0:00

You're listening to the pandemic podcast. We equip

0:02

you to live the most real life possible. And the face

0:04

of these crises. My name is Matt Bodecker. I'm joined

0:06

with a great friend, Dr. Steven Kisler and

0:08

epidemiologist at the Harvard school of public health.

0:11

Good day. Do you find

0:12

sir? Good day. Good, good payday day,

0:14

Matt. It's wait, wait, is it really?

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Yes, it is 3 1 4. And

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so this is a, this is a holiday

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in which mathematicians unite so great.

0:24

This

0:24

is, so this is the exclusive reason why

0:26

we delayed. That's been damaged.

0:30

That's right. That's great.

0:32

So I do apologize for those who were probably looking forward to

0:34

a podcast two weeks out in that three weeks out, Steven

0:37

had a lot going on last week and he still is crushing

0:40

it, but he's still made time to put out a

0:42

relatively quick episode today because we only have. 30

0:45

minutes or less right now, before he has it

0:47

on the median. So we're kinda really

0:49

quick. If you want to donate great pandemic,

0:51

I don't even know how to say, oh, patrion.com/benefit podcast.

0:54

I'm not trying to go so quickly right now. Like we've got

0:56

to get Steven

0:57

all these questions here on here.

1:00

I know we did that so badly for

1:02

the intro and outro. So if you want to

1:04

do that, you can do that in the show notes. One-time gift

1:06

in the show notes, Venmo, PayPal. Great.

1:08

It is now two years since we've been going on

1:11

for the pandemic podcast and the pandemic as

1:13

well. So this is a big milestone for

1:15

us. One year seemed normal. Two years seems

1:17

outrageous for us to be together. Like,

1:20

I don't know what happened to. Thank you for

1:22

all those who's left reviews. One quick one, I'll

1:24

leave on February 25th where there's a couple

1:26

as we near the two year anniversary of COVID exploring

1:29

exploding in the U S I want to express

1:31

my gratitude for the pandemic podcast.

1:33

You've been and continue to be a

1:35

steady source of information I can trust. Thanks

1:37

guys, for all your efforts. So

1:40

pretty all those.

1:42

Yeah, totally. And real shout out for people

1:44

who have like been barren

1:46

with us for this entire time. It's I know, it's

1:48

yeah, appreciate it. And glad that we've gotten to connect

1:51

with many of you over the course of the pandemic. So

1:53

yeah, it would be great someday in person and the guys are in

1:55

wherever Boston, Denver

1:58

feel free to send an email, Matt living in the

2:00

real.com. We'd love to connect with you guys in one

2:02

way or another. So thank you for all those reviews. So

2:04

let's get going. And is there anything else on the

2:06

show notes I need to talk about for intros? I feel

2:08

like I'm missing something, but not

2:10

that important. We have less than 30

2:12

minutes. So let's start with the outline right now.

2:14

Stephen, the first thing I would talk about is policy

2:16

and guidelines. Things are changing. Things are rapidly

2:19

changing and things have changed and

2:21

so much so that like I went to the grocery, no,

2:23

not the grocery store, but I've been to other places and had been unmasked.

2:26

Going into restaurants. Now, things are really kind of normal.

2:28

Hospitalizations are so low now that I feel comfortable

2:30

that going in and just kind of starting to

2:32

live a normal life. Now you'd

2:34

have policies and guidelines trying to keep

2:36

up. I know Hawaii is going to release. There's finally

2:39

in in March 26. So

2:42

no more, you don't need to have quarantine,

2:44

that kind of stuff. Airlines have continued

2:46

their mask mandate. Just I think

2:48

for up until the second week of April, but

2:51

could change rapidly. I think they're consulting really

2:53

powerful people like you and other people to figure out what

2:55

the heck they're they need to

2:56

do. And so that's, yeah, that's a generous

2:58

description for,

3:01

so they're figuring that out. So everything's

3:03

changing. One thing that changed is the CDC guidance. I

3:05

want you to inform us in me, particularly because

3:07

I'm with you, I'm like what's going on

3:09

with the change of the CC guidelines, because apparently

3:11

it was one thing. And it was like the cases

3:14

per a hundred thousand and an article

3:16

mentioned, I'll put this in the show notes that the

3:18

new transition to the guidelines or not

3:20

the guidelines, but the measurements the

3:22

initial one had like 75 in the

3:24

country being at high risk or whatever, that,

3:27

whatever that level was, the new.

3:29

Guidelines or the new way they measure criteria

3:31

for COVID infections, but to down

3:34

along like 15% of the U S at high, high risk.

3:36

So can you help explain what's going on and

3:38

how we use this and that going

3:39

forward? Yeah, totally. I

3:41

mean, I think this really folds in nicely to

3:43

a lot of conversations. Previously

3:46

about just the complexity of making

3:48

decisions and changing guidelines around the pandemic.

3:50

It is, it is, it is not an easy job. And

3:52

I, I can't say that I am excited about

3:55

every, all of the updates to the CDC has made,

3:57

but I also kind of understand. Where

3:59

a lot of it is coming from and what it's been motivated

4:01

by. So, the, the, I think the,

4:03

the the biggest thing that

4:05

has caught people's attention is this big shift in the U

4:07

S map, right? Where it's like places

4:09

turn from red to green where it's like high risk versus

4:12

low risk. And it's like, what the heck? Like, somebody just

4:14

decided to change the rules and then, and that, and that

4:16

again, plays into this notion of like that.

4:19

And I think there's this false notion that

4:22

that good faith and honest

4:24

communication implies consistent

4:27

unchanging communication, right? Because

4:29

the context is constantly changing too. And it's changed

4:31

hugely in the in the context of

4:34

increasing vaccination rates and a lot

4:36

of underlying immunity from previous infections. So

4:38

now the same number of cases that we saw

4:41

a year ago does not mean the same thing as

4:43

the same number of cases that we're seeing today because

4:45

due to that underlying immunity and

4:47

due to our improvements in our ability to treat

4:49

COVID, we have, we have drugs now that are effective

4:52

at each stage of infection. Like it's,

4:54

it's just a different ball game. And so

4:56

it's not that, eh, Just

4:59

that, someone decided that the pandemic

5:01

was over and we need to, change, but

5:03

it's like this, this also reflects to a large

5:05

degree, the reality of the situation, which is that

5:08

the risk of severe outcomes given infection

5:10

is, is hugely reduced. Now, thankfully

5:13

in this country due to all of the, everything that we've

5:15

been through and everything that we've done to try to make it that

5:17

way. And so that's really what the guidelines reflect.

5:20

The, I think there is still room for criticism

5:22

in that. They're they've really scaled

5:24

back a lot on surveillance and have

5:26

made the triggers for

5:28

changing these guidelines tight to

5:31

mainly tied to hospitalizations. Nope.

5:34

On the one hand, that makes sense because the

5:36

that's by far the sort of the most stable

5:39

indicator of how much. COVID is, is

5:41

circulating at a given time because there are so many idiosyncrasies

5:43

with testing. Like it's really hard to know what case

5:46

counts mean in one place versus another. I

5:48

think those people get tested for all sorts of different reasons,

5:51

but of course the difficulty is that hospitalizations

5:53

are hugely delayed. And so by the time you see

5:55

a big rise in hospitalizations

5:58

there's a good chance. There's already a lot of COVID spreading Too

6:00

late to really turn around a major

6:02

event. So something we're gonna have to watch this closely.

6:05

I do think this is sort of a, a work in

6:07

progress, defining what these guidelines should be.

6:09

But yeah, hopefully that, that gives a little

6:11

bit of nuance to what's going on.

6:14

So w guess would probably be to be expected

6:16

then if it's still an, a kind of an evolving

6:18

situation that we could probably see a series of changes

6:20

within the CDC, as it grows and understands

6:22

and reflects and, and kind of finds its

6:24

stable ground for this new endemic it's. This is

6:26

not the final say of how we're going

6:28

to measure going forward. Cases and

6:30

how to respond to it. Exactly. Yeah. I mean, this

6:32

is, this is the scientific and political

6:34

process and I, and I don't mean political here as a dirty

6:37

word. It's like, it's, the CDC has made their

6:39

guidelines and then there's been a lot of response

6:41

from other government institutions, from

6:43

other academics, from other, just even lay

6:45

people who are responding to these guidelines and maybe

6:47

even pointing out things that the CDC hadn't

6:49

considered, despite their good faith efforts to consider

6:51

all possibilities. And then Nope. Factor

6:54

that in. And then if it is, changes need to be made, then

6:56

I am confident that they'll be.

6:58

Okay, sounds good. All right. We're going to, we're

7:00

going to do a lot of speed rounds here. So next

7:02

being around variant let's touch base on this.

7:05

I was really not thinking much of B2 still

7:07

don't but there was one article that kind of

7:09

raised my eyebrows a little bit about

7:12

how maybe New York has seen a little bit of a sub

7:14

variant spread. Not sure how accurate

7:16

that is. I haven't got a chance to kind of chase this down to

7:18

see, but a particular line in

7:20

this article. I'll put in the show notes.

7:23

And that is that a, this B2 variant

7:25

is up to 30% more infectious. Last

7:28

I heard this was, it was like three to 6%

7:30

more infectious. And I was like, oh, well, that's, that seems

7:32

about right. 30% of

7:35

an already outlandish, like

7:37

crazy variant. What

7:40

are you hearing? Whereas B2 on

7:42

your radar right now. And are these, are

7:44

these kind of Well, is the

7:45

accurate, yeah, so there's, I mean, there's a huge

7:48

amount of uncertainty around these statistics and a

7:50

big part of that is because, again, the context

7:52

is changing hugely. And so,

7:54

as, as we've talked about, and I think there's been a lot of

7:56

discussion about this sort of in the media as well,

7:58

that that an increase in

8:00

infectiousness can be due to a whole bunch of different

8:02

things. Maybe that's increased intrinsic infectiousness,

8:04

but a lot of times it's actually an interplay

8:07

with previous immune exposure which

8:09

vaccines you've gotten, how recent they've been, which

8:11

various strains have infected your community,

8:13

how recent those outbreaks have been. And

8:15

that can create a huge amount of variation in the infectiousness

8:18

of a given various. In a given population.

8:21

So I think part of the reason we're seeing these like vastly

8:23

different estimates of the infectiousness

8:25

of BA two relative to BI one is,

8:27

is just due to that because it's spreading in different

8:29

populations. I mean, I think it's worth noting that we've,

8:31

we've had BA two circulating at low levels in the

8:33

U S for months now, and it hasn't

8:35

really taken off in most places. So

8:38

that's kind of confusing too. So there's, there's a lot

8:40

going on here besides just sort of

8:42

a baseline difference in infectiousness. It

8:44

seems like it really needs to get to get lucky in a

8:46

way in a given population before it can really

8:48

take hold. And it just hasn't been able to do that. So,

8:51

so at least in the U S it seems to me

8:53

like that 30% is probably, as, as

8:55

just a baseline figure. I think that that's a little high,

8:58

because I think if that were the case as. Every

9:00

every BA two is 30% more infectious than BI one.

9:03

We would have seen huge outbreaks of BA two already

9:05

at this point, but in some communities, I'm

9:07

sure that's the case that that 30% is,

9:09

is, is accurate. And so it's just a matter of finding

9:11

the right communities. And then once it gains a foothold,

9:13

it can spread. Okay,

9:15

great. Anything else that we should be concerned about or on our

9:18

radar? Because I've been kind of out of the loop. I've

9:20

been snipping articles here and there, but I haven't seen anything

9:22

about variants of concern besides B

9:24

this B2, is that a

9:26

proper kind of reflection right now? Nothing bigger

9:28

than that. It's pretty much all that right now. We

9:30

we've seen some upticks in cases, for example,

9:32

in the UK where they've already had a large BA

9:35

one wave and, and some of that seems to be driven by

9:37

BA too, but there's so far in all

9:39

of the increases in cases that we've seen around the world

9:41

there aren't any new variants that have been implicated

9:43

in that. And it also doesn't seem like from what

9:45

we've seen, there's really any difference in clinical severity

9:47

between BI one and BA too. So I think

9:50

that's a big reason why, that's, that's pretty much all we've heard

9:52

about and that seems to reflect what I'm seeing

9:54

too.

9:55

Okay, great. So let's hit now the vaccine

9:57

booster situation, there's a few articles here

9:59

and there. Talking about the second booster is, is

10:01

this something that's going to be coming down the pipeline for us

10:03

relatively soon? Maybe not.

10:05

Where did you guys thinking about. This

10:08

booster in some articles

10:10

will say that, ah, it's been tested.

10:13

It's a very marginal boost

10:15

compared to the original booster for the Omicron, particularly.

10:18

So maybe it's not something is going to be on

10:20

our, the forefront of our radar.

10:22

Come this fall. What are you guys

10:24

talking about?

10:25

Yeah. So, at this point it that's,

10:28

that reflects my understanding too, that there

10:31

especially for people who are who

10:33

have. Normally

10:35

functioning immune systems and

10:38

I've gotten a booster, it seems like getting

10:40

a booster booster. Doesn't really

10:42

it doesn't give you a huge improvement

10:45

in protection against severe

10:47

disease. We're still gathering that information because

10:49

again, one of the, probably the

10:52

biggest element of this. Rate

10:54

at which protection from the vaccine declines.

10:57

And we just haven't had people who have been

10:59

vaccinated and boosted for long enough to

11:01

really know what that

11:03

rate is and, and what the floor might

11:05

be in that reduction in immunity. No,

11:07

that said, one of the big promises and boosting was

11:09

that it would give you much longer term immunity. And so my

11:12

hope is that it's holding up better over time. We'll have

11:14

to wait and see, but that's so far I haven't seen

11:16

any data that suggests that another booster

11:18

is, is. Makes

11:20

sense at this point. Great.

11:22

And that, it's good to hear. That's probably mostly speculation

11:25

cause their number articles are saying that, oh, it

11:27

looks like the booster could last for

11:29

months and months and months, if not years and years and years.

11:32

And that's really, at this point in time, people just probably speculating

11:34

on what little data we have right now, but this

11:36

doesn't take time before. Okay, so

11:39

this one, you said you don't know too much about,

11:41

but I want to put it on the radar for people who

11:43

might be interested because this article was

11:45

fascinated me and I haven't heard anything about this

11:47

until this one article. And this is about this

11:50

from AstraZeneca and I'm probably going to blow

11:52

the name, but it's like Abu shelled or something like that.

11:54

And for those of you who are immune compromised

11:57

and have received your vaccine and your booster,

11:59

and then maybe got tested and realized, man, I had no

12:01

antibodies surface from this. This

12:03

is a promising reality. I do know it seems

12:05

incredibly scarce and that people

12:07

who actually desperately need it are on huge

12:09

waitlist. So, I'm hoping, I'm hoping that

12:11

by just even putting this out here and making it more

12:13

people can be aware of it, then it might push for

12:15

more readily available, but this has ever shelled

12:18

AstraZeneca. I think it's a. And then, or

12:20

maybe a vaccine, I couldn't quite gather that,

12:22

but whatever it is, you take it beforehand and

12:24

it's kind of vaccine specifically for immune compromised

12:27

and it should prompt promising results of those who had zero

12:29

antibody. From two vaccines

12:32

and a booster that people received antibodies

12:34

and felt a lot more confidence in going out

12:36

and even doing basic stuff in life. So huge

12:39

check to up in the show notes, read about it. Okay.

12:42

Last few things when we'll talk about it. Yeah. That

12:45

are that are kind of pressing for me. COVID

12:47

side effects. So I've been reading about

12:49

this now. I know you you've, you've punted a couple

12:51

of the, one of these things to mark needs a chime

12:53

in, on some of this clinical stuff. But

12:55

we have long covet. We've been seeing this for years.

12:57

We talked about from the very beginning. And now

13:00

for me, a new thing on my radar, clearly

13:02

probably not for the scientific community is this

13:04

Epstein-Barr thing has been really, I've

13:06

been seeing this a lot lately in the news

13:09

and now seeing connections towards

13:11

maybe long covet and Epstein BARR.

13:14

And I'm out of live on this. So maybe you can start with this.

13:16

What is this EBV thing that 95,

13:19

apparently 95% of us carry. And

13:21

a few of us, it can raise its ugly head and

13:23

do something. Terrible things like

13:26

Ms. Which my cousin has even

13:28

cancer and other times it just doesn't

13:30

do anything kind of sounds like COVID itself.

13:33

Right. Where sometimes you're just escaped completely

13:35

and otherwise you're in the hospital and near death. So

13:37

in fill this in and where we're at might be in its relationship

13:39

to long COVID and other things.

13:42

Yeah. So this is, this is great. It's, it's an area

13:45

that I'm personally and scientifically really interested

13:47

in as well. And I think it, it folds into this

13:49

broader discussion of like, w w how

13:53

is it that we have so many infectious diseases and

13:55

yet we know so little about the

13:57

sort of long-term outcomes from them.

13:59

So for a bit of background,

14:01

you're right. This Epstein-Barr virus is

14:03

extremely common. As you said, most of us

14:06

have been infected by it, or will be infected by

14:08

it at some point in our lives. And, and in the vast

14:10

majority of cases, it seems like it doesn't really do

14:12

much. But in some it's, it's been implicated

14:14

by an, different cancers. There's a recent really

14:16

paper in science that really did convincingly

14:19

link the Epstein-Barr virus to Ms.

14:21

And so, but again, I think the really important

14:23

thing from that is that getting infected

14:25

with Epstein-Barr does not mean you will get Ms. It

14:27

just means that it's one of those. Important

14:29

conditions amidst an entire backdrop

14:32

of genetic and environmental conditions

14:34

as well, that could

14:37

lead to the development of Ms. And

14:39

so the difficulty in understanding these things

14:41

is really related to another

14:43

phenomenon in medicine and science

14:46

that I hear people talk about a lot, which is like, about

14:48

nutrition. So like, why do we know so little about

14:50

how, what we eat on a day-to-day

14:52

basis? Affects our health and the

14:54

long-term. We do know a fair amount,

14:56

but, but like, what's, what's the deal there? Like how

14:58

is it that something as common as eating is something

15:01

that we have so little information about, and that's

15:03

really because the of two things

15:05

coming together, which is that the results,

15:07

the health outcomes of

15:09

different diets are subtle.

15:12

And delayed. So usually,

15:15

the difference between, taking in, a certain

15:17

number of grams of red meat versus half as many grams

15:19

of red meat. The impact

15:21

of that is probably there.

15:24

But it's relatively

15:26

small and it only accrues over

15:28

a long period of time. And so that's, that's, that's

15:31

the sort of question it's really difficult to study scientifically.

15:34

And so with infections, it's very similar

15:36

because usually you have, you have very high rates

15:38

of infection that might

15:40

lead to a slight difference in risk

15:42

for a given infectious disease or

15:44

for a given health outcome. And oftentimes they're

15:47

delayed hugely. I mean, the development of cancer,

15:49

the development of Ms is going to be vastly

15:52

delayed from the point of infection. And so it's really

15:54

difficult to go back in that causal chain and say

15:57

this thing. Is what caused this downstream

15:59

serious effect. And so that's part of why we're still

16:01

learning about this, but there are ways that we're beginning

16:03

to get a lot more information about this. So I

16:07

do think that there are there's probably a lot

16:09

of links that we don't yet know that we're just beginning

16:11

to understand between infectious diseases

16:13

and more long-term chronic and outcomes.

16:16

Things that we understand to be chronic. And

16:18

one of those is this link between Epstein-Barr and

16:21

various other health conditions. I think it's certainly

16:23

the case with COVID. We don't really know what the longterm

16:25

effects of COVID infection are, but it

16:27

does seem like certainly, long COVID certainly

16:30

exists is debilitating. And we don't

16:32

really know how long. Certain

16:34

cases of long COVID might last that's related

16:36

to other things, we had mentioned

16:38

mano, which Epstein-Barr can, cause there

16:41

are some similarities between mono

16:43

and long COVID. There's some similarities between lung

16:45

COVID and other types of inflammatory

16:47

disease that can be triggered by other sorts of viruses

16:50

that lasts for long periods of time. And

16:52

I think really what a lot of this comes down to is that we don't have

16:54

a really clear understanding of how viruses

16:56

interact with our with

16:58

our immune system. Because really what

17:00

a lot of these things are is that an infection

17:03

has perturbed the way that our immune

17:05

system responds. And usually, at

17:07

best the immune system has a short. Intense

17:09

response that clears the virus and then returns to normal,

17:12

but sometimes an infection can prompt the immune

17:14

system to have a longer lasting response and it doesn't

17:16

ever really return to that normal state. So,

17:19

so that, that seems to be part of what's happening

17:21

here with with these different viruses.

17:24

So genetically, Epstein-Barr and COVID are very

17:26

distantly related. SARS cov two is a

17:28

RNA virus, meaning that it uses RNA to

17:30

encode its genome Epstein-Barr is a DNA virus.

17:33

So it actually uses a genome that. More

17:35

similar in some sense, at least molecularly

17:38

to ours. That may also be part

17:40

of the reason why Epstein-Barr can cause

17:42

some of these downs long long-term outcomes is

17:44

because it's it is just a little bit more close

17:46

to our actual genome and so can integrate

17:48

into our genome in in ways

17:51

that is a lot harder for something like SARS, cov two

17:53

to do. So there are a lot of important micro biological

17:55

differences, certainly at the clinical level.

17:57

And, and thinking about. The outcomes

17:59

of these things. I do think there are some similarities

18:02

that we have a lot to learn from.

18:04

Great. A couple of things before you had the last thing before

18:06

we get going in about 10 minutes, this reminds

18:09

me, I read an article about how I think

18:11

some countries like Sweden and stuff, how they

18:13

did their first wave, it didn't get much of any

18:15

kind of impact. And there are Tracy and

18:17

some of the things I, I don't know if Epstein-Barr was

18:19

part of this equation that this might be

18:21

kind of a tangent reminded me of like a series of reasons

18:24

why. And you were saying that I think the reason

18:26

why I was triggered by this, cause he would say there might be a distant

18:28

relationship between Escobar and COVID. I mean,

18:30

there was some, but not really, but

18:32

they mentioned that how, when they were trying to trade.

18:35

Like maybe why some people didn't get infected in Sweden.

18:38

They saw a relationship between each one and N one

18:40

and the Corona virus. There was like some similarities

18:43

in its, in its like molecular

18:45

just enough similarity that maybe somehow

18:48

that H one N one outbreak, blah, blah, blah, helped

18:50

the protect them just enough, a serious of people.

18:52

Have, did you see much about that, of this connection between.

18:55

You

18:56

know, I didn't see much about the connection

18:58

between certainly, different types of

19:00

viruses. I've heard some, some conversation about

19:02

previous, previous coronavirus outbreaks

19:04

that might've given some amount of protection, but

19:07

it is true that know, one of the other examples that comes

19:09

to mind is. We do know that

19:11

flu and RSV give you some amount of immunity

19:13

against one another. So if you have a really big flu outbreak

19:16

that can push the spread of RSV, which

19:18

is usually a childhood respiratory illness and it can

19:20

move it around and it, and it's, they seem to interact

19:22

with each other through this sort of broad spectrum immune

19:24

response. And so it wouldn't be surprising to

19:26

me that a, the, an outbreak

19:28

of a virus that does ramp up the immune system's response

19:30

could actually provide some short-term protection against

19:33

infection from another virus. Yeah, it's I,

19:35

I haven't seen a lot of data on it, but it's totally plausible.

19:38

Okay, great. For those of you just, I'm going to keep

19:40

a close eye. We'll keep a close eye on this whole kind of EBV

19:42

thing. It's been passing to me and where am I go

19:45

in the future? The questions I had also, I was

19:47

like Pimms and em, and Missy, which I w

19:49

that Stephen's defaulted to mark. I'm

19:51

curious about this. So, it will have mark I

19:55

know mark, if you're listening, get back on or

19:58

submit your resignation. Okay. Last part

20:00

before you get going, the endemic, what does the future hold

20:03

for us now? This is we only about 10 minutes or less. I'm

20:05

really curious of what does it look like going forward

20:07

for us handling one great article came out

20:10

from the Atlantic. Why America became numb to cupboard.

20:13

You have to read this, if you haven't. So please open the

20:15

show notes for those of you. One of the things

20:17

they talked about is this kind of like bifurcation

20:20

of direction, where are we going to go now? Is it, we

20:22

do, do we desire going back to normal? Is that

20:24

what we're trying to do? Or do we want to build back

20:26

better? Right. And so it was a great

20:28

article about how most people actually

20:31

truly do want to build back better, but

20:33

they perceive as if the rest of the world just wants to go back

20:35

to normal, probably because we're just so desperate,

20:37

right. To just go back into our habitual

20:39

lives. But we do. On a large

20:41

sense, want to build back a better. So I want to kind

20:43

of throw it back to you and you had some insights with

20:45

potentially with Ukraine, this kind of stuff that I haven't heard

20:47

yet. So I'm fascinated about how, what the future

20:50

holds for us as we move forward to this, living with

20:52

this and what, what direction we ought

20:54

and should, and shouldn't be going.

20:56

Yeah. So I mean, one of the things that I'm thinking

20:59

about a lot with us is how there's

21:02

The the COVID pandemic has really

21:04

I think in, in many ways highlighted our

21:06

collective relationship with

21:09

mortality because it's been a long time since

21:11

we've had such a new profoundly

21:15

impactful. Event

21:17

that globally has caused an increase in

21:20

mortality on the scale that COVID-19 has.

21:23

And so, I think it's interesting because prior

21:25

to the pandemic we had become numb to

21:28

all sorts of different types of death. And

21:30

so now there's this question, we're starting to see

21:32

this phenomenon with COVID-19 where it's like, okay.

21:34

So at some level we're going

21:36

to have to start to accept a certain amount of death,

21:38

but now there's there's.

21:42

There's this there's this sort of recognition and intentionality

21:44

about it, where it's like, well, Hey, wait a minute. Like what w

21:47

what other things have we been doing this with? But

21:50

we didn't even realize it. And I think that that's really, one

21:52

of the big motivations for like, how do we build

21:54

back better? Like, we've been using flu

21:56

as a baseline. We accept X number of flu

21:58

fatalities per year. But then that raises the question

22:00

like, that's, that's a choice too, to

22:02

a large extent, there w we can never,

22:05

we can never eliminate all, I,

22:07

I don't think that will ever be immortal in

22:09

the, on this world, but like, we won't be able to

22:11

remove all of our risks of

22:13

death. I, I think that in many ways that's a fool's

22:15

errand, but a

22:18

lot of these things are, are when. Get

22:20

right down to it, their choices, right? We're in

22:23

many ways, they're like choices about who lives,

22:25

who dies and how many, and and.

22:28

It's you know, that, that is, that does simplify

22:30

it to some extent, but that, I think

22:32

that thinking about it in those terms is really useful because we

22:34

do have a fair amount of agency in some of these things.

22:36

And we do have to ask, w what, what is acceptable

22:39

and what does it mean to build back better?

22:41

And so folding this into sort of

22:43

another area is that, we're, we're

22:45

thinking a lot about building back better returning

22:47

to normal. But I think it's also easy to forget

22:50

that this idea of normalcy

22:52

is a little bit of an illusion to that

22:55

our lives both individually and

22:57

collectively as a society operate

22:59

as a as, as this movement

23:01

from crisis to crisis in a way, right?

23:04

Like we're all dealing with one,

23:06

I don't think that. Any of us can probably

23:08

honestly say that when the COVID-19 pandemic

23:10

hit, that everything in our life was perfect, everything

23:12

was good. We were at a tournament, totally normal state.

23:15

We were in like this perfect equilibrium, Zen,

23:17

whatever. And then the COVID pandemic came through and messed

23:19

everything up. Right. We were all dealing

23:21

with all sorts of stuff before

23:23

it hit. And our experience of the pandemic

23:26

has been a layering of this

23:28

new crisis over the top of all of the other crises

23:31

that we had been dealing with on a personal and

23:33

community and social level. And

23:36

so I think a big part of what we need to think

23:38

about as we're thinking about this endemic relationship

23:40

with COVID-19 is this recognition that it's not,

23:43

we can't just think about it in isolation, but we need

23:45

to think about it in the context of the

23:47

messiness of life. And so that's where you're my thinking

23:49

about the conflict in Ukraine was also coming

23:51

in, which is that we're, we've,

23:53

we've been talking all about the pandemic

23:55

and shifts and variants and And,

23:58

and what it looks like to return to endemicity, but,

24:00

but the return to endemicity looks very different

24:02

when you're in a country, who's at peace versus when

24:04

you're in a country at war similarly

24:07

the sorts of concerns that we have.

24:09

And, and again, so I'm an epidemiologist.

24:11

So I'm dealing with, with a lot of the infectious

24:13

disease outcomes here, but of course,

24:16

the biggest issue right now is, is in,

24:18

in Ukraine is not really coming

24:20

from pathogens. It's coming

24:22

from bullets. And and that's, that's, that's

24:24

a difficult reality too, but that's,

24:26

what I want to note here is that

24:28

there is also a lot of issues with. Here

24:31

to where people are unable to

24:33

get care for their chronic illnesses. Women are having

24:35

to deliver babies and bomb shelters, and that's

24:38

not good for anyone's health. And infectious

24:40

diseases are spreading as well. So thankfully

24:42

we're at a place with COVID-19 where if this

24:44

conflict were to have happened two years ago,

24:46

COVID-19 would have been. An absolutely awful

24:49

layer over the top of this, it's still not

24:51

good. But certainly, as people are crowding,

24:53

as people are displaced, there's going to be a lot more spread

24:56

of COVID-19. Actually one of my biggest concerns

24:58

is actually with other infectious diseases as well.

25:00

It turns out that the rates of tuberculosis and Ukraine

25:02

as some of the highest of anywhere across Europe.

25:04

And so again, crowding people indoors

25:06

and close proximity and the sort

25:08

of mass migration out of Ukraine could also create

25:11

a really big issue there. So there are a lot of infectious

25:13

disease outcomes that we need to think about. And I think

25:15

that the biggest upshot from all of this is that there,

25:18

there really is no normal. It really is

25:20

just this sense of how do we manage

25:23

this? Crisis and

25:25

issue that that is becoming more familiar

25:28

and more predictable in the midst of lives

25:31

that are unfamiliar and unpredictable at every

25:33

single turn. And, and I think that that's,

25:35

that's the much bigger question that I don't know how to answer. I mean,

25:37

I'm just raising all of these points that all of, and like,

25:40

you know, we all know that like that's our tagline, right.

25:42

Life is complicated and it will

25:44

continue to be. But I think that it's important to

25:46

think about how we. Develop

25:50

our relationship with COVID-19 and other infectious

25:52

diseases against this backdrop of realizing

25:54

that everything else is also going to be difficult

25:56

and complicated at the same time.

25:57

That's great. I mean, yeah, I mean so much in my mind,

25:59

I only have like a few minutes left. I

26:02

think this has been a big learning lesson for me. And I think for

26:04

the whole girl, I think in some sense, we're in our infancy

26:07

in dealing with like global connection. We're

26:09

not, we haven't really reached maturation in this reality

26:11

because I think hundreds of years ago, we lived in,

26:13

we lived in a small village or a community,

26:16

and that became our world. And then because of technology,

26:19

our world expanded and became large, so

26:21

much larger than my mind and my heart and my soul

26:24

can grasp. Right. I can easily get overwhelmed

26:26

right now. My problems exist beyond my

26:28

community. I see them, I read them on the

26:30

news. They're bigger. And so then

26:32

chances for greater anxiety. And

26:34

I feel like the gift here is the pandemic is

26:36

expedited expedite in our maturation,

26:38

right? Of like, okay. The fact

26:40

of the matter is we live in a global community. We

26:42

learn very much that we can not be siloed. Even if

26:44

we try, we Americans try to be a silent in our

26:47

small little bit. It's. The

26:49

COVID taught us that there's no way we can actually

26:51

fully eradicate the outside

26:53

world and live in our bubble of utopia,

26:55

which doesn't really exist anyway. And

26:57

so just now trying to regroup

27:00

together, understand how do we actually

27:02

live in a world that can be joyful,

27:04

can be peaceful in some level, but

27:06

also without, without becoming siloed

27:08

and realizing that there's a world out there that's in

27:11

constant crisis and we're in constant crisis in

27:13

one way or another. And how do we incorporate all the. And

27:16

still live a fulfilled life. And I think

27:18

that's, that's the complication right? Where

27:21

it never was utopia. And this is, this

27:23

is the next step of us, of our,

27:25

of our growing of how do we

27:27

still live life, move forward,

27:30

be hopeful without ignoring the

27:32

things around us and keeping our eyes

27:34

open. And I ended up for me. That's probably it for

27:37

those of you who are like living the real, that's my whole concept

27:39

of like, that's kind of what it is like, how do we actually like

27:41

live in a complicated. And

27:43

respond simply without having

27:45

to, silo the rest of the

27:47

world from us. That's a hard task. I don't have

27:50

an easy solution, but that's the awakening. Right.

27:52

So, thanks for that. That's really, that's really

27:54

awesome. Okay. We've got to go.

27:56

He has a meeting in eight minutes and he probably needs at

27:58

least two and a half minutes to prep. So. Thank you all

28:00

for listening on this episode, you can reach out to

28:02

me [email protected]. Please

28:04

email me, let us know what's going on at four. It to mark

28:07

and Steven always. If you

28:09

want to support us patrion.com/pandemic

28:12

podcast Elizabeth $5 a month or one-time

28:14

gift PayPal, Venmo all in the show notes. If you want

28:17

to reach out to Steve. S

28:19

T E P T N K I S

28:21

S L E R in Twitter. It's an awesome place to follow

28:23

him and get a lot information, a lot of information

28:25

epidemiology, and what's going on in virus,

28:28

the virus studies and all that kind of stuff, which is beyond

28:30

my pay grade, but I li I read

28:32

it anyway. Okay. I have a wonderful

28:34

two weeks. We'll see you for sure. Well,

28:36

hopefully God willing in two weeks. Take

28:39

care and have a wonderful couple of weeks. All right, bye.

28:41

Bye.