Factually! with Adam Conover - How to (Actually) Protect Yourself from COVID-19 with Immunologist Erin Bromage

Episode Date: June 17, 2020

States, stores, and workplaces are reopening. But how can we tell which spaces and activities are safe, and which aren’t? UMass Dartmouth immunologist Erin Bromage joins Adam to reveal what situations to avoid, how to protect yourself, and which risky-seeming form of transportation is actually surprisingly safe. Learn more about your ad choices. Visit megaphone.fm/adchoices See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

You know, I got to confess, I have always been a sucker for Japanese treats. I love going down a little Tokyo, heading to a convenience store, and grabbing all those brightly colored, fun-packaged boxes off of the shelf. But you know what? I don't get the chance to go down there as often as I would like to. And that is why I am so thrilled that Bokksu, a Japanese snack subscription box, chose to sponsor this episode. What's gotten me so excited about Bokksu is that these aren't just your run-of-the-mill grocery store finds. Each box comes packed with 20 unique snacks that you can only find in Japan itself.

Plus, they throw in a handy guide filled with info about each snack and about Japanese culture. And let me tell you something, you are going to need that guide because this box comes with a lot of snacks. I just got this one today, direct from Bokksu, and look at all of these things. We got some sort of seaweed snack here. We've got a buttercream cookie. We've got a dolce. I don't, I'm going to have to read the guide to figure out what this one is. It looks like some sort of sponge cake. Oh my gosh. This one is, I think it's some kind of maybe fried banana chip. Let's try it out and see. Is that what it is? Nope, it's not banana. Maybe it's a cassava potato chip. I should have read the guide. Ah, here they are. Iburigako smoky chips. Potato

chips made with rice flour, providing a lighter texture and satisfying crunch. Oh my gosh, this is so much fun. You got to get one of these for themselves and get this for the month of March. Bokksu has a limited edition cherry blossom box and 12 month subscribers get a free kimono style robe and get this while you're wearing your new duds, learning fascinating things about your tasty snacks. You can also rest assured that you have helped to support small family run businesses in Japan because Bokksu works with 200 plus small makers to get their snacks delivered straight to your door.

So if all of that sounds good, if you want a big box of delicious snacks like this for yourself, use the code factually for $15 off your first order at Bokksu.com. That's code factually for $15 off your first order on Bokksu.com. I don't know the way I don't know what to think I don't know what to say Yeah, but that's alright Yeah, that's okay I don't know anything Hello, welcome to Factually, I'm Adam Conover

And look, COVID-19, if you haven't noticed, is very much not over. But that hasn't stopped every single state in the country from beginning the process of opening back up. And because, once again, we simply do not have a unified national strategy for reopening, wish we did, but it does not exist, well, states are free to choose their own pandemic adventure, and most of them seem to be choosing the bad ending. With 21 states now showing rising caseloads over the weekend, it's difficult to feel confident in any state's response, and it's even harder for us to understand what makes one plan work and another plan not work.

Like, is there something about the roller rinks and pool halls of West Virginia that make them safer than the ones in Wisconsin? If there is, I don't know what it is. So in the absence of clear national guidance, how do we the people, as average Americans, tell what environments are safe and what aren't? Like, let's talk about my industry, comedy. I am desperate to do stand-up comedy again. My dog and my girlfriend are sick of listening to my observations. I need an audience. Well, hey, maybe good news. Some comedy clubs are opening back up. But wait, are they opening up safely enough to stop there being a spike in cases at their shows? Like, I'm not sure which of my jokes are worth risking the lives of

a room full of people. Maybe the one about how New York and L.A. are different? No, probably not. So how do I tell whether or not it's safe to do comedy in these clubs? I mean, some of them are putting rules in place like keeping people six feet apart and regularly disinfecting the cutlery or whatever. But a lot of clubs are also making the employees wear masks, but letting the patrons go mask free. That sounds bad. And no matter what they do, they're still gathering a lot of people together in a small, unventilated space where they're all going to be laughing, you know, particles into the air. Sounds like it could be a recipe for a super spreader event to me.

And, you know, I don't want the headline out of my first weekend in Boise being 50 people sickened with COVID at an Adam Conover show. So how do I decide whether or not it's safe to do those shows? And how do I decide what's safe to do in my everyday life? Like we know that certain kinds of events

have the potential to spread COVID-19 at a rapid pace. For instance, earlier this year, a choir practice in Washington state led 52 out of 61 attendees to become ill. And they weren't, they were keeping their distance. They weren't touching each other. They were just singing in a room together and almost all of them got COVID and some died. And it's not just choirs and comedy clubs. A South Korean study found that 112 people were infected with the virus within 24 days after participating

in, quote, dance classes set to Latin rhythms at 12 indoor locations. Zumba should not be a death sentence. But here we are. So with this various range of restrictions going up in different places, the differing risk factors in all these different activities, the uneven guidance from our state, factors in all these different activities, the uneven guidance from our state, local, and national governments. How are we the people supposed to tell what environments are safe and what are not? What practices are safe? How best can we protect ourselves and our communities? We all desperately need to know the answers to these questions, and clear answers have been terribly hard to come by. Well, I am here to tell you today that there are ways we can mitigate our risk. And to talk about them,

we have the perfect guest to come on the show. Aaron Brummage is an immunologist and a professor of biology at the University of Massachusetts in Dartmouth. His writings on this topic have gone viral. Unfortunate turn of phrase, but here we are. They have gone viral because they do such a great job of summarizing the most up-to-date research on how the pandemic spreads and explaining how we might keep safe from it.

Without further ado, please welcome Aaron Brummage. Aaron, thank you so much for being here. Thank you for having me here, Adam. I've really been looking forward to this interview because I read some of your pieces that you've written over the last month on what the real risk factors are with COVID-19 spread, about how some of what we worry about is maybe less of a risk factor and some of the risk factors that we don to consider when they're evaluating, is this situation that I'm going into safe or is this a place where I could easily get COVID-19? Yeah. So we know that the most risky situation is a room full of people that are all talking. Those things put together when you've got an enclosed space, lots of people, each of them talking, trying to talk over the top of each other, puts plenty of respiratory droplets that could contain the virus into the air. You breathe that in and it doesn't take longer than 10,

20 minutes and you can be infected in that environment. And you talked about in the piece of yours that I read first, this famous case in Washington with the choir practice, where these were folks, a few dozen folks who were social distancing and nobody was shaking hands and they were following all of the advice they had been given at that time about not touching surfaces. But they had like a two-hour choir practice, and most of them came down with COVID. And it was for that reason? It's because just the air part, like the particles moving through the air? Yeah, so they were in a hall attached to a church. They were renting out a space. So you can

imagine those community halls that they usually have. There was about 60 of them there. It's an enclosed space. You know, it was still fairly cold. So there's no open windows, but they were aware that the virus was around. We didn't quite have the same level of care about how concerned we were with the virus at that stage. But they were in that space. They were singing for many, many hours. They didn't shake hands. They brought their own music.

And yet, after just that two hours of singing, nearly 50 of them became infected. Out of the 60? Out of the 60. So it took a bit of time and there could have been some transmission from the infected person to another one of the choir singers. There's only one person who was infected in that group? They believe it was only one. That one affected, say, a husband of a husband-wife group. And then that husband and wife went home and then he infected her a few

days later. It took a number of weeks to work all the way through, but 50 people ended up being infected out of that one encounter and that one person. And so what's so striking about that example to me is that I think a lot of people are still operating under those same, you know, mental guidelines that like, hey, keep six feet apart. Don't touch things. Maybe wear a mask and you should be good. And a lot of places are reopening under those conditions. Hey, we're going to wipe stuff down. We're going to keep people far apart, but we're still going to gather people together in rooms for various purposes.

And that's having read your work. That concerns me. Do you have that concern? It does. And so, you know, when we typically talk about, you know, transmitting a virus, being infectious and infecting other people, typically someone thinks, oh, I had it and I give it to you, not I have it and I give it to a room. But when we start talking about a virus that is in respiratory droplets that can be dispersed, aerosolized in the air and hang around in the air, it's not just the person that you're talking to or shaking the hands of. It can be everybody inside that space. So we really need to be looking at these indoor environments and

working out how much new air do we have coming in, how much filtration is happening. Because once it does start getting released into that room, it can take a lot of people down. I mean, the biggest example of this is the South Korean church. The church is huge, like tens of thousands of members. But from a single person coming to church, starting to infect other church members, it ended up going from her to the next group to the next group out, and it ended up infecting 4,800 people. Wow. From one initial person? One initial index case just radiated out as those people had interactions and more interactions. So how can these places actually protect themselves? Actually, I want to give you a specific example that I've been waiting until this interview to talk to you about, because I really need to know.

I'm a comedian. I do stand up comedy. Comedy clubs obviously all closed down. Some are starting to open now and some are doing it in a risky way. Some are trying to be more careful. Right. But I'm looking at your work. I'm looking at listen to what you're telling me. And I'm thinking, my God, a comedy club is the perfect place to spread this. Because, I mean, you said talking is bad. Singing is bad. Laughing. If people are laughing three times a minute, belly laughs and those particles are going through the air. And let me tell you, comedy clubs are not well ventilated. Generally, they're they're in basements and things like that. And so I'm looking at these clubs and they're saying, hey, you can come to a show. We're keeping people six feet apart. We're only filling a third of the seats. The waiters and waitresses are wearing masks and we're going to

wipe down all the tables and chairs and, you know, not reuse glasses or, you know, that sort of thing. And I'm looking at that thinking, this sounds like a recipe for a super spreader event. And I don't know how to evaluate how good a job this place is going to do of preventing that as a performer who's concerned about my audience all getting sick. So what could a business like that? Now, look, stand up comedy is going to be killed by this pandemic. This is like and it's already a tenuous industry that barely makes any money in a good year. So I'm very you know, I want these places to be able to open. But how how can we evaluate whether or not they're opening well and what can those clubs

be doing as an example in order to make sure that they're not causing spreading? Yeah. So it's certainly not a one size fits all approach. But one of the simplest ones you can do is you can sit there and say, how well is my state testing and how many positive tests per negative test are run. So if we are testing in LA or we're testing in Massachusetts and we run a hundred tests and we hit five of those being positive, that's giving you a rough idea that 5% of the population are infectious right now. So if you had a a comedy club with 100 people in it, the bets are five of them are infected. So, when you start thinking about, okay, can I drop that down to 50 people rather than 100? Now, we've only got two and a half.

And so, you've got to think about, yeah, you've got to think about those numbers. So, reducing the number of people down helps in the sense that if we get to 1% and you've got 100 people together, the chances are there'll be zero, no one infected, maybe one, and maybe two, like there's sort of that curve of probabilities. So now you're at a fairly low level. Get below 1%, you can gather 100 people together much more safely. So it depends on where you live and where that event is actually happening with the risk. They're things you can't change because you can't change what's

happening in the community. So people that own clubs, though, should be looking at those type of numbers to realize how many people should I have in this environment before it is safe. If you start dropping numbers down, it does make it safer because there's less chance that someone will be infected in there. And if there is, there's fewer people that will be infected from it. So it's a balance. from it. So it's a balance. We know that masks, the evidence coming out now is really showing that masks work. Tell me about that. Yeah. So there was a lot of uncertainty at the start

about masks and whether they would actually stop this particular virus. actually stop this particular virus. The work with influenza, for example, it was some said yes, some said no, but we didn't have the data on this particular virus. But over the last few weeks, we're really seeing that those respiratory droplets, what's coming out of your mouth when you're talking and speaking and laughing, they contain a lot of infectious viral material. And if we can catch them at the source, which is out of your mouth and out of your nose, they don't go into the air. And if they don't go into the air, they're not there to infect the other people around you. And why that's important in an enclosed space is if someone is breathing that material into that space, it builds up. Think of being in an enclosed space is if someone is breathing that material into that space, it builds up.

Think of being in an enclosed room with someone smoking a cigarette. One puff, okay, two, three, it fills up the room more and more. That's what happens with this virus. So if you can put a filter on it, which is that mask, and capture 50, 60, 70% of it coming out, you lower the amount of virus in the air, which makes it safer for everybody else. We should make people with a virus go breathe outside, outside of the bar. Yeah. Well, if we could just identify them all, right, that would really help. And talk to me a little bit about one of the things you you've written about is how let's, let's expand on that idea. It's like dose over time and quantity of dose over time. So like if you breeze by someone who's infected outdoors and you share a breath or two of air, then maybe you're, you're not getting that many particles. But if you're sharing an enclosed space with that person for two hours, that's the real risk factor. Is that right? That's the real risk factor. So what we have, and we know this, we can't do these types of studies with people because it's just not ethical. But we know this from doing animal studies where we're looking at infectious disease,

that you can give them a lot in a single dose and they become sick. Or you can give a lower dose but over a longer period of time and they become sick. So the dose and the time become really important. So when we think about this from a people standpoint, you can get a really high dose from a face-to-face conversation, three feet away, where that person's talking to you and maybe it's a little bit of spit that comes across lands on your eye you breathe it in through your nose or in through your mouth it can be over and done with then that can be enough

because in that one droplet was enough infectious material to establish infection but that's the most risky but it's not the one that's going to lead to a big spreading event that gets a lot of people because it's the person in front of you. What is a little bit harder to get your head around is that when you are talking and breathing, there's other droplets that go up into the air and they just start to build up in the air. And maybe you've got to get to this number of a thousand particles to get sick. That first spit droplet gave you a thousand, you're now infected. But you can also get it by breathing in a hundred particles over 10 breaths. Right. Or 10 particles over a hundred breaths or one particle over a thousand breaths. So the longer you spend in that environment,

the higher your risk is of infection. It's exposure to the virus over time. And it's how much of a dose you get at that one space. So let's go. So let's go back to our comedy club. That's like, if you have one person in the corner, they came by themselves.

They're at a table all alone. They're six feet away. But they're laughing, you know, a couple times a minute. And the place is poorly ventilated. Their particles are slowly building up in the air until it gets to sort of a critical mass where now everyone else is actually breathing a large dose because they spent two hours in this space, hypothetically. Right. It's a balance. So let's think that what I expel now will hit the ground in roughly 10 minutes. So it doesn't stay in the air indefinitely. There are some viruses that do do that, that will be airborne for a long period of time. Doesn't seem like this one does. We're not a hundred percent sure, but it doesn't seem like it does. It's really what I breathe out over a 10 or 15 minute period that comes to a sort of balance over that time. Now, if you're on the

other side of the room, certainly your dose is going to be a little bit lower than the person that's closer. But you are being affected by that person on the other side of the room. I see. Well, let's talk about some situations that are a little bit less dangerous than many people might think. You've written a piece on how, on flights that you've taken over the last few months. And you've explained why flying is not, I mean, I would have thought it would be the same as the comedy club example I'm talking about, where you're in this little box

and you're breathing recirculated air and you're with all these other people, but that's not your view. No, so it seems like it's the perfect mix for it. Lots of people jammed in together in a space that's super enclosed. And yes, that is a real risk. But what they've had to do in planes, as they've got to understand infectious disease as well, is they've had to improve the quality of air inside the plane. And so this came

out of the 70s. In the 1970s, there was a couple of outbreaks on planes of influenza, and they realized we need better air exchange. And so most modern new planes, especially the big ones, they will change the entire air volume of the plane every three to four minutes. Wow, all the air? All the air, every three to four minutes. Wow. All the air. All the air every three to four minutes. And then on top of that, they have this really high efficiency filtering system called a HEPA filter. And they turn over the entire cabin volume 25 to 30 times an hour. So there's this massive turnover of air inside there. So what happens five rows behind you is not really going to affect you. Your main concern on that plane are the people immediately around you. Person sitting on the

seat on your left, the person sitting in the seat on your right, turning to have a conversation with them. Yeah. The guy with his head on your shoulder, falling asleep, breathing in your face. So I look at it as the sneeze zone. So someone that sneezes or coughs that bubble that's around you, that's the high risk area. And that's why on planes masks are needed is that if someone does sneeze, someone does cough, someone does talk to you right next to you, there's nothing that's going to spray on you. And that's what you need to protect yourself on a plane. So plane travel seems a little, ah, but it's the air environment is actually quite, quite good. And you wrote about what you, your actual routine when you have flown during the pandemic that sort of made you feel that you were being safe? Would you

share that with us? Because I'm sure everyone would like to know how an immunologist protects himself when he's flying. Yeah. So we were debating on going on this trip and it was a long trip because it was from Boston to Sydney, Australia. So it was 20, 24 hours on planes. And it was as everything was starting to really heat up in the United States. So we were like, should we do this? Should we not? But I also knew that it was probably the last time I'm going to get to see my family for quite a while. So we put in place a system for my family, it was four of us to actually travel from essentially leaving home to coming back home, you know, a few weeks later. And it was everything from making sure that at

the airport, for example, only one person came in contact with all the contact points. So like when you're checking in, it was always me that went up to the counter and my family stood away. when you're checking in, it was always me that went up to the counter and my family stood away. When we were ordering food, it was only me. Because if they all had contact and that person was infected, all four of us could have got infected in one go. So we sort of reduced those interactions down as much as we could inside the airport. Do you draw straws to see who would be the person to do it? No, it was, I don't know why it ended up being with me. Cause you know, my wife is just as good as I am with this. Um, you know, I've got a 10 and 13 year old, so it was really stick your hands in your pockets.

Don't touch anything. Um, so we made sure that we only had those single contacts. Um, we let everyone board the plane before we got on because I didn't want to be choked into a lot of people going in through a boarding area. We checked ahead of time to make sure we had space on the plane. So we paid a little bit of extra to get a few extra seats clear around us. So we did a little bit of checking ahead of time, but then on the plane itself, we brought wipes, so Lysol wipes. We put them in a Ziploc bag. As soon as we got on the plane, we wiped down every contact surface that was near us.

Basically, top to bottom of the screen, of the armrests, of everything. Even though I think they're doing a fairly good job, it just lets you drop your anxiety down on the yeah um we had a hand sanitizer with us um we tried not to touch things as much as we could on the flight but when you're on a 16 hour flight you get up you move around so it was just a matter of um you know washing hands regularly with the sanitizer when you go to the bathroom, realize that you need to wash your hands really well coming out of that. And just not being on guard, but just managing your environment as much as you possibly can. Now, because we were actually visiting people that were in the high risk category, and we had been on planes for 24 hours. When we actually arrived

at our destination before we visited anybody, we showered from head to toe, put our laundry in a bag. We just treated everything like it was contaminated. And then once we had done that, we just said, hi. So we repeated that on the way home. And that was a few months ago though, correct? That was the end of March. So do you feel now things having gone as far as they have in the month since, would you take that kind of trip now? How do you think people should think about plane travel if they have to, you know, they have a trip coming up when they're weighing those risks? So you've got to look at where you're flying from, where you're

going to and what your own risks are. So if you're young, you've got no comorbidities and you need to travel for work, you can do that fairly safely. Knowing that if you do get infected, the high probability is you're going to be fine at the end of this. If I was older, if I was in my 60s or my 70s, and I had high blood pressure or a heart problem, and I was looking at flying to Florida to go and spend some time down there, hell no. I'm not doing that. I don't think that that's wise because it's not something you had to do and you're already at risk. You don't have as much of an opportunity to fight this off as a younger person does. If I was flying out of New York City four weeks ago, I would be really worried about that because when we were at the height of this,

ago, I would be really worried about that because when we were at the height of this, 5, 6, 7% of the people were infected in New York City, meaning that a flight of 100 had 5, 6 or 7. The chances are one of them is sitting next to you. Whereas if I was flying out of Alaska with their 30 cases, it's different. So you've got to look at your own risks. You've got to look at the city you're in, where you're going, and do you really need to do that travel? So I know for work, I'm looking at having to head to LA in a couple of weeks time. But I also know that my risk factors are low. My family's risk factors are low and I can manage all of those interactions because I'm not meeting up with a lot of people when I get there. So the chances of me getting it or bringing it back are low. So it's just taking those extra precautions. I think airlines really

need to step up and do their piece on this is if they're saying masks need to be worn, they need to work out a way to make sure that everyone that's on that flight is wearing the mask all the time, unless they're eating or unless they're drinking. They can't just go, oh, we've said this is our job, but we're not going to enforce it, which I've seen some shakiness on flights with that, where they, people get off, peel the mask off and the cabin staff don't want to have those altercations on a flight. Yeah. I think that becomes important that they do do their job with this.

Yeah. I mean, I feel for flight attendants who already have to deal with so much during a flight to also think about even having to clean out, having to desanitize a plane in between flights is, I mean, it's hard enough for them to clean it normally. There's just too much for those folks to do. So I understand why. When you think about them and their own risk as well being on that flight, they're having interactions with 50 or 100 people when they're serving food, giving them drinks. I really look at the risk to the cabin staff as well. Um, I really look at the risk to the cabin staff as well. Um, and so two, three, four, five people on a flight that choose not to wear masks. It's not just about the people that are around them. It's also that cabin crew that are in that environment for four, five flights a day.

Um, it puts them in a pretty awkward situation that they have to be the enforcer for their own health. Yeah. But I mean, these these companies really need to be taking it seriously. I mean, when I think about just, again, myself as a comic hosting a show, I'm like, the thing I can't have is like a news story to come out to say, hey, Adam Conover had a show and 60 people got COVID-19. to say, hey, Adam Conover had a show and 60 people got COVID-19, right? Or there was an American Airlines flight where, you know, four fifths of the people on the flight died of COVID. I mean, the numbers from that, again, that choir practice or some of the other examples you've been giving us are huge. And like, you know, if you're gathering people together, you've got the responsibility to make sure that you're not creating a super spreader event. That's my view anyway. Yeah, it is. It's absolutely. And I mean, it's something that I keep saying in all of my

posts is you have to solve the biology in order to fix the economy. We've already seen in, I think it was Houston this week, five restaurants that opened all had to close because they ended up with infections in their staff at their workplace. They didn't address the biology and guess what? Now they're not earning any money. The restaurants closed down for at least two weeks while they get the place sanitized, they get their staff healthy. You have to address the biology in order to fix the economy. So when we are thinking about this, if a business takes a sort of a laissez faire approach where they don't really think it's serious, but it gets in and infects three

or four of their employees, those people are out for a month. You've lost the faith of the community to think it's a safe place to eat or listen to comedy. Um, you've really got to think about this from the point of view of the biology, address that, and then you can create a safe workplace, a safe environment that people, you don't recover from something like this if there is an outbreak at work and you are taking it half cared. situations that there's a lot of confusion about how dangerous they are. The massive protests against police violence that we've seen in the last two weeks. There's been a lot of talk about whether or not those are going to cause the spread of covid. Certainly, I think when the police are, you know, here in L.A., zip tying protesters together and stuffing them in a van for six hours, I think that's a likely place you'd get COVID.

But, you know, seeing, okay, outside, less of a risk factor because, you know, there's a maximum ventilation outside, but you've got 40,000 people gathering as they did in Los Angeles and Hollywood last Sunday. How do you view that? Yeah, so if I took the same number of people and put them indoors that were outdoors in the same spacing, same distance, so it'd have to be a pretty massive indoor space. But if I did that, we know that the transmission success of the virus is about 18 to 20 times greater indoors. Wow. So taking those same people and putting them outside reduced it by a factor

of about 20 fold in regards to the transmission. Okay. There will be, there's no doubt that the protests will result in more infections. Okay. What I doubt we will see though, is the super spreading events because it's not building up in the environment. And these weren't roaming mobs of people. You sort of, as people were marching, the people around them were fairly static. You moved with a group that you were marching along with. So where the risk really comes is those people that were immediately around you in that environment. So that means that, you know, one person that's infected may infected one or two people that were around them rather than 60 or 70 if it was an indoor space. So we're definitely going to see an increase in transmissions, but it may not actually show up in the data straight away. Because let's say like rough numbers and say we had 600,000 people

that were protesting based on the national numbers, maybe about 3,000 of those would be infected. And we're looking at around about 20,000 new infections a day. So if those 3,000 infected one each, we've got another 3,000, which 20 to 23, you don't really see a difference. It's just that up and down blip that we see in the day's numbers. Where we may see the protest have an effect is 3,000 people infected, 3,000 new people who then went home to their households and infected two or three people in their homes. Now that goes from 3,000 to 12 or 15,000.

And now you see that in your numbers. So we won't see this for at least two weeks. If it's going to have a big effect, it may be in that two weeks to four week mark after the protests were on. But it definitely was a risk and there certainly will be more transmission because of this.

It strikes me as hard to measure though, because this is the same week that like Los Angeles County, for instance, is reopening. So how are you gonna quantify it when we're having this massive change in human behavior at the same time? Right. And that's it. The amount of noise in the data is just, it's insane. And so that's where you can't look at little blips and little humps. Yeah. You've got to look at trends. You know, are we, you know, we've seen that we're on this downward trend for a while, but now the last two weeks we seem to be plateauing. We're sitting at about 20,000 cases per day. We're sitting at around about 800 to 1,000 deaths per day. As places are reopening, if we start seeing

that come up, it's going to be hard to say that this is a protest hump, same way as it's hard to say that we have a Memorial Day bump. It makes sense right now. We've got this Memorial Day reopening bump that we're seeing, but it could just be noise. I don't want to read too much into it. With the protests, considering how many people were involved, if in three or four weeks we start seeing this trend really coming up, it's going to be a mixture of both the protests and um you know entering phase one two and some places phase three contributing to this so it's all going to be mixed up okay well i have so many more questions for you but we have to take a quick quick break we'll be right back with more Aaron Bromwich.

OK, we're back, Aaron. So we've been talking about these super spreader events and, you know, you were saying, hey, protests are maybe not a super spreader event. A large number of people in an enclosed space could be. Is that the real risk for, you know, our COVID-19 infections really skyrocketing? Like the person to person is not as worrying as having these places where one person is able to infect 100. Like if things really go bad, is it going to be for that reason? to infect a hundred? Like if things really go bad, is it going to be for that reason? Certainly limiting these large gatherings of people will have a big effect on the trajectory of what the rebound looks like, the second wave, whatever we want to call it looks like. If we can limit the sizes of gatherings, that limits how many people can be infected. But let's not take away too much that a dinner party may be all that it takes to get things going. You put 10 people into a room, sitting down having a dinner, eight of those go away back to their own families and friends and they infect more.

It doesn't have to be 100 at one time. It can all start from that one case. It doesn't have to be 100 at one time. It can all start from that one case. You know, we see this quite regularly, like the gym, the gymnasium outbreaks that happened about four or six weeks ago. One instructor infected that was training 30 other instructors on a new form of new workouts. I think it was eight or 12 of those instructors became infected, went back to their respective gyms and in total infected 108 people. So it,

it starts, these transmission chains are the things that really get it going. The vast majority of people that are infected will only infect one, maybe two others. But then you have these, some people, they're called super shedders. They release an enormous amount of virus. And if you put one of those people into an environment where there's a lot of people, they can take them all down. The nightclub case in South Korea is the great example of that. The one asymptomatic gentleman that went out to a few bars, it was over 100 people that he infected or indirectly infected over a period of a few weeks from that one night out.

Wow. Okay, well, let's just speaking of asymptomatic carriers, let's set this straight because there's been some conflicting information about this. Asymptomatic carriers, do they or do they not spread the disease? Yeah. So asymptomatic, I'm going to call them never symptomatic. And that makes it pretty clear. You got infected, but you never get a cough. You never get a fever. You never get any of the signs of it. So if you are never symptomatic, it. So if you are never symptomatic, your role in this bigger amplification is probably pretty small. You may infect one other person, but typically we think of them as having a lower viral load and not infecting many others. So these are people who get it, but unless they're tested,

they would never even know. They never exhibit a symptom. They just go about their lives. And there might be a lot of people walking around two years from now saying, I never got it. But in reality, they did and they just didn't know. Yeah, so we've got a number. It's around about 15% of people that get exposed. That's the best number we've got at the moment.

15 people that get exposed to the virus will never show symptoms. Wow. They may become immune. And their role in the bigger picture of the outbreak is probably quite small. But what is important is you've got these never symptomatic people, asymptomatic, never there. The pre-symptomatic people are the ones that we really need to worry about. So with this virus, you get infected. You can't infect anybody for a day,

a few days while the virus builds up in you. And then the virus starts to be released from your cells and it now can be released out. Five days out from being sick, you've got a little bit of virus. Four days out, you've got more. three days out more. And in those two days before you get that first cough or first fever, you have enormous amounts of virus in your nose, in the back of your throat, in your lungs, but you feel fine. You feel fine. You look fine. You've got no indication that you are sick. Those people, the guess is those people are responsible for about 50% of all new infections. Within those few days up to before showing symptoms, they can cause up to 50% of new infections. That's why masks are important because you just don't know if you're on the way

up to getting there. The other half of infections are from people that, oh, I've just got a cough, or I feel sick, or they really are sick and they're out transmitting it. If you do have any symptoms, you've got to stay home. You've got to isolate yourself away because you have a big role in transmitting this. But there's that key moment at which you could be pre-symptomatic and not realize that you got it uh and not be self-quarantining because hey my risk factors are low etc etc um but spreading it uh even you know

without realizing it and that that seems to be the real risk that we should should we all just sort of treat ourselves as being potentially in that state at all times, just in order to stop ourselves from maybe spreading the disease? Yeah. So that's why we have physical distancing. It's just because you don't know who is infected. If you can provide that six feet distance between you and another person, those little droplets coming out of your mouth, hit their feet. They don't land in their face. At three feet, they land on their face. So that leads to that direct transmission.

That's why we're limiting the number of people inside spaces because we know inside spaces, these droplets, these viral particles can build up and you get infected. That's why we have masks. So we are essentially having to treat everybody as potentially pre-symptomatic to try to get this under control. And if we look at the data that the states that are doing that, mask use, social distancing, limiting people inside, are all declining. The states where masks are optional and you may only get 20 or 30% of people doing it, where we're opening restaurants and opening bars up, we are seeing either flatlining or starting to increase up in those particular states. So we can see a big difference between states that are

adhering to the mask use and social distancing and those that are not. And I think we're going to see that even amplify more over the coming weeks. Wow. So wearing masks, then it almost sounds like vaccination, where if you have a certain amount of the population wearing masks, that's going to help prevent the spread a lot. But if it dips below a certain a certain level, then you're going to see more spread. Yeah. So let's not use the vaccination one because that one's a permanent effect. I'm an idiot. Please don't. Yeah, yeah.

No, like the vaccination one would be great if we get there. But if we can get roughly 80% of people using masks, it can drop the transmission by about 40 to 50% in the community. That's an enormous drop, enough to almost lead it to extinction. But if you've only got 30 or 40% of people using it, using masks, it has virtually no effect at all. Wow. So it's, you know, if I'm wearing a respirator

and I'm the only one wearing a respirator, yes, I'm protecting myself, but it's doing no community benefit. If 20 or 30% are doing like wearing masks, it doesn't provide that same community benefit as what strict social adherence to it is. Yeah. But this does get to the point I was trying to make, which is, when you're getting your flu shot, you know, herd immunity. If we all you protect the other people in your community by doing that. And masks are the same way. We're all contributing to the overall norm of mask wearing that's going to protect everybody in the community every time you put that mask on.

Absolutely. Yeah. It's a social conscience, a social contract. You do your part. I protect you. You protect me. And by taking that sort of community mentality, it doesn't solve the problem, but it certainly drops down the risk substantially in the community. Between extra hand washing, social distancing and mask use, we could almost perpetually keep going at a fairly normal state until we get to a vaccine or something without these major spikes. Take little chunks out of the armor of the virus

with those three steps, it dramatically alters the trajectory of how this pandemic goes forward. Can we talk about just mask types a little bit? There's N95 masks, there's fabric masks. And even in the fabric masks I have, I've got many different types. I've got some that were sewn, you know, sort of crafted. They're like double walls of fabric with elastic that like cover the whole face. Those are very inconvenient and itchy. I also have just like a stretchy piece of fabric that, you know, you can wear as sort of a gator around your neck and then just pull up and stick over your mouth. But it's a very thin piece of fabric. I use that while running because, you know, I need a little bit more airflow. So I wonder if

you could just break down what, you know, how people should be thinking about different types of masks. Yeah. So I'm definitely not in the category of mask use 100% of the time. If you are outdoors and you can maintain six feet of space all the time, I don't see the need for having a mask. There's no real biological reason to actually doing that. The only time I would suggest at that stage you need a mask is if you come across a friend and you want to have a longer conversation with, then it just makes sense that you have a mask if you're going to be in that six feet zone

when you're outside. But I guess it's easy just to say what we do as a family. When we are out and not thinking that we're going, so we're outside but not thinking we're going to come across any sort of constriction or space, we do exactly what you do, a neck gaiter. We use them for some, they stop you from getting burnt, but you just pull it up over your nose. If you get into a choke point where somebody comes past on a path or a trail, they stop any spits and larger drops coming out. They're not going to stop the virus coming out in tiny little droplets,

but they do the job of reducing emissions down in that environment to make it less risky. So we have those when we know we're not going inside. When we're going into a store or an enclosed environment that you can still maintain distance most of the time. Like in shopping centers, like in a grocery store, you can't maintain six feet all the time, but the encounters are really brief. With those ones, they're a simple cloth mask, a t-shirt mask, a basic surgical mask. Any of those are just fine. Now, if I was a worker in there, I would be investing

in something a little bit better because as a worker, you're in there for six, eight hours, you want something that not only is going to catch your breath, but it's going to filter on the way in as well. So then just yesterday I was in New York City and I needed to get into some places that were fairly busy, I had a respirator for those because I was going to be in an indoor enclosed environment with lots of people for 10 or 15 minutes. So I had a respirator there to lower my risk down while I was in that space. Is it like an N95 mask? Yeah.

Is that what you mean? Yep. So I use them in my lab. So I have them sort of all the time to use because I work with some nasty bugs that I need to keep out of my body myself. Okay. So even before this started, you were in the habit of wearing a mask to make sure you didn't accidentally inhale a virus in your course of work. Yeah. Well, not viruses. So I work with pathogenic bacteria that jump from animals to humans. So I work with zoonotics that jump across from animals and cause disease in us, just like this one came from bats. I work with some pretty fun stuff that if it got into me, it wouldn't be that fun. So I'm used to working with things that would like to use me as a food

source. And I try to avoid letting them do that. Can you just give me a tidbit? Because we've been talking about this thing that isn't your main work for 45 minutes so far. Can you just give me a tidbit of what your work is? What's the most fascinating thing that you've been doing right before this happened? Yeah, so one of the big things that I work with, I work with a lot of US farmers trying to keep their animals healthy. So we work on strategies to reduce how pathogens jump through farm animals through management. So it's all the same principles that we have with humans. The higher the density of animals you have in an area, the quicker a pathogen can move through. And when we can't necessarily engineer the space, we try to make

a vaccine that will protect those animals from infection from it getting in. So I've worked with everything from viruses that do get into bats and jump across to animals, through to working with fish, working with turtles, chickens. You sort of name it, I sort of throw my hand into working on those. Wow. So when COVID-19 popped up, you were like, all right, humans, just another kind of animal. I can do that one too. Yeah, it actually came out because I teach a class called Ecology of Infectious Disease. And so we look at how hosts, pathogen and the environment interacts together and how you can manipulate one to affect the other. And so when I was putting this class together at the beginning of the year, I always put an interesting relevant pathogen into it.

So last year it was triple E, the equine encephalitis. A few years before that it was influenza. And so in December and early January, I saw this virus starting to emerge out of China and went, here we go. We've got something that we can actually use as a real world, real life, real time example for my class. So my class of students and I started working on this in the very first weeks of January and tracking exactly what the virus was doing, what we were doing, then trying to control the virus. And then by the time it got to about

February, I was like, okay, this is no longer an academic exercise. This is really going to mess up our lives. And that's where things started to change for me a little bit. I started to sort of send these little messages out to my students, but also my group of friends on Facebook, saying, call me crazy, but life's about to change. And if in a few months time I'm wrong, I'm sorry. You've spent a couple of hundred dollars on toilet paper and Purell, but I don't think I am. And so I started doing that. And then, you know, I was writing a sort of a post every day,

including when I was in Australia, just sort of preparing friends and family for what was going to come. And then it just snowballed into, holy hell, I need to start telling people about how to protect themselves because I know how to do it because I deal with this every day. But this is not a skill set that most people have. And so that's where a lot of these, a lot of my posts came from was everyone's getting bombarded with information from everywhere and it's hard to work out fact from fiction. So what I did was like go through, go through the data,

use my skill set and say this is the important part that we need to focus on. So it's sort of been all consuming now for the last six months and there are certainly people that are better equipped than I to talk about this. I mean, there are coronavirus experts, there are epidemiologists that work on the front line of these things. Um, but one of the great things for me is sitting at 10,000 feet, um, listening to and working with the experts, but being able then to understand what they're saying and then distill it to a level that literally I was writing to my mom. That level really, I think, has helped in the communication effort about what's going on and where we should shun our anxiety for what's happening. Yeah. And I found your work really

clear. I mean, as you said, there's many different types of experts in many different sort of epidemiologists and virologists, et cetera. But, you know, your focus on, hey, here are the risk factors that an individual should be aware of is really helpful and really clear. I'm curious, talking about the future, looking at all the different industries that are reopening. You told me that you're doing some consulting with the film industry to help them safely reopen, which is thank you for doing that for my part of the world. But I'm curious, if you look around at all the different parts of society, all the different industries, all the different governmental organizations that are starting to reopen, are there any that you feel have really great

challenges that are maybe not being taken seriously enough? Do you look at the sports leagues or the schools or anything like that and say, oh, wow, this is really rough and it's going to be rough for a while? Yeah. So I think they're really looking at them and saying, these are challenging. I don't think anyone's not taking them seriously enough, but I think the biggest challenge ones are, um, live events, um, be it live music, be it comedy. Um, it's going to take some pretty creative solutions, um, in the venues in order to lower the risk. Like we're not going to eliminate risk. We can't eliminate this unless we stay home. So it's learning to live with the risk, but we need to drop it to a level that is manageable yeah um so there are certain some certainly some challenges with these live events that bring a lot

of people in close contact for an extended period of time indoors um you know some of the theater companies i'm working with it it's like, get outside, at least practice outside. Think about using the open air auditoriums, you know, those type of things. You can really, if you start thinking a little bit more creatively, you can work out solutions that lower risk. I look locally at our boards of health with restaurants, like I always thought restaurants head was exploding at the start, how to get around this. I reached out to a lot of those boards of health and said,

extend their space outdoors into their car park. Let them use that so they can get back to a closer capacity for what they were. And I'm looking at what they've done locally. It's great. They've I know it doesn't sound very appealing, but now we've got dining happening in car parks that have been set up and landscaped really nicely to give that dining experience and get that business back on their feet so creativity works out pretty well now schools schools is a real challenge and this is going to be the hardest one that we have, because when we look at the people who have been infected to date and the data that we have, we're seeing 20 year olds getting infected, 30, 40, 50, 60, 70, 80.

But we're not seeing many people under the age of 20 infected. And there's this thought that there may be a bit more resistant than us older folk to infection. But when you really look at the data, what has actually happened is because we've locked them up in our houses, they're not essential workers, they're not playing with their friends, they just haven't been exposed to the virus at the same level as what you or I have in regards to the general population. And it's something in the order of only about one fifth of the kids per the adults have seen this. So they're only 20%. And we're seeing that with very little antibodies, very little infections. So when we start getting into a school environment, and we don't really know the extent of how kids are not only infected but

how they transmit um it's a little worrying to to think about that like we know children don't get as sick but what if we've got 30 kids in a classroom one of it brings it in 20 of them get sick okay they don't get too sick, but each of those kids then go home and infect their family or their grandmother in a multi-generational home. Remember, we talked earlier about how it spreads out from that one case. So, it's not just schools in isolation, it's what happens when they leave that school environment. And so working out what happens not only to the kids, but how we then control community spread, that's going to be a difficult one. We're seeing in Israel schools being closed down. They stayed open. They're having to close down because they're

seeing spread. We saw the same in Montreal with schools being open. So there's going to be some pretty big soul searching happening in the next couple of months about what's going to happen and what schools will look like. I've got two young kids. I can't imagine them being in masks all day, not being able to interact with their friends. That's not something I want for my kids, but nor do I want them to bring it home and kill their grandmother. I sort of worry about that. The other real big challenge one and the one that my eyebrows are fully raised is the cruise industry. We're hearing that a couple of the big cruise lines are going to start traveling again in August. Let's throw a few thousand people on a boat.

I, you know, we've seen norovirus, we've seen these things go through those ships so easily. And this may not be quite as infectious as norovirus, but it may actually be. I really, my heart sinks for how we address this. I don't know. I don't know how we address it aboard those industries, um, sufficiently to make me want to jump on a boat quickly. Yeah. But that's unfortunate.

I mean, people like to look down their nose at the cruise industry, um, and, you know, sort of be snobs about it, but like, I mean, that's an affordable vacation for a lot of people who don't get to go on. But, you know, I know friends who take those vacations because that's the only vacation that they can afford that they can bring any of their relatives on. You know, they're disabled or elderly relatives can go and have a great time too.

And like, it's not something that we, oh, just don't go on a cruise then. Like that is a loss for folks who count on that as being their way to, to get out of the house and, and. Right. I mean, they're amazing experiences. You get to see a lot of things by sitting and letting it go past you. And there's so much entertainment on there. I mean, I, I am pretty confident of American ingenuity to solve problems.

It's just that if we're just going to go back to business as usual on those with only taking a few extra precautions, I really don't think that that's going to work. I think they're going to go out, they're going to have a trip, there's going to be a hundred people get infected and they're going to bruise their reputation quite badly. But if they really take the, you know, one of the things I get really excited about is this healthy building approach. If they take the healthy building approach and put it into a ship where they really think about air filtration and air exchange and work out ways to treat the environment better to lower the risk of transmission,

then they might be able to do this. I just, I, I'm not educated enough on the engineering of, you know, ship systems to be able to say that their systems are flexible enough to become more like an airplane and less like a boat. Right. I mean, how much, and how much can they be rebuilt? I'm not even sure. Like, you know, those things are in service for decades. So, well, let's let's talk about the broad future. I've heard that many folks who are, you know, experts in communicable diseases are concerned, A, about a second wave. There's been a lot of talk about that. I've also heard people say, hey, this is maybe just the the first pandemic that we have to worry about. This is you know, I think about, you know, I lived in New York when Hurricane Irene came through and it was pretty bad and people were like, oh, it wasn't that bad, though. We probably don't really have to worry about these hurricanes. And then the next year, Hurricane

Sandy came through and really walloped the area. And I've heard a little speculation that, hey, maybe this is Hurricane Irene and there's another pandemic that's going to bear down on us in the next couple of years. I'm just curious about your thoughts on those risks. Yeah. So, you know, these virus, the bacteria, they're always jumping from animals. They're jumping from animals to humans. Most of the time they jump and they fizzle out really quickly. So some of the avian influenza that hit Hong Kong, it was really easy to jump from a bird to a human, but it was really difficult then to transmit from a human to human, and they sort of fizzled out. But these things are happening all the time. This particular bug was a perfect storm, very well adapted for a human body, transmits very

effectively, but importantly, it transmits while you're not showing symptoms. SARS, the first one, it was only the 24 hours leading up to getting sick that you were actually able to infect others. So you only came in contact with a few people in that day. And so it didn't transmit as easily to others. Whereas this one, you got five days of looking, feeling fine and getting huge. So this was really the perfect super storm that came through. I think the only thing it could have done a little better is killed better. That's the only way that this thing would have been a better pathogen. It really was this, it is this nasty bug. So I'm not too worried about, I mean, we're always going to get more, the whole thought of an, like an avian or a swine influenza coming through is

always there. You know, one of those pandemic strains, we always need to keep our eye on that. But I don't look at this as happening every year or happening more frequently. I just think that they've been happening quite frequently as is they've just not been this perfect one. We're going to have this one essentially forever. I mean, it's not going away. It's going to be the fifth human coronavirus. We've already got four in us. They just caused the common cold. I don't think this is on the common cold scale. It's more on the influenza scale, but it's going to be that once it's run through the population. At the moment, we're all just, we're all baked for it. We're all just food. Everyone can be infected like everybody else. Some of us get it a little bit

more severely than others. But while we have very low resistance to this in the community, it's just going to keep going. And it's not going to be a second wave, in my opinion, because a second wave means it came up, dropped down, went eventually essentially to nothing. And then the conditions, the environment changed, and then it comes back out again and bangs back through the entire community. That's not going to happen in the US because we're not working on an extinction protocol here. We're not trying to get rid of it. It's sitting there at 20,000 people per day, three months after it started tearing through our community so what we're looking at is a rebound like if anything we're going to go on this low slow drift down um and then come fall

uh when we all go back inside again and the humidity drops again um it could get rough again yeah i mean so you, so you wouldn't, you wouldn't call it a second wave because it's not going to go down that far. It's just going to be a rebound. Sorry. You were saying. Yeah.

So if I was living in Australia where, where they're looking at 10 new infections per day at the most, they could get a second wave. If they opened up tourism again and people came in the U S at 20. at 20,000 per day, it's not a second wave. It's just a buildup of the folks. We're just in the water. Yeah, it's just everywhere. So, you know, this is just going to be with us now.

It's really how we manage it going forward. We're going to see fewer people die from it because we're going to learn as we go through about how to treat people better, how to isolate the really sick people, like the people that are highly vulnerable better. As long as we do a really good job with that, we're going to see the number of infections may come up, but the deaths come down. My concern with this is we've had such a huge focus on deaths for the last three months. You don't really hear about people talking about the long-term consequences of infection. It's a dramatic example, but if you look at the example of the 20-year-old girl that got infected,

anywhere else, she would be dead. But in the US, they were able to give her a double lung transplant. Her life has changed forever now. And if you look at the pictures, the article of this came out a few days ago, the pictures of the lungs that they took out of her were just destroyed, unlike anything I've ever seen. And this is what we're sort of forgetting in this pandemic is, yeah, you might get sick, you might recover, but what if you're 20 years old and you've lost 20% of your lung function and it takes 10 years to recover? You're still upright, you're still participating in community, but you're not going to be running a 5k race anytime in the near distant future. We're seeing an increase in allergy and autoimmunity in people that are recovering.

What if it's triggering some other things inside us? People really haven't thought about what the long-term consequences of this will be because we haven't had long-term yet. So it's important to focus on protecting those people that are going to die from this. But it's not something that I just want to run out and get and get over and done with because even though the chances are I will recover, what are the implications for that recovery? Is it going to be just 30 days of being sick? Or am I not going to be able to run alongside my kids again, because I keep running out of breath. And there's all of these other things that happen. So as time goes on, we're going to get a better understanding of what damage this bug does outside of death. basically, right, like every year. So do you feel that, you know, right now I get my flu shot every year. Am I also going to be getting my coronavirus shot every year? Is it going to be that sort of

disease where like you or my COVID-19 shot, I should say, where, you know, it's a it's a disease that's just constantly making the rounds and you should always be concerned about it. And if you get it, hey, it might not kill you, but it's going to really, really fuck you up? Yeah. So it just depends on what type of immunity this sort of, you know, gets. Like if you get measles when you're a kid, you're protected almost for life. But if you get coronavirus from just the normal one that gives you a cold, you've only got immunity for a few months. So in the time between now and getting a vaccine, everyone that gets infected, we may find that it provides protection from reinfection for five years. And so then it's not quite influenza, it's more like a tetanus shot.

So rather than every year, we need it once every five years or 10 years. But on the other hand, we might find that you need to have it every year because it's either changing or immunity doesn't last that long. So we don't know at this stage with this. But again, this isn't you having pathogens jumping over from animals to humans. Not many people know that measles was an animal disease, um but not many people know that measles was an animal disease um rinder pests it jumped over from humans from animals to humans maybe 2 000 uh 1500 years ago and just devastated humans um and up until we had a vaccine uh there was a lot of mortality and morbidity happening with that one and it took into the 60s before we had these really good vaccines to actually stop some of these, you know,

pretty horrendous childhood illnesses. Yeah, granted, being infected gave you protection. But when you've got a 1 in 1000 chance of dying, or, you know, a 1 in 500 chance of ending up with some sort of neurological deficit because of infection, You know, do you want to run that risk of not vaccinating? Some people say yes. But, you know, there's quite a few bugs that have jumped from animals to us that we have to think about on a regular basis. But this one, like I said, perfect storm. Ebola is a great one, but it is so lethal and so obvious with its symptoms and signs. It's very infectious, but you stay away from someone when they're bleeding out of their eyes or ears. You know, there's Napa virus. There's a whole bunch of these ones out there that scare the

hell out of people that work in infectious disease like me, but they didn't have that perfect mix of how well that they move in populations of people. So, like you said, it's with us for a while. We need to understand it. Every week there's something new we understand about this. We're not going to have all the answers and we're not going to have them for years. stand about this. We're not going to have all the answers and we're not going to have them for years. I really do hope we get to a vaccine before we get to herd immunity through natural infection, because getting to herd immunity through natural infection means a lot of dead people. Yeah. And a lot, as you say, of seriously ill people who've been disabled by the virus, etc.

Yeah. Yep. Potentially there's, I mean, let's think about this, that one of the symptoms that people sort of talk about is losing smell and losing taste. Think about what part of your body the virus has to affect to do that. Okay. So that's up in your brain. That there, like, so it's having a neurological problem. So what other things might it be doing?

We just, we don't, we don't know. So there's a, there's a whole bunch of things that go on with this just beyond the mortality that we really need to understand. Well, I found this conversation. It has made me hopeful because I feel like I understand a lot of these risk factors better in terms of how I'm going to live my life for the next couple of months. But yeah, it's also, it's a very stark picture you've painted. I can't say enough how much I appreciate

you coming on and talking to us about it. Yeah, no worries at all. I mean, I really do enjoy talking about and educating people about this. And it's not about being doom and gloom. I mean, I hope I'm wrong with the vast majority of stuff that I talk about. I know masks work, but I really hope that this thing just dies out. And I will quite happily take the ridicule of people saying that you were wrong,

you were wrong. But what I really want to do is I want to make sure that people understand that there are risks beyond just dying. And that with very simple modifications in your life, reduce the risk, mitigate the hazards, we can get back to doing something normal without having to panic or be anxious about things all the time, or be on the other end of the spectrum, which is, oh, it's not a risk and I don't care. Have the tools, have the education, make smart decisions about what you do and things start to look much more normal if we do that. That's a wonderful message.

Thank you so much for being here, Aaron. I really appreciate it. No worries at all, Adam. It was great being here. Well, thank you once again to Aaron for coming on the show. That is it for us this week on Factually. I want to thank our producers, Dana Wickens and Sam Roudman, our engineers, Ryan Connor and Brett Morris,

Andrew WK for our theme song. Hey, you can find me online at adamconover.net. Send me an email if you want at factually at adamconover.net. Tell me how the show's striking your ears lately. And you can follow me at Adam Conover wherever you get your social media. Until next week, hey, keep that mask on. We'll see you next time on Factually. That was a HeadGum Podcast.