Pandemic: Coronavirus Edition

Vaccine mix and match and why are the models so off

• Dr. Stephen Kissler and Matt Boettger • Season 1 • Episode 89

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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. My name is my bad name. Is Matt Boettger. Not Becker. That'd be what call me. I don't even

Stephen Kissler:

know how to get dressed up for us Halloween.

Matt Boettger:

We're going to get into that in just a second. And you're totally right, is because it's the day after Halloween and they have three wild and crazy boys. So my name is Matt Barker and I enjoy. With my one, a great, great friend, Dr. Stephen Kissler and epidemiologist at the Harvard school of public health. How are you and happy? Happy. One day past Halloween.

Stephen Kissler:

And the happy one day past Halloween year too. Yeah, I'm doing all right. It was, I mean, for me it was a very uneventful Halloween here. So did you dress up? I did not dress up. I dressed up in my PJ's and went to bed. Gosh. Yeah, it's been a long couple of weeks, so, yeah, I've just been trying to catch up on some rest, which has been good. But yeah, there were a bunch of kiddos running around our neighborhood. There's a lot of young families close by where we live. So, lots of little goblins and monsters running around last night,

Matt Boettger:

which was no. No, I don't know. Cause I've never been to your place. I have no idea. Do they come to your doorbell or are you like in an apartment complex where they don't? Did you get trick or treaters or did you just put a big sign saying I don't wanna deal with you. I'm just tired. I'm an epidemiologist.

Stephen Kissler:

Yeah. So I live in an apartment building, so usually we don't get trick or treaters. We're like way up on the fourth floor too. So they'd have to come quite a ways. Last year we thought about setting up a candy shoot out the window, but never got that put together

Matt Boettger:

last city on that thing from four story could just knock some kid out though

Stephen Kissler:

with. That's right. That's right. Yeah, that was, that was part of the reason why we decided not to,

Matt Boettger:

Well, okay. Yours was uneventful. Mine was incredibly eventful. So I apologize if this goes in places it's not supposed to go in the next 45 minutes because I feel absolutely hung over from. Because I have a sweet tooth and the boys went out in a week. This is kind of a few times in the year. We just allow them to be like, okay, you can be wild and free. They're pretty contained otherwise. And so we went out, went to a few houses of friends and family, and we told them one piece of candy per house, but then we got talking to friends and we weren't monitoring. And they took about 65 pieces and ate them like in one like 15 minutes setting, just consuming as much as they could. And so it was a crazy. Totally wild, totally fun. And I'm exhausted. And we, we didn't get to sleep till probably after close to 1:00 AM. So that's for me at 43, that is a wild night.

So

Stephen Kissler:

that's a wild night. How did, how were COVID precautions? Like what did that look like? And odd existed?

Matt Boettger:

Yeah. I mean, at least outside, but nobody is like, you know, if you had a mask it's because you had, you were a goblin, not because of anything else. And so, it seemed like it was. You know, our neighborhood is doesn't have a lot of trick-or-treaters so, and were close. We were gone, but we went to one that is just known for its houses. They're incredible. And it was just packed. I mean, just the streets were just crammed with trick-or-treaters because it is the coolest sight to behold. So, Yeah. Not much, not much going on, so yeah, it's all there. So, well you, Hey, Stephen, I don't know if you saw this, but we got another review. I want to read this to everybody. Who's listening. Love it. This is from Kate Jan from Tuesday. She says pure excellence. I love this podcast. It is so informed. It is so informed. While at the same time. So relatable, the information is presented in a clear, concise and conversational way. So it was easy to digest and reflect on the host, add a dash of nuance and every now and then some humor, I think we need to add some more humorous Stephen amongst the informative content. And so it's overall quite enjoyable. Some very helpful insights into the relevant issues presented in the time. I really liked the last podcast. Please do a follow-up with regards to the boosters and mixing and matching. As I think we would all benefit from your wisdom, keep living the dream. And I think thank you again so much Kate for giving that. Thanks. It's it just makes us, it lightens our spirits. I think we should go there and talk about the mix and match and we might just kind of go round about and have those towards the end of our outline, but then she kind of set the pace for us. Let's start with that because. It was two weeks ago. And I think we were suggesting that was going to be the case, but I think it just shortly after we released the episode, then it became officially. So we can, we can mix and match. And so now the question is now I don't even know, and maybe you can help frame this because I am not following as detailed as I used to be with all the COVID note news, but there's boosters out. Right. And so now I don't know who. Who's available to get them right now. And what does it mean to mix and match? And since I got Pfizer back in March, should I be fighting for Moderna to get a nice little, you know, accent to my booster or what's going on in your guys' is like talk and discussion there at, at, in Harvard.

Stephen Kissler:

So, I love the question and I think that these mixing and matching of vaccine doses. It's a really interesting and kind of new area in a way for for vaccine regulation. Although, you know, it's, it is frequently the case, you know, there have been many times when a. Seen has been updated or changed. And so there have been, you know, people will get a couple doses of one and then maybe a couple of doses of another the most, well, I mean, clearly we get a different type of flu vaccine every year. And so we have a decent amount of evidence on that. Also for any parents of young. I guess by now they'd be somewhat older, but in 2010, this vaccine that you get for pneumococcal disease got updated. And so that's another one where kids got boosted with a different vaccine than they got originally. And so there's some really interesting stuff we've looked into there. So this isn't like a totally new landscape, but I do think that it's interest. To look at, especially in the context of COVID. And so, I think I'll lay out first, some of the some of the key points that we need to keep straight in our minds when we're thinking about these boosters or a third doses. And then and then talk about Some of the evidence that I've seen. Just anecdotally what some of the people around me have been doing and to thinking about among my colleagues. And so hopefully we can dig into it. So first you know, a couple of weeks ago we had this announcement from the FDA that they were considering and then ultimately approved and sort of gave their blessing as safe and effective. This idea of mixing and matching. Different COVID vaccines. So the official term for that is heterologous boosting. And so, so you may see that kicking around it. If you're looking for more sort of, peer reviewed scientific information, that that might be the term that you want to search for. And so, yeah, so a lot of this is based off of a couple of different observational studies and actually one sort of prospective Study that was done, looking at how different vaccines behaved when they were used as a booster against the backdrop of another vaccine. And so maybe we can link to one of these in the show notes, the one that I've been sort of relying on the most which does. Sort of a three by three grid. So nine different possibilities where, you know, you get J and J Madonna or Pfizer as your first dose or doses. And then it gets boosted with one of those other three. So you multiply the three by the three and you get sort of all of the different combinations. And they looked at Efficacy. And, and they looked at reported side effects from each of these things to do this really sort of comprehensive analysis of what the different boosters seem to do. Now, one caveat with that study is that one of the big things that's been in the news about the Madonna and the Pfizer vaccines is that the maternity has seemed to be giving slightly higher and more durable immune response. If we think that part of that is because the dose was bigger. More and more data injected into you. And that is changing. So with the third dose of the Medina, I think they're going from a hundred microgram to a 50. So they're basically having the dose that you got originally. Whereas for the Pfizer, they're all three of the same, but this study was done with a booster of Madrona. That was the same size as the original two. So that's going to affect things a little bit too. So the boost that you get, what perfectly match up with the data that we have available because they've adjusted to use guidelines a little bit part of the reason they've done that is because of what we'll talk about in a minute, which is that probably with a smaller dose, you're less likely to get some of the side effects, including the myocarditis. Anyway, all of that aside the evidence for mixing and matching the vaccines is pretty good. It seems like mixing the vaccines tends to be at least as good as getting the same one that you got before. It does depend a little bit on what you got before. And so one of the things that I was most encouraged to see was that for somebody who got a Johnson and Johnson type vaccine, initially, if they boosted with a Medina or a Pfizer, then their antibody levels came up, basically indistinguishable to somebody who got Pfizer. Or Madonna first and then got boosted with those same vaccines later. So, that was not the case. So if a person had Johnson and Johnson originally and then got boosted with the same, their antibodies were not quite as high as the person who was boosted with Madrona or Pfizer. So. As far as my public health recommendation for people who got a Johnson and Johnson vaccine, or maybe you're living abroad and you've got something like the Oxford AstraZeneca vaccine, which is very similar, I would say boost with one of the marinade vaccines if possible. And that will basically put you right in, right in line with the people who got MRNs from the beginning. Very protective, very good antibody levels. And I think that's good. No, Of course, we haven't really been following the, you know, in some places. So in Israel, for example, we've been able to follow people and we see that their immune response is pretty long after they've gotten these boosters. But I think one of the interesting things will be to see how mixing and matching affects the duration of immunity. And based off of what I know about immunology, I actually expect that people who have. Mix, especially people who may have gotten a Johnson and Johnson first and then get an MRI and a vaccine. I would anticipate that those people may be among the people who have the longest lasting immunity, because it exposes your body to the most diverse range of of of, of, you know, different antigens that it's fighting against. Unfortunately, if you start. Pfizer and Madrona, and then get a Johnson and Johnson. Your antibodies don't actually boost as high as you would. If you got just three Pfizers with three modernize or two Pfizers and a maternal and vice versa. So I wouldn't necessarily recommend following up with, you know, an MRA with the Johnson and Johnson, especially if you're in a high risk group, but if you're young and healthy and a Johnson and Johnson is available I have something different because there's a chance that it may actually give you a more diverse immune response. That wouldn't be a bad idea necessarily. You know, it, it, it will still give you a very robust boost. Even if the antibody levels initially aren't as high as they would be. We don't know for sure, but it could last longer you know, based off of the, what we know about immunology that's, that's, that's possible. So all of that is to say that if you've gotten Johnson and Johnson, I highly recommend following that with an MRN, a dose. If you've gotten one of the MRN vaccines probably get the one that you got originally, but you could consider switching to the other one. And it seems basically to come out in the wash. And then if you've got the MRMA vaccine first. If you're a bit of a Maverick and you really want to try something new, go for the Johnson and Johnson it won't hurt. And and it could potentially give you longer lasting community, but we don't have the hard evidence to back that up yet. But if you wanna play it safe, just get a third MRN dose and you should be good

Matt Boettger:

to go now. That's great. That helps up talons. And here's my follow-up question. And that is, if you say, okay, we do the J and J and then we've seen that if you fought with the MRMA man, you pushed, it puts you kind of right on the heels. Everybody else with say, who just got MRN a and then if I heard you right, that, but if you have an MRI, NY, and then go to J and J you're not, you may not see the same kind of. Boost. Why is that? It seems such a weird thing in the end. They're the same thing, but order means something apparently. And is there, I mean, am I going way beyond the scope of what we can talk about? Like why, how can that.

Stephen Kissler:

Yeah, I, so I don't fully understand it either. And, and I'm not sure that anyone does, but it, part of it is just how our immune system works. You know, there's there are all sorts of examples where both for vaccines and for natural infections that your immune system does very different things upon the first, second, third, sometimes fourth, fifth exposure to a pathogen. And and that has to do with Just what it's been exposed to, how long it's been between exposures, things like that. And it, it comes down to all of these little biological timers in your body that it takes a certain amount of time for some cells to be produced. And then after a certain amount of time, these other cells will die away. And so there are these relative concentrations of different chemicals in your immune system that basically the, the, the precise sort of relative frequencies of these different cells and these different signalers in your body. It can really affect what your body does when it gets exposed to something and, and some of those dynamics persist for years and years and years. And so, so I don't, I don't know for sure what it is about that that caused that. But definitely ordered. That's

Matt Boettger:

helpful. That's helpful. Okay. I'm going to pause for a brief moment here because there's more so if we wanna talk about two things I didn't mention, but if you want to leave a review, please do so like the like Kate did we love them have kind of, helped us, encourages us to keep going. If you want to support us, you can do that at patrion.com/pandemic podcast is a$5 a month goes a long way, or just a one-time gift, PayPal, Venmo all in the show notes. And I was talking to Stephen earlier about this, and we're gonna get right back into the good stuff in less than two minutes. There's a pre-roll and putting out about, so if you, if you're new to our podcast, welcome, we're excited that you're listening and you have no idea what I'm about, what I'm about to talk about. If you're a long listener, then, you know, right. So another one of my side things is I have this, this, this business living the real, where I do coaching them, developing it. It's been a little bit on a hiatus for a couple of months, cause I kinda regroup through some life transitioning and I'm gearing up to do some. To the next step, the next level. And so I could love your help right now. So listen, the pre-roll, there's a survey to fill out. I'm trying, I'm looking at three different groups of people. And my curiosity among all of our listeners, Stephen, is like, who fits in? What category if anybody fits. Cause I, I haven't done the research of going into like Spotify or apple podcasts to see what our demographic audience really consists of. And I'm excited to hear about this. So. It really helped me tremendously. The survey will probably take less than two minutes, maybe even a minute. And maybe if you're open and willing, I could get on a 10 minute conversation, phone call with a few of you just to understand your pain points and to just to be able to understand, see whether this is an area that I, that I could be most useful in. So check out the pre-roll. If it's still going on, listen to it. If you can take the two minutes, any fit, one of these three groups I'm looking at right now, fill out the form. It would be greatly helpful. Well, let's get right back into why you're here and that's the pandemic and what's going on. We talked about the booster and all that kind of stuff. I saw Stephen that Colorado has seen a resurgence. This is the state that I'm living in. I kind of expected it. It's been kind of slowly percolating for a while. We've been seeing hotspots all over the place. As you always say, Stephen is utterly unpredictable. Who's going to get what, when, where, why, how? And so here we are. I'm not sure why we're in this place. It's the fall holidays. That's part of it, I'm assuming. Right. And the weather's cooling off. Cause I think part of it is that Colorado has been exceptionally warm and we've had you right now. I was just telling you, before we start recording Steve, and I'm like, Hey, it's snowing. So by the way, if you hear like pitter patters are screaming or yelling, it is post Halloween. There's still sugar in my boys' system. I cannot contain it. Good news is it started to snow. So they ran outside, which helps with the footprints above, above me. And we had our, I think this is our first snow, which is a little bit, a little bit long. Right. So it's been warm. So I think that's part of the reason why we've been our numbers have been a little bit lower than other places. Cause we've been outside and enjoying the good weather and now it's on the cooler. But what I want to relate this to is an article that you've spoken about a number of times, Stephen, in one way or another, we've talked about this and the article says this, why do the modelers always seem to get COVID infection rate wrong? And so very striking question. The why it's related is because the same thing, I think it's the same reason why. You don't know whether Colorado is going to be hit when, where, why, how and why, why the Northeast, why the Southwest and who's next. It's like, you could predict this Stephen and you could be absolutely right or absolutely wrong, but I found it and there's this one line at the very beginning that struck me. And I want to use this as the kind of catapult for you to just launch into explain why is it that you guys are so good at what you're doing? But at the same time, it can be so off. And when it comes to the future and he says this modelers insist that they are not making predictions, they are merely presenting scenarios to help politicians make decisions, but as hard to avoid the conclusion that many of these have been wide off the mark. Right. So taking that help us understand that. Man there's been way things off the mark, but at the same time you're doing what you guys do best and some of the best models. How do we kind of reconcile these two things is like, these are guiding, this is guidance for us. And just because they're widely off the mark doesn't mean we just throw them out. The baby and the bathwater,

Stephen Kissler:

right? Yeah. So there's a couple of different layers to this and I'm glad you bring it up. Cause this was, I mean, this is one of my favorite subjects, right? This is like the bread and butter of what I do is these models and, and thinking about them and how to make them useful. Cause if they're not useful, then. Might as well, get a different job, you know? And so, yeah, it's so I think that, right, so the different layers to this, so first models can serve a bunch of different purposes. And you can get into an awful lot of trouble. If you try to use a model that was built for one purpose to tell you something that it wasn't built for. So what do I mean by that? Well, The different reasons that we might use a model is to first just gain a better intuitive understanding of something. So I think of it kind of similarly to like, if you, if you're like struggling with something in your life, if you were feeling, you know, some way that you don't understand you're just. Kind of miffed at the world and don't know where it's coming from. One of the ways that you can gain some more clarity about that is by writing about it by just like sitting, thinking really precisely and working through. Okay. So like what happened leading up to this point? What are all of the, what's the scenario? What am I thinking? What's going through my mind right now. And so you basically. There, and you just think very precisely, very sequentially about a problem that you're having. And just in going through that process of thinking about it, you can gain some clarity as to the mechanisms that are underneath sort of what you're feeling. And then you can begin to do something about it. Now that doesn't necessarily mean that you can predict forward and say exactly how I'm going to feel, but you can at least have a deeper understanding of sort of what the guiding principles are. And then you can tweak something and then. Sit down two weeks later and write something again and see how it went. So that's one of the things that modeling does for us is that even aside from the output of the model, usually we focus a lot of the, the, the news. And even I, as a model, I think about like what, what the model is telling us, what are the projections? What are the forecasts? But sometimes the act of modeling itself is sort of like this way of writing a scientific journal to try to more deeply understand the problem that we're facing.

Matt Boettger:

Second kids coming down here. There we go. They're back.

Stephen Kissler:

Great. Yeah. So that's that's one way is to just sort of like try to get a better understanding of the underlying things that, that make a system work. So in this case, an epidemic spread, now we can also think about using models to Too. And these are the words that the article is using to make projections or predictions. I like to use projections or forecasts. Now there are some models some infectious disease models that are used for making forecasts, but a lot like making weather forecasts, they're only accurate for a very short period of time. So you can make a forecast. Maybe a week ahead, maybe two weeks ahead. And that's, you know, that's true for weather and that's true for epidemics and, and you can do, you actually can do a pretty good job of that, but once you get past that, I mean, I'm not going to trust a weather forecast that's four weeks out for sure. Nor should you really be able to trust an epidemic forecast that's four weeks out because intrinsically the system is just too complex to measure that far away. With epidemics it's especially difficult because we have these behavioral feedbacks too, that that responds to what the epidemic is doing. So even more so than the weather there are these complexities. So I'll get back into that in a moment too, but then there's also these questions of projections. So the other thing that models can help us do is look maybe further into the future and ask a bunch of sort of if then questions and in this case, rather than. Trying to get an understanding of precisely how many cases are there going to be on a given day or within a given timeframe? Really, what we're trying to do is to assess orders of magnitude. And so to say, if we make this change, is it going to have a big effect or a small effect relative to this other change that we could make? So really we have these two policy decisions that we might make and we say, okay, which one is the best and models? Well, we don't know precisely what this one will do, but across all of the different models that we ran, this one had a much bigger, positive impact. So that's probably the choice that we should make. We don't know exactly what it's going to do, but you're a lot more likely to do something good if you choose this one versus this one. And so the issue that we often run into is that we use this last category of models that are used for making these projections and policy decisions. And then we compare them with the actual case counts. And while you're there, they're totally off. And it's like, well, yeah, because we never had the data to make the. Predictions, the sorts of forecasts that you're asking them to make in the first place, these models were built for an entirely different purpose. And they did help make certain decisions and in some ways, The proof that the models did a good thing is because the forecasts were wrong. Right? Because that's the other thing is that the decisions that the models are helping us make are helping us to avoid these scenarios that were casts are warning us about. And if they're successful, our forecasts are going to be wrong. Because, and that's different than the weather because we don't, you know, or if I similar or

Matt Boettger:

similar to the weather, instead of like, it's kinda like when you, there's a big train of warning, I'm from the Midwest and you know, you know, that tornadoes kill and all of a sudden the sirens go off, everybody goes to the basement, there's no desk. And you're like, see, Tunez don't kill him. Like, no, no, no is because there was a siren then everyone to the basement. And so they weren't out in the streets. Right. Exactly.

Stephen Kissler:

Yeah. So that's what we're in the process of doing is trying to ring those sirens when they should be around and trying not to ring them when they shouldn't. And then and so then the outcome is this sort of thing where yeah. All of the forecasts and projections are off because. We're responding to those forecasts and projections and, and trying to do something here. So, so I think that all of those reasons, all of those things are reasons why, you know, there's Y Y you know, the modelers have been wrong in air quotes. And, and that's, you know, that's not to say that, like, we've, we've pitched a perfect game. You know, a lot of these models. Frankly been off we've we haven't accountant counted for things that we should have accounted for. We've, you know, just based some models on data that turned out to be not very reliable at times. You know, things can go wrong in modeling as well. So that's, you know, that's not to say that like, we've, we've done everything right. And the problem is just in how they're being interpreted, but, but really the, that, that is the primary issue here. And I mean, and I don't, you know, I don't, I don't blame people who. Experts in this area for not necessarily, you know, being able to make these distinctions on the fly, right? Like I've, I've been involved in mathematical modeling for years and years and years and years. And it's taken a lot of experience to get an intuitive feel for how models differ and what sorts of things they can. And can't tell us at different times most of my work over this past year, well, most of it has been the modeling itself, but second, only to that has been communicating how to interpret the models that I built to people who are not initially modeling. And that has been immensely challenging. So I think, you know, the best that I can hope to do here is to just sort of communicate that there are these different purposes that models serve. And that that a big reason why it seems like some of the model outputs aren't necessarily matching up with what actually happened. Are, are these different things that either they weren't built for that purpose? Or they work. Yeah,

Matt Boettger:

exactly. No, that's really helpful. Totally helpful. And I mean, thank you for allowing us to understand that epidemiology is still a credible,

Stephen Kissler:

credible. I hope so. Yeah. I mean, I, I have to, yeah, I do have a vested interest in that. This is what I believe in and do, but, but yeah,

Matt Boettger:

I would imagine, you know, and this is just, it will move on just a second, but. And I'm sure you're feeling this as well, that this particular pandemic at this particular point in time at this state in technological advancement probably has been, or we probably haven't seen it quite yet or has been, or will be an exponential explosion of. Perf more perfected, epidemiological modeling for the future, because I'm sure this has been like the just poster child of like given where we're at with our technology and then what we, what we currently have. But then all of a sudden realizing, oh my gosh, where we admitted misdirected our investments in technology and research and what we should be putting and doubling and tripling down for the next one, there was a, probably just thousands of aha moments for epidemiologists at this, at this, in this past year, year and a half.

Stephen Kissler:

Totally. Yeah. I really think that you know, I don't want to overstate it, but I think that, you know, from that this pandemic has. Really let of spark. And I think that the field of epidemiology was kind of primed already to take that spark in the, in the sense that, you know, we have a lot of new technology that gives us new insight into where disease is spreading and who's getting infected and why and how people move and how people interact. And like all of those pieces were kind of there. And then this crisis hits that really just sort of focused everyone and Motivated all of these problems that we've sort of been circling around for awhile, but there hasn't really been this concrete nucleating sort of factor that that really revealed what we know and what we don't in, in, you know, a, a real sort of. Setting and this has done it. So I think that, you know, we're going to see the reverberations of this within epidemiology for a long time. And I think a lot of those are going to spill over into everyday life too. I think that just public health and especially public health from the standpoint of infectious disease is just going to be. A feature of our existence moving forward for awhile. And it'll be really interesting to see how that, and on

Matt Boettger:

a popular level, like, I mean, not just in the research, like, I mean now, you know, I'm looking at this thing called the aura ring. Have you seen that the aura ring died and there were three just came out with those of you who are like, not geeks. I'm like, it's like, I mean, I wouldn't have been this intrigued by it until now, like, oh, the, you know, the temperature and how that can actually potentially show infection. Any days in advance this, these, these technologies are now becoming a very, you know, it's now it's in the consumer area, right. Versus just in research. So I'm excited for what this could be the next year or two and further. Yeah. Let's continue on. So we talked about Colorado, the resurgence, we talked about the modeling you know, I, I noticed just a couple days ago, the global COVID cases are on the incline or an increase again after two months of kind of a little bit of a hiatus, so to speak you know, I was. Just wonder if that's anything to do with this new variant going on. I know there's not a lot of information on it. This is the Delta plus which is just such a weird thing. I feel like this is an apple product Delta plus, so more leg room, more like, oh my gosh. And eat. And there's, there seems to be, maybe you can echo back and incorrect. Anything. I read a few articles. Not much is going on when it comes to this particular variant, like a, I feel like, ah, you know, it's more of a headache than like a crisis and it's, it seems to be a little bit more contagious. And I see a lot of like these, like almost like shrugs their shoulders. Like, I dunno what w what's what do you mean.

Stephen Kissler:

Well, yeah. So one of the new pieces of information, that's very good about this is that, you know, whenever we see one of these new variants, there's inevitably a study that follows soon after asking, you know, how are the vaccines holding up against it? And the answer for this Delta plus variant is very well, basically just as well as they've been holding up against Delta. So the really good thing about that is that there had been some uncertainty about whether the increased contagiousness of this Delta plus variant. Was due to something intrinsic about its transmissibility. That's just sort of stickier as we've talked about before. Or if it's getting around our immunity, because that's another way in a, in a very highly immunized population, then one way to increase your. Transmissibility is to get around immunity, but that doesn't seem really like the main feature here. It just seems like it's Delta, it truly is Delta plus. Right. It's like Delta with a little bit extra. Right. And so, and that that's it. And it's, and it's really just a little, you know, it is starting to. What we call displace the previous lineages of Delta. So where it's circulating, it sort of increases in prevalence relative to the other predecessor Delta strains that had been circulating. And th that's a function of its increased contagiousness, but but it's not so much more contagious that it's causing these massive new outbreaks, like we saw when the Delta first emerged. So I think that's why you're seeing a lot of shrugs of shoulders because. The same old story little bit of a tweak it's worth, you know, those of us who spend our days and lives, you know, with our heads sunk deep into these data to be able to distinguish between these things and to keep track of what's going on. But by and large, it really hasn't changed the landscape much. Now that said it's you know, we can't totally. Like we are starting to see rises in cases globally. As you've said, there are surges in Colorado, there are different surges across different places in the us. And all of that, you know, is against this backdrop of Delta and Delta plus. And so the, the increases in case. We can't really separate from this variant, but they also, I think aren't being principally caused by the fact that there's this new variant. I think that there are other factors in play, including just the virus, making it to communities that have lower immunity. And especially here in the Northern hemisphere, starting to get into our wintertime respiratory illness season. So one more plug to get your flu shot if you have yet. And so, because this is, this is the time, right? It's November where we're starting to see respiratory viruses going around. This is normally when we start to see increases in other coronaviruses anyway, so, it's, it's my expectation that we're going to, it's going to be harder to control during this time of year in this part of the world. And so we can expect to see some surges for sure. But I think that really, to me, it's that seasonality that is really the main driver of what we're seeing. Okay.

Matt Boettger:

And as we land this plane and coming back to the vaccine, we talked about the boosters and the mix and match. And by the way, on that one, I saw an article about this, about FDA, I think said this yeah. Medina boosters Pfizer and Madrona boosters for people 40 and older. I didn't quite understand all of this cause I, when I see, like, what is the standard now? Does that mean that anybody forward 40 and older can get one right now? It depends on the state. W what does this

Stephen Kissler:

mean? Yeah. So I have no idea. And it seems like these guidelines are changing by the day. And so I think the main thing is just, you know, keep you keep watching the CDC, their webpage should lay out, you know, whether or not you are approved talk to your doctor because one of the other big sort of grab bags of people who are eligible for this vaccine, or is that people who are at risk of severe outcomes from COVID. And there's a little bit of subjectivity as to, you know, who falls into that category as well. I think there's also a case to be made for people who are caretakers of people who are at high risk. And so I think in many cases just talking to your doctor and saying like, Hey, here's my situation. Would you recommend getting one? And they can provide you some really clear guidance as to whether or not to get it. I think at this point, you know, it's you know, if you really, if you really championed at the bit to get the booster, like I think there are ways to get it. And by and large, I think it's worth sort of following the CDC guidelines because there are, you know, following the best available evidence and the vaccine supply and trying to make sure that people who need it most are getting it. So, you know, I haven't gotten my booster yet. Probably will. But it hasn't come up for my age group, my risk group yet. And so I'll wait until it does. And that's really what the CDC is in charge of doing. I know we talked about this before and the FDA is sort of in charge of saying, you know, this is safe and effective. And then the CDC is in charge of saying, okay, this is how we're going to do it. This is how we're going to sort of roll these things out. And so that's why the CDC is really the group to, to watch for these kinds of things, because they're sort of the central. Organizing agency around around these suggestions. So, but yeah, that said, I mean, I think that if, if you feel that for whatever reason, you would be better off with a booster sooner rather than later than you know, first I, I would really recommend just talking with your doctor and seeing if there's any way to get it through them. But a lot of these doses are available now. And so, and especially now that they've been approved for anyone who's gotten any vaccine that's been approved in the U S already, there's really nothing holding you back.

Matt Boettger:

Great. Good news. Okay. What's going on? This was kind of the kiddos. So just recently we saw that the FDA approved ages five through 11 for the vaccine. What does this mean? Do you know much about what's going on here with the next step is, is the same thing where that's the FDA and then we're still waiting for the CDC to see what, how this is going to be.

Stephen Kissler:

That's right. Yeah. My understanding is that we FDA gives the green light. CDC, I don't think has yet come out with their guidance, but I expect that on the order of hours, two days. And so, keep an eye out for that. So, you know, once again, you know, if if you've got a kiddo in this age range, or if you are one yourself, how do all our five to 11 year olds who listened to this podcast? I don't know if there's any out there. The I talked to your pediatrician, but I expect these to be approved right now. It's just the Pfizer, as you mentioned they're waiting on evidence for the Medina in part because just fewer people have gotten it. And so we just haven't had as many cases to observe. And so they're trying to watch, you know, for cases of myocarditis and all these kinds of things to just really pin down these numbers of. Rare events that can happen in result of vaccination, but they really just want to know very precisely like what these rates are so that we can, you know, help people through them if they arise. But the Pfizer has been cleared by the FDA. I expect it to be to have the guidelines from the CDC very soon. And so if you, or your caretaking, someone in that age range, then then I think it makes sense to, to, to get that vaccine. It could go a really long way as we're, as we're looking at, you know, family gatherings over the holidays and just schools during the wintertime respiratory illness season it could go a long way towards preventing outbreaks in schools, towards preventing kiddos, from bringing infection home to their families. So epidemiologically speaking, I think that this could be a really important step forward. Good.

Matt Boettger:

That's good news. And, you know, The surprise me, this article is related. It was a why you should vaccinate your kids against COVID-19 is a good article. I'll put in the show notes. But one thing that surprised me and I didn't, I don't know if this is accurate or not, but maybe you would know it was saying COVID-19 was the sixth leading cause of death among children ages five to 11 in 2020, blah, blah, blah, has led to nearly 700 deaths among children. And in a typical flu season, this is the part approximately 200 children die. And an unacceptably high number for which we recommend universal vaccination cover remains far more deadly for children than the flu. Is that true? I always thought it was the, I, the flu was always like, that was worse for kids for when it comes to COVID-19 or is this something that sounds familiar? No,

Stephen Kissler:

it's, it's hard. I mean, once we get into those numbers, like 200 to 700 out of the total number of kids in that age range in the us is like really, really, really tiny number as it is. And so, and one of the other things too, is that like, you know, we've been really paying a lot of attention to COVID. And so there, there may well be flu deaths that weren't necessarily recorded as flu deaths. One of the other really clear things is that, you know, especially with young kids, the thing that I think of with young kids, Getting really severe cases of flu is that often it's not the flu, it's the secondary bacterial pneumonia that follows on from the flu that does the most damage. And that's really true across age groups, but especially for kids who are immunocompromised or who have asthma or who have some sort of a chronic condition that makes them a lot more susceptible to respiratory illnesses. That's, that's really what we're thinking about. Once we get into numbers, sort of, of that size, where we're talking nationally about 200, 700, it's hard to really draw a hard and fast conclusions to my mind. Those are, you know, despite the fact, you know, 700 is definitely a bigger number than 200, right? Like from one perspective, that's like a three and a half fold difference. Like that's, that's big. But in absolute numbers, that's. Small as well, which is not to minimize it at all, but really what it really, all I'm trying to say is that yes, both COVID and flu are, are issues for kids. You know, we are protecting them, makes an awful lot of sense, but especially for kids in the younger age groups, you know, it's, they're, they're on par with each other, for sure. And so, Yeah, I think that's

Matt Boettger:

good. Well, thank you for putting that perspective. That ends it for this episode. Thank you all for listening again. If you can leave a review, we love it. So you can do that on apple podcasts. If you wanna support us as little as$5 a month at patrion.com/pandemic podcast, can help us keep this going or just a one-time gift to PayPal then Mo in the show notes, check out that pre-roll again, please fill out that survey. If you ha, if you fit one of those three categories. Grilly appreciate any time you can help me to focus my own next work for living the real. And if you would get a hold of Stephen S T E P H E N K I S S L E R at on Twitter, or if you want to just reach out to us via email matt@livingthereal.com, let us know how you're doing and how we can help invest to serve you. Hope you guys have a wonderful week. We'll see you guys in two weeks, take care and.