ASM238 Your COVID-19 Questions

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this week we're taking your coveted 19 questions on ask sciencemike [Music] welcome to ask science mike this is a podcast where we believe every sincere question deserves an honest and non-judgmental response i'm your host mike mccarg the science mike from the title and this is a program where we you know respond to curiosity with evidence-based information in an emotionally focused and emotionally aware way a combination i find all too rare in our world right up top this week i've got a couple of announcements number one is have you ever noticed that when life is changing we often find ourselves in some way at odds with our friends and family and social community whether it's a new job or moving to a new city or having a change in your faith system or your gender identity or your sexuality any time we go through a season of change often the people around us just don't get it like why are you changing why are you different i like the way you were before what's going on and that can lead us to feel lonely and estranged and confused and sap us of the energy we need to continue to change and grow as people and so i've created something called the overview program that is named after what happens to astronauts when they see the earth from space for the first time and uh it is a way that's based on evidence and psychology and behavioral economics and all these things that i study and love that helps us make it through transitions and thrive in the process you see the overview program is an evidence-based system for navigating change and i use a non-judgmental supportive space for collaborative problem solving to do that so we use the overview program which is a step-by-step process and then we create kind of an emotional space around that that helps us make it through change successfully it's support at the moment you need it the most now of course the every program is not and i mean is not therapy or counseling or coaching as i'm not a therapist or a counselor or a coach this is simply a way to go through an evidence-based process with some support and an outside perspective there's two ways we do that number one it's something called overview stations which is a 10 person eight week program which is marvelous you know i've done these before uh we're bringing them back because people are requesting it but um this the group model of working with other people is really powerful as you see other people you know going through a transition that's not your transition but this the commonality and the similarities you face means not only do you find solidarity but it's really easy to have a sounding board and a perspective so that's overview stations 10 people overview voyages is two people one of them is me so be me and you going through the overview program together of course space for that one is extremely i mean extremely limited but because it is a program from science mic both overview stations and overview voyages uh always have scholarship spots available as well so if that sounds interesting to you you are in the middle of or starting some transition in your life and you feel stuck or you feel like you could use a little bit of uh of support as you move through that transition i'd encourage you to go to overviewprogram.com to learn more and apply if you are interested again that url is overview program.com uh the other announcement i'd like to say and this is less of an announcement than just a wow is hey hello to all of you new patrons i have noticed uh the last oh i don't know two or three months a big uptick in the number of patrons supporting science mike and that just means so much to me as you know this is not a show that i do alone there is a team behind it and all of you patrons are helping it so the people who spend all this time making the show happen uh get paid for their efforts and i just so appreciate your participation and i wanted to thank you right at the top of the program this week so with that this week um kind of a special episode i've i've done a few covet episodes you know i'm not ever really sure how much kova to talk about whether uh ask science mike should be a time for people to get away from covet 19 and not think about it and yet i get a lot of coveted questions and especially because people are telling me gosh i just i really don't know who to trust when it comes to my questions about coven19 i don't know what media is trustworthy and what's not and how to tell the difference and uh i got a lot of requests over the last couple of weeks i've done a couple of covet episodes would you do a question and response episode just about covid and so that's what we're gonna do um compared to some of my other covet episodes i don't expect this one to be especially emotionally intense so um you know we've had some some hard things to discuss in other coveted episodes i have had some very um weighty opinions about how we are responding to covet 19 and although that will certainly come up in this episode as well i think this one will be easier to listen to uh for people who are processing stress and anxiety from the pandemic than some of the other covet episodes i've done this one is very solutions focused and it you know helps us set expectations and those sorts of things um and so that's what this episode is going to be i think we'll probably just jump right into it and i don't you know i think i'm just going to like run through the whole thing start to finish one last point we are in the middle of a heat wave in fire season in los angeles so um the air outside my home is full of smoke particles i've been having some respiratory difficulties as a result of that i'm very sensitive to air pollution and so this episode is getting recorded on monday the same day it's going to be released because i've had a lot of coughing and wheezing over the weekend and number two because it is so hot all the air conditioners are running all the time so if you hear any mechanical noises in the background that is my neighbor's air conditioner and if i wait for that to not be on to record in the middle of the heat wave i have to record it like 2 am so i apologize if there are any sound issues or my voice sounds funny at all i apologize i think it sounds okay right now but this is the first time my voice has sounded up to snuff in several days as we've been dealing with a lot of smoke from the fires in la so let's get right into our first question from rachel and rachel says of course this is still a ways out but i'm already thinking of how the need to quickly get a vaccine to market will be used as an excuse from anti-vaxxers who will likely claim that it's unsafe because it was rushed and other more radical conspiracy theories but most vaccines do take a long time to develop so increased risks when this one is first made available seem real do you have any advice on assessing the risk and how to tell when the eventual vaccine is safe rachel as i told you uh in a comment on your question this is an outstanding question um i think it's both broadly applicable and well composed you know i've heard so many vaccine conspiracy theories lately i mean not just online people in my life that i know and love and respect have been in all seriousness asking me if kovid 19 is was created by bill gates to sell vaccines and i really have to dig deep into uh you know my non-judgmental gear to respond uh to questions from friends like that in an uh an amicable and supportive way and so i think you're concerned that um when a covid vaccine arrives it will be met with tremendous skepticism and even conspiracy theories is dead on that is already happening and it is true the medical community is working to mobilize to create a vaccine for covet 19 at a speed unmatched in history and this is impressive work frankly um so what are the risks of that well um vaccines that have gone through an approval process are not risk-free there's no such thing as a no risk vaccine what you want with a vaccine is number one is that it should be it's at a 50 efficacy threshold in other words it's 50 more efficient than doing nothing uh that helps you get towards herd immunity and number two the risks of the vaccine should be dramatically lower than the disease itself okay so uh you know you get the flu shot flu shot is not without risks it has side effects you can get a fever something maybe maybe two percent of people who get a flu vaccine have a short term low fever as a result of that they have inflammation at the injection site well you know a two percent risk of a low fever and swelling at the injection site that's a lot lower health risk than what influenza does to a population group do you see now more rarely flu vaccines people can have allergic responses to them or whatever that are more serious and we know that and say well why would we put someone at risk of a severe allergic reaction to a vaccine that doesn't seem safe and it is simply much safer when you look across an entire population for a very small number of people to have an allergic reaction and then get a medical intervention to to treat that than to leave the disease spreading on its own covet 19 makes an even more obvious case because so many people are dying from covet 19 and let's be clear our research is telling us that the official counts are are under counted probably pretty significantly when we compare overall mortality rates for 2020 compared to 2019 and 2018 and 2017 we see in the united states especially death rates are just they've gone up quite a bit and some of that is because people are avoiding treatments for other diseases because they're afraid of doctor's offices and hospitals and then part of that is people are what they are getting covet 19 and they are dying and for various reasons their deaths are not being counted as coveted 19 deaths and so the threshold for doing less harm than covet 19 you can start to see why pushing the timetable a little bit on vaccines is probably a medically wise move so we have a number of promising vaccines that have already been formulated and have started testing and so your early tests in a vaccine kind of your phase 1 trials are where you see if the if the formulation of this vaccine is effective does this vaccine actually create some degree of additional immunity targeted against a specific disease or not and we have seen a number of vaccines that hit and exceed that golden 50 threshold that is good news phase three and trials is where you do large-scale testing with tens of thousands of participants at that point you are trying to get a better look at your efficacy sure but the main thing you're looking for in phase three trials are side effects what side effects are there and how widespread are those side effects phase three is where you give a lot of people placebo and you compare the side effects of the placebo group to the side effects of the groups that are actually receiving the vaccine formulation this is really important because if your placebo group is showing side effects and your actual vaccine group show the same side effects and the same percentages you have a very safe vaccine and some side effects simply don't show up until after a drug or vaccine has been approved and started to be used across population groups humans are complicated organisms we are biochemically complex we have incredible variances in our composition and so the only way to kind of know how vaccine does in the wild is to release in the wild so our testing is to minimize the chance of serious side effects showing up and i'm actually pretty proud so far in the us it looks like we are not skipping any phase 3 trials in the united states now how do we know well you can bet that there will be whistleblowers in the medical community if people and companies uh rush through phase three trials or try to bury evidence um so so i i tend to have you know still today even in the trump administration a greater degree of trust in vaccines produced here than say what we're seeing in russia where they're already administering a vaccine whose efficacy and overall side effects are not null and i won't be like the first person in line to get the coveted vaccine uh i'm at a higher risk group and i'll probably i'll probably you know i'll step back and kind of watch out ghosts for several reasons number one i'm a podcaster i work from home um i can safely self-isolate longer than some other people can you know if i have a history of heart disease i i am um i want to say i'm obese and i've gotten a lot of pushback from the audience but using that word i can't think of another word in a medical context uh at this moment so i'm just going to run with obese with my apologies to um to the fat advocacy groups for saying the term obese but it's going to be too big a delay to try to work through that language and still get this episode out today i am obese and we know that obesity in conjunction of covenant 19 is a significant risk factor for severe case presentations and death so i have a number of factors that mean if i get covet i have a bigger chance of having a bad case or death from cove than other people but there's some people who are my age they're male like me they have heart disease like me they have all these things and they're essential workers and they have to be out there working i'd rather them have a chance to get the vaccine first so i won't be in the first wave for that reason um and then as you know viruses or as the vaccine is going out we should all be paying attention to news reporting on on what happens but absolutely taking a vaccine is an informed risk typically that risk is very low and it it's too early right now i don't i don't have my like vaccine safety protocol there's too many variables i'm gonna have to wait till the vaccine gets closer and see what the medical community is saying and what kind of uh digging journalists do to uncover things and and then make an informed decision that way i will tell you eventually i will take a covenant 19 vaccine there's no question because the risk of a vaccine is just going to be a lot lower than the risk of the disease itself makes sense okay next question marisa said how can we be strategic and smart about reopening schools should we send kids back if we have the means to help them succeed at home what factors should parents or school districts be taking into account when making the decision to return to in-person schooling marissa another extraordinary question and one thing i've been frustrated about the school conversation in the united states is we treat it like it's a separate conversation than managing the pandemic in general and it is not the safest way to help schools succeed is to control the outbreak more generally in society we have research telling us that children can be super spreaders we have research telling us that children can have even if they have mild cases of covet 19 severe long-term health consequences as a result of having the virus we should not be gambling with our children's lives and we have we have been too [Music] ready to gather indoors as adults uh and that has cost that has cost us schools this fall it is not safe almost anywhere in the united states to open schools back up and pack them with children and it is adults fault it is our elected leaders at the federal level at the state level and the local level when they reopened indoor dining even briefly i just couldn't believe it we're going to talk about that later in the show because there's some questions about air circulation folks it is not safe to be indoors with large numbers of people there kova 19 is wildly out of control in its spread in the united states it's not safe to open schools what factors should we be looking at we should be looking at the total number of coveted cases and covet hospitalizations and cova deaths we should look at our testing capacity our ability to turn tests around and the percentage of our tests that come back positive so right now we don't even have a lot of the ingredients to even start making the assessment and we're talking about open schools so to your point so let's just get that out of the way we have handled this horribly like just a true a truly truly f minus on helping schools we're not funding schools with the funding they need to reopen safely so what do we do in the meantime everybody who can keep their kids home needs to keep their kids home and this is terrible let me just say it is terrible this is bad for children developmentally this is bad for children emotionally this is bad for how children learn distance learning is it is a great model for adults doing work it is a terrible model for children learning we have let our children down our children need to be in school our children deserve to be in school and we have failed them but so we have to stop pretending that we haven't so everyone who can keep their kids home and support them well in distance learning needs to do so and then there's a lot of essential workers there's a lot of families below the poverty line there's a lot of child care needs there's a lot of nutritional needs so partially opening schools to families that need it most is a socioeconomic necessity what does that look like it looks like nutritional drop off and pick up so opening schools up for meals those meals you know you have you have meals that can you pick up and take a meal and go you don't even stay or kids can stay they can eat their food uh in a time limited way they eat outdoors a social distance and then also focusing on elementary first then middle then high school in terms of getting kids back on campus kids that need it uh kids whose families they don't have the technology infrastructure at home the work demands are too high for various reasons they can't keep his result now here's the problem a lot of people just like want to send their kids back to school because they're tired of their kids being home um and i i'm not super optimistic about americans making communal decisions here uh you should be thinking if you can keep your kids home keep your kids home to to allow classrooms to have fewer students in them it can be safer if children arrive at school in a staggered drop-off and staggered pick-up topology and they are they go into a classroom and they stay there all day they are socially distanced in the classroom the classroom is frequently disinfected they don't go to the cafeteria meals are delivered room by room meals are eaten at desk it is not a good picture and basically what you end up with is remote learning at school and again you could listen to me and say mike this is terrible for kids emotionally this is terrible for kids developmentally and absolutely it is it is and it's better than the death toll than we will have if we just open schools again again we are seeing cardiac damage in children we are seeing brain damage in shoulder and we are seeing organ system damage in children from covet 19 and that doesn't even include people that get multi-system inflammation syndrome covered covets bad y'all and we keep just acting like things can go back to normal it cannot now we can't other countries have reopened schools so if we increase our testing capacity if we actually mitigate the virus through a full lockdown four to five weeks and get it back down to the point where contact tracing works to the point where we have universal masking there are definitely ways to get there we just aren't there today that means as many children as possible need to be distance learning my kids start school this week in their bedrooms and uh i'm so fortunate that we're able to support that well and not every family can this this pandemic is really digging into the structural inequalities of u.s society we haven't just failed the pandemic this is outlining and this is highlighting all the ways we fail at cooperating together as a society got a couple of links here for you one is preparing k-12 school administrators for a safe return to school in fall 2020 this is for your own enrichment this is so you can understand the best practices for schools and you can compare what your school is doing to what the guidelines are and then the other is a piece that says what other nations can tell the us about how to safely open schools during the covet 19 pandemic which is simply a collection of observations from other countries that have reopened their schools and done so safely and what you'll see is consistently those countries have done a good job controlling the overall pandemic rate in their society there's doing a good job with the overall infection with the overall pandemic and the us is not not at all and as we are all uh trying to do our best to help our children learn and help culture and be engaged this is a hard time friends and my sponsor kiwi co has been a major part of how we are addressing learning needs at home kiwi co creates crates what the heck is a crate a crate is a sustainably produced a designed in california steam learning kit science technology engineering art and math these are delightful hands-on activities that help people learn by doing uh they are available in various ranges uh that you know very small infants uh there's a line called the panda crate uh it goes all the way up to the maker and eureka crate for uh older teens and adults you can change your line anytime you want you know maybe this week you want to do more this month you want to do more arts focused next month more of an engineering focus that's fine kiwico will let you change what line you're a part of anytime whenever you want it's an absolutely wonderful wonderful product now i will confess it is not just my kids who play with kiwi crates mom and dad do as well so i have my own subscription i like the eureka eureka and maker crates a lot i enjoy it i build a ukulele that was one of the most fun things i've done in a while so it's it's fun for the whole family and ask science mike listeners have a special offer if you go to kiwico.com ask sciencemike they're going to give you 60 off your first first month of any kiwi co line you get started today this is a great way to kick off your in-home learning school year do something special why not kiwico again that url is kiwico.com ask science mike all right another question here we got two oh no it's just one question our next one is two questions and one okay so this question says could we have some input about how to take care of ourselves in this time from voices who are currently still out in the workforce i have a job that i still have to go to and sometimes i feel forgotten when all the public voices podcasts etc are from people who have been quarantining or staying at home as if here we all are this is the universal experience we're all at home when in fact many of us still have to go to work unless we want to voluntarily quit slash lose our jobs everyone's challenges are valid of course but i would love guidance that acknowledges the different challenges of people still having to wake up anxious each day and still go out in the world well i am not a voice who is currently out in the workforce i haven't been an office worker in years even prior to the pandemic but i still wanted to have your question on this this show i wanted the perspective that your question represented even if i can't meaningfully or authentically represent those voices you know i heard a story on npr last week about the mental health crisis impacting our essential workers the rates of depression of anxiety disorders even suicidality and suicidal ideation your question perfectly illustrates our stunning failure as a society in the face of this pandemic and i'm sorry something's happened in the united states you know we it's so often called a christian nation self-described but covet 19 has been showing me that america does not worship christ or the christian trinity or freedom or liberty or the constitution by america's actions america worships money it desires money it desires the approval of money it desires to acquire money and increase the amount of money that it has that seems to be one of the truly universal themes of the so-called american experience money money money money money and we've adopted such a short term pennywise and pound foolish approach to money governments think financially to the next election companies think financially to the next quarter and when you think to the next election or forget the next election to next week's poll numbers and the next quarter you make really dumb decisions like saying it's too expensive to lock down the economy and instead we send people out in the middle of a pandemic we never locked down in this country our shelter at home orders were so narrow compared to other countries that beat this pandemic and the reason our shutdown orders were narrow is because we don't have the infrastructure in place to care for people if you look at america's health care policy and our personal time off laws there are almost none and so you look at the actual policy americans work a lot more and wear a hand-to-mouth culture other than the very wealthy most americans are a paycheck or two away from bankruptcy we have no social safety net of substance to speak of and so that means people like you face a choice go out in the middle of a pandemic and work and potentially catch a disease and die or stop working and lose your health care and lose your home pennywise and pound foolish our economy would be in such better shape if we would have covered the basic needs to food and housing of every american for four to five weeks so no one worried about whether they would have housing or food or bankruptcy and did a full shutdown and use that time to turn around and build up our testing capacity and build up our contact tracing capacity like other countries did and because we refuse to do that because we started such a deficit compared to other countries who have more robust health care systems and more robust social safety nets we're in this protracted twilight zone experience where some of us are stuck at home and haven't seen friends or gone to a restaurant since the first days of spring while others of us have gone to work and worked long hours and constant fear of is today the day that scratchy throat means something more i've been so frustrated friends for both groups and i've been so frustrated that so many people don't even want to have the conversation they only want to have the conversation about the relationship between american capitalism and human exploitation because that's what this is christina what you face every day is exploitation the system has put you between a rock and a hard place what can you do well you can wear a mask all the time you can wash your hands frequently and you can maintain as much distance between yourself and others as you can if possible open some windows some studies show that even 10 minutes of every hour opening windows indoors helps to vent aerosol particles out and reduce transmission rates but ultimately the situation you're faced with is not fair then there's little advice anyone can offer you beyond what i just said wear a mask advocate from everyone to wear masks as policy in your workplace improve ventilation sanitize surfaces wash your hands a lot and create physical distancing between yourself and other people and those of us who are stuck at home we need to spend our energy advocating for those people who are stuck out there working every day it is us who have the time to harass elected leaders ceaselessly about how our country is handling these things and especially my friends those of you with republican representatives republican senators and republican members of the house call them raise hell because our states and our cities are constrained they can't do deficit spending and they can't print currency only the federal government has the ability to shape the economy so fundamentally and we need to let them know that we are not going to accept the working conditions that have been placed on those that still have to work we are not going to accept such widespread economic insecurity republican or democrat alike they all need to know that republicans just have a unique capacity right now to put pressure on the administration right so with the the occupants of the white house have made it very clear they will ignore everything coming from democratic senators and even from the democratic majority of the house that's why i mention republicans not because democrats have handled the pandemic well they have not but because democrats have almost no ability to put pressure on the administration but republican lawmakers do and republican lawmakers will only do that if they are terrified that they are going to lose an election for their office and so that's what we have to do for those of you who have to work every day thank you and i'm sorry i'm sorry for every way that i haven't done enough to hold up a social contract i'm sorry for every action i've taken in my entire life this contributed to the kind of structural inequality that we are being crushed under right now i'm sorry we've got two questions next uh these two questions kind of are in a theme one comes from lauren who said i've read some articles talking about how indoor ventilation systems both air conditioning and heat circulate the air and therefore the virus farther than six to ten feet and i'm immunocompromised so basically i'm afraid to be any indoors anywhere with anyone besides my husband we're going hiking and swimming in places where we can appropriately social distance but we've basically resigned ourselves to the idea that we may not go anywhere like a live library museum store or mall for a very long time because ventilation systems will circulate any coveted germs of anyone in the room or building all around the space how much truth is there to this concern and how cautious do we really need to be and then sachi had a question that said i have heard that a ventilation system with filtration and uv irradiation can reduce viral particles in the air how effective are these systems for prevention of transmission and how expensive are they to install and maintain could we see a mass implementation of such systems that would prevent transmission of other sicknesses in the future and maybe the eradication of sick building syndrome fantastic questions um sick building syndrome is a sad uh side effect of attempts to make buildings more ecologically efficient so if we put a lot of insulation in walls and we seal off buildings and we just cool them indoors using air handling systems it turns out viruses really like that um and they can you know not just viruses not just bacteria but molds and funguses and all kinds of illness-causing organisms find buildings to be a very fancy form of cave if you've ever learned about spelunking or cave exploration you know that there is an increased risk of infection vectors in those environments because the darkness and the temperature just more conducive to those kinds of microorganisms than the outside you know where the sun is is a pretty pretty effective uh giant uv irradiator and um plus you have a lot more air movement and these are good questions they are very complex so when we think about covid transmission which is not airborne like the measles is airborne or not to the same extent but it's airborne in that it appears to be carried in these little aerosol micro droplets you we believe it takes a certain threshold of viral particles in a window of time to create a statistically meaningful risk of infection so it is true that you've that air handling systems do circulate air and can therefore change transmission patterns you know i saw one analysis of a spreading event where there was a restaurant and this restaurant had an air current caused by an air conditioning system that meant that people in the in the line of tables all got exposed to kevin 19 and several people cases meanwhile an adjacent table to the kind of source table where covert got in the room nobody there got sick and it had to do with the direction of the airflow now in terms of that actually cycling through an air conditioner and then getting blown back out nobody knows that that's the so frustrating thing about covid right now so many good questions we don't have answers so if kova is getting pulled into the intake of an air conditioner and then getting blown out again are the droplets insufficient concentration to still transmit the disease we don't know so far most of what we think we're seeing indoors is a result of air movement across a space basically particles getting blown one direction from someone who's sick on to other people that does not appear to also include being pulled into an air conditioner and back out of another vent so far we're not sure now in terms of filtration and uv irradiation uh yeah we know there's uv filters that have an antimicrobial effect that is significant they are very expensive they are relatively difficult to maintain we don't know if they work on covet yet or not there's just not a lot of testing there there's a relatively new technology to begin with and we don't know i would say that's promising i would say is one uh it's not going to be one thing that solves covet right it's going to be a number of interventions stacking together so if you look at like improved uh filtration in air handling systems and universal masking and frequent surface disinfection and and and and you add all these things up each time you're making the space a little bit safer none of them are a silver bullet uh there's just tremendous variability in terms of what the transmission rates of what we've seen indoors air currents are a big factor especially in cases where they create vortexes or vortices because they help aerosol droplets disperse in the air and in some cases even concentrate them um you know kind of to uh your point lauren i've kind of resigned myself for a long time i'm just not going to be going indoors anywhere by a long time i mean until we reach herd immunity with a vaccine because when we do contact tracing of spreading events we're just not seeing a lot of spread events that are outdoors indoors is very risky um masking should absolutely be happening indoors all the time every person other than like at your home and i've seen some guidance that if you have if you have a very at-risk person at your home and like an essential worker to go back to our previous question there should be masks even in the home homes are risky um not homes are risky indoors spaces are risky we have maybe one case of a super spreader event outdoor like maybe one that one's not even certain and then we have a small number that or indoor outdoor where outdoor transmission could have played a role but it looks like outdoors just a lot safer uh you know we look at the protests the black lives matter protests and we're not seeing still in the in the data uh super spreading events come from those and yet gosh we are seeing it at churches and we're having a conversation about is this religious discrimination and churches are fighting to be able to reopen and it's just the science folks outdoors a lot safer just a lot a lot a lot a lot safer because of the wind and the sun and the volume of air that droplets have to disperse in now don't get me wrong i'm not saying go pack in close to people outdoors i guess i can already hear people's thoughts as they're like oh science mike has said outdoors is safe no outdoors is a whole lot safer than indoors and that means probably more promising the the the manufacturing and expert labor required by the way if we've learned anything in covet 19 it's that there's no such thing as unskilled labor that's just not a thing anyway um so we need we would imagine how many the demand for ac installers if we had to retrofit every ac system in a commercial office building and churches and shopping malls with uv filters right that's a huge lift ventilation i think is the easier answer ventilating outside air in some studies has shown promise as little as 10 minutes of every 60 at reducing transmission rates in doors might mean we're like hot for a while because it's summer but the more you can ventilate outside air the safer indoor spaces become um and then eventually i think you know there's promise for you know efficacy of mechanical and uv filters dealt things with like like sick building syndrome i honestly don't think we can manufacture and install uv filters in in enough buildings as fast as we can formulate and distribute a vaccine i think either way i'm not planning i don't think there's going to be a science mic event where i stand on a stage and sell tickets indoors until late 2021 maybe 2022 maybe even late 2022. um it just won't be i don't i don't see how it could be safe before then we gotta hit herd immunity with a vaccine um and so lauren i'm with you you know i'm also um i have a lot of health health factors i'm not immediate compromise but i do have heart disease and so cover 19 is a real risk for me and so i just you know friends will ask if i want to go do blank and i say no what am i willing to do well if you'd like to come over and sit 10 feet away from me in my backyard outdoors let's do that and then i only do a couple of those a month um yeah that's the situation that we are in and that we have kind of placed ourselves in so great questions there rachelle has a great question and it is for people who live alone and haven't been able to really touch anyone since march is it worth the risk to have one cuddle buddy who you don't live with i'm still able to socialize at a distance but the lack of physical affection is really wearing on me i'm in a relationship with someone and we want to be able to touch each other but they work in a public place where wearing a mask is required and live with two other people i work from home and i've read about covet bubbles or pods and wonder if there's a safe way to engage in physical affection with someone i trust where we can be honest about our level of exposure and strict about the precautions we take sometimes it feels worth the risk knowing that this will probably go on for another year or more i can't imagine not touching someone for that long and i'm also concerned about how a lack of touch can be really bad for my mental and physical well-being at the same time it feels reckless to put each other at risk any advice on the right balance considering the risks of covid and the negative effects of lack of touch rochelle i just have heard so many people share the same kind of curiosity and the same kinds of concerns the listeners of this program are a lot younger than me i'm 42. and as i look at the the demographics on the audience of this program you know there's people who still have the word teen in their name listening in significant numbers and then a lot of people in their early 20s and late 20s listening to this program and there are you know your life circumstances are so different than mine i was married before a lot of you were born and um i've thought about you know for me in a very extreme form of social distancing how much easier that's been for me um as someone who's relatively uncomfortable with a lack of physical conduct and is also married so i get lots of cuddles and snuggles with my wife um and you're right contact with other people is essential for mental health and we are starting to play a balancing game between the risks of the impact of covid potential impacts versus the guaranteed impacts of ongoing isolation which are notable and significant one thing i would say about pods so-called covet pods is they are very risky let's imagine that you create a pod in that pod you have six people right and they represent four households well if they represent four households if those people in those pods live with people who aren't in the pod your pods a lot bigger than you think if those other people are in their own pods your pod is a whole lot bigger than we think we start to look at research covet pods don't really work at all because people don't pay attention to the exposure risk they bring into a pod people i don't think they're being malicious or intentionally deceitful but if you can imagine let's forget six people let's say that you have you and two people that are kind of your coveted physical contact people and you would think it's a nice triangle except if the two people you're in physical contact with aren't in contact with each other and they have their own two people and those people have their own two people right you're two degrees from eight people you know how you know how this works if i keep going and they and they have two people and they have two people and they have two people you just have like a really convenient propagation network for covet 19. um so you do if you're going to do these kinds of arrangements covet pods or micro covet pods you have to be really strict about protocols and your pods need to be closed loops of people they need to be self-contained there needs to be people can't be in multiple pods and so one thing i've advocated is uh have a covered roommate someone you move in with for the pandemic and now you create a new household unit with you and that other person or or two other people or whatever get together in the same physical space uh and become the the the equivalent of my family you know i've got me and jenny and madison and macy and ruby our beloved dog we all live here we've all been staying here and we're the people each other have seen you know since late february and um we have seen other people in a socially distanced mass outdoor context um but in terms of people i make physical contact with uh that's the list that's jenny madison macy uh and me and um that's a closed loop the four of us now that's a wife and a husband and two children but you can create the same arrangement with people that you you know aren't your your blood relatives you can choose a family um and then just like a hug is a great thing touch is a nice thing that's i think easier to do if you are sharing a physical premises because otherwise you're just it's a trust thing and um as people get more and more and more and more feeling confined and boxed in by the pandemic uh they just tend to engage in riskier behaviors they're not even always aware of it uh that's human psychology we're we're a tough species that way uh so i would say yes it you know as long as your your your cuddle buddy and you make a closed loop or cuddle buddies that's a lot safer than simply saying well i'm only with three other people at a time at you know that's that's not a very effective mitigation strategy all right forgive me for some reason if i don't scroll for a while my chrome just tends to completely freeze so i apologize for the long delay there this episode won't be edited by greg this will be a live drop after i'm done recording so if you're like what's with the long pauses that's the production difference this week last question comes from joyce joyce says i heard bill gates on cnn talk about the days during which a person with coven 19 is actually shedding the virus slash infectious he said and i don't recall exactly roughly a couple days prior to being infected with or without symptoms and only a few days after so an infected person is not infectious if they have the illness for days slash weeks slash months can you explain in detail what science says is the period of time a person is actually shedding spreading the virus also mr gates was speaking of this to reiterate how useless most tests are particularly if they don't provide same-day results can you speak more to testing as well is it all a false sense of security at this point joyce terrible news we covered 19 there's still so much we don't know one of the things that's tough about covet 19 uh well no not cova-19 one of things that's tough about sars cov2 that's the virus that causes covid19 is it causes basically multiple diseases what we think of as covid 19 right is really the respiratory infection associated with sars c of e2 that's not the only thing sar cfe2 does we have seen cardiac infections from sar cof2 we have seen gastrointestinal infections from sar civ2 now don't get me wrong those are still covet 19. but depending on what systems in your body gets coveted 19 it does affect the ways in which you can shed virus so for example it looks like when people get gastrocovid they do have viral particles in their fecal matter in their stool if that's the case then what we call smear transmission where you have an infected surface is a bigger concern we thought so when we look at covet 19 respiratory we've been saying that smear transmission is not a big deal and it looks like for respiratory infections it's not but people who are getting it in their stomach and in their intestines they are probably having smear contact to get that infection again i don't know for sure researchers don't know for sure but that's an assumption that uh it looks possible perhaps even likely so um and then we know that you can kind of long-haul or long-hauler scenarios some of which are caused by viral particles and some of which after there's no more viral particles appear to be caused by an immune system response to the virus and then you have something like misc that is happening after the virus is already gone who's contagious and who's not we don't know so when you hear bill gates talking about shedding virus what they're talking about is in like the most common presentations of respiratory covid and that's how we make public policy decisions and there there we have some more specifics that's kind of the timelines you're talking about from you know roughly a day or two following exposure you can begin shedding virus and then that can continue you know until day 10 day 12 somewhere in there typically but people can shed virus longer than that and in some cases they can shed virus earlier than that um so that's the problem uh testing helps us cut down now but again if it's all about controlling the rate of infection the more we control the rate of infection the more we have hospital resources because we are making progress in therapeutics we're learning ways to treat covet that are impacting their people who die and impacting how severe severe case presentations are if we can keep fewer people sick at once we can treat people better and the virus is less of a threat to people and therefore less of a threat to society so testing in that case is great the problem with testing right now is we don't have enough testing capacity it takes too long to get test results back there is promising things like the new saliva direct protocol there's a possibility in the near future a testing situation is going to get a lot better but right now some people are waiting 48 hours 72 hours to get test results and yeah that is ridiculous unless you're unless people are quarantining from the time they test to when they get their results a test like that isn't significant and 72 hours later if you haven't quarantined then you may have picked up the virus in the meantime at which point your negative test result is not very helpful um friends increasing our testing capacity is one of the most pressing issues we have if we want to start getting anywhere remotely back to normal if we want to start opening anything especially schools we need to be able to test people frequently something like saliva direct if it ends up working and it's very promising so far if we could test most people twice a week and get rapid turnaround on those tests now we're talking now we have a possibility of kids going back to school and um we have a possibility of of of reinstating the truly truly essential parts of our society and our culture i don't know if stuff like saliva direct makes indoor dining or bars possible again it depends on how low we get our case rate but i can imagine a scenario in which we come to our senses we get good testing through saliva direct in place and as a protocol and then we do one last national four day or excuse me four week lockdown a full lockdown way more locked down than we did in our first so-called lockdown and we actually got our case right low if you did that and then have testing and then quarantine people who have positive uh tests and then do contact tracing quarantine those people as well you'd be surprised how close to normal we could get and then every time you can have a little a little cluster explosion in a given population against city then you do a two-week lockdown again and i know here's what i'm hoping people are hearing that what lockdowns over and over how much better would it be to do a a strong lockdown to get the the case load back under control open things back up and if we're open for six weeks eight weeks 12 weeks 16 weeks you know and then we close down for 14 days again and then we're able to open back up because we have testing and contact tracing i don't know about you that feels a lot better to me than where you know then we have this kind of weird stratification of people are going to work at risk forever and people are going to stay at their homes until there's a vaccine which again could be 12 months could be 20 months until we have that vaccine through testing and distributed to enough people to be meaningful um so right now uh we do our testing's not great we have a lot of false positives a lot negative false negatives more than we want something like saliva direct would give us that turnaround that we need as we learn more about when the virus is infectious and when people are shedding based on the different types of covet presentation great great question joyce i hope you all enjoyed this uh very long episode of questions and response about covid19 i'd like to thank tanner hearn and victory palmisano and andrew golicky and greg nordine and caitlin hermstad and brett cradle and my patrons on patreon and and jeb botiford and all the folks that make ask science mike possible thanks for listening everybody and i will talk to you again next week take care