The Delta variant-variant, the eradication of the flu, Japan again, and apathy from COVID fatigue

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Things Discussed on Episode:

• We Accidentally Solved the Flu. Now What?
• All These Simultaneous Disasters Are Messing With Our Brains
• Japan becomes surprise overnight COVID success story
• Vermont Fall Foliage Report
• Centre for the Study of Existential Risk
• Flu season 2021: how worried should we be?

Transcript

Matt Boettger: 0:00

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 and I'm joined with my good

0:07

friend, Dr. Stephen Kissler.

Matt Boettger: 0:08

And if you actually watch this video, I tell, I forgot to get rid of the other empty face or Dr. Mark Kissler. Who's not here whatsoever. So we're going to move that right like this. So we're over with just the two of us. So, Stephen, I've got you on. Good to see. Yeah,

Stephen Kissler: 0:23

it's good to see you too.

Matt Boettger: 0:24

It's a, how's the weather in Boston. Can I do the normal, like a cliche?

Stephen Kissler: 0:29

I know. Yeah, it's a it's cool enough. Allie and I got to go out and see some of the leaves this past weekend, which was great. Took a drive up through Western mass in the Southern part of New Hampshire. And it's great. This is, this is a special time of year

Matt Boettger: 0:42

now. Are there any tips in that for, so those of us who are those of you who are listening, who are kind of up in the Northeast daily tips for great places to see tree, because it has here in Colorado, it's an as you well know, it's not all over. You've got to go drive to find the Aspen leaves and there's certain hotspots. Is it similar or is it just everywhere? They're just a matter of where you go.

Stephen Kissler: 1:03

Yeah. It's most places are good, at least at some point that there's this like gradient from north to south. So it gets really good, like way up north first and then it's coming down. So here in Boston, actually, most things are still green. We're gonna have little bits of color. So, so it was part of why we ended up driving up north. So there's there's a highway in New Hampshire. That's in the white mountains. That's absolutely beautiful. So that's where we ended up driving them. If you're really into this Vermont publishes a weekly foliage report and it's this newsletter it's, even if you're not living up here in the Northeast, it's the most charming thing you can imagine. So if you need a little bit as false spirit in your inbox every week the Vermont department of tourism gives you a detailed update of where exactly to see the leaves in their state. It's just wonderful. So we're going to go out of our way in your life and

Matt Boettger: 1:48

put that in the show notes, because that sounds awesome. It's awesome. Now better yet is if they have an Instagram feed, so I can be inspired every day by the foliage of of New Hampshire will be great. Yeah. We'll work on that. I'm sure with all your extra free time. Well, good. I'm glad we could connect. Again, this Monday morning, kind of get back on a regular schedule of on Mondays. A few things are normal stuff. You could leave a review. We haven't had one in a little while. We've had a couple more five stars. It was great, but no comments. So leave a comment, inspires us to keep us going. If you can support us. We'd love that as little as$5 a month at patrion.com/pandemic podcast, you can see it in the show notes or just a one-time gift, PayPal, Venmo again, all in the show notes. So Stephen it's been a couple of weeks just shy under a couple of weeks since we were on a Wednesday. And I've been perusing the news. And as you well knows, it's, it's a slow, which is kind of a, I guess, maybe a good sign. Maybe you can fill me in it's it's, it's, it's slow right now in the news on the pandemic and COVID-19 and maybe part of it is I honestly, to be full disclosure, I had. Quite as invested in checking the news every single day, a lot of things on my other life that kind of preoccupy me. But I want to get with you because you've mentioned there's been a couple of things that you've been seeing that's been surfacing. Can you give us an update on the two things you talked about? He was the vaccine, the boosters, and then any variant information that we need to be, to be known.

Stephen Kissler: 3:17

Yeah. So, and I think first of all, I want to kind of echo the, the feeling that you have, where it really does feel like there's No less than the news. And, you know, I also have been sort of like checking my usual dashboards a little bit less frequently. And and I think that that's, you know, that's something that a lot of people I've spoken with have been sharing as well. And, and in large part, I do think that's, that's a good thing we have seen largely you know, declines in cases across the year. For the most part, which is, which is great. And so, and it really, you know, the question is we're, we're coming into this winter season and there's a lot of uncertainty as to what's going to happen with COVID with flu. What do we need to do to be prepared for those things? And I think we'll probably get into each of those things one by one over the course of this episode, but you know, some of the, the major things that have come across my radar over the last. Two weeks or so as first of course, the FDA approvals of boosters or third doses, or in some cases, second doses for those who've received the J and J. And and so the, for the vaccines that have been approved in the U S so the Pfizer, the Medina and the J and J additional doses are now approved. And so there's a matter of supply trying to figure out, you know, how. To get doses to those who need them. There'll be some time that it takes to ramp up. And right now I think that while they have been approved, I think they're currently recommended for people over the age of 65 and those who are working in high contact settings. So healthcare workers, teachers people who are at high risk of in fact, So I think this is all really good news. One of the questions that I've gotten about these is that we're so far, the guidelines all have to do with getting an additional dose of whatever you've already gotten one or two doses of. And there's also been a lot of research that's come out that is still in the early stages, but I think is really maturing quickly. Mixing and matching and looking at, you know, what is the best dose to follow up and given your previous dose? There are no clear cut guidelines on that yet, but in the same way that we got a lot of information, I think it was this past week on third doses. I expect over the next couple of weeks for there to be some more information about mixing vaccine types as well. And there's a lot of really It's difficult to there, there are a lot of layers of difficulty with us because the trials of those who have received different vaccine doses are there are fewer of them because of vaccine company is not going to administer another. The vaccine to their own cohorts. So you know, a lot of the initial information we got is from Pfizer or from Medina. Whereas now we have to rely on these more independent agencies who are running their own studies for people who have gotten different types of vaccines. So that's part of the reason why the information is a little bit slower to come out, but it's coming. And generally from what I've seen certain combinations of doses do seem to be performing pretty well in terms of the duration and level of antibody response. And we've seen that to some extent in the UK too, where simply because of supply issues and the need to vaccinate people quickly, many people got an AstraZeneca dose first, and then that was followed by a Pfizer dose. And those people seem to have fared pretty well. So that's where some of our information is coming from as well. Keep the eye, keep an eye out for that kind of information coming up. So, so the vaccination is really sort of one of the big areas of news that I've seen. The other really is just sort of been emerging over the last day or two. And this has to do with the AOI for variants, which is a sub lineage of the Delta variant. And there've been some substantial increases of this particular variant that we've seen in particular, in the. I think part of that, part of the reason we've been seeing those increases there is again, because the UK is surveillance is unbelievable. And so it's not to say that it's the only place where a sub lineage of Delta might be taking hold. But they've been able to detect it and to identify the fact that this Is a somewhat mutated version of the original Delta that we've been seeing spread. So again, it's still too early to say if the mutations that we've seen in this new variant are sufficient to give it. Some escape from immunity or increased transmissibility. It does seem to be spreading a little bit more rapidly than other variants of Delta that, that came before it. And so I think there is reason to believe that it might be either somewhat more infectious or able to get around some level of. But it also doesn't seem like it's the orders of magnitude difference. Like we saw going from alpha to Delta, if it is it's maybe a little bit more fit, a little bit more able to spread. But I don't think from everything that I've seen so far and from all the commentary that I've seen from my colleagues we may see this additional variance sort of starting to. Represent more and more cases. But it doesn't seem like it's going to be nearly like what we saw with the transition from alpha to Delta. So that's, you know, that's, that's good news, but it's also something that we're going to be watching closely. We've spoken about this topic so many times about you know, just the difficulties of figuring out what makes a variant a variant. And is it just getting lucky or is it actually, you know, genetically biologically better in some way. And how does that depend on the place in which it's spreading and the population. All of those are still, you know, those same questions. I'll still hold here too. And that's why we're still uncertain as to really what exactly is going on with this thing. But it's something we're watching closely. Great.

Matt Boettger: 8:20

Well, a couple of follow-ups in this, so I'll go reverse. Where, what the most, the topic you just mentioned right now, and that is a variance. It seems as though now, maybe this is because Delta is just a dominant force. But it seems as though, like the variants have kind of, been tapering off a little bit. And for those of you who might be hearing the background, my son's kids screaming in the background. Sorry. It just happens. It's part of the life of the, of the household. So it seems like the variants are kind of tapering off. Is this amongst the colleagues who you're talking to. Is there a sense by which it's starting to stabilize or is it more of a, just Delta is just such a dominant force that there's just no other chance. And it's still like, where do you guys find yourselves and kind of landing on those areas of like, is it stabilizing or we find ourselves maybe the next six months, this is going to be kind of really being a taper off or is it just nothing has a competed quite yet. We're just waiting for it. A new dominant variant.

Stephen Kissler: 9:18

Yeah. You know, it's, it's really hard to say famously when one tries to make predictions about biology one has always proved wrong. And so, so it's hard to say, but you are right. The rate at which we've seen new variants emerging and spreading and sort of taking over has declined. And that is largely because Delta is just so contagious. It's really hard to supercharge something past something that is already so supercharged. And uh, you know, part of the reason for that is I imagine because you know, there, there are some constraints on Respiratory pathogens that use certain strategies to infect ourselves. So COVID 19, the SARS cov two virus uses these ACE two receptors in our epithelial cells to attach and then bind and then enter into ourselves. And you can get better and better at that, but ultimately they're there. We expect there to be some limit that just biologically speaking, you can only be. So sticky and you can only become, you know, so fast at invading cells. And that you know, you can explore this evolutionary space, basically you can mutate and spread and that sort of optimizes one part of this equation, but then at some point you just can't really optimize it that much more. So, so I think that that may be partly why we haven't been seeing anything emerging past the Delta. So it's kind of both, both of those things that you said. So first, you know, Delta is already so infectious. And second, because the virus may maybe starting to exhaust some of that what we call evolutionary space it's ability to sort of explore these different strategies that make it more and more infectious. But of course, you know, basic infectiousness is just one part of the equation. People I think are rightly concerned about right now is also the ability to evade immunity and virus can do that in a lot. Generally speaking, there are a lot more ways to do that, partly because Are if for anyone who's, you know, seen either actual microscopic images of the SARS, cov two virus, or even just a cartoon versions of it, it's sort of this circle looking thing with these spikes sticking out of the top. That's the name? The Corona virus stands for the crown or the Corona that surrounds the virus, which are these spike proteins that are so infectious or that are so. Much responsible for the infectiousness of the virus. So these, these spikes help the virus attached to ourselves, but they're also the first thing that our immune system is exposed to. And our immune system doesn't always recognize the bits that are most important for the virus is actual function. Sometimes the virus will just display things on these spikes and it can change those to trick our immune system, basically. And, and this is a very common thing with. So this is why we need flu vaccines every year. This is why flu can infect us year after year after year, because it's essentially like the virus is the same, but it's like, it's changing its outfit. And so it has this, you know, wide range of you know, coats and hats and sunglasses that can put on so that our immune system doesn't quite recognize it as well. And so those things don't actually disrupt the function of the. You know, the virus itself is still the same, but the thing that it looks like to our immune system is a little bit different. And so I think that's what we may start to see here, where we have the, you know, sort of this, this Delta base of the SARS cov two virus, but the variants can now sort of lead to these subtle shifts. And I expect this might be what's happening with this new AOI for variant is that it's found sort of a different coat to put on. And our immune system can't quite recognize it as well as our response. And I think that that is something that we might see. For a long, long period of time. And so if we start to see COVID-19 or the SARS cov, two virus coming into the seasonal circulation, something that looks a lot like flu, I think that this might be part of what's behind it is that it just sort of keeps changing its outfit from year to year. And that's something we're probably never going to totally be able to get ahead

Matt Boettger: 12:57

of. Okay. That's helpful. I mean, I never really made the distinction between. The variant and maybe it's a leveling off and its ability to kind of only be so efficient. And that is a separate dimension to evading the immunity. I always saw them as being one-to-one like once it kind of plateaus out. So, so is it for its immunity, its ability to skip immunity, but those are two separate variables you're saying, and that you could actually level off, but instill in her infinite amount of like hats and coats throughout the lifetime of its of its existence. Right. Okay. Alright, great. And then the other question then is dealing with this, the vaccines and the boosters. Right? Well, now that we have James J and J and, and Madrona being available for boosters, you know, I'm kinda thinking, first of all, I saw Fowchee say something about, oh, this is good news. You know, we could now mix and match. And so is it not quite available to mix and match yet? Are you just saying this is kind of the radar? Or could I go into a Walgreens and get my little menu and be like, Hey, do I want to today? Do I want the modern, I don't want the Pfizer. Do I want the Jane. Or do they, I mean, this may be beyond what you know right now. Or when you go in, do I have to show them my card and say, oh, you had the Pfizer's you're going to get the Pfizer again. Or do I, am I going to have a say, you know, right. Even right now on grant, I'm not 65 rollers. I wouldn't get one right now. Whatever, say to actually change it up by one to two at this point in time.

Stephen Kissler: 14:17

Yeah. So I think my understanding is that if you you know, Walk into a drug store. They go to your local CVS that if you are truthful about your vaccination history, then, and you say that you need a booster, then they will give you a dose of whatever it is that you've gotten before. So it's not yet approved for for a person to mix and match. That said a lot of, I do know that people have. And and I do think that that requires you to not be truthful about what you've already received. So there, you know, so that's that's in play there. But but that's one of the really interesting things about, you know, the way that we've structured our vaccination system for COVID-19 here in the U S is that there's really, there's really not a lot of oversight. Generally people haven't really been necessarily registered with individually identifying information. So the. We can clearly track exactly who's received which doses. And even if we are, then it's actually very easy to sort of subvert that system. So these are not things that I would recommend at the moment I think that, you know, the, the FDA exists for a reason and the oversight is, is, is good. But I do know that it's, it's possible to do that. But not neither recommended nor nor you know, within the boundaries of what has been approved. So, so, so that's, you know, that is all, that's all Yeah, that's all there that said, I mean, I know that. So from, from, just to sort of give a gloss over the research, I think I already mentioned this, but it does seem like, especially for people who have received and adenovirus type vaccine as their first dose. So something like the J and J and the AstraZeneca, and then have followed that with an MRI and a vaccine. Generally it's been well tolerated. Generally. They've gotten very good immune responses that have far surpassed the initial dose of the adenovirus vaccine they've gotten in the first place. So, it's not something I can recommend at this point, but again, this, these are the studies that I'm pointing to that I think we'll start to hear a lot more about very soon. Great. Okay, great.

Matt Boettger: 16:11

Okay. So let's switch gears for a second. I'm going to go back. I know probably like every four to six, maybe eight weeks now, since we're every other week we mentioned the flu and then another, another article came out from the Atlantic. About the flu, which kind of sparked my interest of the idea that the concept that maybe is the flu gone, like, are, is this kind of like not gone below? For years and years and years, we've kind of just a defaulted. The fact that's always going to exist. That's always going to dominate during the winter that we're going to have tens of thousands of deaths, you know, all these things. And so we get the flu vaccine. Now, then last year happens and we have this freakish episode by which we have almost zero flu cases. And so now we're wondering, you know, maybe in August and July, I was one, Hey, it's going to be a bad flu season because now I'm thinking. You know, not so great thoughts of like, okay, well, you know, we had a whole year where it didn't surface and now it's been underground building, you know, Dr. Evil like this, this next year, it's going to be just atrocious. Right? They've they've had more time to think about what they're going to do and it's going to be way worse. And now I'm starting to wonder, you know, because of habitual changes, because now that. You know, the pandemics going to an endemic where it's like, it's, it's going to live with us forever. So we're slowly changing our habits. You know, like of course we, you know, no more lockdowns, that kind of stuff, but you know, like things like working remotely for a couple of weeks or, you know, having school go remote for one week at a time during high, you know, high outbreaks or wearing masks here and there. So all these random things wash your hands more, just having a little bit extra space between people at the grocery store. That's not even that much, you know, all these have a significant impact. Could it be the case that like this whole flu thing is just like going to be behind us for the rest of our lives, as long as we continue down this path.

Stephen Kissler: 17:58

Yeah. It's, it's pretty amazing to me. I mean, I think that what happened to the flu last year, it was just mind blowing, absolutely mind blowing, because flu has just been such a, as you said, it's such a regular part of our experience know certainly for our entire lifetimes and for as long as you know, any of us can remember And it is a remarkable thing that globally, we basically saw no flu last year. You know, it wasn't absolutely zero, but it was historically low and basically everywhere that collects flu related data. Which is unbelievable. So I think, I mean the first thing, and I think, you know, this is, this is what you were talking about already, but it, it really did cause us to take a step back and be like, wow, like. There are things that we can do that we didn't realize would have this level of impact. And it is forcing us to think a little bit differently about infection control. I think you're right, that there are things that we took for granted that now we're starting to think, well, do we, do we have to and you know, like you said, that's not to say that we're going to. Impose all of the restrictions that we imposed last year, so that we're living in a flu zero world for the rest of our lives. But but it is a really important Testament to the fact that like these non-pharmaceutical interventions. Do something, you know, they really, they do something and we can use them in, you know, to, to reduce the burden of flu and other respiratory diseases. And and I think we really need to think critically about how, how best to do that while, you know, while maintaining all of the other benefits of living in a social society, you know, that we have So, so I think it's, it's going to be a really exciting and interesting time to think about what's what's going to happen with the fleet now. So part of the question is, you know what, what's in store for us this year, next year, and over the next five, 10 years. And there's been a lot of speculations that after the near eraser of the flu season last year That there could be a very strong season this year. And that's in large part due to our own immune systems, not so much the virus itself, but the fact that because essentially nobody was exposed to it last year that sort of timer on our immune systems that gets weaker and weaker over time is not going to have gotten that reminder that it usually. Annually or every couple of years. And so that means there's going to be a lot more people running around who are not as protected as they usually are. So the flu is going to be able to spread more easily, might be more intense for the people who do get infected because that immune response might have declined to some extent. And so I think that's been one of the big concerns. But there are, you know, there are some counter. To this too. So there was, we should put this on the show notes as well, but there was recently this writeup from a couple of my colleagues from the UK including my PhD supervisor, Julia Gaga, who has done she spent her career working on flu and its transmission dynamics. And and she's far from convinced that this coming flu season is going to be. The, you know, this big, bad, scary flu season, it could be. I think there's reason to believe that it could be. But one of the other really interesting things about essentially driving flu cases to near zero is that we don't really know how long it's going to take for it to rebound. Usually the flu Sort of spreads from the Northern to Southern hemisphere. And so even though in the up here, you know, we're in the United United States right now, I'm in the Northern hemisphere. We have our flu season during November, December, January time of year. I'm in the Southern hemisphere. It's June, July, August because that's their winter. And so even though the flu is very periodic. In our own experience, there's actually usually a decent amount of flu circulating everywhere in the world at some point. And so one of the really interesting things about the COVID pandemic. Essentially stopped to that pattern. And you can sort of, you can sort of think of this. You could sort of think of this as a pendulum in a way, right? Where if you have a pendulum that's swinging to keep it swinging, all you really need to do is just sort of poke it a little bit. Right. And, and if you just give it the slight little push, once it reaches sort of the top, then it'll keep swinging for a very long period. But if you stop that pendulum, if there's this bowling ball at the end of the string, it takes a lot of effort to get it back to the point where it's swinging back and forth like that year after year after year. And so, so we could be in a scenario like that for flute, where it might actually take some time for it to get ramped up, back to speed. I don't know for sure if that's going to be the case, but I think it's a really interesting idea. They've, they've actually done some formal modeling work to suggest that this might be the case. And before the pandemic a lot of this work was done pre COVID 19. So it was really this sort of theoretical study that was like in the night deal world. If we could just stop flu for a year. What would happen. And now all of a sudden we're living in that world, which is pretty crazy. So we're going to actually be able to see and test whether these projections turn out to be true. So, all of that is a long way of saying that I have no idea what's going to happen this year. And and I think it'll be really interesting to see what happens over the next couple of years. I think that. My hunch is that you know, the flu flu does spread pretty well. And so I, I I'm, I'm actually scheduled to get my flu. This afternoon. And so I'm planning to do that, especially because I do, I do expect this year to have flu circulation. And I think that it could be, even though it's not guaranteed to be bad, I think that there's enough of a chance that I'm definitely going to do everything I can to protect myself and the people around me by getting vaccinated. I'm probably going to be wearing a mask pretty fastidiously all winter long. When I'm in indoor spaces with others who are not part of my normal pod. And so, so that's, that's how I'm going to approach it. But I do think that it's, it's worth noting that We don't know for

Matt Boettger: 23:38

sure. Yeah. Yeah. Yeah. There's one thing I learned in physics and I know nothing about physics. I took a class in college and I thought, I was like, oh, you know what, I'm going to love physics. And I realized, I hated it because it was just too complicated for me. But there's one thing I learned and that was the friction coefficient. And that was like, that was like the one thing that stick with me because it was like, oh, this was like a life lesson. And what you just did where there's this a coefficient of friction, right. Where we know that when something is not moving. It takes so much inertia to get it to move, but once you get a going right, it's so much easier to keep it moving. And that's why I was thinking about the Fleming. To what extent did we, you know, like you just said it stopped and how much more momentum you have to exert to get it to go again. And this is like a life lesson for everybody. This is where like, not to go on a tangent and I will, I'll spend less than 15 seconds on this. I hope. And then. That goals are really, really cool. They actually don't get the work done. You know, it's, it's the habits, right? It's the tactics that, you know, instead of putting the one thing down a day to do, to actually think of a recurring 15, 20, 30 minutes of doing an area of your life that you want to look forward to so that you keep doing it to build momentum to where it becomes easier, right? Just like habit formation. So, taking this example of the flu and hope. Th the end result will be exactly that, right. It just takes too much inertia and we're going to have a a slow percolating flu season, but yeah, that's one good news. Second. Good news is guys get on some good habits, get some good tactics in and build, get rid of that friction coefficient. So that to

Stephen Kissler: 25:05

make life a little bit simpler. I think that's to turn your 15 second tangent into a 32nd one. I think, I think that that's really timely, you know? I, I was, I was just having a conversation the other day with Allie about how yeah, just, just how strange this, this year has been in sort of this it's sort of this. Appendix to the crisis where we're still sort of living in crisis, but also it's, it's like different and I've, I've personally found it really hard to get and maintain momentum really this entire year it's felt like. And so I, I really appreciate that cause it's, it's true. It's sort of like science, reflecting life, reflecting all of these different sorts of things. And I don't know. It's I think it's a message that. We could all stance to here right now. Yeah,

Matt Boettger: 25:45

I agree. I spent a lot of time this weekend working on my own life. I felt the same thing. Like I'm trying to get momentum in my life a little more and do some more stuff. And when I set goals out, sometimes they feel daunting and so scheduling out my day and just make even 15 minute blocks to do something that I haven't done for a while and do it every day. And then you find yourself 30, you know, 30 days down and feeling like, oh, this is once was a hard thing. And now you want to do 30 minutes an hour. And so. Really encouraged people. If you haven't done anything for a long time, because of just the pandemic or just life or whatever, then just seriously blocked 10 to 15 minutes. And just commit to it every day, five to six days a week, close up shop for that 15 minutes. You're gonna find yourself in a different place, 60, 30 days from now feeling better about yourself and all that jazz. So that's our life lesson for today, but, you know, continuing on with the flu for a second, now that we talked about this off. The the recording. But I really curious this idea of where you kind of reflected a little bit Stephen and myself, for sure. This idea of pandemic fatigue and just exhaustion and then not building momentum. And then I was thinking, you know, okay, I'm going to be vulnerable here. Like I'm not the greatest impact in the world. My wife is she, she really can feel for the world deeply. Right. I don't have quite that sensitivity. And it's something that I want to cultivate in my life. The pandemic did not help me Stephen. Right. Because I feel even more exhausted. I feel a little bit apathetic towards people, full disclosure, but I'm working on this. So my curiosity is, have you had any research or no. Talk to anybody about like the flu pandemic of whatever 19, 18, whatever it was that after the entire thing. So-called ended after the next crises where people are like whatever. I just don't care. I can't do it anymore. I mean, is there kind of like, any kind of studies on what, how we deal with this crisis afterwards and how we engage the next crisis? Cause you know, a little, a little careful and like, you know, next price for the guy or whatever. And then it becomes actually a worst scenario because we're like, I'm just exhausted. Is there any kind of research about this, of like how we behave?

Stephen Kissler: 27:45

Yeah, there is, and it's, it's a body of work that I'm not super familiar with, but that I I'm just beginning to dig into. I have another set of colleagues from the UK who who sort of work on the, on the social science side of epidemics and of major crises. But especially infectious disease related crises. So there's there's this wonderful in a way maybe wonderfully morbid, but I think they're super interesting research group over there called crash. And this is at the university of Cambridge and the acronym stands for the center or, no, sorry. It's not. It's Cesar C E S E R for the it's the center for the study of existential risk. And so they collect a bunch of people together who are basically studying existential risks as such. So that includes pandemic pathogens and global warming and artificial intelligence taking over the world. And, you know, all of these different kinds of things and thinking about these things as, as such but also thinking about them very broadly. Not only the scientific sides, but also the social sides. And so. A lot of their seminars are posted online. So if anybody is got a one of these slightly apocalyptic streaks like ideas sure. Feel free to take a look at this. And I, and it's actually really interesting and can be illuminating towards these, these kinds of things. So, so the research is out there and but I think that. Th this pandemic is really going to spur a lot more of it and I'll be interested to see what comes of it. But I think that for me, one of the most interesting places to look at this, that I think that we all have some amount of access to is to look at how art has changed over time. And to some extent, both art and philosophy, but I think art is in some ways, a little bit more immediately accessible in a way. And one of the things that has always really struck me is the shift in art that took place from the late 18 hundreds, early 19 hundreds to the 1930s, forties, fifties, up until the present day. I'm a. Musician. So I've, I've played the violin for a long time. So my first point of access to this was through classical music. And you can see this really huge shift from sort of the classical period and You know, entering into the romantic period of music where oftentimes there are these very lush melodies and it was very creative and spontaneous, but also had this very like clear internal structure. It it, it broke from tradition, but still like had this very strong tie to the tradition of classical music up until that point. And then you hit world war one and world war II. And also of course, the, the 1918 flu pandemic laid over the top of this and music becomes really different. It, it loses a lot of its sense of internal structure and coherence and fidelity to a tradition. It tries to express things in different ways. And it becomes a lot more impressionistic. It becomes a lot more it draws on instruments that one would never necessarily think of as an instrument. So a lot of modern music pieces have, you know, there are people banging on pots and pans, or maybe you've recorded a rainstorm. Features at some point in this piece of music famously Phillip glass writes this piece of three minutes of silence and that's all it is literally, it's just three minutes of silence and it he's composed of this piece. Right. And so, and there's this really interesting sort of anti structuralist movement in art. And I think we can see that in visual art as well, you go to any sort of art museum and the art, you know, before the 1920s is vastly different from the art that came out of. And I think that that's expressing something about a response to crisis that in a way we're still living through. I think that the it's, it's easy to forget just what an upheaval the early part of the 20th century was, and the fact that. Even though, you know, we've been talking during the pandemic about returning to normal life to regular life. I think we forget that we've for the past decades, we've, we've been living in a post-crisis world. And we're still living, you know, we're now living in a post post crisis crisis world where, you know, there's, some of these crises are layering on top of each other, but but I can't say that the world we were living in before. Normal, you know, to the extent that anything ever has been normal. And in some ways, like we've still been trying to respond and grapple with this, this major crisis that that sort of ushered in the 20th century. So I think that there'll be a lot of interesting work, sort of doing some comparative. And analysis of the art and poetry and music that comes out of the post COVID world to the same sorts of things that came out of the post world war one, world war two world where all of it is responding to each other. And, and I think it'll be really interesting to just see what happens there, because as you said and my interpretation of a lot of that art is that there is the sense of Artists sort of pushing the boundaries of of, of the assertion that I can do whatever I want and, and call it art. And that's not, that's not to diminish any of this. I think that that's actually a really remarkably artistic distillation of what's happening or where it's like, really pushing the boundaries of what's possible to be called art. And that's really interesting question. And, but I do think that in some art there's also this Almost nihilist streak to where there's the sense of almost playing with the idea of structure and meaning, and sort of using art as a vessel to say that those things don't actually exist in any sort of substantive way, but I don't think that that's a necessary corollary of living through a crisis either. I think that crises can have both. Obliterate our sense of meaning or they can intensify it. And this seems to be embodied even in your personal sphere, in the responses that you and your wife have potentially felt as well. And then I think that many of us have felt with our friends where, where some of us have been tempted. To hopelessness and a sense of lack of meaning and this feeling of, of real despondence in the world and its state and others have been really spurred to action and charity and love for the other and solidarity from. You know, people who may have never really considered these things or may have only done so on a theoretical level before the pandemic. And it's really interesting because we have all of these little internal responses that are going to be integrated and emerge as this cultural phenomenon. And I have no idea where that needle is going to land. But it's going to be really interesting to see, and that that's one of the things that I'm really excited to pay attention to over the next years. That's

Matt Boettger: 34:03

great. You know, now this is beyond my pay. Stephen and all these are listening, but I've always felt, or not always felt. I felt recently in the past few years, like music and art at least made for me, I'll state just for me and maybe not. So prescription is a descriptive reality and film is a prescriptive reality. It wouldn't mean by that is like for me, music helps me feel my current circumstances. That's that that's that there's a play that for that reason or the field to do more, describe of what's going on in my life. Whereas film. Is more prescriptive, prescriptive, like how I want to be. So w I think about this, I had this philosophy that like, like in calm seasons in America, in the U S right when things are relatively stable, Not like this past year, maybe, maybe when I was growing up in the nineties and things were like, cool. And grunge was all over the place. Right? So that, that the movies for living for me, I would get like, I, you know, I it's chill. It's relaxed. So the movies were. Hydroma high conflict, all the stuff to reflect the opposite of what I was feeling in some sense, like to cultivate motion because my life was so Alexa days a call. Right. But then in high conflict, high situation, at least I can feel in the pandemic. Right. The last thing I wanted to watch is high drama. I wanted funny humor, relaxed, hopeful, inspiring, right. I'm looking for something. On the opposite end, right. That whatever I'm in. And I'm just, I'm just curious if I wonder if that's how even sometimes filmography is actually done, like you're in it, maybe in a war time, you're trying to put out films that actually inspire and uplift and are lighthearted. And during calm times you get war scenes. So it to like evoke that emotion that you're not really feeling. Totally up. So I might pay grade, but that's how I feel anyway about when it comes about how art and film, and maybe at least maybe that's not how it's actually produced, but that's how I digest it. At least in those. Thanks for sharing that, Steve. And I appreciate that. That that's some really great insight. I think we're going to end here one small thing, cause it's only takes a minute. I saw this mark talked about it two weeks ago. We talked about the Japan article that I, that, that I had given him that was probably published a year ago. This one came out recently again, which, which is, I think quite, just ironic stating the same thing. Japan becomes a surprise overnight COVID success story, right? July, August, September, they're being slammed. Maybe partly because of the Olympics, probably because they had low vaccination rates. And then out of nowhere, they're re the, the cases just plummeted. Once again, Japan has just been coming this shine light of being able to deal with COVID and they haven't been dealt, you know, not through lockdowns. Granted, we, as I shared with you back in July, it was like 10% vaccination rate for Japan. Now, as of October, I think it's 75%. So I'm guessing that's a little bit of a game changer when it comes to dealing with infectious disease. But do you have any, any thoughts before we close up on that particular story about Japan being this shining beacon of hope for dealing with the infectious disease, like COVID outside without having to do that.

Stephen Kissler: 37:01

Yeah, and I think it's, it's really inspiring and amazing and impressive. And at the same time, mysterious and confounding, and I, you know, it's really hard to know what this is what's happening here. I think that one of the areas that I'm also really interested in digging into in the coming years is just, how do we make sense of the vast. That in, in how different countries responded and in how they fared in terms of their, you know, the pandemic, because it it's clear that certain interventions did have certain effects, but it's also clear that there's not this perfect one-to-one correspondence. And I think part of that is because of how everyone is so interconnected. But I also think a big part of it probably has to do with these really subtle unmeasurable or at least so far on measured, but very difficult to measure elements. Play into infectious disease control as well. So one of the points I often like to bring up is that you know, we often look at mass mandates and lockdowns as these, you know, interventions. But if you actually look at how people behaved during and around those times, people were changing their behavior long before any sort of lockdown for what was horrible. And meanwhile, people were also changing their behavior in the opposite direction long before those lockdowns were actually lifted. And and so there's this really sort of porous divide between, you know, the things that we can measure, the things that we can identify as this is the beginning of a new thing. And. The actual underlying things that, that affect the spread of disease. So w you mentioned the vaccination rate, so first and foremost, yeah. That's, that is a huge change in vaccination rates in a very short period of time and increasing the number of people who are vaccinated. We'll go a very long way towards reducing the number of cases that are around and preventing people from getting really sick in the first place, which also really helps to bring the observed case counts down. But to me, one of the even more striking things about that is that they were able to do that, that, that, that in Japan, in this very free society that. There was that fast, a vaccine uptake once they become once they became available. And so what that suggests to me is that there's this really interesting. Culture as well, that is amenable to being vaccinated and to doing so very quickly when there arises a need. And so that I, I can't help, but wonder sort of what other small scale decisions are being made on a minute to minute basis for people who are making choices to protect themselves and other people in a way that makes it so that there's this emergent qualities such that Japan has actually fared much better than many other countries in ways that are really difficult to measure. Take place in this fear of policy and have these grand scale interventions that were so attracted to in the Western world. But in fact is probably an entirely different implicit cultural philosophy of contagion and of cultural responsibility and of hygiene and of all of these other things that that are a lot more nebulous, a lot less hard to pin down or a lot harder to pin down. Probably play a profound role in how COVID actually behaves at a given place. So, yeah, so that's, that's another very complex way of saying the same thing I always say, which is that I don't know. But but that that's, that's, that's where my thoughts are sort of pointing. Yep. That's great.

Matt Boettger: 40:11

Yeah. You know, there's so many things I want to say with this. I don't want to keep us too much longer, but. Number one. I saw an article in the Atlantic about, you know, the U S and the dine sense of the pursuit of the common. Good. I don't want to make that a trite reality. I know it gets becomes complicated, but I do see that as a general trend and that's, it's always been the case for the U S because we come out of a rebellion, a particular abelian of being. Dominated. Right. And w and so, per sir, the pursuit of individual freedom has always been a hallmark trait, which is a wonderful trait, right. But when it's a clips to not accentuated and complimented by the pursuit of the common good, it becomes a very difficult reality and self-centered, and becomes hard for everyone. Now I have to ask this question, even though it was on the docket, we didn't get through. It's a loaded question again, and it probably takes a lot of time, but you mentioned it kind of at hand, when you said how, Hey, Japan, free society do all the stuff that, you know, just it's a cultural reality, but then we have the U S we have vaccine mandates, right? It's a different, a different reality, right? We're trying to enforce this law. And I wanted to ask at the very beginning, like if you could, without being political, if you could rate your response to the white house currently, not through necessarily public policy or like, but as a scientist, like, you know, trying to do the best to bring about the best laws and guidance how would you grade it in light of, you know, this, this crazy reality of trying to get mandates and get people vaccinated? Where do you sit in?

Stephen Kissler: 41:32

Oh boy, it's, it's super complex. And I think that, you know, it's tying into the discussion that we were just having is that you know, the white house is, you know, in, and our, our government and political system more broadly is certainly an element of the response, but also is not the end all be all of the response and that You know, we can think about the white houses or, or like our government, you know, I think it's easy to think of it as sort of this almost like this, this head that is dictating the motions and movements of the body, but in many ways, Politics and government is, is, is an emergent quality of this culture that we already have. And so any, any grade that I pass on our, our current government or our government more broadly is also a reflection of the culture that we live in and, you know, the individual decisions that we all make as well. So it's, it's really difficult. I don't think that I can give like a you know, a specific rating, but that I can sort of highlight some of the things that both This administration and the previous administration have done well and have done poorly from a scientific epidemiological perspective. So, I mean, coming into the pandemic, I think that I was, I was extremely frustrated at the slowness at which testing was encouraged and made available. I think we we were unbelievably slow in, in improving our resources for testing. And I think that we put Yeah, it just really just put too much single-minded faith into developing a vaccine. There was really poor messaging about responsibility for one another. And the really just like communicating this very clear sense that we were in a very bad situation, which as epidemiologists, we were all pretty certain about. But but it was never really clearly communicated, but on the flip side, by, by putting so much emphasis on a vaccine, A lot of the work that the previous administration did really helped us to get vaccines as quickly as we did which was a surprise to me and to many of my colleagues that they, you know, came about so quickly. And of course that's not. Just the administration that is also, you know, the scientists, we were also poised with MRN technology that has, you know, the research that has been done over the past decades. So does not, you know, certainly not the single handed success of the administration, but also, you know, a lot of the funding that the administration poured into that. Did help produce in particular, the Pfizer vaccine. Right. And and that's been one of the major success stories of the pandemic now transitioning into the current administration. I do think that the messaging has been a lot more on point with with, you know, what, what is needed for Just mounting a rational public health response on a, on a large perspective. But honestly the testing has still been slow. I say it's really nuts. And you know, finally, you know, just recently there was this announcement that the administration was going to put a lot more funding into rapid tests, which I'm thankful for. It's great. So hopefully we will be able to pick up rapid tests a lot more easily. It'll be cheaper. But good gracious. Like how did it take this long? And and so I think that there have been you know, a lot of, a lot of promises that I was excited for that have taken a long time to come to fruition. I do think that one of the things that this administration has also done well is. Making vaccines rapidly and widely available and really ramping up our vaccination efforts, especially early on. But of course, we've, we've hit a bit of a wall there too. And now there's this really sticky question as to how, how to encourage vaccination. And that then becomes a question that is no longer a scientific and one that I don't know how to answer.'cause you know, there has been a lot of movements towards vaccine mandates and I don't know if that's the right option. I think that that really gets into, you know, I think that increasing vaccination rates is, is something that we ought to be focusing on as much as possible, but how we do that is gets into so many really sticky areas of culture and freedom and social science and all of these things that I don't even begin to know how to comment on. So, So it's mixed, it's mixed throughout. And boy we're going to have a lot of work to do in the coming years to figure out how to streamline all of this stuff. The next time one of these things comes around. Absolutely.

Matt Boettger: 45:23

Thanks for sharing Stephen. That's good, good insights and fair analysis. Thank you guys for listening. We'll be back every two weeks. If you want to leave a review, please do apple podcasts. There's probably another place you can do that as well. Love to see them support us patrion.com/pandemic podcasts. One-time gift Venmo, PayPal on the show notes. If you're gonna get ahold of us on Twitter, S T E P H E N K I S S L E R. And by the way, I read an article the other day that said that most of this whole. Like scientific discourse was done through Twitter. Like all the big leagues like that. That's probably the main places where, which they, you could see it unfold, not on Instagram. So if you want to go on a Twitter and kind of see all the latest going on, you can

46:06

also follow Stephen as well.

Matt Boettger: 46:08

And a, sorry, you can hear a ghost in the background because my doorbell just rang and it's a Halloween one. Sorry about that, guys. The boys are out playing with the doorbell. But so you can, or you can email us matt@livingthereal.com and give us a little note, let us know how you're doing, what's going on and how we continue to support you have a wonderful week. I'll see you guys in two weeks, take care and bye-bye.