0:00

You're listening to the pin. Every podcast we equip

0:02

you to live the most real life possible and the face

0:04

today's crisis. My name is Matt Boettger,

0:06

and I'm joined with my good friend once again,

0:08

and he is no longer in Colorado and

0:10

it stinks. I never got to see him in face to face

0:13

or give him a big fat hug. My friend

0:15

and your friend at Dr. Stephen Kissler and epidemiologist

0:18

of the Harvard school of public health. Welcome

0:20

back to Boston. How are those birds? I hear

0:22

in the background. And how are you feeling being back in

0:24

your old little apartment?

0:27

Hey, it's it's mixed all sorts of things, it's

0:29

always good to be back in her own space and that kind of thing.

0:31

That was really good to be back home for a little while.

0:33

mentioned before that the flight in was super delayed.

0:35

So, if I say anything foolish on the podcast

0:38

today, just chalk it up to the fact

0:40

that. It was a late

0:42

night, huge

0:43

disclaimer for everyone. Like he said, he came and went at

0:45

three 30 in the morning, so that stinks. So

0:47

he's able to join us right now. How

0:49

long were you in town? I didn't realize like over two weeks. Weren't

0:51

you

0:52

or? Not quite, but yeah. They're about, it's

0:54

yeah. Okay. So it was good.

0:55

Yeah. Good, good. All right. Let's get

0:58

a few things. Small things started

1:00

love reviews. If you still have them, keep them coming.

1:02

We really appreciate that and motivates us and also.

1:05

Helps us give us feedback as well. If you wanna support

1:07

us patrion.com/pandemic

1:09

podcast, as little as $5

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can go a long way or just a one-time

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donation at Venmo PayPal, all

1:16

in the show notes, it's all the good stuff

1:18

right now. Let's get right into the seal. I had this

1:20

question this morning, Stephen, in my mind,

1:22

I'm like we've kind of asked this question, but not directly.

1:25

It's been a long road for you. Obviously things are

1:27

much better. Now. I just checked the kind of cases

1:29

this morning. It couldn't be, it was under 5,000

1:31

cases in a day for the U S

1:33

this is just unheard of.

1:35

So things are great for us right now

1:37

in the U S doesn't mean that it's going to continue that way

1:40

necessarily. So there's price, a few things to chat

1:42

about, but I wanted to pick your brain

1:44

about how epidemiology.

1:46

Has changed for you since, before the pandemic

1:49

we've touched on this, but maybe not in this

1:51

kind of specific way, because I would imagine

1:53

in my mind, I'm thinking, okay before the pandemic, you

1:55

were doing your research in your lab, you had to particular

1:57

studies you were doing, and then everything was derailed

2:00

and he focused on COVID. That's

2:02

one thing. So I want to see like how many, like different,

2:04

like ways by which you approach epidemiology,

2:07

how has that changed? But also I'm guessing

2:09

what, what used to be data sets for

2:11

you? They used to go to is probably expanded.

2:14

I'm just seeing, I was going way back, like a year ago,

2:16

we talked about that thermometer that, that smart

2:19

thermometer. And I'm sure before the pandemic, there wouldn't

2:21

be even on your radar as a piece

2:23

of data. And now all of a sudden the Kinnser

2:25

you had the kids, a thermometer, which we have, and

2:27

now you have a date, a new data set. So how has

2:29

data expanded? How have you approached

2:31

differently from before and after the pandemic, as

2:33

an epidemiologist?

2:35

Yeah, that's a great question and something that I

2:38

and my colleagues have been thinking about a

2:40

lot, for sure. You're right. The the

2:42

pandemic has really spurred a

2:44

lot of technological innovation a lot of investments,

2:47

a lot of interest just generally speaking in

2:49

epidemiology. And it's really great. We've gathered

2:51

a lot of data sets that we didn't have before. Some

2:54

of the things that I've been especially excited about is

2:56

that there have been more and more

2:58

collaborations between social media

3:00

companies and people who

3:02

are, different companies

3:05

who have apps, for example, that can help

3:07

give us a sense of our phones and close proximity

3:09

to each other. So integrating

3:12

Health technology into the devices

3:14

that we carry around with ourselves all the time

3:16

is super powerful. And of course it comes along with

3:18

a lot of issues that we're solving in parallel

3:20

in terms of privacy and protecting

3:22

users rights and health records and those kinds

3:25

of things. But there are actually really. Tractable

3:27

ways to solve those problems that are making these data

3:30

available. In part, because we now understand

3:32

the value of it, right? Like before this,

3:34

we as epidemiologists,

3:37

we had to say flu pandemics come along every so

3:39

often then I know the one in 2009 actually wasn't

3:41

that bad, but it could be, and

3:43

that's not a very strong motivation and it doesn't

3:45

really get people to move to action. But now

3:48

the landscape has changed, right? It's like we've all lived

3:50

through this crazy traumatic event.

3:53

And so that has really brought around a lot of these collaborations.

3:55

So the mobile device data, I think,

3:57

is a huge area that I'm really excited to see

4:00

expanding. Some of the other stuff, a lot of it

4:02

has to do with surveillance where people are

4:04

thinking about using like doing surveillance

4:06

for antibodies in donated blood around the

4:08

world and like collecting blood

4:10

from animals, different reservoirs, where we expect. Back

4:12

some of these viruses could jump from animals to humans

4:15

so that we can get a sense of what's circulating there.

4:17

So there's a lot of middle term infrastructure

4:19

that I think probably would have been maybe

4:21

20 to 30 years down the road and is now maybe five

4:23

to 10 which is really exciting to you. So it's really

4:25

sped all of that up. And

4:28

then, this the spring public

4:30

health schools have just been flooded with applicants,

4:32

which is awesome. There's so many people who

4:35

want to be epidemiologists, which I think is really exciting

4:37

too, because that is Yeah.

4:39

That's how these fields keep in gain momentum

4:42

and that poses, questions of itself, how do

4:44

we train all of these people? What do we do to

4:46

make sure that we're giving them the skills that they need?

4:48

Not only to do the sort of work that I was doing before the pandemic,

4:51

but the sort of work that I'm doing now. And so I think that

4:53

then transitions into sort of my personal sort of how

4:55

my approach to epidemiology has changed

4:57

as well over the course of the pandemic and it has changed

5:00

profoundly, it's I've always been very interested

5:02

in infectious diseases, but since before I went

5:04

to college, I've always thought that this was something

5:06

that I wanted to dedicate myself to. And

5:08

I've learned a lot about the theory

5:10

of infectious diseases about how they behave.

5:12

I've read a ton about flu and the, and that's why

5:14

I was in a position to help with the COVID pandemic

5:17

when it emerged. But it isn't. Totally

5:20

different thing to actually be doing crisis

5:22

response on the ground as it's happening,

5:24

trying to keep up with data as it's coming in communicating

5:27

with journalists, having a podcast,

5:29

for example, being responsible for information and that

5:31

various sort of up-to-date manner. It

5:33

really reshaped my idea of

5:36

what is relevant, what are the questions that need to be asked?

5:38

And so it's shifted a lot, for example, pre

5:40

prior to the pandemic I found myself asking

5:42

a lot of questions of I had this more

5:45

abstract interest in like, how do infectious diseases behave?

5:48

How did the. 2009 flu pandemic spread.

5:50

How can we like account for

5:53

how much of it was like the timing of opening of schools

5:56

and how much of it was like differences

5:58

in, regional weather patterns and these kinds of things.

6:01

But a lot of those things, aren't things that you can directly

6:03

intervene upon. There are things like when you have a pandemic

6:05

on your doorstep that you can say okay

6:08

because we have this information, now we need to do this.

6:10

And so I think this pandemic has really refined just the way

6:12

that I ask questions, because it's a lot more

6:15

based around, okay. We have.

6:17

This crisis, what

6:19

are the very pragmatic things that we can do? What are the immediate

6:22

next steps that we can do to make it better?

6:24

What are the new technologies that we have available now,

6:26

or that we could make available very quickly? And

6:29

how would we use them given the fact that we have a

6:31

limited amount of investments to put into all of these

6:33

problems. And so those things are

6:35

more directed at where the rubber hits the road. And I

6:37

think that's going to affect the rest of my career. And

6:39

really, again, zooming back out the careers of epidemiologist

6:42

as a whole, we're all going to be thinking about this and

6:44

I think a much, much more sort of concrete

6:47

applied sort of way which I think is

6:49

really good. I think that's the direction that we needed to head,

6:51

but it takes something like this to

6:53

make that

6:53

happen. Yeah. Now looking back from

6:56

the beginning of March in 2020, and then now

6:58

in the technology that's advanced. Between

7:00

now, and then, and I know there's still, like you said, instead

7:03

of 30 years now it's closer to five to 10 years.

7:05

So there's still things up in a way that you see in the, over

7:07

the horizon that would be enormously

7:09

beneficial for epidemiology. And I'm

7:11

assuming there are a few nuggets that have come along

7:14

the way already that have been incredibly useful in

7:16

light of what you've got. You've seen them in useful.

7:19

Is there anything that you would've done differently

7:22

from March until now? Okay. Now with this

7:24

technology, we could suggest that this particular

7:26

kind of track, if this technology is already

7:29

in existence in the next pandemic,

7:32

we could potentially say, let's

7:34

try this or X or Y or Z versus

7:37

just a nationwide lockdown.

7:40

We're basically, do we have more tools to be a little bit

7:42

more surgical next round

7:44

already? Then we did in 2020. And what,

7:46

w what's one or two of those tools that you see

7:48

that oh, these are really good ones and could be even better in

7:50

the next five to 10 years.

7:52

Yeah. That's a great question. I think, absolutely.

7:55

We have both the tools and we've done a lot of the

7:57

work. To figure out how best to

7:59

use them. And I think, gosh I feel like I beat

8:01

this one with a dead horse, but tests testing, like

8:03

rapid tests for goodness sake.

8:05

That's, that is the biggest missed boat of

8:08

this pandemic and, and turning that into

8:10

a positive statement, we, we have

8:12

this available, we know a lot more

8:14

about both how to produce the tests. But

8:17

also what, how can they be useful?

8:19

How can we think about them and deploy

8:21

them in a way that actually will

8:23

prevent the spread of disease? And I think that

8:26

in the next pandemic, we will be a

8:28

lot quicker at deploying

8:31

those kinds of things. Hopefully if

8:33

we've learned anything from this one I think that's one of

8:35

the things that that I hope to see. And

8:38

I think this is also related, we have rapid tests

8:40

and the ways of using different types of tests, making sure that

8:42

testing is available, but also just

8:44

different types of empowering individuals

8:47

to know. To make it,

8:49

to make good decisions around the spread of disease. Testing

8:51

is absolutely one of them. W we were talking a little

8:53

bit before we went on air, but apple watches

8:56

and phones and stuff, have all of this incredible

8:58

health technology. That's being integrated into

9:00

them from glucose sensors and, heartbeat monitors

9:02

have been there for ages. I don't know if we'll ever

9:04

have like pathogen sensors in these things, but still

9:06

there, even just having a thermometer on there, for

9:09

example, that's keeping track of your baseline

9:11

thermometer your baseline temperature over

9:14

long periods of time. It can begin to tell

9:16

you if there's something strange going

9:18

on and start to trigger you to say,

9:20

your heart rate is increasing. Your temperature is increasing

9:22

some. Maybe you ought to

9:24

be a little bit careful here. Maybe you ought to get assessed

9:26

or something like that, and and so I

9:29

think that increasingly, there's been a long

9:31

trend of putting the power

9:33

of healthcare decision-making in the hands

9:35

of the patients and the legacy of that has been mixed.

9:37

There are times when you actually need

9:40

a doctor to tell you what is right, and to tell you what

9:42

to do. And I think that holds for public health

9:44

too, there's a danger in totally free market

9:46

solution to both medical

9:48

healthcare and public health care. We do still have a role

9:50

for experts and for people who

9:52

are, setting laws, UMass mandates,

9:55

things like that, that those will probably continue.

9:57

But I think as much agency as we put,

9:59

can put into the hands of individuals, which a lot of this technology

10:01

is helping us to do the better. And

10:03

I think like you said, that will help us to have much more

10:05

targeted strategies. In the next pandemic

10:08

and hopefully prevent these kinds of widespread lockdowns

10:10

that we needed to have for this.

10:12

Yeah, I hope so. I didn't even think about the whole

10:14

Bazell thermometer. I'm going to wash make

10:16

such a simple, I would just, I would imagine sort of simple

10:18

technology to put into a watch and

10:21

how incredibly useful. They're already, as we talked about this months

10:23

ago that there was a bunch of independent researchers

10:25

using apple watches and able to be able to use the

10:27

existing technology, let alone what's coming

10:29

up in the fall to determine whether

10:32

you might be having COVID and be upwards

10:34

to 80 to 85% accuracy just

10:36

by monitoring a handful of metrics.

10:39

On the apple watch currently. So in my mind,

10:42

it's all about how quickly can we turn this

10:44

around versus a year and a half or a year.

10:46

If we've got the principles down,

10:49

can we turn this around quickly? The next pandemic,

10:51

this goes to a couple of things we mentioned that

10:53

came up, just two weeks ago, I saw the, now we're having

10:55

dogs sniff out. COVID that's

10:57

pretty crazy to think about.

11:00

Pretty crazy. It blows my mind that works,

11:03

but they actually do incredibly

11:05

well at it. And

11:06

I'm imagining this, in my mind, I'm thinking this is probably

11:08

something that wouldn't really take that long

11:11

in the end. Once you get the smell of it, it's just

11:13

training the dog to be able to do it. So I'm thinking, okay, how

11:15

can we turn it around? Then last week I saw

11:17

this, I was laughing with Stephen about this off

11:20

the record. I'm like, now they've just found

11:22

a sensor. That you can put like

11:24

a smoke detector in your house to sense

11:26

COVID in the room. It takes a

11:28

minimum of 15 minutes in 15 minutes and 30

11:31

minutes to detect it. And it's 95 to a hundred

11:33

percent accurate. There's even better than

11:35

PCR testing because PCR,

11:37

I guess asymptomatic can be hard to do sometimes to

11:39

get to, to get, whereas this can just get

11:41

it in really quickly. Man, if we can turn

11:43

these around quickly, what a game changer.

11:46

The

11:46

next page. Yeah. Yeah, totally. I think

11:48

that's a really interesting idea. That's I don't know. I don't know

11:50

what the, what the yeah. Alarm would do necessarily,

11:53

but you can imagine like setting something up like that in a restaurant

11:55

or in a classroom or something.

11:58

Yeah. And it goes off and you just know that

12:00

you should clear out the space and that

12:02

might prevent, some of these big, super spreading events from happening.

12:05

It's a super interesting tool. Yeah.

12:07

So I'm, excuse me, super excited about the future

12:09

of technology and how to use this in health. And I'm sure as

12:11

we continue down the road and talk about other

12:13

things, when COVID begins to continue to settle

12:16

down, we'll readdress some of these things, but

12:18

nonetheless, there are still a few hot spots

12:20

within COVID. I saw this resurface.

12:23

Two or three times in the past week, this Delta

12:26

variant. And I wanted you to talk about

12:28

this. It looks like they're seen in California,

12:30

10% of COVID infections in the U

12:32

S so far currently, or are

12:35

the Delta variant. And they expect

12:37

it to be dominating the U S

12:39

relatively soon. You want to talk a bit about this and some of the

12:41

potential fears about this. Yep.

12:44

Yeah. So that's, yeah, I think that over the

12:46

past week, I've really heard a lot of my colleagues,

12:49

especially getting more and more vocal about

12:51

this. So to circle back on the discussion

12:53

we had last week, so the Delta variant is the same

12:55

thing as the B 1 6 1 7 0.2.

12:57

Which is the one that was first detected in

12:59

India. And that seems to be responsible for

13:02

the big spike that we saw there. It does seem

13:04

like a lot of epidemiologists

13:06

are also getting on board with this Greek letter naming I'm

13:08

actually revising one of my manuscripts right now to

13:10

switch out all of the old names. So for better or

13:12

for worse it's happening. And so we have this

13:14

Delta variant that's spreading and a couple of reasons

13:16

why it is. It has recently

13:19

been causing more concern amongst

13:21

epidemiologists. So one of

13:23

the things that's always really difficult to tease

13:25

out in a country where

13:27

variant is first detected is when

13:30

you see a rise in cases, is it due to some biology

13:32

of the variant or is it due to some sort of

13:34

shift in the behavior in

13:37

whatever is going on in a given location

13:39

at a given time? And when you have a variant that's

13:41

spreading in just one place, it's really

13:43

hard to disentangle that near impossible.

13:45

And so that's, that's why it's taken us a while to

13:48

really figure out if there is truly in

13:50

fact, something special about the Delta

13:52

variant or if there was just something

13:54

about this particular time. In India

13:56

and neighboring countries that was causing it to really

13:58

catch on like wildfire. I think a number of podcasts

14:01

back I speculated that there was probably something

14:03

special about this variant, just because of how explosively

14:06

it was spreading and how not explosively

14:08

COVID was spreading in India prior to that. And

14:11

that seems to be more and more the case but part of the reason we're

14:13

getting that information now, Is

14:15

because Delta is making up. I think

14:17

now a majority of cases in the UK and

14:20

the UK is starting to see overall COVID cases, beginning

14:22

to rise. Now the UK is one of the most highly vaccinated

14:24

countries in the world. And and they're

14:26

emerging out of a pretty long-term

14:28

lockdown that, that it's not a full lockdown,

14:31

but they do have a number of restrictions

14:33

on. Different things,

14:35

it's very different than the lockdown at the beginning of the pandemic,

14:37

but but they're needing to extend some of those restrictions

14:40

longer than they expect it to because of this rise

14:42

of the Delta variant. And so that's one of the key

14:44

pieces of information is that Delta has now spreads

14:46

to other countries, including the UK and the

14:48

U S as well. And we're seeing

14:50

it taking over the other viral strains.

14:53

Now the other big, bad one that we were really concerned

14:55

about was the or the alpha strain,

14:57

which was the one that was first detected in the UK. And we were concerned

14:59

about that because that was, on the order of probably 40

15:02

to 50% more transmissible than the one we

15:04

had been dealing with before. So

15:06

all indications are that the Delta variant is now

15:08

40 to 50 times for 40 to 50%.

15:11

Sorry, more infectious than the alpha

15:13

variant, which makes it, easily.

15:15

Yeah. The infectiousness of what we had been dealing with, six

15:18

months ago And so that's a big deal and

15:20

there's some evidence coming out that also the Delta variant

15:22

can cause more severe disease too.

15:24

So all of that is coming together so that we're starting

15:26

to see outbreaks in places that might not have

15:28

seen them. If we were dealing with the same thing

15:30

that we had circulating about eight months ago,

15:33

so that's a big cause for concern where it's showing that,

15:35

Delta has the possibility of

15:37

causing outbreaks in highly vaccinated

15:39

areas, just strong evidence for its increased transmissibility.

15:42

And it is sending people to the hospital. No, The

15:45

vaccines that we have available, especially the ones

15:47

that are being used in the U S right now are still

15:49

very highly effective against the Delta variant. I

15:51

think that their most recent estimates

15:53

are that there are about 85 to 90%

15:55

effective against symptomatic disease. Whereas against

15:57

the non variant sort of vanilla flavor,

16:00

COVID there it's closer to maybe 90,

16:02

95%, there's some uncertainty around

16:04

these things. The big concern though, is that For

16:06

the vanilla, COVID a single dose of Pfizer

16:08

and Madonna was all already pretty effective

16:10

a week or two out much less. So for the Delta variant.

16:13

So for the Delta variant to be fully vaccinated, you

16:15

really need the two doses. It seems. And

16:17

so that's one of the other key things, because a lot of countries,

16:20

to try to vaccinate their populations more quickly,

16:22

like the UK have preferred a single

16:24

dose strategy and that are following up with a second

16:26

dose. Not not three to four weeks later, but 12

16:29

to 15 weeks later. And now

16:31

this is changing the calculus where that's no

16:33

longer as effective of a strategy. And so we're going to

16:35

have to, I scrambled to catch up. So

16:37

all of this to say is that the Delta variant

16:40

is causing rises in cases

16:42

in places outside of India now. So it's definitely,

16:44

here it's making it more and more of the cases in

16:46

the U S. And so what is the concern well for fully

16:48

vaccinated people individually speaking,

16:50

it's. Not

16:53

really something you'd probably need to be too alarmed about, especially

16:55

if you're living in a community where other

16:57

people are very highly vaccinated as well. There again

17:00

there, the vaccines are still pretty, pretty darn

17:02

effective against this variant, but

17:04

there are of course, a lot of places in the United States

17:06

where vaccine rates are very low still

17:09

they're lagging and there's still plenty of susceptible people

17:11

around to get infected. So my big concern

17:13

is for communities of largely unvaccinated

17:15

people right now, because people who haven't been

17:17

exposed to COVID yet and who aren't vaccinated

17:20

their bodies are just as susceptible to severe

17:22

disease and illness as they were at the beginning of the pandemic.

17:24

Nothing has changed. If anything, now the variants

17:26

are making it more likely that they'll go to the hospital,

17:29

suffer severe outcomes. And so I

17:31

really do worry, I think. Over the

17:33

summer. We'll probably still continue to see these low

17:36

cases, but we know COVID is going to surge

17:38

again in the winter. That's almost absolute

17:40

certainty that will happen. And that will be largely

17:42

fueled by either the Delta variant

17:44

or something that follows on after that. And so

17:47

for communities where lots of people are in vaccinated, that

17:49

could cause really big problems. And so

17:51

it's, again, just really underlines the importance

17:53

of trying to get people vaccinated as much as we can.

17:56

Both to lessen that

17:58

surge if, and when it comes and to make sure

18:00

that people are, if you are, people are susceptible

18:03

to severe disease.

18:04

Yep. Good. I think you framed that really well.

18:06

Stephen, thanks. So I was thinking when you first said, Hey, you know,

18:09

fully vaccinated in the UK yet

18:11

they're still having a surge. And I think we have

18:13

to be careful when we throw around the language of fully vaccinated

18:15

versus fully vaccinated, because there are so many

18:17

variables. Comparing the two, because, we

18:19

did it with Seychelles Seychelles, wherever that place

18:21

was, where they're fully vaccinated, but yet

18:24

having a rise. But then you did the great nuance

18:26

of well, there were using a lot of different vaccines

18:28

that were less, there's a lot of definitions. So I think

18:31

so first and foremost, the UK is

18:33

similar to the U S and that they focus on

18:35

Pfizer, principally Pfizer. I

18:38

know Madrona I'd imagine.

18:40

Yeah, but I need to double check, but I think, yeah, it's

18:42

largely Pfizer. Yeah. There's AstraZeneca

18:44

too, but, okay.

18:46

So they did that, but then at the same time they did

18:48

focus on a one-shot thing. Whereas

18:50

we didn't here in the U S which makes us a little distinctive

18:53

which could also mean that we don't necessarily

18:55

we'll have such a rise in cases maybe,

18:57

but you're right. The south particularly. A

19:00

lot of states under 50% vaccinated

19:02

and just that public service announcement

19:05

that you may feel totally good

19:07

that, Hey, I'm in Colorado rates

19:09

are pretty good. But as we said before, it's

19:11

not just the individual that needs to be concerned

19:14

because things can mutate and change. And then

19:16

that affects everyone. If we just don't keep

19:18

this relatively low, it's great that

19:20

we're under. 5,000 cases a day, but

19:23

we don't want to reach back out to 20 or 25,000,

19:25

even if it's not in my neck of the woods, because it can still,

19:27

create some problems down the road. Just thinking about the idea

19:30

of, as we continue to get closer to vaccinating

19:32

our children, and it's gonna be another big decision,

19:35

and this is another piece of the puzzle.

19:37

Which has always, people always feel as if, at

19:39

least I talked to people that, we're, fear-mongering,

19:41

it's way past the pandemic, but

19:44

it's not, fear-mongering at least in my mind, it's more

19:46

of it's different than any other thing we've dealt

19:48

with because everything else we've dealt with, we have a lot

19:50

more knowns and unknowns. And even though

19:52

we're really far ahead and we know so much

19:54

more at COVID, there's still unknowns

19:56

that make you want to be a little bit more cautious

19:58

than normal, right? The little, whole long COVID those

20:00

kinds of things. The future variants that

20:03

are, we don't know about. And so this is. Part

20:05

of the material making a decision of vaccine or

20:07

children about, Hey, What could come out,

20:09

what could come later that actually is, puts people

20:11

in worst conditions and put them into hospital.

20:14

Great. No, thanks for that. Let's talk about next,

20:17

the, another little hopeful glimmer, and

20:19

this is the Novavax vaccine. So now we're, we've

20:21

got another game changer. And you're gonna have to talk about

20:24

this. I don't know a lot about this. I just had a hint

20:26

that this is a game changer in a different

20:29

way, Pfizer Madonna game-changer

20:31

because it was so quick, so effective, but

20:33

it came at a cost of highly freeze. It

20:35

need to be frozen only first world countries

20:38

or other countries that could have accessibility to

20:40

these kinds of freezers could actually give it now

20:42

with Novavax. Has it nearly as effective.

20:45

As Pfizer Moderna and if

20:47

I'm correct me, if I'm wrong, it doesn't

20:49

require that kind of intense freeze, which means

20:51

this is a game changer for the world. Am I right?

20:53

Yep. That's right. It's that's the big thing is

20:55

that I think for the global outlook having

20:58

this vaccine approved is a massive

21:00

step forward. There had already been

21:02

this sort of sense of Different tiers

21:04

of vaccine. There's like up at the top, there's

21:06

like the Pfizer and Madrona. And then, there's

21:08

the second tier vaccines of the AstraZeneca

21:10

or the Johnson and Johnson, then, know, again, the fact is that

21:13

they're all like super, super effective against preventing

21:15

people from going to the hospital, which is like really what we're aiming

21:17

to do. But it's yeah, inevitable that

21:19

you just, you get these numbers of efficacy

21:21

and you want the one that has. That 95%,

21:24

so I think what's really exciting about this is that this efficacy,

21:27

is absolutely on par with the best

21:29

vaccines that we have available. And like you said, it

21:31

doesn't need to be stored at super cold temperatures.

21:33

And so that makes it possible to spread

21:36

to vaccinate parts of the world that you

21:38

just can't vaccinate nearly as easily with

21:41

something like a Pfizer or a Moderna. So

21:43

I'm really hopeful that this vaccine

21:45

will Yeah, which just really help

21:48

the global outlook will give us sort

21:50

of one more tool. And

21:52

one that is, that I don't think

21:54

needs to be seen as this like second class

21:57

vaccine. I think that's really important, we need to make

21:59

sure that we're like, You know

22:01

that we're not we're we want to avoid

22:03

contributing to inequities and inequalities

22:05

around the worlds that are already there and just exacerbating

22:08

them by, spreading. And I don't think that would actually

22:10

happen, again I, I have a really high confidence in all

22:12

of the vaccines that we have available, but even the notion

22:15

of that, that like we're giving

22:17

other countries, our second class vaccines

22:19

is just not good. It's not good. So to have a really,

22:22

really good option. I

22:24

think it's going to be super helpful. And meanwhile,

22:26

this sort of comes on the heels of, I think it was the meeting

22:28

of different leaders around the world who have pledged

22:31

to, contribute millions and millions

22:33

of doses around the world as well,

22:35

which I think is super encouraging. And I imagine

22:37

that a lot of those doses will be of

22:39

this vaccine. And like we said, early,

22:41

early on the more vaccine candidates that

22:43

we have that are approved the better it's not, just

22:45

having one. Is great, but

22:48

it's helpful to have two and it's even better to have five

22:50

and, because each of them has strengths in different ways.

22:52

And so this is another really, really great step

22:54

in the right direction. Yeah.

22:55

And a point of clarification because, you compare

22:58

to Pfizer Medina to Novavax. When

23:00

you come to 95%, 90% yet, or Johnson

23:02

and Johnson and yeah, they're both highly effective,

23:05

but I feel like there's like another variable that I haven't really

23:07

dived, dove deep into. And that is transmissibility.

23:10

Do these all share roughly the same kind

23:12

of level of Hey, I can carry

23:14

it, but it's not, I may or may not carry

23:16

it. It may, may not transmit it. I clearly

23:18

know Pfizer Madrona are exceptional in

23:21

this area that it's very rare to actually transmit

23:23

it to another person. If somehow it's on

23:25

you. Is, do you know anything about whether that's

23:27

similar with Novavax or,

23:31

or is that still I think, yeah it's gonna

23:33

take awhile to get that information and cause it's

23:35

it's another one of those things where it's much easier to

23:37

measure the efficacy against symptoms

23:39

than it is to measure the efficacy against transmission. You

23:42

just need a much bigger trial, a different sort of trial

23:44

more. You need to do more testing, more

23:46

regular testing, different types of testing. So I think

23:48

we're going to have to wait on those numbers to be

23:50

sure. And but I'm hopeful, a lot

23:53

of times these things track together. And I think,

23:55

this is good news and I think there's reason to hope that it'll

23:57

get even better. That's

23:58

great. When I recall, I mentioned to you before he got on, he said, Hey,

24:00

let's talk about this. It came a couple of weeks ago

24:02

related to vaccines. COVID-19 vaccine

24:04

could be less spike centric.

24:07

What is this? And w what,

24:10

how can we get some stuff from this?

24:12

Yeah. So this is some cool stuff. And this digs back

24:15

into some research that's been

24:17

done on other viruses as

24:19

well. So the idea behind this is

24:21

that the coronavirus. The reason it's

24:23

called the Corona virus is because it has all of these

24:25

spikes sticking out of it where Corona,

24:27

meaning crowns, by the way, this

24:29

crown thing, Jackson's kind of comical.

24:31

So this went back to about all these people are applying

24:33

for epidemiology. It might be

24:35

the case that my six year old might apply for epidemiology

24:38

because he drew the stick. Figure of

24:40

my middle son, Jude surrounded

24:42

by tons of little Corona viruses that are worldwide.

24:45

And like just last week it says Jude

24:48

sneezed a bunch of Corona viruses and there was all

24:50

over him. When

24:52

on earth would any child draw

24:54

a virus with his sibling before the pandemic?

24:56

This is just. This is literally in

24:59

cold we're we're training. Those little boys become

25:01

epidemiologists. Okay. Continue with the

25:03

that's. Awesome. That's awesome. Yeah. So

25:05

and that's it, right? Cause he probably drew a little red circle with

25:07

these little things sticking off the sides. And

25:10

that's actually pretty, anatomically accurate

25:12

depiction of the Corona

25:14

virus. And essentially the way that it happens is those those

25:16

spikes help the virus to enter yourselves,

25:18

but they're also the first thing that your body sees when

25:21

it's getting an infection. And so

25:23

those are usually the things that your body mounts,

25:26

the strongest antibody response against

25:28

because they're out there, they're poking out the virus

25:31

and it's a very quick way to tell, okay,

25:33

this is something that we need

25:35

to be concerned about. And the immune system will take over

25:37

and start attacking the virus. Okay.

25:40

The trick is that the Corona virus

25:42

and many other viruses like flu as well

25:44

which also has these sticky Offy parts

25:47

that are presented to the immune system. Is that

25:49

one of the things that these viruses have evolved

25:52

to do is to make those parts

25:54

of itself really genetically variable,

25:56

or I guess in this sense it's yeah, it changes

25:58

the proteins. And so basically it's

26:00

like putting on a little disguise. And that's why the Delta

26:03

variant is more infectious

26:05

partially or wiped some of the

26:07

why it's able to get around the immune system to some extent

26:09

is because it has these mutations in the spike proteins.

26:12

So that an antibody that would have recognized

26:14

a previous version of the Corona virus can't

26:16

recognize this one because it just doesn't quite look

26:19

molecularly the same. And so usually

26:21

these spike proteins, they have to have a couple of really

26:23

specific configurations so that they can get into

26:25

cells. But then there are all of these other

26:27

parts that the virus can shift and change around

26:30

simply so that it can get around the immune system. That's

26:32

the whole strategy there. It's this like cat

26:34

and mouse game between the virus and your immune system.

26:37

And so that's one of the tricks and that's, that's part of why we need

26:39

to have Annual flu vaccines as well,

26:41

because the flu is really good at switching

26:44

out these proteins on these spikes

26:46

that are sticking out of it. And it's basically a

26:48

disguise for the immune system. And so we have to update

26:50

our vaccines every year to stay on top of

26:52

that. So where does this come into these non

26:54

spike vaccines? Well, Not

26:57

all parts of the virus are the same. So basically

26:59

to first approximation of virus is just a bunch

27:01

of these little molecules called proteins that

27:03

have a genetic material RNA

27:06

inside of them just floating around inside there's, there's

27:08

other things going on, but that'll do for our discussion for

27:10

now. And there

27:12

are some of those proteins are

27:14

really essential for the virus to survive. So

27:17

you can have little switches, you can have little mutations

27:19

of the spike protein, and that doesn't affect the

27:21

virus's ability to survive because it's on this sticky

27:24

Audi piece, right? It doesn't affect anything. It just

27:26

affects what it's presenting to the human body. As long as

27:28

it's not affecting the thing that allows it to enter the cell.

27:31

But there's. A lot of other protein around

27:33

the virus, much of which is in

27:35

the, what we call the viral envelope which

27:37

is the little box, the sphere

27:39

in this case that contains the genetic material.

27:42

And if you start fooling around with that, if you start making mutations

27:45

in that, oftentimes the envelope just falls apart

27:47

and the virus isn't viable. So it

27:49

can't make mutations. In

27:52

that part of its genome. And so it's a much, much

27:54

more stable part of

27:56

the viruses genome. And so even

27:58

though the immune system doesn't preferentially

28:01

recognize those bits there,

28:03

it still does recognize it to some extent.

28:05

So it's it's I don't know what a good analogy would be,

28:07

but like it's it would be like, if if

28:10

Matt, you like suddenly shaved your head, it shaped your hair

28:12

next week. I would still be able to recognize

28:14

you, but you'd be the same, but it's so

28:16

that's essentially what the virus is doing with its spike. Proteins is

28:19

just putting on these disguises, but if there was something essential

28:21

about you, right? Like you, we can't take

28:23

out your heart for you it's to still function.

28:25

So you can change all of these things about yourself, but there are some

28:27

parts of you that just can't change without.

28:30

Yeah, risking your life. And that's true

28:32

for the virus too. And so if you can make

28:34

a vaccine that rather than targeting the spike

28:36

targets, these parts that don't change nearly

28:39

as much. Then you have

28:41

something that is effective against all the variants

28:43

against everything that the coronavirus could ever throw

28:45

at you basically. And then you have a one

28:47

and done vaccine. And so there's a lot of people working

28:49

on this for flu as well. What they call a universal

28:52

flu vaccine, something that you can get once in

28:54

your life. And that gives you broad protect protection

28:56

against all flu strains, because it targets

28:58

something that is absolutely essential for the survival

29:00

of the flu virus itself. The same is true for the Corona

29:02

virus. So that's where there's a lot of interest in this

29:04

because, without that, we're probably going

29:06

to. Still be playing to some extent this

29:09

game of catch-up with the Corona virus. And maybe

29:11

it will be annual. Maybe it'll be every five years or even 10

29:13

years, but our immunity will decline,

29:16

partly because we're going to stop recognizing that

29:18

spike protein. But if we target other

29:20

parts of the virus, we have a much better chance

29:22

of giving us something that gives us immunity to life. Like

29:24

we get for the measles vaccine, for example.

29:27

So what makes it more difficult?

29:30

Or what makes it easier to

29:32

target the spiky this right. Versus

29:35

the actual little oval,

29:37

like anatomical part of it. Why is that

29:39

so much harder than the spiky part

29:42

to make a vaccine for?

29:43

Yeah. It's interesting. So it, to

29:46

my knowledge, the biggest thing is just

29:48

a matter of the It's

29:50

like the physical structure of the virus itself,

29:52

because there are so many spikes sticking out of the protein

29:55

or sticking out of the virus that to

29:58

actually. Get an

30:00

antibody to something

30:02

that's on the surface of the virus, it

30:04

has to go through this jungle of of things

30:07

that are sticking out. And the spikes, also

30:09

serve as a disguise for that

30:11

part of the virus that is more essential.

30:13

And so you need something that gives you a strong

30:16

enough antibody response that

30:18

you'll have antibodies floating around that won't get duped

30:20

by this spike protein that's around

30:22

it, but we'll actually be able to zero in. And

30:25

make it through that sort of jungle of protein on the surface

30:27

of the virus and actually detect the thing that

30:29

it's trying to detect. So part of

30:31

it is just figuring out how to engineer these antibodies

30:34

in a way that they that they could just reach the virus,

30:36

which is really crazy to think about, we're talking about these

30:38

microscopic particles, but even on that

30:40

tiny, tiny scale, just

30:43

physical blockage is a huge issue. And

30:45

and so that's a big part of it is just is

30:47

just that there's a whole, I am really

30:49

oversimplifying this. There are people who have their, like

30:52

their entire careers on like, why,

30:54

what parts of a protein or what parts of a virus

30:56

are easier and harder to detect and why

30:59

that's the case. And so I'm just giving like a very.

31:02

I'm giving my own understanding, which is pretty rudimentary.

31:04

Maybe I can ask some of my friends who are working on these

31:06

to clarify for me but as far as I know that,

31:08

that seems to be really what the issue is just figuring

31:10

out how to get the antibodies to the places that they

31:12

need to go to detect the virus in the first place.

31:15

Yeah. That's hugely

31:15

helpful. And the image that came to mind

31:17

was like, I know this is falls apart, but like a porcupine it's

31:20

like just full of those little things, but there's no way I can

31:22

get to the base layer that I don't wanna get

31:24

close. So it's a, so it's deadly. So

31:26

I totally get that. Thanks. Speaking of heart, because

31:28

you mentioned about, Hey, you took my heart away and parts

31:31

substantially to me, we talked about

31:33

this off the record that we continue to see our

31:35

off the air. Before we start recording, we

31:37

were talking about how there's this increased documentation

31:40

and articles about this myocarditus

31:42

in. Dealing with teens and

31:45

early twenties. And just wanted

31:47

to tell him this briefly, and I'll put these in the show

31:49

notes and you can chime in Stephen,

31:51

but I just to give the synopsis of what I read a

31:54

cardiologist weighed in and just said, look,

31:56

absolutely. Is myocarditis

31:58

happening between 17 and 24

32:00

year olds? That is totally true.

32:03

Here's one here that yes, between 1624,

32:05

the CDC found that among 16 and 17

32:07

year olds, as of May 31st, there

32:09

were 79 reports of illnesses

32:11

soon after vaccination and ordinarily

32:14

you'd expect to see around 19. And this continues

32:16

for 18 and 24. So you're seeing. There

32:18

is an increase in myocarditis among

32:21

teenagers and early twenties. So that,

32:23

that is an important piece at the same

32:25

time, the cardiologist warned. And I think

32:27

it's just good for everybody to listen to. And you've said this

32:29

before, over and over Stephen, about how

32:32

it's not about either

32:34

the vaccine or nothing. Sometimes

32:36

we get into that fear mode. Like I don't want to,

32:38

but don't realize what you're actually giving up by

32:41

not taking the vaccine is being susceptible to

32:43

COVID, which has a much higher rate

32:46

of. Gravity when it comes

32:48

to some significant effects

32:50

to even teenagers. And so it's

32:52

not a fair comparison.

32:54

Yeah. And then I was, know, I was just looking at this.

32:56

I had this inkling in the back of my mind about like

32:59

myocarditis and it's actually, I wanted

33:01

to check this, but even if you type it into Google,

33:03

for example, the first line is mild.

33:05

Carditis is usually caused by a viral

33:07

infection. It's like the viral

33:09

infections are. What causes it because, and

33:11

we've talked so much about inflammation that your body's

33:13

immune response to an attacking virus

33:16

is too, is this sort of inflammation response

33:18

that causes, all of your muscles to

33:20

get inflamed, to some extent, and your heart is just

33:22

a really big muscle, it's just a big muscle

33:25

taken away there in your heart, in your chest.

33:27

And it's also not surprising that. You

33:29

would have higher rates of myocardial carditis

33:31

after getting a vaccine, which does

33:33

the same thing to your immune system as getting a viral

33:36

infection does, it'd be interesting to compare rates

33:38

of myocarditis, just post COVID. Yeah.

33:40

Infection and raise myocarditis, just post

33:42

vaccine. I'd be very curious to see

33:45

they, they might be similar. It's hard to say, but you're right.

33:47

It's like we're starting to compare these things and

33:49

we know that the vaccine. In

33:51

order to do what it does the vaccine

33:53

necessarily can cause some

33:56

some ill health effects to some extent, I felt

33:58

terrible after I got my second dose of the vaccine,

34:00

I have not been that sick in a very long time. But in

34:02

part that's because the vaccine was working.

34:04

And right. I think just going back to your point

34:06

before it's this it's, this trade-off where

34:08

we were. We're not comparing the vaccine

34:11

to this world where everyone is healthy and nothing

34:13

is the matter. We're comparing the vaccine to this

34:15

world in which there's, this raging better is spreading

34:17

and that makes the trade off. A lot clearer

34:20

in my mind. Yep.

34:21

And then continue it a couple other things.

34:23

First one is that, of those, whatever,

34:26

179 reports, 81%

34:29

really has no significant impact whatsoever. It's

34:31

just a very mild thing goes away on its own. And

34:34

it's nothing. Right? So you have a rarity

34:36

among what? Among 17, 24

34:38

year olds. And among that, the majority

34:40

of them. Do not have any significant

34:42

whatsoever. And then there's a handful that may have to

34:44

go to the hospital. Again, like you said, you don't even know it'd

34:47

be so interesting to compare because it generally

34:49

is caused by a virus. What would happen after

34:51

COVID of general population of 70 and 24

34:53

year olds. And then on top of that, they are,

34:55

one of the articles mentioned that we don't even know

34:58

this could be behavior related. We just don't fully understand

35:00

because a lot of times these teens get

35:02

the vaccine and all of a sudden they go out, started do they're much

35:04

more active. They do a lot more things. So we

35:06

don't have the full spectrum of all different complications

35:09

of this thing, but it's very rare. Any

35:11

1%, nothing impact compared to COVID

35:14

it's not even a fair comparison, so great.

35:18

I think that's it for us for this episode.

35:20

Anything last words to say,

35:22

Stephen? No, I think

35:24

that's it. It's

35:25

yeah. Good. It's just good news continued

35:27

good news for the U S particularly globally

35:29

in general. I would imagine the hotspots

35:31

will continue, but hopefully the vaccines

35:33

can have to go out and get more people to protection. They need

35:36

to get this under bay before fall hits so

35:38

that when we do have a surge, it

35:40

doesn't sound like what we think is going to be right.

35:42

And much more mild experience. That's the goal. Okay.

35:44

Guys and gals have a wonderful week.

35:46

Thank you for tuning in and we will see you next week. Also,

35:48

if you can, patrion.com/pandemic

35:51

podcast, give us a review. We'd really appreciate

35:53

it. Take care. Have a wonderful week. We'll see

35:55

you next Monday. All right. Okay.

35:57

Bye-bye.