Pandemic: Coronavirus Edition

The delta variant is a Tesla when it comes to this particular metric

• Dr. Stephen Kissler and Matt Boettger • Season 1 • Episode 81

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Matt Boettger:

You're listening to the pandemic podcast. We equip you to live the most real life possible in the face of these crises. My name is Matt Boettger. I'm joined with just by one good friend, Dr. Stephen Kissler in Boston, there at the Harvard school of public. How are you doing there, buddy? How's it going? Oh, I'm hanging in there. How are you doing? Good. You look good in blue, by the way. For those of you were just listening, you can't tell that. I don't think I've ever seen you look that sharp on a, on a podcast. So it's it's great to great to see it on you. Well, it's good to have a be back this week, two weeks in a row after being gone for a couple of weeks. And it seems like there's a lot to. It's weird. I feel like there's a little bit of a, I don't know, Groundhog's day don't want to put that like kind of resurfacing last summer stuff. So I feel like we say the same thing over and over, like with like onion, but we peel the onion back and there's like a different layer to it. It's a little bit nuanced, but it's the same stuff. And I think Stephen will carry us all the way through this episode. Obviously I'll ask all the questions. It's probably my mind and my heart right now, before we get started that a couple of few things. Couple of few things makes no sense by the way. So just FYI, I got a few things, a couple things. The first thing is please leave a review. That would be awesome. You can do that at apple podcasts. There's other places you can leave reviews. We just got one last week. I have to read it. I gave it to Stephen and mark and it was awesome. Yeah, this is from S Hayne from Thursday title, finally clear science-based pandemic, and then it goes dot, dot, dot. I can't read that, but here's the actual comment. I love it. I've been following this podcast since the beginning of the podcast. So thank you by the way. And it's fantastic. I'm always looking for the data without the bias and skewing of information with the political agenda. What I appreciate about these guides, they give a few different perspective yet it's solely focused on helping the average person look at this pandemic through the lens of a profession. They look at the complexities. Don't try to have an answer for everything in our humble, as they navigate all the news data, as it rolls in best part. I don't even know their politics. That's pretty sweet. Yeah. I love that. I just want to navigate this the best I can, and truly want to understand the science that's coming in. Thank you guys so much for this podcast. You were all great. Thank you so much. really appreciate that insight. Yeah, I appreciate that. Those are some, those are some great words. Appreciate that a lot. Yeah. So anyway, any more reviews we love them. We can read them as we continue along on the episodes. If you want to support us. In other ways, you can do that at patrion.com/pandemic podcasts. There's a$5 a month can go a long ways to help us keep this going, or a one-time gift through PayPal or Venmo all in the show notes. So let's get going with all this update news. And I kinda want to, I don't know how I'm gonna package all of this first. I had this Stephen and a bunch of different kinds of subheadings in different areas, but I think we can talk about this all in one big picture. So I want to frame it as this. So I read an article where was this article that says, okay. A new way to visualize the surge in COVID-19 cases in the U S I'll put this in the show notes for those of you who want to read along, please do. So this is a great article. There's a handful of solid articles that came out in the past seven days. This one in particularly really got me going, because it reminded me of what I mentioned to you, Stephen and mark, just over a year ago in April ish when things were still crazy, maybe may. And I was getting all of these people coming my way, who knew that I, we started a podcast and all this kind of stuff. And in proclaiming. Hey, this is no different Cove is no different than the flu. And they would show these rates and they show how it's different. And look at the look at how many people it kills in a year for the flu and look where you're at at COVID. And so my best comparison was okay. It's like comparing my, my old crummy 2008 Nissan, four cylinder, and just flooring it for 10 seconds, giving it maybe 90 miles per hour and like 10 seconds probably. And then comparing it to a Tesla at second one. And then say, look, my Nissan's going 90. The Tesla's going 45 in one second. And clearly my Nissan is faster. So game closed. Right. Then we know that wasn't true because at the same time, the flu has been going for years and CA COVID was revving up. How does this article, how does this article come into play the, the new way to visualize all about side? Do you have acceleration that it's one thing to see our normal stuff, right? Stephen, we see the daily cases and they're going up and we see the chart and the going down. But that's just one measurement. I think the measurement, my niece on the Tesla was the example of what you didn't really think about is the acceleration property and the acceleration right now. And you can speak into this. It's really crazy. It's on the order of what we were dealing with last winter. So I am, this is what's weird. Like we're, we're living a last winter acceleration and we're living a life almost. When you go out kind of pandemic free, how do we make sense of all this? What's a common denominator. What's different between them. And back in December where we were much more careful. Yeah. You know, there's a couple of things that have changed and I think you're right. That that thinking about the acceleration is really the right thing to do here. In a lot of ways, the the, the reproduction number that we've been talking about is, is a pretty good measure of, of that acceleration rate.

Stephen Kissler:

It's not exactly that. There's another thing, you know, the, the reproduction number we represent with the big R, which is the number of people who you're expected to infect, but that doesn't inherently have a notion of how quickly you infect those people. So if you have something with a reproduction number of. You might infect those two people in a day, or you might infect those two people in 10 years and then of course leads to a very different kind of acceleration. Right? So, so, so the big arm would be that too, but the little R is the exponential rate of increase in cases. And that, and that's the acceleration we're interested in and it's related to big art because of course the more people you infect, the faster you're going to accelerate, but it also really matters how quickly you infect those people. So, So where does that leave us? Right. So it's pretty clear that in a lot of places, especially places that have started to see outbreaks of the Delta variant, but the acceleration is Tesla style, right? It's you saw that definitely when we saw the Delta variant taking off in India and now in the UK now in the U S. But, I think especially when we were looking at what was happening in India, it was unbelievable that it was like the, the case counts just hit this, you know, vertical wall. It just went straight up very quickly, a very fast acceleration. The acceleration in the UK and the U S has not yet. Quite that fast in part, because we were able to see it coming. We saw what had happened in India. We were able to sort of prepare ourselves a little bit. But it's still been very fast. Like you said, it's been about as fast as it's been in previous waves, which is pretty wild if we take a step back because You know, this is happening in the context of the summer. Whereas this virus tends to be a seasonal virus where we expect the transmission to be strongest in the winter. It's happening certainly in the U S and the UK in the context of vaccination rates. So, you know, vaccination rates are certainly not anywhere near. 80 90 a hundred percent, but we still have people vaccinated. And so that should slow things down too. And so really, I think what this is getting at is just how infectious this Delta variant is that in the midst of all of these things, we're still seeing the spread of the Delta. Now on the other side, of course I am behaving very differently than I was six months ago. Many people are behaving very differently than they were six months ago. And so. Helping the Delta along is that generally where we're seeing more people it just has more opportunities to spread. And so some of the increased, some of this acceleration that we're seeing is, is inherent to the variant. And some of it is just due to the changes in our behavior. But those things together have really helped us sort of see an increase that sort of on par with what we've seen in the winter months. So definitely things are different than they were a few months ago. But with sort of all of these changes that are moving it in different directions that we end up is with a scenario where the increase in cases looks very similar to the way that it did sort of in early December. Before we move on, though. I want to break that down a little bit further, because it's been really interesting here in the U S because we've in many ways sort of, lagged behind the UK by six to eight weeks or so in a lot of instances, sort of the UK has seen a surge first, and then we've seen it here in the U S and actually our overall epidemics have looked pretty similar in a lot of ways with the exception of that lag Which for those of us here in the U S is kind of a fortunate thing because we can look to them to sort of see what to expect in the near future. And so one of the things that I want to emphasize about this is if you look at the case counts in the UK the overall surge is finally starting to come down. So they're starting to see in a sustained decreases in the number of cases, but the size of that surge in terms of the number of cases was pretty similar to the one that they saw in December. But if you compare the number of deaths that they've observed, it's vastly lower. And so we've been talking a lot about delays, you know, have we waited long enough to actually see that increase in deaths? Why at this point, yes. We would expect even the cases in the UK are coming down, we would expect the dusk to still be increasing. But if you compare the raw number of the number of deaths, per case that we see now in the UK versus the number of deaths per case that we were seeing at this equivalent point in the epidemic curve, right. Vastly vastly lower. And I would encourage everyone to take a look at the data. I was looking at the New York times portal for this, but you can see this in a number of different locations and it's, it's actually really quite encouraging that what looks like a very similar scenario is in fact quite different. And, and I really attribute that to the vaccine that a lot of people, especially the people who are at most severe risk of death. So people who are 65 and older Vaccination rates in those people in the UK and the U S are extremely high and we're starting to see the benefit of that. So that's, that's the little bit of good news. That's sort of captured in the midst of all of this sort of craziness. That's great. Now I read an article about this, but how do you've talked to, you talked about this, oh gosh, maybe three or four months ago. This idea of once the vaccine started rolling out that, are we going to see a decoupling between vaccination increases in hospitalizations? And now we're seeing that in a profound way, which is a huge, a huge benefit to see my question to you. In in the past, I kind of took a center, maybe not a solace by any means. So I never want to see an increase of hospitalizations and deaths, but like with, with the, with vaccine positive cases, you know, early on people were getting tested like crazy. Now testing is kinda morphed into less of an intensive reality. And so then I was kind of like really putting all my, my bets on the reality that, well, even if. People aren't going in to get tested. We can still look to hospitalizations to see roughly a proportion. Okay. Well, clearly there's more, there's more spread going on because we're seeing an increase of hospitalizations because you can't hide that. Right. You got to go to the hospital, but now we don't have that figure. We're seeing an increase. Are we, are we thinking that maybe there's even way more than we think, because I would imagine way less people. Then last year, or even thinking about getting tested at this point in time. So how do we factor that in, at any level or are we factoring that in the psychology of all that? That's great. So absolutely. So testing rates overall are sort of declining they've sort of plateaued to some extent. And so yeah, we, we have always been under counting COVID cases and we're probably under counting by even more. Now. Yeah, because fewer people are getting tested. And so you're right. So, so it can be difficult to compare the raw numbers of cases from now to the winter, because, because we're probably under counting by an even greater degree than we were then. Which is interesting. So, so I think, you know, one of the questions sort of implicit in that is. Is that a problem? Should we be, should we be testing more? And I, it's sort of what's, what's the purpose of testing at this stage in the pandemic. And I think this has been one of the most difficult Things to sort of both communicate, but also to sort of wrap my own mind around is what is the purpose of testing? Because actually getting a test for COVID usually serves multiple purposes depending on where you get it, but even a single test will serve multiple purposes. So if I am going to travel, I might get a test before I go just as sort of a baseline test. And so that's trying to sort of, Modulate my own behavior, where if it came back positive, then, then I would stay back. But that same test is also feeding into the data where there's somebody who had a low prior probability of turning positive, but I'm contributing my negative test to that pool of tests. And so I woke up one morning with a sore throat and a headache. I might go to get tested because I'm symptomatic. And so then that also, you know, what I'm trying to do is to See if I should modulate my behavior, see if I should maybe think about going to the doctor for, for to, to get these things checked out. And also, you know, this contributes to the overall surveillance of, of what's going on with COVID in the community. So now, you know, you've layer in vaccination where maybe if I'm vaccinated, I'm less likely to get tested, even if I'm symptomatic. So all of these probabilities are shifting underneath our feet. So what should we do with that? So I think one of the really difficult things about this period of time is that the w what COVID means both individually and as a society is starting to change and to a large part that's because of vaccination. So, Do we need to know exactly how much is spreading. I don't know. I definitely do want to know how many hospitalizations there are with respect to COVID. And I want to know what proportion of those people hospitalized with COVID are vaccinated versus unvaccinated, because that gives us a huge amount of information about if COVID, if, if new variants are maybe starting to chip away at the protection that the vaccine provides, but. What vaccination effectively does is it reduces the risk of severe outcomes from COVID vastly to the point where it's basically in line with a lot of other risks that we face with other infectious diseases as we go about our lives. So then does it still make sense to follow up all of those cases? I don't know. I have some colleagues who say absolutely yes. You know, we need to be following up every single breakthrough case. We need to be testing as much as we possibly can. And then there are others and I'm starting to shift a little bit more towards the side too, which is that, you know, testing requires a huge amount of resources. At least. Level of testing. It takes a lot of money. It takes a lot of time. It takes a lot of personnel. Are there other things that we could be doing that would be more effective at actually reducing the spread of COVID without actually following up every single one of these cases, especially in a world in which the risk of hospitalization and death, given infection from COVID. Actually all that different. If you're vaccinated from a lot of other risks that we face day-to-day that we, that we don't track nearly as closely, we're still in this murky middle ground where the answer is not clear, but I think we're sort of transitioning from one to the other and figuring out how to do that gracefully, I think is a really difficult problem. Yeah. Well, two questions to follow up with that. The first one is you talked about the idea of what would it be like if we reallocate these resources to something else? Prevent the spread. Do you have an idea of what good you'd replace with that? Either in particular or in general? Like, oh yeah. Example would be let's reallocate the reason from X to Y. Yeah. So, a couple of things. So one, rather than maybe widespread testing in the population, sort of concentrating surveillance, testing on schools and on places where people interact very frequently. So instead of focusing on the whole population focused on places where you expect there might be spread where you really want to make. Things don't get out of hand improving ventilation in schools. So, hiring consultants to come out and help schools figure out how to improve their HVAC systems, how to improve sort of just education around the people who are Maintaining the upkeep of these schools too. So, so that again, and w aerosols don't build up in the air and we prevent infections in places where people gather same is true for restaurants and bars and things like that. So if we could really emphasize that and then also you know, one thing that I've sort of been hoping that we would do you, that I haven't really seen a lot of it all is Helping to provide people with effective masks. So surgical masks or even respirators in places, you know, for example, people who are like driving public transit, bus drivers the train drivers, you know, there a lot of the masks. Wearing are still in some cases, even homemade or, you know, there's a lot better than we could do. Both for the general population, sending people a couple of masks or and especially for people in, in, you know, high contact areas. So I think there's a lot of really practical things that we can do with the same resources that would really go a long way towards interrupting spread, but we can be a lot more targeted because I think we're doing enough surveillance to know when cases are ticking up in an alarming. And we don't necessarily need to see every case to know that, here in Massachusetts, in most of the country cases are going up, do we need to know exactly by how many I'm not sure. I think just the fact that they're going up is enough for us to sort of start to calibrate these things and to start to understand who needs these interventions, where do we, where do we allocate these resources? Those are the sorts of things I'd like to see instead. Yeah. And you know, another question with this is this would be, I think, a way more difficult one. I think this is what you're getting into and my guess is if I get into your mind, maybe that's what you're thinking. When do you normalize this? Like you were saying we're, we're, we're at a point now where the vaccinated, those who are vaccinated are dealing with a threat that's similar to other regular viruses that we do not have this kind of measure of containment and measurement and that kind of stuff. What, what is there a, is there a standard by which we can actually transition to say, okay, we've reached this moment by which we can now I think we talked about this last week and this is going to be, I think the perennial difficulty of dealing with a pandemic is when do you move it from. I'm an outlier to something that's, that's actually fabricated into the daily rhythm of life. Like just like we don't measure flu. Every positive case that is, is, is this, is this more of an art than a science for this? Are we when we're culturally ready? Or is there like a metric by which we can look at? Look at? Yeah. There's you're right. There's a lot of, sort of, There's a lot of room for discussion on this. I think in the end, there's nothing that's really cut and dry. I think probably the best way to think about it is to place it in the context of other risks that we face every day. And so in this case, I think that flu is a reasonable, a reasonable thing to do. Part of my hesitancy in, in looking at fluids that actually, I think we could do a lot better at preventing illness and deaths from flu too. You know, there's, as we start to compare risk from COVID to risk from other things, we also have to really critically examine as like, sh should we be accepting this level of risk from these other things as well? Yeah, putting that to one side for now, there, there are risks that we accept every day, including the risk of getting in our car and driving down the street or, or of, you know, flu every year. And so I think that one of the ways that we can start to measure that is looking at a long enough time horizon, usually on the order of a year and asking, you know, how many people are dying, how many people are hospitalized from each of these things. On average, over the course of a year in a particular position, And then ask ourselves sort of, how does COVID stack up right now? Deaths from COVID are still exceeding the rate of death from COVID is still exceeding that from flu, but as vaccination increases as ideally, you know, we find better ways to manage it during surgeries. Hopefully that will come much more in line. And then once it's sort of on par with those other risks that we've come to accept, we can then say, okay, well now, now it's time to sort of fold this into this portfolio of other risks that we that we face every day, every day, while also recognizing that we can make a lot of progress on these other risks too, to improve wellbeing. This is always really challenging because that risk will change depending on. Age groups, depending on the community you're living in, depending on all sorts of different things. And so there's a real danger of doing too much averaging where if we, for example, average the number of deaths from COVID over the entire country, we might really be missing out on a huge number of excess morbidity mortality that are that's occurring in certain age groups or certain communities. And we need to make sure we're not doing that. So we need to make sure we're doing these things sort of on, on the local scale whenever possible. But as long as we're doing that thoughtfully, then I think, yeah, comparing this to other risks that we access adapt in our day-to-day lives as sort of one good metric for determining when we're ready to transition into this being just a reality of our life. Okay. And now you just said how even at this level, at this point in time, you know, being well over a year and of the pandemic, we're still at a place, but which the rates of death and are, are much larger than, or significantly worse than flu and other things in our, in our life as well. Given the, the increase in cases, the the accelerator of the Delta variant. Do you prescribe anything right now in generally different for, for the communities right next? So we're seeing medical professionals. I don't, I don't think the CDC has done it yet. The medical professionals advocate, and even now people wearing masks outside, even if you're vaccinated because of the increase of variants. Among in discussion there at Harvard. Is there anything going on at this point in time, should we advance the level of our caution or still maintain the CDC policies of if you're vaccinated? You're good. Unless you're in a big population. Yeah. So it's I think it's, it's tricky. So there may well be, and I anticipate there probably will be a time when we're going to have to start. Wearing masks because indoors again. Certainly for unvaccinated people who I think by CDC guidelines should be wearing masks indoors anyway, but but it might make sense for vaccinated people to start wearing them inside too. Full disclosure. I am generally wearing a mask indoors anytime I'm indoors. Anyway it just I just feel like it's a small thing that I can do. That's an extra layer of protection for the people around me. And so in my mind, that's just a trade-off that makes an awful lot of sense. But especially as the cases of Delta start to increase Those kinds of things. We'll probably have to start bringing back to some extent. So I think it's still early days. We, it, we may not need that quite yet, but I think, you know, stay tuned. There's definitely some communities here in Massachusetts where cases are accelerating more quickly that I've just as of today or yesterday, re-instated an indoor mask mandate. And And so I think it's coming, it may only be coming for particular communities at different times. It may not be a national sort of thing. But I think that also makes sense. I think the story of this. Epidemic over the next few months, it's probably going to be a very local sort of thing. And so it makes sense to treat it as such great. Now let's you just mentioned how, like you, your personal preference right now, as you go in, you go inside, you wear a mask it's just free. It's a small contribution you can do to help keep COVID at bay. So let's take that and, and move that into what the CDC was talking about. And there's been some criticism about what do we measure when it comes to breakthrough cases. This is all the discussion. The past week, two weeks has been, we're seeing, you know, maybe in June, it was 1%. Of cases or, or are coming from the vaccinated people. Now we're seeing a much bigger number and, or at least relatively speaking that are coming breakthrough infections coming through, you know, so two things, can you help us understand that between breakthrough infections and breakthrough disease? Because I'm sure you've talked about as many, many times, but I saw that distinction a couple of days ago. I'm like, oh yeah, I forgot about that. There's a different one, two. And then CDC, if I, if I'm getting this correctly, has decided at least maybe they've changed. I don't know, at least there was one point in time they wanted to, to measure breakthrough disease and not necessarily breakthrough breakthrough infections, but there's some people say, no, we need to be measuring these because we don't know to what extent we're transmitting this to other people, those who have the vaccine, maybe why that extra level of caution for you to wear the mask. And it's also helpful for genomic research to know, to what extent is the vaccine causing variants. And so measuring this will be helpful for us. And I'm guessing, you said you had interviewed just recently talking about this and he may have a different, a little bit of a different flavor too, to a response to the criticism of the CDC. Yeah, exactly. I you know, it kind of folds into some of what we were talking about before with, with testing in general. Which is that, you know, does it make sense for us to follow up every single breakthrough infection and an infection? Breakthrough infection is an especially difficult thing to do because by definition, if it's an infection, but not a case, you're not showing symptoms. And so figuring out how to test those people. Well, you, you essentially have to do regular testing for everyone, always regardless of vaccination status. It may not be a bad idea, but, but should we be using those resources for that or for something else? So before I get too far, you asked about the distinction between breakthrough infection and breakthrough disease. So, breakthrough infection is when someone who is vaccinated becomes infected with SARS cov two, but remains asymptomatic. So you can become infected, which means usually in this case, meaning that you can test positive through a PCR test But you don't go on to show disease. Now, one of the really important things about this is that oftentimes when a person who's vaccinated becomes infected they do become infected. They, they are able to turn positive on PCR, but they frequently don't even produce enough virus to infect another person. And so, especially in that case, it's like, okay, so the person is not showing symptoms. They're, they're not. Infectious to others. Is, is that something we really care about? Yes. From a research perspective, I'm an epidemiologist. I want all of the data I can surely get, but from a practical perspective, for somebody who's in charge of running a national public health agency, I understand why following up every single one of these might not be the top priority. Breakthrough disease on the other hand is, is what it sounds like where you're someone who's vaccinated who's been infected and then has progressed to show symptoms. Now that's something that we might want to pay some more attention to. I think that there's still some latitude here for disagreement because. If a vaccinated person does go on to show symptoms, they're still unlikely to have severe outcomes from those symptoms. And so, again, this is sort of the, in this paradigm of trying to shift the risk from COVID into something like the risk of other infectious diseases that we deal with all the time. I still become symptomatic with flu with other Corona viruses as well. But does it make sense for every single one of those cases to be tracked? I don't know, there, there may well be bigger fish to fry now, breakthrough hospitalizations, breakthrough breakthrough infections that lead to death. Absolutely. You know, we should be following those up because if we start to see that the risk of hospitalization or the risk of death starts to edge in vaccinated people closer towards what it is in unvaccinated people right now, the difference is still vast. But if it starts to increase, then, then that's a real cause for alarm. Right? Then, then we might really have a variant on our hands and something that we really have to pay close attention to. And I think that rightfully that's why the real emphasis is being placed on that. It's difficult because it means that you can't necessarily compare the numbers directly from unvaccinated people in vaccinated people because we're treating them somewhat differently. And. You know, in some circles that's a real cause for alarm and concern and allegations that, you know, we're trying to hide information or to make the vaccines seem better than they are or something like that. And I think that it's just really, as far as I can tell, it's just, this is sort of playing out in the context of really difficult, practical realities with respect to testing. And so I think that, you know, we can always criticize what the CDC is doing. But But a decision has to be made at some point. And I think that the decisions that they're making with respect to this are. Defensible. Yeah. And, and that's kind of where we're at. So desert it's helpful because like, well, a couple of things, and we probably talked about this already, at least in a roundabout way, in my mind I'm thinking, oh, I want to have a measured because of two things. Number one. To what extent are AceNet asymptomatic people spreading it and causing more spread, but you just mentioned, you've answered that. I saw an article that kind of repeated what you just said, that those who had the vaccine, even if they become asymptomatic, They have like roughly a 40% less viral load to actually spread. So this kind of goes into the question I wanted to ask as well that if between Vaccinated a positive case and an un-vaccinated positive case. And there's, there seems to be a dramatic difference. You've pretty much already said in the past 20 minutes that the viral load is significantly less for those who are vaccine. If you are now, I can see another reason why I would want to be able to be. And that is, well, you know, maybe I get it, I'm a cinematic, but maybe I need to prepare for the possibility of me having long haulers. Right. It's like that, but it's also another article I read. It seems like it's really, and maybe you can echo the same thing. I don't know if you've seen any of it's really, really, really, really, really unlikely that people are going to get along hollers from a vaccinator. Positive case. Has that been a similar kind of discussion going on in your neck of the woods? Yeah, it seems to be so maybe again, to add sort of some nuance to some of this with the W with how, how infections look between vaccinated and unvaccinated people. You know, you're absolutely right. That on average, a vaccinated person is sort of every step of the way less likely to progress. So they're less likely to get infected in the first place. If they're infected, they're less likely to show symptoms. If they show symptoms, they're less likely to produce as much virus as a person who's un-vaccinated and they're less likely to go to the hospital. So all of those things are sort of the vaccine sort of puts a filter at each one of those stages and sort of help screen you out from getting to each of them. That said, you know, one of the things in a lot of the conversation I've had with journalists and even just with, with concerned friends about this, is that, you know, we're starting to see more breakthrough infections. Personally, right? Like I, I now know a friend of a friend who's been vaccinated and has shown symptoms from COVID and there's something super alarming about this too. Right? Like they got vaccinated. What the heck? You know, am I at risk? I've been vaccinated. I don't want to get COVID, you know, what, what should I do about this? And I think. And this is where it's been really helpful to be looking at the data all along. And the sort of thinking about the statistics about this is that again, the vaccines are very effective. They're very helpful at preventing each of these progressions from one stage of illness to the next. But the way that I like to think about it is from the very beginning in the trials, the vaccines were 95% effective at preventing symptoms, right? Just very good between 90 and 95% effective. Basically these are for the modern and the Pfizer vaccines, for example What that means is that for every 20 unvaccinated people who show symptoms, you're going to expect one or two vaccinated people to show some else. So the ratio is about 20 to one, 20 to two. That's actually not all that uncommon. Now, of course, if you show symptoms, you're less likely to go to the hospital. You're less likely, you know, all of these things. So, so the vaccines really especially protect against those severe outcomes, but, but I think it's worth bearing in mind that actually symptomatic breakthrough cases are now. That's surprising in some sense, too. And so this is another reason why, why following all of them up doesn't necessarily make sense, because it doesn't imply necessarily that there's a new variant or that there's something to be super alarmed about. It's just that as we've known all along the vaccines are not a magic bullet, but they are helping us keep control of the epidemic. And so, so that's sort of. Big sort of caveat in all of that. Now we're still learning a lot about the long haulers issue. And I think that that's going to be one of the most interesting things is to see the relationship between vaccination and long hauling. There've been some anecdotal suggestions that even people who have suffered from COVID long hauling. Their symptoms have some have improved after getting vaccinated as well. So like the developed COVID before they were vaccinated, they had long haulers, they got vaccinated and the vaccine somehow seems to have contributed to some of those symptoms clearing up. Totally anecdotal. I don't think we have any solid evidence as to if that's actually the case on sort of a widespread scale. But I do think that the relationship between vaccination and long hauling is going to be super important. To my knowledge, we don't really know yet. The extent to which vaccination prevents your odds of developing long haulers. I would anticipate that it is much lower in the sense that the vaccine seems to protect against every stage of illness. But one of the difficulties with this as both that long hauling is still not super well-defined. And so it's difficult to say when exactly you have a case of it or not. And it also takes longer to develop. And so it's, we're just going to need more time to collect those data too. So, I would believe those kinds of things, but I think that we're still sort of in the early stages of getting evidence on the relationship between vaccination and long hauling. Good, good. You know, speaking of which, I think what adds a level of complexity to breakthrough cases, as you mentioned, all the different, you know, 90, 90%, 95%, but then they include, right. Even those who've been given the first vaccine, but didn't follow up and get the second vaccine. So this is going to skew statistics even more because we know that especially the variant. Are a little bit stronger against those who chose to get the first vaccine, but not the second one. And if they get a positive case infection or disease, there's still a vaccinated group, even though they weren't fully vaccinated. Right. So they're part of that, that lump sum is that, is that. That's right, exactly. Yeah. Going to add some more of the statistics as well. So speaking of that double vaccination, I saw this in the news. Just want to bring it out. It's interesting. Nixed, AstraZeneca and Pfizer shot boost Cova antibodies up to like six times. So just showing now we've been talking about this for all, you know, six months, seven months. About at some point in time, we're going to start seeing a lot more of these studies and tests of mixing two different types of vaccines. To see how it increased the antibody levels. And I think that was a great first step with AstraZeneca and the Pfizer. Now I did see that when it comes to the variants, particularly beta, gamma and Delta, it's not quite as big of an antibody jump, but nonetheless, starting to see these tests to show some good, good positives. Okay, last thing I'm gonna talk about before we go I brought this up to you before we start recording, and I thought it was going to be a moot point, Stephen. And you're like, oh, this is actually kind of interesting concept. So I wanted to bring up the last week. We didn't have time for it, but I saw articles at a U S life expectancy dropped by 1.5 years in 2020. Right? So this is, I think the most significant drop we have had in life expectancy. Since when we go to war to now, I think it's not a big surprise. The reason for this is particularly COVID is, is the hallmark reason for why this happened when I mentioned this to you, Steve. And you're like, oh yeah, this would be a really fun topic because of X, Y, and Z. And explain you guys been having some discussion about this. Why don't you chime in and talk about this life expectancy? What might be happening in the future and this, the craziness and the complexities of dealing with this kind of the stuff? Yeah. So, you know, there's so many different ways that we can Look at the impact of this pandemic. You know, we've looked at excess mortality, we've looked at cases, we've looked at deaths and hospitalizations over time, cumulative specific span of time, peak level, you know, there's all sorts of different ways that we can measure the impact of COVID. And one of them are, is this variation in life expectancy? One of the reasons people like to use this measure is because it's sort of a blanket measure. Wellbeing across the population. I before we really dive into it, I want to, you know, sort of talk about what life expectancy is and what it is not. So what life expectancy sounds like is how long a person is expected to live. If they. Born on this day. And it's not really that what it is is actually sort of what a hypothetical, how long a hypothetical person would live. If at every age they faced the same risk that a person who lived through this year faced. So that's why the COVID pandemic has had such a big impact on life expectancy. It's it's not to say that now. Everybody's, you know, we had a couple of years shaved off our lives. I do feel like I had a couple of years shaved off my life after this past year. But what it's really saying is basically, you know, what sort of risk did we face over the course of this year? And because of all of the excess mortality from the pandemic it's it decreased life expectancy.

Matt Boettger:

Now, one of the things that would've made this number go up even further is if COVID had been much more severe in younger people than an older. For example, so that would have decreased life expectancy even more. So it's sort of a measure that sort of assesses risk of death over time by different age groups and so on.

Stephen Kissler:

So you're right. It is still really important that life expectancy for this year dropped by about a year and a half, which is more than it's dropped since world war II. And so, so, so there's that, so, so that's basically what it's measuring is sort of this one more metric of sort of. The impact of the pandemic over this past year now, what do we expect going into the future? Well, there's this really interesting phenomenon that's called mortality displacement, and the idea behind it is that you know, EV everybody dies of something. But yeah. If in a particular span of time, you're exposed to an excess risk. You're are no longer going to die of what you would have died of you die of that other thing instead. So in this case, that excess risk is COVID. Some people have talked about it using a word that. Don't like, but it's like basically like mortality harvesting in a way where it's sort of like COVID has sort of collected people who would have died from other causes, but has made their cause of death COVID instead. And in some cases, this is true, right? A lot of, especially people who were very old, who had lots of co-morbidities like those are the people who are most likely to die from COVID. And so they might have died in a couple of years from pneumonia or from some other kind of blood infection, but instead they died from cancer. So, what does that do as we look forward to life expectancy? Well, this is actually a pretty well-documented phenomenon in people who studied demography and, you know, just sort of the study of populations over time, which is that when you have one of these, you know, really catastrophic events in a population, essentially you see this mortality displacement phenomenon and what it does is it the people who basically. Shorter times left for this world are the ones who are most likely to succumb to whatever it was. And that means that the remaining population actually on average has a longer span of life ahead of them. So what you see actually is this rebound. So there's this decline in life expectancy, but then in the following years, it kind of rebounds. And so there's this artificial increase in life expectancy for a couple of years, following these catastrophic events until it sort of settles back into normal. Why is this interesting and not just sort of like an academic thing, you know? Well, one of the ways that people frequently advocate for policy change is by quoting differences in life expectancy, between racial and ethnic groups, between demographic groups, between geographic locations, for example. And we know that the pandemic has been more severe for certain groups for especially disadvantaged groups lower socioeconomic income, racial and ethnic minorities, these sorts of things. The rebound is usually proportional to the size of the decrease in life expectancy that we saw before. So, so we run the risk of in future years saying that, oh, you know, actually, actually life has gotten a lot better for these disadvantaged communities. We thought that it was going to be really bad. We thought that, you know, they were going to be suffering for a really long period of time. But look, their life expectancy has actually increased and it's increased by a factor even more than those communities that are better resourced. How good are we doing? You know, this is wonderful. We don't have to provide resources to these communities at nearly the rate that we thought we did, because it seems like they're just kind of taking care of themselves, which is not at all the conclusion we want to draw from this. Right. Because really it's just an entirely artificial. Rebound, it sort of comes out of the way that these statistics are calculated. So that's something we're going to have to pay really close attention to in the coming years. And so as we're thinking about these life expectancy, I think I, I sort of, I want to emphasize to not place too much doom and gloom on the, on the decline in life expectancy. It's terrible, but it doesn't mean that you personally are less likely to live as long as you were before. Assuming you're still listening. Podcasts, but then also in the future, we're going to see some really wonky things happening with life expectancy. And so it's worth sort of tempering our surprise at these things because a lot of it just sort of falls out of the calculations. I can definitely see this right in the future being used and hijacked for media and political influence. So it's good to kind of get that sobriety right here and right now, and also I had no idea. About what life expectancy really meant. And so thank you for clarifying that because you think it's kind of just self-explanatory because it's life expectancy, but it's odd thing. Like everything else. It's a little bit complicated and a little nuanced. Thanks for sharing that, Stephen. I think that'll end in wrap this episode up. Thank you all for listening and thank you for all who were on live or watch it and split up in two different videos. Sorry for the little bug and technical difficulty same stuff you'd like to review. Please leave a review on apple podcasts. Please support us$5 a month at patrion.com/pandemic podcasts or Venmo, PayPal. One-time gift all in the show. Check out the show notes. There's some really interesting articles that came out this week. I'll put them in there for you to read and enjoy, have a wonderful week, and we'll see you next week. Take care. And bye-bye.