Dr. Aakriti Pandita, MD | India and no more masks?

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Resources to Help Support India

• Dr. Aakriti Pandita's India Covid SOS
• The United States Can and Should Do More in India by Dr. Aakriti Pandita

Things Discussed on Episode:

• CDC’s mask guidance spurs confusion and criticism, as well as celebration
• Let my children take off their masks, the science says it is safe
• Children and COVID-19 with Daniel Griffin (Long COVID, Vaccines, School Safety)
• COVID-19 Was 'A Preventable Disaster,' WHO-Ordered Report Says

Transcript

Matt Boettger: 0:00

You're listening to the pandemic podcast. We equip you to live the most real life possible. And the fastest crises mine is my boss. Can I join with, oh my gosh. Two people Dr. Stephen Kissler and epidemiologist at the Harvard School of Public Health and this other dude who I have no idea. I forgot his name. Oh yeah. Dr. Mark Kissler. He's a doctor at University of

Mark Kissler: 0:19

Colorado. It's been a long time. I feel like I missed you. Like, I feel like it's

Matt Boettger: 0:23

all you like a lot of holiday, like Merry Christmas, happy new year. Happy St. Patrick's day. So, how are you guys doing?

Mark Kissler: 0:33

Good good hanging in there. We're yeah, I think we have a lot of great stuff to talk about. We've started to open up a little bit as our, as a family. And so we've been doing some things. And we went I went actually to a movie for the first time a week ago to celebrate a friend's birthday. And so we can talk about, we, we went to see, he like rented out a whole theater for like, A very small group of people. And we went to see jaws and there's actually some COVID COVID relevant film criticism related to jaws, which I'll bring in later in the day. So just

Matt Boettger: 1:03

got on a boat with tons of people with no masks. Oh no,

Mark Kissler: 1:06

it's it's good. It's good. It's good. Just, just wait for it. But it was, it was fun and it was, you know, it definitely didn't feel nor like. Normal. And, and again, you know, it's not that we're really hoping for kind of a return to total normalcy, but but we started started open up a little bit, which is, you know, is all the things that is you know, it feels good, but it's also complicated related to the international situation. So it will what kind of target do you want to go

Matt Boettger: 1:29

public with your saying about you want, did we average ever Levine and how you want to get it's complicated as our promo is my

Mark Kissler: 1:35

interest. I think we just, I think you just. Made that

Matt Boettger: 1:39

public. Yeah. Yep. Oops,

Mark Kissler: 1:42

thank you for that. Yeah. We're we always bantering before the show about our pre-show song and I've been advocating really strongly for an Avril Levine. It's complicated. And somehow I get, I get out voted every week.

Matt Boettger: 1:54

Here's the thing for those of you baffle. If you're listening, if you're part of our subscriber base. Or there's any connections to several, and we can get licensed to put it, please email it Madeline in the real.com because we would love to have it. And it would change the course and the whole trajectory of her podcast. So good. So let's put a bookmark mark on that whole thing. So I want to, I have a lot of questions you gone for a while, but. Families. And it's one thing, you know, we're going to talk about the no mass and the vaccination, but then when you have a family it's divided just because of the vaccine, how do you actually cope? How do you actually have a summer? What do you do? What's safe. What's not. So let's put a bookmark on that. We'll come back to that in a little bit. Let's let's hit a couple small things, our normal stuff, right? If you can leave a review, I think the last review was like April 23rd. I feel like we're antiquated. So we need to get another review. So if anybody would like to inspire us, you can go to apple podcasts, do that. If you wanna support us, we'd love that because we want to continue this and try new ways to keep this going. As we just approached transitioning maybe from a pandemic focus to just maybe health and public health. Then the different, different areas of discussion where things are complicated and how we can embrace that. And yet still respond in a simple way. So you want to support us patrion.com/pandemic podcast. As little as$5 a month goes a long way or so one time gift at PayPal Venmo. Those are all in the show notes. If you subscribe to apple podcasts and you look at the show notes, it looks like a bunch of junk and that's apple podcast fault. I've emailed them. So you don't see any hyperlinks? No. Anything. It just looks like jumble. Hopefully they'll get that fixed. If you're anything other, you'll be able to find the links easily right there. Okay. I think we're ready to get going. Guess what mark told us. So we will brought on a guest. And this is awesome because it was about a month ago, Stephen. It was just you and me. We've been going solo on that stranded island for like a month and a half. And we got mark back and we have talked about India and the difficulty and all this crazy stuff. And so we brought on a special guests that mark knows. So I want to definitely give a warm welcome to Dr. Pandita to the, to the show. Thank you so much for coming on now. Let's start here now. I don't know you whatsoever. And the audience doesn't know you let's just start who you are, what you do. And your connection to, to India.

Dr. Aakriti Pandita: 4:05

Thank you, Matt. Thank you so much for having me here. And so let me tell you about myself. I'm an internal medicine physician and infectious diseases physician at the university of Colorado. I was actually born in India in Kashmir, which is a place in the north north most part of India. And because of it's a very unstable place and because of genocide, my family was displaced. So I pretty much grew up in new Delhi. My father was a physician who set up the small practice there in a very low income neighborhood of Delhi. And I grew up basically being his little assistant in helping him out in his clinic. And it was mostly cut work. So, you know, I didn't like it back then, but the reason I. Really bring this up as, because I think that's where I had my first experience of social inequities in general and how closely they are tied to healthcare. Most of what we saw were infections. We felt simple problems that really had very simple solutions. They didn't need technique, you know, big technology or sophisticated. Problem-solving and yet you know, a lot of times you do. Not not being able to access those simple problem, you know, solutions used to be a lot of steps that were totally preventable. So I think that's overall inside me and I went on to pursue my medical school in India. Before finally coming here to the U S and I then, you know, specialized in infectious diseases. Now I still keep my ties very closely with India. My family is there and you know, I, I, my work has mostly been in the field of tuberculosis and advocacy in general. Until COVID hit and then like rest of the world, I got pulled into COVID and so far I have been working with TB and COVID in that

Matt Boettger: 5:51

area. Great. Now, first and foremost, how has your family, like you, they're still there in India. Are they doing okay? Are they healthy? What's the status of your family right now?

Dr. Aakriti Pandita: 6:02

It's, it's not very good. Like I think I'm lucky in the fact my. Immediate family members are safe, but multiple family members, multiple relatives, they have been sick. We have been, I've seen a lot of debts. Like every time I talked to my mother, it's like, you know, two or three relatives are dead and that's been the situation for last two weeks, I would say two weeks or so. And it's just getting worse.

Matt Boettger: 6:31

Yeah. And you know, it helped me out as well. Cause I haven't, my life's been crazy the past week or two. I haven't been quite in the news as I have. I'd like to be, and I know when Steve and I were talking three weeks ago, India was just really at, at that point, I thought it was the peak and it wasn't good. There's no way it could get any worse. What's, what's the status of India right now? Is, are we seeing any kind of reprieve or is it still running it? This, this, this fever pitch.

Dr. Aakriti Pandita: 6:54

That's an excellent question. The problem that's happening is what you you're seeing in me. What's the official figures. They don't reflect the reality on the ground. Right now there is the, we have a problem with data transparency and a big problem is that there is a chunk of uncounted debts that have not been there not been registered simply because these. People who are dying, they don't have access to care. So, they either don't make it to the hospital or you know, when they are in the hospital, they don't get labeled as you know, death from COVID. And now it's, it's just getting worse and worse. Now we are seeing these. Dead bodies being washed a rain, two rivers to the shores. And if you, if you really look at the ground situation, it's a ground zero right now. It's a, it's a disaster. And what would the numbers? So yeah, what you're seeing is not what what the reality is. It's just worse. It's

Matt Boettger: 7:53

not any better. Yeah. You know, with your, what you're seeing your research, how can we help. The, you know, both as me as individual, right? Like to, to bring aid, to help India be able to get control of this this really terrible situation.

Dr. Aakriti Pandita: 8:07

That's another great question before that. Let me tell you a little bit about what we are trying to do, because I think the answer to the question, it would be much more understandable. How can people help in general? You know, we, the members of Indian dive for B, especially the physicians have been getting all these desperate calls from my families and friends on the ground. It's not just the rural part or the remote areas that are being affected like that. It's also the big metropolitan cities like new Delhi, UPP, Mumbai, Maharashtra, whatever you can think of the, there is a huge infrastructure. Collapsed. It's not just the COVID and the variance that you're seeing that's causing the deaths, but a vast majority of deaths are due to the infrastructure collapse. There to give you a little example like, you know, a few days ago, I, one of these calls that I got with a family member actually a friend whose father. Had COVID symptoms for a few days. And it was very mild. Couldn't get tested. Couldn't find a provider a lot of, you know, because of the volume and the fact that the whitish themselves as sick and dying, there was a severe health care shortage healthcare force shortage right now. So couldn't see anyone. And this is. Smack in the middle of a city. I'm not talking about rural front. And she called me because his pulse ox were showing numbers were going down rapidly. So he was not able to maintain his oxygen levels. And because I was really well-connected in the area. My own family had a you know, hospital there. So, you know, I thought I could be able to help her very easily. I would be able to get her her father oxygen, or at least some steroids, which are the lifesaving treatment for COVID. But when I called, I found out that all hospitals in the area are shut the family member. Who's a physician. He himself was sick for a long time. His own family, whole family was sick. He did not have any oxygen. He did not have any drugs. And you know, eventually we posted these SOS messages on Twitter, Facebook, and through that, we were finally able to get him a military bed somewhere, but, you know, he died eventually because he had the delay in getting these this basic year. So. This situation, rural India is even worse. And how could we help from here? I think that's how our group came together. We were all these professionals, not just doctors, but scientists. Engineers tech folks who have great knowledge with that. People who have logistics you know, understanding, distribution, understanding. So all these experts came together on this front, which is India. COVID SOS. And I'm I'm, co-leading the advocacy efforts on that group. So we have 500 volunteers at this time and 500 plus I would say at this time, and what we're trying to do is basically to get resources, mobilized resources to these. Patients on the ground and really to help support our colleagues in India. And I think this is an example of you know, why it's not just the doctors and people in healthcare who are needed at this time. We need it's. All hands on deck situation, you need people from different backgrounds we need you know, because we have so much to do and Giving you an example, like you taught, you're hearing about these oxygen concentrators, right? There's a huge shortage of basic oxygen, cylinders and oxygen charges concentrators right now. A big problem that we notice what's happening with these, even if you had an oxygen cylinder, it was not being utilized properly. So, how do you save oxygen? We need innovative solutions, right? So a doctor cannot do that. Basic scientists cannot do that. So that's where the engineers come in. They could help us with solutions like that. Like how can we save these oxygen, make them more long lasting another example I could give you is Telehealth platforms. So we have the doctors here. We could use their expertise to train these volunteers on the ground who don't have medical training. They have never seen deaths in their life and now suddenly are overwhelmed and don't know how to provide basic. Basic COVID care so we could use their expertise to train them. And how do we do that without the tech community helping us on the tele telemedicine platform? Right? So it's a very multidisciplinary collaborative effort that we need to bring actual help to people on the ground.

Mark Kissler: 12:58

Thanks. And I just wanted to make sure that just so that it doesn't get lost in the midst of that, that the name of the organization that you're working with right now is India. COVID SOS, is that right? And you have a website and, and some things that people can go and check out in terms of mobilizing both professionals, you know, engineers, tech, folks, physicians and then lay people on that. It sounds like a great. This groundswell of beginner concerned individuals who are trying to apply their professional expertise as much as possible, which is you know, great to see the really tough situations that's

Dr. Aakriti Pandita: 13:29

mark and you know, started off with few members of the Indian diaspora. And now we have we got a big international community. We have professionals from Canada. We have professionals from us, Europe all over the world, basically. And and they're all, it's incredible how quickly it has grown and how quickly you're working on multiple fronts. We and writers here area like to give you a little example, we just as a part of her advocacy efforts started this project, you know, It's it's a, it's a project to really get the stories from the ground through the medium of writing out to the people who don't know about it. So, you know, it's just an example of how even writers can help. So everyone everyone's talent has a place. Right now in this global catastrophic situation that we are seeing, because it's not just about India anymore. We are seeing the spike in cases in Nepal and Bangladesh. And these are the countries that are heavily reliant on India for medical supplies. And because India has completely collapsed these countries really have no place to go. China would supply. Pink. They're all. Every, you can get some short supply, whatever is going is going to India. And these are the countries who can't even, they'll get it from the supplies, especially oxygen from others. So I think those are going to be even worst effected. The entire Southeast Asia is unstable and now we have Brazil. It's a global crisis. It will become a global crisis very soon. I think it already is.

Mark Kissler: 15:07

Yeah, thank you. I, you know, it's just reflecting on everything that we've seen over this last year. It's been one of the things that's been so striking has been the geographic variability, you know, and how different places are deeply affected at different times. And I think we're in this strange place, I think as a country where we're feeling like we're coming out. You know, out of the pandemic in a lot of ways, we feel a certain amount of relaxing, you know, as we see massive mandates coming down, vaccination rates, you know, they're not perfect are still going up. And there's this discordance between what we're seeing in our local communities. And what we know is happening in these places that are, you know, that are far away, but something that's happened again. And again, and again, I feel like is this emphasis of how much we're also still part of that? Global community and how much what's going on, you know, in a remote. Yeah, to us, part of the world really materially affects, you know, us and people that we know and, and our local communities. And I think I just really appreciate you continuing to bring that that voice of advocacy and just of knowing what's going on, get those stories out because I think it's so, so, so important. Look away from what's going on there. That's such a

Dr. Aakriti Pandita: 16:23

great point, mark. Like, I feel like then this pandemic started, it started. Initially in China. And we were like sitting here in the us thinking, oh, this is not going to affect us. We applying. And it's really tells you how infections. Work. There is no borders. There is no barriers when it comes to the pandemic. We may think that we are safe because we have the new lax scene. But if you think about it, which we have these newer variants emerging right now. If this was to continue and we are talking about occurred vape right now, we have, we actually are the public health experts in India. Think there's going to be another third wave coming somewhere, meetings fall. And that's going to be even even much worse than what we are seeing right now, which is already miserable. Like it's unprecedented, what, what I'm hearing from the ground. And just think about the activity of the mutations and the variants. So, how do we know are protected by the time we see emergence of cases? The virus is already here, but we're always behind in our recognition. And we saw this last year and you know, my concern is that this, this, the network, the way this works, if you have a fire in one part of the house, you can't stay on safe because my room is like, you know, And the other part of the house, the whole house is on fire. So I think are the words and the pandemic works like that without global solidarity and cooperation, there is no end to this pandemic. We, we just keep going to get into certain situations over and over again.

Matt Boettger: 17:59

That's great, Dr. Van DDA. Thanks. So that's been awesome. Now my audio and video got disconnected during the best part of this. So I can't wait to listen to this episode. So I caught the last part before we let you go. And just my. My, my two sensitive care reminds me of the first 10 episodes. One of the, we had Dr. Abraham Nussbaum on, and I think one of his drops that were just so, and this is prophetic because this is now what, the second week of March 3rd week of March of 2020. Right. He's saying that this is probably gonna reveal the fact that we are more deeply connected than we ever thought we could be. Right. And he was addressing more of the idea that we think that we can be silent in our own worlds and just be detached. From the world around us, if we can just somehow manufacture it, but there is no manufacturing. What's where there's nothing we can do. And this just continues to realized the deep necessity. Of addressing the need for a deeper sense of global solidarity. And this is not a liberal agenda or a concern. This is a real, this is, this is the most visceral thing that we could possibly see with India, just this elevate and the fact that we need to take this seriously. And we are deeply connected. And like you said, the variants, the dependency on all the things we need to work together on this. So thank you so much. Yeah,

Dr. Aakriti Pandita: 19:10

absolutely mad. I just like to see, I do see a lot of support from international community. You know, they have been very generous. We see a lot because we also are channeling funds for all these vetted organizations on ground. So I do see a lot of. Support coming in, but the scale of this is so massive that that's not going to be enough and we need much more than that. We need technical expertise. We need creation of field hospitals need disaster management expertise. It's, it's, it's gotten to a point where just you know, there needs to be much more. So I think I completely, you know, I. I agree with your point, like, you know, without this global cooperation and solidarity, this is, this is impossible to contain.

Matt Boettger: 20:00

Yeah, absolutely. We'll gather information, mark. If you want to, it all differs. We need for the show notes for links and these kinds of things that people can access to help and support sound. Great.

Mark Kissler: 20:09

Thank you so much, guys. Thank you so much. Thank

Matt Boettger: 20:11

you, Dr. Doctor, to have a wonderful week. Thank you so much for coming on. Take care. Bye bye. All right, man. I can't wait to listen.

Mark Kissler: 20:19

Yeah, she, no, she had some great points. Sorry. Sorry, your video cut out. But and we'll, you know, we'll chat more, but I think just the sense of getting like you were saying, you know, getting a personal sense of what's going on there is so important. I think because of the ways that it affects just that, you know, everything that's going on globally as well. Absolutely

Matt Boettger: 20:37

great. Let's continue to go forward here because we have a number of things we want to talk about that let's just start with this. Let's riff for a while, but as whole CDC guideline and the masks, I saw on the news. I initially reacted as, Hey, this is cool. This is great. You know? And then, you know, it's got a lot of press lately and we've seen people bull excited about it, frustrated about it. So I want to right away start with, what do you guys let's first for those. Of the listeners who maybe haven't read anything or know anything. What is this from the CDC? What is it sane? Stephen, if you want to take a quick a riff of this and what does it say, and then let's just talk about you guys. What you have to think about this this release of, of. Yeah. Of imprisonment of

Mark Kissler: 21:19

masks. Right?

Stephen Kissler: 21:21

Right. Yeah. So there's there are a number of different level to the actual recommendations, but basically the idea is that for vaccinated people the CDC now recommends that masks are really not needed. In most places there are a few exceptions, including like public transit crowded, indoor venues. So there are some very important exceptions there, but I think that the, the thing that has really been picked up is that basically when you're vaccinated, you no longer need to wear a mask. And and that's, that's like the bottom line again, with those exceptions that that this was really Brought forward. I think there's some really interesting elements of this, you know, there's, there's been a lot of pretty mixed reaction amongst my colleagues. I was I've, I've had a bunch of friends ask me, you know, like what, like what, w what do I feel about this? Like, how, how should I be thinking about this? And the first person who asked me, it took me a while to apply, but the best that I could explain it was like, if you've ever been like, Going up to a diving board. There's like a diving board gonna jump into a pool and it's, it's higher than you've ever jumped before. I have

Matt Boettger: 22:20

never done this by the way, Stephen, I just I'm scared as heck. So I've never, I can't even associate with this, this, this, this, and this, but go ahead. That's great. Great.

Stephen Kissler: 22:30

Yeah, no, that's the thing it's like going up to the edge of this diving board and maybe you're a little bit nervous and you've never done something like this before. And so, you know, your, your test in the spring in us of the board and you're looking and, you know, seeing who's watching and, you know, testing the air and make sure there's not too much of a breeze. And then somebody comes up behind you and pat gives you shop right off, right off the port. Right. That's what I feel like. Yeah, right now is like, we just got pushed off this thing. This is like in a little bit more time, I feel like we would have approached this point. You know, it, like, we, we would've gotten there. I would have jumped off the board, but there was a sudden newness to this that I think cut a lot of us by surprise. Some of the things that I really regret about the recommendation is that first of all, it it, it provides guidance to individuals but not really to the communities or organizations. And I think that that's actually a really big oversight I, there are some recommendations for, for, for communities in there as well, but there it's clear that that wasn't the emphasis. And also, especially that it wasn't tied to any notion of risk in the community of prevalence or cases or fatalities per day. Because this is going to change you know, COVID will rise and fall in different places. And there will be times when we do need communities to wear masks again. And then, you know, and then what did we do? Like there's, there's going to be another shift where and, and so I'm really worried about the future as we try to navigate this complex landscape that that's some of the messaging around these new recommendations will make it more difficult to manage Does he spread through the use of baskets in the future, but we'd love to hear your guys' thoughts as well.

Mark Kissler: 24:05

Yeah. Yeah. Thanks. I, you know, I also similarly had a flurry of questions and, and thoughts and opinions from the broader circle about like, you know, what do we do? What do we think of this? And it's just, I think everybody has all sorts of feelings. You know, that come up related to this most recent you know, recommendation. I'm interested too, as we, you know, I have a couple thoughts initially, but I'm interested to move into this conversation, Matt, that you alluded to earlier about what do we do in settings and particularly in families, in which you might have you know, vaccine discordance, you know, and how do you navigate sort of the complex realities around that? You know, I think one of my great. Disappointments over the course of this whole pandemic has been the difficulty that we've had. I think really as a society in transitioning from conversations about individual risk to conversations about communal stewardship and and communal risk. And one of the things is Stephen, you were saying, you know, this is a sound scientifically, this is pretty sound recommendation from a, you know, Physiologic standpoint, in terms of your personal risk, if you're vaccinated with given the current state of variants and things like that, you, you know, you have a pretty good chance that you're really well protected from very severe COVID, you know, and so, but what that it would, it's hard for me to see is the way that, that. Particular messaging interacts with communities in which we haven't reached herd immunity yet. Like a lot of the country, right. And we're having, you know, an or Denver Metro area we're having, you know, just over half kind of vaccination rates and it may be a little higher than that, of, of immunity given. Infectivity, but we're still not quite at that point. And there's lots of places in the country where we're not at that threshold yet. You know, just a vaccine uptake. And so the conversation about how then do we, you know, make communal spaces. There's just a lot of pressure, I think, to take off the masks you know, given the CDC guideline, there's a lot of pressure as, as local governments are rescinding their public mask ordinances, but of course, You know, we know that not everybody in the community is vaccinated. And we also know that there's still setting up potentials for spread it's. It's interesting to me, I think that we're still framing these questions in terms of individual risk. I say interesting, but I think, I think I've, you know, it's, it's more that it's it's frustrating to me that we haven't developed a better discourse, you know? And I think this has been throughout the pandemic, you know, conversations about very, at the very beginning, you know, should we wear masks and in the guidance around that often was really framed in the sense of individual risk rather than communal. You know, spread and, and I think that a lack of early messaging about asymptomatic spread and the prevalence of that, it's, it's just really, really tough, really tough to see. So I think, you know, as, as excited as I am to start to take steps in which we're more able to participate, you know, in communal life, I think that's really good. And I think there's been a lot of really negative impacts on a lot of people from, from the isolation of this last year, you know, and I'm happy to see things moving in the right direction. I, I don't know exactly who to look for or who to look to for the type of guidance about where, and when, you know, it's still really prudent to wear these masks, because I think there's just so much public pressure for businesses and organizations and things to rescind that you know, and that's, that's where we're at. I think there's, there's other questions too about, you know, populations like kids who can't be vaccinated. I know Matt. You had some questions around kind of like, what do we do in the setting of like younger children around this mandate and stuff. So maybe we can get into that a little bit. Yeah. Yeah.

Matt Boettger: 27:43

That'd be great. A couple of things. Number one, apparently if my new upgrade of our software, I have an expletive button. So mark viewer flick, you need to use it because you're frustrated. I can just press a button cause you sound like you wanted to go there. So that's the first thing I wanted to say. The second thing is was it dealing more dealing with the actual substance of this conversation? And that is, you know, it's weird how you, can you just saying, like, how do I feel? And it's weird how sometimes, like, for me, the, the lay person honestly I have to go to you guys, like how, how, how should I be feeling, which is a weird conversation to have, like the fact that I have to go to you guys, but there's something true about that. Like, I don't know how I ought to feel with this. And they've had, I was processing in my own head of like, what are they trying to do? There is the ground science, like, they were, I have a couple of things here. The, they witness of even just like preventing asymptomatic spread and like, that's just like, You know, one, one person in journals like, wow, this is like an incredible, like the fact that it can do that. It shows the significance of the effectivity of the vaccine. So then on science it's grounded, but then there's that other element you talked about, mark is like basically the art of persuasion and like, whoa. So when we get this information, what are we trying to do with it? I can think of in my mind, what's, it's like when I tell my son, when you clean your room, you can have a cookie. Are they using this kind of rhetoric of like, Hey, if you want to get out. You know, you've got to first clean your room, get the vaccine. Is this their kind of their idea of trying to move forward with this? Which I don't. I just don't think it would be that effective really, you

Mark Kissler: 29:08

know, to, yeah. I think it's a good point. It's hard to know because first we're not privy to those conversations as to like, what's what are the motivations here? But if, if this is intended as an incentive for people to get more vaccinated, I think that on, on its face, You know, I could see that being the case. But I think it's just really tough because then the population that, that we're trying to reach, you know, already has a complicated relationship with things like masks and with official CDC guidance to begin with. And so when, you know, without acknowledging that. Extra layer. You know, I think the using you know, messaging like this simply as an incentive would probably be an effective, I agree with you. And I think, you know, it's not clear to me. I think that for the most part, they're just trying to be upfront and say, this is, this is the state of the science, and this is where we're at. But I agree. I, I think it would be helpful, you know, helpful to have a little bit more sense of it. Maybe, maybe we need to reach a certain threshold. So, you know, a vaccination before it makes sense for. County is to, to lift public mask restrictions or something like that. And that, that additional piece of guidance can be really helpful. I think, because there's just so much that's left up to. But, you know, that sense of what should we do

Matt Boettger: 30:22

next? These are all my, my opinions that had absolutely zero credibility behind it. I'm just using my imagination. I'm like, I see like, almost like swinging the pen on the other way. Like, you know, a lot of criticism for imposing masks while you're outside, even, even alone. Steve and I, we talked about this in the complexities of like advising for mass, even outside, no matter where you're at. And a lot of criticism towards that. And then almost like, Hey, we're one of you look at it. W you know, let's see the message, let's see where we know where we're going the other direction now. Like, we're, you know, we're trying to be, we're trying to play it. We're trying to play the game. Right. You know, trying to pull, you know, again, this is my mind trying to grasp it. Straws of w you know, all of the complex realities of why this was impo, you know, this was, this was provided so quickly, but I have no idea, but. Speculation. We can speculate till the cows come home. I'm used to this let's move forward to something that's a little bit more has some more teeth to it, which, which applies to me and price so many other people. And this has been a hardship. Mark Stephen is just processing what this means for me when I have three little ones who are six and under, who are not going to, it sounds like maybe September now that they might, might be available. So the whole summer. And we want to have fun. And when do I play to the weakest common denominator and just not do anything. So I'm gonna start with you mark, of, like you just said, you're starting to open up and starting to do things. So what are the kinds of things that do your due process? You're trying to move forward with your family to do none of this,

Mark Kissler: 31:46

you know, you know, I think it's worth remembering again that as. As compared to other respiratory viral epidemics children's morbidity, you know, the disease that's caused from COVID is relatively lower. And so I think that's helpful in a certain sense, as we're thinking about how do we, you know, how do we think about the risks of individual families and things like that? And not to say that it's no risk and that when it is. You know, bad, it can be really, really bad. But at the same time, I think that one of the things that I'm thinking a lot about, or what are the situations and scenarios in which we have a reasonable amount of communal immunity amongst the adults and that those are places that that's you know, the probably say for the kids to be as well. And so I, I feel comfortable with that and I'd feel comfortable in at least in my. Personal family with, even with travel and things like that. You know, if everybody's wearing a mask and we you know, take those precautions just because. Of the, sort of the risk profile that we've seen develop over the last year around kids? It, it, I think it's, it is complicated again. And, you know, Stephen was talking, we were talking a little bit beforehand about this sort of perpetual question about do kids spread it to what degree is this a serious. You know, childhood illness and things like that keeps circling around. So maybe he can speak a little bit to his thoughts about that. Cause I think that speaks into this question of how do we keep, you know, keep our kids

Matt Boettger: 33:05

before we do that. Let's just frame this as you go into it, because this, we got this from one of our listeners, a video from Dr. Griffin who's in a biologist. So there was a, an opinion piece from the USA today. Just recently proposed like, look, you're, you're releasing restrictions for mass. Why don't you do this for kids? The science says, and they were quoting science, but the science was back in July and in the summer, which for COVID, that's old news, right? So it looks like from this Dr. Griffin again, I'll put this in the show notes. There's a really good video. The first 15 minutes are enough to watch. He was proposing to look, this is not the case that no longer the case is that the kids don't spread it as easily. Then you say, no, they spread it just as easily as everybody else. They're just like everybody else in the population. And in fact, you know, they're seeing that 10% of even children have long COVID now, before people get scared, a lot of that's just normal things, you know, maybe you don't even notice it until your teenager goes, though, do go football practice. And then realize he's that he's short, he's short of breath, maybe four or five, six months, you know, not a lot of things that are that grave, but nonetheless long Cub at 10% spreads just as much is this a concern as, as we approach our kids going out to the pool and going on vacation, going flights where do we see us and perspective of other. Other other illnesses.

Stephen Kissler: 34:16

Yeah. So, these are really simple, great questions. Something I want to like write something about how our understanding of flu has affected our understanding of COVID and has really like infiltrated the conversation that we're having. So I think, I think part of what we're seeing here. And I mentioned this when we were talking beforehand too, is that the question of whether or not kids are important for the spread of COVID really depends on your baseline, what you're thinking about. So, so seasonal, flu, and pandemic flu. It's very clear that school-aged kids are really the key drivers of transmission. That's like where a lot of the spread happens. And so, and that's now our paradigm for respiratory illnesses that, you know, kids are little buckets of upper respiratory illnesses running around, right. Like to first approximation, that can be true, especially during the winter. And so when we think about COVID, you know, the, the, the prior expectation going in was that. A similar story would play out that kids would really be the main drivers. And then we realized that Some schools that did stay open, didn't see those sorts of outbreaks that we expected to see. We weren't seeing kids coming into the hospital at nearly the same rates as other people, or even as we would expect them to come during a flu pandemic. So what's going on here? So, so, so the first hypothesis was that kids, kids just aren't spreading it well, it's, I think it's true, absolutely. That they're not spreading it to the level that that they spread flu relatively speaking. But I think that the, the point that you brought up earlier that they, they are probably. Yeah, equally infectious, roughly. So to, to other people in the population, you know, there's, there's maybe some modulation there, but absolutely kids spread COVID they get COVID, they spread COVID to other people. There might be some differences in rates there, but it's, it's significant. And, and part of the reason why we don't see infections spreading, why. In kids is, is this issue of clinical severity, which is much, much lower for young kids, especially under the age of 12. So if you compound all of these things together, it makes it appear that kids are not really responsible for spreading COVID at all. And there are much, probably much less so than they are for flu, but, but they do absolutely contribute to the spread. So. So there's a lot of complexity there. And I do think that thinking about transmission amongst kids in schools and wherever kids gather is really important as we move forward. There are absolutely always questions here now of, of you know, risks and benefits, because again, with, with lower clinical severity and kids Then we start getting into that gray area of like, what, what are the trade offs that are worth it? There are all sorts of things that can be risky to a kid's health that we do all the time. Thinking about, thinking about a kid playing football, you know, what is, what are the, like what, what are the risks we're, we're we're confronting here, right? There's a risk from COVID and there's also a risk from concussions and. Now with, you know, whereas for an older adult, the risk from COVID is very high. Now for kids, we can start to have a conversation about this. And I don't know, I don't know what that relative risk is, but, but the conversation I think is still open. So I think that's the thing is we do still need to be really thinking about spread of COVID and kids, especially because then. Outbreaks and kids can spill over into the broader community masks were probably remain important. But I think, you know, this is as, as, as adults are getting vaccinated, I think that it makes sense that this is really becoming the next part of the conversation.

Matt Boettger: 37:22

Yeah, that's great. Yeah. You know, looking at some of the stats here that, that Dr. Griffin put, you know, just to put things in perspective, he even seemed like basically one 10th of 1% of children are or go to the hospital. Right. Very low amounts. So. Would the PR if there is a problem, because the general problem is about the spread, right? How can it get to other communities and create another little pools and populations by which things spread and affect people who are actually more vulnerable, how to protect

Stephen Kissler: 37:46

those one, other sort of complexity to raise there. We were talking about vaccines, you know, when, when all vaccines be available to kids. And I think that that's really important. Like both of you said your households are split where the adults have been vaccinated, the kids have not. And I think here, one of the other complexities that we've been thinking about too, is tying into the. The conversations we were having at the beginning of the podcast is a global vaccine equity, too. It doesn't make sense for us to vaccinate under 12 year olds in the United States when we're still trying to vaccinate over 60 year olds and much of the rest of the world, how do we balance that as well? And so I think that that's, that's another really key issue that we're going to have to start thinking about. And I don't think there are any clear answers to yet. I

Matt Boettger: 38:25

think that leads to the next question, and this is. You know, is it reasonable not to discuss the end of the pandemic? Cause that's, that's exactly, it's a, it's a loaded question because the answer is where do you live? That's just for the U S right now. I think principally, we, you know, having Dr. Pandita on and seen. India and it's literally the polar opposite in the most darkest way that they would even propose that question. But in that makes it even more difficult. Are we, are we in at the end of the pandemic, the U S what do you think of this question proposed by the Atlantic? They bros. Yeah. With caveats, of course, you know? But when you hear this, what come, what first comes to mind?

Stephen Kissler: 39:00

Yeah. It's I, I'd be really curious to hear, hear both of your thoughts on this too. I think that it's right. It, it brings along this sort of feeling of it's this really mixed feeling. Right. So, so thinking just from, from the The aspect of the word itself, right. We think about pandemic. And we talked about this in our early episodes. Like pan means everywhere, global, like universal, right. It's everything. And so it's really difficult for me to think of the end of the pandemic until it's under control everywhere. So even if it, you know, to, to talk about the end of the pandemic in the United States, It doesn't make sense to me. It might be the end of the, you know, epidemic of the COVID epidemic in the United States. But I think it's important that the pandemic continues and that means, you know, back to what we were talking about before, when there's a fire in any part of our house, there's just a fire in the house. And, and to the extent that that's true, we we do still have a pandemic on our hands. One of my concerns, There's there's some historical precedent to this too, where certain infectious diseases have been effectively eliminated from the United States from rich countries, for example. And we don't really think about them. We were talking about tuberculosis earlier at the rates of tuberculosis in the United States, remarkably low, but it's a huge issue in many other countries, HIV. There's still a lot of HIV in the United States, but there's also, you know, decent access to care in many places. And many people who are infected with HIV still you know, under, under proper treatment, their life expectancy is no different from someone who isn't infected with HIV, not the case in much of the rest of the world. Those are both still pandemics too, that are ongoing now. Right. But we don't think about them as such. And I think that COVID. Could become that as well. And that's one of my real concerns. And so, so, so, so that's, that's the feeling that's behind it, the sort of feeling of unrest when we're talking about the end of the pandemic, because I do think that our life will change for the better significantly here in the United States. And with high rates of vaccination you know, thankfully we are starting to feel some sense of approaching normalcy here. But it's it's, it's such a complex picture. And I think, you know, the pandemic as such as something that we're going to be dealing with as a global community for years and years to come. Yeah.

Mark Kissler: 41:12

Mark. Yeah. I don't know if I have too much to add to that. I think that, you know, I think just to echo that this has been, I think, a theme that we're circling around throughout this episode. And

Matt Boettger: 41:20

yep. Yeah, I agree if the reason I proposed the question, cause it just, it does seem like the common thread in this particular episode and just seeing That proposed question as being the auditors where we need to go of not looking at this as through a silo, but looking at this as a, as a global effort and, and just being cautious of these phrases, you know, releasing masks, mandates individual yet, but to global, you know, community health, not maybe a great response, same thing for this question as well. Last question I have for you guys, and this is just interesting thought provoking. I saw this and it said COVID-19 was a preventable disaster who ordered report, says, I read the article. It was nice. It seemed like the biggest thing that it was talking about is that it could have, we could have started earlier. We could have been, you know, we could have declared it an a, you know, a global crisis earlier, earlier February was a wasted month. You know, all these kinds of things, but I guess I wanted to propose to you, like, could COVID have really been preventable. I could see in your mind, Stephen, I'll start with you again. I could see definitely reverse engineer this and say, okay, we definitely could have mitigated the enormity of this collateral damage by a better response, but prevented seems like I can't even see unless I'm missing something a way by which this could be completely prevented. Stephen, any thoughts on that and reflections?

Stephen Kissler: 42:36

Yeah. I also I feel like the word of the day for me is mixed because that's exactly how I feel about this too. You know, it's eh, because I think the answer is, is yes and no. There, there is, I do think, it so much that we could have done earlier on, like you said, Matt, to mitigate the spread of COVID I'm thinking, especially back to the early conversations we had around testing and all of the issues. Yeah. Around testing around surveillance, around just understanding where COVID was when it was spreading. That certainly, certainly many of us in the epidemiological community It felt a little bit like we were shouting into the void. And so there was a sense that like a subset of people knew and had the tools and have the capacity to know what to do to mitigate the spread of COVID. But that didn't really get, you know, adopted. But again, you know, I'm, I'm speaking in hindsight. I don't know for sure if those things would have actually been affected, we don't know for sure. Right? Like I can, you know, go and cherry pick all of the things that I wish wish would have happened differently. And I, and I do think many of those things would have helped, but You know, it's infectious diseases are really complex. Things are incredibly difficult to control. So I think given the technology that we have now, given the knowledge that we have now we probably could have, and to have prevented COVID from spilling over in the first place. So the epidemic that we first detected and with hon. I, I don't see any way given the technology that we have now, we could have prevented that we're beginning to develop technologies of surveillance and you know, we're where we can hopefully anticipate those things and maybe cut it off at that point too. But that that's that's future stuff. That's, that's like doesn't exist yet. So I, I don't think we could have prevented it at that level. And so I think, I think because of that, you're right to, to bring up that it's not, not so much prevention as, as mitigation now, you know, could we have, you know, Reduced to the extent of geographic spread history says potentially yes. As happened with SARS Coby one where there was a flare up and it managed to be contained. But part of that was because of the attributes of the virus itself, where there was, it seems to be a lot less propensity for asymptomatic and pre-symptomatic spread, which is really what, you know, Yeah, bit us with this one. And so there's a lot of complexity here. I do think that yeah, if we were faced with another identical virus to SARS cov two, we could probably prevent it from causing nearly as much damage as it has now, but that's the other problem is the next thing we face. Will not be sorry, SCOBY too. It will be something else. It may be fluid, maybe a Corona virus. It may be something else as well. And, and all of these same questions are going to come up again. So, so it's mixed. I think there's a lot we could have done. There's a lot we could do in the future, but these things are hard and I, I'm not at all confident that this was. Maybe a hundred percent preventable in hindsight. Yeah.

Matt Boettger: 45:16

Mark, any last words?

Mark Kissler: 45:18

Yeah. You know, I think one of the things that's struck me a lot about Stephen's work throughout this pandemic and proceeding it is getting a little bit out of this question of the, the false divide between what is man-made or human influenced and what is natural. Began it particularly in the case of infectious disease. We see this, that there's that to make that divide really strict, you know, is. Is a fallacy. There's just such a complex interaction between what we do between culture, between ideas, between understandings of you know, truth and authority, you know, frankly, as, as we, that that is not, not only is it immaterial or interacting with. Where we call it kind, the, you know, the material facts of the pandemic, right? This like encapsulated, you know, genome that's floating around, but it's just so that's, it's in my mind, in, in extra cable, you know, it's impossible to pull those things apart. And so that to ask, ask that question, I think is in some ways, Proposing a divide that may not be there. And, you know, I promise, I promised you some film criticism at the beginning of the podcast. And so, you know, I think this brings us to that put that point in a, in a way that's you know, I think there's, there's this interesting scene at the beginning. I don't know if you guys have seen. I had never seen jaws before this interesting scene where sheriff Brody is like leaning on this pier and looking out at the water and he knows, you know, he knows there's a shark in the water, but the mayor won't let him close the beach. Right. It's like Amitiza, Summertown, you know, you've got all this stuff. He takes them out on the ferry and gives them a talking to Andy. And I had this moment of just this, this movement. I'm like, oh geez. I even felt like in February, it's like, you know, this thing. And at the same time though, you know, and of course here's this big Hollywood popcorn, you know, blockbuster. All the things that can be said about it can be said, but there's, there's this very interesting and subtle thread, I think at the bottom of the interaction between humans and nature and this kind of tenuous balance and this ability that we have to look away from reality and disability that we have to insulate ourselves from reality until it's so obvious that we can't look away anymore. And at that point, there's all this. You know, retroactive conversation that happens about, you know, what should we have done? What should we have listened to? You know, and who, whose responsibility it was at that point? I just think it's such a valuable reminder because I, I know, or I fear that we're going to be in a situation like this again, at some point, you know, hopefully not in our lifetimes. And, but, but, you know, pandemics. Occur as there as a phenomenon, you know, that we see every century every 50 years or so on. It just strikes me that we have to find lots of really robust ways both to ask these questions and then to remember the good answers to them. Because that, that cultural memory and, and encoding, you know, this is a key to survival. Right. And so I just think that kind of, it opens up onto these broader, broader concerns and things, but those are some of the things that I've been thinking about you know, in the wake of where we're at in the, in the particular pandemic. And then also the ways of course, the you know, that other forms of knowledge. You know, the narratives can be really helpful in kind of understanding and coping with collective threats like that. That's great. Even, even Spielberg desk, that

Matt Boettger: 48:45

there's a reason why there's a reason why Stephen Colbert used jaws back in the last two to did you put it in the show notes? You remember, we put the cupbearer use jaws. This is way to hit. This is a perfect illustration of the response right now of COVID.

Mark Kissler: 48:58

So I think he was right. I think he's right on. Yeah. If it was made now, it would be like too on the nose to be like, oh geez. Okay. I see what you're trying to do here over there.

Matt Boettger: 49:08

Oh, guys, it is so good being with all, both of you today. And please we just thank Dr. Ben DDA for being on helping us to open our eyes to the reality of India. Like I said, it's, it's, it's, it's, it's much harder to see the reality of things until you hear it from someone who's actually has family and he knows what's really going on. So please check our show notes. And how you can actually support India. Again, if you're on apple podcasts, it might be jumbled and hard to actually decipher, but if you're on any other, a director, you should be able to have easy access to click on the link and help support. So I think that brings us to the end. Mark. Stephen. Good to see you guys. I hope all of you guys are listening. Have a wonderful week. We'll see you guys next Monday. Take care and bye-bye.