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You're listening to the pandemic podcast.
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We equip you to live the most real life hospital and the face of these crises.
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My name is Matt Boettger and I'm joined not with four, three other people.
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If those of you who are going to watch this, actually, there was two other places for two of the people that we're not going to have on today, but I'm with my one good friend, Dr.
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Stephen Kissler, an epidemiologist, the Harvard school of public health.
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Good morning to you.
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It's good to see again,
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buddy.
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Good morning.
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Oh man.
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Well, you know, if you hear a bunch of buzzy and sound my background, I apologize today.
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This is not normally the case.
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It is now December things are actually starting to cool down.
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And my wife just told me she's freezing upstairs.
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So there's none negotiating on the heater being on right now and I'm in the basement.
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So I'll do my best to filter it out.
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But I got to put my priorities first and put you guys second.
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So that's the way it is.
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It's been two weeks.
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Last time we talked, you know, Omicron was like relatively new.
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We were talking about, Hey, how was Thanksgiving?
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And it was great.
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And well, you know, you're, while you're having your meal, you saw all these news, like percolated about Omicron.
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And it came on fast and quick and it was unknown and we were like, nervous about it.
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And what could it be?
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It sounds like within two weeks we got a fair about of news.
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Now, granted things could change pivot at any point in time, but we got a good amount of news to talk about an update about the Omicron, which seems.
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Generally, it's pretty good news, but we'll talk about that in a moment before we get going, the normal stuff.
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If you're listening, it's your first time listening.
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Welcome to the show.
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If you're not, and you've listened to us for a while and you haven't left a review, please do so.
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It'd be great.
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It really helps us leaves us, inspires us to keep this going.
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We just got another one in November 29th is the day our last one aired from DCB, J C N J.
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All right.
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That's that's that?
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That's his, her name I've been listening to throughout the pandemic and I've been remiss.
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I have been remiss is not leaving a review, right?
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So it has been fascinated to hear an epidemiologist SKUs.
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What he's learned about a novel virus in real time.
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It has also been reassuring to receive useful actual advice on living, living life and managing risk during the most significant global crisis of my lifetime, the information is delivered clearly and without the hysteria sensationalism we get in the headlines.
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The format, a conversation between a lay person.
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That's me an expert is gaze Katie to never drive as we head into Omicron winter, which I like that.
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Oh, Cod winter.
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It seems like we just, it was, seems like it was just Delta summer.
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I looked at tinny to rely on the podcasts that stayed in.
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And take reasonable steps to keep myself and my partner safe and healthy.
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Thank you so much for that
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review.
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Yeah, that's great.
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Really appreciate that.
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It's I'm glad that somebody enjoys learning about this on the fly with me, because sometimes I feel like I'm stumbling around in the dark.
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So
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I feel, I feel like we need to get email addresses to be like, you know how when you go into like, okay, I didn't even get this Stephen, but you go to a graduation ceremony and somebody gives a talk.
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There's a Tim honorary doctorate you're given, right.
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All these honorary doctorates, like for listening to you, we should give like a little certificate of honorary doctorates to everybody who listens because just listening to you and getting our own educated.
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Understanding of what's going on.
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So thank you, buddy.
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So, oh yeah, you can support us financially.
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patrion.com/pandemic podcast.
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Little as$5 a month goes a long way.
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It helps a lot.
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And as well as one time gifts, PayPal, Venmo, all in the show notes.
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I think that's all the good news.
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Get into a few things.
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First thing before we get into COVID, every once in a while other things fall in the news now eventually cover, it's going to go from a pandemic to an endemic and the news is not going to be so sensationalized and we'll move.
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Hopefully this podcast continued going maybe every other week and do other topics, that kind of stuff.
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So it's good to kind of get familiar with other things as well.
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Stephen, you're an expert in the flu, right?
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Because this is kind of like your, your whole PhD and every once in while we, we see this stuff, resurfacing, its ugly head.
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This one is interesting.
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I saw this article, Satan did COVID 19 cause flu strain to go extinct.
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So I read a little bit more about this.
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This is a guest, the influenza B Yamagata lineage.
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I don't know anything about this.
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I just get my flu vaccine.
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Call it.
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Good.
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What is this?
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I know how much do you know about this?
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What does this mean?
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And my biggest question is, okay.
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I didn't even know how many lineages, so there's four apparently.
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Right?
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So maybe, maybe we're down to three.
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Does this make vaccines easier and more effective down the road?
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If we knock out one
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lineage?
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Yeah.
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So, I think that the, the potential extinction of this particular influence of B strain is it's interesting on a couple of different levels.
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So to take a step back There are a lot of different varieties of the flu that circulate that we can the ones that currently circulate or at least have circulated up until recent memory can sort of be split into four large classes.
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And they are two types of influenza, a, which are somewhat closely related to each other.
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And two types of influenza B, which are a bit more distantly related.
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From a, they sort of clustered together.
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And the designations of these things largely have to do with how the virus looks on its surface and therefore how our immune system responds to it.
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Someone that a there's the AA slash H one N one.
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So you'll remember the 2009 swine flu pandemic was an H one N one variety.
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So this is pretty much a descendant of that.
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And then there's also an a H three and two strain, which would circulating prior to the pandemic in that.
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And that the 2009 pandemic didn't manage to displace which was interesting because in most previous pandemics, the, the previously circulating strain has been displaced, but now we have this sort of coast, circulation of two eight strains, and also to be strains.
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So the bee Victoria and the bee Yamagata strains that that are sort of.
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To the a H one N one and the H three N two.
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So I think that the one that you had mentioned was this B Yamagata.
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Flu strain.
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So when we get vaccinated against the flu, we often get vaccinated against multiple strains of flu at once.
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So up until recently, it was usually a tri Vaillant flu vaccine, which was usually against two types, both of the, a types and one of the B types.
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More recently there have been a quadrivalent flu vaccines that have been protective against all four varieties.
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But now there's this question of, you know, are we going to see this this flu B strain continue to circulate.
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With the non-pharmaceutical interventions and with whatever else led to the reduction in flu cases, it seems like we haven't really seen much of a resurgence of this particular flu B strain.
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While we have seen circulation of the others around the world.
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So we think that this flu string, if it were around would have the opportunity to spread, but we haven't seen it yet.
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So there's a possibility that it may have gone extinct, which is interesting.
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So I do think that it would help with vaccine formulation.
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It would mean.
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You know, be able to go back to a tri Vaillant flu vaccine, which would make it a little bit easier to produce it would make it so that you know, there are fewer chances for an a mismatch between the vaccine and the thing that's currently circulating to cause more disease.
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I do think that the games would be.
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Marginal.
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In my understanding the most of the flu that we see is due to the flu a stream.
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So H one N one N H three and two are the things that really tends to cause a lot of the disease.
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The B strains do cause quite a bit of disease as well, but really the, the A1C seemed to be the ones that are sort of the most robust spreaders.
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And so while it would be helpful, I do still think that the other strains may well just sort of fill in that.
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That's provided by the absence of this other strain, but definitely for the sake of producing vaccines more quickly and more effectively, I do think that it's a, it would be.
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Great.
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I kind of assumed that I'm in Australia, went missing all of a sudden, I'm guessing it's probably not the strongest one available right now.
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So it's not going to be that much of a difference, but Hey, it's like a little supplement gives us a little bit of boost.
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Okay.
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Helpful information.
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Let's get into the COVID stuff.
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Now, before we get into Omicron, which is kind of a big topic, there's a few other things I came across in the past few.
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So we we've talked about Dr.
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Ostroff and how respected he is.
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And he's been back in the news again because of his prediction, like 18 months ago or whatever it was he predicted within 18 months or so about 800,000 deaths in the U S and crazily.
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He's almost like spot on.
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He might, we're not even at quite the 18 month mark, maybe we were a few weeks away and we're probably about 7,000 short from that prediction.
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So he's back in the surface, in the limelight of the news.
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And one of the things that he mentioned, and now I just wanted to throw it to you to accept even what this means.
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And it was a short blurb on a video.
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And he talked about the distinctive, the distinction between two types of surges.
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Recently, we know, we know the India surge and we're all avail, or we are really, we don't last, last summer, we talked about this and how it was a significant spike went really, really high, but then it plummeted quite quickly.
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Once it reached its spot.
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And then there's the other version, which is kind of UK, I guess, which is experiencing, which is again, a spike, maybe a slight.
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And then maybe then resurrect its ugly head and then continuing like this, a spike for a long period of time.
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Now he had juxtapose this with the U S saying this summer, the Southern us seemed to represent the India version.
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And now we're seeing which I was unaware.
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The Northern part of the U S is experiencing kind of UK version.
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This is that kind of spike and then sustainable.
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Now maybe you can help parse this.
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What does this mean?
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Is, is, is there a way to understand this and predict this?
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You know, my, my, my thing is, oh, it's just, again, I'm a lay person.
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So I'm like, oh, it's just simply a matter of time where, you know, in the Southern it was all Delta.
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Right.
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But in the now when the Northern's heading well, it's Delta now Omicron.
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And so maybe that's the reason why it's simple as that, or maybe it's more complicated.
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So what does this mean for us and for people who are listening about these types of.
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Yeah.
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So, I love this question because it gets at a lot of sort of fundamentals of infectious disease transmission.
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It also uncovers a lot of what we don't really know.
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So, so this is this is actually an area that we in, in, in my research group are beginning to look at in some detail to try to understand sort of what leads to these pretty different experiences with the virus across different places.
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And.
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How long will it take places to sort of synchronize in their experience or will they ever, because if we go back to the example of flu most of the U S for example, and really basically temperate regions across the globe are pretty well synchronized where we have our flu outbreaks during the wintertime.
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And there's a little bit of variation in timing, but nothing like what we've been seeing with the experience of, you know, these major surges followed by huge declines relative to sort of this sustained degree of transmission.
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I think there could be a couple of things going on, you know, the, the first and most obvious element that we don't really have a clear sense of how to measure it, how to account for just.
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Differences in human behavior.
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And so we know for sure that you know, in, in the Southeastern United States the indoor season tends to be the summer, whereas in the Northeastern us, it tends to be the winter.
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And so, when people spend time indoors versus outdoors and what the relative fraction of time they spend indoors versus outdoors could play some role in this.
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And that could help to explain some of the differences between The differences in the experience of the virus in places with different sorts of climates.
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Some of it may have to do with underlying immunity and the degree to which things like non-pharmaceutical interventions have been put in place.
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So, I've been trying to think of a good analogy for this, but you know, you, you can imagine that You know, I'm, I'm trying to think of something like, almost like when you're bouncing a basketball, right?
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Like if you if you throw it at the ground, it'll keep bouncing.
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For awhile.
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Whereas if you sort of gradually drop it to the ground, it's going to take a much longer time to hit the ground, but it'll just sort of like gradually get there.
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And one of the things that you can see with infectious disease dynamics potentially that could be going on here is that in places that suffer a really major surge they basically synchronize the immunity of everybody in that population.
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And so then as immunity wanes, That basically everybody sort of has the same degree of immunity and you could reach this point where all of a sudden there can be this new explosive outbreak, whereas in a place that has a buildup of immunity, that's much more gradual.
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You may end up with sort of this asynchrony between people and their immunity.
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And so because of that, there's sort of these people who can get reinfected at different points in time, but it's just sort of this much more gradual kind of transition to an endemic virus.
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So that could be part of it too.
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And one of the things we're trying to ask with our, with our research is, is to what extent could each of these things we contributing to these different sorts of trajectories that we see in different.
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Hmm.
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Okay.
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That's helpful.
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Yeah.
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Yeah.
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Cause I was unaware of that.
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I know Colorado, we're still kind of slowly coming out of our surge has been kind of a little bit ongoing and not quite as fast as a plummet, more sustainable for us.
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It's it's I think it's harder because it, you know, again, it's the environmental, environmental parts of, of our state where generally we've been having a pretty warm fall.
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So we've been outside more is starting to cool off.
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So I could see us having a greater sustained.
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Levels now.
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Totally random.
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I have Fred thrust in the show notes, but Polis our governor.
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Totally.
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I didn't even, I didn't even tell you this.
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This is a bolt.
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I don't know if you saw it in a news.
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He made a bold statement.
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Maybe not bold, but he was just like, it was good.
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I think where he, you know, we're seeing a surge of the, of, of, of the virus here and, and he just kind of said, look, I'm not gonna do any more state of emergencies I'm done with these.
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Like, he's like, Everybody's had a time to get the vaccine by now.
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It's been long overdue.
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Now.
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Boozers like, you know, basically if you don't want the vaccine, then you're playing that game.
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Now.
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It's like, there's been wide availability, right.
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And we've had them all over the place.
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We've you can get them at Safeway.
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You can get grocery stores, you can get them at, at clinics.
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You can go to outdoor events.
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We've did our best to make them widely available the whole state.
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Now it's to the point where.
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I'm wiping my hands clean.
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I'm no more state of emergencies now, local levels.
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They can do whatever they want, feel free, you know, port about counties.
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They can do whatever they want, but as a state level, that part is done and it got a lot of press and over the past couple of days, and you know, my intuition is felt like that's probably a good, a good decision at this point in time, you know, it's, it's now just like, if you chose not to get the vaccine, now he told him knowledges, of course you can get breakthroughs with the vaccine, but it is much more rare.
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He said, this isn't about.
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And our hostels right now, I think only 16% between 13 and 16% of those hospitalized are vaccinated.
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Right.
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So we're talking about the overwhelming population run backs.
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So, so we're seeing the sustainability right now and now things are starting to cool off.
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You can hear my heater in the background, right.
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That people are going to more indoors, so I could see it then continuing a little bit longer in those kinds of things.
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So, yeah, that's helpful.
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Okay.
00:14:31.890 --> 00:14:33.030
It's let's continue on.
00:14:33.061 --> 00:14:35.760
One thing I wanted, we talked about, and this might be a short conversation.
00:14:35.760 --> 00:14:40.410
I saw this Atlantic and not quite sure why they posted this article because to me it's helped.
00:14:40.681 --> 00:14:47.341
She seemed really relatively easy answer said, why are we still isolated vaccinated people for 10 days?
00:14:47.341 --> 00:14:54.030
I just had a friend who, who is vaccinated got COVID and, you know, asked to be quarantined for 10 days.
00:14:54.480 --> 00:14:55.561
I haven't really thought much about this.
00:14:55.561 --> 00:14:55.951
I'm like, okay.
00:14:55.951 --> 00:14:56.160
Yeah.
00:14:56.221 --> 00:14:57.961
You know, because even though I've heard things.
00:14:59.086 --> 00:15:00.015
Oh, and you're vaccinated.
00:15:00.436 --> 00:15:02.176
You can shed the virus quicker.
00:15:02.265 --> 00:15:03.346
You're contagious less.
00:15:03.346 --> 00:15:07.005
So that makes sense of being, being quarantined for less.
00:15:07.035 --> 00:15:18.495
But we also hear that there are people who remain contagious for, so I'm just assuming we just say 10 days because Hey, some people are still contagious, but is there, is this more nuanced than I'm actually thinking?
00:15:18.495 --> 00:15:22.515
Is this something that the other discussion like, Hey, we should, we should knock this down for people who are battling.
00:15:23.370 --> 00:15:33.740
Yeah, I think, you know, I think you're right, but like, from, from what I've seen, you know, we've, we've done some work that suggests that that people who are vaccinated may clear the virus on, on average more quickly, but you're right.
00:15:33.740 --> 00:15:40.451
Like there there will be some number of people who still retain the virus and are still infectious for a number of days.
00:15:40.480 --> 00:15:41.230
And sort of that tenant.
00:15:41.730 --> 00:15:48.480
Sort of captures the range when we expect people to be potentially infectious to others.
00:15:48.561 --> 00:16:01.451
I didn't get to read the article, but I I w I would actually maybe even go a step further and say, you know, why are we isolating anyone for 10 days at baseline in, because what I think we should be doing is.
00:16:02.015 --> 00:16:05.135
Using tests to spring people from isolation.
00:16:05.135 --> 00:16:14.966
So I do think some people will need to be isolated for 10 days or even more if they continue to test positive on a rapid antigen test which indicates that they may be infectious.
00:16:14.966 --> 00:16:20.515
But I do think that we could probably spring a lot of people vaccinated or not from their isolation period.
00:16:20.515 --> 00:16:26.125
If they have a sequence of negative, rapid antigen tests, suggesting that they're past their infectious period.
00:16:26.245 --> 00:16:29.096
And so I think that there are ways where we can be.
00:16:29.730 --> 00:16:37.451
Smarter about this, using the tools that we have available to reduce the amount of time that people are in isolation and isolating is pretty disruptive.
00:16:37.451 --> 00:16:55.149
You know, it's like, I think when we, you know, when we think about it, like, you know, okay, like 10 days you get COVID or whatever, you know, like, but But, you know, for family, with kids, I for anybody, like when you actually think about like being stuck in your house for 10 days, like it's not fun, especially if you're like feeling okay.
00:16:55.629 --> 00:17:05.240
And and so it is important for reducing spread, but I do think that there are a lot of things we could do given the technology we have available to reduce the isolation period to only the span of time that it needs.
00:17:06.265 --> 00:17:06.535
Great.
00:17:06.684 --> 00:17:15.244
Well, that's a perfect segue because we're going to continue this discussion right now with that in light of the holiday travel, you said you just did a Q and a live Q and a about holiday traveling.
00:17:15.244 --> 00:17:27.345
The reason why I think it's the perfect segue is I'm guessing these tests might be part of the equation for good holiday travel, because so maybe first talk about like what you talked about and how to prepare for holiday travel.
00:17:27.384 --> 00:17:29.265
Do it safely, be able to see your friends and family.
00:17:29.654 --> 00:17:33.464
And I want you to dovetail this with what we just talked about.
00:17:34.214 --> 00:17:37.515
That if for instance, you do get COVID right.
00:17:37.724 --> 00:17:42.605
How could you use antigen tests to then best conclude that you're okay to go out.
00:17:42.605 --> 00:17:44.134
Cause we know they're not perfectly effective.
00:17:44.134 --> 00:17:46.625
So do you couple them with other things, do you do two every other day?
00:17:46.625 --> 00:17:47.404
And then we get to natives.
00:17:47.704 --> 00:17:51.154
How do you, how does that formula fit into like check off the box?
00:17:51.664 --> 00:17:54.125
Hey, I just got COVID it's 10 days before Christmas.
00:17:54.694 --> 00:17:55.875
I'm able I'm I'm okay to see my
00:17:55.875 --> 00:17:56.505
grandparents.
00:17:56.954 --> 00:17:57.255
Yeah.
00:17:57.884 --> 00:17:58.785
Yeah, so.
00:18:00.000 --> 00:18:06.839
The taking the first bit about sort of, how can we think about holiday travel and gatherings this year?
00:18:07.309 --> 00:18:21.670
In my advice, even in the context of Omicron is pretty similar to what I've said for holiday gatherings before, which is sort of in this order, you know, get vaccinated and get boosted if you're able Then I think a lot about ventilation, make sure that windows are cracked.
00:18:21.670 --> 00:18:25.240
Fans are on, maybe even have a air filter with a HEPA filter in it.
00:18:25.240 --> 00:18:30.400
If if that's within your means and leaf blower, maybe a leaf blower turn on that leaf blower.
00:18:30.460 --> 00:18:32.079
Yeah, that's right.
00:18:32.079 --> 00:18:32.470
Why not?
00:18:33.039 --> 00:18:35.569
And yeah, and then take rapid test before.
00:18:35.619 --> 00:18:42.359
So one of the things that I didn't realize until this week, but it might be useful for a number of our listeners who are out in Colorado that apparently.
00:18:43.535 --> 00:18:48.555
The state makes rapid tests available for free that you can get repeatedly.
00:18:48.555 --> 00:18:54.434
So I thought originally this was just a one-time thing, but I do think that you can get basically four boxes of the avid by next.
00:18:54.434 --> 00:19:00.194
Now is I think every week or every other week, you have to go on online and sort of fill out a form.
00:19:00.224 --> 00:19:01.634
So it's a little bit of a pain.
00:19:02.799 --> 00:19:07.880
But it takes about 10 minutes to get you know, like four boxes of rapid tests every week.
00:19:07.880 --> 00:19:10.160
And I think that that's, you know, that that's what we should be doing everywhere.
00:19:10.369 --> 00:19:10.819
I did that.
00:19:10.819 --> 00:19:11.269
It's great.
00:19:11.299 --> 00:19:18.890
Like, I, I, I, it's a little complicated cause I signed up me and I thought I was doing my family, but I guess each in a person, each individual person has to sign up.
00:19:18.890 --> 00:19:20.839
So if you have kids, you sign them up.
00:19:21.680 --> 00:19:25.849
So I just signed myself up, got two boxes right away, and then I'll send the rest kids.
00:19:25.849 --> 00:19:28.549
I'll put another six boxes and keep them coming.
00:19:28.579 --> 00:19:29.269
So it's pretty great.
00:19:29.299 --> 00:19:30.529
Great, awesome thing to have on
00:19:30.529 --> 00:19:30.740
hand.
00:19:31.069 --> 00:19:31.859
Yeah, it's wonderful.
00:19:31.859 --> 00:19:31.970
Yeah.
00:19:32.240 --> 00:19:33.916
Yeah, no, I think, that's, that's great.
00:19:33.916 --> 00:19:42.166
And so, you know, now is the time if you haven't gotten them yet, you know, get some of these rapid tests and take them before your gatherings take them before you.
00:19:42.807 --> 00:19:48.057
And you know, I, at this point to travel, I think, I think you need a negative test within 24 hours.
00:19:48.057 --> 00:19:50.396
And so the rapid tests are really helpful for that kind of thing.
00:19:51.057 --> 00:19:56.636
And I think that all of those things even in the context of Omicron can go a long way towards keeping us all safe.
00:19:56.737 --> 00:19:59.047
I think that, you know, Omicron is definitely coming.
00:19:59.116 --> 00:20:03.586
We're starting to see increases in the proportion of cases that are Omicron, especially here in the Northeast.
00:20:04.057 --> 00:20:05.336
It will spread across the country.
00:20:06.227 --> 00:20:14.977
My hope is that here in the U S we w that the, the major OMA Crohn's surges we'll wait until just after the holidays to really get rolling.
00:20:15.007 --> 00:20:19.656
But right now we still have a lot of Delta around to, you know, it's like, oh, Macron is not the only thing to be concerned about at the moment.
00:20:19.656 --> 00:20:27.797
We've got a lot of Delta spreading at the moment to But whether it's still to Oroma Cron, all of these things do seem to be helpful towards preventing spread.
00:20:27.807 --> 00:20:39.376
So, so that's, that's what I would suggest now, if you do get COVID I think that you know, certainly, you know, continuing to test to see when you test negative repeatedly, I wouldn't to spring yourself from quarantine.
00:20:39.376 --> 00:20:41.116
I wouldn't trust a single negative test.
00:20:41.176 --> 00:20:46.557
I would probably trust two negative rapid tests three even better.
00:20:46.886 --> 00:20:58.797
And so, you know, that's, that's already a lot of tests, but, but mainly what I would say is just, just talk to your doctor because at this point, you know, they'll be able to, to guide you through your own particular situation and that there's so much nuance.
00:20:58.797 --> 00:21:07.747
And that has to do not only with, you know, your own medical condition, but the people you might end up seeing and the amount of spread that's happening in your community at baseline.
00:21:07.747 --> 00:21:14.247
So I don't think that there's any sort of hard and fast rule that I can give to everyone that will apply on all of their situations.
00:21:14.247 --> 00:21:15.027
But I do think.
00:21:15.632 --> 00:21:31.001
Between all of the conversations that we've had on this podcast about rapid tests and sort of, The role that they play, that they don't give you certainty either way, but that they do increase the odds of, you know, your actual scenario lining up with what the test is telling you.
00:21:31.332 --> 00:21:41.201
And and so hopefully between all of those discussions, you know, people will be able to interpret the results of their tests in a way that is is useful for whatever, whatever context they're in this holidays.
00:21:42.086 --> 00:21:42.386
Great.
00:21:42.477 --> 00:21:48.926
And you helped me because we were wondering if we had, you know, just being safe before we see my mother-in-law couple weeks ago.
00:21:49.406 --> 00:21:59.886
And he suggested which was helpful because obviously those engine tests aren't a hundred percent and never will be nor the PCR ones, but take not only two different tests, if you can't from two different manufacturers, just a.
00:22:00.412 --> 00:22:05.451
To help that that'll help as well to continue to increase your odds of having the right conclusion.
00:22:06.122 --> 00:22:06.781
So that was helpful.
00:22:07.461 --> 00:22:14.402
You really want go out your way by two different versions and then you can, it just, just helps even more to feel a little bit, a little bit better about the conclusion.
00:22:14.912 --> 00:22:17.342
So I know Alma Crohn's on our, on our minds.
00:22:17.342 --> 00:22:19.892
One more thing, because this is related to the engine.
00:22:21.001 --> 00:22:22.201
We didn't talk about this two weeks ago.
00:22:22.842 --> 00:22:28.951
The antiviral pill is coming out for COVID is a super exciting, because gosh, it's just a reminder.
00:22:30.182 --> 00:22:34.102
Like something about like 80 some percent prevention of, of hospitalizations.
00:22:34.551 --> 00:22:37.852
It's, it's, you know, it's on the verge of like, like the vaccine, right.
00:22:37.882 --> 00:22:39.892
But except for you already, you get COVID first.
00:22:40.291 --> 00:22:41.761
And it, and it makes you better quicker.
00:22:42.211 --> 00:22:42.842
This is exciting.
00:22:42.842 --> 00:22:43.981
Maybe come out in January.
00:22:43.981 --> 00:22:47.612
I'm not sure who it will be available for how readily available it'll be.
00:22:48.257 --> 00:22:54.916
But this hinges again on the same thing, because kind of like that Tamiflu for the flu, I think same thing had to take it pretty closely right after you have symptoms.
00:22:54.916 --> 00:22:56.267
Otherwise it's not nearly as effective.
00:22:56.807 --> 00:22:57.457
Same for this.
00:22:57.467 --> 00:22:59.116
I like this pill.
00:22:59.146 --> 00:23:00.406
I think it's, it's a marker.
00:23:00.406 --> 00:23:03.616
I'm not sure what it is, which one it is that it's, that it's coming out.
00:23:04.067 --> 00:23:04.336
But
00:23:04.336 --> 00:23:07.047
there's there are two we can get into that in a moment.
00:23:07.602 --> 00:23:07.932
Okay.
00:23:07.961 --> 00:23:08.112
Yeah,
00:23:08.112 --> 00:23:13.362
but then, yeah, but I think it's within six days or five or six days of symptoms, you have to take it otherwise not nearly effective.
00:23:13.362 --> 00:23:18.261
So you've got to have these things on hand ladies quick, or be able to get a PCR test really quickly.
00:23:18.261 --> 00:23:21.961
If you want to take this, these pills and really lessen the symptoms.
00:23:21.961 --> 00:23:24.571
So Carrie, you can fill in the blanks.
00:23:24.571 --> 00:23:24.721
Yeah.
00:23:25.321 --> 00:23:25.561
Great.
00:23:25.622 --> 00:23:25.922
Yeah.
00:23:26.311 --> 00:23:26.971
Yeah, so.
00:23:27.767 --> 00:23:32.027
To my knowledge there are there sort of two of these antiviral pills that are coming out.
00:23:32.126 --> 00:23:34.106
So there's one that's produced by Merck.
00:23:34.156 --> 00:23:35.717
And one that's produced by Pfizer.
00:23:35.747 --> 00:23:41.866
So the interim results from Merck were looking pretty promising, but actually they're their conclusions from the final trial where.
00:23:42.711 --> 00:23:48.102
Okay, but not as good, maybe that it was like 30% effective against hospitalizations, but the Pfizer one is looking much better.
00:23:48.102 --> 00:23:56.625
I think that may be the one that you're referring to here where it is like on the order of 80 to 90% effective against preventing hospitalizations, which is incredible.
00:23:56.646 --> 00:24:00.636
I think it's, it's really worth taking a step back that like with both.
00:24:01.592 --> 00:24:10.951
Like pharmaceutical drugs and vaccines, like something that can reduce your risk of hospitalization or death by that much is like, that's pretty amazing.
00:24:11.251 --> 00:24:14.571
And so, I think it's, it's wonderful that we, that we have these things.
00:24:15.451 --> 00:24:18.571
The available and we'll have them coming online very soon, but, but you're right.
00:24:18.612 --> 00:24:31.422
The, the, the difficulty as with Tamiflu is that you need to know if you've been infected pretty early on because you need to start taking the drug within a couple of days after really after infection.
00:24:32.412 --> 00:24:36.652
And yeah, basically the sooner you get on them, the better chance they have to work.
00:24:36.652 --> 00:24:50.451
So, so that really just, again, just underscores the need for testing and for it makes it all the more important to do the sorts of things that we've been hoping for, that, you know, people might test themselves with a rapid antigen test frequently so that they can know.
00:24:50.721 --> 00:24:56.136
And and so I do think that, you know, again if you do start showing symptoms, get tested as quickly as you can.
00:24:56.237 --> 00:25:02.567
And and that will really help to not only guide your own behavior, but now to guide what sort of treatment you might get.
00:25:03.166 --> 00:25:03.406
Yeah.
00:25:03.886 --> 00:25:04.126
Yeah.
00:25:04.156 --> 00:25:13.775
I This is where it gets also just crazy complicated because like COVID symptoms, colds, RSV, flu is like, they all have the same kind of symptoms.
00:25:13.775 --> 00:25:13.984
So.
00:25:15.000 --> 00:25:17.190
You know, you could have the sniffles for a day, it could be allergies.
00:25:17.190 --> 00:25:23.369
And like, you know, at 1250 a pop for an antigen test, unless he got a big budget, it's hard to like, okay.
00:25:23.400 --> 00:25:26.579
Oh, you know, I fill in a little Steph folders, probably just get checked, you know, do Andrew tests.
00:25:26.579 --> 00:25:32.970
I just, I'm just hoping he seems to come down like another 80% where, you know, you can take these and then quickly be able to.
00:25:33.609 --> 00:25:36.730
You know, start tickets like this, just to be on it's an insurance policy.
00:25:36.819 --> 00:25:39.430
And by the way, I got boosted on front Thursday.
00:25:39.430 --> 00:25:41.910
So I've got my booster, Madonna and pre-fill and pretty excited about it.
00:25:41.930 --> 00:25:42.759
Didn't really affect me much.
00:25:42.759 --> 00:25:45.539
I know it laid you out Stephen, but it didn't do too much for me.
00:25:45.539 --> 00:25:51.170
I felt a little fatigue, but I'm not fully, still hasn't fully wrapped up my system, but I'm feeling good about the next step.
00:25:51.170 --> 00:25:51.619
That's great.
00:25:51.920 --> 00:25:52.279
Okay.
00:25:52.819 --> 00:25:55.009
So finally, let's get into Omicron.
00:25:55.039 --> 00:25:58.849
So just spew the beans, Stephen, like where are we at with Omicron?
00:25:59.384 --> 00:26:01.035
Is it as bad as we thought it's was going to be.
00:26:01.035 --> 00:26:02.835
Is it less, what do we know?
00:26:02.964 --> 00:26:05.204
Sounds like we know a lot more information than we did two weeks.
00:26:06.295 --> 00:26:07.075
Yeah, definitely.
00:26:07.075 --> 00:26:10.365
We, we've learned a lot in these last two weeks which is great.
00:26:10.414 --> 00:26:21.194
There is still a lot left to learn but we're in a much better spot in terms of what we know about the virus and about this particular variant now than we were when we first started talking about it.
00:26:21.255 --> 00:26:28.214
So, as I mentioned the last time, I think I mentioned the last time there was sort of this order of events where we were going to first learn about antibody neutralism.
00:26:29.234 --> 00:26:31.365
And then the next thing we will learn about is transmissibility.
00:26:31.634 --> 00:26:33.674
And the last thing we would learn about is severity.
00:26:34.065 --> 00:26:41.785
So, a lot of the big news lately has come from the immune response, the, the neutralizing ability of our antibodies against the virus.
00:26:42.134 --> 00:26:47.085
And as expected, the virus does a really good job of getting around our immune response.
00:26:47.384 --> 00:27:10.484
The mutations that it has really just helps, it helps to disguise it from our antibodies But there've been a couple of, of reasonably promising studies that suggest that getting a booster dose, whether you've been previously infected or had a previous set of doses have any of the vaccines that the booster does can go a really long way towards preventing you basically for giving you protection against the Macron variant.
00:27:10.875 --> 00:27:16.515
Even though the booster dose is still the same old vaccine that we'd had for months, which is great news.
00:27:16.545 --> 00:27:19.934
Now there's some variation from study to study and just how much that.
00:27:20.819 --> 00:27:21.390
Gives you.
00:27:21.390 --> 00:27:35.150
So, there was a study from Pfizer that suggested that the booster dose basically restores your neutralizing antibody levels, meaning that, you know, the ability of your immune system to recognize and essentially eradicate the virus back up to levels of two doses against the.
00:27:35.845 --> 00:27:37.375
Founding SARS cov two strings.
00:27:37.404 --> 00:27:45.855
Now there are a number of other studies that are not quite as rosy as that that suggests that the Omicron will still take a hit in booster, neutralizing activity.
00:27:46.345 --> 00:27:49.494
But that definitely getting a booster is much better than not having a booster.
00:27:49.914 --> 00:27:53.815
So, so that story seems to be fairly consistent.
00:27:54.085 --> 00:28:02.994
The other important thing to note is that most of the information that we have so far on the immune response against Omicron has to do with these neutralizing antibodies.
00:28:02.994 --> 00:28:08.755
So it's this one particular arm of our immune response that recognizes the virus and prevents it from binding to cells.
00:28:08.785 --> 00:28:12.684
But of course that's, there are a lot of other elements of our immune response that are harder to make.
00:28:13.619 --> 00:28:20.400
And that we think actually probably play an even larger role in preventing against symptomatic disease, hospitalization, and death.
00:28:20.970 --> 00:28:25.259
And usually those arms of the immune system are more broadly protective.
00:28:25.259 --> 00:28:30.529
They're able to identify a wider range of variants than these specific neutralizing.
00:28:31.059 --> 00:28:34.990
That's sort of attached to these very precise pieces of the viral surface.
00:28:35.359 --> 00:28:48.740
And so I think that there's a lot of reason to hope that our protection against symptomatic disease and especially hospitalization and death given previous immunity, either through infection and or vaccination will still hold relatively strongly against the Omicron variant.
00:28:49.049 --> 00:28:53.369
But that again is something that we're, we're still on the early stages of gathering information.
00:28:54.369 --> 00:28:58.480
So, another thing so transmissibility, so we know that OMA chronic can spread like wildfire.
00:28:58.619 --> 00:29:05.460
We know that it's taking off that took off not only in South Africa, but that it's been taking off in the UK and we've started to see surgeons here in the Northeastern us.
00:29:05.460 --> 00:29:08.759
So it's definitely it's coming and it is spreading and it is spreading well.
00:29:09.279 --> 00:29:13.690
There's still some uncertainty as to what exactly is behind its increased transmissibility.
00:29:13.690 --> 00:29:13.869
So.
00:29:14.289 --> 00:29:22.339
Basically the two possibilities is first that by getting around our immune system, it's able to infect people into spread more easily, even in people with some level of protection.
00:29:22.740 --> 00:29:29.259
Or second to that is just more inherently contagious that it's able to bind to ourselves a little bit more easily there.
00:29:29.289 --> 00:29:31.930
You know, part of the question is like, to what extent does it matter?
00:29:32.380 --> 00:29:44.700
It does matter some because Whichever one of those things that is, will change the way that the virus behaves in different populations with different degrees of immunity, with different types of immunity who have had different experiences with different variants.
00:29:44.970 --> 00:29:50.089
So I do think it's an important question, but but it's pretty clear at this point that Omicron will be able to spread very rapid.
00:29:50.630 --> 00:29:51.950
Just about anywhere it goes.
00:29:52.230 --> 00:29:57.900
And so sort of in the transmissibility box there, there's a big old check that it's it is definitely more transmissible.
00:29:58.230 --> 00:30:01.690
And and so that's going to be something we're going to have to deal with in the coming months, for sure.
00:30:02.349 --> 00:30:04.210
And so the big question now is, is severity.
00:30:04.210 --> 00:30:19.579
And I think that At this point, we would probably know if Omicron was catastrophic more severe than previous variants, but I don't think we're at a point where we can conclusively say whether it is equally or less severe than things that have come before it.
00:30:19.609 --> 00:30:25.400
So again, there had been some early reports suggesting that some clinical cases of Omicron were not as severe.
00:30:26.525 --> 00:30:38.944
But that can be confounded by all sorts of different things, whether it's, you know, that it took off in younger age groups first, or it happened to take off in a previously vaccinated, an Indianized population.
00:30:38.944 --> 00:30:44.404
And so that the underlying immunity was protecting those people from being as severe as the disease might have been in previous waves.
00:30:45.005 --> 00:30:47.454
And then one of the other things that sort of been spread around is.
00:30:48.724 --> 00:31:04.095
Basically just comparing cases versus hospitalizations in this surge relative to cases versus hospitalizations in previous searches and saying like, oh, well, you know, it's, there, there is a lower fraction of hospitalizations to cases at this point in the surge than there were in previous surges.
00:31:04.115 --> 00:31:10.365
But the issue there is that Omicron is so much more transmissible that we're seeing a much sharper rise in cases.
00:31:10.365 --> 00:31:11.595
And so it might not be.
00:31:12.045 --> 00:31:13.755
There are fewer hospitalizations per case.
00:31:13.994 --> 00:31:15.944
It's just that there are so many more cases.
00:31:15.944 --> 00:31:18.795
So early on that the people haven't had a chance to get sick yet.
00:31:19.204 --> 00:31:23.704
And so, so I think we're still at the very early stages of understanding the severity of a Macron.
00:31:23.704 --> 00:31:30.365
And I'm, I'm, I'm not as optimistic as some have been about the potential for Omicron to be less severe.
00:31:30.615 --> 00:31:31.865
But I am grateful that it doesn't seem.
00:31:32.454 --> 00:31:35.515
You know, much, much more severe than things that we've seen previously.
00:31:35.515 --> 00:31:38.785
So, so that's something we're going to have to continue to watch pretty closely.
00:31:39.515 --> 00:31:49.464
And the last thing to note with this is that as, as one of my colleagues, bill Hanna recently said even the common cold would be catastrophic if everybody got it at exactly the same time.
00:31:50.105 --> 00:31:52.744
Because you know, the common cold does cause hospitalizations.
00:31:52.744 --> 00:31:54.875
It causes pneumonia in older age groups.
00:31:55.914 --> 00:32:00.174
If everybody got it within the same two weeks, like that would cause a huge burden on our health system.
00:32:00.174 --> 00:32:03.934
And it would be a public health event of, you know, unprecedented scale.
00:32:04.295 --> 00:32:14.255
And so even if we end up with an older crown variant, that is no more severe than the common cold, if it's able to infect the world within an order of a couple of weeks, it's still going to be something we're going to have to contend with on a large scale.
00:32:14.615 --> 00:32:29.224
So, So I think that really just underscores the need for boosters for thinking about masking when in indoor spaces and, you know, thinking about all of these plans, we talked about with our holiday gatherings we got to have all our tools on the table to help us against this coming surge.
00:32:30.099 --> 00:32:31.000
And so helpful.
00:32:31.000 --> 00:32:31.150
Okay.
00:32:31.160 --> 00:32:36.579
The two things, number one, this is what you were saying two weeks ago, how quick news is probably bad news, right?
00:32:37.359 --> 00:32:41.690
So like, you know, if it was catastrophic, I would probably hear really quickly on they go, man, this is crazy, crazy.
00:32:41.690 --> 00:32:43.759
So this good news, it may not be quite as catastrophic.
00:32:44.210 --> 00:32:48.440
The other thing I kinda remind me of like, it's like me with like, hands-on stuff.
00:32:48.440 --> 00:32:49.789
Like I'm a tech guy.
00:32:50.029 --> 00:32:56.509
I, I lo I literally load the working on my house, like on any level, even if it's hanging a picture frame on the.
00:32:57.380 --> 00:32:58.849
I will delay it as long as I can.
00:32:58.849 --> 00:33:00.200
Cause I do not wanna get the hammer and nail.
00:33:00.200 --> 00:33:02.779
Cause I figured take me eight hours to figure out how to level this thing.
00:33:02.779 --> 00:33:03.019
Right.
00:33:03.680 --> 00:33:07.549
So it's kinda like when I get my hands and try to work on something, right?
00:33:07.849 --> 00:33:15.200
The more I work on in the house that actually the more complicated it becomes and the more problematic in the more fix it, it has to become.
00:33:15.200 --> 00:33:16.700
So it used to be a small problem.
00:33:17.000 --> 00:33:20.420
Usually when I address it, now it's a much bigger problem because now it's the original problem.
00:33:20.750 --> 00:33:23.480
Now my problem on top of it added on there's more holes in the wall.
00:33:23.480 --> 00:33:25.670
Now we have to putty because I missed a bunch of places.
00:33:26.795 --> 00:33:29.765
And now I say this tongue in cheek, Stephen, because this is clearly not what I'm saying.
00:33:29.765 --> 00:33:31.654
It's like, oh, I miss the good old days.
00:33:31.704 --> 00:33:33.755
The end of the pandemic when life was simple, right.
00:33:33.755 --> 00:33:40.085
Were, oh, it was just a pandemic, but now it's like, it's so much better, but it's more complicated because now we have vaccines and boosters.
00:33:40.085 --> 00:33:49.714
And how does that mix and match and how, and so it's just, I don't know how you guys deal with this stuff as an epidemiologist, as, as things unfolded, like, okay, now we have 18,000 more variables we've got to look at and figure out how that works.
00:33:50.555 --> 00:33:52.355
Again, I'm grateful me.
00:33:52.355 --> 00:33:53.555
I'm grateful your life.
00:33:53.585 --> 00:33:54.755
It makes way more complicated.
00:33:55.835 --> 00:33:56.404
Yes, it does.
00:33:56.404 --> 00:33:58.785
But and that's, that's, that's why we do what we do.
00:33:59.595 --> 00:34:03.884
So the, the last thing then I think the last thing I'll say is it's still on this.
00:34:03.884 --> 00:34:06.464
So this idea of, okay, we talked about this off the year.
00:34:07.079 --> 00:34:11.820
And this is where I'm reading a lot of the news of what you're just saying how, oh, Hey, the good news about the boosters.
00:34:11.820 --> 00:34:18.900
It seems though that it's skyrockets the antibodies so intensely that it sh it seems like it's covering the Omicron variant.
00:34:19.380 --> 00:34:25.710
So when I keep reading this, I get confused because what you've taught me and like I said, cause it sounds like, oh, well it's all about antibodies.
00:34:26.244 --> 00:34:29.215
Response in general, I just vomit antibodies and you're good to go.
00:34:29.215 --> 00:34:31.735
If that's the case, then any vaccine would take care of anything.
00:34:32.034 --> 00:34:34.554
If you could just go and get antibodies rubbed up, but it's not the case.
00:34:34.554 --> 00:34:34.824
Right?
00:34:34.824 --> 00:34:45.684
So this is where it seems really complicated from that it's the same old vaccine it's Reverend about because of this, because the antibody response, it seems like it's going to cover the Omicron, which is highly mutated.
00:34:45.684 --> 00:34:52.375
Do you see where I'm like, I see this, I see a disconnect in, can you help us fill in the gaps of that?
00:34:52.375 --> 00:34:53.065
Can't be the full.
00:34:53.849 --> 00:34:54.570
Yeah, totally.
00:34:54.570 --> 00:35:07.380
So, our immune system, the different arms of our immune system very in large part based on how specific their vision is for a a given virus.
00:35:07.409 --> 00:35:08.820
So there there's some parts of our immune.
00:35:09.405 --> 00:35:18.425
The, the antibodies that we normally think of that have these very precise molecular configurations that allow them to detect very precise structures on the surface of a virus.
00:35:18.815 --> 00:35:24.425
And so those antibodies are really good at seeing exactly when you've been infected with.
00:35:25.324 --> 00:35:29.585
Really closely related to something you've been infected with previously or have been vaccinated against.
00:35:30.025 --> 00:35:39.144
But they can get easily duped by these small changes on the surface of the virus and sort of render them unable to bind to the virus and unable to prevent the virus from infecting ourselves.
00:35:39.625 --> 00:35:42.505
But then there are different parts of our immune system that sort of like.
00:35:43.090 --> 00:35:47.860
Get the gist of the virus, but they don't, you know, they're, they're not necessarily so specific.
00:35:47.860 --> 00:35:50.980
And because of that, it can take them a longer time to respond.
00:35:50.980 --> 00:35:52.150
It takes them a little while longer.
00:35:52.150 --> 00:35:57.670
They sort of have to sit back and consider the virus for a while and say like, is this, is this something we should be concerned about or not?
00:35:57.670 --> 00:36:03.820
And then, and then ultimately, you know, if it's the virus starts to increase in as more other parts of the immune response, start to get revved up, they're like, okay.
00:36:03.820 --> 00:36:08.679
Yeah, this is, this is something that we really need to be worried about to attack and to respond to.
00:36:09.119 --> 00:36:10.619
And so they're the.
00:36:11.590 --> 00:36:13.690
You can sort of think of them as a little bit slower.
00:36:13.800 --> 00:36:19.599
But also able to be a little bit more flexible in their response able to identify sort of wider ranges of virus.
00:36:19.599 --> 00:36:24.340
And then there are other parts of our immune response that are just totally they basically just protect you against everything.
00:36:24.340 --> 00:36:30.250
They're like, I don't know what it is, but we're just going to like go out there and just like, try to eat up whatever we see that doesn't look like me.
00:36:30.519 --> 00:36:34.949
And and so, so all of these different things are in play now.
00:36:35.250 --> 00:36:36.750
Vaccines are.
00:36:37.880 --> 00:36:49.889
Really good at eliciting very specific types of antibody responses and especially a single dose of a vaccine is really good at getting these sort of like highly specific antibodies revved up and sort of stored away in your memory.
00:36:50.969 --> 00:36:58.833
One of the ways that I like to think about vaccination, I I think that, you know, we talk about immune memory as sort of a metaphor for how the immune system works.
00:36:58.893 --> 00:36:59.284
But I think.
00:36:59.798 --> 00:37:12.588
You know, I've, I've found that metaphor to be incredibly rich because I think that it thinking about the immune system as something that has a memory really does go a long way towards helping us understand what the immune system is doing.
00:37:12.588 --> 00:37:24.039
So one of the ways that I like to think of a vaccine is like, so you have this like really complicated image, this picture that you're being shown, it's just basically a picture of the virus, but you could imagine anything and what the vaccine does.
00:37:24.528 --> 00:37:28.278
It flashes that picture before the immune system's eyes very briefly.
00:37:28.278 --> 00:37:32.179
And so it gives us this like quick moment to say like, okay, this is what the virus looks like.
00:37:32.748 --> 00:37:36.949
And with two doses of the vaccine, we essentially got two very rapid flashes of that.
00:37:37.338 --> 00:37:42.889
But if you were shown like a really quick image you know, you would see a couple of sort of general characteristics of the.
00:37:43.699 --> 00:37:53.748
You might really notice one specific detail and if it were flashed before your eyes really quickly, you'd probably pinpoint on that exact same spot twice, because whatever you noticed first, your eyes would be trained to what it had seen.
00:37:54.798 --> 00:38:00.648
Now, if instead, you had been flashed that image twice, and then six months later, I came up to you and flashed to that same image.
00:38:00.648 --> 00:38:04.518
Again, you'd probably focus on a different part because your mind has had time to sort of process.
00:38:05.534 --> 00:38:15.043
And it wouldn't remember the fact that it got sort of so distracted by this one piece of the viral surface, but instead it will notice some other feature about the picture that it didn't see before.
00:38:15.614 --> 00:38:27.313
And that's the value of these vaccines that are spaced out over longer periods of time, because as your immune system gets these flashes of exposure to the virus, and as they're spaced out over longer periods of time, it allows your immune system to sort of mature.
00:38:27.849 --> 00:38:35.918
In the meantime and to forget, which is also a really important part of the immune response so that when it gets wrapped back up, it can notice a different part of the virus.
00:38:36.219 --> 00:38:42.768
And so essentially what we're doing is we're trying to sort of give it these images of the virus from different angles which also happens when you get infected.
00:38:43.039 --> 00:38:48.918
And so because of that, it sort of builds up this sort of entire repertoire of protection against different pieces of the.
00:38:49.739 --> 00:38:51.809
And so they're still very specific to SARS.
00:38:51.809 --> 00:38:54.838
COVID two, I'm just ramping up antibodies.
00:38:54.838 --> 00:38:56.548
As, as, as such.
00:38:56.548 --> 00:39:02.938
It doesn't really give us much protection against things that aren't SARS cov two, for the same reason that a flu vaccine doesn't protect us against COVID-19.
00:39:03.349 --> 00:39:14.728
But nevertheless, you know, getting these repeated exposures will help us over time to broaden our immune response, even against things that our immune system hasn't seen before, as long as they're sufficiently closely related.
00:39:15.784 --> 00:39:16.443
That's great.
00:39:16.773 --> 00:39:17.673
And you hit the nail on the head.
00:39:17.733 --> 00:39:19.204
I really felt super educated.
00:39:19.534 --> 00:39:22.114
I think I earned my honorary doctorate again.
00:39:22.623 --> 00:39:23.414
Thank you, Stephen.
00:39:23.954 --> 00:39:24.393
Appreciate it.
00:39:24.454 --> 00:39:25.594
I hope I hitting the nail on the head.
00:39:25.594 --> 00:39:29.224
I didn't make too many holes in your wall that you have to fill up with pipe until you're way too
00:39:29.224 --> 00:39:31.353
late for that man Swiss cheese in this house.
00:39:31.753 --> 00:39:32.563
So, great.
00:39:32.594 --> 00:39:33.193
That's perfect.
00:39:33.193 --> 00:39:33.704
We'll end there.
00:39:34.123 --> 00:39:35.123
I appreciate Stephen.
00:39:35.143 --> 00:39:36.673
We'll be back again in two weeks.
00:39:36.704 --> 00:39:39.583
Again, if you could not leave a review, please do so inspires us.
00:39:39.914 --> 00:39:48.224
He wants support us patrion.com/pandemic podcast for monthly subscriptions, as well as one-time gifts through PayPal then Mo all in the show notes.
00:39:48.224 --> 00:39:51.673
If you wanna get ahold of us, if you have questions for us, Matt at living.
00:39:52.278 --> 00:39:55.338
Tom, I will forward them on to Stephen and mark.
00:39:55.369 --> 00:39:56.688
I know mark has been here forever.
00:39:56.688 --> 00:40:00.438
He's been busy, busy, busy, but we hope to get them on sometime, at least one time soon.
00:40:00.958 --> 00:40:04.409
And if you wanna get ahold of Stephen, you can do follow him on Twitter, which is.
00:40:05.409 --> 00:40:08.978
S T E P H E N K I S S L E R.
00:40:09.458 --> 00:40:11.739
And I think that's it for this episode.
00:40:11.739 --> 00:40:12.938
Thank you all for listening.
00:40:13.298 --> 00:40:15.998
And we'll see you guys, I think after Christmas now.
00:40:16.028 --> 00:40:19.329
So if those of you who celebrate Christmas, Merry Christmas, happy holidays, happy Hanukkah.
00:40:19.719 --> 00:40:20.648
All the holidays.
00:40:20.648 --> 00:40:21.818
Have a wonderful season.
00:40:22.208 --> 00:40:22.719
Take care.
00:40:22.778 --> 00:40:24.009
We'll see you guys in two weeks.
00:00:00.029 --> 00:00:01.639
You're listening to the pandemic podcast.
00:00:01.639 --> 00:00:05.009
We equip you to live the most real life hospital and the face of these crises.
00:00:05.459 --> 00:00:08.609
My name is Matt Boettger and I'm joined not with four, three other people.
00:00:08.609 --> 00:00:16.260
If those of you who are going to watch this, actually, there was two other places for two of the people that we're not going to have on today, but I'm with my one good friend, Dr.
00:00:16.260 --> 00:00:19.109
Stephen Kissler, an epidemiologist, the Harvard school of public health.
00:00:19.469 --> 00:00:20.160
Good morning to you.
00:00:20.160 --> 00:00:20.910
It's good to see again,
00:00:20.910 --> 00:00:21.179
buddy.
00:00:21.449 --> 00:00:22.050
Good morning.
00:00:23.050 --> 00:00:23.530
Oh man.
00:00:23.530 --> 00:00:26.949
Well, you know, if you hear a bunch of buzzy and sound my background, I apologize today.
00:00:26.949 --> 00:00:28.089
This is not normally the case.
00:00:28.510 --> 00:00:31.210
It is now December things are actually starting to cool down.
00:00:31.570 --> 00:00:33.429
And my wife just told me she's freezing upstairs.
00:00:33.429 --> 00:00:37.270
So there's none negotiating on the heater being on right now and I'm in the basement.
00:00:37.289 --> 00:00:39.579
So I'll do my best to filter it out.
00:00:39.609 --> 00:00:42.700
But I got to put my priorities first and put you guys second.
00:00:43.490 --> 00:00:45.549
So that's the way it is.
00:00:46.310 --> 00:00:47.450
It's been two weeks.
00:00:47.500 --> 00:00:51.189
Last time we talked, you know, Omicron was like relatively new.
00:00:51.189 --> 00:00:53.020
We were talking about, Hey, how was Thanksgiving?
00:00:53.020 --> 00:00:53.649
And it was great.
00:00:53.649 --> 00:00:58.060
And well, you know, you're, while you're having your meal, you saw all these news, like percolated about Omicron.
00:00:58.060 --> 00:01:02.079
And it came on fast and quick and it was unknown and we were like, nervous about it.
00:01:02.079 --> 00:01:02.950
And what could it be?
00:01:03.310 --> 00:01:07.090
It sounds like within two weeks we got a fair about of news.
00:01:07.090 --> 00:01:14.049
Now, granted things could change pivot at any point in time, but we got a good amount of news to talk about an update about the Omicron, which seems.
00:01:14.805 --> 00:01:21.194
Generally, it's pretty good news, but we'll talk about that in a moment before we get going, the normal stuff.
00:01:21.224 --> 00:01:22.875
If you're listening, it's your first time listening.
00:01:22.875 --> 00:01:23.655
Welcome to the show.
00:01:24.075 --> 00:01:27.795
If you're not, and you've listened to us for a while and you haven't left a review, please do so.
00:01:27.795 --> 00:01:28.215
It'd be great.
00:01:28.215 --> 00:01:31.575
It really helps us leaves us, inspires us to keep this going.
00:01:31.965 --> 00:01:38.685
We just got another one in November 29th is the day our last one aired from DCB, J C N J.
00:01:38.864 --> 00:01:39.165
All right.
00:01:39.165 --> 00:01:39.825
That's that's that?
00:01:39.825 --> 00:01:43.805
That's his, her name I've been listening to throughout the pandemic and I've been remiss.
00:01:44.790 --> 00:01:47.459
I have been remiss is not leaving a review, right?
00:01:47.459 --> 00:01:50.430
So it has been fascinated to hear an epidemiologist SKUs.
00:01:50.849 --> 00:01:53.250
What he's learned about a novel virus in real time.
00:01:53.700 --> 00:02:07.200
It has also been reassuring to receive useful actual advice on living, living life and managing risk during the most significant global crisis of my lifetime, the information is delivered clearly and without the hysteria sensationalism we get in the headlines.
00:02:07.715 --> 00:02:09.965
The format, a conversation between a lay person.
00:02:09.995 --> 00:02:15.935
That's me an expert is gaze Katie to never drive as we head into Omicron winter, which I like that.
00:02:15.965 --> 00:02:16.685
Oh, Cod winter.
00:02:16.955 --> 00:02:19.835
It seems like we just, it was, seems like it was just Delta summer.
00:02:20.254 --> 00:02:22.384
I looked at tinny to rely on the podcasts that stayed in.
00:02:23.235 --> 00:02:26.805
And take reasonable steps to keep myself and my partner safe and healthy.
00:02:26.955 --> 00:02:27.794
Thank you so much for that
00:02:27.794 --> 00:02:28.125
review.
00:02:28.455 --> 00:02:29.134
Yeah, that's great.
00:02:29.185 --> 00:02:29.985
Really appreciate that.
00:02:30.074 --> 00:02:36.634
It's I'm glad that somebody enjoys learning about this on the fly with me, because sometimes I feel like I'm stumbling around in the dark.
00:02:36.664 --> 00:02:36.875
So
00:02:37.544 --> 00:02:46.414
I feel, I feel like we need to get email addresses to be like, you know how when you go into like, okay, I didn't even get this Stephen, but you go to a graduation ceremony and somebody gives a talk.
00:02:46.900 --> 00:02:49.360
There's a Tim honorary doctorate you're given, right.
00:02:50.110 --> 00:02:59.379
All these honorary doctorates, like for listening to you, we should give like a little certificate of honorary doctorates to everybody who listens because just listening to you and getting our own educated.
00:03:00.229 --> 00:03:01.580
Understanding of what's going on.
00:03:01.610 --> 00:03:02.360
So thank you, buddy.
00:03:03.780 --> 00:03:06.150
So, oh yeah, you can support us financially.
00:03:06.150 --> 00:03:08.250
patrion.com/pandemic podcast.
00:03:08.280 --> 00:03:09.900
Little as$5 a month goes a long way.
00:03:10.080 --> 00:03:10.949
It helps a lot.
00:03:10.979 --> 00:03:15.629
And as well as one time gifts, PayPal, Venmo, all in the show notes.
00:03:15.750 --> 00:03:17.189
I think that's all the good news.
00:03:17.715 --> 00:03:18.974
Get into a few things.
00:03:18.974 --> 00:03:29.564
First thing before we get into COVID, every once in a while other things fall in the news now eventually cover, it's going to go from a pandemic to an endemic and the news is not going to be so sensationalized and we'll move.
00:03:29.564 --> 00:03:33.824
Hopefully this podcast continued going maybe every other week and do other topics, that kind of stuff.
00:03:33.824 --> 00:03:36.284
So it's good to kind of get familiar with other things as well.
00:03:37.134 --> 00:03:39.534
Stephen, you're an expert in the flu, right?
00:03:39.534 --> 00:03:46.104
Because this is kind of like your, your whole PhD and every once in while we, we see this stuff, resurfacing, its ugly head.
00:03:46.414 --> 00:03:47.344
This one is interesting.
00:03:47.344 --> 00:03:51.965
I saw this article, Satan did COVID 19 cause flu strain to go extinct.
00:03:52.294 --> 00:03:53.974
So I read a little bit more about this.
00:03:53.974 --> 00:03:57.485
This is a guest, the influenza B Yamagata lineage.
00:03:57.485 --> 00:03:58.384
I don't know anything about this.
00:03:58.384 --> 00:03:59.764
I just get my flu vaccine.
00:03:59.794 --> 00:04:00.155
Call it.
00:04:00.155 --> 00:04:00.604
Good.
00:04:01.604 --> 00:04:02.435
What is this?
00:04:02.435 --> 00:04:04.384
I know how much do you know about this?
00:04:04.384 --> 00:04:05.254
What does this mean?
00:04:05.675 --> 00:04:07.835
And my biggest question is, okay.
00:04:07.865 --> 00:04:10.085
I didn't even know how many lineages, so there's four apparently.
00:04:10.085 --> 00:04:10.235
Right?
00:04:10.235 --> 00:04:12.455
So maybe, maybe we're down to three.
00:04:12.905 --> 00:04:16.714
Does this make vaccines easier and more effective down the road?
00:04:16.714 --> 00:04:17.555
If we knock out one
00:04:17.555 --> 00:04:18.004
lineage?
00:04:19.084 --> 00:04:19.384
Yeah.
00:04:19.384 --> 00:04:28.764
So, I think that the, the potential extinction of this particular influence of B strain is it's interesting on a couple of different levels.
00:04:28.795 --> 00:04:40.625
So to take a step back There are a lot of different varieties of the flu that circulate that we can the ones that currently circulate or at least have circulated up until recent memory can sort of be split into four large classes.
00:04:40.935 --> 00:04:45.324
And they are two types of influenza, a, which are somewhat closely related to each other.
00:04:45.324 --> 00:04:48.475
And two types of influenza B, which are a bit more distantly related.
00:04:49.345 --> 00:04:50.877
From a, they sort of clustered together.
00:04:51.338 --> 00:04:59.228
And the designations of these things largely have to do with how the virus looks on its surface and therefore how our immune system responds to it.
00:04:59.408 --> 00:05:02.617
Someone that a there's the AA slash H one N one.
00:05:02.648 --> 00:05:06.788
So you'll remember the 2009 swine flu pandemic was an H one N one variety.
00:05:06.788 --> 00:05:08.737
So this is pretty much a descendant of that.
00:05:09.168 --> 00:05:14.358
And then there's also an a H three and two strain, which would circulating prior to the pandemic in that.
00:05:15.358 --> 00:05:27.737
And that the 2009 pandemic didn't manage to displace which was interesting because in most previous pandemics, the, the previously circulating strain has been displaced, but now we have this sort of coast, circulation of two eight strains, and also to be strains.
00:05:27.737 --> 00:05:33.218
So the bee Victoria and the bee Yamagata strains that that are sort of.
00:05:34.048 --> 00:05:37.557
To the a H one N one and the H three N two.
00:05:38.148 --> 00:05:42.007
So I think that the one that you had mentioned was this B Yamagata.
00:05:43.023 --> 00:05:43.653
Flu strain.
00:05:43.682 --> 00:05:49.502
So when we get vaccinated against the flu, we often get vaccinated against multiple strains of flu at once.
00:05:49.603 --> 00:05:57.252
So up until recently, it was usually a tri Vaillant flu vaccine, which was usually against two types, both of the, a types and one of the B types.
00:05:57.502 --> 00:06:02.483
More recently there have been a quadrivalent flu vaccines that have been protective against all four varieties.
00:06:02.742 --> 00:06:09.002
But now there's this question of, you know, are we going to see this this flu B strain continue to circulate.
00:06:10.077 --> 00:06:20.247
With the non-pharmaceutical interventions and with whatever else led to the reduction in flu cases, it seems like we haven't really seen much of a resurgence of this particular flu B strain.
00:06:20.778 --> 00:06:23.148
While we have seen circulation of the others around the world.
00:06:23.148 --> 00:06:28.427
So we think that this flu string, if it were around would have the opportunity to spread, but we haven't seen it yet.
00:06:28.427 --> 00:06:31.997
So there's a possibility that it may have gone extinct, which is interesting.
00:06:31.997 --> 00:06:35.437
So I do think that it would help with vaccine formulation.
00:06:35.468 --> 00:06:35.767
It would mean.
00:06:36.538 --> 00:06:50.387
You know, be able to go back to a tri Vaillant flu vaccine, which would make it a little bit easier to produce it would make it so that you know, there are fewer chances for an a mismatch between the vaccine and the thing that's currently circulating to cause more disease.
00:06:51.557 --> 00:06:52.968
I do think that the games would be.
00:06:53.747 --> 00:06:54.557
Marginal.
00:06:54.608 --> 00:06:59.577
In my understanding the most of the flu that we see is due to the flu a stream.
00:06:59.577 --> 00:07:04.197
So H one N one N H three and two are the things that really tends to cause a lot of the disease.
00:07:04.567 --> 00:07:11.048
The B strains do cause quite a bit of disease as well, but really the, the A1C seemed to be the ones that are sort of the most robust spreaders.
00:07:11.427 --> 00:07:16.197
And so while it would be helpful, I do still think that the other strains may well just sort of fill in that.
00:07:16.733 --> 00:07:24.392
That's provided by the absence of this other strain, but definitely for the sake of producing vaccines more quickly and more effectively, I do think that it's a, it would be.
00:07:25.632 --> 00:07:25.932
Great.
00:07:26.202 --> 00:07:31.663
I kind of assumed that I'm in Australia, went missing all of a sudden, I'm guessing it's probably not the strongest one available right now.
00:07:31.663 --> 00:07:36.283
So it's not going to be that much of a difference, but Hey, it's like a little supplement gives us a little bit of boost.
00:07:36.312 --> 00:07:36.552
Okay.
00:07:36.973 --> 00:07:38.023
Helpful information.
00:07:38.442 --> 00:07:39.762
Let's get into the COVID stuff.
00:07:39.793 --> 00:07:45.673
Now, before we get into Omicron, which is kind of a big topic, there's a few other things I came across in the past few.
00:07:46.202 --> 00:07:47.822
So we we've talked about Dr.
00:07:47.822 --> 00:07:50.163
Ostroff and how respected he is.
00:07:50.163 --> 00:08:00.603
And he's been back in the news again because of his prediction, like 18 months ago or whatever it was he predicted within 18 months or so about 800,000 deaths in the U S and crazily.
00:08:00.603 --> 00:08:02.297
He's almost like spot on.
00:08:02.303 --> 00:08:08.423
He might, we're not even at quite the 18 month mark, maybe we were a few weeks away and we're probably about 7,000 short from that prediction.
00:08:08.903 --> 00:08:11.634
So he's back in the surface, in the limelight of the news.
00:08:12.358 --> 00:08:16.439
And one of the things that he mentioned, and now I just wanted to throw it to you to accept even what this means.
00:08:16.889 --> 00:08:19.108
And it was a short blurb on a video.
00:08:19.168 --> 00:08:22.889
And he talked about the distinctive, the distinction between two types of surges.
00:08:22.889 --> 00:08:34.859
Recently, we know, we know the India surge and we're all avail, or we are really, we don't last, last summer, we talked about this and how it was a significant spike went really, really high, but then it plummeted quite quickly.
00:08:34.859 --> 00:08:35.849
Once it reached its spot.
00:08:36.734 --> 00:08:43.153
And then there's the other version, which is kind of UK, I guess, which is experiencing, which is again, a spike, maybe a slight.
00:08:44.024 --> 00:08:50.053
And then maybe then resurrect its ugly head and then continuing like this, a spike for a long period of time.
00:08:50.474 --> 00:08:57.104
Now he had juxtapose this with the U S saying this summer, the Southern us seemed to represent the India version.
00:08:57.553 --> 00:09:00.014
And now we're seeing which I was unaware.
00:09:00.313 --> 00:09:05.024
The Northern part of the U S is experiencing kind of UK version.
00:09:05.083 --> 00:09:07.063
This is that kind of spike and then sustainable.
00:09:07.889 --> 00:09:09.538
Now maybe you can help parse this.
00:09:09.538 --> 00:09:10.619
What does this mean?
00:09:11.009 --> 00:09:14.249
Is, is, is there a way to understand this and predict this?
00:09:14.428 --> 00:09:17.879
You know, my, my, my thing is, oh, it's just, again, I'm a lay person.
00:09:17.879 --> 00:09:22.708
So I'm like, oh, it's just simply a matter of time where, you know, in the Southern it was all Delta.
00:09:22.798 --> 00:09:23.129
Right.
00:09:23.558 --> 00:09:27.188
But in the now when the Northern's heading well, it's Delta now Omicron.
00:09:27.428 --> 00:09:30.099
And so maybe that's the reason why it's simple as that, or maybe it's more complicated.
00:09:30.099 --> 00:09:34.208
So what does this mean for us and for people who are listening about these types of.
00:09:35.208 --> 00:09:35.479
Yeah.
00:09:35.509 --> 00:09:41.119
So, I love this question because it gets at a lot of sort of fundamentals of infectious disease transmission.
00:09:41.119 --> 00:09:43.158
It also uncovers a lot of what we don't really know.
00:09:43.568 --> 00:09:57.629
So, so this is this is actually an area that we in, in, in my research group are beginning to look at in some detail to try to understand sort of what leads to these pretty different experiences with the virus across different places.
00:09:57.688 --> 00:09:58.139
And.
00:09:59.323 --> 00:10:16.484
How long will it take places to sort of synchronize in their experience or will they ever, because if we go back to the example of flu most of the U S for example, and really basically temperate regions across the globe are pretty well synchronized where we have our flu outbreaks during the wintertime.
00:10:16.933 --> 00:10:29.283
And there's a little bit of variation in timing, but nothing like what we've been seeing with the experience of, you know, these major surges followed by huge declines relative to sort of this sustained degree of transmission.
00:10:30.244 --> 00:10:39.124
I think there could be a couple of things going on, you know, the, the first and most obvious element that we don't really have a clear sense of how to measure it, how to account for just.
00:10:39.884 --> 00:10:41.203
Differences in human behavior.
00:10:41.573 --> 00:10:51.854
And so we know for sure that you know, in, in the Southeastern United States the indoor season tends to be the summer, whereas in the Northeastern us, it tends to be the winter.
00:10:51.854 --> 00:10:59.484
And so, when people spend time indoors versus outdoors and what the relative fraction of time they spend indoors versus outdoors could play some role in this.
00:10:59.484 --> 00:11:07.264
And that could help to explain some of the differences between The differences in the experience of the virus in places with different sorts of climates.
00:11:07.923 --> 00:11:15.344
Some of it may have to do with underlying immunity and the degree to which things like non-pharmaceutical interventions have been put in place.
00:11:15.374 --> 00:11:26.803
So, I've been trying to think of a good analogy for this, but you know, you, you can imagine that You know, I'm, I'm trying to think of something like, almost like when you're bouncing a basketball, right?
00:11:26.803 --> 00:11:30.683
Like if you if you throw it at the ground, it'll keep bouncing.
00:11:31.374 --> 00:11:32.183
For awhile.
00:11:32.244 --> 00:11:37.943
Whereas if you sort of gradually drop it to the ground, it's going to take a much longer time to hit the ground, but it'll just sort of like gradually get there.
00:11:38.364 --> 00:11:49.913
And one of the things that you can see with infectious disease dynamics potentially that could be going on here is that in places that suffer a really major surge they basically synchronize the immunity of everybody in that population.
00:11:50.244 --> 00:12:02.969
And so then as immunity wanes, That basically everybody sort of has the same degree of immunity and you could reach this point where all of a sudden there can be this new explosive outbreak, whereas in a place that has a buildup of immunity, that's much more gradual.
00:12:03.278 --> 00:12:07.058
You may end up with sort of this asynchrony between people and their immunity.
00:12:07.058 --> 00:12:16.509
And so because of that, there's sort of these people who can get reinfected at different points in time, but it's just sort of this much more gradual kind of transition to an endemic virus.
00:12:17.764 --> 00:12:19.323
So that could be part of it too.
00:12:19.703 --> 00:12:27.344
And one of the things we're trying to ask with our, with our research is, is to what extent could each of these things we contributing to these different sorts of trajectories that we see in different.
00:12:28.318 --> 00:12:28.708
Hmm.
00:12:28.859 --> 00:12:29.129
Okay.
00:12:29.158 --> 00:12:29.788
That's helpful.
00:12:29.879 --> 00:12:29.969
Yeah.
00:12:29.969 --> 00:12:30.178
Yeah.
00:12:30.208 --> 00:12:31.769
Cause I was unaware of that.
00:12:31.769 --> 00:12:39.839
I know Colorado, we're still kind of slowly coming out of our surge has been kind of a little bit ongoing and not quite as fast as a plummet, more sustainable for us.
00:12:39.839 --> 00:12:50.158
It's it's I think it's harder because it, you know, again, it's the environmental, environmental parts of, of our state where generally we've been having a pretty warm fall.
00:12:50.158 --> 00:12:52.589
So we've been outside more is starting to cool off.
00:12:52.589 --> 00:12:55.259
So I could see us having a greater sustained.
00:12:55.948 --> 00:12:56.489
Levels now.
00:12:56.548 --> 00:12:57.359
Totally random.
00:12:57.599 --> 00:13:00.119
I have Fred thrust in the show notes, but Polis our governor.
00:13:00.239 --> 00:13:00.658
Totally.
00:13:00.808 --> 00:13:02.099
I didn't even, I didn't even tell you this.
00:13:02.668 --> 00:13:03.328
This is a bolt.
00:13:03.568 --> 00:13:04.828
I don't know if you saw it in a news.
00:13:04.918 --> 00:13:06.110
He made a bold statement.
00:13:06.110 --> 00:13:08.301
Maybe not bold, but he was just like, it was good.
00:13:08.301 --> 00:13:19.100
I think where he, you know, we're seeing a surge of the, of, of, of the virus here and, and he just kind of said, look, I'm not gonna do any more state of emergencies I'm done with these.
00:13:19.100 --> 00:13:22.370
Like, he's like, Everybody's had a time to get the vaccine by now.
00:13:22.400 --> 00:13:23.571
It's been long overdue.
00:13:23.600 --> 00:13:23.841
Now.
00:13:23.870 --> 00:13:27.740
Boozers like, you know, basically if you don't want the vaccine, then you're playing that game.
00:13:27.740 --> 00:13:27.921
Now.
00:13:27.951 --> 00:13:30.291
It's like, there's been wide availability, right.
00:13:30.410 --> 00:13:31.821
And we've had them all over the place.
00:13:31.821 --> 00:13:32.870
We've you can get them at Safeway.
00:13:32.870 --> 00:13:35.120
You can get grocery stores, you can get them at, at clinics.
00:13:35.120 --> 00:13:36.081
You can go to outdoor events.
00:13:36.081 --> 00:13:38.931
We've did our best to make them widely available the whole state.
00:13:38.980 --> 00:13:40.010
Now it's to the point where.
00:13:40.946 --> 00:13:42.296
I'm wiping my hands clean.
00:13:42.775 --> 00:13:45.206
I'm no more state of emergencies now, local levels.
00:13:45.206 --> 00:13:47.846
They can do whatever they want, feel free, you know, port about counties.
00:13:47.875 --> 00:14:06.895
They can do whatever they want, but as a state level, that part is done and it got a lot of press and over the past couple of days, and you know, my intuition is felt like that's probably a good, a good decision at this point in time, you know, it's, it's now just like, if you chose not to get the vaccine, now he told him knowledges, of course you can get breakthroughs with the vaccine, but it is much more rare.
00:14:06.926 --> 00:14:07.706
He said, this isn't about.
00:14:08.780 --> 00:14:16.250
And our hostels right now, I think only 16% between 13 and 16% of those hospitalized are vaccinated.
00:14:16.250 --> 00:14:16.431
Right.
00:14:16.431 --> 00:14:19.071
So we're talking about the overwhelming population run backs.
00:14:19.350 --> 00:14:23.311
So, so we're seeing the sustainability right now and now things are starting to cool off.
00:14:23.311 --> 00:14:24.811
You can hear my heater in the background, right.
00:14:25.140 --> 00:14:29.100
That people are going to more indoors, so I could see it then continuing a little bit longer in those kinds of things.
00:14:29.100 --> 00:14:30.120
So, yeah, that's helpful.
00:14:31.591 --> 00:14:31.890
Okay.
00:14:31.890 --> 00:14:33.030
It's let's continue on.
00:14:33.061 --> 00:14:35.760
One thing I wanted, we talked about, and this might be a short conversation.
00:14:35.760 --> 00:14:40.410
I saw this Atlantic and not quite sure why they posted this article because to me it's helped.
00:14:40.681 --> 00:14:47.341
She seemed really relatively easy answer said, why are we still isolated vaccinated people for 10 days?
00:14:47.341 --> 00:14:54.030
I just had a friend who, who is vaccinated got COVID and, you know, asked to be quarantined for 10 days.
00:14:54.480 --> 00:14:55.561
I haven't really thought much about this.
00:14:55.561 --> 00:14:55.951
I'm like, okay.
00:14:55.951 --> 00:14:56.160
Yeah.
00:14:56.221 --> 00:14:57.961
You know, because even though I've heard things.
00:14:59.086 --> 00:15:00.015
Oh, and you're vaccinated.
00:15:00.436 --> 00:15:02.176
You can shed the virus quicker.
00:15:02.265 --> 00:15:03.346
You're contagious less.
00:15:03.346 --> 00:15:07.005
So that makes sense of being, being quarantined for less.
00:15:07.035 --> 00:15:18.495
But we also hear that there are people who remain contagious for, so I'm just assuming we just say 10 days because Hey, some people are still contagious, but is there, is this more nuanced than I'm actually thinking?
00:15:18.495 --> 00:15:22.515
Is this something that the other discussion like, Hey, we should, we should knock this down for people who are battling.
00:15:23.370 --> 00:15:33.740
Yeah, I think, you know, I think you're right, but like, from, from what I've seen, you know, we've, we've done some work that suggests that that people who are vaccinated may clear the virus on, on average more quickly, but you're right.
00:15:33.740 --> 00:15:40.451
Like there there will be some number of people who still retain the virus and are still infectious for a number of days.
00:15:40.480 --> 00:15:41.230
And sort of that tenant.
00:15:41.730 --> 00:15:48.480
Sort of captures the range when we expect people to be potentially infectious to others.
00:15:48.561 --> 00:16:01.451
I didn't get to read the article, but I I w I would actually maybe even go a step further and say, you know, why are we isolating anyone for 10 days at baseline in, because what I think we should be doing is.
00:16:02.015 --> 00:16:05.135
Using tests to spring people from isolation.
00:16:05.135 --> 00:16:14.966
So I do think some people will need to be isolated for 10 days or even more if they continue to test positive on a rapid antigen test which indicates that they may be infectious.
00:16:14.966 --> 00:16:20.515
But I do think that we could probably spring a lot of people vaccinated or not from their isolation period.
00:16:20.515 --> 00:16:26.125
If they have a sequence of negative, rapid antigen tests, suggesting that they're past their infectious period.
00:16:26.245 --> 00:16:29.096
And so I think that there are ways where we can be.
00:16:29.730 --> 00:16:37.451
Smarter about this, using the tools that we have available to reduce the amount of time that people are in isolation and isolating is pretty disruptive.
00:16:37.451 --> 00:16:55.149
You know, it's like, I think when we, you know, when we think about it, like, you know, okay, like 10 days you get COVID or whatever, you know, like, but But, you know, for family, with kids, I for anybody, like when you actually think about like being stuck in your house for 10 days, like it's not fun, especially if you're like feeling okay.
00:16:55.629 --> 00:17:05.240
And and so it is important for reducing spread, but I do think that there are a lot of things we could do given the technology we have available to reduce the isolation period to only the span of time that it needs.
00:17:06.265 --> 00:17:06.535
Great.
00:17:06.684 --> 00:17:15.244
Well, that's a perfect segue because we're going to continue this discussion right now with that in light of the holiday travel, you said you just did a Q and a live Q and a about holiday traveling.
00:17:15.244 --> 00:17:27.345
The reason why I think it's the perfect segue is I'm guessing these tests might be part of the equation for good holiday travel, because so maybe first talk about like what you talked about and how to prepare for holiday travel.
00:17:27.384 --> 00:17:29.265
Do it safely, be able to see your friends and family.
00:17:29.654 --> 00:17:33.464
And I want you to dovetail this with what we just talked about.
00:17:34.214 --> 00:17:37.515
That if for instance, you do get COVID right.
00:17:37.724 --> 00:17:42.605
How could you use antigen tests to then best conclude that you're okay to go out.
00:17:42.605 --> 00:17:44.134
Cause we know they're not perfectly effective.
00:17:44.134 --> 00:17:46.625
So do you couple them with other things, do you do two every other day?
00:17:46.625 --> 00:17:47.404
And then we get to natives.
00:17:47.704 --> 00:17:51.154
How do you, how does that formula fit into like check off the box?
00:17:51.664 --> 00:17:54.125
Hey, I just got COVID it's 10 days before Christmas.
00:17:54.694 --> 00:17:55.875
I'm able I'm I'm okay to see my
00:17:55.875 --> 00:17:56.505
grandparents.
00:17:56.954 --> 00:17:57.255
Yeah.
00:17:57.884 --> 00:17:58.785
Yeah, so.
00:18:00.000 --> 00:18:06.839
The taking the first bit about sort of, how can we think about holiday travel and gatherings this year?
00:18:07.309 --> 00:18:21.670
In my advice, even in the context of Omicron is pretty similar to what I've said for holiday gatherings before, which is sort of in this order, you know, get vaccinated and get boosted if you're able Then I think a lot about ventilation, make sure that windows are cracked.
00:18:21.670 --> 00:18:25.240
Fans are on, maybe even have a air filter with a HEPA filter in it.
00:18:25.240 --> 00:18:30.400
If if that's within your means and leaf blower, maybe a leaf blower turn on that leaf blower.
00:18:30.460 --> 00:18:32.079
Yeah, that's right.
00:18:32.079 --> 00:18:32.470
Why not?
00:18:33.039 --> 00:18:35.569
And yeah, and then take rapid test before.
00:18:35.619 --> 00:18:42.359
So one of the things that I didn't realize until this week, but it might be useful for a number of our listeners who are out in Colorado that apparently.
00:18:43.535 --> 00:18:48.555
The state makes rapid tests available for free that you can get repeatedly.
00:18:48.555 --> 00:18:54.434
So I thought originally this was just a one-time thing, but I do think that you can get basically four boxes of the avid by next.
00:18:54.434 --> 00:19:00.194
Now is I think every week or every other week, you have to go on online and sort of fill out a form.
00:19:00.224 --> 00:19:01.634
So it's a little bit of a pain.
00:19:02.799 --> 00:19:07.880
But it takes about 10 minutes to get you know, like four boxes of rapid tests every week.
00:19:07.880 --> 00:19:10.160
And I think that that's, you know, that that's what we should be doing everywhere.
00:19:10.369 --> 00:19:10.819
I did that.
00:19:10.819 --> 00:19:11.269
It's great.
00:19:11.299 --> 00:19:18.890
Like, I, I, I, it's a little complicated cause I signed up me and I thought I was doing my family, but I guess each in a person, each individual person has to sign up.
00:19:18.890 --> 00:19:20.839
So if you have kids, you sign them up.
00:19:21.680 --> 00:19:25.849
So I just signed myself up, got two boxes right away, and then I'll send the rest kids.
00:19:25.849 --> 00:19:28.549
I'll put another six boxes and keep them coming.
00:19:28.579 --> 00:19:29.269
So it's pretty great.
00:19:29.299 --> 00:19:30.529
Great, awesome thing to have on
00:19:30.529 --> 00:19:30.740
hand.
00:19:31.069 --> 00:19:31.859
Yeah, it's wonderful.
00:19:31.859 --> 00:19:31.970
Yeah.
00:19:32.240 --> 00:19:33.916
Yeah, no, I think, that's, that's great.
00:19:33.916 --> 00:19:42.166
And so, you know, now is the time if you haven't gotten them yet, you know, get some of these rapid tests and take them before your gatherings take them before you.
00:19:42.807 --> 00:19:48.057
And you know, I, at this point to travel, I think, I think you need a negative test within 24 hours.
00:19:48.057 --> 00:19:50.396
And so the rapid tests are really helpful for that kind of thing.
00:19:51.057 --> 00:19:56.636
And I think that all of those things even in the context of Omicron can go a long way towards keeping us all safe.
00:19:56.737 --> 00:19:59.047
I think that, you know, Omicron is definitely coming.
00:19:59.116 --> 00:20:03.586
We're starting to see increases in the proportion of cases that are Omicron, especially here in the Northeast.
00:20:04.057 --> 00:20:05.336
It will spread across the country.
00:20:06.227 --> 00:20:14.977
My hope is that here in the U S we w that the, the major OMA Crohn's surges we'll wait until just after the holidays to really get rolling.
00:20:15.007 --> 00:20:19.656
But right now we still have a lot of Delta around to, you know, it's like, oh, Macron is not the only thing to be concerned about at the moment.
00:20:19.656 --> 00:20:27.797
We've got a lot of Delta spreading at the moment to But whether it's still to Oroma Cron, all of these things do seem to be helpful towards preventing spread.
00:20:27.807 --> 00:20:39.376
So, so that's, that's what I would suggest now, if you do get COVID I think that you know, certainly, you know, continuing to test to see when you test negative repeatedly, I wouldn't to spring yourself from quarantine.
00:20:39.376 --> 00:20:41.116
I wouldn't trust a single negative test.
00:20:41.176 --> 00:20:46.557
I would probably trust two negative rapid tests three even better.
00:20:46.886 --> 00:20:58.797
And so, you know, that's, that's already a lot of tests, but, but mainly what I would say is just, just talk to your doctor because at this point, you know, they'll be able to, to guide you through your own particular situation and that there's so much nuance.
00:20:58.797 --> 00:21:07.747
And that has to do not only with, you know, your own medical condition, but the people you might end up seeing and the amount of spread that's happening in your community at baseline.
00:21:07.747 --> 00:21:14.247
So I don't think that there's any sort of hard and fast rule that I can give to everyone that will apply on all of their situations.
00:21:14.247 --> 00:21:15.027
But I do think.
00:21:15.632 --> 00:21:31.001
Between all of the conversations that we've had on this podcast about rapid tests and sort of, The role that they play, that they don't give you certainty either way, but that they do increase the odds of, you know, your actual scenario lining up with what the test is telling you.
00:21:31.332 --> 00:21:41.201
And and so hopefully between all of those discussions, you know, people will be able to interpret the results of their tests in a way that is is useful for whatever, whatever context they're in this holidays.
00:21:42.086 --> 00:21:42.386
Great.
00:21:42.477 --> 00:21:48.926
And you helped me because we were wondering if we had, you know, just being safe before we see my mother-in-law couple weeks ago.
00:21:49.406 --> 00:21:59.886
And he suggested which was helpful because obviously those engine tests aren't a hundred percent and never will be nor the PCR ones, but take not only two different tests, if you can't from two different manufacturers, just a.
00:22:00.412 --> 00:22:05.451
To help that that'll help as well to continue to increase your odds of having the right conclusion.
00:22:06.122 --> 00:22:06.781
So that was helpful.
00:22:07.461 --> 00:22:14.402
You really want go out your way by two different versions and then you can, it just, just helps even more to feel a little bit, a little bit better about the conclusion.
00:22:14.912 --> 00:22:17.342
So I know Alma Crohn's on our, on our minds.
00:22:17.342 --> 00:22:19.892
One more thing, because this is related to the engine.
00:22:21.001 --> 00:22:22.201
We didn't talk about this two weeks ago.
00:22:22.842 --> 00:22:28.951
The antiviral pill is coming out for COVID is a super exciting, because gosh, it's just a reminder.
00:22:30.182 --> 00:22:34.102
Like something about like 80 some percent prevention of, of hospitalizations.
00:22:34.551 --> 00:22:37.852
It's, it's, you know, it's on the verge of like, like the vaccine, right.
00:22:37.882 --> 00:22:39.892
But except for you already, you get COVID first.
00:22:40.291 --> 00:22:41.761
And it, and it makes you better quicker.
00:22:42.211 --> 00:22:42.842
This is exciting.
00:22:42.842 --> 00:22:43.981
Maybe come out in January.
00:22:43.981 --> 00:22:47.612
I'm not sure who it will be available for how readily available it'll be.
00:22:48.257 --> 00:22:54.916
But this hinges again on the same thing, because kind of like that Tamiflu for the flu, I think same thing had to take it pretty closely right after you have symptoms.
00:22:54.916 --> 00:22:56.267
Otherwise it's not nearly as effective.
00:22:56.807 --> 00:22:57.457
Same for this.
00:22:57.467 --> 00:22:59.116
I like this pill.
00:22:59.146 --> 00:23:00.406
I think it's, it's a marker.
00:23:00.406 --> 00:23:03.616
I'm not sure what it is, which one it is that it's, that it's coming out.
00:23:04.067 --> 00:23:04.336
But
00:23:04.336 --> 00:23:07.047
there's there are two we can get into that in a moment.
00:23:07.602 --> 00:23:07.932
Okay.
00:23:07.961 --> 00:23:08.112
Yeah,
00:23:08.112 --> 00:23:13.362
but then, yeah, but I think it's within six days or five or six days of symptoms, you have to take it otherwise not nearly effective.
00:23:13.362 --> 00:23:18.261
So you've got to have these things on hand ladies quick, or be able to get a PCR test really quickly.
00:23:18.261 --> 00:23:21.961
If you want to take this, these pills and really lessen the symptoms.
00:23:21.961 --> 00:23:24.571
So Carrie, you can fill in the blanks.
00:23:24.571 --> 00:23:24.721
Yeah.
00:23:25.321 --> 00:23:25.561
Great.
00:23:25.622 --> 00:23:25.922
Yeah.
00:23:26.311 --> 00:23:26.971
Yeah, so.
00:23:27.767 --> 00:23:32.027
To my knowledge there are there sort of two of these antiviral pills that are coming out.
00:23:32.126 --> 00:23:34.106
So there's one that's produced by Merck.
00:23:34.156 --> 00:23:35.717
And one that's produced by Pfizer.
00:23:35.747 --> 00:23:41.866
So the interim results from Merck were looking pretty promising, but actually they're their conclusions from the final trial where.
00:23:42.711 --> 00:23:48.102
Okay, but not as good, maybe that it was like 30% effective against hospitalizations, but the Pfizer one is looking much better.
00:23:48.102 --> 00:23:56.625
I think that may be the one that you're referring to here where it is like on the order of 80 to 90% effective against preventing hospitalizations, which is incredible.
00:23:56.646 --> 00:24:00.636
I think it's, it's really worth taking a step back that like with both.
00:24:01.592 --> 00:24:10.951
Like pharmaceutical drugs and vaccines, like something that can reduce your risk of hospitalization or death by that much is like, that's pretty amazing.
00:24:11.251 --> 00:24:14.571
And so, I think it's, it's wonderful that we, that we have these things.
00:24:15.451 --> 00:24:18.571
The available and we'll have them coming online very soon, but, but you're right.
00:24:18.612 --> 00:24:31.422
The, the, the difficulty as with Tamiflu is that you need to know if you've been infected pretty early on because you need to start taking the drug within a couple of days after really after infection.
00:24:32.412 --> 00:24:36.652
And yeah, basically the sooner you get on them, the better chance they have to work.
00:24:36.652 --> 00:24:50.451
So, so that really just, again, just underscores the need for testing and for it makes it all the more important to do the sorts of things that we've been hoping for, that, you know, people might test themselves with a rapid antigen test frequently so that they can know.
00:24:50.721 --> 00:24:56.136
And and so I do think that, you know, again if you do start showing symptoms, get tested as quickly as you can.
00:24:56.237 --> 00:25:02.567
And and that will really help to not only guide your own behavior, but now to guide what sort of treatment you might get.
00:25:03.166 --> 00:25:03.406
Yeah.
00:25:03.886 --> 00:25:04.126
Yeah.
00:25:04.156 --> 00:25:13.775
I This is where it gets also just crazy complicated because like COVID symptoms, colds, RSV, flu is like, they all have the same kind of symptoms.
00:25:13.775 --> 00:25:13.984
So.
00:25:15.000 --> 00:25:17.190
You know, you could have the sniffles for a day, it could be allergies.
00:25:17.190 --> 00:25:23.369
And like, you know, at 1250 a pop for an antigen test, unless he got a big budget, it's hard to like, okay.
00:25:23.400 --> 00:25:26.579
Oh, you know, I fill in a little Steph folders, probably just get checked, you know, do Andrew tests.
00:25:26.579 --> 00:25:32.970
I just, I'm just hoping he seems to come down like another 80% where, you know, you can take these and then quickly be able to.
00:25:33.609 --> 00:25:36.730
You know, start tickets like this, just to be on it's an insurance policy.
00:25:36.819 --> 00:25:39.430
And by the way, I got boosted on front Thursday.
00:25:39.430 --> 00:25:41.910
So I've got my booster, Madonna and pre-fill and pretty excited about it.
00:25:41.930 --> 00:25:42.759
Didn't really affect me much.
00:25:42.759 --> 00:25:45.539
I know it laid you out Stephen, but it didn't do too much for me.
00:25:45.539 --> 00:25:51.170
I felt a little fatigue, but I'm not fully, still hasn't fully wrapped up my system, but I'm feeling good about the next step.
00:25:51.170 --> 00:25:51.619
That's great.
00:25:51.920 --> 00:25:52.279
Okay.
00:25:52.819 --> 00:25:55.009
So finally, let's get into Omicron.
00:25:55.039 --> 00:25:58.849
So just spew the beans, Stephen, like where are we at with Omicron?
00:25:59.384 --> 00:26:01.035
Is it as bad as we thought it's was going to be.
00:26:01.035 --> 00:26:02.835
Is it less, what do we know?
00:26:02.964 --> 00:26:05.204
Sounds like we know a lot more information than we did two weeks.
00:26:06.295 --> 00:26:07.075
Yeah, definitely.
00:26:07.075 --> 00:26:10.365
We, we've learned a lot in these last two weeks which is great.
00:26:10.414 --> 00:26:21.194
There is still a lot left to learn but we're in a much better spot in terms of what we know about the virus and about this particular variant now than we were when we first started talking about it.
00:26:21.255 --> 00:26:28.214
So, as I mentioned the last time, I think I mentioned the last time there was sort of this order of events where we were going to first learn about antibody neutralism.
00:26:29.234 --> 00:26:31.365
And then the next thing we will learn about is transmissibility.
00:26:31.634 --> 00:26:33.674
And the last thing we would learn about is severity.
00:26:34.065 --> 00:26:41.785
So, a lot of the big news lately has come from the immune response, the, the neutralizing ability of our antibodies against the virus.
00:26:42.134 --> 00:26:47.085
And as expected, the virus does a really good job of getting around our immune response.
00:26:47.384 --> 00:27:10.484
The mutations that it has really just helps, it helps to disguise it from our antibodies But there've been a couple of, of reasonably promising studies that suggest that getting a booster dose, whether you've been previously infected or had a previous set of doses have any of the vaccines that the booster does can go a really long way towards preventing you basically for giving you protection against the Macron variant.
00:27:10.875 --> 00:27:16.515
Even though the booster dose is still the same old vaccine that we'd had for months, which is great news.
00:27:16.545 --> 00:27:19.934
Now there's some variation from study to study and just how much that.
00:27:20.819 --> 00:27:21.390
Gives you.
00:27:21.390 --> 00:27:35.150
So, there was a study from Pfizer that suggested that the booster dose basically restores your neutralizing antibody levels, meaning that, you know, the ability of your immune system to recognize and essentially eradicate the virus back up to levels of two doses against the.
00:27:35.845 --> 00:27:37.375
Founding SARS cov two strings.
00:27:37.404 --> 00:27:45.855
Now there are a number of other studies that are not quite as rosy as that that suggests that the Omicron will still take a hit in booster, neutralizing activity.
00:27:46.345 --> 00:27:49.494
But that definitely getting a booster is much better than not having a booster.
00:27:49.914 --> 00:27:53.815
So, so that story seems to be fairly consistent.
00:27:54.085 --> 00:28:02.994
The other important thing to note is that most of the information that we have so far on the immune response against Omicron has to do with these neutralizing antibodies.
00:28:02.994 --> 00:28:08.755
So it's this one particular arm of our immune response that recognizes the virus and prevents it from binding to cells.
00:28:08.785 --> 00:28:12.684
But of course that's, there are a lot of other elements of our immune response that are harder to make.
00:28:13.619 --> 00:28:20.400
And that we think actually probably play an even larger role in preventing against symptomatic disease, hospitalization, and death.
00:28:20.970 --> 00:28:25.259
And usually those arms of the immune system are more broadly protective.
00:28:25.259 --> 00:28:30.529
They're able to identify a wider range of variants than these specific neutralizing.
00:28:31.059 --> 00:28:34.990
That's sort of attached to these very precise pieces of the viral surface.
00:28:35.359 --> 00:28:48.740
And so I think that there's a lot of reason to hope that our protection against symptomatic disease and especially hospitalization and death given previous immunity, either through infection and or vaccination will still hold relatively strongly against the Omicron variant.
00:28:49.049 --> 00:28:53.369
But that again is something that we're, we're still on the early stages of gathering information.
00:28:54.369 --> 00:28:58.480
So, another thing so transmissibility, so we know that OMA chronic can spread like wildfire.
00:28:58.619 --> 00:29:05.460
We know that it's taking off that took off not only in South Africa, but that it's been taking off in the UK and we've started to see surgeons here in the Northeastern us.
00:29:05.460 --> 00:29:08.759
So it's definitely it's coming and it is spreading and it is spreading well.
00:29:09.279 --> 00:29:13.690
There's still some uncertainty as to what exactly is behind its increased transmissibility.
00:29:13.690 --> 00:29:13.869
So.
00:29:14.289 --> 00:29:22.339
Basically the two possibilities is first that by getting around our immune system, it's able to infect people into spread more easily, even in people with some level of protection.
00:29:22.740 --> 00:29:29.259
Or second to that is just more inherently contagious that it's able to bind to ourselves a little bit more easily there.
00:29:29.289 --> 00:29:31.930
You know, part of the question is like, to what extent does it matter?
00:29:32.380 --> 00:29:44.700
It does matter some because Whichever one of those things that is, will change the way that the virus behaves in different populations with different degrees of immunity, with different types of immunity who have had different experiences with different variants.
00:29:44.970 --> 00:29:50.089
So I do think it's an important question, but but it's pretty clear at this point that Omicron will be able to spread very rapid.
00:29:50.630 --> 00:29:51.950
Just about anywhere it goes.
00:29:52.230 --> 00:29:57.900
And so sort of in the transmissibility box there, there's a big old check that it's it is definitely more transmissible.
00:29:58.230 --> 00:30:01.690
And and so that's going to be something we're going to have to deal with in the coming months, for sure.
00:30:02.349 --> 00:30:04.210
And so the big question now is, is severity.
00:30:04.210 --> 00:30:19.579
And I think that At this point, we would probably know if Omicron was catastrophic more severe than previous variants, but I don't think we're at a point where we can conclusively say whether it is equally or less severe than things that have come before it.
00:30:19.609 --> 00:30:25.400
So again, there had been some early reports suggesting that some clinical cases of Omicron were not as severe.
00:30:26.525 --> 00:30:38.944
But that can be confounded by all sorts of different things, whether it's, you know, that it took off in younger age groups first, or it happened to take off in a previously vaccinated, an Indianized population.
00:30:38.944 --> 00:30:44.404
And so that the underlying immunity was protecting those people from being as severe as the disease might have been in previous waves.
00:30:45.005 --> 00:30:47.454
And then one of the other things that sort of been spread around is.
00:30:48.724 --> 00:31:04.095
Basically just comparing cases versus hospitalizations in this surge relative to cases versus hospitalizations in previous searches and saying like, oh, well, you know, it's, there, there is a lower fraction of hospitalizations to cases at this point in the surge than there were in previous surges.
00:31:04.115 --> 00:31:10.365
But the issue there is that Omicron is so much more transmissible that we're seeing a much sharper rise in cases.
00:31:10.365 --> 00:31:11.595
And so it might not be.
00:31:12.045 --> 00:31:13.755
There are fewer hospitalizations per case.
00:31:13.994 --> 00:31:15.944
It's just that there are so many more cases.
00:31:15.944 --> 00:31:18.795
So early on that the people haven't had a chance to get sick yet.
00:31:19.204 --> 00:31:23.704
And so, so I think we're still at the very early stages of understanding the severity of a Macron.
00:31:23.704 --> 00:31:30.365
And I'm, I'm, I'm not as optimistic as some have been about the potential for Omicron to be less severe.
00:31:30.615 --> 00:31:31.865
But I am grateful that it doesn't seem.
00:31:32.454 --> 00:31:35.515
You know, much, much more severe than things that we've seen previously.
00:31:35.515 --> 00:31:38.785
So, so that's something we're going to have to continue to watch pretty closely.
00:31:39.515 --> 00:31:49.464
And the last thing to note with this is that as, as one of my colleagues, bill Hanna recently said even the common cold would be catastrophic if everybody got it at exactly the same time.
00:31:50.105 --> 00:31:52.744
Because you know, the common cold does cause hospitalizations.
00:31:52.744 --> 00:31:54.875
It causes pneumonia in older age groups.
00:31:55.914 --> 00:32:00.174
If everybody got it within the same two weeks, like that would cause a huge burden on our health system.
00:32:00.174 --> 00:32:03.934
And it would be a public health event of, you know, unprecedented scale.
00:32:04.295 --> 00:32:14.255
And so even if we end up with an older crown variant, that is no more severe than the common cold, if it's able to infect the world within an order of a couple of weeks, it's still going to be something we're going to have to contend with on a large scale.
00:32:14.615 --> 00:32:29.224
So, So I think that really just underscores the need for boosters for thinking about masking when in indoor spaces and, you know, thinking about all of these plans, we talked about with our holiday gatherings we got to have all our tools on the table to help us against this coming surge.
00:32:30.099 --> 00:32:31.000
And so helpful.
00:32:31.000 --> 00:32:31.150
Okay.
00:32:31.160 --> 00:32:36.579
The two things, number one, this is what you were saying two weeks ago, how quick news is probably bad news, right?
00:32:37.359 --> 00:32:41.690
So like, you know, if it was catastrophic, I would probably hear really quickly on they go, man, this is crazy, crazy.
00:32:41.690 --> 00:32:43.759
So this good news, it may not be quite as catastrophic.
00:32:44.210 --> 00:32:48.440
The other thing I kinda remind me of like, it's like me with like, hands-on stuff.
00:32:48.440 --> 00:32:49.789
Like I'm a tech guy.
00:32:50.029 --> 00:32:56.509
I, I lo I literally load the working on my house, like on any level, even if it's hanging a picture frame on the.
00:32:57.380 --> 00:32:58.849
I will delay it as long as I can.
00:32:58.849 --> 00:33:00.200
Cause I do not wanna get the hammer and nail.
00:33:00.200 --> 00:33:02.779
Cause I figured take me eight hours to figure out how to level this thing.
00:33:02.779 --> 00:33:03.019
Right.
00:33:03.680 --> 00:33:07.549
So it's kinda like when I get my hands and try to work on something, right?
00:33:07.849 --> 00:33:15.200
The more I work on in the house that actually the more complicated it becomes and the more problematic in the more fix it, it has to become.
00:33:15.200 --> 00:33:16.700
So it used to be a small problem.
00:33:17.000 --> 00:33:20.420
Usually when I address it, now it's a much bigger problem because now it's the original problem.
00:33:20.750 --> 00:33:23.480
Now my problem on top of it added on there's more holes in the wall.
00:33:23.480 --> 00:33:25.670
Now we have to putty because I missed a bunch of places.
00:33:26.795 --> 00:33:29.765
And now I say this tongue in cheek, Stephen, because this is clearly not what I'm saying.
00:33:29.765 --> 00:33:31.654
It's like, oh, I miss the good old days.
00:33:31.704 --> 00:33:33.755
The end of the pandemic when life was simple, right.
00:33:33.755 --> 00:33:40.085
Were, oh, it was just a pandemic, but now it's like, it's so much better, but it's more complicated because now we have vaccines and boosters.
00:33:40.085 --> 00:33:49.714
And how does that mix and match and how, and so it's just, I don't know how you guys deal with this stuff as an epidemiologist, as, as things unfolded, like, okay, now we have 18,000 more variables we've got to look at and figure out how that works.
00:33:50.555 --> 00:33:52.355
Again, I'm grateful me.
00:33:52.355 --> 00:33:53.555
I'm grateful your life.
00:33:53.585 --> 00:33:54.755
It makes way more complicated.
00:33:55.835 --> 00:33:56.404
Yes, it does.
00:33:56.404 --> 00:33:58.785
But and that's, that's, that's why we do what we do.
00:33:59.595 --> 00:34:03.884
So the, the last thing then I think the last thing I'll say is it's still on this.
00:34:03.884 --> 00:34:06.464
So this idea of, okay, we talked about this off the year.
00:34:07.079 --> 00:34:11.820
And this is where I'm reading a lot of the news of what you're just saying how, oh, Hey, the good news about the boosters.
00:34:11.820 --> 00:34:18.900
It seems though that it's skyrockets the antibodies so intensely that it sh it seems like it's covering the Omicron variant.
00:34:19.380 --> 00:34:25.710
So when I keep reading this, I get confused because what you've taught me and like I said, cause it sounds like, oh, well it's all about antibodies.
00:34:26.244 --> 00:34:29.215
Response in general, I just vomit antibodies and you're good to go.
00:34:29.215 --> 00:34:31.735
If that's the case, then any vaccine would take care of anything.
00:34:32.034 --> 00:34:34.554
If you could just go and get antibodies rubbed up, but it's not the case.
00:34:34.554 --> 00:34:34.824
Right?
00:34:34.824 --> 00:34:45.684
So this is where it seems really complicated from that it's the same old vaccine it's Reverend about because of this, because the antibody response, it seems like it's going to cover the Omicron, which is highly mutated.
00:34:45.684 --> 00:34:52.375
Do you see where I'm like, I see this, I see a disconnect in, can you help us fill in the gaps of that?
00:34:52.375 --> 00:34:53.065
Can't be the full.
00:34:53.849 --> 00:34:54.570
Yeah, totally.
00:34:54.570 --> 00:35:07.380
So, our immune system, the different arms of our immune system very in large part based on how specific their vision is for a a given virus.
00:35:07.409 --> 00:35:08.820
So there there's some parts of our immune.
00:35:09.405 --> 00:35:18.425
The, the antibodies that we normally think of that have these very precise molecular configurations that allow them to detect very precise structures on the surface of a virus.
00:35:18.815 --> 00:35:24.425
And so those antibodies are really good at seeing exactly when you've been infected with.
00:35:25.324 --> 00:35:29.585
Really closely related to something you've been infected with previously or have been vaccinated against.
00:35:30.025 --> 00:35:39.144
But they can get easily duped by these small changes on the surface of the virus and sort of render them unable to bind to the virus and unable to prevent the virus from infecting ourselves.
00:35:39.625 --> 00:35:42.505
But then there are different parts of our immune system that sort of like.
00:35:43.090 --> 00:35:47.860
Get the gist of the virus, but they don't, you know, they're, they're not necessarily so specific.
00:35:47.860 --> 00:35:50.980
And because of that, it can take them a longer time to respond.
00:35:50.980 --> 00:35:52.150
It takes them a little while longer.
00:35:52.150 --> 00:35:57.670
They sort of have to sit back and consider the virus for a while and say like, is this, is this something we should be concerned about or not?
00:35:57.670 --> 00:36:03.820
And then, and then ultimately, you know, if it's the virus starts to increase in as more other parts of the immune response, start to get revved up, they're like, okay.
00:36:03.820 --> 00:36:08.679
Yeah, this is, this is something that we really need to be worried about to attack and to respond to.
00:36:09.119 --> 00:36:10.619
And so they're the.
00:36:11.590 --> 00:36:13.690
You can sort of think of them as a little bit slower.
00:36:13.800 --> 00:36:19.599
But also able to be a little bit more flexible in their response able to identify sort of wider ranges of virus.
00:36:19.599 --> 00:36:24.340
And then there are other parts of our immune response that are just totally they basically just protect you against everything.
00:36:24.340 --> 00:36:30.250
They're like, I don't know what it is, but we're just going to like go out there and just like, try to eat up whatever we see that doesn't look like me.
00:36:30.519 --> 00:36:34.949
And and so, so all of these different things are in play now.
00:36:35.250 --> 00:36:36.750
Vaccines are.
00:36:37.880 --> 00:36:49.889
Really good at eliciting very specific types of antibody responses and especially a single dose of a vaccine is really good at getting these sort of like highly specific antibodies revved up and sort of stored away in your memory.
00:36:50.969 --> 00:36:58.833
One of the ways that I like to think about vaccination, I I think that, you know, we talk about immune memory as sort of a metaphor for how the immune system works.
00:36:58.893 --> 00:36:59.284
But I think.
00:36:59.798 --> 00:37:12.588
You know, I've, I've found that metaphor to be incredibly rich because I think that it thinking about the immune system as something that has a memory really does go a long way towards helping us understand what the immune system is doing.
00:37:12.588 --> 00:37:24.039
So one of the ways that I like to think of a vaccine is like, so you have this like really complicated image, this picture that you're being shown, it's just basically a picture of the virus, but you could imagine anything and what the vaccine does.
00:37:24.528 --> 00:37:28.278
It flashes that picture before the immune system's eyes very briefly.
00:37:28.278 --> 00:37:32.179
And so it gives us this like quick moment to say like, okay, this is what the virus looks like.
00:37:32.748 --> 00:37:36.949
And with two doses of the vaccine, we essentially got two very rapid flashes of that.
00:37:37.338 --> 00:37:42.889
But if you were shown like a really quick image you know, you would see a couple of sort of general characteristics of the.
00:37:43.699 --> 00:37:53.748
You might really notice one specific detail and if it were flashed before your eyes really quickly, you'd probably pinpoint on that exact same spot twice, because whatever you noticed first, your eyes would be trained to what it had seen.
00:37:54.798 --> 00:38:00.648
Now, if instead, you had been flashed that image twice, and then six months later, I came up to you and flashed to that same image.
00:38:00.648 --> 00:38:04.518
Again, you'd probably focus on a different part because your mind has had time to sort of process.
00:38:05.534 --> 00:38:15.043
And it wouldn't remember the fact that it got sort of so distracted by this one piece of the viral surface, but instead it will notice some other feature about the picture that it didn't see before.
00:38:15.614 --> 00:38:27.313
And that's the value of these vaccines that are spaced out over longer periods of time, because as your immune system gets these flashes of exposure to the virus, and as they're spaced out over longer periods of time, it allows your immune system to sort of mature.
00:38:27.849 --> 00:38:35.918
In the meantime and to forget, which is also a really important part of the immune response so that when it gets wrapped back up, it can notice a different part of the virus.
00:38:36.219 --> 00:38:42.768
And so essentially what we're doing is we're trying to sort of give it these images of the virus from different angles which also happens when you get infected.
00:38:43.039 --> 00:38:48.918
And so because of that, it sort of builds up this sort of entire repertoire of protection against different pieces of the.
00:38:49.739 --> 00:38:51.809
And so they're still very specific to SARS.
00:38:51.809 --> 00:38:54.838
COVID two, I'm just ramping up antibodies.
00:38:54.838 --> 00:38:56.548
As, as, as such.
00:38:56.548 --> 00:39:02.938
It doesn't really give us much protection against things that aren't SARS cov two, for the same reason that a flu vaccine doesn't protect us against COVID-19.
00:39:03.349 --> 00:39:14.728
But nevertheless, you know, getting these repeated exposures will help us over time to broaden our immune response, even against things that our immune system hasn't seen before, as long as they're sufficiently closely related.
00:39:15.784 --> 00:39:16.443
That's great.
00:39:16.773 --> 00:39:17.673
And you hit the nail on the head.
00:39:17.733 --> 00:39:19.204
I really felt super educated.
00:39:19.534 --> 00:39:22.114
I think I earned my honorary doctorate again.
00:39:22.623 --> 00:39:23.414
Thank you, Stephen.
00:39:23.954 --> 00:39:24.393
Appreciate it.
00:39:24.454 --> 00:39:25.594
I hope I hitting the nail on the head.
00:39:25.594 --> 00:39:29.224
I didn't make too many holes in your wall that you have to fill up with pipe until you're way too
00:39:29.224 --> 00:39:31.353
late for that man Swiss cheese in this house.
00:39:31.753 --> 00:39:32.563
So, great.
00:39:32.594 --> 00:39:33.193
That's perfect.
00:39:33.193 --> 00:39:33.704
We'll end there.
00:39:34.123 --> 00:39:35.123
I appreciate Stephen.
00:39:35.143 --> 00:39:36.673
We'll be back again in two weeks.
00:39:36.704 --> 00:39:39.583
Again, if you could not leave a review, please do so inspires us.
00:39:39.914 --> 00:39:48.224
He wants support us patrion.com/pandemic podcast for monthly subscriptions, as well as one-time gifts through PayPal then Mo all in the show notes.
00:39:48.224 --> 00:39:51.673
If you wanna get ahold of us, if you have questions for us, Matt at living.
00:39:52.278 --> 00:39:55.338
Tom, I will forward them on to Stephen and mark.
00:39:55.369 --> 00:39:56.688
I know mark has been here forever.
00:39:56.688 --> 00:40:00.438
He's been busy, busy, busy, but we hope to get them on sometime, at least one time soon.
00:40:00.958 --> 00:40:04.409
And if you wanna get ahold of Stephen, you can do follow him on Twitter, which is.
00:40:05.409 --> 00:40:08.978
S T E P H E N K I S S L E R.
00:40:09.458 --> 00:40:11.739
And I think that's it for this episode.
00:40:11.739 --> 00:40:12.938
Thank you all for listening.
00:40:13.298 --> 00:40:15.998
And we'll see you guys, I think after Christmas now.
00:40:16.028 --> 00:40:19.329
So if those of you who celebrate Christmas, Merry Christmas, happy holidays, happy Hanukkah.
00:40:19.719 --> 00:40:20.648
All the holidays.
00:40:20.648 --> 00:40:21.818
Have a wonderful season.
00:40:22.208 --> 00:40:22.719
Take care.
00:40:22.778 --> 00:40:24.009
We'll see you guys in two weeks.
