Pandemic: Coronavirus Edition

How has the the pandemic changed the field of epidemiology?

• Dr. Stephen Kissler and Matt Boettger • Season 1 • Episode 77

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Matt Boettger:

You're listening to the pin. Every podcast we equip you to live the most real life possible and the face today's crisis. My name is Matt Boettger, and I'm joined with my good friend once again, and he is no longer in Colorado and it stinks. I never got to see him in face to face or give him a big fat hug. My friend and your friend at Dr. Stephen Kissler and epidemiologist of the Harvard school of public health. Welcome back to Boston. How are those birds? I hear in the background. And how are you feeling being back in your old little apartment?

Stephen Kissler:

Hey, it's it's mixed all sorts of things, it's always good to be back in her own space and that kind of thing. That was really good to be back home for a little while. mentioned before that the flight in was super delayed. So, if I say anything foolish on the podcast today, just chalk it up to the fact that. It was a late night, huge

Matt Boettger:

disclaimer for everyone. Like he said, he came and went at three 30 in the morning, so that stinks. So he's able to join us right now. How long were you in town? I didn't realize like over two weeks. Weren't you

Stephen Kissler:

or? Not quite, but yeah. They're about, it's yeah. Okay. So it was good.

Matt Boettger:

Yeah. Good, good. All right. Let's get a few things. Small things started love reviews. If you still have them, keep them coming. We really appreciate that and motivates us and also. Helps us give us feedback as well. If you wanna support us patrion.com/pandemic podcast, as little as$5 can go a long way or just a one-time donation at Venmo PayPal, all in the show notes, it's all the good stuff right now. Let's get right into the seal. I had this question this morning, Stephen, in my mind, I'm like we've kind of asked this question, but not directly. It's been a long road for you. Obviously things are much better. Now. I just checked the kind of cases this morning. It couldn't be, it was under 5,000 cases in a day for the U S this is just unheard of. So things are great for us right now in the U S doesn't mean that it's going to continue that way necessarily. So there's price, a few things to chat about, but I wanted to pick your brain about how epidemiology. Has changed for you since, before the pandemic we've touched on this, but maybe not in this kind of specific way, because I would imagine in my mind, I'm thinking, okay before the pandemic, you were doing your research in your lab, you had to particular studies you were doing, and then everything was derailed and he focused on COVID. That's one thing. So I want to see like how many, like different, like ways by which you approach epidemiology, how has that changed? But also I'm guessing what, what used to be data sets for you? They used to go to is probably expanded. I'm just seeing, I was going way back, like a year ago, we talked about that thermometer that, that smart thermometer. And I'm sure before the pandemic, there wouldn't be even on your radar as a piece of data. And now all of a sudden the Kinnser you had the kids, a thermometer, which we have, and now you have a date, a new data set. So how has data expanded? How have you approached differently from before and after the pandemic, as an epidemiologist?

Stephen Kissler:

Yeah, that's a great question and something that I and my colleagues have been thinking about a lot, for sure. You're right. The the pandemic has really spurred a lot of technological innovation a lot of investments, a lot of interest just generally speaking in epidemiology. And it's really great. We've gathered a lot of data sets that we didn't have before. Some of the things that I've been especially excited about is that there have been more and more collaborations between social media companies and people who are, different companies who have apps, for example, that can help give us a sense of our phones and close proximity to each other. So integrating Health technology into the devices that we carry around with ourselves all the time is super powerful. And of course it comes along with a lot of issues that we're solving in parallel in terms of privacy and protecting users rights and health records and those kinds of things. But there are actually really. Tractable ways to solve those problems that are making these data available. In part, because we now understand the value of it, right? Like before this, we as epidemiologists, we had to say flu pandemics come along every so often then I know the one in 2009 actually wasn't that bad, but it could be, and that's not a very strong motivation and it doesn't really get people to move to action. But now the landscape has changed, right? It's like we've all lived through this crazy traumatic event. And so that has really brought around a lot of these collaborations. So the mobile device data, I think, is a huge area that I'm really excited to see expanding. Some of the other stuff, a lot of it has to do with surveillance where people are thinking about using like doing surveillance for antibodies in donated blood around the world and like collecting blood from animals, different reservoirs, where we expect. Back some of these viruses could jump from animals to humans so that we can get a sense of what's circulating there. So there's a lot of middle term infrastructure that I think probably would have been maybe 20 to 30 years down the road and is now maybe five to 10 which is really exciting to you. So it's really sped all of that up. And then, this the spring public health schools have just been flooded with applicants, which is awesome. There's so many people who want to be epidemiologists, which I think is really exciting too, because that is Yeah. That's how these fields keep in gain momentum and that poses, questions of itself, how do we train all of these people? What do we do to make sure that we're giving them the skills that they need? Not only to do the sort of work that I was doing before the pandemic, but the sort of work that I'm doing now. And so I think that then transitions into sort of my personal sort of how my approach to epidemiology has changed as well over the course of the pandemic and it has changed profoundly, it's I've always been very interested in infectious diseases, but since before I went to college, I've always thought that this was something that I wanted to dedicate myself to. And I've learned a lot about the theory of infectious diseases about how they behave. I've read a ton about flu and the, and that's why I was in a position to help with the COVID pandemic when it emerged. But it isn't. Totally different thing to actually be doing crisis response on the ground as it's happening, trying to keep up with data as it's coming in communicating with journalists, having a podcast, for example, being responsible for information and that various sort of up-to-date manner. It really reshaped my idea of what is relevant, what are the questions that need to be asked? And so it's shifted a lot, for example, pre prior to the pandemic I found myself asking a lot of questions of I had this more abstract interest in like, how do infectious diseases behave? How did the. 2009 flu pandemic spread. How can we like account for how much of it was like the timing of opening of schools and how much of it was like differences in, regional weather patterns and these kinds of things. But a lot of those things, aren't things that you can directly intervene upon. There are things like when you have a pandemic on your doorstep that you can say okay because we have this information, now we need to do this. And so I think this pandemic has really refined just the way that I ask questions, because it's a lot more based around, okay. We have. This crisis, what are the very pragmatic things that we can do? What are the immediate next steps that we can do to make it better? What are the new technologies that we have available now, or that we could make available very quickly? And how would we use them given the fact that we have a limited amount of investments to put into all of these problems. And so those things are more directed at where the rubber hits the road. And I think that's going to affect the rest of my career. And really, again, zooming back out the careers of epidemiologist as a whole, we're all going to be thinking about this and I think a much, much more sort of concrete applied sort of way which I think is really good. I think that's the direction that we needed to head, but it takes something like this to make that

Matt Boettger:

happen. Yeah. Now looking back from the beginning of March in 2020, and then now in the technology that's advanced. Between now, and then, and I know there's still, like you said, instead of 30 years now it's closer to five to 10 years. So there's still things up in a way that you see in the, over the horizon that would be enormously beneficial for epidemiology. And I'm assuming there are a few nuggets that have come along the way already that have been incredibly useful in light of what you've got. You've seen them in useful. Is there anything that you would've done differently from March until now? Okay. Now with this technology, we could suggest that this particular kind of track, if this technology is already in existence in the next pandemic, we could potentially say, let's try this or X or Y or Z versus just a nationwide lockdown. We're basically, do we have more tools to be a little bit more surgical next round already? Then we did in 2020. And what, w what's one or two of those tools that you see that oh, these are really good ones and could be even better in the next five to 10 years.

Stephen Kissler:

Yeah. That's a great question. I think, absolutely. We have both the tools and we've done a lot of the work. To figure out how best to use them. And I think, gosh I feel like I beat this one with a dead horse, but tests testing, like rapid tests for goodness sake. That's, that is the biggest missed boat of this pandemic and, and turning that into a positive statement, we, we have this available, we know a lot more about both how to produce the tests. But also what, how can they be useful? How can we think about them and deploy them in a way that actually will prevent the spread of disease? And I think that in the next pandemic, we will be a lot quicker at deploying those kinds of things. Hopefully if we've learned anything from this one I think that's one of the things that that I hope to see. And I think this is also related, we have rapid tests and the ways of using different types of tests, making sure that testing is available, but also just different types of empowering individuals to know. To make it, to make good decisions around the spread of disease. Testing is absolutely one of them. W we were talking a little bit before we went on air, but apple watches and phones and stuff, have all of this incredible health technology. That's being integrated into them from glucose sensors and, heartbeat monitors have been there for ages. I don't know if we'll ever have like pathogen sensors in these things, but still there, even just having a thermometer on there, for example, that's keeping track of your baseline thermometer your baseline temperature over long periods of time. It can begin to tell you if there's something strange going on and start to trigger you to say, your heart rate is increasing. Your temperature is increasing some. Maybe you ought to be a little bit careful here. Maybe you ought to get assessed or something like that, and and so I think that increasingly, there's been a long trend of putting the power of healthcare decision-making in the hands of the patients and the legacy of that has been mixed. There are times when you actually need a doctor to tell you what is right, and to tell you what to do. And I think that holds for public health too, there's a danger in totally free market solution to both medical healthcare and public health care. We do still have a role for experts and for people who are, setting laws, UMass mandates, things like that, that those will probably continue. But I think as much agency as we put, can put into the hands of individuals, which a lot of this technology is helping us to do the better. And I think like you said, that will help us to have much more targeted strategies. In the next pandemic and hopefully prevent these kinds of widespread lockdowns that we needed to have for this.

Matt Boettger:

Yeah, I hope so. I didn't even think about the whole Bazell thermometer. I'm going to wash make such a simple, I would just, I would imagine sort of simple technology to put into a watch and how incredibly useful. They're already, as we talked about this months ago that there was a bunch of independent researchers using apple watches and able to be able to use the existing technology, let alone what's coming up in the fall to determine whether you might be having COVID and be upwards to 80 to 85% accuracy just by monitoring a handful of metrics. On the apple watch currently. So in my mind, it's all about how quickly can we turn this around versus a year and a half or a year. If we've got the principles down, can we turn this around quickly? The next pandemic, this goes to a couple of things we mentioned that came up, just two weeks ago, I saw the, now we're having dogs sniff out. COVID that's pretty crazy to think about.

Stephen Kissler:

Pretty crazy. It blows my mind that works, but they actually do incredibly well at it. And

Matt Boettger:

I'm imagining this, in my mind, I'm thinking this is probably something that wouldn't really take that long in the end. Once you get the smell of it, it's just training the dog to be able to do it. So I'm thinking, okay, how can we turn it around? Then last week I saw this, I was laughing with Stephen about this off the record. I'm like, now they've just found a sensor. That you can put like a smoke detector in your house to sense COVID in the room. It takes a minimum of 15 minutes in 15 minutes and 30 minutes to detect it. And it's 95 to a hundred percent accurate. There's even better than PCR testing because PCR, I guess asymptomatic can be hard to do sometimes to get to, to get, whereas this can just get it in really quickly. Man, if we can turn these around quickly, what a game changer. The

Stephen Kissler:

next page. Yeah. Yeah, totally. I think that's a really interesting idea. That's I don't know. I don't know what the, what the yeah. Alarm would do necessarily, but you can imagine like setting something up like that in a restaurant or in a classroom or something. Yeah. And it goes off and you just know that you should clear out the space and that might prevent, some of these big, super spreading events from happening. It's a super interesting tool. Yeah.

Matt Boettger:

So I'm, excuse me, super excited about the future of technology and how to use this in health. And I'm sure as we continue down the road and talk about other things, when COVID begins to continue to settle down, we'll readdress some of these things, but nonetheless, there are still a few hot spots within COVID. I saw this resurface. Two or three times in the past week, this Delta variant. And I wanted you to talk about this. It looks like they're seen in California, 10% of COVID infections in the U S so far currently, or are the Delta variant. And they expect it to be dominating the U S relatively soon. You want to talk a bit about this and some of the potential fears about this. Yep.

Stephen Kissler:

Yeah. So that's, yeah, I think that over the past week, I've really heard a lot of my colleagues, especially getting more and more vocal about this. So to circle back on the discussion we had last week, so the Delta variant is the same thing as the B 1 6 1 7 0.2. Which is the one that was first detected in India. And that seems to be responsible for the big spike that we saw there. It does seem like a lot of epidemiologists are also getting on board with this Greek letter naming I'm actually revising one of my manuscripts right now to switch out all of the old names. So for better or for worse it's happening. And so we have this Delta variant that's spreading and a couple of reasons why it is. It has recently been causing more concern amongst epidemiologists. So one of the things that's always really difficult to tease out in a country where variant is first detected is when you see a rise in cases, is it due to some biology of the variant or is it due to some sort of shift in the behavior in whatever is going on in a given location at a given time? And when you have a variant that's spreading in just one place, it's really hard to disentangle that near impossible. And so that's, that's why it's taken us a while to really figure out if there is truly in fact, something special about the Delta variant or if there was just something about this particular time. In India and neighboring countries that was causing it to really catch on like wildfire. I think a number of podcasts back I speculated that there was probably something special about this variant, just because of how explosively it was spreading and how not explosively COVID was spreading in India prior to that. And that seems to be more and more the case but part of the reason we're getting that information now, Is because Delta is making up. I think now a majority of cases in the UK and the UK is starting to see overall COVID cases, beginning to rise. Now the UK is one of the most highly vaccinated countries in the world. And and they're emerging out of a pretty long-term lockdown that, that it's not a full lockdown, but they do have a number of restrictions on. Different things, it's very different than the lockdown at the beginning of the pandemic, but but they're needing to extend some of those restrictions longer than they expect it to because of this rise of the Delta variant. And so that's one of the key pieces of information is that Delta has now spreads to other countries, including the UK and the U S as well. And we're seeing it taking over the other viral strains. Now the other big, bad one that we were really concerned about was the or the alpha strain, which was the one that was first detected in the UK. And we were concerned about that because that was, on the order of probably 40 to 50% more transmissible than the one we had been dealing with before. So all indications are that the Delta variant is now 40 to 50 times for 40 to 50%. Sorry, more infectious than the alpha variant, which makes it, easily. Yeah. The infectiousness of what we had been dealing with, six months ago And so that's a big deal and there's some evidence coming out that also the Delta variant can cause more severe disease too. So all of that is coming together so that we're starting to see outbreaks in places that might not have seen them. If we were dealing with the same thing that we had circulating about eight months ago, so that's a big cause for concern where it's showing that, Delta has the possibility of causing outbreaks in highly vaccinated areas, just strong evidence for its increased transmissibility. And it is sending people to the hospital. No, The vaccines that we have available, especially the ones that are being used in the U S right now are still very highly effective against the Delta variant. I think that their most recent estimates are that there are about 85 to 90% effective against symptomatic disease. Whereas against the non variant sort of vanilla flavor, COVID there it's closer to maybe 90, 95%, there's some uncertainty around these things. The big concern though, is that For the vanilla, COVID a single dose of Pfizer and Madonna was all already pretty effective a week or two out much less. So for the Delta variant. So for the Delta variant to be fully vaccinated, you really need the two doses. It seems. And so that's one of the other key things, because a lot of countries, to try to vaccinate their populations more quickly, like the UK have preferred a single dose strategy and that are following up with a second dose. Not not three to four weeks later, but 12 to 15 weeks later. And now this is changing the calculus where that's no longer as effective of a strategy. And so we're going to have to, I scrambled to catch up. So all of this to say is that the Delta variant is causing rises in cases in places outside of India now. So it's definitely, here it's making it more and more of the cases in the U S. And so what is the concern well for fully vaccinated people individually speaking, it's. Not really something you'd probably need to be too alarmed about, especially if you're living in a community where other people are very highly vaccinated as well. There again there, the vaccines are still pretty, pretty darn effective against this variant, but there are of course, a lot of places in the United States where vaccine rates are very low still they're lagging and there's still plenty of susceptible people around to get infected. So my big concern is for communities of largely unvaccinated people right now, because people who haven't been exposed to COVID yet and who aren't vaccinated their bodies are just as susceptible to severe disease and illness as they were at the beginning of the pandemic. Nothing has changed. If anything, now the variants are making it more likely that they'll go to the hospital, suffer severe outcomes. And so I really do worry, I think. Over the summer. We'll probably still continue to see these low cases, but we know COVID is going to surge again in the winter. That's almost absolute certainty that will happen. And that will be largely fueled by either the Delta variant or something that follows on after that. And so for communities where lots of people are in vaccinated, that could cause really big problems. And so it's, again, just really underlines the importance of trying to get people vaccinated as much as we can. Both to lessen that surge if, and when it comes and to make sure that people are, if you are, people are susceptible to severe disease.

Matt Boettger:

Yep. Good. I think you framed that really well. Stephen, thanks. So I was thinking when you first said, Hey, you know, fully vaccinated in the UK yet they're still having a surge. And I think we have to be careful when we throw around the language of fully vaccinated versus fully vaccinated, because there are so many variables. Comparing the two, because, we did it with Seychelles Seychelles, wherever that place was, where they're fully vaccinated, but yet having a rise. But then you did the great nuance of well, there were using a lot of different vaccines that were less, there's a lot of definitions. So I think so first and foremost, the UK is similar to the U S and that they focus on Pfizer, principally Pfizer. I know Madrona I'd imagine.

Stephen Kissler:

Yeah, but I need to double check, but I think, yeah, it's largely Pfizer. Yeah. There's AstraZeneca too, but, okay.

Matt Boettger:

So they did that, but then at the same time they did focus on a one-shot thing. Whereas we didn't here in the U S which makes us a little distinctive which could also mean that we don't necessarily we'll have such a rise in cases maybe, but you're right. The south particularly. A lot of states under 50% vaccinated and just that public service announcement that you may feel totally good that, Hey, I'm in Colorado rates are pretty good. But as we said before, it's not just the individual that needs to be concerned because things can mutate and change. And then that affects everyone. If we just don't keep this relatively low, it's great that we're under. 5,000 cases a day, but we don't want to reach back out to 20 or 25,000, even if it's not in my neck of the woods, because it can still, create some problems down the road. Just thinking about the idea of, as we continue to get closer to vaccinating our children, and it's gonna be another big decision, and this is another piece of the puzzle. Which has always, people always feel as if, at least I talked to people that, we're, fear-mongering, it's way past the pandemic, but it's not, fear-mongering at least in my mind, it's more of it's different than any other thing we've dealt with because everything else we've dealt with, we have a lot more knowns and unknowns. And even though we're really far ahead and we know so much more at COVID, there's still unknowns that make you want to be a little bit more cautious than normal, right? The little, whole long COVID those kinds of things. The future variants that are, we don't know about. And so this is. Part of the material making a decision of vaccine or children about, Hey, What could come out, what could come later that actually is, puts people in worst conditions and put them into hospital. Great. No, thanks for that. Let's talk about next, the, another little hopeful glimmer, and this is the Novavax vaccine. So now we're, we've got another game changer. And you're gonna have to talk about this. I don't know a lot about this. I just had a hint that this is a game changer in a different way, Pfizer Madonna game-changer because it was so quick, so effective, but it came at a cost of highly freeze. It need to be frozen only first world countries or other countries that could have accessibility to these kinds of freezers could actually give it now with Novavax. Has it nearly as effective. As Pfizer Moderna and if I'm correct me, if I'm wrong, it doesn't require that kind of intense freeze, which means this is a game changer for the world. Am I right?

Stephen Kissler:

Yep. That's right. It's that's the big thing is that I think for the global outlook having this vaccine approved is a massive step forward. There had already been this sort of sense of Different tiers of vaccine. There's like up at the top, there's like the Pfizer and Madrona. And then, there's the second tier vaccines of the AstraZeneca or the Johnson and Johnson, then, know, again, the fact is that they're all like super, super effective against preventing people from going to the hospital, which is like really what we're aiming to do. But it's yeah, inevitable that you just, you get these numbers of efficacy and you want the one that has. That 95%, so I think what's really exciting about this is that this efficacy, is absolutely on par with the best vaccines that we have available. And like you said, it doesn't need to be stored at super cold temperatures. And so that makes it possible to spread to vaccinate parts of the world that you just can't vaccinate nearly as easily with something like a Pfizer or a Moderna. So I'm really hopeful that this vaccine will Yeah, which just really help the global outlook will give us sort of one more tool. And one that is, that I don't think needs to be seen as this like second class vaccine. I think that's really important, we need to make sure that we're like, You know that we're not we're we want to avoid contributing to inequities and inequalities around the worlds that are already there and just exacerbating them by, spreading. And I don't think that would actually happen, again I, I have a really high confidence in all of the vaccines that we have available, but even the notion of that, that like we're giving other countries, our second class vaccines is just not good. It's not good. So to have a really, really good option. I think it's going to be super helpful. And meanwhile, this sort of comes on the heels of, I think it was the meeting of different leaders around the world who have pledged to, contribute millions and millions of doses around the world as well, which I think is super encouraging. And I imagine that a lot of those doses will be of this vaccine. And like we said, early, early on the more vaccine candidates that we have that are approved the better it's not, just having one. Is great, but it's helpful to have two and it's even better to have five and, because each of them has strengths in different ways. And so this is another really, really great step in the right direction. Yeah.

Matt Boettger:

And a point of clarification because, you compare to Pfizer Medina to Novavax. When you come to 95%, 90% yet, or Johnson and Johnson and yeah, they're both highly effective, but I feel like there's like another variable that I haven't really dived, dove deep into. And that is transmissibility. Do these all share roughly the same kind of level of Hey, I can carry it, but it's not, I may or may not carry it. It may, may not transmit it. I clearly know Pfizer Madrona are exceptional in this area that it's very rare to actually transmit it to another person. If somehow it's on you. Is, do you know anything about whether that's similar with Novavax or,

Stephen Kissler:

or is that still I think, yeah it's gonna take awhile to get that information and cause it's it's another one of those things where it's much easier to measure the efficacy against symptoms than it is to measure the efficacy against transmission. You just need a much bigger trial, a different sort of trial more. You need to do more testing, more regular testing, different types of testing. So I think we're going to have to wait on those numbers to be sure. And but I'm hopeful, a lot of times these things track together. And I think, this is good news and I think there's reason to hope that it'll get even better. That's

Matt Boettger:

great. When I recall, I mentioned to you before he got on, he said, Hey, let's talk about this. It came a couple of weeks ago related to vaccines. COVID-19 vaccine could be less spike centric. What is this? And w what, how can we get some stuff from this?

Stephen Kissler:

Yeah. So this is some cool stuff. And this digs back into some research that's been done on other viruses as well. So the idea behind this is that the coronavirus. The reason it's called the Corona virus is because it has all of these spikes sticking out of it where Corona, meaning crowns, by the way, this

Matt Boettger:

crown thing, Jackson's kind of comical. So this went back to about all these people are applying for epidemiology. It might be the case that my six year old might apply for epidemiology because he drew the stick. Figure of my middle son, Jude surrounded by tons of little Corona viruses that are worldwide. And like just last week it says Jude sneezed a bunch of Corona viruses and there was all over him. When on earth would any child draw a virus with his sibling before the pandemic? This is just. This is literally in cold we're we're training. Those little boys become epidemiologists. Okay. Continue with the

Stephen Kissler:

that's. Awesome. That's awesome. Yeah. So and that's it, right? Cause he probably drew a little red circle with these little things sticking off the sides. And that's actually pretty, anatomically accurate depiction of the Corona virus. And essentially the way that it happens is those those spikes help the virus to enter yourselves, but they're also the first thing that your body sees when it's getting an infection. And so those are usually the things that your body mounts, the strongest antibody response against because they're out there, they're poking out the virus and it's a very quick way to tell, okay, this is something that we need to be concerned about. And the immune system will take over and start attacking the virus. Okay. The trick is that the Corona virus and many other viruses like flu as well which also has these sticky Offy parts that are presented to the immune system. Is that one of the things that these viruses have evolved to do is to make those parts of itself really genetically variable, or I guess in this sense it's yeah, it changes the proteins. And so basically it's like putting on a little disguise. And that's why the Delta variant is more infectious partially or wiped some of the why it's able to get around the immune system to some extent is because it has these mutations in the spike proteins. So that an antibody that would have recognized a previous version of the Corona virus can't recognize this one because it just doesn't quite look molecularly the same. And so usually these spike proteins, they have to have a couple of really specific configurations so that they can get into cells. But then there are all of these other parts that the virus can shift and change around simply so that it can get around the immune system. That's the whole strategy there. It's this like cat and mouse game between the virus and your immune system. And so that's one of the tricks and that's, that's part of why we need to have Annual flu vaccines as well, because the flu is really good at switching out these proteins on these spikes that are sticking out of it. And it's basically a disguise for the immune system. And so we have to update our vaccines every year to stay on top of that. So where does this come into these non spike vaccines? Well, Not all parts of the virus are the same. So basically to first approximation of virus is just a bunch of these little molecules called proteins that have a genetic material RNA inside of them just floating around inside there's, there's other things going on, but that'll do for our discussion for now. And there are some of those proteins are really essential for the virus to survive. So you can have little switches, you can have little mutations of the spike protein, and that doesn't affect the virus's ability to survive because it's on this sticky Audi piece, right? It doesn't affect anything. It just affects what it's presenting to the human body. As long as it's not affecting the thing that allows it to enter the cell. But there's. A lot of other protein around the virus, much of which is in the, what we call the viral envelope which is the little box, the sphere in this case that contains the genetic material. And if you start fooling around with that, if you start making mutations in that, oftentimes the envelope just falls apart and the virus isn't viable. So it can't make mutations. In that part of its genome. And so it's a much, much more stable part of the viruses genome. And so even though the immune system doesn't preferentially recognize those bits there, it still does recognize it to some extent. So it's it's I don't know what a good analogy would be, but like it's it would be like, if if Matt, you like suddenly shaved your head, it shaped your hair next week. I would still be able to recognize you, but you'd be the same, but it's so that's essentially what the virus is doing with its spike. Proteins is just putting on these disguises, but if there was something essential about you, right? Like you, we can't take out your heart for you it's to still function. So you can change all of these things about yourself, but there are some parts of you that just can't change without. Yeah, risking your life. And that's true for the virus too. And so if you can make a vaccine that rather than targeting the spike targets, these parts that don't change nearly as much. Then you have something that is effective against all the variants against everything that the coronavirus could ever throw at you basically. And then you have a one and done vaccine. And so there's a lot of people working on this for flu as well. What they call a universal flu vaccine, something that you can get once in your life. And that gives you broad protect protection against all flu strains, because it targets something that is absolutely essential for the survival of the flu virus itself. The same is true for the Corona virus. So that's where there's a lot of interest in this because, without that, we're probably going to. Still be playing to some extent this game of catch-up with the Corona virus. And maybe it will be annual. Maybe it'll be every five years or even 10 years, but our immunity will decline, partly because we're going to stop recognizing that spike protein. But if we target other parts of the virus, we have a much better chance of giving us something that gives us immunity to life. Like we get for the measles vaccine, for example.

Matt Boettger:

So what makes it more difficult? Or what makes it easier to target the spiky this right. Versus the actual little oval, like anatomical part of it. Why is that so much harder than the spiky part to make a vaccine for?

Stephen Kissler:

Yeah. It's interesting. So it, to my knowledge, the biggest thing is just a matter of the It's like the physical structure of the virus itself, because there are so many spikes sticking out of the protein or sticking out of the virus that to actually. Get an antibody to something that's on the surface of the virus, it has to go through this jungle of of things that are sticking out. And the spikes, also serve as a disguise for that part of the virus that is more essential. And so you need something that gives you a strong enough antibody response that you'll have antibodies floating around that won't get duped by this spike protein that's around it, but we'll actually be able to zero in. And make it through that sort of jungle of protein on the surface of the virus and actually detect the thing that it's trying to detect. So part of it is just figuring out how to engineer these antibodies in a way that they that they could just reach the virus, which is really crazy to think about, we're talking about these microscopic particles, but even on that tiny, tiny scale, just physical blockage is a huge issue. And and so that's a big part of it is just is just that there's a whole, I am really oversimplifying this. There are people who have their, like their entire careers on like, why, what parts of a protein or what parts of a virus are easier and harder to detect and why that's the case. And so I'm just giving like a very. I'm giving my own understanding, which is pretty rudimentary. Maybe I can ask some of my friends who are working on these to clarify for me but as far as I know that, that seems to be really what the issue is just figuring out how to get the antibodies to the places that they need to go to detect the virus in the first place. Yeah. That's hugely

Matt Boettger:

helpful. And the image that came to mind was like, I know this is falls apart, but like a porcupine it's like just full of those little things, but there's no way I can get to the base layer that I don't wanna get close. So it's a, so it's deadly. So I totally get that. Thanks. Speaking of heart, because you mentioned about, Hey, you took my heart away and parts substantially to me, we talked about this off the record that we continue to see our off the air. Before we start recording, we were talking about how there's this increased documentation and articles about this myocarditus in. Dealing with teens and early twenties. And just wanted to tell him this briefly, and I'll put these in the show notes and you can chime in Stephen, but I just to give the synopsis of what I read a cardiologist weighed in and just said, look, absolutely. Is myocarditis happening between 17 and 24 year olds? That is totally true. Here's one here that yes, between 1624, the CDC found that among 16 and 17 year olds, as of May 31st, there were 79 reports of illnesses soon after vaccination and ordinarily you'd expect to see around 19. And this continues for 18 and 24. So you're seeing. There is an increase in myocarditis among teenagers and early twenties. So that, that is an important piece at the same time, the cardiologist warned. And I think it's just good for everybody to listen to. And you've said this before, over and over Stephen, about how it's not about either the vaccine or nothing. Sometimes we get into that fear mode. Like I don't want to, but don't realize what you're actually giving up by not taking the vaccine is being susceptible to COVID, which has a much higher rate of. Gravity when it comes to some significant effects to even teenagers. And so it's not a fair comparison.

Stephen Kissler:

Yeah. And then I was, know, I was just looking at this. I had this inkling in the back of my mind about like myocarditis and it's actually, I wanted to check this, but even if you type it into Google, for example, the first line is mild. Carditis is usually caused by a viral infection. It's like the viral infections are. What causes it because, and we've talked so much about inflammation that your body's immune response to an attacking virus is too, is this sort of inflammation response that causes, all of your muscles to get inflamed, to some extent, and your heart is just a really big muscle, it's just a big muscle taken away there in your heart, in your chest. And it's also not surprising that. You would have higher rates of myocardial carditis after getting a vaccine, which does the same thing to your immune system as getting a viral infection does, it'd be interesting to compare rates of myocarditis, just post COVID. Yeah. Infection and raise myocarditis, just post vaccine. I'd be very curious to see they, they might be similar. It's hard to say, but you're right. It's like we're starting to compare these things and we know that the vaccine. In order to do what it does the vaccine necessarily can cause some some ill health effects to some extent, I felt terrible after I got my second dose of the vaccine, I have not been that sick in a very long time. But in part that's because the vaccine was working. And right. I think just going back to your point before it's this it's, this trade-off where we were. We're not comparing the vaccine to this world where everyone is healthy and nothing is the matter. We're comparing the vaccine to this world in which there's, this raging better is spreading and that makes the trade off. A lot clearer in my mind. Yep.

Matt Boettger:

And then continue it a couple other things. First one is that, of those, whatever, 179 reports, 81% really has no significant impact whatsoever. It's just a very mild thing goes away on its own. And it's nothing. Right? So you have a rarity among what? Among 17, 24 year olds. And among that, the majority of them. Do not have any significant whatsoever. And then there's a handful that may have to go to the hospital. Again, like you said, you don't even know it'd be so interesting to compare because it generally is caused by a virus. What would happen after COVID of general population of 70 and 24 year olds. And then on top of that, they are, one of the articles mentioned that we don't even know this could be behavior related. We just don't fully understand because a lot of times these teens get the vaccine and all of a sudden they go out, started do they're much more active. They do a lot more things. So we don't have the full spectrum of all different complications of this thing, but it's very rare. Any 1%, nothing impact compared to COVID it's not even a fair comparison, so great. I think that's it for us for this episode. Anything last words to say,

Stephen Kissler:

Stephen? No, I think that's it. It's

Matt Boettger:

yeah. Good. It's just good news continued good news for the U S particularly globally in general. I would imagine the hotspots will continue, but hopefully the vaccines can have to go out and get more people to protection. They need to get this under bay before fall hits so that when we do have a surge, it doesn't sound like what we think is going to be right. And much more mild experience. That's the goal. Okay. Guys and gals have a wonderful week. Thank you for tuning in and we will see you next week. Also, if you can, patrion.com/pandemic podcast, give us a review. We'd really appreciate it. Take care. Have a wonderful week. We'll see you next Monday. All right. Okay. Bye-bye.