Pandemic: Coronavirus Edition

How the Black Lives Matter protests are part of the pandemic solution and NOT the problem

June 10, 2020 Dr. Stephen Kissler and Matt Boettger Season 1 Episode 29
Pandemic: Coronavirus Edition
How the Black Lives Matter protests are part of the pandemic solution and NOT the problem
Pandemic: Coronavirus Edition
How the Black Lives Matter protests are part of the pandemic solution and NOT the problem
Jun 10, 2020 Season 1 Episode 29
Dr. Stephen Kissler and Matt Boettger

Dr. Stephen Kissler and Matt Boettger talk candidly about how the protests surrounding Black Lives Matter is NOT a change of "narrative" for the pandemic by healthcare professionals and scientists, but rather part of the solution. This is one if not the best episode yet according to Matt. :-) Listen now!

We offer transcription now! Caution, it is AI transcription so please excuse AI errors.

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Things Discussed on Episode:

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Show Notes Transcript

Dr. Stephen Kissler and Matt Boettger talk candidly about how the protests surrounding Black Lives Matter is NOT a change of "narrative" for the pandemic by healthcare professionals and scientists, but rather part of the solution. This is one if not the best episode yet according to Matt. :-) Listen now!

We offer transcription now! Caution, it is AI transcription so please excuse AI errors.

  • Download here -
  • See it on the podcast website here -

Can you Rate and Give us a Review in Apple Podcasts?

Please consider supporting us to help upgrade our equipment and offload our editing responsibilities:

  • Give monthly (as little as $5 a month) on our Patreon Page -
  • Give a one time gift through Venmo at @mattboettger
  • Give a one time gift through PayPal here:

Matt Started a New Podcast:

  • Check out Matt's new "Living the Real" podcast which just released this week. You can find more information on his website and please do not forgot to sign up to get information on future content as well as be notified when Living the Real is approved on Apple Podcasts.
    • Living the Real Podcast:
    • Sign Up To Be Notified on Future Content and When LTR is approved in the Apple Podcast directory:
    • Learn more about Matt's 3-M framework here:

Things Discussed on Episode:

Support the show (

[00:00:00] Matt Boettger: [00:00:00] You're listening to the pandemic podcast. We equip you to live the most real life possible in the face with today's crises. My name is  and I'm with dr. Stephen Kissler and epidemiologist the Harvard school of public health. And not dr. Mark Kissler. He not only could not be available at the hospital, but he said he's being crushed right now.

[00:00:16] So that means he's crushing it himself at the hospital. So we can't hear back from him. So. Good to see you again, Stephen, how you been buddy? 

[00:00:23] Stephen Kissler: [00:00:23] You guys good to see you too, man. I'm doing all right. 

[00:00:26] Matt Boettger: [00:00:26] Good, good. I know how to respond to 

[00:00:28] Stephen Kissler: [00:00:28] that. I say 

[00:00:29] Matt Boettger: [00:00:29] really? I got to find it. I've got to find a new question. Cause right now it's really hard to ask the question instead of like, unless we just say it's complicated.

[00:00:39] It's okay. Good to have you here. And it was good to chat with you again this week. A few things when I get, before we get started, first and foremost one, before I forget. To give a shout out to my nephew, Sammy long. He graduates today. He's going to walk via his car. So that's interesting. I think at 4:30 PM, he's in, San Diego, California.

[00:00:59] So [00:01:00] Sammy, congratulations. I'm excited to see you in about an hour and a half on zoom before we see you walk. So congratulations and a couple of things. thank you guys all for the wonderful reviews on Apple podcasts and all the other venues that you can leave reviews for. So greatly appreciated. We need more of them to help rise us to the ranks so we can be seen and known.

[00:01:20] I know this provides a lot of value to a lot of people to give us sober analysis of the pandemic in the context of everything else that's going on, with the black lives matters and all these things. They're just, exacerbating the, the, the, the difficulties that we face right now. Another particular review I want to read right now, this is from Mel GPL, C buff.

[00:01:39] She says, go bus. Right. See you. Alum to love, hearing your expert thoughts. Can't wait to hear your thoughts on what schools should look like in fall. I know all of us working parents with little kids are super interested because the distance learning and rotating schedules, especially for elementary age, children are just not sustainable sustainable for the long term.

[00:01:57] Keep up the great work. So I might pick see if I [00:02:00] could pick Stephen's brain a little bit about what he thinks about elementary schools or schools in general. I know it's difficult. This makes me just so excited that I have kids that are not in school right now, because that's just a whole. Other level of like complexities.

[00:02:12]so, even though it's still painful to have a little Rugrats run around nonstop, Patrion, if you want to support us, we're still looking for some awesome donations to help us fully fund the equipment that we're purchasing. You can do [email protected] podcast. As little as $5 a month can help a lot.

[00:02:31] Just a onetime gift. If that's what you want to do, PayPal or Venmo. And that's all in the show notes. And again, I have a new podcast coming out or a new episode come out next Wednesday. Cause they're biweekly called living the real. You got to live in the sign up. I have a conversation with Kim winter who is a partner at Le lay through it.

[00:02:47] I think, it's a law law firm there in Kansas city. We talk about meditation and how it saved her life. So it's coming up next week. So sign up to get that in subscribed to living the real podcast. Okay. I think let's get straight [00:03:00] into the news again, when we go seven days. Without chatting, hanging out.

[00:03:03] There's just a lot of stuff, even though I'm really want to frame this with, did the pandemic leave? Did it just go? 

[00:03:11] Stephen Kissler: [00:03:11] Yeah, it's just seems like it's sometimes 

[00:03:13] Matt Boettger: [00:03:13] I feel like I were talking about this outside of the recording because there's things I just can't say. Publicly to everyone. I wish I could. You guys are all friends, but there's just some things, but man, I'm feeling this kind of other worldly experience to a deeper level.

[00:03:27] Like I feel, well, I don't want to use a very terrible line. There's actually pigeonholes people, but I feel not. Like, I feel like anomaly to the rest of the world. I feel like I'm this outsider and I feel it more and more and more, and it's just been really hard. And now with the pandemic leaving, I'm like, should we continue this podcast?

[00:03:46] I'm like, I know what's going on. Nobody's talking about it. Nobody cares. But it's all the more reason than I'm more than excited to have this episode because it is real. It's still there. And in fact it actually might be more there than it was three weeks ago. So, in a big extent, so let's talk, [00:04:00] let's talk about this.

[00:04:00] So. Stephen. I had a friend sent me this text message and I saw this today, the day prior. So, but I had not read the article. It was asymptomatic spread of coronavirus is very rare. The, who says, so first time I read this, I'm like, do you know my initial reaction, Stephen? Ah, crap. This sucks because I just knew this was going to cause some kind of like.

[00:04:22] Turmoil or some kind of suspicion. And yet the next day I had a friend post this to me on texts and just says, interesting dot, dot, dot. I'm like, Oh man, come on. I'm like, what do you mean by interesting? There's nothing. So I need you to start right here. Explain this. What do they who mean? And what's the difference between asymptomatic and pre-symptomatic.

[00:04:42] And are the lumped in the same context in this particular article? 

[00:04:45] Stephen Kissler: [00:04:45] Yeah. So the, the problem is they're, they're not lumped in, in this particular article. And, if you, if you go forward about, I don't know if it's maybe 24 hours, maybe a little bit more, there's another statement from the world health organization saying that they regretted saying this because it led to a [00:05:00] lot of confusion.

[00:05:01]and because, and, and it did because. So, so here's the thing it's like, what, what do we mean when we're saying very rare and like very rare compared to what? so, right, so. COVID is very, very transmissible, right? We know that it's, it's more transmissible than the flu by, by, by the measures that we have this reproduction number that we've measured.

[00:05:22] It's about three. So you're, you're, you're if you're infected, you're expected to pass it on to three other people. But, but if you think about the number of people that you normally come into contact with far fewer now, maybe, but in the general course of things, you're going to come into contact with far more than three people.

[00:05:36] Over the course of your infectious period. Right? So in that sense, we're already speaking of, even though it's a very infectious disease, we're already sort of talking about a rare event in some sense, and that's, even if you're symptomatic and you're transmitting something already, right? Sure. Now, certainly if you're symptomatic, you're more like you're definitely more transmissible, probably substantially more transmissible than if you're not actively showing symptoms.

[00:05:57] So. The thing that, that, that, that sort of [00:06:00] blows my mind about, about that statement is like, okay. So, so it is true that, you know, we're still trying to measure and get our hands on what exactly are the relative rates of transmission between people who are asymptomatic, which means you never show symptoms.

[00:06:13] Presymptomatic which means prior to showing symptoms, we know that people can be very infectious the day or two before they start showing symptoms. And that's, that's not what they're talking about at all in this, in this WHS statement. and then symptomatic transmission. So my response to that world health organization, claim was that, you know, yes, they say that it's very rare, but we would not have a pandemic on our hands if asymptomatic and pre-symptomatic transmission, we're not a major player in this epidemic, right.

[00:06:44] That is the reason why we were able to keep track of SARS, the original Corona virus that spread and why we have not been able to keep track of this one. Period. I mean, there was back in February when we started to realize that this was an issue with Cyrus, Kobe too. That's when I knew that this pandemic had our number like that.

[00:06:59] That's [00:07:00] when I knew that this was a problem like that. And that's what I knew that everything that things were not going to look good because it was precisely that because that's what, that's, what keeps you from, From seeing what's going on. And so even if it's a very rare event, the fact that you don't have symptoms means you're not modulating your behavior.

[00:07:13] And so, you know, it contributes to overall transmission and into their trajectory of the epidemic in a very important way. So. I think that's that's the difficulty here is, is even if on an individual level scale, it might be a rare event. Nevertheless, it is the reason why we have a pandemic honorarium.

[00:07:30] Matt Boettger: [00:07:30] So this didn't help anything. And what's the context of this, like, because what are they trying to respond to? I mean, who are they? I mean, what makes this. This news. I mean, I know I get it the next day that the who regretted this. So first the conclusion is get a PR person might be really helpful to help them kind of help them know how to present information in a way it's helpful to us.

[00:07:52] But what's the context of this? Like what does this really change? Anything for us in the sense of. Say a month ago. I [00:08:00] know we were seeing kind of a, we were seeing, information come out about, we were noticing, I don't know if it was presymptomatic or asymptomatic. I have no idea which one it was, but seeing that there were people who didn't have signs that had what I, you know, I'm not a scientist, I'm just using the scientific jargon quote, viral shedding.

[00:08:16] More than a person with symptoms at times. Right. So we were seeing this, we're seeing episodes of people who didn't have symptoms, having large amounts of viral shedding in their system, which of course would probably lead to a sense of like, okay, this could probably be spread. So is there any difference?

[00:08:33] I mean, is there a new science or is this just wrong information? Like what's, what's, what's going on with this. Wishy washy stuff. 

[00:08:42] Stephen Kissler: [00:08:42] Yeah. So it's the world health organization has made a couple of statements. So sort of my perception of a lot of the things that they say is that they're very good at being scientifically accurate.

[00:08:53] And it is, it is the case that there's, we're still gathering evidence about asymptomatic transmission early on in the epidemic. I [00:09:00] think we talked about this on a previous podcast where they, they said that there was no evidence. Of asymptomatic transmission, right? Yeah. But that doesn't mean that there is evidence that there's not asymptomatic transmission.

[00:09:10] It's just that they were saying a scientifically accurate statement. And, but that causes a lot of confusion because it's interpreted in, in, in, in sort of a broader way. And so I've realized that that when, when thinking about the world health organization statements, you really have to just like, absolutely take them at their word and.

[00:09:27]because any extrapolation from it can, can lead to danger. And so I, I don't actually know what exactly they were responding to. I know in the, in a statement where they said that they regretted saying it, that they were said they were responding to a couple of particular studies and it was in response to a particular statement that was in the context of a conversation.

[00:09:43]and so, so, so I'm not entirely sure what the dynamics were there, but yeah. but that's, I mean, I think that's, that's the issue is that, you can say things that are scientifically accurate, but that are nevertheless misleading. And I think that they've been in that situation a couple of times over the course of this outbreak, which is just kind of an unfortunate spot to be.

[00:10:00] [00:10:00] Matt Boettger: [00:10:00] Yeah. Yeah, no, that was really helpful. I just, I was mind blown by this article and, and I know. And, and part of this is, I think we talked about two weeks ago of I've. Now this isn't necessarily a scientific community changing their mind, but the idea that this is kind of a new thing and as evidence circulates and granted, you know, the.

[00:10:20]you know, maybe a month ago, these unique circumstances that the, who saw of communities who did extraordinary measures, to be able to do what was it like? You know, cross-reference and check all of the people they were, they were exposed to, showed maybe that there it's harder to be, you know, transmitted through asymptomatic.

[00:10:40] Right. It's a new stuff, but nonetheless, you know, we get more information, things change that does not lead to the fact or any kind of idea that this now is conspiracy and that's, that's what blows my mind. Like I love what you said to me ago. I'm like, Oh yeah. Scientists typically think of changing.

[00:10:55] Mine is the pursuit of learning. Oh, yeah. Okay. Well, yeah, we have a, we have a lot to learn [00:11:00] from that, which is ironic. So, in light of that, so you, you talked about the fact of the matter is that we wouldn't be, we wouldn't have, we wouldn't, we wouldn't have a pandemic on our hands. If we didn't have such an easy amount of transmission through this virus that leads us to the other big news, right.

[00:11:15] I've seen this a lot more hitting headlines, even though it's harder to find headlines right now that are, that are COVID related, seeing Texas, hitting new peaks on hospitalizations for COVID. since for a couple of days now, I think at least two days in a row. I see an article here that the data suggests that pandemic could be coming back with a vengeance.

[00:11:35] Of course, every time I see these dramatic terms, I'm a little cautious of what that vengeance means and how it does compared to a again, coronavirus spike, 14 States and Puerto Rico hit highest ever seen daily averages. And then, so I have one more question too, but that's on the opposite. I want to start with this.

[00:11:51] What are you seeing right now going on? I mean, there's theories out here. The Memorial day contributed. Maybe now we're just seeing the effects of Memorial day. and I want to talk [00:12:00] to you in just a few moments and you can hit it on the radar, but I wanna to go deeper with the, with the whole protests and the marches that are going on right now and how that may contribute.

[00:12:09] But where do you see the U S going right now? Are we, are we starting to lose that momentum and starting to slip? Or is this just kind of the normal cycle of things? what what's to be expected the next few weeks, do you think? 

[00:12:21] Stephen Kissler: [00:12:21] Yeah, I mean, there are a number of States that are starting to see spikes in cases.

[00:12:25] And I think that, it's hard to attribute them to any one thing in particular. it seems like. Memorial day could have contributed. I mean, we know, you know, that's, it seems like with other respiratory illnesses, there is often a holiday effect where like, for example, over Christmas, you have people mixing with different people and then coming back and then a week or two later you see spikes and flu cases, things like that.

[00:12:45] So yeah, it's, this is something that we know happens. And, and I think the big question is whether that spike will be sustained. You know, there's, there's always a temptation to see a spike in that, just draw a straight line through it and say, you know, in three weeks we're just going to be, this is going to be awful.

[00:12:58] And that's probably not going to be the [00:13:00] case either. I think that, you know, the answer is probably going to be somewhere in between that we're going to see spikes in cases in some places. And certainly as places are beginning to open up. Some places have opened up more than others and we'll start to see more transmission.

[00:13:13] And again, just sort of the, some of the randomness of this epidemic will kick in. Again, we know that, you know, a lot of the transmission that happens depends on, you know, early, super spreading events and places where a lot of transmission occurs and whether or not you had one of those early on will affect, you know, how many cases you have in a couple of weeks time.

[00:13:31] So. There's a lot of uncertainty here, but it's not surprising to me that there are a number of places where we're seeing, cases go up. There's also an increase in testing, which is leading to the number of cases going up. But the one that, the one that really caught my attention was Texas. As you said, because if we're seeing hospitalizations going up, then that's really something to pay attention to because those are transmissions that happened three or four weeks ago.

[00:13:52] And that means there's a lot more coming down the pipeline. and so I think that that's, that's something that we'll have to watch very closely. and that I think. Basically [00:14:00] speaking in a bigger picture, we might be entering into one of these phases where we were talking about early on how there might have to be this intermittent nature to this physical distancing, where we sort of open up a little bit, but then we might have to clamp back down again and then open up some and, and I think we might be on the cusp of us realizing maybe on a couple of weeks time that, ah, we might actually have to like.

[00:14:18] 10 things down a little bit again, or risk again, overwhelming health systems and that sort of thing. So, it'll be, it'll be a difficult balance and not least because of some of the things that you just mentioned. 

[00:14:29] Matt Boettger: [00:14:29] Sure. And now you mentioned a couple episodes ago about how you saw in previous, Pandemics where initially it hits New York, it hits cities.

[00:14:37] And then down the road, the second kind of wave, or what do you call different ways of surges or waves that ended it begins to hit the rural community communities. And I saw a couple of articles suggest that maybe that now it's starting to kind of hit the rural communities. Have you seen that at all yet or, or is I'm just wanting to know if that is that starting to.

[00:14:57] Percolate in rural communities or is that still maybe [00:15:00] a little ways potentially away 

[00:15:01] Stephen Kissler: [00:15:01] as far as I can tell, it seems like that might still be a little ways away. I think, I think that might be beginning to some extent, but it really seems like the cities are still the hotbeds of transmission at the moment.

[00:15:10] Matt Boettger: [00:15:10] And then on the flip side of this. Now, I don't know how old this article was. So it could, I mean, sometimes things change so quickly. You can day to day, so it might be a few days old. And if it's still the case, I don't know if you read it as well, but I, it was like why Georgia's coronavirus cases haven't surged after its reopening.

[00:15:25] So I don't know if it's still the case, Stephen, but at least at this point in time by Vox, it's suggesting that George is, is kind of an outlier right now that still hasn't quite surged after its reopening. Do you have any insights to why, if that's still the case and if so, why that might be the outlier or the anomaly in Georgia?

[00:15:42] Yeah. I 

[00:15:42] Stephen Kissler: [00:15:42] don't think I have much to add other than, than what was included in, in that Vox article where they were essentially, I mean, one of the statements that they said is maybe, maybe it just hasn't happened yet. I mean, there, there is an element of. Of luck to this and, you know, the timing can be quite variable just depending on, you know, when you have like these real sparks, the super [00:16:00] spreading events, they were talking about how maybe people haven't actually changed their behavior as much as, you know, like opening up a lockdown.

[00:16:07] It sounds very dramatic, but we know that people are kind of doing their own thing with respect to this, but that also doesn't. Explain why not Georgia and why certain other places like Florida and Texas and your sorts of things. So, it's not totally clear. my, my sense is that it's, it's probably more of just a, not yet sort of thing.

[00:16:26] And at the timing of these surges, we'll, we'll just be different in different places. But I don't have any, I don't have any clear answers to that. Okay, 

[00:16:33] Matt Boettger: [00:16:33] great. Well, you know, part of that, as we get into the deep dive, the biggest thing I want to kind of talk to you about Stephen is it's been hitting me a little hard, a little bit harder lately is, you know, I've been really working with you and Mark and all these things about dealing with.

[00:16:46] How we need to do social distancing and do our best, do our best, be our best at really helping to keep this at Bay until we can get an, a vaccine at the same time, being able to make sure we keep the economy going and, and ride this [00:17:00] hard, this balance. And then we have the protests come in and, the grieving of George Floyd and the, the, the rightful protests that are going on.

[00:17:10] And I'm not so much concerned about the actual physical protesting. I I do. It does worry me. Right? Because as we just talked about how the black community can be up to two, two times as susceptible to two to pretty harmful consequences of COVID. So that concerns me. But the biggest thing is just this, this article that I saw, it was good with the title.

[00:17:31] It was, we often accused the writer of distorting science. But the left changed the coronavirus narrative overnight. And I really felt like I was being to see this where some of the people were like, there were, you know, the quotes and epidemiologists, not you, thankfully, maybe I'll all just say, no, this is, this is okay, this, this is a pursuit of, of healthcare.

[00:17:51] And I get that part. I get the sense of, I get the spirit of the spirit of what he's saying. But it concerns me. Cause I feel like science is starting to go out the [00:18:00] window. Like let science be science, let politics be politics. And I'm seeing this. Okay. At one point in time, the night before it was nobody go outside 10 people at max, keep six feet apart.

[00:18:12] And then overnight a narrative begin to change of like, but it's okay for having hundreds of people to come together and protest. And I know people are against the violence part. I get that part, but just coming together, it's scary to me, not only on the fact that people are doing this and risky, but just the science community at some level.

[00:18:29] I feel like they're kind of like now I'm starting to, it starts to chip away at my trust. So, can you speak back to what's going on in your side? Isn't it, the knowledge is and Harvard and what are your conclusions about this and what do you think about all this? 

[00:18:39] Stephen Kissler: [00:18:39] Yeah, so we've been thinking and talking an awful lot about these protests and trying to make sense of them and make sense of.

[00:18:47]sort of where they sit in, in the public health sphere and what we ought to be doing with them about them. how, how we are to be responding as, as people who are dedicated to [00:19:00] upholding public health. So, the, the guardian article that you, that you just mentioned, I think has some important points.

[00:19:08]although I think it's also. Full of quite a few straw man arguments. so, I mean, there, there were a lot of sections in there where, where, I'm glad that I wasn't on, being recorded as I was reading the article because there were a few, there were a few eruptions, shall we say? in response to, in response to what was being said, especially 

[00:19:26] Matt Boettger: [00:19:26] we'll put those in the, after, after show, we recorded those who watched him.

[00:19:30] I had a little camera. It's hilarious. 

[00:19:32] Stephen Kissler: [00:19:32] Fantastic. Yeah. So, I mean, so there was this, The bit that got under my skin with the article was, was when the author was talking about how, I don't remember what group he was saying, whether it was scientists or liberals or academics, or what have you were, were, blindly calling for these shutdowns.

[00:19:50] And it's like, there's, there's been nothing blinds. About any of this, right? We have not wanted the lockdowns to happen. You know, like this, this was not, and we recognized that we were really [00:20:00] stuck between a rock and a hard place. and especially there seem to be in the, in the article, this accusation of, of sort of this to face sadness and this sort of, ignorance of poverty and of the fact that like poor people were going to suffer the most from, from the lockdowns.

[00:20:12] And that's, that's, that's been clear from the start too. Yeah. As well as the fact that poor people are the ones who are going to suffer the most from COVID as well. Right. And so, so like that's what we were weighing from the very beginning of this is that, people are going to die and, or actually, and, but people are going to lose their jobs.

[00:20:29] And those, both of those burdens as with every societal burden is going to be felt most by the people who are most impoverished, most vulnerable, these sorts of things. And so that was, that's the dilemma that we're in and that's the dilemma we've been talking about this whole time. And so there, there was sort of this false sense of like, you know, these people were out of touch and we're calling for this lockdown, but didn't really pay attention to the Naknek, to the downstream consequences and sort of thing.

[00:20:50] Just not. That's just not an accurate assessment of the history of events. Like that's just poor history right there. so, so there's that. And so then there's the question of like, okay, so what do we think [00:21:00] about, about the protests themselves and thinking about, you know, you're absolutely right. We're having these gatherings of hundreds of people, sometimes thousands of people together.

[00:21:07] And the, and that, that is, that is not physical distancing ladies and gentlemen, you know, and, and, and it it's, it's not right. It's, it's simply not. And, and that's the fact is right. That, that presents. A substantial risk for transmission, for sure. And I think we need to be upfront about that, right? Like we're, we're not saying all of a sudden that these protests are safe or that, that, you know, that these things don't matter.

[00:21:31] You know, the, the, the protests themselves will, will contribute to the transmission of illness. So also will the hundreds of people that flocked to beaches over Memorial day weekend, and all of the people going to casinos and gambling right now, where there's also not an awful lot of social distancing going.

[00:21:45] So there, there are a lot of things that are happening right now, in addition to protests that are going to contribute to the spread of, of disease. Now, there has been, certainly I know in my local area there with all of the protests that I've seen in, your car window, there's been a real [00:22:00] emphasis on physical distancing to the extent that people are able to bringing masks.

[00:22:04]I know of volunteers from local hospitals who were bringing hand sanitizer to hand out to people and making masks to hand out to people doing our best to mitigate the effects of, of, of COVID. During these protests. Right? So, so that's, that's really one important thing is that these, these protests aren't being held.

[00:22:21] You know, in, in some sense, it's not really in spite of COVID, but it's, it's, it's recognizing that, that these things are contemporaneous. and, and so that's sort of what's happening. So I think, I think the last thing is sort of, so how do we think about. How do we think about the events that are happening from a public health perspective?

[00:22:38] Because I'm an epidemiologist and that's what I do. And I think that that's the place where I can sort of shed the most light. So, so I think that we can, we can, one of the arguments that, that, that was set forth in this guardian article and that, that I've heard a lot of, a lot of people raise is that, you know, Race, which is really at the root of the protests that we're seeing right now is, is, is an incredibly important aspect.

[00:22:58] But it's only one of many [00:23:00] aspects that leads to poor health outcomes, right? There's there's race, there's poverty, there's incarceration, there's, you know, imperfect housing, all sorts of things, you know, that, that sort of conspired to lead to. Poor health outcomes. but I think that what's one of the things that we're thinking about as in, in public health is that, you know, how, how do all of these potential causes relate to one another?

[00:23:22] You know, if you list them off, it sort of seems like this laundry list of things that contribute to poor health outcomes. But then, then we have to sort of, If you'll indulge me for a moment, let's, let's, let's take a moment and sort of think things through, sort of do like a bit of a logic game in a sense.

[00:23:35] So, so let's think about like this, this list of things that all contribute to poor health outcomes. And there, if we, if we think about then sort of how, how do we order them? How do we think about the relative importance of like, which comes first, which is principle, which is secondary, how do we begin to make sense of this?

[00:23:51] Right. So, We can ask ourselves, you know, which ones proceed, which others, you can imagine that poverty could lead [00:24:00] to, incarceration or to some of the other downstream effects and these sorts of things. so it could one's race, right? Race, race could contribute to, To poverty in all sorts, in all sorts of different ways.

[00:24:10] And so I think that race is a really interesting factor here because of the things that I mentioned. It's the only one that can't be the result of any of the others, right? You can't be poor and then become black as a result of that. Right? Like it doesn't work that direction. And so even though these things are definitely all deeply confounded with each other and, and, and you can't ever attribute a single cause to anything.

[00:24:31] Just by virtue of the epidemiological evidence by the fact that we know that racial minorities are more likely to suffer much more severe health outcomes of all varieties. Race must be upstream of these things. Right. Because it is, it can affect these others, but these others cannot affect it. Right.

[00:24:48] And so we know that race is one of the things that's lying at the headwaters of a lot of a ton of these public health ILS. Right. And so to sort of finish off the argument here. Right? So, so we have, we have races this year. There's this potential [00:25:00] factor that, that is affecting all of these downstream outcomes.

[00:25:03] And then, and then the question is, so, so how does that happen? Why is it that race affects these things? And the only two alternatives that I can think of is either that there's something intrinsic about race, where there's something extrinsic about race. Like it's either the difference either comes from within, or it comes from without.

[00:25:18] And I think that, you know, Fundamentally, it's sort of like, if you think that there's something intrinsic about a racial minority, that makes them more likely to be impoverished, like that's aside from being, you know, blatantly like that, that is sort of the definition of racist. Right. That's sort of what exactly.

[00:25:36]and so, and I think that the, you know, beyond that there. There's a thousand, you know, there's so much evidence to reject why that would necessarily be the case. So what we're left with is that there are extrinsic factors that make race, a contributor to the things that lead to downstream public health effects.

[00:25:49] Right. And so, and that, that is the definition of systemic racism, right? And that's, that's what these these protests are about. And that's why I think a lot of public health professionals have really gotten behind them in a lot [00:26:00] of ways. Because we know that we're in the middle of a pandemic, but this issue lies at, you know, is one of the things that lies at the headwaters of so many other things that we have dedicated our lives to improving and fighting that, that, that it's important, you know?

[00:26:14] And, and we can't really say like, well, let's, let's, you know, I know that this, these awful things happened and there's a lot of sentiment around protesting right now, but let's just call them off for two years till we get this pandemic under control. And then, you know, we'll just, we'll just start it up again.

[00:26:27] Once everything is. Safe, you know, that that really won't work either. And so, so, so we're, we're again, stuck in a dilemma. And I think that, that the problem here is that the story of COVID is a story of dilemmas, right? It's a story of things happening at the wrong time, at the wrong place, to the wrong people.

[00:26:43] And. And we, we get in these, in these situations where, you know, when we start lobbing accusations at different people, for being hypocritical and stuff, it's, it's ignoring the fact that all of these decisions are being made when we're really stuck up against a wall. And, and so we're trying to make decisions and make priorities on the fly.

[00:27:00] [00:27:00] And I can really sympathize with people who are arguing that this issue right now, Is worth the risks and we can mitigate the risks of coronavirus, knowing what we know now in a lot of different ways, but I can, I can really sympathize with the fact that, that this, this time and these protests. Are worth the risks, 

[00:27:18] Matt Boettger: [00:27:18] man.

[00:27:19] Stephen, you're a good man. I could see going back weeks with Mark and you and just seeing how could we joke and his tongue and cheek that it's okay. It's complicated. And the one thing I want to pick out with this is that I think what you've exposed is, and maybe it can, may not be the epicenter, but it's a, it is a core maybe tenant or tenants of the complication because there's one set of criteria as a scientist.

[00:27:43] And that's the data, that's the information that's about the virus, what it's doing, and that has its own game plan. That's has its own agenda that has its own predictions and advisements to the world. And then there's story, which you guys picked up [00:28:00] on narrative, which is not. It's not extrinsic, it's intrinsic to the data.

[00:28:06] And I think that you've hit it so well that there's two things you, as scientists are trying to put together. And that is the data of COVID and the story of racism of systemic racism and seeing how these actually two come together. To create a pretty terrible situation. And so it's so easy for so many people on Facebook and social media to point the finger at the hypocrisy of how dare you shut down the casino, but then not allow people to protest right.

[00:28:41] Or allow people to protest. And that is taking simply data. And principles without any human flesh and story on it as if somehow the casino has the same value and contribution as, as systemic racism [00:29:00] and, and, and its, and its consequence to overall. Wellbeing of humanity and particularly to the healthcare system.

[00:29:06] So thank you, Stephen, for, I mean, they use you shed a lot of light. Cause I, I intuitively I felt like, gosh, we, we, we should allow them because your idea of, well, let's just wait two years and then I know this, I know that personally experienced this, where if you, if you, if there's something that happens and it stirs up true emotion, it's a just cause.

[00:29:25] And then you postpone it for something. It never picks back up again because we all know that the intellect. Is not very strong when it comes to motivation, right? It is emotion. It is the feeling of the story of what happened, the tragedy of George Floyd. And this is clearly not a singular event. This is just the icing on the cake after already a lot of turmoil.

[00:29:47] And this, this is a necessity and we see the consequence of this. Oh, man, Stephen, I'm learning so much that if it was postponed and they're going, it's not about learning. It's about, it's about actually doing something. I get that. I don't want to be ignorant of [00:30:00] that, but I think first and foremost, I do need to learn something that I haven't been, been I've been ignorant in the past and I don't think it had been the case.

[00:30:06] Oh, I know. Without a doubt, if we would have postponed these. the effect would have never happened. That needs to happen. So thank you, Stephen, for, for sharing that, that helps a lot. Okay. I think that's all we've got for now. This was an awesome way to end. you know what, let's ask one more question and totally random, just to end on a fun, happy note.

[00:30:25] Right in the sense that you'll probably not even have an answer. That's how happy it'll be. Right. It's always good when you stump the scientist. Right. So we went back to that, a, that a review from Globus, and she mentioned about, gosh, I'm I'm clearly she must have elementary school children. I'm guessing that's the case.

[00:30:42]And she's like, what, what would you suggest? Do you have any concentrate, DIA? I mean way at the very beginning, Steve, remember the very first episode you were, we were like, this is way back in March 9th before we even knew hardly anything. Right. And you were saying, we don't even know if kids can even transmit at this point.

[00:30:57] I mean, I don't know, things are different now, but [00:31:00] that was March like fifth, right. Something like that. so because we're not seeing any evidence of that, is there, has there any been any more advancement and do you have any idea of. What you might suggest about elementary school in the fall, or you just as blinking in deer, in headlights as I am right now.

[00:31:18] Stephen Kissler: [00:31:18] Oh boy. Yeah. There's, there's some deer in the headlights right there. yeah, so it's, it's gonna be really hard. Right. And it's just like every state and every city has taken their own approaches to these different things. That's probably going to be what happens this fall too. Yeah. Some of the, some of the options that I've heard is that some schools are going back for a couple of days a week, so that they have, you know, half their students on Monday, Tuesday and half the students on Wednesday, Thursday.

[00:31:40] And they're sort of doing like a shift sort of thing, which allows for some in-person instruction. But I mean, I don't know. I don't know what working parents do with that. Right. Like, I don't know. I don't know. I don't know. I don't know how you do it, and this is, this is another one of those dilemmas, right.

[00:31:56] That comes up where, you know, we're, yeah. Talking about school [00:32:00] closers that that's like, that's never something that we want to do because it sounds like such a simple intervention, like such a simple, you know, like, just keep the kids at home. Right. They'll stop from transmitting illness, but what a hugely disruptive thing, and you know, what a difficult thing it is for families to, to, to cope with, It does seem like kids are probably about as good as Tran at transmitting covert as, as anybody else.

[00:32:20]as far as we can tell that's, that's where the weight of evidence seems to be pointing recently. So, again, thankfully it doesn't seem like they're. Yeah. it seems like they're pretty rarely at high risk of severe outcomes. So I think that's a good thing, but, but yeah, I think that it's not totally clear what things are going to look like.

[00:32:35] I think that though, now that we know we're beginning to know more about transmission, I think that we'll probably. Yeah, I do do our best to create spaces within the schools as well that make it less likely for kids to transmit to each other. So, you know, this is something that I haven't put a lot of thought into, but I know a lot of people have, and I think that people are really using the summertime right now to try and figure out how to do this.

[00:32:55] Cause it was all just really rushed at the end of this last school year to try to figure things out. And [00:33:00] there were a lot of things that, you know, just didn't go very smoothly. So, my hope, I guess, is just that administrators are really using this time. As I know they are. to really think about how to, how to help students in the fall and, and how to support families.

[00:33:11]it's a difficult thing, you know, and I, my, my heart really goes out to, to everybody who, Yeah, who has kids in school right now? It's just, it's just a really hard thing. 

[00:33:19] Matt Boettger: [00:33:19] I know maybe this, that if it's any help, which I doubt it is, but our, our oldest would be going into kindergarten this year for the first year.

[00:33:26] So this next fall and in light of the pandemic, we just decided we're homeschooling for this first year, because we just didn't know what was going to happen. And we're like for his first year of school, We just didn't personally like, who does, he's been playing Jojo back and forth and there's, then it's like, I want his first year to be like the solid year of like, Hey, I'm here.

[00:33:43] And we're all having fun. And there's just too many unknowns and it just has to be a weird transition year. And so we're like, you know what? Forget it. We're into the hard work of homeschooling just for this year to figure out what's how this all ends with. Hopefully then reintegrating them into first grade, you know, into, into, into school in the next year, when it's all said and done, [00:34:00] said, and done, we just didn't want to deal with the complexities of the situation.

[00:34:02] So my heart goes out for all the parents who are struggling with what, what on earth? And, and you're like you said, this is so systemic again to poverty. I mean, what do you do when, when school is canceled? And so many kids rely on food. For lunch, and, how quickly this was, taken away, in this past spring.

[00:34:18] And I heard a number of articles where it really hit some poor communities pretty significantly. obviously, so, so. I'm, I'm way more than, hopeful that this fall we'll have much more support behind it and have a lot more intentionality and planning to reengage the kids back into the school system.

[00:34:35] Okay. Well, once again, if you, have any questions for Stephen S T E P H E N K I S S L E R at Twitter. any questions for me, we'd love to hear from our listeners. If you get a chance. we had another one just the other day, send an email. We would just, it's good to hear what's going on in your, in your, in your world right now and how we can help and be a support.

[00:34:54] So that's mat mat had living in the So email me, we'll put you on the [00:35:00] show, hear what's going on in your side of the world. Again, if you want to be on the, if you want to hear my other podcast, living in the real good living up for the newsletter. We have a great episode.

[00:35:08] Come out next Wednesday. And I think that's it hope you guys. Oh yeah. If you want to support podcast, Patrion, Venmo or PayPal, all in the show notes, have a wonderful week. Congratulations to all you who are graduating this and this year. Sorry, you couldn't walk and walk virtually.

[00:35:25]but, we will see you all next week. Take care. Bye

[00:35:28] bye.