0:00

You're listening to the pandemic podcast. We

0:02

equip you to live the most real life possible in

0:04

the face of these crises. My name is Matt

0:06

Boettger and I'm joined with once again. My great,

0:08

good lovely friend, Dr. Stephen Kissler.

0:11

Lovely. That's wonderful. That's not what I get there, especially

0:14

when I look like I'm like emerging from the cane as I often

0:17

do

0:18

so you can watch it live or watch

0:20

it later. I'm here with Dr. Stephen Kissler,

0:23

an epidemiologist at the

0:25

Harvard school of public health. How

0:27

are you doing fine, sir?

0:28

Hey, I am doing all right. It's it's good

0:31

to see you. It's you know, it's, the weather here

0:33

is finally warming up a little bit, which is great. And

0:35

yeah. With COVID cases are going down, which has even

0:37

greater. So Sue things

0:39

are

0:39

great, right? You can go outside and

0:41

the COVID is going down. It's crashing here

0:43

and all the good news. You're going

0:45

to get a cold wintry blast. Next couple of

0:47

days. I know it's gonna hit a lot of people. It's going down like 10 degrees

0:50

tomorrow. Yeah.

0:52

Yeah. It's it's I

0:54

think so. So yeah. Yeah.

0:56

It's not over. So we had a beautiful day here. It's like

0:58

60 degrees to the boys at walking.

1:01

They were not used to it. They were like sweating. Like it's so

1:03

hot. I'm like, it's 59 degrees. We're

1:05

not quite hot yet, but nonetheless, so

1:07

that was good. One bit of fun news. I

1:09

wanted to tell everybody, this sounds like a shock. So we're almost

1:12

two years into this pandemic podcast. I think

1:14

it's like March 4th or fifth or

1:16

six would be two years. And I got

1:18

to see. Kissler for those of you

1:20

who have not been, you

1:22

know, been listening only recently. He was a long

1:24

time guest for a while. Stephen's brother, he's a

1:26

doctor at university color hospital. And

1:29

I haven't seen him since before the pandemic. So

1:32

it was like two weeks ago or what a week and a half ago, I got

1:34

to see him in face, face to face

1:36

at a coffee shop for the first time. And it was really,

1:38

really awesome. So didn't get to see Stephen,

1:40

you're still way up in the Northeast, but hopefully sometime

1:42

we'll reconnect. So it was good to see him.

1:44

And I think there's a number of things, so we've got another great.

1:47

Five-star is by far the best covet

1:49

podcast. This is from. Cat

1:51

2 7, 8, learn something new every

1:53

time. Thank you. Cat 2 7, 8. I really

1:55

appreciate it. Here's my goal. We have 13 left

1:57

to get to 200. We'd love to get there by

2:00

March 6th or fifth, whenever our two year

2:02

anniversary. So if you can get five minutes,

2:04

two minutes, one minute, leave a little review would

2:06

greatly help. If you want to support us financially

2:09

$5 a month or a one-time gift, you can do that

2:11

on patrion.com/pandemic podcast

2:13

or one-time gift Venmo, PayPal,

2:15

all in the show notes. So,

2:19

what do we talk about now? I mean, it's like, it's,

2:24

COVID cases are plummeting. Everybody's

2:27

going back to normal. You have mass

2:29

mandates released everywhere, I think, except for Hawaii,

2:31

at least for the U S we're talking about the us here who Hawaii

2:34

is to the long kind of the holding strong

2:36

on that. But I would imagine they'll probably release those

2:38

relatively soon. There's a lot

2:40

of stuff. So I think maybe we need to focus on the

2:42

transition and talking about, we've

2:45

mentioned this a handful of times, right? But

2:47

now it's like serious, unless something else happens.

2:49

I'm hoping that's not the case of this actually is a transition

2:52

to some sense of normalcy for

2:54

an, you know, a period of time. And

2:56

I want to start with this. There was a email from

2:59

a lady named Wendy. So thank

3:01

you for. Us and it was a great,

3:03

great, I'm assuming you're from the UK, Wendy.

3:05

I have no idea. It sounds like that. Cause it

3:07

was really focusing on the scientists

3:10

kind of basically epidemiologists the scientific

3:12

community in the UK versus

3:14

that of the U S so

3:17

I want to pitch this cause I think this might be a good segue

3:19

into. Talking about what's next? How do

3:21

we live with this? Because

3:23

there's always a bit of confusion about what

3:25

to do with do next. And Wendy's email

3:27

really there's much more to this, but

3:30

she kind of showed how well the UK scientists

3:32

for example, are pretty

3:34

hesitant when it comes to discussing.

3:37

Really advocating for

3:40

vaccines for children. Right. And kind

3:42

of, there, these are more hesitant apparently

3:44

than the U S is the U S a little bit more

3:46

for it and really strongly kind

3:48

of advises it, whereas UK doesn't

3:51

and clearly both are looking at

3:53

the research. Clearly, both are trying to make the best

3:55

sense of out of all of this in light of what's

3:57

what's going on right now and what might be next. And

4:00

I want to just throw it to your way. I mean, I know without

4:02

a doubt, I'm sure you've talked, spoken

4:04

to email texted, tweeted, who knows

4:07

some UK scientists. And

4:09

how, w you know, where does this kind

4:12

of discrepancy come from?

4:14

It's not really huge. It's literally just one

4:16

is advanced. Advancing the cause

4:18

for vaccines ones, he's like, ah, sure.

4:20

Get it if you want to, but we're really not recommending it because

4:23

we think that they think that the costs might

4:25

weigh, outweigh the small benefit for

4:27

that demographic. So start with that.

4:29

Let's just talk about how those two camps,

4:31

how do you guys relate to one another? What's this discrepancy

4:34

coming from? Talk to us about.

4:36

Yeah. So there's, you know, there are a couple of things

4:39

that come to mind with us, you know, and the

4:41

first is that when we've talked about this, a number

4:43

of times on the podcast before, but

4:45

how the

4:49

recommendations that are given for public

4:51

health. Are

4:54

rooted in science, but not exclusively

4:56

based in science that they're, you know, they,

5:00

they, they have a foundation in science, but then they also

5:02

reflect a given societies

5:04

preferences and tolerance of risk.

5:07

And. Just the different ways that you weigh things that

5:09

really can't be quantified very easily. And

5:11

so, you know, I, I can sort of talk subjectively

5:14

to this a little bit because I mean, I lived in the UK

5:16

for about five years. And so

5:18

I got pretty sort of an intuitive

5:20

sense for you know, in very

5:23

broad generalizing strokes, the

5:25

sorts of differences culturally, when it comes

5:27

to Facing a medical risk

5:29

that exists between the U S and the UK. So,

5:32

you know, one of the things that really struck me when I moved to the UK is

5:35

that health and safety is

5:37

is like a top priority in anything that you do.

5:39

So, when I went to the UK, started

5:41

my PhD I went to like two full days worth

5:43

of training about Research safety

5:46

basically. And some of it had to do with lab work,

5:48

but most of it, I mean, I, you know, I type

5:50

at a computer all day. Right. And so we had

5:52

like seminars about ergonomics

5:54

and about like how to

5:56

like, just be, keep yourself

5:59

safe and healthy about like, you know, the

6:01

different possibilities for fires. If you like.

6:04

Hit your computer up too much. If you plug

6:06

too many things into the wrong outlet or whatever. Right. And

6:09

so, so it's interesting because it's like far from

6:11

being like cavalier that I, I found

6:13

my experience in the UK to actually have sort of like health

6:15

and safety sort of at the forefront of their minds.

6:17

But a lot of that was from a preventive

6:20

mindset. There's this real deep sense

6:22

of, of the need for pre. And

6:25

I can trust that some to my experience here in the U

6:27

S where you know, and again, again, this is

6:29

like super generalizing. This is totally subjective and

6:31

not based in any sort of evidence other than my own life,

6:33

but but I feel like, you know, here we do

6:35

sort of like sometimes play into the stereotype of kind

6:37

of shooting from the hip a little bit. And it's like, okay, well, you

6:39

know, you want to do that. All right, good luck, you know, Godspeed

6:41

and see how that turns out for you. And

6:44

then, you know, the flip side of that is that I think

6:46

that we often rely on interventions

6:48

in the sense of like, Drugs and pharmaceuticals.

6:51

We really like taking something when something goes

6:53

wrong. And so, so, so it's interesting

6:55

because I think that in a sense, the, the,

6:57

the UK, my experience there was that

6:59

they seem, they tend to be a little bit more conservative in terms

7:01

of prescribing things including like drugs

7:04

and antibiotics, and then also like, recommending

7:06

vaccines. And they tend to weigh these things

7:08

a little bit differently. Whereas here in the U S I think

7:10

that we're Yeah. I tend to be a little bit quicker to say

7:12

like, yeah, give him the drug, give him the vaccine,

7:15

you know, this is what we should be doing. And just like really having

7:17

a lot of faith that, that administering

7:19

some kind of pharmaceutical intervention is

7:21

probably going to be a good thing. So, so part

7:23

of it is, I think is probably rooted culturally

7:25

to some extent. The other thing, you know,

7:28

thinking about what's happening, you know, with the UK

7:30

is recommendations is also this element of time.

7:32

And I think that this is something that we could probably

7:34

pay a little bit more attention to. Here

7:36

in the U S which is the. The

7:39

recommendations are really based on an understanding

7:41

of where the pandemic is right now. As

7:43

you mentioned, the, the, the recommendations may

7:45

well change. If we get a new variant,

7:47

if case will start to increase because that's when

7:49

the cost benefit ratio is really going to shift,

7:52

kids do have a high risk of biochem. From

7:54

COVID-19. But the issue is

7:57

that if you give all kids a vaccine,

7:59

and if COVID cases are very low

8:01

than the relative, like the absolute risk of it,

8:04

getting myocarditis is higher

8:06

for the vaccine than for COVID. But

8:08

if we start getting a major COVID outbreak that completely

8:10

flips on its head, and then it makes a lot of sense to give kids

8:12

to that. And so, with

8:14

that in mind, you know, we're no longer in a

8:16

situation where vaccine supplies

8:18

are scarce, especially in the U S and the UK.

8:20

And so they have a lot of trust that like, if

8:22

a new variant emerges chances are they'd be

8:25

able to reverse this recommendation,

8:27

get it administered as quickly as they need to, to protect

8:29

those kids from serious outcomes from COVID-19.

8:32

But right now I think the, the assessment is,

8:34

is that it doesn't make sense. And

8:36

that's a pretty nuanced statement to

8:38

send. And so I think here, they're sort of like, tending

8:40

towards, you know, just saying, yeah, it's recommended

8:42

everybody should get it. It seems like it is safe and effective

8:44

and it very much is. But there's a little

8:46

bit more of a bias here, I think, towards that

8:48

kind of intervention. So that's perfect. And

8:50

that's a great segue, Stephen, could we talk

8:53

about. Before we started recording

8:55

about these two articles coming from the Atlantic,

8:57

which I thought it was somewhat comical, but also,

8:59

Hey, it's journalism. It's fabulous. And

9:02

this is two articles was there's no

9:04

justifying our children last COVID

9:06

policy. So in, in a nutshell, I'll put these in the show

9:08

notes, read them. I think they're really, really great articles. Just

9:11

really saying, Hey, the, the, the idea of

9:13

imposing masks. On

9:15

children at school and then releasing

9:17

them everywhere else makes absolutely no sense. There's

9:19

no logic behind it. And so, and they tried to look for

9:21

the logic and they said it was illogical.

9:25

And then there was another article within, I think

9:27

days later that said mass

9:29

mandates don't need to make sense, same

9:32

place the Atlantic in a really fascinating

9:34

article. The reason why I think at the

9:36

segue is that one of the, one

9:38

of the first article about they

9:40

just couldn't find a logical reason to keep mass

9:42

for children. They use an example

9:44

of the CDC in how. Where

9:47

you were, where you were saying is where I think nuance

9:49

may be, could be placed back

9:51

into the CDC more, a little bit more

9:54

available talking about how, like, when they recommended, you

9:56

know, boosters for, I think 12 and older, they

9:58

just made it universal and how, like they were saying, well, you know what?

10:00

The ad that seems almost discredit a number of

10:02

things and discredits, maybe the efficacy

10:04

of the first. By just saying it. So it kind of makes that

10:06

kind of scare like a, wait a minute, the first two don't count, not

10:09

understand the nuance of maybe individuals of like

10:11

saying, well, it depends on your circumstances where we have, like

10:13

you were saying, Stephen, like, where are we at in

10:15

a wave or lack thereof. And so

10:17

that lack of nuance seems to maybe

10:20

make that credibility fall apart for the CDC.

10:22

And so you're saying, well, that may be something we could learn from,

10:24

from the UK of adding a little more

10:26

nuance to our, to our public policies. So,

10:30

yeah, absolutely. Yeah. So I think,

10:32

I mean, I, and I, and it's so tricky because the, that

10:35

nuance can get lost at so many different layers. I mean,

10:37

sometimes it just never exists in the first place,

10:39

you know, from, from the ones who are making the recommendations.

10:41

But a lot of times it also just gets filtered through the

10:43

media or through, you know, social

10:45

media or whatever. And a lot of the nuance

10:47

that is, is in fact, there just gets filtered out.

10:49

And so the message that we end up hearing. It's

10:52

not nearly as complex as it should be. So I think,

10:54

you know, the, the, the responsibility for this

10:56

doesn't really just rest on any single person's

10:58

or single institution's shoulders. But I think, you

11:00

know, the fact is that there

11:03

is a lot of nuance that, you know, we

11:05

can, we can do a lot better with both communicating

11:07

and accepting nuance.

11:09

And I think, you know, this, this question of masks in schools

11:11

is a really interesting one because what it also points

11:13

to as another sort of, logical approach

11:16

to addressing

11:18

issues during the pandemic that I've seen repeat itself

11:21

again and again which is. Something

11:23

some issue like masks or

11:26

a certain type of vaccine recommendation and

11:29

point out an inconsistency. And

11:31

then but what often happens is that you say

11:33

you, you know, the, you point out the inconsistency

11:36

and then you argue for. One

11:38

change. But in fact, there's almost

11:41

always two changes that are possible. So

11:43

in this case, you know, you could say that and

11:45

I agree that it's, it's kind of inconsistent

11:47

to say, we need to have masks in schools, but we're not

11:49

going to have masks anywhere else. And

11:51

so, you know, one option is to say, okay, well, we shouldn't have masks

11:54

in schools then either because if we don't have anywhere else than

11:56

what's the deal, but also this might

11:58

be pointing towards. Well, maybe, you know, maybe we

12:00

should be thinking about masking at certain times

12:02

in other places too. And maybe, maybe schools

12:04

are sort of the last thing that are helping to remind us

12:06

that actually this is, you know, this is a useful

12:08

thing in certain places at certain times.

12:10

And we should be bearing that in mind and we should be having an open discussion

12:13

as to when are masks appropriate and when aren't, they absolutely

12:16

it's inconsistent, but how do we make it consistent? There's

12:18

a lot of different ways to do that. And so

12:20

trying to be really open-minded

12:22

about, about what those possibilities might

12:24

be. So I think, you know, for me, that's, that's real, the main

12:26

upshot of this is that as we

12:28

are making this

12:30

really important transition from

12:33

sort of crisis management into at least a period

12:35

of time when we're probably going to be in

12:37

more of a sort of control and management phase

12:39

of the pandemic and who knows how long that will last,

12:42

but may it last forever. And

12:44

but. Inevitably,

12:47

we're going to have inconsistencies.

12:49

We're going to have decisions that were being made for

12:51

reasons we ourselves don't fully understand.

12:53

And it's only by reflecting upon

12:56

the state of things as they are. And then

12:58

starting to think about how we should adjust to those things

13:00

that we will finally reach that consensus.

13:02

We don't, I think holding ourselves

13:04

to like consistency

13:06

at the societal level. At all times it's

13:08

just much too high of a bar and I think it's something we

13:10

should always be striving towards for sure. But.

13:13

It's okay. If it's not, because that's where, that's

13:16

where creativity comes from. That's where creative

13:18

social solutions come from is when people do things

13:20

in different ways. And you say like, Hey, that's working

13:22

and that's not, and this is how we can sort of reconcile

13:24

what's going on for a more. Sort of policy.

13:27

So I think we're, we're still sort of in the, in the, in the evolution

13:29

phase of these policies, we're still trying to figure out what they're going

13:31

to be as we transition into this next stage. So all

13:34

of the diversity that we see in how different

13:36

people in different institutions or approach are approaching

13:38

it, I think is actually really important. And.

13:41

That's helpful. I think a good, good piece

13:43

of advice of, I mean, he's looking at my own life

13:45

of how inconsistent I am in my own personal

13:47

life of, I try to be reasonable. I try to

13:49

think through things, but nobody can be this way.

13:52

Nonstop. We all are this complex web

13:54

of emotions and intellect and, and

13:56

history and environment and all kinds of stuff.

13:58

And so on an individual level of

14:01

it's that. To maintain consistency

14:03

in your own life. It that's on an exponential

14:06

level and he talked about on a society and a societal

14:08

level. So I think that's helpful to kind of give

14:10

some compassion towards the CDC and other places

14:12

are striving to give that as

14:14

much as possible. Going back to mass

14:16

mandates. Don't need to make sense again. I love

14:18

this article. One thing I loved about this

14:21

is it really kind of focused on the point of. These

14:25

masks in schools mandates,

14:27

or like the last place by which we can, it can be

14:29

imposed. Right. And that's probably one of the reasons why

14:32

it's maybe still being done and not arbitrarily

14:35

this, this author to know is he or she, I

14:37

need to look at that and mentioned how

14:39

well it does kind of make sense, even that's

14:41

the title. Whereas, you

14:43

know, bars, restaurants, they're letting

14:45

go of all their mass mandates and schools

14:47

are this last place that that's kind of Harbor

14:50

of mask in whether it's illogical or not.

14:52

But the fact of the matter is there is a truth to be said

14:54

that if you're having somebody who is like a grandma

14:57

or grandpa, more than likely, they're

14:59

going to be in more contact with the school

15:01

than a bar. Right. And so

15:03

just by that level of loan shows that

15:05

this still is a place by which we can have a discussion

15:08

and talk about. Utterly irrational

15:10

makes sense. And like you said, the fact that it's

15:13

still, there is a reminder that we're not fully

15:15

out of everything yet know granted, we want to move towards

15:17

normalcy, but it is a reminder that

15:19

we still need to have these discussions because once all

15:21

that is gone, I would

15:23

imagine we're so frustrated. So burnout,

15:25

so exhausted out of sight, out

15:28

of mind, right? In

15:30

until something happens and then we

15:32

just look for a pill to

15:34

fix it as soon as possible. So that's

15:37

helpful. That's helpful. Okay. So a quick update

15:40

on the, the, the, the

15:42

little, the BA two variant, you know, I read an article

15:44

just a few days ago up in the show notes that it could

15:46

be more dangerous. It sounds like this is a credible

15:48

research. It was done on like

15:50

a lab. Right or

15:52

mice or durable. I'm not sure what it was. So

15:55

this is me being the lay person and I just read it, thought

15:57

it was interesting. And when to throw it back to you to say,

15:59

is there any kind of word on your end about.

16:02

What BA two might be looking like

16:04

kitten propose any kind of hiccup

16:06

in the spring or summer or not.

16:09

Yeah, so, I mean, I think this is another one of those areas

16:11

where thinking about reaching scientific

16:13

consensus is really important. So

16:16

as, as you said, there was that study that suggested that

16:18

in. And I'm, I'm not actually sure which kind of fuzzy

16:20

animal it was, but it two generated

16:22

more severe outcomes of disease.

16:26

But that actually contrasts with a lot of evidence

16:28

that's coming from places where BA two is

16:30

currently spreading in humans

16:32

a lot. And there's actually really no discernible

16:34

difference in rates of hospitalizations

16:37

and deaths with versus.

16:40

The a one being the sort of original

16:42

Omicron variant. And so, you know, there's,

16:45

there's, there's a lot that separates you and me from

16:47

a durable and a hamster. And you

16:49

know that yeah. And

16:51

I, I believe it or not, you know, that's not just on the physiological

16:54

scale, but but with physiology, you know, it's like

16:56

there's these viruses

16:58

are constantly changing the, their

17:01

receptors, the things that make them stick to cells

17:03

and enter into them. And just by random chance, you might,

17:05

you know, get something that works really

17:07

well for one species and really poorly for another species.

17:09

And so, while those kinds of studies

17:11

are valuable, That

17:14

translating these things across species is, is

17:16

notoriously difficult. And so,

17:18

so, you know, I think that the, the weight of evidence

17:20

is that even if there is a difference in severity,

17:22

it's probably slight and is

17:24

probably not going to make a

17:26

huge difference on the population scale,

17:28

you know, we'll have to keep watching it for sure. But I

17:31

I'm not too too concerned about that at

17:33

the moment. Now it does look like BA two is probably

17:35

a little bit more transmissible than BI one, which is just

17:37

mind blowing to me. I mean, like how much more can this thing

17:39

ramp up? Infectiousness it's

17:41

unreal. But the leap and infectiousness

17:44

is much, much smaller than the leap from Delta

17:46

to Omicron. And that's part of why, you know, we've

17:48

seen BA two bubbling along here in the

17:50

U S for months at this point, but

17:52

nowhere hasn't really taken off to become the dominant

17:54

lineage. We're starting to see upticks

17:57

especially here in the Northeast. And I expect to see

17:59

that around much of the rest of the country, but it

18:01

is. Utterly different than

18:03

the invasion of the initial Homer crown wave. Right. Which

18:05

was just like this absolute explosion of cases.

18:08

And so, so yeah, so I mean, it, it

18:10

sort of seems like, you know, between Delta and Omicron

18:13

the virus like replaced its engine

18:15

from like a lawnmower engine to like a Hemi,

18:17

you know, super-duper V8, whatever. Whereas

18:20

this is just sort of like doing some. Yeah,

18:22

it took it in for a tune-up and you know, it was as a little

18:24

bit more infectious, but that's kind of what we're dealing

18:27

with right now. Furthermore, you know, in, in South

18:29

Africa we saw a huge wave of BA one

18:31

another, starting to see some BA two. And even though

18:33

BA two is increasing there, the overall

18:35

number of cases I believe is still declining.

18:38

It's declining at a slower rate than it was before, but

18:40

they're still going down and we'll have to watch

18:42

that closely. But again, like none of the indications

18:44

that I'm seeing are suggest that BA

18:46

to. It's going to be

18:48

catastrophic, the more severe or catastrophic,

18:51

the more infectious it's just kind of like, the SQL

18:53

you know, the

18:55

good, good. And I heard, I would imagine since

18:57

it is kind of like, well, at least it doesn't have its own

18:59

Greek alphabet yet. Right. It's just a, that

19:02

it means it's similar enough to those who maybe

19:04

got BA one that they'd be

19:07

relatively immune to.

19:09

That's right. Yeah. And you know, there is

19:11

one of the things that I have seen in a lot of labs

19:13

have been looking at the antibody

19:15

cocktails, the sort of neutralization

19:18

antibodies that are sometimes administered to people

19:20

who go to the hospital and BA and

19:22

BA to do different, some important ways

19:24

for that. There are some things that were

19:26

effective against BI one that are not against

19:28

BA two. And actually I think vice versa that

19:30

some of the things that weren't effective against BA one

19:32

now, Effective against BA two

19:34

again. But by and large, it seems like the immunity

19:37

from BA one does seem to, you know, on

19:39

the whole transfer over to BA two as well.

19:41

So it doesn't mean you can't get reinfected. We

19:43

know that that's, you know, that happens all the time with

19:45

SARS cov two. But you know, each exposure

19:47

gives you some protection and it seems like, you know, they're

19:50

very closely related. And so BA one

19:52

does seem to give you at least a pretty decent amount of time.

19:55

Great. Great. Now, as we move into the transition

19:57

to just living with this and making it become an endemic

19:59

and just becomes part of, you know, kind of like living

20:01

with the flu, when the articles that

20:03

I read, as well as, as, as us pushes

20:06

to a pre COVID reality high-risk

20:08

and disabled Americans feel forgotten. So

20:10

I read this and it was a really powerful

20:12

article that I read. But, you know,

20:14

my question is this is, this

20:17

is not something new. Clearly there's been other

20:19

diseases. Before 1918,

20:21

where we're mass, the last time we were mass all everywhere

20:23

as a, as a, you know, and so

20:26

I guess my pitching this back

20:28

to you, like, what do we do as a transition?

20:30

I feel like this is less maybe descript

20:33

descriptive than prescriptive, or

20:35

I don't know which way to say it, but it's the

20:37

flu I would imagine has the same

20:40

kind of intensity for people

20:42

who are vulnerable, who are on the, you know, who have

20:44

immune compromised systems. Is

20:46

this more of like, okay, It's not

20:48

necessarily a COVID question or is it more just a wake

20:50

up of like, oh, what have we been doing the past 20 years

20:53

with all these things? And maybe this is

20:55

something we need to address as a public policy to

20:58

help these people who suffer

21:00

greatly. And I'm sure during the winter season

21:03

feel a little bit more unnerved

21:04

than we. Yeah. Yeah.

21:07

So, I mean, I would in, in my mind this,

21:09

this was one of the most valuable

21:11

and important sort of like media articles

21:13

that's come out in recent months. So once

21:15

again, ed young from the Atlantic knocks it out of the

21:17

park. You know, he's been one of my favorite science writers

21:20

throughout the pandemic and and this one is

21:22

nice because it's, it's also actually compared to some

21:24

of his previous ones. It's relatively short. It's

21:26

pretty quick read. And, and super illuminating.

21:28

And so, you know, I,

21:33

I sympathize and agree a lot with, with, with what's

21:35

been presented in this article. I think it's just super

21:37

important because you know, you're, you're right. There

21:39

are there are a lot of people with compromised

21:42

immune cells. Who have been facing, you

21:44

know, like an increased risk from everything

21:46

for ages. And I think, you know, it's

21:49

so easy to forget about

21:51

disability and about vulnerability

21:53

and all of these different things. In many

21:55

ways. I think our society, especially in the Western

21:57

world, especially in the U S has just completely structured

22:00

around shielding us from

22:02

death, from suffering, from

22:04

disability. And And that's,

22:06

you know, that's, that's not good. And,

22:09

and, and one of the things that COVID has done is it's

22:11

really brought some of these things to the forefront

22:13

and some really important ways. So,

22:15

you know, as, as you mentioned, like we,

22:19

there's, there's part of the question of like, you know, we haven't really.

22:23

Done much in terms of public policy to protect

22:25

these groups in the past, you know, is, should

22:27

we be doing anything now? And I think, you know,

22:29

it, again gets back to that idea that like, you know, there's,

22:31

there's this inconsistency and there are two

22:33

routes, you know, one is that like, oh, well we didn't do anything before.

22:35

We probably don't need to do anything now. Or it's like, well,

22:38

maybe we should have been doing something before. And

22:41

you know, maybe, maybe that's the way to correct the

22:43

inconsistency. And so, you know, I,

22:46

in the article. Yeah.

22:48

It says that, you know, precisely none

22:51

of these people who are interviewed, who are immunocompromised

22:53

suggested that we should be going into any sort

22:55

of like permanent lockdown. You know, they, they recognize

22:57

that they have a medical condition that puts

22:59

them at greater risk from literally

23:02

just living life. But

23:04

but there is really the sense, you know, the thing that really

23:06

stood out to me was the sense of just being forgotten of

23:08

people just not really caring. And, and it's,

23:11

I've seen this all the time and that drives me up a wall,

23:13

but this sort of like, using sort of like the

23:16

elderly and immunocompromised to sort of this throw

23:18

away line for the exception to everything of COVID

23:20

and it's like, well, okay, like when did we, when did we stop

23:22

caring about the elderly and the immunocompromised,

23:25

right? Like when did they become an asterisk that we

23:27

can sort of no longer. You know, that we can just sort of say,

23:29

oh, well for this group over there, you know, these things might differ,

23:31

but we're not going to necessarily say how they differ. We're not

23:33

going to say, you know, what the actual change

23:35

in risk is going to be. We're just going to sort of do

23:38

our due diligence by saying they exist and then sort of move

23:40

on with our lives. And I think, you know, I think that's just

23:42

is a, is a huge, huge injustice.

23:45

So with that said you know,

23:47

we make the comparison between COVID and flu as well.

23:49

And you can think about it from, you know, for a person who's immunocompromised.

23:52

It's basically like being unvaccinated to a large

23:54

extent. And so. COVID is a lot more severe than a

23:56

flu for, for somebody who's totally immune naive.

23:58

And so the risks that they're facing is now not

24:00

just from flu, but also from this additional risk

24:02

of COVID-19. And I

24:04

think that's important, you know, that, that there's, you know,

24:07

this just sort of ratchets up that

24:09

risk of being out in the world for people whose

24:11

immune systems are compromised. And so. So

24:14

I think that, you know, I don't know yet

24:16

what the answer is to this. Once again,

24:18

I mean, I don't think it's realistic to say that we're going to be

24:20

able to eliminate all risk

24:22

from everyone or even to distribute

24:24

risk equally among individuals. I mean, it's just the

24:27

sad reality of the world that like people

24:29

face different risks in life

24:31

for all sorts of different reasons. You

24:34

know, w we should always be striving to improve

24:36

the lives of, especially the people who are most vulnerable,

24:39

but you know, that's, that's yeah, that's

24:41

that that's, that's the project of the entire human

24:43

project, you know, that's not the project of a couple of

24:45

years. But in the meantime, I think just like recognizing

24:48

that there are a lot of people who are immunocompromised,

24:50

and even if you're not, you will be one day, you know, that's

24:52

what happens when you get older. And

24:54

so just recognizing this is not something abstract,

24:57

this is not something rare, even, you

24:59

know, that there are a lot of people who we probably

25:01

don't even know who are around us, who are immunocompromised.

25:04

And just recognizing that they're an integral

25:06

part of our world and trying to be a little bit more

25:08

mindful of, of. The

25:11

risks that they suffer going around the

25:13

world from day-to-day. So, yeah, read the

25:15

article that articulates all of this about a thousand times

25:17

better than I was able to just now, but

25:18

yeah, that's great. And I mean,

25:21

sorry, for those of you who are hearing a bunch of sounds in the

25:23

background of mine boys got raised cars yesterday,

25:25

and so I was slower. So I apologize,

25:27

but that's the nature of where I'm at right now. I'm in the basement.

25:30

We have wood floors above. So I think that

25:32

puts it in a great perspective. And thanks for sharing

25:34

that. Just the idea of that. I mean, it's. You

25:37

know, let's move to this idea of controlling COVID

25:39

in the future. What am I look like? You know, I mean, just

25:41

as a side note, I totally just, this

25:43

has probably no relevance, but it

25:45

has saddened me. I'm a person, you, you

25:47

as well, a person of faith and come from

25:49

particular tradition and the tradition

25:51

has a longstanding hold, you know, being

25:54

me being Catholic and, and of

25:56

really caring for those in the margin. And it

25:58

was, it was, it was hard for me in, in, in many

26:00

circles around me who didn't feel

26:02

that same way to consider. As

26:04

a, as a place where we could really double down and

26:07

care for those in the margins. And elevate

26:09

them and protect them. I'm at costs

26:11

that might, that actually might cost a little bit

26:13

of suffering on ours. So there was a big, it

26:15

was a big eye-opening moment. I'm not saying that was

26:18

shared by every institution or

26:20

every Catholic, but it, but it wasn't my

26:22

circles and it was hard to swallow. So I, I appreciate

26:24

you bringing this up to the surface that this should be a universal

26:26

focus for so many people. But coming

26:29

into the, into the sense of, of

26:31

control and how to begin to control COVID

26:33

as we move this to an endemic, what do you think this

26:35

looks like now? I think for you, or maybe

26:37

I'm pitch it to you as maybe more like in the U S cause

26:39

I feel like it's a dummy, a very different world, not to be like

26:41

Peyton Manning joke, but like, you

26:44

know, I don't feel the SNL where you talking about Emily and Paris

26:46

and then it went viral and anyway, it was hilarious.

26:48

He was, it was the interview. Peyton

26:50

Manning, like, what'd you think of the Superbowl?

26:52

I was like, oh, I heard it was great. And they like, well,

26:55

you heard it was great. Like, well, I got caught up in Emily and Paris.

26:57

And so it's, it's a huge joke, but

26:59

nonetheless, we, so we started watching Emily and Paris and it was

27:01

like, it's, it's an awesome show. And

27:03

like you said, it really opened my eyes to the cultural

27:06

difference of even like France and how they think

27:08

of like, like, oh yeah, we really do us

27:11

Americans really. Don't like to talk about death

27:13

or hard things and we like to escape it. Right.

27:15

Entertainment. It's a very different reality. So

27:17

it imagine how. Control

27:20

our environments and be shaped largely

27:22

by our culture. Like you said, like also

27:24

when the sense of we maybe are not so

27:26

into prevention, maybe why we have diabetes

27:29

and in a very unhealthy way, we have

27:31

a tendency, right. Generalizing to

27:33

focus on after the matter and how do we fix

27:35

it and how do we get medicine and that kind of stuff. So.

27:39

And the U S particularly, how do you look like the

27:41

next best steps for controlling this? Now,

27:43

given that there is a large amount of people who are

27:45

not going to want to do much of anything, because

27:48

we're kind of done with this. So we want to push it to somebody

27:50

else or something else.

27:53

Yeah, gosh, you know, it's I think that

27:55

this, this question sits on all sorts of different

27:57

levels. You know, we can talk about epidemiologically,

28:00

which, you know, we have to some extent in previous episodes

28:02

too, about, you know, what, what

28:04

does control mean? And like, how do we think about

28:07

you know, relative risk and comparing the risk from

28:09

COVID to the risks of other things that we face. Day-to-day

28:11

like the risk of flu and car

28:14

crashes and different sorts of things. Like

28:16

how do we sort of bring that into. You

28:19

know, probably ideally a similar level

28:21

because in a way, you know, we've, we've gotten used

28:23

to living with a certain level of risk. And part of the difficulty

28:25

of COVID-19 is that it's increased our risk

28:28

of. Dying of hospitalization.

28:31

And and so, you know, again,

28:33

the, the options before us are to

28:35

control COVID until it comes sort

28:37

of falls back in line with the risks that we were

28:39

already accepting, sort of bring it back down to the status

28:41

quo or to

28:44

think about like what it means

28:46

to live now in a world. It's

28:48

just a riskier place to be than it was before.

28:51

And I don't think that those are necessarily exclusive.

28:54

I hope that they're not, you know, I think that, you know, that we

28:56

still have a lot of work to do to prevent COVID

28:58

cases where we can and to bring, you know, the,

29:00

the The impact of COVID down

29:02

as much as we can, both at the individual and

29:04

at the societal level. But also, you know,

29:07

seeing this as a much more general kind of wake up

29:09

call of precisely this, this

29:11

issue. And I think, especially this is common in America

29:13

where it's like, we don't, don't

29:16

really want to think about death and about dying

29:18

and about risk and about, you know, and

29:20

in many ways that's sort of seen as like a morbid

29:22

or a tablet. Kind of thing, but you

29:24

know, just kind of recognizing it, trying, trying

29:27

to take this as an opportunity to

29:31

readjust our our own

29:33

relationship with suffering

29:35

and death and dying. And to

29:37

recognize that like, you know, we've, we've

29:39

been living in a time in history that

29:42

is just absurdly

29:45

Different than anything that has come before in

29:47

terms of the reduced risk from dying

29:49

from infectious disease or,

29:51

you know, like, even just accidents

29:54

and toxins and things, you know, we

29:56

have so much more knowledge that we've really been living

29:58

in this, you know, hugely privileged

30:00

time in history. We

30:03

can frequently forget

30:05

about our own death and the death of those around us and,

30:07

you know, and it's wonderful, you know, like I'm not, I'm like,

30:10

that's great. And that's, you know, that's, that's

30:12

what I've thrown my entire professional weight behind

30:14

is sort of furthering that progress. You

30:16

know, that's, that's really good, but I think that,

30:18

you know, we can get, get caught in the in

30:21

the trap of Just because we've made so many

30:23

strides to pretending, or

30:25

at least, you know, living as if none of these difficult

30:27

things exist at all. And I think that this

30:30

has really shown us that that's not the case.

30:32

And that, you know, we may well be living

30:35

in a decade or two, you know,

30:37

like the coming decades may, will be more risky

30:40

for all of us than the previous two decades.

30:42

And that's going to be one of the first times in recent memory that

30:44

that's been the case, you know, and that's a really hard

30:47

pill to swallow, but But but

30:50

you know, as, as we think about transitioning to

30:52

this endemic relationship with COVID, I think there's,

30:54

you know, there's a lot from the policy perspective, from the epidemiology

30:57

perspective, but I, the

30:59

thing that really interests me right now is sort of like, how

31:01

do we all know. Sort of

31:03

bear this, this new reality

31:06

and sort of from like a psychological

31:08

spiritual perspective, how do we understand

31:11

that transition and what does it look like for our

31:13

society to sort of, just response to this

31:15

crisis that we've just been through and that in many ways

31:17

is an ongoing and will continue to go

31:19

on at some level for probably

31:21

years to come.

31:23

Yeah. I mean, to have that kind of awakening of a mortality,

31:25

and I would feel like just practically

31:28

speaking. You know, even though I would, I would say

31:30

prime generally the most, the world probably

31:32

looks at us in some sense of, you know, I feel

31:34

like kind of infants and our, the way we behave at times.

31:37

And they think that the advantage,

31:39

I guess, is kind of, you know, I'm thinking like of the Tesla, right?

31:41

The Tesla was, was created it's battery, it's automated.

31:43

You can, you can send the car can drive now, granted, you can't

31:45

just like fall asleep. I'm not trying to advertise any

31:47

kind of stuff, but it kinda, it kind

31:49

of a rings to the American ears. Like,

31:52

oh my gosh, a Tesla, I can drive. I

31:54

can go to the bar and get wasted still, and then it's

31:56

still drive home. Right. You know? So it's like, And

31:58

again, we're not advertising, we're not, we don't want that to be the case,

32:00

but like, there's this temptation again, you know, everything

32:02

that fixed so we can still maintain our life and

32:04

something else. I mean, I think that's a hardship

32:07

and a difficulty, and I don't think really it's, it's ethically

32:09

the correct way to pride process things. However,

32:11

the gift, I think the opportunity in this is maybe

32:14

like, okay, we're America

32:16

and nobody wants to wear masks anymore. Maybe

32:18

nobody will care anymore. And we'll just walk around.

32:20

What do we do now? You know? And I think putting

32:22

I would imagine. There to be a lot of resources

32:25

being put into technology that

32:27

does it for us, right. Air filtration,

32:29

all these kinds of things, and, you know, really advancing

32:32

these kinds of things beyond measure to

32:34

at the cutting edge so that we can still be in a bar

32:36

and restaurant and then feel as if nothing's

32:38

going to happen to us. Because guess what, we, we developed

32:40

the filtration that we can actually go with

32:43

COVID and it'll suck it out of us. Right. And and

32:45

we don't have to worry about a thing, you know,

32:48

Yeah, exactly. I, you know, and this is maybe,

32:50

you know, going going off, you know, further

32:52

on something that I have absolutely no qualifications

32:54

to talk about at all. But but I do think, you know, going back to some

32:56

of the themes that we were talking about at the beginning of the

32:58

pandemic about some of the cultural differences between

33:00

different places, I think, I think you're

33:02

right. That certainly living in the UK, being

33:04

in Europe, there was sort of this deeper

33:06

sense of a rootedness

33:09

of a Yeah. Even just a acknowledgement

33:11

and mortality in the sense that, you know, there, the,

33:14

for example, the memorials to the people who are lost

33:16

in world war one and world war II were just everywhere.

33:18

And and, but, you know, yeah,

33:21

you were saying that like the, the, the view of America's

33:24

is sometimes sort of childish. And

33:26

I have to say that like, Probably

33:28

my perception of the us and

33:30

its sort of global standing was

33:32

probably more critical before I left for the UK.

33:35

Then when I lived there and came back in

33:37

the sense that, you know, I was I sort of saw that

33:39

youthfulness as kind of a negative thing,

33:43

but after being there, you know, I came to really appreciate

33:45

that. Like for, for all of the

33:47

traps that our youthfulness

33:49

as a nation causes us to fall into. There's

33:51

also this really remarkable. Energy

33:54

and edginess and swagger that

33:57

kind of comes with, you know, being a relatively

33:59

young nation as well. But we're

34:01

sort of like on the cusp of our maturity as

34:04

a country, I think, you know, especially, you know, if you think about

34:06

relative to some of the political systems

34:08

that have been set up in Europe for, for such a long time.

34:10

And so, you know, I think that, that, that's

34:12

another thing that I think as a country, this pandemic

34:14

sort of offers a new reckoning for us, where it's like

34:17

you think of about our personal lives and our,

34:19

our maturing, you know, happens sort of. Start

34:22

since usually brought forward, especially by crises,

34:24

you know, when something awful happens or when something great

34:26

happens, but when there's major turning points in life,

34:28

you know, that's when we, as individuals really mature.

34:31

And I think that that sort of like, forces us to question

34:33

now, you know, we, we have been sort of this. Scrappy

34:36

young nation for a while. And now there's

34:38

sort of this really critical point where we have to

34:40

kind of decide what we're going to be about and

34:42

what is the process of our maturing going to

34:44

look like? And there are a lot of different ways that it

34:46

can look and, you know, people can mature well and can mature

34:49

poorly, but The fact is they do

34:51

one way or another there's no,

34:53

you know, and and so I think that's,

34:55

that's really the question that's facing us now is

34:57

that you know, what do we, what do we do with these pieces,

35:00

recognizing you know, who we are, who

35:02

we've been, and that it's different than anywhere else

35:04

in the world. But, and so our path forward

35:06

needs to be also different than anywhere else, but also

35:08

needs to reflect like who we are and who we want to be

35:11

in relationship as we move forward. So that's

35:14

great. Yeah, maybe I had too much coffee

35:16

this morning. There's

35:18

give me some of that coffee. That's awesome. That's

35:21

great. No, that's a great way to end on. I remember.

35:23

I mean, I love my dad and enslaved. I remember when I was

35:25

really, really young. I had all this enthusiasm

35:27

and energy about, oh, I'm gonna do this, we need this and this.

35:29

I remember we were, I was in the back of the car. I was like, one day you'll

35:31

get older and you'll see things more clearly

35:33

or whatever. I don't know, wasted it. Like, that'd be like that. I

35:35

think. There's clearly some

35:37

wisdom in that, but like, I kind

35:40

of really echo to me what you just said is like,

35:42

oh yeah, there. Yeah. The U S is a scrappy

35:44

young energizing, and here's

35:46

the older folks, older countries looking at us

35:48

and either a encouraging

35:50

us because after all our energy provides

35:52

some really cool advancements, but also there's

35:55

some pitfalls to are, are, are

35:58

a little blinded towards looking at the things that scare

36:00

us. And, but we've been, we're being

36:02

faced with a huge moment right now and we are being

36:04

forced to grow up. And we don't want

36:06

to lose who we are, but bring it, we'll bring to the table

36:08

and become something even more mature. So. That's awesome.

36:11

Stephen. I hope a level of listeners get

36:13

value. I got a lot of value from what you just said. So I appreciate

36:15

a lot of food for thought for the next couple of days. So

36:18

we will end on that fabulous note. These

36:20

scrappy young dudes are gonna sign

36:22

out. And we'll be back in a couple of weeks, but

36:24

in the meantime, if you want to reach out to us

36:27

[email protected], do you have an email

36:29

like Wendy? Did. I love them for Dawn to

36:31

Stephen and even mark, even though he don't know who he

36:33

is, maybe. And he'll be back on. I know he'll be

36:35

back on at some point in time, and then if you

36:37

want to get a hold of Stephen S T E P H E

36:39

N K I S S L E R in Twitter.

36:41

I really recommend you following him

36:43

on Twitter and his. That he has

36:45

a tailored, it's been fun

36:47

to, to in really eyeopening to follow those,

36:50

those tweets. If you wanna support us patrion.com/pandemic

36:53

podcast, or Venmo

36:56

PayPal on the show notes. And if we could get 13

36:58

more people deliver review by

37:00

March six, I think that's the date. That'd be our two year anniversary.

37:03

That'd be cool. That'd be awesome. I think. That's

37:06

good. So the next time we're on, we'll be around

37:08

the two year mark. So won't be as

37:10

fabulous and as intense as our first year,

37:12

that was too much work for me in a super fund, but

37:14

we'll just keep on carrying on. All

37:16

right. Have a wonderful two weeks and

37:18

we'll see you all. Or you'll hear from us

37:21

in two weeks. Take care and

37:23

bye-bye.