Pandemic: Coronavirus Edition

Omicron begins to lose steam and defining what "it" is...

• Dr. Stephen Kissler and Matt Boettger • Season 1 • Episode 94

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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 Barker and I'm joined with my good friend, Dr. Steven Kissler and epidemiologist, the Harvard school of public health. How are you doing good for. Hey, I am doing all right. Or look at that. I'm in the background twice. Sorry. You don't see me, but for those of you who can see this, I'm in there twice. I'm not going to change it right now. Change it later, but that'll be okay. Good. I'm glad you in. Well, how's the how's winter treating you and Hey, I hear good news up Northeast there. Right? There's some you guys are not really experiencing sweats, quite switch, such huge peak. Yeah, thankfully, the cases are turning around with our Omicron surge finally. It was a heck of a spike. And so it's really nice to see those coming down and maybe we can dig into that some more, but it's the, the wastewater surveillance has been coming down for about a week and a half now. And it's been dropped. Basically just as fast as it rose, which is really, really encouraging, good cases are coming down. Unfortunately, hospitals are still very full. I have a couple of friends who work in the hospitals around here and it they've said that, you know, the number of people with COVID and the, the amount of burden on the hospital has been similar to early 20, 20. So hospitals are still really struggling with this way. Then it'll still be a little while. I think before there, they start to see some relief from the declining cases, but but it's definitely encouraging to see to see them turning around. Yeah, that's good. And I've been hearing these cases over and over and over, or these, a lot of articles and just sat at the constant talk of like the headlines of burnout of nurses and doctors. And I mean, I haven't talked to your good brother mark for a while and I'm sure you're in contact with him. I don't know if you can speak on his, on his behalf at all. Yes, he has. He'd been having to go into the hospital a little bit more or has he been kind of more, you know, segmented? Cause I know he does different kinds of rounds and sometimes he gets pulled into the COVID wards and that kind of stuff. But are they seeing a little bit more of like they're tapping into additional resources in Colorado or has it been a little more. Yeah. You know, they they've, they've reintroduced a lot of their surge measures in, in Colorado as well. So they have been calling in doctors who normally wouldn't be coming in and it just takes a lot more a lot more hands on deck to deal with patients. You know, it's one of the things that They, that there's been a lot of conversation about lately is you know, distinguishing people who are in the hospital for COVID versus with COVID. And you know, it is, it is true that the prevalence of Omicron is so high that we do have a lot of people who are in the hospital, not necessarily because they have COVID, but they definitely have COVID. And you know, that that's naturally going to happen just because there's so many people who are currently infected. But I think one of the things that is worth mentioning is that, that that's not necessarily that helpful to the health system because they still have. Give people who test positive for COVID all the same protocols, all the same isolation measures require as much higher standards of care requires, you know, different types of segmentation from other parts of the hospital. And so it's still generates a huge burden on the hospital healthcare system. Even if the person might not be currently seriously ill with COVID. So, that's part of the reason why this is still, it's still such a huge issue. I mean, it's helpful because I think a lot of. We since we're not, I mean, I speak for myself. I mean, obviously I'm not part of the healthcare system for me at all. So it's easy to just talk about words as simply like juxtapositions, like width and for, and you know, that kind of stuff like, oh, see, no there's most of these cases are just happened to be with, you know, but those words are not empty. It's not like it's like a F like, like it's not so much of a easy dichotomy that even though they're with, I didn't even think about that. Like, A huge amount of resources if they did not come in with COVID. Right. Right. And so it's, it's not that simple, right? Like we've been saying for which I am now utterly shocked, Steven, by the way, I'm thinking about this, we were approaching two years as podcast and like one year was like, like, oh, like that made sense. But when I realized I'm going to be tears, like holy smokes, I know time has flown so much. So. It's just really complicated. So I'm glad you made that, that, that, that you gave that nuance for us as well. Before we continue to go on it's the same stuff. We had another review, come in, love this, wanting to read this by HR senior leader. And this was on January 10th. Recently. I listened to almost every known podcast on. And this always delivers fresh insights, not found another as Dr. Kissler is clear kind and reasonable balls and strikes are used information to protect the workforce. I oversee and see around corners with this, every changing information landscape, the host, Matt Bottger asks about the real world concerns. We're all facing to great effect. So thank you, HR senior leader. He's also. He was, he sent me an email gave me a sweet mask. The checkout, when I, when I did that, when I did a crowdsourcing question. So I'll put this in the show notes, it's a 3m mask. It looks like it'd be a good one to use. And it's still on back order. I'm waiting for it to come in. But it might be helpful for the old glasses. So if you want to leave. Please do so you can do to help us support us, keep it going. patrion.com/pandemic podcast. That's for as little as$5 a month can help us keep us sustainable. We're just a one-time gift, PayPal, Venmo all in the show notes. If you check it out there. So let's start with this question. I know this sounds kind of weird, and this might get into conspiracy theory stuff, but if, for me it's real world, because I was presented by it just a week ago. And basically I was talking to someone and I was hesitant to go into an indoor bar in the, in the middle of a peak time. And you know, I think they were a little. Not really happy. They didn't want to go to this bar with them. And it just kinda made a slide remark about, you know, gosh. Yeah. And I don't know how, where it came from Steven, cause it kind of felt like it was out of the, out of the, kind of the context of what it was talking about. But the person just mentioned about, Hey, you know, if, if. You know, I got a polio vaccine and, and also I got polio. I'd be very raised, skeptical about you know, the, the, the vaccine itself and kind of left it at that. I'm like, you know, there's a lot of dots to fill in there. Cause I wasn't even talking about vaccines. I was talking about going to the bar, you know, so it was kind of a weird punch, but then I was like, huh, I wonder where this person got this. So I just did a quick Google search. I like, oh, it looks like this might be some some kind. Headlines, just like a month ago, comparing polio to to COVID. This might be a good thing of a lesson for me of just comparing the two, because it's not just, you're comparing the two as absolutes. You also have to compare them in points of time. Right? When polio was, was, was resurrecting its ugly face and when covered with red writing out of the place, and I would imagine. They're both different diseases. They both have different kind of, you know, levels of, of, of intensity and how it has variants. Right? So maybe just using this as a launch point, to help me to understand like how these are really the similarities between the two and the dissimilarities between the two to help us get perspective of that. This is not the same kind of. Yeah. Yeah. I mean, I think it's I really appreciate you bringing this up because it gets at the heart of a lot of Yeah, conceptions about infectious disease that I think have, have, are deeply rooted and have not really served us well during this pandemic. And I think, you know, first and foremost is that a lot, a lot of us have forgotten what it was like to live with polio. And you know, I, I thankfully never really had to experience that. Because polio was eradicated, you know, like. Yeah. You know, not, sorry, not eradicated, it's eliminated. Meaning that we don't have circulation in the U S in many other parts of the globe, but it's not eradicated in the way that smallpox is because we do still see polio circulating in different parts of the globe. Although it's, you know, hopefully on the docket for eradication. But that said people who were vaccinated against polio could still get polio. The reason we're not getting polio right now is not because so much, it's not so much because we're vaccinated. It's because it's very well controlled. Because. We don't have the opportunity to get infected. Now, a big reason why that's the case is because of the vaccination, because vaccination helps reduce the spread of polio, but that wasn't the only thing. There were plenty of other public health measures in place as well. That helps to reduce polio cases to the point where we were essentially helping the vaccine do its job by preventing it from getting challenged and preventing it from getting tested so much So, so that's one thing, you know, actually one of the really key differences between the polio vaccine and the COVID vaccine is that unlike the COVID vaccine, the polio vaccine is what we call a live attenuated vaccine, which means that there's actually a small amount of, of you know, weakened, but live polio virus in the vaccine. And in some rare cases that can actually lead to an active polio infection. And that's been one of the reasons why it's been really difficult to fully. Eradicate because in very rare cases, the vaccine actually actually cam leads to a case of polio, which can then spread out. That's not true for COVID at all. You know, so in many ways the polio vaccine differs in that key respect and, and, and the COVID vaccine is actually in some ways superior in that sense, because it cannot cause COVID so that's one thing, you know, and the other, th th the main thing that you know, I think is most sort of surprising to me about that statement is that, like, it just Puts the value of vaccination into such a binary and such an individual perspective that it really kind of misses a lot of the point, which is that, you know, the vaccines Th there are still plenty of breakthrough infections happening with vaccines early on. We hoped that there would be a very give you a very strong protection against infection at all with the new variants, especially it turns out that that's not the case. You can still absolutely get infected, but the evidence is absolutely rock solid that it will keep you from getting seriously sick and it will keep you from dying. You know, Not in a hundred percent of cases, but that the difference in hospitalizations and deaths for people who are vaccinated in a specialty who are boosted relative to people who are unvaccinated is, I mean, it's just remarkable. It's like so incredibly high. And that's reducing strain on our healthcare system, which is helping keep everyone safe, regardless of whether it's, you're going to the hospital for COVID or not. It's keeping, you know, you, it's basically helping us to translate. To a period of time where COVID-19 is a manageable infectious disease. Rather than something that's turning our society upside down. So yeah, absolutely. I mean, I kind of get the sense that like, okay, if I got a vaccine for something and got infected, I'd be skeptical about the vaccine. That just the, the implicit assumption there is that a vaccine should guarantee that I do not get infected ever with this pathogen. And that's just a misread. Like, that's just not the way that most vaccines work. And so, but, but that doesn't mean that they're not extremely helpful. So it really it's sort of like paints it back to that, to my personal experience. It's like, well, I could get infected. We absolutely, you could. But it probably protect you and you'll never get to see what would have happened otherwise. And you know, it, it, it just, it has so many benefits that compound across an entire population that it's it's really about thinking about this as a public health problem. Yeah, no, that's helpful. I mean, probably so many things as well. Like I, you know, I read a few things, but how, like, you know, again, I don't know much about that. I polio is like gastrointestinal, obviously. And COVID is, is in, I mean, the diseases are vastly different and the viruses are vastly different. The way they evolve is totally different. The way they spread is totally different. I mean, they're there. It's almost difficult to find two more dissimilar pathogens. So it is so, yeah. And that was really helpful cause I, yeah, I was just struck by that. And like in, I think there's been this false sense of security, especially in the U S particularly, right. I can't speak on being an or since generally because public schools do demand a level of vaccination we've successfully really, you know, eradicated or got rid of, or. Really reduce the amount infection of so many serious disease that have feels as. Once you're vaccinated, you're a hundred percent protected. So there was like, and so, and, but that's now we're learning that that's actually not the case, but thankfully when you get up to 95% of vaccine, people be in vaccine, like polio, it's really effective. Right. And then they're just not a lot of fight going on and a competition. So I hope that helps the listeners. Some of you guys I know helped me cause I was like, oh, I want to get a little bit deeper into this. The next thing I wanna ask you about is there's been about a year with the Biden administration in the white house. We did this previously with the Trump administer. And we're getting, we're not political here, but just epidemiology perspective, looking at a year, where do you feel like the white house white house kind of hit the nail on the head? And where do you feel like maybe there's there's opportunity for growth for this 2022. Yeah. So, I mean, I think that there've been you know, a number of different ways in which the administration and you know, sort of governments all the way down have have responded to the COVID pandemic during this most recent year. And one of the big successes that I see is the. Making vaccines available and distributing them early and quickly and effectively. Especially in the early stages here in the U S our rate of vaccinating, our population was the highest in the world or, you know, among the highest in the world. And so it And that was really important because in many ways we were trying to suppress an active raging fire. So, so the speed at which vaccines are taken up was incredibly important. And so, by securing a lot of doses of distributing those doses it was by no means perfect. It was, you know, very despite all of the efforts that were in place, that they were still unequally distributed. And then there were there were less available for people who have. Higher barriers to care in general. You know, a lot of, a lot of these issues remained, but nevertheless vaccination rates rates really did increase very quickly. And I think to great credit of you know, governments all the way down from, from the byte administration all the way down to, you know, local communities that were, that were actually the ones, the boots on the ground, getting these vaccines and doses under the arms of people who needed. So I think that's been very good. And I think that sort of the overarching emphasis on the pandemic has been important. Just making sure that it's a consistent part of the discussions about what's going on and that it is an issue that we, that we need to deal with. So I think that it's I'm glad to see that there's been Attention paid to it, at least in the sense that it's, it's remained a part of sort of the national discussion. Of course, one of the places where I had hoped that we would make greater and faster progress than we have is with the availability of testing. I still think that, you know, that this part under the pandemic, the difficulty of getting either PCR tests that rapidly turned around or The cheap rapid tests. You know, I think that that's I'm, I'm really surprised that we're still having so much trouble with that at this point. Especially given the ways that other countries have, have managed to solve a lot of those problems. So, so, so that's been a real frustration for sure. And yeah, so, and then of course, you know, I think that the The United States interfacing with the rest of the world. It's also been mixed. I mean, I think we've, of course, you know, w thankfully we've, we've given a lot of vaccine doses to countries that need them. We've made them available, done a lot of manufacturing and helped to build some of the infrastructure for global vaccine distribution, which I think is very good. But of course, there's always, always more to be done there. Great. That's helpful. You know, you were talking about how a little bit late to the game for rapid testing, you know, I, you know, it's been good. I think as of this week up in the show notes, you know, you can sign up to get four free tests, at least I'm not sure. Maybe it's all you get. I'm not sure. From from the federal government. So. I'll put a link in the show as I sign up for USBs super simple. It was great. I read an article about how this is one of most successful things the government's done, because it was like, I mean, so many people signed up probably because I was released. The way I signed up Steven, I actually thought there's no way this could be a government sign up sheet because it literally took one minute. I feel like it would take like pages of like proving this and this, and what's your social security number, all that stuff. But it was just basically your, your postal code. Right. And that was just putting your address. And there you go off to the races. So I'll put that in the show notes. I also, you know, I don't know if you know anything about this Steven, but I saw it. I hear about this about free and 95 masks. And if that's part of the federal thing as well, I hear it's coming soon. I saw linked. Is that true or is that somebody, you know, I, I don't know. I, I think, I think we'll we'll know it when we see it, for sure. Sure. I, I think it's, you know, I think it would be great, you know, like I, again, like I think that there've been a lot of opportunities to invoke things like the defense production act to to just generate the supplies that we need to deal with this pandemic. And I think that rapid tests could fall under that. I think that high quality masks could fall under that. It really does seem to be the case that and 95 or similar masks really do help both protect you and to the people around you. And so all of these things I think are really common sense, pretty simple, straightforward things that we can do. You know, and I'm saying this simple, you know, from, from my armchair here, somebody who like runs mathematical models, but doesn't actually have to do any logistics, but that said, you know, as a country, we've, we've pulled off some pretty impressive things, you know? Right. Like we put people on the moon, I think, I think. We can, we can send out some rapid tests and then 95. That's awesome. Great. That's helpful. You know, and speaking of which, you know, this is a, there's an article I read here just this morning. I really enjoyed it. I'll put in the show notes, COVID loses 90% of ability to infect within 20 minutes and air this study. I'll let you guys read this as beyond my pay. Did I to, to provide the analysis to this, but what's interesting about taking, talking about how taking an older method what I'm trying to look for here, which I find is Goldberg drums with, with, with airborne viruses, a little bit more of a mainstream normal way, realized that when it comes to Omicron virus, it really does degrade rather quickly. And this just goes to, to, I think, confirmed the fact of the, of the. Four and 95 masks because it's really the close proximity. That's the most dangerous, right. We've kind of been knowing this for a while now. So, you know, maybe it's not necessarily at a restaurant and doors and it's the person 150 feet away from you. It is possible. It's always possible, but it's probably more likely if this is true. That it's the dude right next to you or the person you're talking to and why it's. So if you're, if you're within close proximity to have a mask on for the protection, especially during this time when we are really tapping so many resources, as Steven mentioned, so I'll put that in the show notes. I'll also put in the show notes, we've talked about over and over and over. This is why I think getting free and 95 mask, it would be so helpful because there there's so many knockoffs that you can get that aren't and 95, right. To be able to. That's actually officially, no, you're getting the right stuff and get it for free, but I'll put a couple links into the show notes about places you can go to be absolutely confident that what you're getting is the real deal and not some kind of knockoff that is. So let's talk about this, Stephen, you mentioned about how now that the, the kind of, what we're thinking about as being a transition, right? The case is starting to plummet. They're starting to come down in the U S not everywhere, but we're starting to see this. So now the mindset starting to shift to pandemic, to endemic. So what is it going to look like? I know this has been on your mind where you're studying this, what the stuff's going on. What's the talk going on, what it might look like when this becomes an endemic and how will we know that, you know, Fowchee mentioned a couple of things about maybe when we see a new variant that shows up, that's like, you know, not, you know, kind of like Omicron, but it doesn't have its transmissibility craziness that will really start getting to the endemic phase of things. So kind of give me your thoughts on this transition. Yeah. So I think that there's, this is really the a major topic of discussion amongst my colleagues right now, too. Or just sort of like, how, how do we think about this next phase of our experience with COVID-19? And so I think the first thing to note is that when, when we think about an an endemic infectious disease, I think that there can be this, this implicit. Almost like sigh of relief that like pandemic is this big, bad, ugly thing. And that endemic means that we're, you know, we, we've kind of kicked it and it's like kicking around and, you know, causes some issues, but we're, you know, we're, we're basically doing all right. And I think, you know, we're, we're fortunate in places like the United States, that for pretty much all of our endemic infectious diseases, that's the case, but I think it it's worth remembering that endemic does not necessarily mean good. Malaria is endemic. Tuberculosis is endemic to many areas of the globe and caused hundreds of thousands of deaths every year and disability and all sorts of different things. And so when we say endemic, Really in my mind, what it refers to is a An acknowledgement that that the dynamics of the disease have become regular or predictable in some way. So one of the reasons why I still believe that at least through the Omicron wave, we've still been very much in the pandemic phase is because there have still been so many curve balls, so many surprises, especially with the emergence of variants. We can contrast that to our experience with flu. Every 30 years or so we have a flu pandemic where there's this crossover from animals into humans, but so far, you know, for quite a while, it seemed to follow a pretty regular pattern where temperate regions of the globe have a flu epidemic every year, right around the same time. And, you know, within a certain amount of variation, that's of a similar size and we have vaccines and we're able to predict sort of which flu strains come out every year. Not so with COVID. At least up until this point, but the hope is that we will transition into a period of time where we can at least predict and therefore anticipate the dynamics of COVID-19. And that'll allow us to stay one step ahead and hopefully control it a little bit more easily, but just because it's endemic does not mean that it's harmless. And so I think we really need to bear that in mind. Now, some of my colleagues have also been trying to make a third distinction between pandemic endemic and epidemic. So you can think about some infectious diseases trying to think of good examples. It's, it's, it's difficult because a lot of the infectious diseases that we're most familiar with here in the U S are, are in fact epidemic in a sense that they have these cycles that, that that happen annually. But there are, there are plenty of other examples of illnesses around the world that are maybe more properly endemic in the sense that the risk stays relatively constant over the course of a year. And just sort of continuous circulating regularly as opposed to in these sort of major epidemic cycles. And that's important too, because you know, the. The, it, it doesn't just matter. The total number of cases that happen, or the total number of hospitalizations or deaths, it matters how quickly they happen to. And that's one of the big issues with flu is that if we could somehow even out the flu season and spread it out over the course of the entire year, that would actually be kind of helpful because flu can also cause a lot of problems in our emergency departments and in our hospitals during the winter months when it's released. If you layer COVID over the top of that, if we expect it to become an annual wintertime illness and we still have flu circulating and COVID-19 like, that starts to cause a lot of issues. And so I think there are a couple of things that we still need to understand, you know? To what extent are we going to be able to predict the dynamics of COVID-19 moving forward? I'm hopeful that we will sort of settle into a more predictable pattern of COVID-19 spread probably with spikes in the winter, like many of the other respiratory viruses that we have. But the difficulty with that is that means that we'll be layered on top of the other respiratory viruses we already have. And I, I really do think that our for, for. Years to come. Our healthcare system is going to have some difficulty dealing with us. And and I think that what that means is that there will probably be a knock on effect for those of us in the general public as well. Where during times of peak transmission in the winter months, we might have to wear masks indoors again. You know, that might also be a periodic review. Of our lives. And you know, maybe that's not to say, you know, who knows what the policies will be, who knows what we will actually do. But I think that it may well be a sensible thing to advise depending on how severe these COVID-19 surgeries end up being in the winter months. And then the last possibility is, you know, COVID-19 SARS, cov two is very infectious and more so than many of the other respiratory viruses that we, that we know of currently. So, so it's possible that it will buck the trend of seasonal wintertime transmission and that we might actually see COVID epidemics sort of happening sporadically around the year, much. Like we see the spread of flu in more tropical regions of the globe that don't have as clear delineation between their seasons. But we don't know yet. And that's precisely why we're not yet in the endemic phases because we, because we just don't know. Okay. That's super helpful. So there's a couple things that, that really shed light on this. Number one, it kind of reminds me of this idea of it. Not that I want to compare this to like nine 11, but it's like a lot of us who are of age. It can wreck it. Remember the time where you could go to the airport and not have to go through so many security to actually meet them at the gate and go, you know, all the travel seemed to be a lot easier and that part of our life is completely gone now. And it's always been gone now as much more security. Will it be like this where it will look back and like, do you remember the days before? COVID where we actually went to restaurants in the winter and we didn't have to wear masks, but is it a permanent fixture seasonal, you know, this becomes a permanent reality, like here and there during the peak season that. Could be that's one thing I was thinking about, the second thing is I think you helped me understand to my next question, which I keep kind of maybe it's beating a dead horse or whatever it is, sorry for that. There was a terrible phrase to say or whatever, but it's this idea of whether this is the time to, you know, be okay to get Omicron. If you haven't been infected, it's still in the headlines. I feel like you kind of begin to tap into this because. Right now we're still in the pandemic and that, you know, it's a much, it's, maybe it's a much safer time to venture out when it's getting close to the endemic, when it becomes more predictable, predictable. Cause I'm trying to understand like why, why do I want to force myself to stay in right now and, and stay away from this? Which is like so far, the lesser of evils have shown its ugly face in the past year. You know? And, and the reason why I say this is because. Staying. So I don't, you know, the biggest thing I'm going to do is I don't want to overwhelm the healthcare system, which has already tapped in burdens. So that's, that's my, my primary concern right now. Right. That's I think that's a higher risk than me having going to the hospital, myself me, me transmit to somebody else who might have to go and then burden the health care system. But there's some articles that I want to just to throw your way, vomit them at you. So to speak. And then you can just kind of wrestle with that and helped me understand, you know, there was a couple of articles, one that said they knew that from the CDC, natural immunity, stronger than vaccine alone and Delta wave. I mentioned about the natural immunity, six times stronger than the vaccine. Now, of course, there's lots of caveats to this that I want to. Before I give the mic back to Steven. It clearly recognized the fact that it's not recognizing boosters is fact that it's towards the end of the vaccination rollout. So it was probably already losing some sense of its strength. So there's all these caveats, but there's this sense? Of natural immunity in some certain situations being more effective, I'm not advocating, not getting the vaccine. My thing is always like, oh, a both and combo. Like if I'm I'm fully boosted and if I somehow get it, maybe I'll be a little more protected if there's some really ugly faces coming down the road six months from now, right. I'm going to stay on top of my vaccinate vaccination. And then I think the other one was this whole thing with this article. Off the record helped me to understand it. It really confused me and of this thing. T-cells from common cold can provide protection against COVID-19. You mentioned before over a year ago, Steven we're well, over a year ago, there's been evidence that other coronaviruses just the common cold type can help build our immunity, which makes sense. Right. There's a natural exposure. That's somewhat similar. And those T-cells really help us as. The build a sense of protection, right? But there is a sub part of this article that was confusing to me, there was saying, well, you know, kind of juxtapose juxtaposing, the vaccination being current COVID 19 vaccines target the spike protein, which mutates regularly creating variants, such as Omicron, which less than the efficacy of vaccines against symptomatic infection. Right. And then says on the other hand, in contrast the eternal proteins targeted by the protective T-cells, we identified mutate much less. There is almost as kind of this like distinction between, oh, almost telling me Stephen, like, well, if you get vaccinated, that's really good. That's just the, that's just the spike protein. But if you get it, but natural muni, like the common cold, you get the breadth and scope of those, the deeper proteins of that virus, which is more protective and really emboldens the T-cells and then you were telling me, and that's where I hand it to you. That that's not necessarily that simple of, of, of, of of Yeah. Great. So, yeah, so a lot of different things here, you know, I think the first thing about like the difference between immunity from natural infection versus immunity from vaccine, from vaccination there have been results on this that have been all over the shop. I was, I was just looking at another study that said actually, yeah, Vaccinated people are five times more protected than people with natural immunity during the Delta wave. And I think, you know, the, the critical thing to bear in mind here, you know, when we're trying to sift through these things is, you know, first the importance of consensus that any one study especially an observational epidemiological study, it's going to have a lot of biases that we need to account for. And so. A single study is not a very reliable thing to base our information on with respect to these, you know, sort of, one phrase understanding of, of our immune response to COVID-19. In my understanding based off of all of the studies that I've seen it seems like natural immunity that natural infection does provide pretty good protection against Definitely severe disease from COVID-19. I basically judging by the fact that I've seen about as many studies saying that natural infection is better. And as I've seen studies, that vaccination is better. I'm inclined to think that they probably give you similar degrees of protection. And that probably the most protected people are the people who have had both. That said, you know, when you get natural, in fact, You were at a risk you're in a risk to your own health. You're in a risk to the health of the people around you. And I think that that needs to be weighed very heavily as we're thinking about these things that, that you don't get that immunity for free in the way that you sort of do with the vaccine. And I say sort of, because, you know, getting the vaccine did not feel good to me, right? Like I paid for it for a day, but I knew that I wasn't contagious to other people. And I knew that like I was going to recover from that nasty headaches that I had. You know, and, and so that's fine. Like that, that to me was, was very it was a much greater value than the immunity that I might've gotten through natural infection. Now that said, like, we're now in a period of time where Omicron is spreading, a lot of people are asking if they should just get the infection and get it over with. And you know, I, I don't think that that last. Phrase is, is accurate because we're not necessarily going to get it over with. We're in the sense that we get reinfected with flu year after year after year. And there are plenty of breakthrough infections, both vaccine, breakthrough infections and re infections post-infection that happened. And so, you know, it's, it's not really so much getting over it, you know, over our experience with COVID. W w again, we're going to be dealing with us for quite some time. But with all of that said, you know, I, I was just reflecting the other day with with some friends about how it's easy to forget that this time last year, you know, we didn't have the vaccine. I didn't have the vaccine. A few people did you know, healthcare workers might've been vaccinated by now, but like were totally unvaccinated at this point last year and Alfa was spreading. And. My behavior around COVID-19 was very different than it is now. My risk tolerance was very different because being vaccinated and now boosted my risk of both acquiring and spreading COVID-19 is very different than it was at that time. We know more about the virus. And so I've been more I, yeah, I've, I've been like, I'm going to the grocery store that, and you know, more often than I would, you know, at that time of year I'm not dining in doors, but I feel better about like seeing people one-on-one Yeah. In like an apartment or in a, in a space where we're not expected to see a lot of other people. And that's sort of where I've set my risk tolerance right now. Especially because we're in the middle of such a nasty surge here where I'm really trying to make sure that I'm not one more link in the chain of transmission. But that will all change too. As our cases come down, then all sort of relax my behavior some too. So I think the main thing is that I have a lot of confidence in the vaccines and their ability to protect me and the people around me from severe disease. And that's part of why. Sort of less restrictive with my behavior right now. Why I'm less concerned about getting a Macron. And I mean, I don't, I don't particularly want to, this would be a pretty inconvenient time to be laid up for a week, which I may well be, or I may feel nothing, I don't know, but either way, you know, I'd rather not right now, but you know, th that's very different than what I was thinking last year, where it was like, I absolutely do not want to have this. And again, that that's me. Everybody has their own different considerations. If they're taking care of somebody who's elderly or immunocompromised or kids who would have to stay home from school, if they were, you know, like that could COVID means something so utterly different to different people. That I think that's worth bearing in mind. So I'm trying to be a little more conservative with my behavior because I recognize that I'm around people who have a lot more to lose from getting COVID than I do. And so I don't want to spread it to them, especially now that COVID rates are so high. But you know, I do think. If you're vaccinated and boosted that provides a lot of protection against Omicron. I, I'm less concerned about getting infected now than I was a while ago, but I'm still doing a lot to make sure that I don't. Yeah, that's helpful. I mean, the fact that sometimes we get so stuck in the phrase, like, just get it over with that. We don't stop to ask ourselves or maybe even ask our friends, like, what is it like, you know? Cause, cause I think that's a big question. Cause it's. W w the face, the honest truth. It's not, we're not getting COVID over with, but there may be something underneath that, that I need to be compassionate with myself or compassionate with that other person. Right. Like this sense of it could be, I just want to have more connections. Right. I feel really isolated again. Right. Well then, okay, well then, then you need to explore that it right. It to figure out. Cause I, I, we don't want to be completely abandoned our critical friends. How can we actually, and you gave the perfect expression, you know, perfect illustration of last year. There's there has been a lot of growth for you personally, in the sense of where I was last year and now with protection where I'm at this year. Yes. Am I still doing things to protect myself and people around me? Yes. Am actually doing more things I did last year. Absolutely. Right. And so really diving down personally, what it is. And then being able to talk through that and going back to what you said Thanksgiving, and then incorporating what's your risk budget. And so there's your own risk budget as well as the risk budget of the community around you. And both those that be put into that equation, which of course, as we say, every single, maybe every other episode, it's utterly complicated and there is no. I wish, you know, I, my undergrad in computer science, I sometimes, you know, maybe I don't, I mean, sometimes I wish that life was maybe a little more binary, like a microchip, but it's just not, it's just not that way. Life has complicated and it brings up, you know, I think a more general point too. And I've been thinking a lot about like when, when somebody comes to me and asks for advice about. The COVID either they've had an exposure or they become infected themselves or somebody they know has been infected. And it's like, what do I do? And I imagine a lot of us have been in the scenario where a friend or family member has come to us and been like, Like this was the situation that's happened. Like what do I do? And I really do think that as, as I've sort of watched my own response to that question and watch it to the response of other people around me to that type of question, it's so easy to Again, not ask what that it is to sort of project our own uncertainties and insecurities and presuppositions about COVID-19 into that person's life and say like, well, you got to do this, this and this. And I, there were, there were times when I did that, you know, early in the pandemic and realized that I was not really hitting, hitting the mark at all. And so, you know, I've, I've really tried to transition to, you know, somebody says like, this is the scenario. And then to just sort of ask and lay out, like, you know, first, how are you doing? How are you feeling? Are you okay? And then like, what are your concerns? Like, what are your parameters? What are your constraints? What are your most fearful about here? What's the situation you absolutely want to avoid? What's acceptable to you. And oftentimes these are like that, that yields so much more of a fruitful discussion because you know, a lot of times the people I've spoken with are like, not particularly worried about their personal health, but maybe they're teaching a class full of 30 students who have parents who are unvaccinated. And it's like, okay, well, Great. So, so we can think about ways to help you keep your class safe. And that's a very different thing than like trying to prevent any sort of spread at all. Like, you know, it's and I think that that allows us to really get into the meat of these things and it's really worth recognizing just like. Again, I mean, how different each of our experiences with this virus is and how different each of the things that we need to consider when we've been exposed, when we've been infected are and really trying to enter into each other's realities with that, I think is just just really important. Man you gave us some, some gold there, a buddy, and I'm going to go back two minutes. I looked at it and then at 39, and I'm going to document as questions you asked. I'll put them in the show notes. I think they're really important questions. I mean, I know you just riff and I'm sure you could probably get more deeper questions, you know, if you thought about it, but those are really strong and evocative questions. And you know, I'm thinking of that, that HR senior leader, a guy who gave us a great review and the struggles that he asked it. To to face he's he's going into places by which he has staff that has to go in for the sake of just for, for a lot of reasons, right? The, the, to keep community going, keep business going. And there are people who probably have a lot of perspectives on how they feel about going into a public. And to be able to, instead of just bringing down judgment, either a, you know, one way or another, to be able to sit with these people and ask them the right questions to get, get at the core and then help to be accommodating, say, okay, well, you know, we have to protect and you know, you have to do your job and. Yeah, I want to protect, I want to do both. And a lot of times it's easy to make it a policy when really needs to be personal. Right. And that's, and that's, that's what I really appreciate the personal touch you gave to that. So I'll go back to minute 39. I'll listen to Steven's w words of wisdom for them. And bullet point questions. Use them with friends. I'll use them myself. And oftentimes I think we need to use them with ourselves first because we get so excited. About things that we don't even know what the reason is behind the motion. We're like, no, I don't want to do it. Like what, what is it? You don't even know yourself. I don't know. Oftentimes, so maybe start using yourself as a, well, well, speaking of complexity, Stephen, let's end on this, which just because just shows the nature. And I reason I want to highlight this because. One thing I love about you, Steven and mark, when he, when he, when he's on is that this is not political. And this is just like, we're, we're trying to ride this middle ground of just pursuing the truth of what's going on and helping to protect people on an individual basis and as a community. And so this one article I read the CDC is flawed case for wearing masks in school, which of course I trust the CDC. I, I, I, I, you know, I appreciate all the CDC. Does I follow it on a regular basis for my own family? But here you had an interesting article by the Atlantic, suggesting the CDC aired in kind of adopting this study that was done from Arizona. Again, I don't know much about it. I just read the article, but it was fascinating. And I also trust the Atlantic. They have a really good journalism there about how basically this was a very, very flawed study. That's trying to promote the idea that masks in schools for kids for kiddos, you know, says like three and a half times. Three and a half times protective against getting COVID. And so this is a very, it was a, just a crazy study in the sense of like, there was no say like this showed the how effective mass war and basically went through this whole thing, showing that it's actually probably a terrible study and it shouldn't wasn't even used. They didn't even follow really. Scientific regimen. Right? And that there's a, been a handful of other studies that show that's not the case. Look, wait, like you were saying just like 15 minutes ago. It's not just one study. It's it's consensus. You got to look for that showed, but I just want to throw it to your way of like it's complicated because even when the CDC gets involved and they're there, they're not a hundred percent perfect. Nobody is. And so things happen like this, that just throw things in a loop and us lately. We're just sitting here watching TV, watching our screens, getting advice. It makes things even more difficult to hear. Okay. Now, you know, I don't know. Did the CDC do this for a favor for someone? Did they not? I don't, I have no clue. Was it just a mistake? Whether just an oversight, but it just lead us in a, in a, in a hard spot of like, Hey, where do we go to make sure we're doing our best to, to, to get the right information? Yeah. So I think one of the things that I Yeah, I I'm really interested in sort of the communication of scientific understanding and of health policies. And that was not really something I thought much about at all until this pandemic. But the CDC is of course the, the central public health communication agency in the U S and one of my big frustrations up to this point is that I think that There could be a lot better communication around the motivations and parameters around the policies that are being recommended. And so, yeah, I think that what I suspect is that, you know, this, this study from Arizona may have come out and raised the issue of masking in schools back to the forefront. But I doubt that the policy I mean, first of all, it, in my understanding, it's just kind of a continuation of recommendations rather than really a change. And and while, you know, this study gives us very impressive, suggested gen of the protective degree of masks. There are a lot of other studies that show much smaller, but. Meaningful protective value from masks. And so, again, there's sort of this consensus lurking in the background that, you know, the, the, the coincidence of these of the statement being made on the heels of this article makes it seem like the two are linked and they may well be. But my hope is that these decisions are being made on, on really sort of three different levels. You know, one of them. His degree of need. We have a lot of COVID circulating right now, and we really need to do what we can to reduce the spread because of the amount of strain that there is on the healthcare system, in the amount of hospitalizations and deaths that are still occurring. Second, you know, of course the science and, you know, do we have evidence that that what the interventions that we're proposing are likely to be effective and that science can take all sorts of different Layers of evidence in a way you can have randomized controlled trials, which are sort of the gold standard of evidence. But science sometimes also means that there's a plausible reason to believe that something may work based off of experience with other viruses or in other venues, maybe not in schools, but in workplaces or something like that. All of that is then being synthesized and then applied. Third thing which has been really operational during the pandemic, which is this idea of the precautionary principle, which is that we don't know really what Omicron is going to do. We don't really know. Or at least we do have a much better sense now, but that wasn't the case three weeks ago, right? Yeah. And so, so, so there's, this, trade-off where we have this intervention that we know is likely to help and very unlikely to hurt. And and, and we can deploy this to at least to give us the best chance we have to blunt this coming tsunami of infections. And so there's the sense of like, where. While we're waiting for better evidence. We're going to take reasonable precautions based off of what we already know to avoid a future, you know, to, to try to at least avoid a scenario that we really don't want to get into. And so those, I think are the layers on which, on which decisions are being made. Okay. Each of these different sort of levers play to different degrees into different decisions. And I would love for there to be a lot more transparency as to how each of them inform the policies that are being made. Because then I think we might be a lot more likely to say like, oh yeah, like I understand that. Like, and maybe we're really not sure how useful masks are, but Hey, you know, basically what they're saying is like for the duration of the surge, it's probably not going to hurt as much as it could very well help. So, all right. I can get behind that logic. But if I'm basing it on. Study, that's really poorly controlled and wasn't conducted in a very good manner then would be like, why should I trust you? It's the same advice, but it's different reasoning. And that changes my behavior and my response to you, to the guidelines that are being made. So, so I think that that's something that generally we can do a lot better with, about scientific communication, but in the absence of that, I think it's helpful for us to keep in mind, you know, those of us who are trying to abide by and understand the. Policy recommendations to recognize that there really are these different elements in play and that it's not always. A causes B and you know, a prompt B policy decision. But that there are a lot of other things sort of going on in the background. And and sometimes it can be helpful. You know, if the public health agencies can't do this for us, at least we can think for ourselves through what does, does this make sense? Like, is this a policy that I might come up with on my own. Even in the absence of, of this study. And I think that that can sort of help us to sift through these things and and maybe give a little bit more grace for those who are trying to develop these policies on the fly. Yeah. Thank you, Steven. Yeah. I just think like, it's like, you know, I'm sure it's even more than, than even complicated than this, but digging as, as a, you know, these three legs of that tripod of science and that really be able to understand that like, okay, when something like this is done and everyone it's great to see that, like everyone, it's not like it's, it's, it's a study proving the opposite thing that's been. So that maybe it'd be a call call for a while. But it's, it's maybe an exaggerated reality of something that that's already been shown in one way or another, that it's effective. So that's one thing. And then if it's using a particular leg of the tripod of precautionary, right. It's probably saying like, look, maybe this study isn't perfect, but it continues to lend itself towards the precautionary reality and the evidence that we see already that it does protect, right? So it's not like a blatant lie or an error. It's actually in the vein of the right direction of what science has been going. And. Precaution says let's continue down this path and elevate it. Right. That's helpful. I appreciate Steven. Thanks for that clarification. Always words of wisdom from Dr. Dr. Steven Kissler. I appreciate it, buddy. We're going to end on this note for the next couple of weeks. Thank you all for listening. If you want to get a hold of us, ask a question, tell us how you're doing. If you have questions around the globe that I don't have time to research, you can do that@matlivinginthereal.com. If you want to get ahold of Steven on Twitter, I really, really, really suggest to you His channels on Twitter, a lot of great information there. S T E P H E N K S S L E R. If you can support us patrion.com/pandemic podcast. One time gift PayPal, then Mo in the show notes, and please leave a review. It inspires us and keeps us going. Have a wonderful next couple of weeks. We'll see you then in two weeks, take care and bye-bye.