Pandemic: Coronavirus Edition

What does it mean to "trust science"?

• Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger • Season 1 • Episode 87

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Matt Boettger:

You're listening to the pandemic podcast. We equip you to live the most real life possible and the face to face crises. My name is Matt and I'm joined with two buddies of mine. This is a miracle Dr. Mark Kissler. Here he is at the university of Colorado hospital. He's back. He's. Come out of some dark place and able to reveal the surface of his own head for us and talk to us for a few minutes moments. And then Steven, our, our reliable steadfast guy and in his own little apartment there in Boston epidemiologists at the Harvard school of public health, how are you guys doing?

Mark Kissler:

Good. It's good to see that I missed your radio announcer voice. It's been a while since I've heard that. So it was good. It's good to hear that this morning again,

Matt Boettger:

I'm glad that that's somebody can, can enjoy that, man. Well, you know, we don't have a lot of time this morning because you know, we'll start. Steven only because that's the context. And then we'll move to mark because I want to hear what's going on in your neck of the woods. But Steven, we had adjust for those of you who are listening. You're going to realize we're publishing this a couple of days late. Steven's been at a conference and in fact, he even Keven gave a talk at this conference. I'm actually completely in the dark of this conference. I have no idea what's going on, what you're doing, Steven. So can you fill me in as well as the rest of the world about what conference you're doing and then what talk did you get?

Stephen Kissler:

Yeah. So I have been at the virtual conference on virus dynamics which has been hosted by interestingly the Fred. Oh my gosh. I tried

Matt Boettger:

to get a ticket to that one.

Stephen Kissler:

I know it was, yeah, there were sold out, like within five minutes. It was crazy people all over themselves. Yeah, so it's, it's hosted by the Fred Hutchinson cancer research Institute in Washington and Washington state university. So interestingly, the Fred Hutch does does a lot of work on infectious diseases as well. Because the intersection between that and cancer is pretty, hugely important. And so there with this workshop they're interested in How viruses behave within the human body. But not just SARS cov two. A lot of this workshop historically has been around HIV. And in fact, a lot of the research on viral dynamics in general has been from HIV. So we've had to adapt a lot of the work that they've done over the past few decades to try to learn what we can about Cyrus Kovi too. So, the presentation that I gave. It was the very first one of the conference. So, it was a little bit stressful way to set the pace. Yeah.

Matt Boettger:

Something like that. You probably made everybody feel just really bad eyes.

Stephen Kissler:

It was so I spoke about And some of the things that we've talked about on previous episodes where we've had some, some manuscripts that have come out to our collaboration with the NBA. So where we've been doing frequent testing in players and staff and vendors and family members with the NBA. And when we do that, we can see how much virus people have in their bodies, if they do become infected and using that we can build mathematical models to fix. How long the infection lasts and whether that changes depending on which variant they're infected with or whether or not they're vaccinated. So some of the things I was talking about in particular where the the, the variants and the vaccines and how they affect how the virus behaves in our body. So the vaccine really helps clear the virus out of our bodies more quickly. But you can still produce quite a bit of virus if you do get infected. So that's, that's been a big part of the reason why some of we've had some of these shifting guidelines lately where now vaccinated people that are still recommended to wear masks in indoor settings and these kinds of things. It's based off of some of these findings. From measuring these viral concentrations and people over time. So we were just talking about those things and and the conference has been really interesting. It's been really cool to hear people digging into some of these questions for a lot of different angles.

Matt Boettger:

That's great. And is this I'm guessing this is all behind like a paywall there's no. To access your talk down the

Stephen Kissler:

road. Yeah. There's there was like a conference registration that we had to put in. But I think that I should be able to get access to at least at least my talk. And so I'm hoping to post that somewhere after the conference is finished.

Matt Boettger:

Great. So those are you're listening and you're interested once Stephen gets it. I'll make sure we put it into some notes, a show notes of some episode in Woolwich. That's awesome. And is it still going on, Steven? Are you

Stephen Kissler:

done? Yeah. Today is the last day, so,

Matt Boettger:

yeah. Okay, great. Are you skipping out right now? Just bailing out of the conference, that to deduce podcast reserve that

Stephen Kissler:

there's a break it's actually since it's hosted on the west coast, it's on Pacific time. So it starts at 8:30 AM their time, but 1130 miles. So I've got another hour before the first session. Yeah.

Matt Boettger:

Okay. That's where the time crunch mark has had to you. Cause we haven't heard from you for ever. And in fact, you know, as we were Steven and I were meeting every other week, you send an email to us saying, Hey, here's some stuff I'm going to talk about him and hearing about this, the hospital, talking to friends. So I know you've got a lot on your mind, but I want to first hear what's been going on a day in the hospital since we haven't heard anything about that forever. And then B we've been before we started recording this, we started talking about your personal life and kids going back to school. I'm sure a lot of would appreciate what's going on in that transition in the kiss, their family and how that's being.

Mark Kissler:

Yeah, for sure. So, well I can start there. So kids are back at school. It's a little bit of a different flavor than the end of last school year in that they've been treating COVID cases just a little bit differently and not shutting down the whole classroom for weeks. If there's. Yeah, like a case in the community that's related to a kid. And they're still doing masking in all the classes as far as I know as of a couple or as of a week and a half ago or so when they last reported, there's been no outbreaks amongst the kids at the school. And I think, you know, from from just like an educational standpoint and from a consistency standpoint they've been doing a really good job of keeping the kids in the classroom as much as possible and really supportive of that ongoing. You know, just the ongoing educational needs of the kids. So that's been good. And you know, we feel pretty well supported as a family from that standpoint. What else was going on? Hospital life is kind of status quo right now. And so we've been. We've seen an uptick in the case numbers as we've approached the fall. For sure. And now we're kinda, you know, it kind of goes up and up and down by the week. We saw more we, our ICU had been a little bit more full. And so we've been helping out there a little bit. And some of that is because once patients are so sick that they need ICU level care. You know, often they're on a, on a ventilator or high flow oxygen for many days. And so that just kind of creates a different flow for the patients and and our therapeutics wise we're still using, there's not been a lot of big changes. So we're definitely still using the dexamethazone, which has the most robust evidence for mortality, but. We're using REM desk severe you know, which again is more it has, less, less of a strong signal in the mortality realm than than our other therapeutics, but that's something that we've been using in our institution. And then we also for patients who get very, very sick, despite the dexamethazone we are using the Tocilizumab and, or the bear setting of which are those molecular. Kind of the monoclonal antibodies that help reduce inflammation and cellular signaling. And so those, they have some you know, there's some nuances around who we use those for and when but for the most part, I haven't seen a lot of big therapeutic changes you know, in this cycle, in this latest cycle of COVID. And I think there's just an understanding and an expectation that as we approach the winter months, We are accustomed to seeing a surge in the winter related to respiratory viruses and things like that. And so we're expecting that and that there's going to be sort of a concurrent increase in COVID cases, along with her other respiratory viruses. So we're preparing for that from a staffing standpoint and our operations team is hard at work, you know, making sure that we're going to have enough teams to take care of all the patients that. Okay. Great.

Matt Boettger:

Well, you know, before we get into some of the questions you had from a couple of weeks ago, there's two things I'm taking about given what you're just talking about. Hey, I'm just curious in Colorado, have we seen any other increases of like viruses or like, you know, flu as that starting to uptake? Are we still kind of like on the, you know, the delay on that, I'm curious about how that's gonna pan out down the road next few months, because yeah. We can have a big flu season or, you know, there's still a lot of people masking obviously. And so it might have its benefits once again this year. So I think that's my first question to you and I forgot my second one, but oh yeah. The other one was about treating. And about you know, talking about this, we were talking about this merch thing. And so when does it tie that into the treatment, but the first is, have you seen any flus flu, like symptoms surfacing here in Colorado?

Mark Kissler:

The flu is definitely here, so we're starting to see some cases. And this is, you know, as expected. So here, you know, here we are beginning of October sort of, you know, beginning end and you know, I think Steven could probably speak more epidemiologically. There's also, you know, as, as we've seen and as we know there's going to be some complex factors. Intersect with influenza to determine whether this is bad flu season or a mild flu season. And I think it's hard to predict, you know, at this point from a clinic purely clinical standpoint it's more a question of how do we. You know, how do we prepare and get ready? Cause we don't know exactly what we're going to see. And just kind of take it as it comes. This Merck thing is pretty interesting and I have, haven't had the chance to do a deep dive on the evidence yet though initial, at least in terms of the reporting on the initial studies. Quite promising for an outpatient treatment to prevent severe disease. And so it's an antiviral medication. And it, so it would be mostly used in the outpatient setting. They're they're the conversation point or they're marketing it a lot as sort of a Tamiflu for COVID. So this idea that, you know, you, you have initial symptoms and a positive test, and then you can use this medication. To help reduce the symptom burden, maybe shorten the course. And we've been using things like there's certain you know, monoclonal antibodies that they use in the outpatient setting as well. If, for people who are at high risk to help reduce the symptom burden burden, but it seems to me that this would be potentially a big step forward in terms of having something that can be really widely available and act on the virus itself early in the. So Steven, do you have any thoughts about that? Yeah.

Stephen Kissler:

That's basically my understanding of it as well. It's one of the really exciting things about it is that it is like you said, Meant to be available at a time in the infection that we don't really have anything available for people. All of the therapeutic interventions that we have are either vaccines to prevent you from getting infected in the first place or things that help you once you've already gotten to the hospital. And so this has been a really sort of critical gap in our therapeutic portfolio that we have for COVID-19. So it's I'm, I'm really encouraged by it. It seems like from my understanding, the evidence of its efficacy was so good that they actually stopped the trial short because they couldn't justify not giving the people in the placebo arm, the, the drug because it was, it seemed to be so effective. So I think that that's, that's a very good sign. And we'll see, but I think that it it's, it's good news.

Matt Boettger:

That's great. Now I, you guys dropped this on me. I had no idea. I didn't know. So a couple of things that maybe you just said, and maybe I was just tuning out and thinking about my next question, which I can sometimes do. So I apologize, but now is this an over the counter prescription thing that you just, is it over the counter prescribe? And how quickly would this be available? Is it still a ways away before it could become to the masses?

Stephen Kissler:

I'm actually not sure about that. I, it would be a prescription drug. So you would need to have some sort of healthcare encounter to to get it. But I think the, the, probably the, the, the two hurdles standing in the way still are FDA approval. So they've shown the evidence of of the efficacy, but it still needs to be approved. And then once, once that's done, then, then the production. So it'll still be a little while, but Hopefully not too long.

Matt Boettger:

Great. Well, I'll definitely we'll keep that in mind. And if I see anything in the media about it, I'll put it in the show notes for this particular episode. So. Mark, let's get back to you now because you had some questions. This is the, I'm glad you're here, mark, because I feel like, well, I'm the most, like the most reclusive right now, I live in a tunnel cave. First it was Steven. I actually worked someplace, went to a building, dealt with a lot of conspiracies on a regular basis and I no longer work there. And I really don't talk to very many people that me and my wife and my kids. We're kind of all on the same page on some level. So, but you you're out in the hospital, you've been engaging a lot of people, you know, you've had some, you've had some pretty strong encounters. So talk about that and sort of facilitate some of this kind of conversation about the vaccine hesitancy and just dealing with all these, these prescriptions of lockdown to

Mark Kissler:

masks. Yeah. But I think that's good. I agree. I think I've been the least reclusive of the trio here in case. You know, out and about both at work and and in our, in our community in edit, it's an opportunity for that. I think we've had some interesting conversations with folks that I'm close to. Both at work and outside of work around a couple of specifics. Things. And so the questions that have been coming up at this point for me fall in generally kind of two categories. And so one of, well, I'm going to say actually three categories, cause you brought up the Illume home testing thing recall. And so that in the pre-show when we were talking about that, so I want to that's kind of thing. Number three. Topic, number one that we've been talking about a lot is our vaccines yet again. And so things getting, breaking down some of the various reasons for people not getting vaccines and in particular, getting a lot of questions about w people say, well, if I've already had COVID, what's the utility of getting the vaccine and then conversations around who does. Who do I trust and how do I get sort of the preponderance of evidence that the vaccine is the right thing. And, you know, I think we've seen this a lot in there's different angles that different media outlets have used to report on vaccines. So some have been Widely publicized cases of young people dying who were unvaccinated. And that takes on a certain flavor when it's picked up by the media that I think can be, they have, have a sense of sort of, of a punitive or a shaming aspect that is really repellent to a lot of people. And understandably so, and then there's this other sense of like, okay, how do we, how do we actually engage in reasonable conversations about the reasons and. And is there a way to develop some certainty or even, you know, marginal certainty about are the side effects, you know, dangerous and how do we. We are communal responsibility anyway. So I've been getting a lot of ongoing questions still. Particularly as different workplaces have rolled out vaccine mandates for their employees. And so what I've seen is that as the is different workplaces are saying, okay, we're coming up against a deadline often that coincides with the fall coming on and, you know, expected surge, then people are forced to say, okay, am I going to file for an exemption? Then, if I am on what grounds and if I'm not, what's my relationship with my employer, am I going to leave? Am I going to seek alternative employment? Things like that. And so it's really become real for a lot of people in this timeframe be, and mostly because of those employer mandates. So that's thing. Number one, that's been the topic where a lot of things have been sorted. Topic number two has been a little bit of conversation around how do we evaluate how we did with the pandemic and in particular, how do we look at epidemia life? Evidence looking forward and knowing that there's going to be a point in the future in which we encounter in a rapidly spreading infectious disease again. And so I think, you know, we've experienced where there's just a lot of feelings that people have around mandates and statements by the CDC and things like that. And still a tremendous amount of feeling. There's been changing goalposts. We don't really know what's real. We don't know if these mandates were effective. And so what I'm interested in talking to Steven about a little bit is how do we think about the quality of epidemiologic evidence? How do we really get a sense. What interventions were helpful. And what, what interventions might we be able to forego and future pandemics? And things like that. I think it, there's, there's a certain amount of despair of knowing that I've been encountering people where it's just like, There's just no way to tell. And particularly because we can't do things like randomized controlled trials, you know, like we do for drugs when we're talking about these big social interventions. And of course those big social interventions have been the things that have really impacted people. You know, in huge ways. And then thing, number three, is this, this question of, you know, the at-home testing, I think has been really relevant and people are trying to make wise decisions of like, can I go to an event if everybody's vaccinated? And do you test beforehand and then with the Illume tests, having a bunch of false positive tests, how does that change our orientation towards home testing? Does it change? Is that a blip or is that sort of a indicator of the utility of these things to begin with? So I think. Those, those have been kind of the three topics that have been circling around. And then you know, just to throw one more in the mix is, is the mental health burden that we've seen. And, and I think just as this pandemic has stretched on now from a year to network going on, you know, almost two years and it feels like. We're still kind of digging ourselves out. I do think that there's a really significant burden in the community. People who are really suffering from things other than just infectious disease as this is going on. So, so those are, those are the. To concerns that people have been bringing to me the points of conversation. And I don't know, we have just a few minutes, but maybe we want to kind of hit those, you know, 1, 2, 3, 4 as we go and see what you guys

Matt Boettger:

think. Yeah. Sounds good. I'm so glad you brought this most simple questions to the foregrounds. Cause we didn't have a lot of time to adjust. Really some surface level, just icebreaker topics. Okay. So maybe we should do this in somewhat of reverse, reverse order, because I feel like a lot of time, I think the Illume thing, the mental health, let me not quite reversed because the mental health is a big, big, a big bag of something. So let's hit, let's hit handle a loom and what that symbolizes and then work backwards from there and do the Illume. And then the question about the lockdowns from Steven. So. Stephen. This is your show. Now a glad, a great questions here. I will let let's talk about the Olympics that was on mine thing as well. Like, oh, is this just a blip or are we get, are we changing our tune to maybe these aren't the best thing it's causing more problems. So, any thoughts on that? Yeah.

Stephen Kissler:

It's it's tricky, right? It's like what we w we want these tests to be as accurate, meaning as sensitive and as specific as possible. So we don't want false negatives. We don't want false positives. And so I think that I am still, I'm still deeply convinced that that rapid tests like the Illume test and especially like some of the others that are available to buy an X now. And many of the others they have not yet been approved in the U S but that have been approved in many other countries in the world. Can be, and should be a central element of our route out of this pandemic and sort of, emerging from this two year long You know, a real burden that we've all been carrying. I think that the, the issue here is around how, how we use tests because the tests, test doesn't exist in isolation. A test, it gives you information about some specific scenario that you're trying to learn something about. So one of the things that there that you can do to adjust for these false positives as to. Include a verification test, which many of the tests already do. So there are very simple ways to get around some of these issues with false positives, false negatives that really enhance the accuracy of the tests. And the thing that we're lacking most is not. Good testing technology, but good testing protocol. People don't know how to use the tests. People don't know when to use the tests and the tests are very good if you know those things, but in the absence of that, the tests are useless no matter how sensitive and how specific they are. So that's my major frustration is that even these tests that have lower in this case, specificity, meaning they were giving some false positives. They could still be extremely useful. If used in the right way. And so, so that, that I think is the issue. We're trying to find a technological answer to something that is actually much more fundamental and in some ways straight.

Mark Kissler:

Yeah. And I think just to specify, it's not by used in the right way. It doesn't mean there's a improper testing technique being used, but what's what I believe you're referring to as a sense of understanding this concept of what's my pre-test probability you know, do I have symptoms? What am I testing for? Then the test characteristics that are inherent to the test itself. And then that those two things actually interact to give you a post-test probability of actually having COVID. And so there's it. And there's other ways to think about that. Like, what are the scenarios in which we're using these tests, but that is that right? That you're meaning it's not that we don't know how to use the tests, but it's actually, we don't know how to operationalize. You know, to make decisions.

Stephen Kissler:

Exactly, exactly. And right. And even like, what are, what exactly are we testing for? So there's, there's the pre-test probability, there's the test itself. And then, you know, what are, what are we going to do with this test once, once once it comes out, do I want to know if I have COVID and needs to seek medical care? Do I want to know if I should send my kid to school or not? Do I want to know if I should like show up to a family gathering and all of those things, contextualize how you interpret the result that you get. And I think that we, we have a pretty good sense of, of what to do and all of those different cases, but the communication around it has been pretty poor, at least here in the U S.

Matt Boettger:

That's great. That's helpful. It can. I I don't know if this relevant to remind me of this concept, like habit stacking, where like you, you're trying to build a good habit and as an island, it's just not sufficient. You really can't get a good habit sometimes to get started, but if you stack them with other existing things that actually elevates the probability that you actually can develop a good habit, I think this is like a similar, like taking an, you know, a rapid test in of itself is one thing, but to stack it with all the other things that help to surround it's context and circumstances really elevated. The effectiveness of the actual test. So the treated as a one pill thing, it's just not going to be it's purpose is to be used in context. Right. And so that's, that's really helpful. Thanks, Steven. I appreciate it. Okay, go ahead,

Mark Kissler:

mark. Do you have, oh yeah, I was just going to say let's hit, let's hit that. The next question. Right. Right.

Matt Boettger:

This is a big one locked down. Even in my little basement, you know, it still affects me. So when I talked to no one about myself and maybe a few people online the whole concept of, you know, do lock downs did lock down to work. Did the, are the mass working? And there's all this evidence that would get from the media of people who were fully mass in the spread like wildfire or people, you know, you know that mark. Really old article. I sent you guys from Japan about the existence of how without lockdowns, this is how they survived that this was, this was a while ago. This was well over a year, I think a year ago when that article came out, maybe less. So just wanted to propose it of like, you know, in mark, you can reframe this a little more about just how, how, how do we know what's effective? What's not, and how do we come to conclusions and epidemiologist? Yeah.

Stephen Kissler:

Yeah. It's, I think that it's, this is A tricky question. And it's one that we've been grappling with as epidemiologists, as people who tend to deal with observational data, as opposed to trial based data all the time. But never has it been so central to our existence as humans in society. There was a lot of debate around this early in the pandemic as well. Where there was even a split between sort of, different groups of epidemiologists, some of whom Did not think that we can justify things like lockdowns because we didn't have the sort of randomized controlled evidence to justify them. And others who were and I, I, in many of my colleagues tended to fall more into this camp, which was that we don't necessarily know what the effect of lockdowns will be, but we do know what the effect of COVID. On a city on a community can be. And we have sufficient reason to believe that this could very well be helpful in the immediate term. And so based on the precautionary principle, this is something that we should be doing even in the absence of evidence. And we should be collecting evidence as we go. But now we're in a very different situation where, you know, the pandemic has been spreading for quite a long time. In theory, we, we do have, and should have some evidence on this and, and in fact, we, we do but as far from straight. So we can look at the examples of some countries that have very strict lockdowns, very strong countermeasures. And many of them have had very few COVID cases. Their economies are doing very well. We can look to Australia, New Zealand. For example, there was the example of Japan. I think we were talking about earlier. Yeah, and different countries have fared very differently here. But on the other hand, you know, some we might contrast the response in Germany versus the U S which, which are actually quite different. I think Germany tended to have a. Stricter response. They've been a lot quicker to adopt technologies like rapid tests and to use them in ways that I think are very sensible. And that has definitely helped, but also, you know, the they're not in the situation that Australia and New Zealand are. They're much closer to the per capita mortality that we have in the. Then you might expect given the difference in the response between the two different places. So one of the big issues here is that just there are so many different moving factors from individual culture and political response and just sheer luck, one way or another. And all of these different things sort of play into making it really difficult to draw conclusions as to, you know, what what, what is the dose response of a week of lockdown to reduce COVID cases? And that's, that's the sort of evidence that we're, we're never going to be able to have perfectly. It is something that we can, it's an evidence-based that we can build over time. As we look back at the experience that we've had over the last couple of years and begin to disentangle it, but it's, it's a messy process. And I'm going to really. Empathize with the frustration that that many people have about you know, like there's, there's sort of the sense of, of futility and almost hopelessness that we can ever know for sure. And I think that that's in a I empathize with it deeply because that's, that's sort of where my entire professional life is situated. I, I feel that frustration every day. And but I, I am convinced at this point that even if the quality of evidence that we might have is poor relative to something that you might have in a, in a trial, it's not nothing. And I think that that matters still.

Mark Kissler:

That's good. You know, I think a couple of themes come out, you know, as I'm hearing you talk about that, I think one of them is I think that there has been a lot of frustration amongst people who, especially who are I think less inclined to. Mask mandates, vaccination mandates locked down, things like that. At the use of the, this narrative of well science says that, you know, XYZ, and I think that you draw some important nuance there where that even within the scientific community, there's some conversations going on about how do we use these models to inform what shall we do? And it would be. It's so tough because I think a lot of people feel as if they don't have access to the scientific knowledge, the models themselves, to the ability, you know, to really parse that such that they CA that it feels as if they're, they can't participate in that conversation in a rightly, because it takes experts. To do that. That's why you went to school for as long as you did and your, your colleagues and continue to learn, you know, out of school. And then what happens. And I think this ties to our last point around the vaccines is that in that scenario, you know, in which I can't participate, you know, in. More nuanced conversation that really weighs the data. Then what I ended up trusting are local authorities and local authorities that I'm at here or cohere to my pre-existing set of beliefs to a certain degree. Right. And so I thought there was. Newsweek article I'm using this kind of by way of transition to our vaccine point, but Matt, you sent out this, this interesting Newsweek article about a woman who is, you know, very highly educated and articulate and talked about the reasons that. It was not vaccinated. And you know, she, she was like, I believe that the vaccine is important. She wasn't categorically, you know, anti-vaccine and Juan, you know, believes in COVID and wants it to end, but laid out her reasons. And what I found most interesting, you know, I think some of the reasons there, you can go point by point. And you, and I, I feel like, you know, Somebody who you could have a really fruitful dialogue with and who, you know, I might learn something from, and she might learn something from me about, you know, how do we weigh the relative risks of side effects for instance, or how do we understand the evidence that she cited about people who are vaccinated still spreading COVID you know, I think there's some really important. Around that. And you know, the way that the vaccine actually reduces the incidence of getting infected, you got to stack those probabilities. So we can talk about all that point to point, but where she ended her argument, I think is the most illuminating thing, which is that it was in a conversation with her physician who she trusted. And she didn't get this unequivocal yes. That you need to get vaccinated. And so for her that crystallized, you know, all of these little factors, like a little bit. You know, frustration about the changing goalposts or the perceived changing goalposts frustration about the CDCs messaging frustration about, you know, the government and various ways, but then it crystallizes in this local conversation and a local sense of who then do I trust. And I think that's, I don't know, I feel as if we're really encountering that in a lot of in a lot of ways. And so, you know, we, and as we know, there's just a lot of variability. Then in these local authorities you know, variability and how valid their advices how evidence-based it is, you know, and I think just in your one's desire to listen to somebody, you know, based on a whole lot of issues that maybe don't have anything to do with COVID. And so that, I don't know, I, it, it seems to me when I'm having these conversations about. Vaccination you know, and, and some pretty real stress that people are experiencing related to work and vaccine. That it's often coming down to the sense of like, who's my local authority that I can trust around this to kind of cohere, you know, all these vague feelings that I have into something that's actionable. Does that strike you guys as right? Is that something you've been seeing too amongst, you know, friends or I imagine a lot of us have kind of homogeneous work environments are more or less homogeneous work environments. Right. Where there's a lot of. You know, but, but I think for, for those of us who have friends you know, our family that span these ideological starting points, I think this has been really relevant.

Matt Boettger:

Yeah. I totally agree. I don't even think it's so much local authority, but if it just authority in general, because like, you know, it's so easy, it depends on what, you know, What's kind of the, the fat of the culture, but like, you know, if it's football, you know where to go for your authority, it might be ESPN or whatever it is. Like you got your places to go to, like, where do I need to get my information of like, what's happening and how do I make my decisions, that kind of stuff. But when it comes to. When it comes to a, you know, a pandemic, we haven't, this hasn't been a fad. We don't know where to look to. And the first thing I thought about mark is like, where's like the NCAA brackets of epidemiology. It's like, you know, you have, you have one side and here's the brackets of here's one side, here's the other side. These are all the professionals going at it, talking about how do we deal with the pandemic and begin to be able to digest it in a way. And inform ourselves versus like, I have no idea. If it wasn't for a random Facebook post by Steven in like I, whatever it was February of 2020, I would have no idea about any of this stuff. What an epidemiologist really does. And I've been informed by just my lowest hanging out. And for me, it's, it's not in the forefront of my mind. It would be okay. A doctor's a physician. So that's the end all be all. What do you think I'm done? Right. Had no clue that there was another area. Mark, you did, because you went to school for this, right? So, virology and vaccinology, all this stuff, I had no idea. It's just not even in the realm of having to even find this information. So,

Mark Kissler:

yeah, and I think it's interesting. Even just the idea of a bracket there's this, we were so deeply committed right now in in America to a competitive or kind of a conflict oriented that there are two sides. Right. And I think there's. W one of the helpful things, I think that the conversation around vaccine hesitancy is bringing up is with this reminder that there aren't, isn't a uniform reason that people are not getting vaccinated and there's not a uniform prejudice against vaccine. That it's actually is a lot you know, there's a lot of things going on there, but also this characterization that there are two sides, we're so deeply committed to that. And to these metaphors that we're using about. You know, th that are fundamentally they're, they're combat oriented metaphors. And we use that in all levels of our society right now, to sort ourselves out, you know, and sure. Maybe there's, I'm not sociologist or an anthropologist. I'm sure there's. A lot of strong tendency to sort ourselves in this way. I found it to be extremely unhelpful you know, over the last year and a half two years and I think it would be great. I, one thing I'm interested in is how do we, how do we begin our conversations from a starting place that undercuts that metaphor that says like, let's not figure out, let's not sort out where we stand before we engage. Let's engage. Something real, that matters and be really rigorous intellectual rigorous about it. But that's kind of, that's often I think, kind of pie in the sky. So,

Matt Boettger:

I think in some sense it is binary, but like, You know, for me this I over supply it, I can be over supply things, but like it's either in this situation there, the vaccine get the vaccine or not vaccine. But then like in my mind that brackets is kind of a good imagery because in, from that there's a narrative that plays out and that narrative, it gets a little more complicated as you expand out where there's, there's more, there's more nodes, there's more things. There's more complexities for reasons. Why? Because there's no one reason there's, you know, I'm not vaccine because of. Immune compromise, whatever, but then it keeps going further and further, further, and we find tons of different nuances to the reasons why, you know, there's the one extreme, the anti-vaxxers and there's the, then there's the other ones are just like, because of concern, not having the right information. And there's a myriad of reasons, right. Or those who who'd actually take the vaccine. There's tons of reasons why that mean that as you expand outward, that neural network becomes wider and wider and wider and more. You know, but, but, but it seems as if there is some common thread that kind of unites those decisions to be able to find and discover, but I that's kind of way, but not in combat. Yeah. Not in a combatitive sense.

Mark Kissler:

Yeah, yeah, yeah. I'm aware of the time and where everybody Stephen's gotta be pretty quick. Is there something else that, that you guys wanted to chat about or Steven that's on your mind this week? Thinking about this stuff.

Stephen Kissler:

Yeah, no, I think the only other thing, like, just on that last point to just echo that I've, I've also experienced I've spoken with a lot of people who have very diverse and well thought out reasons why they themselves might not have gotten vaccinated. And it really, you know, This is one of the I think difficulties, you know, again, I think about this as a statistician, as an epidemiologist, I think it's also just a real human problem with like, how do we, how do we avoid flattening narratives? And it came to mind when we were talking about the The role that the media has played in shaping some of the narrative around the pandemic. And I think mark something that you had mentioned earlier about how there is this discussion going on, even amongst. About what should we do? And yet that somehow gets flattened and distorted as it as it reaches people who are not scientists to make it seem like there's this monolithic. Scientific opinion on all things which then becomes sort of more of a moral statement than a scientific statement at some point. And I think that it's, it's really interesting. I, I don't know what to do with this, but I think that this is, you know, this is a deep Issue in that, you know, I think both, you know, both the, the media itself, but also just the platforms with which we share information can sometimes serve to amplify single messages to the detriment of, of more nuance within those messages. And make it seem like there is a single reason to not get vaccinated and that a person who is unvaccinated falls into this very stereotypical category. And we can, you know, think about that with all sorts of different things that have arisen during the pandemic. One of the really interesting things to me about this is that there's also. Concurrent major shift within the scientific community to make our research and our communication more and more open and accessible. So there's a huge open access movement in journals. We, we post almost everything as preprints. There are many scientists, key blogs where you can directly access their thinking. Many of us have been publishing op-eds in different newspapers and magazines. And so basically all of this was to say that I, I don't, I don't understand all of the issues. And and, and why, you know, why some of this flattening takes place amidst this landscape where, where it should be much easier to have direct access to the people who have been thinking about these things for long before. COVID 19 had a name So, I don't know what to do about this, but I do think that that just maintaining this, this initial stance, whenever encountering any new piece of information that that there's probably a lot of complexity that that underlies whatever message you're hearing is probably a valuable thing.

Mark Kissler:

Yeah, I think that's great. I think the last thing I just wanted to make another plug to kind of go, we didn't, of course, we're not going to break down this whole. Conversation around you know, depression, hopelessness, social isolation that's much bigger of a scope than I think any of us can really tackle. But I do think just as a, a personal plug, if I would just encourage everybody, who's listening to check. Folks around them and just be aware that I think there's a lot going on underneath the surface for a lot of people right now. There's a lot of, and so just just checking on people and making sure that we're not, you know, perpetuating this dis you know, whatever distancing that we're doing to be actually you know, interpersonal. Distancing as much as possible. So it can, it can make a big difference, I think, to look in on somebody and, and to check in. So I just encourage everybody to be doing that. That's okay

Matt Boettger:

to end this market. Thanks. You know, I kind of like a good beginning of March of 2000. Asking people again, same thing, mark. You're asked for the check in on people. There's almost in some sense, a little bit more nuanced where our habit was to be really open out and doing things. And we're being forced to being closed down. Now you've been closed down for a year and a half, almost two years. This in the most subtle way, is that reaching out with a context of leaning into human contact, again, it's like we built a reverse habit now it's been so intense. Our, our initial reaction is to stay away. And I'm not saying that if you feel like you're conscious of saying whatever that may be, but to encourage ourselves to reach out connect and now fight the urge to be isolated and begin to try to find ways to re-encounter the world, because this is not going to end at least this. Mental cycle for a long while. So there's, there needs to be another rehabilitation going on. So thanks for sharing that. Okay. That ends this episode. Glad to have mark in so thankful you could join us and hopefully you can be more regular. I know there's a lot of things going on in your life. Steven, so good to see you have a wonderful rest of your day, the conference and forever the everyone who is listening. Thank you for listening. Please subscribe. If you haven't subscribed, if you can join us to support us patrion.com/pandemic podcast,$5 a month and go a long way. One time donations, Venmo, PayPal, all in the show notes. Please leave a review. We love them and inspires us, keeps us going and reach out to us, matt@livingthereal.com. I will immediately forward that on to mark and Steven, so they can be encouraged as well and even answer questions as they come along. Take care, have a wonderful week. We'll see you in a couple of weeks. All right, bye bye-bye.