind of pie in the sky.
(33:32):
So,
Matt Boettger (33:32):
I think in some sense it is binary, but like,
You know, for me this I oversupply it, I can be over supply
things, but like it's either inthis situation there, the
vaccine get the vaccine or notvaccine.
But then like in my mind thatbrackets is kind of a good
imagery because in, from thatthere's a narrative that plays
out and that narrative, it getsa little more complicated as you
expand out where there's,there's more, there's more
nodes, there's more things.
(33:52):
There's more complexities forreasons.
Why?
Because there's no one reasonthere's, you know, I'm not
vaccine because of.
Immune compromise, whatever, butthen it keeps going further and
further, further, and we findtons of different nuances to the
reasons why, you know, there'sthe one extreme, the
anti-vaxxers and there's the,then there's the other ones are
just like, because of concern,not having the right
information.
And there's a myriad of reasons,right.
(34:13):
Or those who who'd actually takethe vaccine.
There's tons of reasons why thatmean that as you expand outward,
that neural network becomeswider and wider and wider and
more.
You know, but, but, but it seemsas if there is some common
thread that kind of unites thosedecisions to be able to find and
discover, but I that's kind ofway, but not in combat.
Yeah.
Not in a combatitive sense.
Mark Kissler (34:34):
Yeah, yeah, yeah.
I'm aware of the time and whereeverybody Stephen's gotta be
pretty quick.
Is there something else that,that you guys wanted to chat
about or Steven that's on yourmind this week?
Thinking about this stuff.
Stephen Kissler (34:47):
Yeah, no, I think the only other thing,
like, just on that last point tojust echo that I've, I've also
experienced I've spoken with alot of people who have very
diverse and well thought outreasons why they themselves
might not have gottenvaccinated.
And it really, you know, This isone of the I think difficulties,
(35:07):
you know, again, I think aboutthis as a statistician, as an
epidemiologist, I think it'salso just a real human problem
with like, how do we, how do weavoid flattening narratives?
And it came to mind when we weretalking about the The role that
the media has played in shapingsome of the narrative around the
pandemic.
And I think mark something thatyou had mentioned earlier about
(35:30):
how there is this discussiongoing on, even amongst.
About what should we do?
And yet that somehow getsflattened and distorted as it as
it reaches people who are notscientists to make it seem like
there's this monolithic.
Scientific opinion on all thingswhich then becomes sort of more
(35:50):
of a moral statement than ascientific statement at some
point.
And I think that it's, it'sreally interesting.
I, I don't know what to do withthis, but I think that this is,
you know, this is a deep Issuein that, you know, I think both,
you know, both the, the mediaitself, but also just the
platforms with which we shareinformation can sometimes serve
to amplify single messages tothe detriment of, of more nuance
(36:12):
within those messages.
And make it seem like there is asingle reason to not get
vaccinated and that a person whois unvaccinated falls into this
very stereotypical category.
And we can, you know, thinkabout that with all sorts of
different things that havearisen during the pandemic.
One of the really interestingthings to me about this is that
there's also.
Concurrent major shift withinthe scientific community to make
(36:33):
our research and ourcommunication more and more open
and accessible.
So there's a huge open accessmovement in journals.
We, we post almost everything aspreprints.
There are many scientists, keyblogs where you can directly
access their thinking.
Many of us have been publishingop-eds in different newspapers
and magazines.
And so basically all of this wasto say that I, I don't, I don't
(36:58):
understand all of the issues.
And and, and why, you know, whysome of this flattening takes
place amidst this landscapewhere, where it should be much
easier to have direct access tothe people who have been
thinking about these things forlong before.
COVID 19 had a name So, I don'tknow what to do about this, but
I do think that that justmaintaining this, this initial
(37:20):
stance, whenever encounteringany new piece of information
that that there's probably a lotof complexity that that
underlies whatever messageyou're hearing is probably a
valuable thing.
Mark Kissler (37:31):
Yeah, I think that's great.
I think the last thing I justwanted to make another plug to
kind of go, we didn't, ofcourse, we're not going to break
down this whole.
Conversation around you know,depression, hopelessness, social
isolation that's much bigger ofa scope than I think any of us
can really tackle.
But I do think just as a, apersonal plug, if I would just
(37:53):
encourage everybody, who'slistening to check.
Folks around them and just beaware that I think there's a lot
going on underneath the surfacefor a lot of people right now.
There's a lot of, and so justjust checking on people and
making sure that we're not, youknow, perpetuating this dis you
know, whatever distancing thatwe're doing to be actually you
know, interpersonal.
(38:14):
Distancing as much as possible.
So it can, it can make a bigdifference, I think, to look in
on somebody and, and to checkin.
So I just encourage everybody tobe doing that.
That's okay
Matt Boettger (38:24):
to end this market.
Thanks.
You know, I kind of like a goodbeginning of March of 2000.
Asking people again, same thing,mark.
You're asked for the check in onpeople.
There's almost in some sense, alittle bit more nuanced where
our habit was to be really openout and doing things.
And we're being forced to beingclosed down.
Now you've been closed down fora year and a half, almost two
years.
This in the most subtle way, isthat reaching out with a context
(38:46):
of leaning into human contact,again, it's like we built a
reverse habit now it's been sointense.
Our, our initial reaction is tostay away.
And I'm not saying that if youfeel like you're conscious of
saying whatever that may be, butto encourage ourselves to reach
out connect and now fight theurge to be isolated and begin to
try to find ways to re-encounterthe world, because this is not
(39:08):
going to end at least this.
Mental cycle for a long while.
So there's, there needs to beanother rehabilitation going on.
So thanks for sharing that.
Okay.
That ends this episode.
Glad to have mark in so thankfulyou could join us and hopefully
you can be more regular.
I know there's a lot of thingsgoing on in your life.
Steven, so good to see you havea wonderful rest of your day,
(39:29):
the conference and forever theeveryone who is listening.
Thank you for listening.
Please subscribe.
If you haven't subscribed, ifyou can join us to support us
patrion.com/pandemic podcast,$5a month and go a long way.
One time donations, Venmo,PayPal, all in the show notes.
Please leave a review.
We love them and inspires us,keeps us going and reach out to
(39:49):
us, matt@livingthereal.com.
I will immediately forward thaton to mark and Steven, so they
can be encouraged as well andeven answer questions as they
come along.
Take care, have a wonderfulweek.
We'll see you in a couple ofweeks.
All right, bye bye-bye.
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