Does Vitamin D help and will variants grow exponentially

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Things Discussed on Episode:

• New clinical trials raise fears the coronavirus is learning how to resist vaccines
• CDC director says community spread of South African strain is here
• Why COVID demands genetic surveillance
• Infectious Disease Expert Warns ‘Category 5’ COVID-19 Hurricane Is About To Hit
• Transmission of coronavirus in schools can be limited if kids mask up, study suggests
• Can Vitamin D Help Fight Covid-19?

Transcript

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Matt Boettger 0:00

You're listening to the pandemic podcast. We could view to live the most real life possible in the face of these crises. My name is Matt Boettger and I'm joined with my two good friends. And if you're watching this streaming this live, you only see what one, there's an empty desk as Mark ran away to go grab something. But first and foremost, Dr. Stephen Kissler epidemiologists at the Harvard School of Public Health and Dr. Mark. So we actually have him here. They strip that away from the hospital. He is here somewhere. He's coming back a doctor with University of Colorado Hospital. You can hear him in the background. Stephen Mark. Good to see you. Are you back? Are you, are you here for the podcast, Mark? Just stopping by to hello here.

Mark Kissler 0:36

I just opened up my computer.

Matt Boettger 0:39

Here we go, man. This is, this is the thing.

Mark Kissler 0:43

This is what we do. I just spilled. I just got a glass of water and I spilled it all over the desk right before I started. So that's a

Matt Boettger 0:48

random, I thought you were going to say you're brand new M one Mac, but then Nope, it's a desktop, which is good. Cause that, that would be sad.

Mark Kissler 0:58

That's right. The actual physical

Matt Boettger 1:00

desktop totally on it. Okay. Well we're all here. This is exciting. So we've got some stuff to chat about, but a couple of things, just the normal stuff. So please leave a review. We've got some more views coming in. They're just great. We love them. It keeps us motivated. Helps us rise a little bit. So just to make this well, People can see it and listen to it, check it out and find the value in it. You can do that at a, you can do that on Apple podcasts. Just the link is in the show notes, you can support us patrion.com/pandemic podcast. As little as $5 a month goes a long way or a one-time gift, Venmo or PayPal all in the show notes. So we have a handful of things that we want to chat about, but I, but one thing I keep telling our listeners that we're going to get to your question. So before I go any further. I want to address two or three questions so we can knock these out. So here's the first one. This is from, Oh, POG. I think I'm sorry if I butcher your name, pug pug. I really apologize. I'm totally American. I know nothing but like names like Sam, Matt, Beth, all like, you know, mano singular or mana monosyllabic. So those are the ones that I can nail. So here's a question from POG, right? So he was concerned about high schools. He has seen her twins are they're visiting universities. He's got some concerns about this and he wants to know, right? There's hope there's a vaccinate, the vaccinations coming out more and more every day. We can talk about that in a little bit, but he want to know now we've, we've heard from Fowchee. Who talks about how 85%, 80%, this is what we need to strive for. I think he would, he is asking is like, what level of vaccinations do we need to have before we begin seeing the virus having a difficult time finding new hosts? Is there like a, a lower number, like a milestone that we can like begin to look forward to Stephen, give any information on that one. Oh,

Stephen Kissler 2:47

boy, that's a tricky one to answer. So I can speak to some of the things that we're seeing in other places that have ramped up their vaccination rates really high. So the the main example of this right now is Israel. Who've vaccinated, a lot of their population. I think. Most recent estimate was that over 70% of people over the age of 65 had gotten the vaccine both doses already. And so they're starting to see declines in the rates of people who are being hospitalized for COVID. But this gets back to that sort of fundamental question of does the vaccine well, Does the vaccine prevent against transmission? We're pretty sure it does, but then how much? So we have these estimates of the efficacy of the vaccines that are super high. But we don't know how much they actually prevent against transmission. So so even if, if we have a very high vaccine coverage, but the vaccines don't prevent a lot against transmission, then we're still gonna see cases popping up. Even though fewer people are going to have severe illness. For sure. That said, like I said, in Israel, we're seeing these high rates of explanation and we're seeing lower rates of hospitalization. So I think that once we get to probably 30, 40% of the population vaccinated, especially the high risk population, we'll really start seeing those effects. 50, 60, I think it will be pretty clear, but I think we're still a ways off from that. Okay. Okay.

Matt Boettger 3:59

Well, it's better than 85%. So that's yeah, I that's, that's really helpful. So second question comes from our listeners, John, and his question is basically, this is an interesting question and somewhat of a gloomy question, I guess part potentially answer is we've talked about right. Exponential growth and how it's hard. It's a difficult concept and we're seeing it here and there in certain towns. And then there's the variants that are coming up and they're sprinkling and they're becoming larger. His question is given how large the virus has spread and it continues to spread around the world. Can we talk about variants growing exponentially in the same way that we're talking about? COVID if so, if not, then what are the implications of that?

Stephen Kissler 4:39

Yeah, so I think that Outbreaks grow exponentially sort of by nature. And the question is just how quickly exponentially. So even within exponential growth, there's a whole variety and that's related to the reproduction number and to how quickly the infections turn over. So if you have a reproduction number of like 1.1, for example, so that means that, you know, out of 10 people. They'll infect 11 others it's going to grow exponentially, but that's going to be a pretty slow rate of exponential growth into a lot of people really get through the disease. Whereas if your reproduction number is three or four, that thing's just going to take off like wildfire. Yep. So best estimates is that the UK variant might be 50 to 70% more transmissible than than the virus we're dealing with. So I do expect some amount of exponential growth from that one as well. Okay. But of course, a lot of this is in our hands as well to some degree. So things like distancing, masking those kinds of things do help sort of reduce that level. So, so it's sort of this, this balance that we're trying to strike. So, so yes, the new variants can absolutely grow exponentially and I expect that they will, as they have in many countries in Europe. But that doesn't mean that it's gonna. Completely take us over it's there, there are things that we can do to slow its rate. And I think that that's really what we need to focus on in the weeks ahead. Okay. Well, I

Matt Boettger 5:51

want to jump to this right now because it kind of related. We talked about Osterholm in the past and he, I followed him a little bit, not that much of our listeners follow him. And last week or even two weeks ago, we've been talking about the future of the variants in the us and what to expect next two or three months. And you were kind of giving a little bit of a hopeful, potentially a hopeful cautiously optimistic. Take the next two or three months osterhome come out with, it came out with an article maybe a day ago from the Huffington post and maybe it was from someplace else is syndicated really having a very different outlook of language that can hurricane five up ahead and really dire. This is going to be really difficult if we don't do something dramatically. So he's kind of airing on the let's release all vaccines. It's not due to dosage just so we can try to our best to not have this hurricane five. Come into place. So in light of what you just said, what do you, what do you still, what are your colleagues talking about at Harvard right now about the potential two or three, three months? Is it somewhere in the Oster home or are you guys all over in different variations of what you guys think? Or what do you have a United front or what do you guys expect next? Two, three months. And I get it. This is kind of like we're daring into witchcraft here. Right? Trying to understand what's the what's what's what's going to happen. So where do you guys find yourself in light of osterhome in the couple past weeks that you've been talking about.

Stephen Kissler 7:07

Yeah. So there's there's definite some apprehension, I would say, like we're, we're worried about the next few months and, and what they could bring. Just given what we've seen that the variants can do in places where they really do take off and take hold. I think that Some of the optimism or maybe lack of pessimism as a is that you've heard me express is, is actually related to what Dr. Oster home has been saying and is, is, is related to the fact that I'm confident that we'll be able to do those things. That he mentioned that we need to do to prevent it from being a category five hurricane. I think that if we did nothing, if we stopped vaccinating people or really slowed down vaccinations and started to go back to our normal lives and these new variants were starting to spread, we'd be in a very bad spot, but I'm optimistic that we won't do that. That will continue to ramp up our ability to vaccinate. That you know, we'll keep paying attention to these numbers. And so I think, I think we will potentially still see high levels of spread the other sort of point yeah. To make about the potentially the difference between what I was talking about and what Dr. Foster home is saying is that it depends on a lot on where you're looking specifically, like what geographic scale you're looking at. So I think on the whole, across the United States, we might be in for a lot of, sort of high level transmission for awhile, but we might be able to avoid some of the large spikes, as I've said before that we saw in the UK, for example, just because this is starting to take off after the holidays, after the primary winter season, when coronavirus has spread. But that said. There could be a lot of specific communities where we see really bad outbreaks from the new variant. And those will be average out with other communities that are seeing low levels of transmission to sort of over the overall, across the entire country. I think that we're probably going to see high levels of transmission sort of tailing off into the summer, but that I think we do have to be careful because within specific communities, there's still a very high chance that some places will just get unlucky and see a lot of spread from these new

Matt Boettger 9:02

variants. Yeah. And just before we go to the last question from apparently your aunt Patty, Patty. Okay. We'll say aunt Patty going back to the flu of last week. I love that. So I read more some more,

Mark Kissler 9:12

huh? Just for, if you're talking about names that, that one's got two syllables too. That's a,

Matt Boettger 9:17

yeah. Let's see. Did you see, I just like self fulfilling prophecy. Lesson two, all you people who, who have a limited mindset, if you have a fixed mindset, you're going to sabotage yourself. I can not do any more than just one syllable words. I'm John I'm toast. So sorry.

Mark Kissler 9:37

I just had to get that in there.

Matt Boettger 9:39

Well done. Well played. Okay. So I hope that the big meta analysis right there for everybody. Okay, so going back. Did the flu last week? It was, it was really, I think, insightful to this article and I read it a little bit more about it and seeing that like, there's like 40, 40 times less. Hospitalizations going on. I mean, that's very hopeful. I think I looked at the CDC is more like I saw like two to four times less hospitalizations, but it put in the context of like, the stuff that we're doing is working and they're working well, that it can really put down the flu down to almost non-existent and where we're at. I mean, could you imagine, I just think of myself if it was like, Two to four times worse. COVID was right now that it's already just, just feels not only really challenging, but mentally challenged as well to have it that much more significant and would just be outrageous. So what we're doing works, we need to keep doing it and especially in light of the variants. So let's get into speaking of which, what we're doing, one of things we're doing is we're masking we're masking up and we're trying to do the best we can. Mark, you were saying that there was a question from. I'm sort of call her aunt Pat. Is that okay? I don't know. Patty, what was the question?

Stephen Kissler 10:53

I'm Steve. So she was curious, I was speaking with her the other day. And so we've been talking a lot about masks and about the now more and more people have access to higher-ed. Basically higher efficacy masks. So masks like N 95 masks, the kn 95 masks. But of course you can't run those things through the washing machine. And so the question is what do you do after you've worn them?

Mark Kissler 11:14

Yeah. You know, I think that's a good question. I, you can definitely reuse and 95 masks. And we do that in the hospital a lot. Other things, I don't know if I have a rigorous answer to the best way to post, to treat a mask, but I tend to the cloth masks, we just throw in the washing machine to make sure we dry them. Other masks that might be reusable, but not able to be washed. I would just hang it up, maybe hang it up in a window or in the sunlight and let the UV rays do a little bit of their disinfecting. And the big thing is to let it dry and get the respiratory droplets and stuff dried off of it in between uses. But I wouldn't worry too, too much about sterilizing the mask itself in between uses.

Matt Boettger 11:54

Great. That's how I see a lot of people hanging in their mask on their rear view mirror.

Mark Kissler 11:59

Perfect. Right. Could be, that'd be really good. That's actually, that's a pretty good storage strategy. All things considered, and then it's there if you need it. So

Matt Boettger 12:08

yeah, I think we'll do it. It's like, it's the, it's the new Where those little green trees back in the nineties. So you put in this little century, so that's right now, now, now we just need to get scented masks. So it actually new car. So that'd be great. Yeah, I know, you know, that's a really bad idea, really, really bad. So that's my entrepreneurship at its best. Okay. So. Variant let's hit some of these things trials or trials, raise fears. Coronavirus is learning to resist vaccine saw this. Now here's the deal we talked about. We're talking about a little bit more of like the mental exhaustion with COVID right now and just w just the enduring this, I would just talking to my brother-in-law and just his own fatigue of like, and it's even in some ways it's even worse. And this is related is because now that the vaccines out, I'm like, we're really, really excited. We get really energized. We're pumped. And then something happens, which feels like it's sabotage has bursts our bubble. And we kind of go regarding these really big waves, right? Like, Oh, it's here, it's here. Ah, no, it's not here. It's here. There's complications. So now here's another bubble what's going on with this that we've taught before that it seems to be working well, the vaccine across all variants, is this something of a new research, new insight or is this kind of like that fear-mongering stuff?

Stephen Kissler 13:23

Yeah, I mean, and I can really relate to the feeling that you just mentioned too. You know, there's like, I feel like that a couple of times over the course of the pandemic, it's, it's almost easier when you can just hunker down and know that things are going to be rough for awhile, but when there's that like little bit of of hope or something, and then it, things get more complicated again, man, it's, it's just hard, but we can try to break this down a little bit in terms of the vaccines. So there's been a lot of vaccine news lately and. I think the overall summary of that is that some of the new vaccines that have come out and some of the ones that we've had for awhile, like the Madrona vaccine appear to still be highly effective against the new variants that are spreading that's that's the key thing, although their effectiveness In general for some of the variants, depending on the ones that they've been tested against is a little bit lower. Now I think the important thing here is to take a look at what we mean by effectiveness. So when we're talking about vaccine effectiveness, really we're talking about the ability to have the vaccine to prevent illness. Of any sort from COVID. And that's what the, sort of the baseline values that we've been hearing, the, the like 95% for the Pfizer and Madrona vaccines. I think it was 66%, something like that for Johnson and Johnson. And so. You know, those seem like really wide gaps and they are to some extent, but I think the important thing is that for protecting against severe illness and teth, it seems like the vaccines are very, very, very, very effective. All of them really we've seen very few severe outcomes and deaths from people who have been vaccinated. And that's true for basically all of the vaccines that we've had and true. It seems to be Both for the variants and for sort of your run of the mill COVID. And so I think that's the really good news here is that even, even if a person becomes sick, their chances of those severe outcomes are still very low, no matter which vaccine you get. And no matter whether it's the very inter regular COVID. So I think that's the good news and it's worth paying attention to these other things, because. It is still possible for COVID to evolve into escape, the vaccine to, to, to allow more infections. And that could also feed down the line into more severe illness and death, but that's not what we're seeing yet. The evidence really hasn't borne out in it suggests that the vaccines are really still very effective against those worst outcomes.

Matt Boettger 15:36

Okay. That's great. That's good news. And it all, no question about that and just a few minutes, but related to the variant. Now the CDC director says that there is community spread of the South African strain. And this is the one that I think that we're all kind of mildly little cautious with. Oh, no. To what extent, it's more deadly now I have, this is, is that, so is that true? You know, do we have community spread? And I guess the, the question that's more specific about this is, is there any update with genetic surveillance? At this moment in the U S because we know the UK was just rocking it. That's how they be able to detect it relatively early. You know, we've been kind of playing of trying to play catch up. So how do we even know, do we have enough genetic surveillance to actually know there's community spread? Are we just kind of, punting is assuming that it's pretty widespread. The variants are in the U S by now. And if, so I know this is a complicated question, but you can handle these things, right? You're you you're at Harvard, you got all this, right? So the last one is, is related is, you know, if there's, if there's spread all over the U S and we see the stats dipping down further and further and further, is it, does this still mean that maybe we may not get this de luge of increase or. Where are we at? It's this seems confusing and mixed signals all over rates going down. Can we spread lack of genic surveillance? What's the truth.

Stephen Kissler 16:55

Yeah. So we're still learning a lot about these new variants. Genetic surveillance is a really hard thing to ramp up very quickly. And so here in the U S we are still playing a fair amount of catch up that said the surveillance that we are doing you know, we have We do know how to do surveillance and how to basically run the statistics on those numbers to get pretty good estimates of how much spread there is given pretty small samples. And so that's what a lot of a lot of these findings that you've cited are coming from where we're detecting spread of certain variants. It's basically looking around and trying to find evidence of that, given the limited resources that we have available. So absolutely these variants are probably more widespread in the U S than the official numbers. Say but that said, I really, I mean, even just based off of the fact that the cases are coming down right now and that when we have gone looking for the new variants, we haven't seen them really taking over yet. Like they have in places like the UK. So just that they're still not super widespread in the United States at the moment. Now, there are a couple of other interesting things. I was just looking yesterday. One of the other things we've been learning about these variances that they're not. All the same. And that's something worth keeping in mind as well. So there's this great Twitter thread. If anybody's on Twitter by Christian Anderson, who's an immunologist at the Scripps Institute, basically breaking down what we know about the new variants and he has this interesting hypothesis that a lot of the. Data sort of bears out which is that the variant that's been detected in the UK seems to be inherently more transmissible, that it basically spreads more easily. And that's why we saw these major spikes of infection in the UK, followed by spikes and infection in many other places in Europe. It probably still hasn't taken holds to a large degree in the United States, but that may well just be a matter of time. The other variants that we've been paying attention to specifically the ones that were first detected in South Africa and in Brazil, It seemed to be a little bit different. They have sort of been spreading widely, but mainly the places where they've really taken hold are places that have seen major outbreaks of SARS cov two previously. So the concern with those ones is that they might be able to escape some of the natural immunity that you get. From an initial COVID infection and then they can continue to spread there. So there are different sorts of evolutionary and transmission pressures going on to make these viruses spread in different ways. And so really the initial concern is for the UK variant, which really seems to be able to spread more easily, no matter who you are. And then these other variants can come in and follow afterward and can potentially cause. Infections in people who have already been exposed to the virus once. So those are the sort of dynamics that we're trying to pay attention to now. And so what I anticipate in the next couple of months is that we'll see continued spread of the UK variant that that might cause a severe spikes in some particular locations. And we'll probably average out to sort of high levels of infection sustained across the United States. And then these other variants are things that we're going to have to sort of continue to pay attention to as we move into the summer. As more people get vaccinated as more people get exposed to the UK variant. And then these other strains might have the possibility of these other variants might have the possibility of sort of taking causing other infections in places where COVID has already passed through.

Matt Boettger 19:57

Okay. All right. Now, before we headed over to, to Mark, last question about this, we kind of related the spread and the variants CNN says study supports argument that coronavirus doesn't spread in schools. I know we both, when we read that. I kind of had a little bit of a little chuckle. What does that mean? Does that mean that as long as you put a sign up on your, on your, on your home saying, this is the school that COVID does not enter or whatever, what is this? Is this a new research?

Stephen Kissler 20:21

Yeah, I mean, I think that really, maybe we can take a step back. I think what this gets down to is something that we've talked about, especially more towards the middle of last year is just the ways that science has communicated. I think that oftentimes we hear these reports in the news of scientific study reports X and then you have to wait a couple of weeks and then you have another scientific support study that refutes X. And part of the issue with this is sort of the way that we w we look at science, which is oftentimes we think of a specific scientific study as proof. In a way or at least a very strong evidence of something. Whereas actually, I mean, my relationship with most of the science that we do is in terms of consensus. And when I see multiple studies building up a study that building up sort of an idea that supports itself and makes sense and a lot of different angles of data support, then I'm a lot more inclined to believe it. So. It absolutely COVID can spread in schools. It does spread in schools. We've seen it. And so and so that's sort of a splashy headline. Really, really can't be true now. A lot of the prevention measures that schools have been taking, wearing masks, making sure their students are distanced. These kinds of things do help prevent the spread of COVID COVID may well spread less easily among especially very young kids. And so so that's all, that's all good news, but, but it is absolutely spreading there. And and I think that we can get lulled into a false sense of security. Like you said, where once you walk into the school building. You're safe, but the reason you're safe is because of all of these other things we've done to make sure that it's safe. And we need to make sure we keep doing that and improving upon that. And I think that's, that's the main

Matt Boettger 21:54

thing. It had this image of like Lord of the rings and Gandalf it'd be like, you shall not pass. Right, man. I wish that's what I that'd be. That'd be awesome. We need that. We need, we need that for this. Okay, Mark. And I like

Mark Kissler 22:12

that. I just want to, just to like you know, I, as I'm thinking about kind of what Stephen's saying about consensus and about having a really robust grip on. What our scientific knowledge is actually saying with something as important as our schools open or not to society, right? That's, that's hugely important to kids, to education, disparities, to, you know, future outcomes for education. And also just to families, that's a tremendous difficulty for a lot of families to have schools not be open. And then it changes the way that they can work and just has these huge, big, far reaching effects. I think that's all the more reason why having a really. A strong grip on the real science is so, so important. As opposed to using anecdotal evidence here and there, or like, you know kind of piecing together or, or applying what we think is going on to the anecdotal evidence that we have access to and then making decisions based on that could lead us to very different. Places around some of these decisions. And so I think, you know, when I hear Stephen talk about how, you know, of course COVID spreads and schools, and of course, you know, these are going to be, even if we're not seeing a lot of children infected, they can still be hotspots for community, transmission, things like that. That's so it's so crucial. It's so crucial to communicate that in an effective and compassionate way, you know? Because I think it's just, it can be very misleading. To get into this mindset, that there are certain places that are immune and it's just silly if it were not, you know, Opening the flood Gates and things like that. And so I think that, you know, that holds in your hand, both of those things, the importance of reopening the importance of really you know, having communities and contexts with other people, as well as, you know, what's really going on with the virus.

Matt Boettger 23:56

That's great. That's great. Yeah. I mean, it's kind of like, what does it, it's a, it's this temptation for. Simplicity for a Greenlight go, you know, like I want to buy down in black and white and to that kind of, so I can know which way to choose, but life just more complicated

Mark Kissler 24:10

and yeah, and that there's not an either or either in the sense that like, if we, if we accept the fact that there is transmission going on in the schools, you know, that's not necessarily saying that, okay, now we all need to go back into our basement caves, you know, never see the light of day. I think it's just having a higher resolution on that. Discussion, but also the sense of a consensus in which we lack broadly, you know, about everything. It's nice. I think, you know, hopefully trying to figure out how we can recover that as a scientific community is a helpful thing. So it's just a, just a random

Matt Boettger 24:42

thought. Yeah. Okay. Let it go. A few things first. I want to hear an update with you, Mark. With the hospital. I know you're going into COVID routines tomorrow. So what's going on at the hospital? Any updates with there?

Mark Kissler 24:54

So we, the hospital is super busy right now and it's not necessarily, COVID busy, it's busy, just all around. So we're seeing just you know, who knows, there's this kind of waxes and wanes you know, over, over time. And sometimes we have busy months and sometimes less busy months, but the hospital is super, super busy right now. And so I'll be on a dedicated COVID team. And interested to kinda, you know, re-engage with that, I've been off, off of COVID services for a couple of weeks now and just kind of see where things are at, but it seems like you're, for the most part, at least at our hospital in Colorado we're relatively steady or to relatively steady, I would say there's been some ups and downs since the Beginning of January or so overall in a S in somewhat of a downtrend in the number of COVID cases. And I think we're all looking to February and March and hopeful that at least as a local community, we're going to have fewer cases over that time.

Matt Boettger 25:44

Good, good. Now, are you seeing the same thing that I've been reading about flu, like very low dot existed and you seeing the

Mark Kissler 25:49

same thing in your hospital? And I've actually heard the same that the other place that I think is really sensitive for that kind of. Differences the children's hospitals. So in speaking to my colleagues who work over at the pediatrics side there's really a lot less of the typical respiratory viruses and hospitalizations that go on in the pediatric population. So, you know, the children's hospital like ours, you know, big academic center does go through this pretty massive peak in the winter compared to the summer months because of things like bronchiolitis. Influenza and all of those respiratory viral illnesses of childhood that can be very serious in merit hospitalization. And they have seen a global decrease in all of those things. And you know, I think that that just makes sense in terms of the, this same viral transmission patterns, that effect starts Coby to affect all of the millions of other viruses of childhood. And so, you know, I think that's that you know, it's definitely something that we've been

Matt Boettger 26:41

seeing. Great. Great. Okay. Look, here's the perennial question I've had for months, right? Mark. We've been talking about this vitamin D I've been, I mean, I hear you. I know you've been dodging this, right. And so you said he'd been up in a research. I got it. No, I've got no, this is like, before we ever in this podcast, I got to know where their vitamin D is the ultimate. Silver bullet to COVID. Yeah, totally.

Mark Kissler 27:02

Yeah. Well, there you go. I mean, I think it's, it depends so much on the framing of the question, right? Like so much of what we're talking about. I do think so. There's so vitamin D is interesting and I think you know, we've talked about why there's a couple of reasons why I think it's a cause for a certain amount of hope, right? One is that it's. Very accessible at a relatively low cost intervention that if it did have an effect size, especially on a population level, that would be really great. And it's also kind of, it's nice because it comes from sort of a net it's, it seems like a more natural type of intervention. And so I think it hits a lot of the things that make it feel. Good. To people, you know, here's a natural intervention, that's low cost, easily disseminated. And maybe it has an effect on population health. And I, there has been, so there's been some interesting stuff around vitamin D that's been published. There is some correlation data. And this is, I think the key is differentiating, you know, our different qualities of evidence and the importance of that. Because the trick is that, so, so let's, let's back up a little bit. So vitamin D you know, is, is crucial for bone and muscle health. That's kind of its primary role. But there's also been some evidence growing over the last. In a couple decades that it has a significant effect on some immune functions and also that it can affect cardiovascular health even cancer. And that there seems to be some relationship to its hormonal activity, to a lot of the ways that the body maintains its homeostasis. Okay. Also though individuals who are who have, or are higher risk for things like obesity, hypertension, and diabetes are often. Also groups that are at risk for vitamin D deficiency. And you can already start to see where this might be going. Right. And so some of the initial correlational studies said that the incidents, so the amount of times that people with low vitamin D got COVID was higher to, you know but that's different from saying if you have low vitamin D you're more susceptible to getting. COVID because a lot of the same risk factors that run together for vitamin D deficiency also have been independently identified as risk factors for COVID infection and for severe outcome. And so some of those things you know, include socioeconomic status. They include darker skin colors because your skin is so crucial in using ultraviolet energy to convert vitamin D to its active form. So. Yeah, we see this kind of conflation or at least a potential conflation of social drivers of community health with vitamin D status. And is vitamin D kind of a, an indicator of that or a cause I think the vitamin D is interesting because I do think it may be a little bit of both. So I do think, you know, there is some evidence that it has at least some preliminary evidence that it may have some immune function and help in other respiratory. Illnesses, but there hasn't been a really robust randomized clinical trial to suss out whether or not it has an effect on Sergeant Coby too. Now that's so that's kind of on the side of prevention, population level health And I think also maintaining that distinction between sort of the public health brain and the clinical brain has been important. And that's really been highlighted this whole year because often thinking clinically, you know, which I think very much about the individual patient and the singular case and therapeutic benefits of somebody who's already sick. But that paradigm is, is very different. When you, you know, and it's very different from what Stephen needs to think in every day, in terms of prevention of transmission, big level, social interventions and things like that. And so I, I'm very sensitive to the, you know, to that degree too, but I think it's worth asking, is there a therapeutic benefit to vitamin D you know, if you get COVID, should you take vitamin D or if you take vitamin D throughout the year, or are you going to be less at risk for severe COVID. All great questions. You, I don't think there's any evidence that increasing your vitamin D intake past what they're already recommended daily amount is, is going to be helpful at all. And so, as long as you're replete and you've got enough vitamin D, which, you know, typical sources are like fatty fishes sunlight, you know and then dairy and milk and dairy products. And if you're, you know, if you're vegan or you don't get you know, vitamin D from those sources in your diet, you can take supplementation. And there's some guidelines about the number of international units per day that you should use. But. The other population are breasts in a breastfed babies up to one year, get vitamin D supplementation as well typically, but you're outside of those kind of special cases. If you don't have a vitamin D deficiency to begin with, I'm not convinced that increasing your intake is going to be super helpful or have really meaning clinically meaningful effect size. The other thing about it is vitamin D is a fat-soluble vitamin. And so it is, you know, there's something that you can overdose on and Sue, you don't want to be taking mega doses of vitamin D out of concern, you know, for COVID because that actually caused more problems. Good. Yeah, so that's kind of, you know, that's kind of the summary. I think this is one of those really interesting things where I think there may be an effect. And I think that one of my questions as a clinician is, okay, how does this change? My clinical practice? Should I be screening for vitamin D deficiency on admission for COVID patients? For all of my. Hospitalized patients, you know, or is this something that's more appropriate for primary care setting if vitamin D it turns out I was looking at that, cause they're just curious. I think it's a, what we call a negative acute phase reactant. So it's one of the substances in the blood that if you're sick, it may actually go down. And so you may get some falsely low readings, like for my. Patient population, if I'm testing vitamin D and everybody probably see a lot of load up vitamin D is that may not be as clinically significant because they're already sick. You know, other things, but I do think, and it's something that that is often done in a, we did in my In my residency practice, where I did some primary care at a community health clinic, you know, vitamin D testing was part of what we did for certain at-risk populations and things like that. So I think just continuing the same, some of these same real fundamental population, health level interventions, you know, the same things we've been talking about with like diabetes prevention, hypertension prevention, things like that do have downstream effects and really the health of our. Our corporate health, you know, as a as a, as a community really does matter. Our baseline health when something like this comes

Matt Boettger 33:21

along. Yep. Good. Well, thanks for finally tackling that. I know it would be a complicated, complicated subject. It's going to be nuanced, but it was helpful. I know this is a lot of our talk at our house. Like we're always kind of craving any kind of natural, I think either whether it's a false sense of control, whatever of like taking whatever you can and just to help you multivitamins make you feel as if yeah. You're building a little bit of resistance too. It's it's a gravitational force. If you were to get it, you know the other question this was related to Fowchee mentioned this scientists working on therapies to make COVID less deadly. So my, this is more of like, educate me Mark on this issue because early on we talked about therapeutics and I, this has all been a learning curve for me. And after a few months, I got the kind of maybe overt sense from you guys that, that viral antiviral therapeutics oftentimes don't work that effectively versus like bacterial therapeutics. I don't know if that's correct or not, but. So it's the way it's kind of a struggle. And then, then I read about HIV is kind of this juxtapositions comparison of a drug that is an antiviral that has grown in research. And it's worked very effectively to kind of keep HIV at Bay to keep people living much, much longer. So I just want to know a couple that made the biggest question for me is. We're having a tough time with therapeutics when it comes to COVID. Are we ever, do you think there's hope that we going to have like an HIV drug that's a therapy that's as effective as COVID or is there a distinction between these two that I'm not quite seeing?

Mark Kissler 34:44

Yeah, I think I think these are very, very distinct disease processes and very distinct sort of programs of research and therapeutic goals. Right. When you look at those. So you're right. And just to back up again, that you're right to say that there's a significant difference between some of our antiviral medications in our antibacterial. Medications or, you know that they have different mechanisms of action and they sort of have a different, you know, character about them, like how they, how they interact with the pathogen. That being said, you know, I think we, we do have to think a lot about sort of targeted antiviral medications for targeted viral infections. And so H you know, asking about HIV in the, in the context of the SARS, cov two, they're really very, very different in the sense that HIV creates a long-term chronic infection. And and. The a lot of the mortality and morbidity related to COVID is kind of what this acute and infection period. You know, of course there is the long haul COVID effects and these, these long-term sequella, but it's really fundamentally sort of a different disease paradigm that I would, I would say, you know, HIV is. W is really sort of the last great epidemic that we've had prior to this one with the exception of, in some of the, the smaller flu and SARS and MERS. And and so there has been, you know, fortunately a lot of research directed in that area, but also I think in the sense that that's, that's a disease process that if, if uninterrupted, that's not something that the body necessarily gets rid of. That it's not something that the body gets rid of on its own. And so it just requires sort of a different therapeutic approach. And so I think that well therapeutics for COVID may be antivirals. There's sort of a whole different sense of like, when is that clinically useful for what populations and the kind of the type of research and the amount of time it would take to have you know, have robust antivirals in this case. I think they're really kind of. Best thought of is completely different processes.

Matt Boettger 36:40

Okay, good. That's helpful. Yeah, but it's weird because I see this in many articles, comparing HIV therapeutics to COVID probably at least a half dozen in the past six months. So I was just curious, I'm interested to

Mark Kissler 36:53

see, I'm curious to, I, you know, I wonder if it. I wonder if there are they comparing the mechanism of, of an antiviral agent or they can, because I think that's, again, you know, are we talking on the level of the physiology of the virus? Yeah. We're talking on the level of the epidemiology of the virus, you know or you could, because there could be similarities, you know, in the physiologic mechanism for an antiviral between, you know but the epidemiologic level is, is pretty distinct.

Matt Boettger 37:21

Yeah. Okay, good. Well, let's land on this because we talked about the beginning. It's weird, Mark. You brought this up. I know in two minutes, you're going to have broadband being sucked, derived. So. We'll see how much we can, we can get from you on this conversation. But so I w I was the middle of the night, last night. I was just thinking about our, how we open up our podcasts and dealing with these issues, these crises of the day, I'm like, Oh, man, I don't know if we've really, really hit this in depth this much lately we've been talking about. Just what's going on in the science. And the fact of the matter is I'm fatigued still. I'm imagining you guys are fatigued as well. You know, Stephen, for many reasons, you are the ultimate lockdown boy. So you've got to feel it intensely as well, but we just to check in and where you guys are. I mean, this goes back to a question way back from someone from Terry, Terry we just had an idea of just talking about, Hey, we, you guys are great. We love what you do. We love listening to you. And I feel like we need to talk more about the consequences of these, these orders, the, whether it's lockdowns or masks and the mental health and the increased suicide and increased depression. And it's important to acknowledge that. And I would imagine still to this day, Stephen, imagine it still was a big conversation piece, even in your world, among your colleagues of, of dealing with the issue, not just the epidemiology of the, of the coronavirus, but just the consequences of the life that we're living as well. So I'm going to check with you guys, how you guys feeling and what's going on in your own world when it comes to the fatigue and just this hope, and then kind of like a little bit of a retraction in more patients that we need. Always Mark. You want to go first because you might bail out in about 30 seconds.

Mark Kissler 38:56

Yeah, you bet. You know, I think it's just been something that's been on my mind a lot. And I agree with the sentiment that, you know, I, as important as it is to focus on the science of these things. I see that as a means to the end of how do we support. Or community health as a whole and the mental health and health of our communities, you know, it's definitely a key part of that. I, I think that actually one of the most toxic things that's happened through this whole pandemic has been the dichotomy of you know, do, do we care about. Economics and people's mental health or do we care about getting COVID? And I think that that is it's false. That's not a true dichotomy. Nor is it helpful? And what happens is I think that there's, that, that does a disservice, I think, in. Every direction. And so, you know, I'm, I'm really, I I've been thinking a lot about the prevalence and just the significant you know, difficulty of things like depression and anxiety and the way that that's been multiplied, you know, a thousand fold this last year because of how tough this year has been for. So, so many people, and I think isolation is never a good. Thing, you know, it's just not good for humans. And so I th that's part of, I know Stephen and Stephen arrived talked about this a lot offline about holding those two things together, you know, and really understanding trying to be as rigorous and as targeted as you can be around things like lockdown recommendations and things like that. Yeah. Well, always bearing in mind, you know, the negative consequences of those things. It's tough. I do wish, I mean, I hope that that just having a little bit of a greater awareness of that both on a structural level, but also on an interpersonal level is something that comes out of this, that like, you know, checking in with folks, like, how are you doing? And making sure that you're just kind of, you know, always have those. That that intent out for something that may be an invitation to talk about something that's tough. I don't think, I think in, you know, different places, we have different sort of cultural tolerance for being able to talk about those kinds of vulnerabilities, mental illness or even just not Frank, you know, depression and anxiety, but just not feeling well, you know, not, I'm not. Doing so hot right now, you know, like those little invitations I think are things that we always have to just be aware of and listening for you know, as much as we can in each other. Because it's just so, so prevalent right now. That

Matt Boettger 41:22

was a great. Yeah, I'll get to see what you say, but just to remind me of, like, it's kind of like, not again, not in the bad sense of marriage, but like early on in a marriage. It's really wonderful. And then you can forget about the idea of like maybe dating your spouse. You have kids, it gets overwhelming. And there's a sense of like, if you still need to ask, how is she doing? How are you doing connecting or these things? And we've been in this COVID for now a year now where we can forget, like, we set it a lot, like check in with your grandma, check in with your mom, check them. And then now we've been different. Like, ah, I've, I've, I've forgotten that habit. But it's still all the more important to like taking those cues of like, I'm not doing so well, stop ask some questions and invite somebody into your life, you know, hear what's going on their life. I mean, just hearing someone and listening can go a long way to dispel a lot of the anxiety, the fear, and just the, the, the physical ailments you get from just being stressed all the time. So, Stephen, how are you feeling?

Stephen Kissler 42:12

Yeah, I mean I think, I think that all is really just sort of does a good job of describing sort of where I'm at too. I think that, so after, certainly after the holidays have passed and you know, getting into 2021, I think that it's just been It's very strange, even psychologically to sort of see the years sort of turned around and then us sort of returning back to the time of year that we were in when a lot of this was first getting started. And so I've, I I've, I've also just sort of found myself sort of dazed and just amazed that we are where we are. And there's just like a real, a real sort of heaviness to it. Right? Like we anticipated that this, this could be really bad and it was. Better in some ways than we expected and worse in other ways. And but no matter what, I mean, everybody's had a really, really difficult last 12 months. And so, yeah, I think as Mark said, there's we can really get into this Mindset of, of an either or where yeah, we either care about mental health and, or, or we care about COVID and we can't really do both of those at once, but they're they're so they're so intimately connected. And. And as an epidemiologist, as somebody who's invested in public health, you know, we, we, we actually have sort of a professional mandate to care about all of these things at once. You know, ours, ours is the fields that, that thinks about health in in all of these sort of. Broad census to not, not the only one, but, but we have to, you know, it's all of these things contribute to human wellbeing and flourishing and that's those are the things that we care about. So so it's really hard to see us suffering sort of on, on both counts. You know, that, that COVID has been really difficult and mental health has been. Really disastrous in many ways too. And I think, yeah, really, really the only solution that I can see is, you know, again, you know, we're, we're, we're slowly getting control of the virus. And that's a very good thing that absolutely helps. And then the other thing is just, you know, along the way that we're just like we're, we're each entrusted to each other. No matter who we are, no matter where we are. And and just sort of really drawing back on the communities that we have Seeking help when we need it and giving it when we're up to it to sort of doing the best we can to work our way through.

Matt Boettger 44:20

That's great. I mean, the biggest, I think action point for Emmy listening right now is like find three people this week and reach out to them, see how they're doing. That'd be a great thing to just do, just to re, re, re re kind of like get the catalyst and get movement going and conversation, and just having that relationship and that touch point again. Stephen, just, I don't think we get enough kudos to you about just. People think he's an epidemiologist you're sitting there and you're in your apartment, hanging out crunching numbers and having the time of your life. And it's just not that way here. I feel like the image as you were talking is like a captain of a ship. And they're like the last piece of the law, the last people, the last person to leave and go down with the ship. And you're like the public health captain. And I know there's other captains out there. Right. But, but for your world, it's like, and you take it so seriously, Stephen, like. You're willing to enter in a number of sacrifices to be the last person off the ship. And I don't think people who are listening truly understand the nature of how serious you take this. So Stephen, thank you for what you do once again, but also just thank you so much for the example that you are, that you understand that you may say one thing and, and believe one thing, and then you live it out. Even to an extreme measure to, to have that integrity. And we really, really appreciate that. So thank you so much before you do, and your sacrifice does not go unnoticed. On that note, I think we're closing to it and you're absolutely welcome my friends. At least we can do if you guys want to write some, some letters, do a Metta live in the real.com, you can do it. So send it over my way. We'd love to hear from you as well. You know, just we'll close on this. I just see it in the student body here at CU had three members of our student body lead because of just depression. And that kind of stuff. So so I've just seen it. It's starting to really take hold. People are dropping out of things, leadership, that kind of stuff is just too hard. They're just trying to get by with their school and that's just a microcosm of the rest of the world. So support the people around you. It's more the most important thing. So find three people today, reach out to them, tell them you care about them. You love them and how much you support them. You're there for them. Okay. Do you wanna reach out to Stephen S T E P H T N K S S L E R on twitter@mathliveinthereal.com. You can do that. Let us know how you're doing. Let's let us know how we are doing and if would support us, you can do at patrion.com/pandemic podcast, or PayPal Venmo all in the show notes. Thank you all so much for listening. We will see you guys, all guys and gals next Monday. Take care and bye-bye.