Pandemic: Coronavirus Edition

Dr. Stephen comes out of his Delta research cave to talk about his findings and the pre-pub

• Dr. Stephen Kissler and Matt Boettger • Season 1 • Episode 84

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Matt Boettger:

You're listening to the pandemic podcast. We equip you to live the most real life possible in the face of these crises. Ooh, I'm winded. Sorry. I came home from the basement. My name is Matt Boettger and I'm joined with my one good friend, Dr. Stephen Kissler and epidemiologist at the Harvard school of public health. How are you? Fine, sir.

Stephen Kissler:

Hey, I'm doing all right, man. How are you doing, doing

Matt Boettger:

well, apparently I need exercise cause we were getting ready to record. And the door to the basement upstairs is open. And I could hear my boys screaming and jumping wildly. And so I wanted to solve that. So I ran upstairs to quick closet. And now after five seconds of moving, I'm absolutely winded and I need to take a nap

Stephen Kissler:

and we all need a nap at this point. You know, anybody who's listening to this, who's like trying to decide between listening to the podcasts and taking a nap, take the nap first.

Matt Boettger:

Hey, you know what? We might even been a loyal to sleep right with our sweet, sweet talk. Right. So if you're having a tough day, Plug us plug us in your ears and you'll fall fast asleep and have COVID dreams, which I don't know if that's a dream or a nightmare. Oh, well, thanks for joining everybody. We're glad to be back. We took a break last week and there was a reason for that because, well, Dr. Mark, like usual couldn't join us. And Steve. Was going crazy with some Delta research. And so he was burning the midnight oil. I thought it's only good for us, us listeners to give him some time and to do what he does best, which is great news for us this week, which means we get to chat about what he has found. Talk about this pre-pub that might be going out today, or as he's letting me know before we get to that, let's do the basic stuff. That is number one. Please leave a review. I was going to do both of them, but I didn't have time to snapshot. And maybe I am, maybe I can pull it up really quickly, but we have one from J K G U H C D F. That's a really profound name five stars. I learned so much from this podcast. I look forward to every episode and usually listen to them more than once, because they are so much information to absorb. Thanks for all you do. You're absolutely welcome. It's my pleasure. I learned so much every time I'm out here. Cause I'm the one with all the questions and I get them answered. I'm the lucky person in this podcast, another one from Renee bird and I'm going to 10th. This is the best podcast out there on the pandemic. The three hosts are intelligent and well-spoken the discussions are based on science and real life experience. I'm a registered nurse. Therefore, what I most especially appreciate. Is that the information is not dumbed down or scripted. There's very little political opinion expressed. It is clear. The topics are well-researched keep up the great work gentlemen Marine from Philly Marine. Thank you so much. There's more she says on here. But thank you so much for making that review. It's so helpful. So if anybody else can please do it, keeps us going. It keeps us motivated. Not so much me, it motivates me, but Stephen and mark, the ones that do the heavy lifting, it keeps them lifted up and

Stephen Kissler:

strong. Yeah, I appreciate that.

Matt Boettger:

And if you can support us in other ways,$5 as little as$5 a month at Penn patrion.com/podcast or one-time donation, Venmo, PayPal, all in the show notes. We'd love to have your financial support to keep this going. And I think that's all the good stuff. So let's get right into this. Steve and I have a handful of questions and it's been two weeks now and I've seen a number of a number of headlines pop up that just, I wanted to discuss with you. But it sounds like from what we talked about before we got on, we might be able to get most of the address through your pre-pop they were talking about, so let's go straight into this. We didn't get you last week. There's a reason for it share like what's going on, what motivated this research and what kind of things he has found.

Stephen Kissler:

Yeah. So this is sort of version number three of a ongoing study that we've been working on. So this is. A study, that's been following a cohort of individuals and they've been tested for COVID very regularly as, as often as we can, we're doing it every day. And this is with what we call quantitative PCR tests. So when you get tested for COVID normally unless it's one of the rapid tests you're getting tested with PCR. And one of the benefits of that is What that gives back is that actually, it doesn't just give you a positive or negative, but it actually gives you this sense of how much virus is in your body. Now, when you yourself get tested, you usually only get that positive or negative result, but on the backend, there's this continuous. Yeah. That tells you basically how much, how much virus was in the sample. So since we've been following this cohort of people over time and they're getting tested whether or not they're sick, whether or not they're showing symptoms inevitably some of them do get infected. And what you get to see with that is you see out of the entire trajectory of the viral load in their body over time. So you can see it basically what it looks like. Is it okay? It sort of looks like this little triangle where it just sort of goes up and then it reaches a peak and then comes back down and then sort of, sometimes you get these sort of low level positives that sort of linger for a while when your body's sort of spitting out viral fragments as it's recovering, but by and large, it's basically actually this really remarkably simple increase in decrease in viral load as the virus sort of takes off in your body. And then as your immune system takes over and fights it off. So why is that important? One of the things that allows us to do is to look at how those, what we call viral load trajectories differ between people. And so one of the things we've been looking at is how they differ between different variants. So looking at the alpha variant, the Delta variance, the previous variance and looking at how it differs between vaccinated and unvaccinated people. No. Why does that matter? Well, if we have an understanding of how these viral trajectories look we can get a sense for how long the infection lasts, which has implications for how long people need to quarantine. We can get a sense of if people who are infected with different virus, Produce more virus, which might mean that they're more infectious. We can get a sense of if vaccinated people clear the virus more quickly, which would give us a sense of why vaccinated people might not be as transmissible as unvaccinated people. So all of these things sort of underpin a lot of our understanding of, of what drives the spread of COVID-19 and what we can do to prevent it better in a sort of finer and finer categories of people. So, what did we find? Well, I mean, as I mentioned, the main axes that we've been looking at this on are comparing alpha Delta and sort of non variants of concern and then comparing vaccinated and unvaccinated. So one of the things that we found was that there's actually not a lot of difference between the variants in these viral trajectories. So, whether you're infected with alpha Delta or non variants, according to the data that we have. You basically produce similar amounts of virus and similar amounts of time. And you clear it basically equally quickly. Now that contrasts with some recent findings, you know, there was that study that we talked about a little while ago that said, you know, people who are infected with Delta or a thousand times, you know, they produce a thousand times more virus. Okay. The more we dig into that study, the more I am not totally convinced that that's the case. There've been a lot of other studies that suggest that the peak viral loads are similar. Not many have reproduced that sort of orders of magnitude higher viral concentrations. Okay. So, and this happens all the time in science, you know, it depends on how you analyze the data. It depends on where the data's coming from. And that's why it's really important to have a lot of different studies looking at this from different angles so that we can reach some kind of consensus. Yeah. So that's what we're aiming to do with this piece is sort of reach some kind of consensus here. So, okay. So we find that the variants have similar viral trajectories within how, how do we account for the fact that alpha it was more infectious than that Delta is even more infectious than that. Yeah. Well, one of the key things that seems to be in play here is that it actually probably has something to do biologically with the virus itself and how how strongly it binds to our mucosal cells basically. So what are those? Yeah. Yeah, exactly. It's like, what gives you a snotty nose? And so, basically the viruses first point of entry into our bodies. And so, so it can probably bind more strongly to those, which makes it more infectious. And so even though you're producing the same amount of virus, that means that it takes less virus to create an infection. And so that's one of the places that we get the difference in infectiousness. Now the other thing is that with these viral load trajectories, we've been measuring them from the notes from nasal swabs, but you know, the human body is a pretty complex multifaceted place. So just because you have similar viral trajectories in the nose does not mean that you have similar vial or trajectories in the throat or in the lungs or in different parts of the body. So one of the things that might be happening is that you know, you might be producing. Equal amounts of virus in the nose, but maybe it's actually the amount of virus in your lungs. That's most important for transmitting. That's just not something that we had access to. So motivates a lot of other studies. Now the other axis that we were looking at this on was people who were vaccinated versus unvaccinated and there, we actually do see a pretty clear signature that. Both groups of people produce similar amounts of virus, but vaccinated people clear the virus more quickly. And that's consistent with a couple of other studies as well that have come out recently, which, you know, suggests that you're probably not as infectious for as long. When you get the vaccine. Now, one of the things we couldn't measure, but that another study has recently come out with us. That also, it seems like in vaccinated people, even though you're producing the same amount of measurable viral fragments, basically through this PCR test when you're vaccinated, less of that virus is viable. Less of it is able to create an infection at another person. So even though you're sort of like spitting out as much viral genetic fragments, When you're vaccinated, that means that your immune system is doing a better job at sort of chopping up the virus and making it so that it can't go on to transmit to other people. Which is a good thing as well. So both of those things are probably contributing to reduced infectiousness from vaccinated people too. So that's all good news. That's great. Yeah. So that's, that's basically what we found. And those are some of the findings that we're trying to grapple with and figure out, you know, what do they mean now? What do we do with that?

Matt Boettger:

Yeah. The first thing I thought of when you were talking about the viral loads, you said that relatively the same amount, but it seems as though that maybe it's, you know, they're not quite as bad. The first image I had was like 1990s, Mike Tyson's punch out we're out if he has any played that. But like where you're, you're, you're boxing the dude. And then when he starts to tour twirling around in circles, before he drops as if like, you know, they're getting, just getting beaten with the vaccine and it kind of come out, but they're like dazed and confused. They're all bruised. And there's like one in randomly don't even know what they're doing. So, so it's a possibility that, okay, you have the same viral load, but it's not viable, meaning that it's just not quite as effective. Yeah. Or to build in fact of the people. That's. That's awesome. Yeah. Was there anything that you found related to? Okay, so all this data came out. It's like a combination seemed like the UK study, the CDC talking about, okay. Same viral load, but it's shorter period of time. So it still benefits us. Was there any innovation you did in the study or maybe anecdotal along with the research about demographics of people? Does it affect any other. Have a tendency to affect a different demographic. Like I'm thinking of children like usual because my kids are still in vaccinated. Is there anything related or is this still seem to be, it's the same kind of reality, but just different kinds of ways it's transferred.

Stephen Kissler:

Yeah. So this is you know, I think this, this is actually a good entryway into sort of how how do we learn about these things as epidemiologists in the first place? Yeah, so, the short answer is that we still don't know. It's, there's, you know, We have definitely seen, you know, record hospitalizations among kids in places where Delta is surging. But again, there are two possible explanations for that. One of them is that Delta, you know, as such is just more pathogenic in kids than previous variants. Or, you know, again, kids are much more likely to be unvaccinated because the vaccine hasn't been approved in young kids. And so maybe what we're seeing is just the relative benefit of vaccination in older age groups. So when you compare what's happening in kids to the older age groups, it looks like kids are being a lot more severely infected, but really what we're seeing in kids is what we would be seeing across the board, which is a terrifying thought with Delta. If we weren't, you know, if, if there wasn't this reality of vaccination And the, the, you know, the incredibly unsatisfying answer is that we are not sure yet. Part of the difficulty is that, you know, and this is the eternal struggle in epidemiology is that we can really only observe, you know, our, our present moment. And we can't really go back and, you know, say in the exact same circumstances that alpha was spreading however many months ago. Compare that to somebody who was infected with Delta instead. What's the difference in probability that those two people would have you know, ended up in the hospital or, you know, depending on their age group, because you know, so much has changed. We're, you know, whether it's, you know, differences in restrictions, you know, and distancing differences and masking variation in vaccination rates, you know, the variant itself, whether or not schools are in session, all of these things are profoundly changing the environment in which it's spreading, which makes it really difficult to disentangle these things. So, Thinking, you know, as a statistician, you know, the way that we usually approach these things is that and you know, this, this runs deeper than statistics too, but yeah, we, we usually prefer the simplest explanation, sort of the, the explanation that, you know, nothing has changed until there's evidence to. Suggest otherwise. So that's the idea of the null hypothesis. If you go back to your stats, 1 0 1 courses, right? So, you know, it's kind of this arbitrary concept, but you know, practically speaking, what it means is that our null hypothesis here is that Delta is more infectious across the board. And we know for sure that that's the case. And then the question is, is that sufficient to explain everything that we're seeing and it might be, it's going to take a lot more evidence to suggest that it's both more infectious and. Has different, you know, pathogenicity profiles in different age groups. Because so far what we're seeing is, is consistent with increased infectiousness across the board. There could be other things in play, but we just don't have the, the strength of the evidence that we would need to overturn that sort of no hypothesis. Okay.

Matt Boettger:

You know, going back to number one, it's just, it's just still kind of a scary thing for us. Cause we just to try and figure out what, what should we do as chill, you know, with our kids. And it's hard when you say you don't know because it's, school's in session now, thankfully we're homeschooling another year and that helps a little bit, but we have a wedding to go to in a couple of weeks and we know all three of them are unvaccinated and just in, so this kind of gets to the other thing. So my kids are unvaccinated. Millions of kids run backstage were obviously younger. Like my six, five and three, your best course of defense is to wear a mask. Right. That's what I can do. Right. And social distancing rent. If you're, if you have to go out right and wash your hands and all that. So playing devil's advocate here, in the sense of, in light of your study that you guys found like potentially that roughly the same viral load Delta alpha, but maybe one of the situations is that it's the, the quality of the virus that's actually causing the infection and not necessarily quantity. Now, when I'm thinking in my head going back and reverse engineering, why were masks? It was because it was the quantity, the focus was on quantity. And so that a mass helps reduce that. Cause it's, it's not perfect. But now if it's now quality, maybe then it seems like it's a possibility of the mass may not be quite as still effective, right? No matter what, it's not like, it's like, it's, it's still protecting you, but it seems like Delta can chip away. At the effectivity of the mask. So a little bit, if it is the quality, if safe would just, if it just, I mean, I'm exaggerating here, but if it just takes one particle to infect you, which again, that's not what Stephen's saying. Just, just theorizing then it, it can get in sneak in and then bam, my kids are infected. Right. Is that, is that a possible scenario that could be likely in Delta and causing part of the surgeon even. I get it. It's a different ball game. This summer, people are out the pool. People are kind of forgetting this pandemic. People are being a little more, so there's that whole behavioral issue, but even us who are being protected with masks could we could be even more vulnerable with masks.

Stephen Kissler:

Yeah. I mean, I think that that's one of the really important things with Delta is that it has sort of chipped away at All of the precautions that we normally take now that as you rightly say it hasn't eliminated them. Masking is still helpful because you know, it's not a single viral particle that's going to infect you. And so if you imagine that a mask reduces the amount of virus that you spread out into the world, by some, you know, by some percentage, you're still reducing that percentage, you know? And, and so it's going to reduce the probability of infection by that same amount. It's just. Delta's infectiousness has ramped up that much more to ultimately, you know, again, the rule of thumb that I usually use is we think that Delta's probably about twice as infectious as the original SARS cov two that we've been dealing with and probably, you know, one and a half times more infectious than alpha, so that I've basically been, you know, dividing all of my precautions by two now, basically that you know, that the amount of time that I feel comfortable spending. Reduced by about that much. It's the amount of protection that I assume that I'm getting from my mask and that. Principally that I'm giving to other people by wearing my mask is reduced by about that much. If I'm infected, I'm likely to infect about twice as many people as I would have infected, you know, 12 months ago. And so that's kind of the rule of thumb and that sort of helps me to get a sense of agency around this, where it's like, you know, it's, it's not that it helps to avoid this sense of panic that like, oh gosh, you know, we're back at square one, nothing works. Everything is, you know, everything is awful. And, and it's true, you know, Delta is, is a very formidable virus, you know, it is, it's incredibly infectious. And and, and we need to live in that reality, but I think that it's it's still true that like all of the things that we've been doing are still effective. We just have to be on top of them a little bit more than we were. Yeah.

Matt Boettger:

It's been hard. I know I met, I was talking to a friend slash acquaintance the other day. I could tell where he sat, you know, with his, you know, COVID and the political situation. And it was just so hard to take. And I'm like, it's, the evidence seems overwhelming. But then when you get things like, this is where I think it becomes a difficult reality. One of the articles I read was how the media isn't necessarily portraying the gravity of breakthroughs. The possibility, because we're trying to constantly advance the cause of like, no, get the vaccine, get the vaccine. And no, you know, Stephen, you've always been great at being in the middle of like, no, the vaccines absolutely indispensable and there's breakthroughs annually, but it's it's you got to. Now you hear people about breakthroughs. And so I read articles from friends who are conspiracy theorists and see even the media grieves that the vaccines pointless. I'm like, oh my gosh, this is just like mind boggling to me that it can take something like a headlight and clearly didn't read it and not extrapolate it and hold these things, intention that they're absolutely indispensable, you know, thankfully, you know, go, we just, I just, before we recorded Stephen, I told you that the Ft, I got a tweet, a tweet saying FDA grants, full approval of the Pfizer vaccines. My hope. I mean, this is a big day because I know I've had a handful of people in my small networks. Just say, look, I'm not taking the vaccine. Not because they're like conspiracy theorist, but they just want to wait until FDA approval. That's their check mark. And they're okay. So my hope is that this is going to unlock a wave of people to start taking the vaccine because we've realized, and I'm going to have another question to you in just a second, because this is going to be a flip side of what I'm just about ready to say, because we're seeing that the majority. Of infections are in places by which vaccine rates are just incredibly low, right? Missouri, Arkansas, Florida, Mississippi all these, all these places, you know, I know Oregon suffering tremendously right now, but a lot of those pockets are in low vaccinated places. So all the more to help people see the truth to get vaccinated. But here's the outlier. Maybe we need to circle back to this about Israel, right? Israel is just like, they are the poster child of vaccine. And from what I'm gathering, they're suffering a surge. And you know, and maybe you can help explain it my guess, maybe they were early adopters to the vaccine. Could it be waiting a little bit? And so it's among your guys' discussions. How do you guys make sense of that when we're here today and Hey, you know, Arkansas, the reason why you're not you're you're, you're, you're you're so high is because you're, you know, a lot of it's because you're in vaccinated.

Stephen Kissler:

Yeah. I mean, as, as you know, I've, I've been really trying to stay away from it. Drawing too much of a causal link between the young, this particular geographic location is getting hit hard at this particular time because of X, Y, or Z. Because I think that that really LOLs us into this false sense of security, you know, where I'm sitting up here. Boston, Massachusetts. And I think, you know, there's, you can get caught in this sense of like, oh, well, what's happening there because vaccination rates are low and it could never happen here. And we have fallen into that trap way too many times, this pandemic for that to be, you know, it's just, it's illogical, you know? And like, like you said, you know, we have, we have cases surging in Israel. Thankfully, the vaccine is largely providing a lot of protection against severe disease and death. You know, that, that remains the truth. And that's the key. There is evidence, you know, it's as you said, the early adopters, and so probably some of that protection is waning. Part of the difficulty is that, you know, Since, since the vaccines were prioritized in the highest risk groups, those are also the people who have the lowest levels of immunity at this point from the waiting. So they're the most likely if the vaccine protection has waned to end up in the hospital. And so we're seeing an additional boost from that and why some of these breakthrough infections are probably additionally severe because among vaccinated. The people with the lowest levels of immunity are likely to be the ones who were originally at most risk of severe disease. So we're sort of in that weird situation right now as well. But again, I think the critical thing is that like, you know, we are going to continue to see surges potentially major surges in places that have high vaccination rates. And nobody, you know, nobody can consider themselves, you know, totally immune or totally, you know, safe from like this. This pandemic is not, it's not over. I, you know, it's like, and it would be, I know, right. And that, you know, it kills me to say that, right. Like I, I want it to be done so badly. And that's, you know, that's what we've been busting our tails to try to do. But the reality is, is like it will continue to spread. And I think what Israel, the data from Israel show is that, you know, even with high vaccination rates, we're going to continue to see surges in cases. And we're going to have to figure out how to deal with it. Again, you know, surgeries and cases no longer mean exactly what they did before because of the protection from the vaccine against severe disease and death. So, so we're going to have to start to get used to seeing surges and cases and maybe reduce our level of alarm at that because they won't translate into the severe outcomes at the same rate as they were before. But yeah, I mean, I think that, you know, part of the reason we're seeing an early surge in the Southeastern us is because, you know, lower vaccination rates generally, you know, but it's also a lot warmer there. So people are spending a lot more time indoors. That's going to change, you know, in a lot of the rest of the country, our indoor season is coming up here in the fall and in the winter. So I totally expected another surge up here, you know? And so there's this real danger in sort of this Smugness that we can get that like, oh yeah. Well, you know, they're, they're suffering because they, you know, whatever don't have, you know, aren't getting vaccinated and it's their fault. And it's like, no, no, this is not that we've been, we've been down this road too many times before. And it's, it's counterproductive and it it'll catch us. Flat-footed and we're, it's just not good.

Matt Boettger:

Yeah, and I, and now I want to get into it before I get into it. I want to talk about the waning, right? This idea of waning and the idea of this, the rise of talking about boosters, right. I've seen a lot of headlines promoting boosters. I've also seen a lot of headlines and epidemiologists have a second opinion. Thankfully, I've got you on here, so we can talk about whether you think before we do that, just to clarify to everyone. Cause I see this often over and over again. We know that the vaccine isn't as effective as it was at the very beginning, when it comes to the Delta variant and people throw around that 43% as if it's like some dramatic, terrible number in that you have like a 40, you know, you have like a 57% chance. Having something bad happened to you, but just I qualification that 43% is only about infection, right? It's just the infection, right? The still hospitalizations they're in the upper, upper seventies, eighties and onward. Right. That it's pretty high. So it's, it's still very high percentage that protects us from that, which we're actually trying to stay away from. So I wanted to make that clause. I want to go now straight into this idea of waning, right? We're seeing, I'm hearing this idea that about it's about the eight month mark. I'm not sure people are getting this and maybe I need to be corrected. People are saying, oh, it looks like about eight months. Now. It depends on what you're talking about. Pfizer, Madonna. I have no idea that there might be a sense of winning beginning to surface. And so there is this desire for booster. Of course. Now I'm thinking about my mother-in-law and does she, should she get one in October, in November? That's one thing, pragmatically speaking. I saw, I didn't show it to you, Stephen, and maybe you did see it it's like futurism website or whatever. I don't know what it was, so probably probably not credible, but it should have mapped. And I don't know where they asked information from, but they showed like first and second shot. And then, you know, how you get immunity pretty high in that second shot after a while. And then it begins to tail. Like we would assume, I don't know how many months or years, but then they had this idea. That I don't know where this evidence came from, but the third one, the booster just skyrocketed way above, even the second shot of immunity. That there's a sense by which it really does a good job at third one. So that made me all the more, want to give it my mother-in-law. But again, where do you guys stand in? In light of, Hey, Israel might be this, but boosts her. Should we be offering these? Should we be starting to get them? What do you guys consider?

Stephen Kissler:

Over there. Yeah. So yeah, I mean, it's it's still unclear. It's, it's becoming. More and more, yeah, I would say that we're sort of converging on the idea that that a third dose would would be helpful that it does sort of skyrocket your immunity and gives you longer lasting in unity overall. And this, you know, this, this makes sense. Like we kind of, there are a lot of vaccines that we get 2, 3, 4 doses of, you know, when we're young kids and it, it requires. Those repeated, repeated exposures for our body to finally amount a permanent response to to whatever it is. So, so it really, you know, we're talking about boosters, but another way that you can think about it is just as you know, we're trying to sort of fine tune what the standard vaccination course should be for SARS cov. Now one of the places where some of this data is coming from is that a number of different countries have varied the amount of time that they place between their first and their second doses. So for example, in the UK, when the alpha variant was really starting to take off, they really prioritize getting people their first dose. And so for many people, rather than having, you know, a three or four week window between their first and second dose, many people have closer to a 12 week window. And some of the evidence coming back as suggesting that actually that longer window is providing more durable immunity to those people. That that immunity seems to be longer lasting. So that suggests that actually, maybe we should wait a little bit longer between the doses and maybe even give a third dose, you know, 12 weeks 36 weeks after, you know, our last dose. And that, that time sort of allows our immune system to. Go through all the processes that it needs to go through to Mount a really good memory to this virus. And it's tricky because this, this various from pathogen to pathogen, you know, the way that our immune system interacts with different pathogens is so different. Like, it just it's so specific to each one. So we kind of have to figure this out on the fly. And that's what we're doing right now. Now the other big issue, while there are two big issues, you know, so we're talking about. Third dose second dose. You know, what about all the people who have gotten Johnson and Johnson and, you know, different, you know, vaccines, you know, what do we do there? And I think that's another big question, you know, do you boost with an MRI and a vaccine? Do you, you know, what how does this work? And I think that that's a really important question, too. And for anyone who's gotten the J and J vaccine, you know, We're working on this hard too. So I know that there's like a lot of conversation about, you know, Madonna and Pfizer and do you get a third dose? And like, it's like, you know, a lot of people are feeling left out in this cause like, you know, I didn't get you either, you know, and I've only gotten one dose of anything, you know, what do I do? For as far as I know, you know, the guidance isn't totally clear yet, but but we're working on it. So hang tight

Matt Boettger:

comes to dosages and the booster, you know, my, you know, I've been hearing that material. Excuse me, he looks slightly more effective with the Delta variant and it's kind of it's, you know, now you really get a taste of this Stephen where back in April and may was all about Pfizer at the Atlantic. Of course. Atlantic. I'm just in love with either just their titles of themselves. They must do very good job at getting really good titles cause their titles suck me in every time. But you know, talking about how the Pfizer gang is over in this idea, that back in the spring, there was the Pfizer gang. Like the Pfizer was the premier stamp of approval. Right, right. If you're a Pfizer, like you, you are good. And now we're seeing that Pfizer isn't quite as effective with a Delta compared to now the Moderna. So just goes to show. It really doesn't matter what you get because you can't predict the future future. And it could be like five months from now it's AstraZeneca or J and J that's actually knocking it right off the slate. So you just don't know sending something I'm like, okay, well, all I can go is with my baseline. What I know. Was my mother-in-law McKay. You know, I want to kind of fight for her to get to cross over the barrier. She had Pfizer and you know, get the, get a booster that's Madonna, right. That kinda stuff to help, help get, get it, get her along the way. So these are all the considerations I'm working on and seeing, you know, my kids and not being unvaccinated in a wedding coming up in a few weeks and seeing the increase of yeah, COVID sure. But we're talking off the record that RSV. It's kind of raising its ugly head. Right. And, and, and it it's, it's causing a threat to young young kids who, I don't know how much I would imagine it has to be. Super rare, like getting the combo kick in the butt, where they get COVID and RSV and that's causing some problems when you have to. So, you know, really, I guess my PSA and I'm just here. I am just a layman. I know nothing about this, but I'm just taking my advice from things I've read and interpreted my interpreter interpolation from mark and Stephen. And, and that is like really focused on, you know, this is another winter to really focus on the boys getting a flu vaccine. Yeah. You know, and then when, when, and if the vaccine comes available for for young ins to really, to, to go for that, because the last thing I want is, you know, we talked about this last year of having the potential combo of getting the flu and COVID at the same time, I think that can, that potentially can cause a wreck. So, so just, just that consider that as where we get in the fall, all those kinds of things. Yeah. Any last words for you? Anything to,

Stephen Kissler:

oh yeah. Just, you know, circling back to the third dose thing. I mean, I know one thing we haven't really touched on, at least on this episode is like the issue with a vaccine equity too, around the world. And I think that that's a huge issue we have to play into too. You know, we've been talking mainly about the epidemiology of it and probably ideally, you know, everyone will have multiple doses of a highly effective, safe vaccine, but. Yeah, there are so many places around the world where, you know, vaccination rates are under 1%, you know? And so then the question is like, does it make sense to be giving relatively healthy 30 year olds in the United States, a third dose of Pfizer Medina. When they're 80 year olds, you know, all over the rest of the world who haven't gotten anything yet. And I think that that's a really critically important question and something that we have to weigh. So that was just, just a little addendum. I wanted to put into what we've been talking about to make sure it didn't get lost.

Matt Boettger:

I'm glad you said that one thing I'm going to end on. Totally random. We talked about this. I think it's fascinating. Last fall, see, university of Colorado where I worked. I worked. At the Colorado, but I worked on that campus and they did I don't know if all universities did this or not. I, I feel like they one of the first, but they did the wastewater testing. Right. And so all the dorms and they could, they could really easily determine whether there was an outbreak in the dorm and lock it down. It seemed very effective. I heard it's like cost affordable, that kind of stuff. And so there was an article that just came out, just proving the effectiveness down to the point of even houses, individual housing units could determine. And that's a powerful reality and you know, I'm, I'm so gung ho with technology, Stephen, I don't really sometimes think of the ethics behind it. I'm like yes, technology suite, but you were talking about how this could be a great new as an epidemiologist. This sounds great, but this could be a slippery slope and cause some concerns for people, you know, and it's a privacy.

Stephen Kissler:

Totally. Yeah. So I think that, I mean, what I want to start with is just like the possibility of wastewater surveillance for COVID and for other pathogens is you know, the potential is huge. It's great because it's it, it is the most passive of passive surveillance that you could do, you know? And. And so, you know, it doesn't require anything of the people who might be infected or infectious. You're literally just monitoring sewage for traces of the virus. And you can get pretty good, pretty good pictures of if an outbreak is happening in a given location, your rights, you know, see you as a really, in many ways, a pioneer in this technology, you know, we're able to detect outbreaks in dorms before anybody came down with symptoms and Yeah, that's great. That really revolutionizes our ability to manage infectious diseases like this. I think we're going to see a lot more of these kinds of things as we move on forward. Now, one could envision a future in which you have a little, you know, a little virus monitor that's sitting, you know, at the sewage outflow of every household in the United States. And so then it gives, you know, a little ping to whoever's in the house and you know, so it was like somebody, you know, might be infected and, you know, we recommend, you know, here are the different resources you have and the different precautions you might want to take. And on the one hand, that's a great, you know, that, that gives you a lot of power and you know, you can, you can figure out what to do with that information. But I mean, this gets back to the age old question in public health is like, how, how do you do surveillance? Well, how do you do it anonymously? How do you do it in a way that doesn't infringe on people's privacy and freedom and in a way that I, you know, ideally can't get easily corrupted, you know, like, Yeah, I think that that, that could end up being also a slippery slope. If you have information on the level of individual households or even individual people, you know that in times of crisis, that might make a lot of sense. You know, sometimes we need those kinds of responses, but as a constant sort of surveillance, you know, could be great. But I could also see it being a little bit dangerous in the sense that it, my eight. Provided, you know, depending on who has access to that information, it could lead to all sorts of stigma or you know, restriction of basic rights. And and you know, I, I, I'm always trying to look ahead to, you know, we have No, this is, this is a respiratory virus that we've been dealing with for a while. And so now, you know, it's like, okay, COVID, we've been, we're used to living in a world where COVID is spreading. And so it's kind of hard to imagine, you know, this really being twisted, but you can also imagine like a year ago, especially when tensions were really high around. That could have led to some real backlash, you know, imagine your neighbors find out you have COVID or something. And yeah, and I imagine that it's, you know, different kind of disease that spreads in a different route, you know, all of the stigma around HIV or around, you know, whatever, like what if it was something else? What if what if it was a disease that, you know, like HIV was highly correlated with? Especially when it was first spreading with sexual orientation and you weren't out to people, you know, who you were in your neighborhood, or, you know, like all of these things, the questions and the complications layer upon one another in a way that sort of blows my mind. So the technology is hugely, hugely promising. And I think we, as with any new technology, we have to be very, very mindful about how we use it in a way that is maximally. Effective and has the minimum chance of really backfiring.

Matt Boettger:

Yeah. Well, you just summed that up again, once again, it's complicated, right? Because we're dealing with human beings and it's, it's the, you know, efficiency is, is, is one particular thread. But it is definitely. Not the only thread. So thanks for sharing your thoughts on that. I appreciate it. I think we'll end there. Those of you who are listening, thank you so much for joining us this week. And again, we strive to do this every single week whenever we can. And if we don't, there's usually a big reason because we want to be available as much as possible, particularly during this time of Delta and who knows what will be next in the next 6, 8, 9, 10 months buy one piece of solace and I'll send us one more real your way, Stephen, before we end. Response. I heard that with this particular kind of virus, like all viruses, it can be like this, a lot of mutations, but eventually it stabilizes down the road and it's like, this isn't expected to be like this forever. That at some point in time, it's going to mature and find a more routine method of, of mutation. Is that something that, that is a hopeful. Anecdote to

Stephen Kissler:

and on. Yes, I think so. And I, I think, I think that's likely, eventually it will sort of explore the space of different mutations that it can have and it'll find it kind of probably reach its happy equilibrium. That's that's what I expect. And so yeah, we got some more work to do yet before that, but but I think there is hope. Okay.

Matt Boettger:

Great. Thank you. We'll end on that. It's a nice piece of hope. Thank you all for tuning in. If you wanna support us patrion.com/pandemic podcasts, one-time gift PayPal, Venmo all in the show notes. Please give us a review. You can email me, matt@livingthereal.com. Send us some good wishes. What's going on in your neck of the woods, Bruce. I'm thinking of you in Australia right now. Just kind of hearing a lot of stuff going on right now. So I'd love to hear what's going on in your neck of the woods. Have a wonderful week. We'll see you all next week. Take care end.