Pandemic: Coronavirus Edition

All about Omicron and a little about Deltacron...

• Dr. Stephen Kissler and Matt Boettger • Season 1 • Episode 93

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Matt Boettger:

You're listening to the pandemic podcast. We equip you to live the most real life possible in the face of these crises. My name is Matt Boettger and I'm joined. I took forever to find this guy he's been gone forever and hunt. Stephen Dr. Stephen kisser and epidemiologist Harvard school of public health. How are you doing

Stephen Kissler:

buddy?

Matt Boettger:

Doing good. It's I don't know what to say. Like Merry Christmas, happy new year, blah, blah, blah. We've went through a couple holidays, right? Yeah.

Stephen Kissler:

Happy new COVID wave. Yeah,

Matt Boettger:

exactly. So many exciting new things. One that you don't want to surf on. That's right. No. We're back where we apologize. Usually it's every two weeks and we never told you we just kinda stopped. And probably because it's the holidays and we were selling Christmas new years. I don't know if I mentioned this to everyone who's listening. Stephen probably knows a little bit, but in our household, it is literally a wave. Of holiday stuff that almost makes me tired to the point of, I mean, utter exhaustion. So we had our anniversary on December 18th and of course we had Christmas. Then my oldest son was born on Christmas day and then we had new year's day. Then my youngest son was born on January 3rd. So we had his birthday and then we had my wife's birthday in next week and during the 17th, and then we had my son's birthday on January 20th. So it's a lot and it's. It's a lot of partying. It's a lot of budgeting that needs to be done better for next year. And then on top of that, he's, you know, Stephen, my son, my youngest son, two days after his birthday had to go to the hospital. That was totally my fault. I was vacuuming. Our our playroom rather aggressively, if you anybody knows me, I do things very quickly cause I wanna get these done. And I was swinging the handle, like crazy vacuuming the carpet and I had no idea was behind me. I just drilled him in the head. Cut, open his head. I feel really bad. With the hospital. We were a little nervous with during the surge and but we were extra cautious. I called Stephen like at 10:45 PM at his time at night. That's the privilege of being his friend, I guess. And, and, and, and crossing boundaries, asking him any tips before I go in the hospital. But yeah. Yeah. So as you know, it was a lot going on and you had some holiday fun too. You did some traveling, right? Yeah,

Stephen Kissler:

that's right. Made it out to Florida to see Allie's family and also out to Colorado briefly. So, yeah, it was, it was good. It was really nice to get, to see some family over the holidays for sure. I bet.

Matt Boettger:

I mean, you are isolated because you had from your family, you don't have any family up there in Boston. Yeah.

Stephen Kissler:

Neither of us really have family up in this area. So, yeah.

Matt Boettger:

So I'm glad you were able to get out and see some family and we're back in now. So we've got a lot to talk about. We'll see how much time we have. The normal stuff, right. Please relieve review. We got a review just a couple days ago. No, Stephen. He didn't. If he saw it from J a E O T, this podcast has kept me grounded and informed. I'm grateful that Matt research has the right questions to ask and that Dr. Kisser Lee lends his time and knowledge to give listeners his expertise. I know that what I'm hearing is a latest and best information as we know it at this moment. Thank you. So, yep. That's good. More welcome. Super excited to get these these reviews. So please, if you want to leave a review, it inspires us and it keeps this podcast in front of mind and many people on all the big directories, as well as you want to support us patrion.com/pandemic podcasts. Those$5 a month can help us keep this going or just a one-time gift, PayPal, Venmo. You can get all of that. In the show notes. Okay. So let's get going. We already talked about Alma Cron. He back in way back, I feel like forever ago in December 13th. And it was kind of being to rear its ugly head and boy, oh boy. Does it rear its ugly head? I can't believe when I see the charts of this, it's just like, I feel like it's like an error, like miss some data errors. So like nothing spikes that intensely. So I think before I get into the nitty gritty details of everything. Why don't you just give us a little kind of surveillance of like what you've been seeing what's been going on with Omicron? How does it compare to other ones? I mean, now we probably have plenty of data to get a good analysis of where we're at and where might we be going in the next two weeks?

Stephen Kissler:

Yeah. Yeah. So. Holy goodness, this this variant is infectious. It is yeah. It's eh, so, so there's, I mean, there's a couple of things in play, and I think that we spoke about some of these things in previous conversations as well, but we've gotten a lot more certainty around. Sort of what is OMA crowns, shtick. So, is it more infectious? Inherently? Yes. It seems to be even more transmissible than Delta, even after you account for prior immunity. And even if you account for sort of changes in behavior and such, so it's ramped up infectiousness again by twofold threefold, plus you layer on top the immune. Evasion where it can and we'll talk more about that in a moment, but it's, it's able to cause breakthrough infections like mat it's infecting a lot of people who have been vaccinated who have been previously infected. It's just able, able to do that because of all of its mutations. And so that contributes to its apparent infectiousness as well, because if it's more infectious at baseline and if it's able to get around our immunity and you know, Generally, you know, people are I mean, like we just said, I, I traveled to this year to see family. I didn't do that last year. And I imagine that that probably maps to a lot of other people as well. So our behaviors are different too. And so part of like, all of those things together are leading to this sort of hockey stick pattern of cases that we're seeing in the U S and, and across the globe. So yeah, so there's, there's a major surge of Omicron To add on top of all of that. We are currently smack dab in the middle of peak coronavirus transmission season, right? Like first two weeks of January is when the other common cold Corona viruses spike. Every year. And so this is the most difficult time to control the spread of a coronavirus. Plus we have this new variant and all of these other things sort of layered on top of it. And so that's, that's causing a huge surge in cases. And unfortunately, I mean, that's, that's also leading to a pretty big surge in hospitalizations right now, too. We haven't seen as much of an uptick in deaths right now, thankfully. But but I expect that to follow. And even though on a case by case basis, McCrumb really does seem to be less severe than Delta, especially in the people who are vaccinated. They're just the sheer number of cases is enough to really really cause a lot of.

Matt Boettger:

Yeah. You know, I think they're just thought of, I couldn't get in my head. He said, hockey stick. I'm like Neil. I'm like, can we just blame all this? And Canada

Stephen Kissler:

Porter person who wrote a review, asked us to mention Canada and other one time we mentioned them

Matt Boettger:

totally out

Stephen Kissler:

of context. This is not his fault.

Matt Boettger:

I want to make sure I'm just joking, everybody. That is this fear joke. But yeah, this is exactly, you know, one of the things that. How do you see this? When it comes to booster? You said vaccine, there are breakthrough cases. I haven't got a chance to see, you know, clearly I would imagine, you know, there's a pretty decent amount of breakthrough with people who do not have the booster. I have the booster. Do we see now roughly how many breakthrough cases happen with the booster? Is it still pretty significant? Is it pretty well protected? Where is that on the spectrum for the

Stephen Kissler:

Omicron? Yes. So we're, we're still learning about that because it's And there was. There's a lot of reasons that it takes some time to collect those kinds of data, but people who are boosted are still getting breakthrough infections, for sure. Every, every exposure that you get to the viral surface proteins, whether it's through a vaccination or through a previous infection reduces the odds that a new infection will actually take hold. So, we, we do, from what I can tell, we're seeing reduced rates of infections in people who are boosted versus people who. But Omicron can absolutely cause breakthrough infections and people who are boosted as well. And I think the real upshot of that is that people who are boosted have a lot of very good protection against severe disease. And so that's still the very good news boosting really sort of brings your immunity from sort of a personal health perspective, right back up in line to where it was previously with two doses. So that's, that's the good news, but it does seem like infections can happen. Maybe not as well if you're boosting. This thing's pretty infectious.

Matt Boettger:

Yeah. I can imagine when it gets to the other question, this is contextual. So I mentioned that my youngest son had to go to the hospital to get glue, thankfully, not in stitches now, before we did that, we called our pediatrician. And this is where I think it's complicated because I hear from so many people just consult your pediatrician and just consult your doctor about, you know, vaccine, blah, blah, blah, how it relates. I feel like that's even complicated because. I was on the phone with him. He happened to be on call and we were talking about, should we take him to the hospital? He's got a pretty good cut. We really don't want to go to the hospital if we don't have to, because we still have some more holidays to celebrate all these complexities. And so he was like, oh, I think he should probably take him in. And then that's when my wife wanted me to ask, like, ask him about. You know, the flu vaccine and the COVID vaccine and what he thinks about that. Right. And we trust our pediatrician. He's great. We love him to death. And I was really confused about his answer. And I wanted to throw this to you and all of our listeners, I would imagine I'm not the only one who's getting these kinds of mixed signals at times. And that he was kind of initially saying right away. Yes. I would say a hundred percent get the flu vaccine for your child. It's a very dangerous, I highly recommend it. You really should be getting. And there's even times in a couple of years past where you kind of almost alluded to that. If you're not going to get your COVID, you're not going to get your kid the flu vaccine then probably just don't take them out much during the winter. Right. Just keep them inside. So he's really PR pro pro flu vaccine. Great. Then I asked about the COVID one, right? And then he's he was like, ah, no, you know, don't give them the code vaccine doesn't really do anything for kids, especially with Omicron. Right. It's just like a common cold, no big deal. And he was very dismissive of it. I was a little perplexed by his answer. I'm like, it's. Overly simplistic. Yes. To the flu. Absolutely. There's no hesitation, no way on the colored vaccines, because it really doesn't affect kiddos. Don't worry about it. We only give it to the kids who obviously are diabetic or obese or have those kinds of issues. Right. We give them to them for sure. Right. But if you're. No need to get it. So I looked up some stats on flew in, you know, not to scare anybody, but you know, kids deaths and that kind of stuff. And like 2019 was like the latest, probably good statistic. It'd be like 543 kiddos, unfortunately passed away in 2019. And something like 476 kiddos have passed away in two years for COVID. Right. So the numbers are about half, right. But then again, those are low numbers. And then, you know, I see in the complexity of the flu vaccine, not being that effective right this year, it kind of missed the mark, but it actually is really good for preventing hospitalizations. It's just that you missed them. I get infected. So seeing all of them, like it doesn't seem that black and white, I'm the wondering, is this more of a political decision than a scientific decision? I would imagine people who are pro fluid. Pro COVID where do you land in all this kind of things? Because I'm hearing this from a pediatrician and it's informed us. I'm like, ah, this doesn't ring.

Stephen Kissler:

Yeah. Yeah. It's I find it sort of perplexing too, because in my mind, I mean, for a long time, I've sort of, I think that a reasonable rule of thumb is that for for children under the age of 12, I think the flu is a reasonable. Proxy for the severity of COVID as well. And it, and, and you just cited that statistic as well of the number of of deaths related to flu versus related to COVID. And those are, I mean, those are pretty similar numbers. That of course glosses over, you know, a lot of other Uncertainties, including, you know, there are things that flu can cause that are not death, but that can be sort of longer term complications as with COVID. There are issues with long COVID and young kids as well. It's w we it's, it's hard to really quantify those things. We're still learning about a lot of those things, but as the first rule of. I think that the risk on a per person basis is pretty similar for young kids between flu and COVID. And in, in many ways I actually see flu as sometimes even at greater risk for kids under the age of six, especially. And so, but, but I think that they're roughly the roughly in line with each other. So if. If I were to meet someone who is, you know, thinks that the flu vaccine is worth getting, I would also imagine that they would think that the COVID vaccine is worth getting and vice versa, but it sort of puzzles me why there would be a very clear split between the two that just doesn't make a lot of sense to me. And I'm yeah. I'm glad you

Matt Boettger:

see that. So those of you who have received that similar information, maybe get a second opinion because I feel like, yeah, I felt the same thing. I'm like, ah, you know, if the flu vaccine is good for the kid and prevented it, I would imagine the code's vaccine. And again, like you said earlier off the air, I mean, it's, it's also not, not taking consideration at this point in time. The transmission of flu is substantially less than the transmission of COVID right now. Right? So that's a whole different variable that makes, can make it more severe in its own level as well. And that gets back to another question, Stephen, again, kiddos, cause I have kiddos and I'm always thinking of my kiddos is a few weeks ago there was an article about hospitalization for kiddos is increasing substantially because of Omicron. And then maybe two weeks later, I see another qualification of this. Where do we stand with hospitalizations and kiddos? Is it kind of, this seems to be something that might be slightly more aggressive towards kids or is this something that you've helped us before? Is that it's just the nature of the transmission that makes it look as if. Bigger.

Stephen Kissler:

Yeah. So, so both of those things and one more. So first of all, you know, of course kids are less likely to be vaccinated and boosted at this point. And so there's differences in immunity there. There's a lot of spread and kids, especially from schools right now. And so, so the, just the raw case counts, we expect to be high in kids right now. And the other thing is that there is, especially in, in certain parts of the country right here in Massachusetts, we have a major Omicron surge right now. But we actually saw this in South Africa too, which is that not everyone who is in the hospital. With a positive COVID test is there for COVID. Since the rates of Omicron are so high, I mean like this low in case I haven't emphasized that enough, this thing is incredibly infectious, right? There are a lot of people who currently have crown infections in the United States. As a matter of course now when you go to the hospital, generally you get a COVID test or at least you're screened somehow for COVID. And so in many places, those end up in the hospitalization statistics, even though the hospitalization was not for COVID itself. Now that doesn't mean that hospitalizations aren't spiking. I mean, COVID is bringing people to the hospital. Omicron is bringing people to the hospital, but some fraction of those cases is also going to be counts of people who have tested positive for COVID while in the hospital, but are not. Because of COVID and I think that'll probably especially be a complicating factor for young kids because there'll be going to the hospital and there are a lot less likely to be in the hospital for COVID, but there's a lot of COVID in young kids right now. And so I think that that might be one of the confounders here as well. So, so really we're thinking about these hospitalizations statistics, especially in kids with a grain of salt definitely. I mean, definitely COVID can bring a kid to the hospital. Flu can bring a kid to the hospital for sure. But some of the spike that we're seeing is incidental. Yeah.

Matt Boettger:

And another thing they putting consideration, I don't know if you said this Stephen, or if I read this, so it should be credit to you then I apologize. I have no idea, but something about how, even if the common cold received this kind of intensity, there'd be just so many hospitalizations of that. I mean, it's the, it's the enormity of the influx of infections. That's, that's overwhelming the hospital, even if, even if it homo Cron general. It's a common cold. This could just wipe out hospitalization, hospitals really quickly and their resources just because it spreads

Stephen Kissler:

so fast. Yeah.

Matt Boettger:

So that lead me to his question, which I kind of may lead the jury to my own answer. And that is, should I just get OMA chronic, get it over with like, there's these mixed signals of like these, you know, one, one article from both of the Atlantic boosted, God Omicron, you still might not be super immune. You know, in my mind I was talking to my wife. What's the possible, I mean, not having a COVID party of course, but like saying, okay, we're not going to shelter in place for three months. We're still going to go out and, you know, wear a mask. But if we get it, wouldn't that maybe be a good time because OMA Crohn's generally not too dangerous. And if we're boosted and we get Omicron, and if the next variant comes at raise its ugly head and it's worse, maybe we have, we have an extra insurance policy of, of, of weathering the storm until the next booster. Should we go ahead and allow it or. Not, you know, this article is suggested maybe not, but then a previous article by the Atlantic mentioned, well, there's T-cells. And, and because of those that might actually help you with the next variant, where do you stand in this kind of like Alma Cron dance of it gets just a common cold. Let's just get this sucker and build my immunity versus maybe, you know, balance that.

Stephen Kissler:

Yeah. So, I mean, I think sort of. Bringing this into the context of the previous conversation. You know, the biggest thing that, you know, the thing that's on the forefront of my mind now is trying not to get Omicron right now because I don't want that, even though it does seem to be like, I'd probably be better off if I had gotten infected with Omicron than if I had gotten infected with Delta right now, given my vaccination status and so on. Breakthrough in the chronic infections can still hurt quite a bit. I mean, when we talk about mild infections, that doesn't necessarily mean the sniffles, you know, you could be, you could be coughing up a lung for a good week or two and feel pretty fatigued and that's still considered a mild infection. Right.

Matt Boettger:

That's good. And that's going to say really fast. Cause my wife was like I said, oh, it's just mild. Like, well, all my friends are having it. And they were like in bed, like just like coffin and they don't want to go to bed, but that's not modeling like what. Their definition of mild is, is like comparative to a hospital where you're on a ventilator,

Stephen Kissler:

right. Is exactly, I think it gets worth. And this was illuminating for me too, that like these, these classifications of, of mild, severe, et cetera, are, are made by generally by clinicians, by people who are in the hospital who really see the severe cases. Right. So if you're, you know, sick in bed and feel like you've gotten hit by a train. That doesn't feel mild to me, but if you, you know, if you have somebody who's treating patients in the ICU, see is here, they're going to shrug their shoulders and be like, yeah, it'd be all right. You know, smiled. So it's all a matter of perspective too. And so, you know, and, and because of that, you know, Could lead me to need some type of medical care right now, even if I don't end up in the hospital. And that's kind of what I'm trying to avoid at this point which I think it's, it's worth noting that that's very different than what I was trying to avoid this time. Last year, when the thought of getting infected. Also from a personal standpoint, and from the standpoint of exposing people around me, there was just a lot of risk there that vaccination has done a lot to blunt. And so right now, really my on the forefront of my mind is. Trying to keep our healthcare system from really getting overwhelmed. And thinking about it from a personal perspective, too, right? Like I'm talking about our healthcare system, but like, this is my brother we're talking about. Right. Like, I, I, I, we're trying to keep these people who are keeping us healthy from getting so burned out and, you know, having to work over to. And you know, people are leaving healthcare positions in droves right now because of just how awful of a situation this has been. And, and that's, you know, that that's who that's, who we're doing it for. And so maybe it'll, maybe it's helpful to talk about Sort of the precautions that I'm taking right now. So I'm vaccinated, I'm boosted. I got my booster in November and I am not indoor dining. We've decided to, to put that on hold for now. But we're still, you know, getting takeout from local restaurants to. Both try to support them. And because I get sick of my own cooking and I I've transitioned to wearing mainly kn 95 masks. When I'm going indoors with places where there are other people's different going grocery shopping, for example, I'll, I'll put on a, on 95. And, but I'm still going grocery shopping. Maybe not as frequently as I, as I was or try to get some deliveries and such, but I I'm happy to go into a grocery store. And so part of that is sort of feeding into, I think, what you had been getting at with your previous question, which is that like, I don't want to get Omicron right now. This wouldn't be a particularly good time for me to be laid out in bed for a week and a half. But I'm also a lot less concerned, like. Given the, the raw statistics, it's, it's pretty unlikely that I would end up in the hospital with it. And so I'm not locked down to the degree that I was this time last year. Everybody has their own risk calculus, which has to do with their own level of risks that they're willing to tolerate with their own personal situation, their health situation, the people they might be taking care of. So it's really hard to sort of give recommendations that are applicable across the board. But that's sort of the way that I've been approaching it.

Matt Boettger:

Great. And let's hit the Canaanite and 95 masks. I, myself moved towards that. I had kind of just a regular mask and about Thanksgiving, first week of December, I moved to permanently to the K N 95 mask, but I'm a dude. I wear the same thing. I have it in my pocket. I pulled it out. I had the same thing for the past month. Is it okay? I mean, it's not green, it's still looking the same color. Right. So that's good. It's good for me, but like, am I okay? I mean, Now that we're moving to these kinds of, okay. Cloth mass, back in the day, you just throw them in the wash or wash and reuse them. No big deal. Now I've got these kn 95 mask and I'm just too lazy and I might have it for three years and just not even do anything with it, still use it. When can I reuse these? What's the best kind of, how do you approach your canine by mass replacing it or keeping it, do you have any, any tips for us who are just like. I'm not being super cautious with my mask. Oh yeah.

Stephen Kissler:

It was I was going to say pay attention to how it smells, but then again, if you get COVID

Matt Boettger:

that doesn't the front of the mask and if it tastes really bad and then go ahead and note that that's not the one.

Stephen Kissler:

No, don't do that. I mean, yeah. So I think that like, generally, you know, it, it, it seems to be okay to reuse these masks for, for a number of, of, of uses. I, ah, Yeah, it depends a lot on sort of like how long you're using it as well. I'm I tend to fall on the side of like, if I pull something out of the fridge and it smells a little bit funky, I'm like, I'm going to pitch it rather than unit. I'm pretty cautious with that kind of thing. You're an epidemiologist. Yeah, exactly. So I I tended to change out my probably every like five to seven days or so. And and, and also, you know, bearing in mind that like, I'm usually only wearing them for like quick trips out. Right. I'm not, I'm not like wearing this all day long. If I had to wear a K on 95 all day, I'd probably be changing it daily. And so, and, and a lot of that is just because it's like a. I don't know, like it's just, just helps to keep it fresh. So, yeah, I, I it's, I don't know if there's like solid data on this, but I do know that like, that it seems like. You can reuse them, especially if they're not, if they haven't gotten wet, if they haven't gotten soiled in any way they, they hold up their protection over time. But you also don't want to be breathing in your own gunk too much. So,

Matt Boettger:

yeah. I hear hear that. Yeah. And I had saw a couple articles in the same thing that you can reuse them for a while, and it depends on how long you use them, use them all day then, but you can normally use them maybe for a few weeks and just. If you just use them kind of sporadically right here and there and small Smuckers, but just keep them. I think I read which I don't do. They're like, don't put it in your pocket. Don't just put your purse. Don't just hang it on your ear. Put it in like a, a paper bag. Or if you do a plastic ziplock bag, don't zip it up all the way. Cause the moisture can then condensate that kind of stuff. So just make sure to take those precautions. I learned a couple of things. I'll put a, put one of those in the show notes as well about that. One of the other things I want to talk about is a number of articles have been about with Omicron being this kind of beginning of the end, that because of this, I've heard even things like, oh, this could be the first time where there actually might be a, some sense of herd immunity, because it's just so intense. I don't even know what that means and let a variance that kind of stuff. I feel like it's a meaningless. But like, I, you know, Alma con may be the harbinger of the end. That's the one I hear Omicron case they're hitting highs, but new Delta may put end in sight. Omicron could potentially hasten the COVID pandemics end. So all these things about the end right now, the apocalyptic, like the entire.

Stephen Kissler:

Yeah, I was going to say, you know, I've for my entire life, I've always been a little bit skeptical of the people who, you know, say the end is near. And so, I think that applies on every level. And but that said, you know, I think that what w what it is, I do think that there actually may be some truth to that where At this point, a lot of people who have been who have, who are going to get vaccinated, have already been vaccinated. Omicron is probably gonna affect just about everybody, you know, especially if they haven't been vaccinated yet. And so that's going to give, essentially everybody. Almost everyone, some degree of exposure to SARS COVID two which should feed forward into some degree of protection from severe disease and illness. And so I do think that there's, there's some reason to hope that because the monochrome wave is so intense, that future waves will be blunted to some extent because our immune systems will have gotten one more exposure to this thing. I'm hopeful for that. But you know, epidemics are famously elusive when it comes to defining beginnings and ends. You know, it's as, as with the great apocalyptic poem, it's not going to end with a bang, but a whimper. You know, we're just going to slowly transition into this period of time where our perception of the virus is going to change. The severity of the virus is going to change and thoroughly isn't going to be the switch that happens with the Omicron variant, but it's going to be sort of one more. Interests us towards that endemic phase where we're going to be dealing with COVID as a commonly circulating illness for a long time. And so I do think, you know, one of the actually really good strokes of fortune, as far as I can tell with this virus so far, is that it does seem like. Multiple exposures tends to increase the breadth, the level and the duration of your immunity. That's not always true for all pathogens. Sometimes repeated exposures get worse with time. Sometimes they don't do much at all. So, in some ways we got lucky with this one that, that actually our immune system does build up over time with it. That's usually the case, but it's not a guarantee, but it seems to be the case with SARS COVID two. So I think we're just sort of getting closer and closer to that base.

Matt Boettger:

Okay. Now, speaking of a baseline in the transition, the CDC changed their policy for isolation, which seems to be another kind of transitionary point for us from, I think it was 10 days to now five days. So a couple things I want you to respond to. Number one, what do you think about this? This is now five day thing. Is it a good policy? And the second big thing I want you to at this time? Excuse me. The second thing I really want you to talk about is I was thinking about this, like, okay, I was reading about this policy change and the why behind it, and then there's some science behind it. And I get that, but I feel like this is another example of science. Using supply and demand to make their decision. I think this is an important thing that I want you to just talk about for a little bit, because to me, this is one Elmo by which it becomes fodder for conspiracy theories. So I have three examples here back in the day, early in 2000, right? In 2020 in spring, when it first came out, Fowchee started talking about how cloth masks were first. You first don't worry about cloth masks, not at all. And then, then it was just cloth masks and then cloth masks. And part of this, like a confusion, I felt part of it at least was the idea that the hospitals weren't getting the necessary resources they need. So a policy became like, oh, just use Claus pass. Right. Because they're just as effective. And then in the end we realized they're not just as effective. And so then we want to like blame them as being like wrong or some kind of conspiracy thing. Because in the end, I'm thinking they're not only being scientists, they're using supply and demand to make their decisions. And the second example is the isolation period, right? This one changes down to five days. Part of it might be in science, but part of it also, because everybody was homesick you last week and people have to work. And so we have to change this supply and demand like, oh crap, let's change the five days now, is it? Because 10 days wasn't really a number in that we're just making up crap. No, it's because it was really. But now there's a new problem that we have to address. We have to change the number because of a greater problem. And then the third one, we'll talk about it a little bit. As I'm seeing this now is testing like the, the the over-the-counter testing first, it was like, just test, test, test now, like, oh, don't ask don't test. If you're asymptomatic don't test because we're writing the shortages on. So you're seeing these like scientific explorations and then presenting us a model of what to do, and then it kind of changes. Partly because of supply and demand, I think because we had to thank consideration, but it's not because science is wrong or it's conspiracy theories because it's just one other variable that needs to be considered for public policy. Can you wrap your inner weave, all those into this, this particular question.

Stephen Kissler:

Right. So, so regarding the CDC guidelines, like you said, they've, they've reduced the isolation period of five days and critically that, that, that applies if you are no longer symptomatic and they ask that you continue to wear a mask pretty diligently for, for the full 10 day period. Now that said people can absolutely be infectious for more than five days after. After a after detection. And so there's there's a risk here. I think you're right. That essentially what they're trying to do is to balance the need for people to work and to sort of return to their more normal lives with the risk of continuing infection. I think it's a really difficult call to make the. The policy that I would hope for is a test to move out of isolation. Because that'll spring some people from isolation after three days and it'll spring some people out from isolation after seven days. But but that's going to be a lot more relevant metric for whether or not you're likely to spread infection to others. And, and so. This would be the way to go. People can be infectious for up to seven to 10 days, for sure. Or at least seven to 10 days after their, their detection. And so I do think that, you know, we need to be mindful of the fact that this update to the guidelines is posing some degree of risk of onward spread. And I think that, you know, That that the right policy is not to re increase it to 10 days. It's to use the technology that we now have available to make better decisions and more personalized decisions based on whether or not you actually are infectious. Yeah, that gets, that gets to the question about testing now, too. Right? So there's been a lot of this, this questions about, you know, should we be tests doing asymptomatic testing as much as we have them? So I think there are a couple of layers to this as well. So the, the question about shortages of tests, I mean, it's kind of true, but I really don't think that individuals should be shouldering that burden, right. Are, are frankly it's, it's the Machinery of government and manufacturing that is failed us here. You know, it's, we, we should have these tests in much greater supply than we do. And and so now it's sort of being, you know, asking individuals to say like, oh, we need to conserve these things. It's like, well, yes, but like, Well, why, why, why we had to conserve them for the entire pandemic? You know, it's, it's a little bit crazy. But that said, you know, we are in the situation that we're in. And so maybe, I don't know, I, for the sake of, of of, of Like maintaining our supply chains. I really can't get behind to this argument of like testing less. I think if you need to get a test, you should, you should get a test. And, and our, our supply chains need to sort of find a way to, to keep up with that one way or another. That said, so there's also been a lot of questions about rapid antigen testing with respect to the Omer crown variant. And it really does seem like, the rapid tests. Don't seem to be able to pick up the Omicron variant as well in the early stages of infection as they used to be able to. And so it seems like people are able to be infectious prior to turning positive with a rapid test, for example, whereas previously there was a really tight correlation where if you're positive on an engine test, you're infectious, and if you're not positive, you're not infectious. That correlation is sort of getting broken up a little bit. And part of that might be due to the way that Omicron causes. It seems like there's a lot more sort of like, Throat based symptoms with Omicron and that it might sort of reside in the throat a little bit more than it resides in sort of the anterior narrows on the, on the front of the nose. And so part of it is maybe not even that the test is not good, but actually the swab itself is having some issues picking up the. Nope. There've been some videos circulating and one of them I think, is actually useful from the United Kingdom. What is it? The UK HSA, the health security agency in the UK where they actually walk you through the steps of taking a combined throat and nose swab. And there are some tests in the UK that actually are approved and call for that, but there are some people who have been. Yeah, maybe we should try to do this with rapid antigen tests and see if they that increases their positivity. So there's not a lot of clear data on that, but full disclosure, I've swapped my throat with a Binance now and then swapped my nostrils as well. When I was taking some rapid tests recently made me gag a little bit. It wasn't particularly pleasant, but but you know, like, and it was a little bit gross stick in a swab that had just been down my throat up. I know it was too, but like all for the sake of science and for the sake of trying to prevent the spread of. Spread of COVID Lord have mercy. And so, yeah, so I mean, if you're interested in looking at some of those videos that are out there, I would recommend the one from the UK HSA because that's, that's generated by their public health agency and really goes, walks through the steps of giving yourself a throat swab, full disclosure, not approved by the FDA. This is not like on the package, you know, like. And so, yeah. If you do that, recognize that you're deviating from the recommended protocol of these tests, and that comes with all of the standard, you know, whatevers that come along with that, I'm not a lawyer. I am an epidemiologist, so sorry for the vagueness here. But that said, you know, that that does seem to be a feature of Omicron potentially that there might be differences and where it resides in our system. And that could change the way that tests respond to it as well. Okay.

Matt Boettger:

Yeah. And I heard about this. I mean, well, I mean, from my wife, there's just been weird, weird things happen. I mean, we have people getting COVID all over the place. I mean, every meeting I have is virtual over half of those people in the meeting have actively COVID, but we were hearing like, oh yeah, this family got covered the whole family, but we didn't get COVID but we got sick. Cause we could, we took an engine test and it said we weren't, we weren't positive, but we're like, I'm sure it's probably covered if the whole family's covered. And you got sick too. And he had. Chances are, I mean, it's not, yeah. It's just a, maybe a bad, bad test. Right. So great. That's helpful. Anything on the whole supply and demand thing, like immediately, like, is it part of like the kind of, I mean, this is where I, it's hard for me to understand, like as a, as an epidemiologist, your peer on the science side of this things, and then there's public policy, which then takes all of this stuff that you provided and then somebody else filters it to provide the best possible decision for the sake of. Right. Yeah. A government or society.

Stephen Kissler:

Yeah. I think, you know, th th those things definitely come into play. And it's like on all sorts of different levels. Right. So there's like, there's the science, there's the policy is sort of like supply and demand. There's the question of just sort of like, what level of risk are we willing to sustain as a population, as a society, and sort of all of those things factor into the decisions. Now, my hope would be that like, as these policies change, that we. I have very clear information about sort of what's behind those changes. And to what extent it is supply and demand, at what extent it is, you know, Hey, we're actually going to begin to accept this degree of spread, recognizing that the science suggests that we can still spread COVID after these five days. But you know, we're going to say that like there's so much COVID circulating anyway, that we don't think this is going to add substantially to an individual person's risk of acquiring COVID given how much is out there at the moment. And so, you know, very principled, various sort of like clear. Rationale for the changes in guidelines, because absolutely all of these factors. Feed into what the guidelines are. And I think that the real issue is that a lot of times it hasn't been clear what those motivations have been throughout. And I think that if we can be clear on those things and we can really hopefully avoid a lot of the skepticism, that's been leveled towards the.

Matt Boettger:

That's great. I think that's a perfect answer yet. I think that sometimes I feel like it is being clouded or like not being addressed at the forefront, which then makes it feel like somebody's hiding something and it's not intended to just make it been great. You know, just how it's presented. Okay. So let's get to the next thing. So we talked about this. There is a new variant, right? Well, who knows? There's probably tons of variants out there, but there's new variant. That's hitting the press as a, recently from Cyprus. So a shout out to our, our, one of our Cypress friends out there. Not the best of news, but. You and talk about this as it was it called the Delta crown or something like that. I know it's like

Stephen Kissler:

a little bit ridiculous, right? Like, so we have Delta plus for a little while, and now it's like OMA, Delta, flu Macron or whatever. And it's like, yeah, so, so, right. So, so this one that I think we can actually probably like, well, let me take a step back. Right? So, so there's, there has been some suggestion that the COVID that starts Coby to the virus can do something that we call genetic recombination. So basically when you get infected with two different stereoscopy, two variants in theory, they could switch some little parts of their genome and generate this sort of hybrid variant. So in theory, that's true. It's been sort of observed. Some small, relatively isolated instances. But then this really hit the news with the Delta Cron variant that I think they're talking about now, from what I can tell, this is probably an issue with laboratory contamination. So oftentimes what happens is when you're doing sequencing. You'll have swabs that pick up DNA, that you then run through a sequencer. And if at any point in the process that swab gets contaminated with another variant that's circulating, where if you're doing a lab that's processing SARS, cov two sequences, you've probably got some Delta in there and some of them are crown. You can end up with a sequence that looks like a hybrid between the two, even though that's not actually the thing that you isolated in the first place. Part of the reason we think that this is likely an issue of contamination is also because in, from, from my understanding in the genetic sequences that have been tagged as these hybrid variants, there are also a lot of other parts of the genome that are. Essentially what we call reversions to the reference sequence. So whenever you're doing a sequence Normally you start from a reference sequence. So sort of a basic SARS COVID two genome. And then what your actual sequencer is doing is trying to figure out where your particular sample differs from that. And if you have low certainty in certain areas, it just reverts to that reference sequence. And if it does that a lot of times, that's an indication that actually you don't really have a good sample in the first place. And so because of the number of calls to the reference sequence that this, that these particular Delta. Sequences have had there's my best guess is that there's some sort of laboratory sequencing contamination going on here and not an actual bonafide new recombination variants sort of circulating right now.

Matt Boettger:

Okay, great. Here's a helpful, it's fascinating how I feel like, you know, our names went from an apple S kind of like Delta plus to now. I think it feels like it's like WWF restaurant Delta crop right now. We're now we're now we're in the, we're in the spotlight, some heavy, heavy lifting here. Okay. That's. We you know, some good news, right? President Biden to promise to think this year, January. So it's beginning the engine test, rolling out free tests to 500 like 500 million boxes or whatever to give out. I just, I'm just so happy with Colorado because I get boxes. It's just amazing how generous Colorado has been with every week. You could get two boxes if you want to. I think twice a week. So up to four boxes a week, if you want to, if you need. Free delivered to your, to your doorstep. So, also crowdsourcing everyone. Here's my question. I have a cane in 95 mask that I sometimes can't even see out. Cause I wear glasses. Does anybody have a K N 95 mass that they purchased that is rock solid. And he feel like, man, I wear glasses and I don't get the fog. Now I know I can put fog stuff on my glasses. I don't want to deal with it. I just want a good canine five glass. If anybody has one. That they want to recommend mad@livingthereal.com. I'd love to get one, a legit one. I'm looking for one preferably not, not pink and roses, just the normal color. That's what, that one that we had, all the suit. We know the, we talked about that the Pfizer 50 authorizes the Pfizer is antiviral pill. We said that might be out now, but probably in. The

Stephen Kissler:

low circulation, I think it's probably being mainly used right now for people who are at high risk of severe disease. So with, with multiple comorbidities and, and such, but, you know, hopefully it will be more and more available as. Okay.

Matt Boettger:

Great. Last few things is quick. Awesome. Put a bookmark on this. I tell this, I told this to you, Steve and I saw this interesting article, a punish shadows. New COVID vaccine from Texas could be a global game changer. It was really interesting. Again, you hear some of the politics. Initially, these, this couple had been working on for decades and prison. Too, I think some big leagues to be a part of the vaccine early on, but wasn't adopted because it wasn't innovative enough. It's kind of an old school method, but some private companies invested in it's a super cheap, pretty effective, 90% effective for the original 80% with Delta. We don't know about Omicron yet, that kind of stuff, but we're, it's like a dollar, a buck, 50 per dose. So this is like a game changer for a global vaccine. So I'll put in the show notes, read about it. My last question to you, it just crazy to think about. Israel has studied fourth dosages. This is Cray Cray. I'm like, man, I feel like we, I thought we're going to go to a restaurant that you're going to have, like, you know, I'll have the lobster and I'll have a dose. Right. So w w w you know, I know earlier on, we were talking about how the third dose could be like this linchpin to keep us for a while, a lot longer than the first and second dose. Where do you see before we end this? Now with this fourth dose, maybe endless dosages coming about, oh boy.

Stephen Kissler:

I mean, I hope it's not endless dosages, especially if they all make me feel the way that the last one or two did. You know, so, but so I'm glad they're studying it and it's the right place to study it because they're one of the most highly vaccinated populations in the world at the moment. It, it does bear studying. And so I think that it makes sense that they're, that they're looking into it for sure. I have not, I know. Well, we'll see, we'll, we'll see what they find. But it seems to me that if, if the two doses plus a, you know, a six month followup booster of an MRI and a vaccine is able to provide as much protection against hospitalization and death, even from. Oh, McCrone, which is a pretty heavily mutated virus. I think that that's, you know, that, that might be good enough, you know, at, at some point, you know, we could you know, you can vaccinate to kingdom come, but the, at some point I imagine we'll reach a point of diminishing returns. Now that depends a lot on, on the extent to which starts be to continues to mutate. We could enter a cycle where it's like a flu shot, where we have to get one every year. I do think that's possible. But but it's still far from a guarantee. And I I'm, I'm still feeling pretty good about the protection that I've gotten from my booster. And so, I'm hoping that'll that'll last me.

Matt Boettger:

Okay. Good. Well, man, it's good to hang with you forever. Yeah, it's awesome. Well, Hey, if you guys want to reach out to us and mad@livingthereal.com email me, I will always forward on to Stephen and mark. I know mark has been here forever. It'll be a while before he is back. He is inundated with a lot of responsibilities right now, but I know he sends his thoughts and loves to all you guys out there. We're listening. Thank you for listening. If you wanna support us patrion.com/pandemic podcast,$5 a month or a one-time. PayPal, Venmo. We really appreciate that. Please leave a review. If you want to check out Steve, and you can do that on Twitter. I'm in following him more and more and more lately, I had you on Twitter, but I didn't really follow you that much, but lately I've been following all the people you follow. I've been learning a lot of real time. Good stuff with the people you follow Stephen. So S T E P H E N K I S S L E R. Check him out. You can subscribe to his feed. You can do that on Twitter and you'll get a lot of great real-time information there. Thanks for listening. We are back to our regular episodes until further ado. Every two weeks have a wonderful week. We'll see you guys in a couple take care and bye-bye.