We know a lot more about Omicron now and there is some good news

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Things Discussed on Episode:

• Did Covid-19 Cause Flu Strain to Go Extinct?
• Expert made eerily prescient prediction about Covid. See his new prediction
• Why Are We Still Isolating Vaccinated People for 10 Days?
• Success of COVID antiviral pills hinges on speedy, accurate tests
• We Know a Lot More About Omicron Now - The Atlantic
• Pfizer says booster shot of its vaccine protects against omicron variant
• What makes boosters more effective than the first two Covid jabs?

Transcript

Matt Boettger: 0:00

You're listening to the pandemic podcast. We equip you to live the most real life hospital and the face of these crises. My name is Matt Boettger and I'm joined not with four, three other people. If those of you who are going to watch this, actually, there was two other places for two of the people that we're not going to have on today, but I'm with my one good friend, Dr. Stephen Kissler, an epidemiologist, the Harvard school of public health. Good morning to you. It's good to see again,

Stephen Kissler: 0:20

buddy. Good morning.

Matt Boettger: 0:23

Oh man. Well, you know, if you hear a bunch of buzzy and sound my background, I apologize today. This is not normally the case. It is now December things are actually starting to cool down. And my wife just told me she's freezing upstairs. So there's none negotiating on the heater being on right now and I'm in the basement. So I'll do my best to filter it out. But I got to put my priorities first and put you guys second. So that's the way it is. It's been two weeks. Last time we talked, you know, Omicron was like relatively new. We were talking about, Hey, how was Thanksgiving? And it was great. And well, you know, you're, while you're having your meal, you saw all these news, like percolated about Omicron. And it came on fast and quick and it was unknown and we were like, nervous about it. And what could it be? It sounds like within two weeks we got a fair about of news. Now, granted things could change pivot at any point in time, but we got a good amount of news to talk about an update about the Omicron, which seems. Generally, it's pretty good news, but we'll talk about that in a moment before we get going, the normal stuff. If you're listening, it's your first time listening. Welcome to the show. If you're not, and you've listened to us for a while and you haven't left a review, please do so. It'd be great. It really helps us leaves us, inspires us to keep this going. We just got another one in November 29th is the day our last one aired from DCB, J C N J. All right. That's that's that? That's his, her name I've been listening to throughout the pandemic and I've been remiss. I have been remiss is not leaving a review, right? So it has been fascinated to hear an epidemiologist SKUs. What he's learned about a novel virus in real time. It has also been reassuring to receive useful actual advice on living, living life and managing risk during the most significant global crisis of my lifetime, the information is delivered clearly and without the hysteria sensationalism we get in the headlines. The format, a conversation between a lay person. That's me an expert is gaze Katie to never drive as we head into Omicron winter, which I like that. Oh, Cod winter. It seems like we just, it was, seems like it was just Delta summer. I looked at tinny to rely on the podcasts that stayed in. And take reasonable steps to keep myself and my partner safe and healthy. Thank you so much for that

Stephen Kissler: 2:27

review. Yeah, that's great. Really appreciate that. It's I'm glad that somebody enjoys learning about this on the fly with me, because sometimes I feel like I'm stumbling around in the dark. So

Matt Boettger: 2:37

I feel, I feel like we need to get email addresses to be like, you know how when you go into like, okay, I didn't even get this Stephen, but you go to a graduation ceremony and somebody gives a talk. There's a Tim honorary doctorate you're given, right. All these honorary doctorates, like for listening to you, we should give like a little certificate of honorary doctorates to everybody who listens because just listening to you and getting our own educated. Understanding of what's going on. So thank you, buddy. So, oh yeah, you can support us financially. patrion.com/pandemic podcast. Little as$5 a month goes a long way. It helps a lot. And as well as one time gifts, PayPal, Venmo, all in the show notes. I think that's all the good news. Get into a few things. First thing before we get into COVID, every once in a while other things fall in the news now eventually cover, it's going to go from a pandemic to an endemic and the news is not going to be so sensationalized and we'll move. Hopefully this podcast continued going maybe every other week and do other topics, that kind of stuff. So it's good to kind of get familiar with other things as well. Stephen, you're an expert in the flu, right? Because this is kind of like your, your whole PhD and every once in while we, we see this stuff, resurfacing, its ugly head. This one is interesting. I saw this article, Satan did COVID 19 cause flu strain to go extinct. So I read a little bit more about this. This is a guest, the influenza B Yamagata lineage. I don't know anything about this. I just get my flu vaccine. Call it. Good. What is this? I know how much do you know about this? What does this mean? And my biggest question is, okay. I didn't even know how many lineages, so there's four apparently. Right? So maybe, maybe we're down to three. Does this make vaccines easier and more effective down the road? If we knock out one

Stephen Kissler: 4:17

lineage? Yeah. So, I think that the, the potential extinction of this particular influence of B strain is it's interesting on a couple of different levels. So to take a step back There are a lot of different varieties of the flu that circulate that we can the ones that currently circulate or at least have circulated up until recent memory can sort of be split into four large classes. And they are two types of influenza, a, which are somewhat closely related to each other. And two types of influenza B, which are a bit more distantly related. From a, they sort of clustered together. And the designations of these things largely have to do with how the virus looks on its surface and therefore how our immune system responds to it. Someone that a there's the AA slash H one N one. So you'll remember the 2009 swine flu pandemic was an H one N one variety. So this is pretty much a descendant of that. And then there's also an a H three and two strain, which would circulating prior to the pandemic in that. And that the 2009 pandemic didn't manage to displace which was interesting because in most previous pandemics, the, the previously circulating strain has been displaced, but now we have this sort of coast, circulation of two eight strains, and also to be strains. So the bee Victoria and the bee Yamagata strains that that are sort of. To the a H one N one and the H three N two. So I think that the one that you had mentioned was this B Yamagata. Flu strain. So when we get vaccinated against the flu, we often get vaccinated against multiple strains of flu at once. So up until recently, it was usually a tri Vaillant flu vaccine, which was usually against two types, both of the, a types and one of the B types. More recently there have been a quadrivalent flu vaccines that have been protective against all four varieties. But now there's this question of, you know, are we going to see this this flu B strain continue to circulate. With the non-pharmaceutical interventions and with whatever else led to the reduction in flu cases, it seems like we haven't really seen much of a resurgence of this particular flu B strain. While we have seen circulation of the others around the world. So we think that this flu string, if it were around would have the opportunity to spread, but we haven't seen it yet. So there's a possibility that it may have gone extinct, which is interesting. So I do think that it would help with vaccine formulation. It would mean. You know, be able to go back to a tri Vaillant flu vaccine, which would make it a little bit easier to produce it would make it so that you know, there are fewer chances for an a mismatch between the vaccine and the thing that's currently circulating to cause more disease. I do think that the games would be. Marginal. In my understanding the most of the flu that we see is due to the flu a stream. So H one N one N H three and two are the things that really tends to cause a lot of the disease. The B strains do cause quite a bit of disease as well, but really the, the A1C seemed to be the ones that are sort of the most robust spreaders. And so while it would be helpful, I do still think that the other strains may well just sort of fill in that. That's provided by the absence of this other strain, but definitely for the sake of producing vaccines more quickly and more effectively, I do think that it's a, it would be.

Matt Boettger: 7:25

Great. I kind of assumed that I'm in Australia, went missing all of a sudden, I'm guessing it's probably not the strongest one available right now. So it's not going to be that much of a difference, but Hey, it's like a little supplement gives us a little bit of boost. Okay. Helpful information. Let's get into the COVID stuff. Now, before we get into Omicron, which is kind of a big topic, there's a few other things I came across in the past few. So we we've talked about Dr. Ostroff and how respected he is. And he's been back in the news again because of his prediction, like 18 months ago or whatever it was he predicted within 18 months or so about 800,000 deaths in the U S and crazily. He's almost like spot on. He might, we're not even at quite the 18 month mark, maybe we were a few weeks away and we're probably about 7,000 short from that prediction. So he's back in the surface, in the limelight of the news. And one of the things that he mentioned, and now I just wanted to throw it to you to accept even what this means. And it was a short blurb on a video. And he talked about the distinctive, the distinction between two types of surges. Recently, we know, we know the India surge and we're all avail, or we are really, we don't last, last summer, we talked about this and how it was a significant spike went really, really high, but then it plummeted quite quickly. Once it reached its spot. And then there's the other version, which is kind of UK, I guess, which is experiencing, which is again, a spike, maybe a slight. And then maybe then resurrect its ugly head and then continuing like this, a spike for a long period of time. Now he had juxtapose this with the U S saying this summer, the Southern us seemed to represent the India version. And now we're seeing which I was unaware. The Northern part of the U S is experiencing kind of UK version. This is that kind of spike and then sustainable. Now maybe you can help parse this. What does this mean? Is, is, is there a way to understand this and predict this? You know, my, my, my thing is, oh, it's just, again, I'm a lay person. So I'm like, oh, it's just simply a matter of time where, you know, in the Southern it was all Delta. Right. But in the now when the Northern's heading well, it's Delta now Omicron. And so maybe that's the reason why it's simple as that, or maybe it's more complicated. So what does this mean for us and for people who are listening about these types of.

Stephen Kissler: 9:35

Yeah. So, I love this question because it gets at a lot of sort of fundamentals of infectious disease transmission. It also uncovers a lot of what we don't really know. So, so this is this is actually an area that we in, in, in my research group are beginning to look at in some detail to try to understand sort of what leads to these pretty different experiences with the virus across different places. And. How long will it take places to sort of synchronize in their experience or will they ever, because if we go back to the example of flu most of the U S for example, and really basically temperate regions across the globe are pretty well synchronized where we have our flu outbreaks during the wintertime. And there's a little bit of variation in timing, but nothing like what we've been seeing with the experience of, you know, these major surges followed by huge declines relative to sort of this sustained degree of transmission. I think there could be a couple of things going on, you know, the, the first and most obvious element that we don't really have a clear sense of how to measure it, how to account for just. Differences in human behavior. And so we know for sure that you know, in, in the Southeastern United States the indoor season tends to be the summer, whereas in the Northeastern us, it tends to be the winter. And so, when people spend time indoors versus outdoors and what the relative fraction of time they spend indoors versus outdoors could play some role in this. And that could help to explain some of the differences between The differences in the experience of the virus in places with different sorts of climates. Some of it may have to do with underlying immunity and the degree to which things like non-pharmaceutical interventions have been put in place. So, I've been trying to think of a good analogy for this, but you know, you, you can imagine that You know, I'm, I'm trying to think of something like, almost like when you're bouncing a basketball, right? Like if you if you throw it at the ground, it'll keep bouncing. For awhile. Whereas if you sort of gradually drop it to the ground, it's going to take a much longer time to hit the ground, but it'll just sort of like gradually get there. And one of the things that you can see with infectious disease dynamics potentially that could be going on here is that in places that suffer a really major surge they basically synchronize the immunity of everybody in that population. And so then as immunity wanes, That basically everybody sort of has the same degree of immunity and you could reach this point where all of a sudden there can be this new explosive outbreak, whereas in a place that has a buildup of immunity, that's much more gradual. You may end up with sort of this asynchrony between people and their immunity. And so because of that, there's sort of these people who can get reinfected at different points in time, but it's just sort of this much more gradual kind of transition to an endemic virus. So that could be part of it too. And one of the things we're trying to ask with our, with our research is, is to what extent could each of these things we contributing to these different sorts of trajectories that we see in different. Hmm.

Matt Boettger: 12:28

Okay. That's helpful. Yeah. Yeah. Cause I was unaware of that. I know Colorado, we're still kind of slowly coming out of our surge has been kind of a little bit ongoing and not quite as fast as a plummet, more sustainable for us. It's it's I think it's harder because it, you know, again, it's the environmental, environmental parts of, of our state where generally we've been having a pretty warm fall. So we've been outside more is starting to cool off. So I could see us having a greater sustained. Levels now. Totally random. I have Fred thrust in the show notes, but Polis our governor. Totally. I didn't even, I didn't even tell you this. This is a bolt. I don't know if you saw it in a news. He made a bold statement. Maybe not bold, but he was just like, it was good. I think where he, you know, we're seeing a surge of the, of, of, of the virus here and, and he just kind of said, look, I'm not gonna do any more state of emergencies I'm done with these. Like, he's like, Everybody's had a time to get the vaccine by now. It's been long overdue. Now. Boozers like, you know, basically if you don't want the vaccine, then you're playing that game. Now. It's like, there's been wide availability, right. And we've had them all over the place. We've you can get them at Safeway. You can get grocery stores, you can get them at, at clinics. You can go to outdoor events. We've did our best to make them widely available the whole state. Now it's to the point where. I'm wiping my hands clean. I'm no more state of emergencies now, local levels. They can do whatever they want, feel free, you know, port about counties. They can do whatever they want, but as a state level, that part is done and it got a lot of press and over the past couple of days, and you know, my intuition is felt like that's probably a good, a good decision at this point in time, you know, it's, it's now just like, if you chose not to get the vaccine, now he told him knowledges, of course you can get breakthroughs with the vaccine, but it is much more rare. He said, this isn't about. And our hostels right now, I think only 16% between 13 and 16% of those hospitalized are vaccinated. Right. So we're talking about the overwhelming population run backs. So, so we're seeing the sustainability right now and now things are starting to cool off. You can hear my heater in the background, right. That people are going to more indoors, so I could see it then continuing a little bit longer in those kinds of things. So, yeah, that's helpful. Okay. It's let's continue on. One thing I wanted, we talked about, and this might be a short conversation. I saw this Atlantic and not quite sure why they posted this article because to me it's helped. She seemed really relatively easy answer said, why are we still isolated vaccinated people for 10 days? I just had a friend who, who is vaccinated got COVID and, you know, asked to be quarantined for 10 days. I haven't really thought much about this. I'm like, okay. Yeah. You know, because even though I've heard things. Oh, and you're vaccinated. You can shed the virus quicker. You're contagious less. So that makes sense of being, being quarantined for less. But we also hear that there are people who remain contagious for, so I'm just assuming we just say 10 days because Hey, some people are still contagious, but is there, is this more nuanced than I'm actually thinking? Is this something that the other discussion like, Hey, we should, we should knock this down for people who are battling.

Stephen Kissler: 15:23

Yeah, I think, you know, I think you're right, but like, from, from what I've seen, you know, we've, we've done some work that suggests that that people who are vaccinated may clear the virus on, on average more quickly, but you're right. Like there there will be some number of people who still retain the virus and are still infectious for a number of days. And sort of that tenant. Sort of captures the range when we expect people to be potentially infectious to others. I didn't get to read the article, but I I w I would actually maybe even go a step further and say, you know, why are we isolating anyone for 10 days at baseline in, because what I think we should be doing is. Using tests to spring people from isolation. So I do think some people will need to be isolated for 10 days or even more if they continue to test positive on a rapid antigen test which indicates that they may be infectious. But I do think that we could probably spring a lot of people vaccinated or not from their isolation period. If they have a sequence of negative, rapid antigen tests, suggesting that they're past their infectious period. And so I think that there are ways where we can be. Smarter about this, using the tools that we have available to reduce the amount of time that people are in isolation and isolating is pretty disruptive. You know, it's like, I think when we, you know, when we think about it, like, you know, okay, like 10 days you get COVID or whatever, you know, like, but But, you know, for family, with kids, I for anybody, like when you actually think about like being stuck in your house for 10 days, like it's not fun, especially if you're like feeling okay. And and so it is important for reducing spread, but I do think that there are a lot of things we could do given the technology we have available to reduce the isolation period to only the span of time that it needs. Great.

Matt Boettger: 17:06

Well, that's a perfect segue because we're going to continue this discussion right now with that in light of the holiday travel, you said you just did a Q and a live Q and a about holiday traveling. The reason why I think it's the perfect segue is I'm guessing these tests might be part of the equation for good holiday travel, because so maybe first talk about like what you talked about and how to prepare for holiday travel. Do it safely, be able to see your friends and family. And I want you to dovetail this with what we just talked about. That if for instance, you do get COVID right. How could you use antigen tests to then best conclude that you're okay to go out. Cause we know they're not perfectly effective. So do you couple them with other things, do you do two every other day? And then we get to natives. How do you, how does that formula fit into like check off the box? Hey, I just got COVID it's 10 days before Christmas. I'm able I'm I'm okay to see my

Stephen Kissler: 17:55

grandparents. Yeah. Yeah, so. The taking the first bit about sort of, how can we think about holiday travel and gatherings this year? In my advice, even in the context of Omicron is pretty similar to what I've said for holiday gatherings before, which is sort of in this order, you know, get vaccinated and get boosted if you're able Then I think a lot about ventilation, make sure that windows are cracked. Fans are on, maybe even have a air filter with a HEPA filter in it. If if that's within your means and leaf blower, maybe a leaf blower turn on that leaf blower. Yeah, that's right. Why not? And yeah, and then take rapid test before. So one of the things that I didn't realize until this week, but it might be useful for a number of our listeners who are out in Colorado that apparently. The state makes rapid tests available for free that you can get repeatedly. So I thought originally this was just a one-time thing, but I do think that you can get basically four boxes of the avid by next. Now is I think every week or every other week, you have to go on online and sort of fill out a form. So it's a little bit of a pain. But it takes about 10 minutes to get you know, like four boxes of rapid tests every week. And I think that that's, you know, that that's what we should be doing everywhere.

Matt Boettger: 19:10

I did that. It's great. Like, I, I, I, it's a little complicated cause I signed up me and I thought I was doing my family, but I guess each in a person, each individual person has to sign up. So if you have kids, you sign them up. So I just signed myself up, got two boxes right away, and then I'll send the rest kids. I'll put another six boxes and keep them coming. So it's pretty great. Great, awesome thing to have on

Stephen Kissler: 19:30

hand. Yeah, it's wonderful. Yeah. Yeah, no, I think, that's, that's great. And so, you know, now is the time if you haven't gotten them yet, you know, get some of these rapid tests and take them before your gatherings take them before you. And you know, I, at this point to travel, I think, I think you need a negative test within 24 hours. And so the rapid tests are really helpful for that kind of thing. And I think that all of those things even in the context of Omicron can go a long way towards keeping us all safe. I think that, you know, Omicron is definitely coming. We're starting to see increases in the proportion of cases that are Omicron, especially here in the Northeast. It will spread across the country. My hope is that here in the U S we w that the, the major OMA Crohn's surges we'll wait until just after the holidays to really get rolling. But right now we still have a lot of Delta around to, you know, it's like, oh, Macron is not the only thing to be concerned about at the moment. We've got a lot of Delta spreading at the moment to But whether it's still to Oroma Cron, all of these things do seem to be helpful towards preventing spread. So, so that's, that's what I would suggest now, if you do get COVID I think that you know, certainly, you know, continuing to test to see when you test negative repeatedly, I wouldn't to spring yourself from quarantine. I wouldn't trust a single negative test. I would probably trust two negative rapid tests three even better. And so, you know, that's, that's already a lot of tests, but, but mainly what I would say is just, just talk to your doctor because at this point, you know, they'll be able to, to guide you through your own particular situation and that there's so much nuance. And that has to do not only with, you know, your own medical condition, but the people you might end up seeing and the amount of spread that's happening in your community at baseline. So I don't think that there's any sort of hard and fast rule that I can give to everyone that will apply on all of their situations. But I do think. Between all of the conversations that we've had on this podcast about rapid tests and sort of, The role that they play, that they don't give you certainty either way, but that they do increase the odds of, you know, your actual scenario lining up with what the test is telling you. And and so hopefully between all of those discussions, you know, people will be able to interpret the results of their tests in a way that is is useful for whatever, whatever context they're in this holidays.

Matt Boettger: 21:42

Great. And you helped me because we were wondering if we had, you know, just being safe before we see my mother-in-law couple weeks ago. And he suggested which was helpful because obviously those engine tests aren't a hundred percent and never will be nor the PCR ones, but take not only two different tests, if you can't from two different manufacturers, just a. To help that that'll help as well to continue to increase your odds of having the right conclusion. So that was helpful. You really want go out your way by two different versions and then you can, it just, just helps even more to feel a little bit, a little bit better about the conclusion. So I know Alma Crohn's on our, on our minds. One more thing, because this is related to the engine. We didn't talk about this two weeks ago. The antiviral pill is coming out for COVID is a super exciting, because gosh, it's just a reminder. Like something about like 80 some percent prevention of, of hospitalizations. It's, it's, you know, it's on the verge of like, like the vaccine, right. But except for you already, you get COVID first. And it, and it makes you better quicker. This is exciting. Maybe come out in January. I'm not sure who it will be available for how readily available it'll be. But this hinges again on the same thing, because kind of like that Tamiflu for the flu, I think same thing had to take it pretty closely right after you have symptoms. Otherwise it's not nearly as effective. Same for this. I like this pill. I think it's, it's a marker. I'm not sure what it is, which one it is that it's, that it's coming out. But

Stephen Kissler: 23:04

there's there are two we can get into that in a moment. Okay. Yeah,

Matt Boettger: 23:08

but then, yeah, but I think it's within six days or five or six days of symptoms, you have to take it otherwise not nearly effective. So you've got to have these things on hand ladies quick, or be able to get a PCR test really quickly. If you want to take this, these pills and really lessen the symptoms. So Carrie, you can fill in the blanks. Yeah.

Stephen Kissler: 23:25

Great. Yeah. Yeah, so. To my knowledge there are there sort of two of these antiviral pills that are coming out. So there's one that's produced by Merck. And one that's produced by Pfizer. So the interim results from Merck were looking pretty promising, but actually they're their conclusions from the final trial where. Okay, but not as good, maybe that it was like 30% effective against hospitalizations, but the Pfizer one is looking much better. I think that may be the one that you're referring to here where it is like on the order of 80 to 90% effective against preventing hospitalizations, which is incredible. I think it's, it's really worth taking a step back that like with both. Like pharmaceutical drugs and vaccines, like something that can reduce your risk of hospitalization or death by that much is like, that's pretty amazing. And so, I think it's, it's wonderful that we, that we have these things. The available and we'll have them coming online very soon, but, but you're right. The, the, the difficulty as with Tamiflu is that you need to know if you've been infected pretty early on because you need to start taking the drug within a couple of days after really after infection. And yeah, basically the sooner you get on them, the better chance they have to work. So, so that really just, again, just underscores the need for testing and for it makes it all the more important to do the sorts of things that we've been hoping for, that, you know, people might test themselves with a rapid antigen test frequently so that they can know. And and so I do think that, you know, again if you do start showing symptoms, get tested as quickly as you can. And and that will really help to not only guide your own behavior, but now to guide what sort of treatment you might get.

Matt Boettger: 25:03

Yeah. Yeah. I This is where it gets also just crazy complicated because like COVID symptoms, colds, RSV, flu is like, they all have the same kind of symptoms. So. You know, you could have the sniffles for a day, it could be allergies. And like, you know, at 1250 a pop for an antigen test, unless he got a big budget, it's hard to like, okay. Oh, you know, I fill in a little Steph folders, probably just get checked, you know, do Andrew tests. I just, I'm just hoping he seems to come down like another 80% where, you know, you can take these and then quickly be able to. You know, start tickets like this, just to be on it's an insurance policy. And by the way, I got boosted on front Thursday. So I've got my booster, Madonna and pre-fill and pretty excited about it. Didn't really affect me much. I know it laid you out Stephen, but it didn't do too much for me. I felt a little fatigue, but I'm not fully, still hasn't fully wrapped up my system, but I'm feeling good about the next step. That's great. Okay. So finally, let's get into Omicron. So just spew the beans, Stephen, like where are we at with Omicron? Is it as bad as we thought it's was going to be. Is it less, what do we know? Sounds like we know a lot more information than we did two weeks.

Stephen Kissler: 26:06

Yeah, definitely. We, we've learned a lot in these last two weeks which is great. There is still a lot left to learn but we're in a much better spot in terms of what we know about the virus and about this particular variant now than we were when we first started talking about it. So, as I mentioned the last time, I think I mentioned the last time there was sort of this order of events where we were going to first learn about antibody neutralism. And then the next thing we will learn about is transmissibility. And the last thing we would learn about is severity. So, a lot of the big news lately has come from the immune response, the, the neutralizing ability of our antibodies against the virus. And as expected, the virus does a really good job of getting around our immune response. The mutations that it has really just helps, it helps to disguise it from our antibodies But there've been a couple of, of reasonably promising studies that suggest that getting a booster dose, whether you've been previously infected or had a previous set of doses have any of the vaccines that the booster does can go a really long way towards preventing you basically for giving you protection against the Macron variant. Even though the booster dose is still the same old vaccine that we'd had for months, which is great news. Now there's some variation from study to study and just how much that. Gives you. So, there was a study from Pfizer that suggested that the booster dose basically restores your neutralizing antibody levels, meaning that, you know, the ability of your immune system to recognize and essentially eradicate the virus back up to levels of two doses against the. Founding SARS cov two strings. Now there are a number of other studies that are not quite as rosy as that that suggests that the Omicron will still take a hit in booster, neutralizing activity. But that definitely getting a booster is much better than not having a booster. So, so that story seems to be fairly consistent. The other important thing to note is that most of the information that we have so far on the immune response against Omicron has to do with these neutralizing antibodies. So it's this one particular arm of our immune response that recognizes the virus and prevents it from binding to cells. But of course that's, there are a lot of other elements of our immune response that are harder to make. And that we think actually probably play an even larger role in preventing against symptomatic disease, hospitalization, and death. And usually those arms of the immune system are more broadly protective. They're able to identify a wider range of variants than these specific neutralizing. That's sort of attached to these very precise pieces of the viral surface. And so I think that there's a lot of reason to hope that our protection against symptomatic disease and especially hospitalization and death given previous immunity, either through infection and or vaccination will still hold relatively strongly against the Omicron variant. But that again is something that we're, we're still on the early stages of gathering information. So, another thing so transmissibility, so we know that OMA chronic can spread like wildfire. We know that it's taking off that took off not only in South Africa, but that it's been taking off in the UK and we've started to see surgeons here in the Northeastern us. So it's definitely it's coming and it is spreading and it is spreading well. There's still some uncertainty as to what exactly is behind its increased transmissibility. So. Basically the two possibilities is first that by getting around our immune system, it's able to infect people into spread more easily, even in people with some level of protection. Or second to that is just more inherently contagious that it's able to bind to ourselves a little bit more easily there. You know, part of the question is like, to what extent does it matter? It does matter some because Whichever one of those things that is, will change the way that the virus behaves in different populations with different degrees of immunity, with different types of immunity who have had different experiences with different variants. So I do think it's an important question, but but it's pretty clear at this point that Omicron will be able to spread very rapid. Just about anywhere it goes. And so sort of in the transmissibility box there, there's a big old check that it's it is definitely more transmissible. And and so that's going to be something we're going to have to deal with in the coming months, for sure. And so the big question now is, is severity. And I think that At this point, we would probably know if Omicron was catastrophic more severe than previous variants, but I don't think we're at a point where we can conclusively say whether it is equally or less severe than things that have come before it. So again, there had been some early reports suggesting that some clinical cases of Omicron were not as severe. But that can be confounded by all sorts of different things, whether it's, you know, that it took off in younger age groups first, or it happened to take off in a previously vaccinated, an Indianized population. And so that the underlying immunity was protecting those people from being as severe as the disease might have been in previous waves. And then one of the other things that sort of been spread around is. Basically just comparing cases versus hospitalizations in this surge relative to cases versus hospitalizations in previous searches and saying like, oh, well, you know, it's, there, there is a lower fraction of hospitalizations to cases at this point in the surge than there were in previous surges. But the issue there is that Omicron is so much more transmissible that we're seeing a much sharper rise in cases. And so it might not be. There are fewer hospitalizations per case. It's just that there are so many more cases. So early on that the people haven't had a chance to get sick yet. And so, so I think we're still at the very early stages of understanding the severity of a Macron. And I'm, I'm, I'm not as optimistic as some have been about the potential for Omicron to be less severe. But I am grateful that it doesn't seem. You know, much, much more severe than things that we've seen previously. So, so that's something we're going to have to continue to watch pretty closely. And the last thing to note with this is that as, as one of my colleagues, bill Hanna recently said even the common cold would be catastrophic if everybody got it at exactly the same time. Because you know, the common cold does cause hospitalizations. It causes pneumonia in older age groups. If everybody got it within the same two weeks, like that would cause a huge burden on our health system. And it would be a public health event of, you know, unprecedented scale. And so even if we end up with an older crown variant, that is no more severe than the common cold, if it's able to infect the world within an order of a couple of weeks, it's still going to be something we're going to have to contend with on a large scale. So, So I think that really just underscores the need for boosters for thinking about masking when in indoor spaces and, you know, thinking about all of these plans, we talked about with our holiday gatherings we got to have all our tools on the table to help us against this coming surge.

Matt Boettger: 32:30

And so helpful. Okay. The two things, number one, this is what you were saying two weeks ago, how quick news is probably bad news, right? So like, you know, if it was catastrophic, I would probably hear really quickly on they go, man, this is crazy, crazy. So this good news, it may not be quite as catastrophic. The other thing I kinda remind me of like, it's like me with like, hands-on stuff. Like I'm a tech guy. I, I lo I literally load the working on my house, like on any level, even if it's hanging a picture frame on the. I will delay it as long as I can. Cause I do not wanna get the hammer and nail. Cause I figured take me eight hours to figure out how to level this thing. Right. So it's kinda like when I get my hands and try to work on something, right? The more I work on in the house that actually the more complicated it becomes and the more problematic in the more fix it, it has to become. So it used to be a small problem. Usually when I address it, now it's a much bigger problem because now it's the original problem. Now my problem on top of it added on there's more holes in the wall. Now we have to putty because I missed a bunch of places. And now I say this tongue in cheek, Stephen, because this is clearly not what I'm saying. It's like, oh, I miss the good old days. The end of the pandemic when life was simple, right. Were, oh, it was just a pandemic, but now it's like, it's so much better, but it's more complicated because now we have vaccines and boosters. And how does that mix and match and how, and so it's just, I don't know how you guys deal with this stuff as an epidemiologist, as, as things unfolded, like, okay, now we have 18,000 more variables we've got to look at and figure out how that works. Again, I'm grateful me. I'm grateful your life. It makes way more complicated.

Stephen Kissler: 33:55

Yes, it does. But and that's, that's, that's why we do what we do.

Matt Boettger: 33:59

So the, the last thing then I think the last thing I'll say is it's still on this. So this idea of, okay, we talked about this off the year. And this is where I'm reading a lot of the news of what you're just saying how, oh, Hey, the good news about the boosters. It seems though that it's skyrockets the antibodies so intensely that it sh it seems like it's covering the Omicron variant. So when I keep reading this, I get confused because what you've taught me and like I said, cause it sounds like, oh, well it's all about antibodies. Response in general, I just vomit antibodies and you're good to go. If that's the case, then any vaccine would take care of anything. If you could just go and get antibodies rubbed up, but it's not the case. Right? So this is where it seems really complicated from that it's the same old vaccine it's Reverend about because of this, because the antibody response, it seems like it's going to cover the Omicron, which is highly mutated. Do you see where I'm like, I see this, I see a disconnect in, can you help us fill in the gaps of that? Can't be the full.

Stephen Kissler: 34:53

Yeah, totally. So, our immune system, the different arms of our immune system very in large part based on how specific their vision is for a a given virus. So there there's some parts of our immune. The, the antibodies that we normally think of that have these very precise molecular configurations that allow them to detect very precise structures on the surface of a virus. And so those antibodies are really good at seeing exactly when you've been infected with. Really closely related to something you've been infected with previously or have been vaccinated against. But they can get easily duped by these small changes on the surface of the virus and sort of render them unable to bind to the virus and unable to prevent the virus from infecting ourselves. But then there are different parts of our immune system that sort of like. Get the gist of the virus, but they don't, you know, they're, they're not necessarily so specific. And because of that, it can take them a longer time to respond. It takes them a little while longer. They sort of have to sit back and consider the virus for a while and say like, is this, is this something we should be concerned about or not? And then, and then ultimately, you know, if it's the virus starts to increase in as more other parts of the immune response, start to get revved up, they're like, okay. Yeah, this is, this is something that we really need to be worried about to attack and to respond to. And so they're the. You can sort of think of them as a little bit slower. But also able to be a little bit more flexible in their response able to identify sort of wider ranges of virus. And then there are other parts of our immune response that are just totally they basically just protect you against everything. They're like, I don't know what it is, but we're just going to like go out there and just like, try to eat up whatever we see that doesn't look like me. And and so, so all of these different things are in play now. Vaccines are. Really good at eliciting very specific types of antibody responses and especially a single dose of a vaccine is really good at getting these sort of like highly specific antibodies revved up and sort of stored away in your memory. One of the ways that I like to think about vaccination, I I think that, you know, we talk about immune memory as sort of a metaphor for how the immune system works. But I think. You know, I've, I've found that metaphor to be incredibly rich because I think that it thinking about the immune system as something that has a memory really does go a long way towards helping us understand what the immune system is doing. So one of the ways that I like to think of a vaccine is like, so you have this like really complicated image, this picture that you're being shown, it's just basically a picture of the virus, but you could imagine anything and what the vaccine does. It flashes that picture before the immune system's eyes very briefly. And so it gives us this like quick moment to say like, okay, this is what the virus looks like. And with two doses of the vaccine, we essentially got two very rapid flashes of that. But if you were shown like a really quick image you know, you would see a couple of sort of general characteristics of the. You might really notice one specific detail and if it were flashed before your eyes really quickly, you'd probably pinpoint on that exact same spot twice, because whatever you noticed first, your eyes would be trained to what it had seen. Now, if instead, you had been flashed that image twice, and then six months later, I came up to you and flashed to that same image. Again, you'd probably focus on a different part because your mind has had time to sort of process. And it wouldn't remember the fact that it got sort of so distracted by this one piece of the viral surface, but instead it will notice some other feature about the picture that it didn't see before. And that's the value of these vaccines that are spaced out over longer periods of time, because as your immune system gets these flashes of exposure to the virus, and as they're spaced out over longer periods of time, it allows your immune system to sort of mature. In the meantime and to forget, which is also a really important part of the immune response so that when it gets wrapped back up, it can notice a different part of the virus. And so essentially what we're doing is we're trying to sort of give it these images of the virus from different angles which also happens when you get infected. And so because of that, it sort of builds up this sort of entire repertoire of protection against different pieces of the. And so they're still very specific to SARS. COVID two, I'm just ramping up antibodies. As, as, as such. It doesn't really give us much protection against things that aren't SARS cov two, for the same reason that a flu vaccine doesn't protect us against COVID-19. But nevertheless, you know, getting these repeated exposures will help us over time to broaden our immune response, even against things that our immune system hasn't seen before, as long as they're sufficiently closely related.

Matt Boettger: 39:15

That's great. And you hit the nail on the head. I really felt super educated. I think I earned my honorary doctorate again. Thank you, Stephen.

Stephen Kissler: 39:23

Appreciate it. I hope I hitting the nail on the head. I didn't make too many holes in your wall that you have to fill up with pipe until you're way too

Matt Boettger: 39:29

late for that man Swiss cheese in this house. So, great. That's perfect. We'll end there. I appreciate Stephen. We'll be back again in two weeks. Again, if you could not leave a review, please do so inspires us. He wants support us patrion.com/pandemic podcast for monthly subscriptions, as well as one-time gifts through PayPal then Mo all in the show notes. If you wanna get ahold of us, if you have questions for us, Matt at living. Tom, I will forward them on to Stephen and mark. I know mark has been here forever. He's been busy, busy, busy, but we hope to get them on sometime, at least one time soon. And if you wanna get ahold of Stephen, you can do follow him on Twitter, which is. S T E P H E N K I S S L E R. And I think that's it for this episode. Thank you all for listening. And we'll see you guys, I think after Christmas now. So if those of you who celebrate Christmas, Merry Christmas, happy holidays, happy Hanukkah. All the holidays. Have a wonderful season. Take care. We'll see you guys in two weeks.