Factually! with Adam Conover - The Science of How COVID-19 Affects Us Differently with Sabra Klein

Episode Date: July 8, 2020

How does COVID-19 affect men and women differently — and what the heck is a virus in the first place? Johns Hopkins Bloomberg School of Public Health microbiologist Sabra Klein joins Adam this week to explain. 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.

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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 all right. Yeah, but okay. I don't know anything. Hello, welcome to Factually. I'm Adam Conover. And look, given the absolute devastation caused by coronavirus, as I'm recording this, we've got three million cases and one hundred and thirty thousand people dead in the United States alone. You know, we don't talk about the virus in very positive terms. We're like the fucking coronavirus. When's it going to end? I hate this thing. But crucially, and this is really interesting. When's it going to end? I hate this thing.

But crucially, and this is really interesting, we also, when we talk about it, we give it intent, right? Like news reports describe it as insidious, as though it's an evil genius which has probed human society and biology to discover our weakest points and plot some kind of invasion. We talk about the virus as moving undetected in our bloodstream before we show symptoms like it's a cat burglar. Humans can't help but personify this thing. I mean, that's what we do. And since the novel coronavirus is doing such a good job at ruining lives, so our thinking goes, well, it must know what it's doing. But of course,

with a moment's thought, we know that's not the case. Coronavirus isn't smart in any conventional human sense. In fact, it's dumb, dumb, dumb, dumb, dumb. And like all viruses, it's extraordinarily simple. Viruses are made up of just bits of genetic material surrounded by protein and an outer membrane. That's it. They can't even reproduce on their own. Instead, here's how they work.

They get into cells in whatever form of life they can, whether it's a plant, animal, fungal, or bacteria. And when they're in that cell, they lose the protein coating and their genetic material plugs into the infected cell's replication machinery and manufactures more of itself. A virus isn't so much an evil genius

as it is a biological computer glitch or a miniature chemistry set. And not only are they incredibly bare bones, they're also tiny. For instance, the hepatitis virus is about 40 times smaller than E. coli bacteria. That's because unlike bacteria, they don't have the machinery of life that bacteria do. You know, bacteria are complex little life forms. They can communicate, they can

live inside or outside of the body. And in fact, we need bacteria to do things like help us absorb food in our gut. Although they're single-celled, bacteria can make their own energy and sustain themselves. Viruses, not so much. And compared to the simplest single-cell organisms, viruses are incredibly basic. Again, just little bits of genetic material in a tiny protein sheath. In fact, they are so simple, there is some question among scientists as to whether they're even alive. After all, they can't even replicate without a host cell. So over the course of our knowledge about them, scientists have thought of them at some times as poisons, then at other times as life forms, and then sometimes as a kind of biological chemical.

Viruses exist in a biological gray area, a part of life, but not quite alive. And there's an irony in that, right? How can these fun-sized packages of genetic info have such huge, outsized impacts? How can a squirmy bit of code and protein devastate the world this way? And how is it that a tiny bit of genetic information in a simple little sheath can have such different effects on different people? Well, here today to talk to us more about viruses and educate us on this topic, our guest is Sabra Klein. She's a professor at Johns Hopkins Bloomberg School of Public Health and is an expert on viruses and how men and women respond differently to them. Please welcome Sabra Klein. Sabra, thank you so much for being here.

Thank you for having me. So you're a microbiologist at Johns Hopkins Bloomberg School of Public Health, right? Did I get it right? You got it correct. I am. And you study specifically, I want to talk about everything about viruses. I want to learn a lot about viruses and coronaviruses and COVID-19 today. Okay. But you, one of the things you study specifically is sex differences in a coronavirus and I assume other viruses. How does, how does that make you think differently about what we're all going through right now? Absolutely. So, you know, as you said,

I am a microbiologist. So as a biologist, I think about some of the biological ways in which men and women differ and how well we can both recognize and respond to and hopefully clear a viral infection. And I studied this both in the context of infections, but also even vaccinations. So that's something else that, you know, you and I could discuss as well. But, you know, generally speaking, women tend to mount more robust immune responses right away, right when we first recognize that something foreign has entered our body. And in this case, if we're going to be talking about the SARS-CoV-2, as it's been abbreviated. This is a single-stranded RNA virus. So, all that means for your listeners is it's a piece of RNA. And, you know, viruses like SARS-CoV-2, what they do, they travel light. And as a piece of RNA, in order to live and replicate,

they have to take over our own cells and utilize our own cell machinery in order to replicate. And they do that quite well. And so right when they enter, women tend to mount more robust responses. We recognize and respond to them with a greater inflammatory response, which can turn into greater what we call adaptive immune responses, which are kind of the memory responses so that if we ever get exposed to things a second time, we might be able to clear it even faster. But this often means that women tend to have less virus in them than our male counterparts. And there are some early data that have come out of Wuhan, China. I think we're waiting to see if this is replicated through other studies. But there was an interesting study that, to my

knowledge, is still a preprint, but it was actually a nice study. It will likely make it easily through peer review. And it showed that even within families, women or females, I should say, this actually even included female children, tended to clear the virus faster. They weren't shedding the virus in the nasal swab samples for as long as the males in the family. And they did this with many families. And why I think that's important is because it controls for things like exposure. Because depending on the culture, depending on the norms of that culture, you might have more men working outside of the home, or you might have situations that are resulting in greater exposure that could explain why men have more virus or shedding virus longer.

But when you're in a family, you're kind of equalizing that exposure. That's really fascinating just from a research perspective. But what could that mean in terms of how we might behave differently or like a therapy that we could come up with for the disease? Absolutely. Absolutely. So, you know, so how I often think about this, again, from a biological perspective, if women tend to mount greater immune responses to viruses, we may also mount greater immune responses to vaccination as well. Because, you know, really all a vaccine is, is it's usually either a piece of the virus, so it's just a portion of the virus, or if it's a live viral vaccine, then it's usually some attenuated form of the virus, or it's just killed virus.

When the female immune system sees this, it tends to mount a greater and more robust response. And where I have historically studied this to the greatest extent is in the context of the influenza vaccine. So the vaccine that, you know, we're all supposed to go and receive seasonally. I do my best to get it every year. Okay. That is good to hear. That is very good to hear. I guess some good news is that SARS-CoV-2 does not seem to mutate as readily or as quickly as influenza viruses. It also does not appear to reassort. So one of the things by reassort,

what I mean is that one of the things that the flu virus can do is it can take a little bit of genetic material from one strain of flu and it can mix with genetic material from another strain and create a new strain. And that's why we need new vaccines every year, right? That's exactly. So, you know, I think many of us are hopeful that while we don't really know

the duration of our immunity or how long that immunity lasts, we are hopeful that it will not require annual vaccinations, especially given that the SARS-CoV-2 does not appear to mutate, you know, the same way or at the same rate that we see with influenza viruses. But you think that we might see that men and women respond differently to the vaccines once we have one? Yeah. So, you know, much of my work has shown that these vaccines, and it's across diverse vaccine platforms. Women tend to mount greater immune responses and there is some evidence of greater efficacy of the vaccine. and as public health practitioners is that, you know, these vaccines are going to induce the type of immunity that prevents us from getting infected. And, and, and as you know, the flu vaccine partly because of the mutations of the virus,

it's not perfect. So a lot of times you'll hear stories, Hey, I got the vaccine and then I got the flu. The vaccine doesn't work. And what data suggests is that even if it isn't perfect and you do get the flu, presumably you get a much less severe form. You are significantly less likely to die than if you didn't get the vaccine. So I do think these become kind of, you know, important points to keep in mind, especially as, you know, we're moving toward development, you know, we're in the midst of, you know, in many cases, phase two, and even the start of some phase three clinical trials for the COVID-19 vaccine. We don't yet recommend dosaging or formulations based on whether you're a male

or a female. You know, I think these are things that need to start getting considered. It may become more important to maybe even consider about boosting for men. You know, so these are things that I discuss in this type of context, but, you know so these are things that i discuss and in this type of context but you know i think we're still trying to change policy i think we've seen that happen um with regard to age you know so we know that as we age and as we get older um for vaccines these are individual older adults are individuals 65 years and older we know that that because of some of the immunological decline that can occur as we age that, you know, sometimes we do need a different dose for older adults. And so maybe we might start doing that for men and women as well eventually.

Yeah. Well, let's take it back to basics here because I was talking about this in the intro. Viruses are one of the weirdest things in life, I think. Are they living? It's very philosophical. Yeah. Are they living? I mean, because bacteria.

So take me to this level, right? Blow my mind like I'm in, you know, Virology 101, right? And I'm thinking about this for the first time. Like bacteria are alive. They're little creatures. Absolutely. Absolutely. But viruses are just what they're

just like little they're just what little strings of of code genetic material of code beautifully said yes they can either be they can either be rna or they can be they have, you know, they've evolved ways to utilize often receptors that we have on, on the surface of our cells and our body, lots of different cells and which cells get infected often depends on which virus. But if we stick with our example of SARS-CoV-2, which again is an RNA virus, it's going to primarily infect epithelial cells. So epithelial cells lining our respiratory tract, going through our nose, down through our trachea, into our lungs. And, um, it's going to, it's going to get in there, um, by a receptor, a receptor that, you know, we have on ourself or other physiological functions. So, you know, viruses are experts at taking advantage of things that we can't get rid of because we need them for other purposes.

So you need the lungs, you need the epithelial cells. Right. And you need the receptors on a lot of these cells for, again, for other basic physiological functions. And these viruses are very good at taking advantage of this and then using those receptors to kind of get inside of our cell. this bit of genetic code, as you put it, is in our cell, then it can start to utilize aspects of our cell, things that are inside of our cell, things that we use for our own cellular functioning, the virus can now use to make itself into a virus particle that can then bud from a cell. And now you've got, now it's living. Now it's a real, it's a living virus particle. But part of what it's made of is from you.

And now it can go and it can infect other cells and it can continue to replicate. And that will continue. But we have evolved to have this wonderful immune system that we have that it is wonderful, but it often takes a while, you know? So in order to genetically rearrange cells within our own body to really start to recognize and know, okay, I've got to create an army of cells that are going to recognize SARS-CoV-2. You know, people don't

want to hear this, but this can take weeks. Because you're talking about genetic rearrangement within our cells, this just takes time. And so we have some immune responses that can be immediate, like within hours of getting exposed. And then we have other responses that are going to take days and even weeks in order to mount, to really get rid of the virus. And so this is when it kind of gets into the gray area of this is when people enter into the, you know, hospital. This is when people can enter in to the intensive care unit and how well we can mount that immune response, you know, becomes really important. Got it. Because the symptoms are, those are immune responses, right? When you have a fever or something like that, that's your body fighting

back. It's not caused directly by the virus. And so if it takes your body a couple of weeks to recognize that the virus is spreading, that's why you're asymptomatic, but you're still full of virus. You have a lot of virus in you. Yes. I see. And, and, and, you know, I think an interesting point that you made is, you know, some of what, you know, what doesn't take weeks for us to develop is that inflammation that, and it does, that does contribute, as you said, that's exactly the cause for fever. That's our own immune response causing this and, and some of the tissue damage that we're seeing in patients and, and some of the the acute distress that's occurring in the lungs of patients with very severe COVID-19, which is, you know,

what we call the disease that's caused by the infection with this virus. Oh, COVID-19 is a disease. And the name you said earlier is the name of the virus. Yes. Yes. Oh, so what what and what's that name again so SARS-CoV-2 is the RNA virus that causes COVID-19 COVID-19 being the disease so when you get when you get diagnosed and you're put in the hospital if it's severe enough you have COVID-19 but it's caused by this virus. Got it.

Got it. I never understood that. Thank you for that. Yeah. And so it turns out that in, gosh, I mean, in almost 90% of countries around the world that are disaggregating their data, and in particular, their mortality data and separating it for men and women, what we're finding is that men are typically at about a twofold increased risk of dying from COVID-19. And that's being shown around the world in age groups, most adult age groups. So where I've seen data broken down are starting at about age 20 on up to

90 plus years of age. So among really rather diverse ages, we're seeing that men are significantly more likely to be hospitalized, to enter into intensive care units, and to die from COVID-19. And so, you know, people like myself, we want to understand why. And there's the biology, you know, like we've been talking about that immune response that might be contributing. But there are a lot of amazing investigators around the world, also very interested in how our behaviors Might be contributing to some of this. And so we often refer to some of the behaviors, maybe our lifestyle choices, things we might do that may put us at greater risk, either of exposure or of more severe outcome. We often refer to those as gender

differences. When you introduced me, you know, you brought up the sex differences, that's the biological difference, you know, between a biological male and a biological female. And gender is sort of, you know, it's more in reference to some of the social or cultural norms that might influence the behaviors, the occupations, the lifestyle choices that we each might make. So, you know, as an example, in diverse countries around the world, men are significantly more likely to smoke. Yeah. Men are significantly less likely to wash their hands. And data show that when you've been washing their hands,

men are significantly less likely to use soap. So here's my public health announcement. You know, I mean, there's anecdotal discussions. I've yet to see a study of this, but just anecdotal write-ups about, you know, the demasculinization associated with wearing masks. Right. And so are men significantly less likely to wear masks? And again, I have not seen data yet, but I've seen in the popular press, you know, just some discussions of this. So these become some of the gender differences. I think other examples, and this could start to be a bridge between lifestyle and our biology, some of the, what we call in science and in medicine,

comorbidities. So what comorbidities are, these are other diseases that might make an individual or put an individual at greater risk of more severe outcome from COVID-19. So we've heard about things like having diabetes, being obese, having heart disease, having hypertension are all examples of if you have some of those other diseases, you are at an increased risk of having more severe outcomes. Basically what that means, you're more likely to die from COVID-19. And there probably is some biology associated with this. There might've been some behaviors that led you down that path

to having some of those other disease states. But it turns out that across the board and across diverse countries, you often find that these other diseases, these other comorbidities are more frequent in men as compared with women. Yeah. I mean, it just makes me think about, this is something I've talked about on my show before, and this is not your, I know it's a little bit off from your area of expertise, but like, you know, there's so much talk, like even as a man,

like I grew up hearing about like, man, all of these sort of social impositions that are put on women are like bad for women's health, you know, you know, body image and eating disorders and all those sorts of things. And it wasn't until years later, like in my 30s, until I realized that the same thing happens to men that like all of these ideas that are spread about men, just for instance, smoking to take that example, smoking has been advertised to men so much more over the last century, the Marlboro man and everything else.

And guess what? That's deadly. And men smoke at higher rates and we dive at a higher rate. And like, this is sexism, right? This is the, this is,

this is the end. And, This is the, this is, this is this and, and, but you know, you know, that's so rarely in men's conversations about ourselves. And, you know, and I do want you and your listeners to know that there are international groups who are focused on men's health, you know, specifically because this is becoming a public health crisis. And I think there are ways to reach men to have these discussions. Because when you start to recognize you brought up advertising, you know, and how this can contribute to, these can contribute to some lifestyle choices that at different times, especially when we're younger, we may not recognize are going to be very detrimental

or create worse outcomes for us later in life. And so then people like myself, I mean, you know, yes, I, you know, I see myself as a women's health expert, but I also see myself as a men's health expert because I really am trying to better understand why men and women and the complexities of why men and women may differ in outcomes of various diseases. Thinking not only about our biology, but how behavior could be impacting this as well, you know, and, you know, several, again, wonderful international investigators are also, you know, trying to really raise awareness that as we enter into a potential second wave of COVID-19, I think there's... Or we already are. Or we already are, especially here in the United States. But it turns out that worldwide, 70% of our frontline healthcare workers are women. And so what that does to exposure

and do we start to really, if we start to really, especially if a second wave is worse than the first wave here in the United States in particular, do we start to see increased rates of exposure, infection, and maybe worse outcomes in women as we move forward. So I do just want to put a plug in there that occupation can become very important in these discussions of differences between men and women. So getting back to the virus itself, I know that the SARS-CoV-2,

did I get it right? Yes, absolutely. Oh, good. That's a complex name to remember. It is a coronavirus. Coronavirus is actually a type of virus. What is a coronavirus as distinct from, like, I remember people saying, oh, you know, we knew a pandemic was going to come, but we thought it would be an influenza. We didn't realize it would be a coronavirus. And so what is a coronavirus? So typically as we, as we used to really think about coronaviruses, these are the viruses that typically cause the common cold. And I think as you recognize, you rarely go to a doctor for the common cold. Usually you can manage it through over-the-counter remedies or just kind of, you know, bearing through it. We really haven't worried about these coronaviruses.

These are kind of referred to, if you will, as alpha coronaviruses. And other than these viruses, which we have obviously known about, these coronaviruses for a very long period of time. in 2003 we had the first emergence on record of what's referred to as a beta coronavirus so this is a more pathogenic coronavirus and this particular coronavirus which we refer to as SARS-CoV it emerged in Hong Kong and we were really able to get it, for the most part, under control. Air travel did result in the spread of this virus to other countries, but we really were able to keep this under control. We quickly figured out that these coronaviruses, these beta coronaviruses were being carried by bats. And in the case of this 2003 outbreak that occurred, we identified the civet cat as an intermediate host in a way

that the virus got from bats to people was by way of this cat that was at some of these live animal markets in China. So we figured that one out. Then in around 2010, we had, and it's actually still ongoing, another outbreak of a pathogenic coronavirus. This coronavirus, this is the MERS virus. This is the MERS virus. So that's for Middle East or Middle Eastern respiratory syndrome virus. So this virus is found primarily in the Middle East. And again, we have it evolved in bats. Bats transmitted this to camels and camels then expose humans. And so many more camels and many more interactions between camels and humans occurring in the Middle East, which is

why we primarily find that there. So now we have this third highly pathogenic coronavirus, the SARS-CoV-2 that you and I have been talking about. And exactly as you said, I think because these other pathogenic coronaviruses were just outbreaks. They've kind of been in limited regions of the world. We've been able to contain them. Yeah. Most people were not predicting that the next 100-year pandemic would be from a coronavirus. We predicted that it would be from an influenza virus, which is, you know, earlier in our discussion, we discussed they mutate easier and more rapidly. They can reassort and make brand new strains that our immune system has never seen before. We really assumed that's what it would

be. And I think around the world, we've got some incredible surveillance for flu. And now, let me be clear, both here in the United States and elsewhere, many of us who were a part of a lot of these larger surveillance efforts were in a position to quickly transition a lot of our research to SARS-CoV-2. And is there any, I'm just curious, were we like caught flat footed at all because we thought it would be influenza the whole time? Or were we sitting around a lot of flu kits when we should have had coronavirus kits or not when we should have had, but, you know.

Yes. I mean, in some respects. I mean, we have some really decent tests in place. You know, debates about the quality of the tests and the kits for knowing if you have flu and knowing precisely which strain of flu you have. We don't have those debates because we really are, we're set up with a very good international infrastructure to diagnose influenza and you can know exactly which strain you were infected with. And we have wonderful monitoring in place. And, you know, so I think what's been tough is, as a scientist, I think what's been most difficult is that the public is having to see sometimes in the early stages how imperfect and what the process of science really looks like. And things are often not

immediate and they're often not without fault immediately. And, you know, I realize that can be very frustrating and stressful, especially when you're in the midst of a pandemic. But accuracy in science, I mean, this takes time. This really takes deep, deep knowledge of what it is that you're developing, what it is you're testing, how you're testing. We usually get, you know, years to really hone some of what we know. And, you know, the people developing these kits, you know, they were doing this on the order of weeks, not years, and having to do it very publicly. Yeah.

You know, so where before you even had a moment to maybe, you know, validate or have other labs validate, it's out there and everybody's trying to buy your kits and everybody, and then the public gets upset when, you know, they have to hear that everything maybe isn't the same and every kit isn't as accurate as every other kit. And then we get into the debates about, should you be going and knowing whether you've been you have the virus or whether you have those antibodies against the virus you know and and these are the challenges and um i you know my hope is that it doesn't erode um faith in science but more just an appreciation that science is a process and it's's usually a process that does take time for us to do it in as accurate and thorough and we replicate things to know that we can believe what we're seeing.

And right now, we're giving you guys everything hot off the press. Yeah. Just not a situation that scientists are used to being in or that the public is used to being in as regards science. Like normally we don't give that much of a shit about the cutting edge science, right? Where we'll, we'll wait five years for it to be solid. Absolutely. And now in real time, you know, you you're having us come on shows like this, you know, to have fabulous discussions. But a year from now, it's some of what I've said on here is wrong. This is my disclaimer, you know, that we're still in the early stages and things may shift. And we may

find that the storyline is changing as we continue to understand more about the virus, more about how to measure the virus, more about our immune system, how to measure those immune responses, how long those immune responses last. I get asked that all the time. And I think most of us, it's a very unsatisfying thing to say, but we don't know. We presume because it is a virus and it's in a family of viruses that virologists are familiar with, that there will be long-lived immunity, but that's yet to have been shown. And there are a lot of aspects of this particular pathogenic coronavirus that just doesn't seem to completely fit even, you know, with other pathogenic coronaviruses. So we're still learning with you, but yet we also have to share some of our expertise in real time. I think it's important. I think that's our role,

that we should be doing that. And I can't tell you as a scientist just how both emotional as well as motivating it is to see the public interest in wanting to know so much about a virus and wanting to know so much about their immune system, how their immune system functions. I mean, this is exciting. You know, this is what, you know, I mean, it's, yes, it's, it's good. Well, I, I mean, on that note, I have a lot more questions for you about this. We have to take a really quick break. We'll be right back with sabra klein um something i was thinking about over the break again when you're talking about about health differences between men and women and their different health vulnerabilities i think all the time about how much more blind men are to those differences. Like I feel like women know, oh man, susceptible to this, or again, this is a cultural pressure

that's placed on women. That's unhealthy. Men tend to deny it in women sometimes and say, oh, that's not really a problem. And then they tend to not see it in themselves. They tend not, not to notice or, or it's just not part of our dialogue. And I'm just curious if you have any idea about why that might be, because it perplexes me. Okay. So your anecdotal observation is backed up by solid data. Wow. Yeah. So two points that I'll make. So first let's go off what you ended with. You know, men are significantly less likely to take advantage of health care in countries where health care is available equally to men and women. Because unfortunately, we get to take that for granted here in the United States. But that's not the case elsewhere.

Women often in various countries do not have equal access. So if you have equal access, men are significantly less likely to take advantage of healthcare and seek out healthcare. So, you know, going back to why could COVID be more severe? Maybe if you're not paying attention to your symptoms or you're ignoring your symptoms, you may be waiting too long before seeking out care and finally seeking that care out at a point where the disease has become more serious. So absolutely, you know, there are data to speak to that. But, you know, a point or how I interpreted a point that you made, so please correct me if my interpretation was incorrect, correct me if my interpretation was incorrect, you know, about women being disregarded for, you know, if you will, some of their aches and pains and there are actually data that speak to this and how many times unidentifiable pain or symptoms that don't fit nicely into the repertoire of symptoms for a particular disease.

And I think where this has been studied the best is in the context of heart disease, where women often experience not gripping pain, but rather this very nondescript feeling of indigestion and pressure. I've heard of this. the calcium buildup in the blood vessels, it's often more evenly distributed in blood vessels from females as compared with males. Males, you tend to get a clumping in one place until eventually it just completely blocks and you have an explosion and that explosion and gripping pain is really characteristic of the quote unquote male heart attack. Women, it tends to be more of an even distribution of that buildup. And as a result, it's kind of a slow leak and that slow leak results in this nondescript feeling or reported feeling of indigestion and some pressure and discomfort.

And there are data showing that even in studies that have been designed in which case reports are written up and handed to physicians can be the exact same case report. All you're doing is you're changing the name and you're making it a stereotypical female-sounding name or stereotypical male-sounding name. And it turns out that if in these vignettes or these descriptions of having heart-related symptoms, if it mentions nothing about stress or other aspects of a person's life, physicians, both men and women, are likely to diagnose both with having heart disease. The moment you mention things about life stresses, maybe care of an elderly family member

or divorce, just anything little. Just throw in one line that there's a stressor. The men still get correctly diagnosed as having heart disease and the women, it gets turned into a psychiatric recommendation. And there are absolutely data of, you know, to show that women are significantly more likely to, when experiencing heart disease, be sent for a psychiatric evaluation. So I do think some of this, you know, when, you know, it may not be complaining, it may be being in touch with your body and knowing your body and knowing when you're not feeling, you know, right. So I do think we're all of this, you know, I mean, I think, you know,

these different biases, they're playing out. You know, I think COVID-19 is revealing on so many levels in equities. Some of it may be based on gender, as you and I have been talking about, but, you know, it is not my expertise at all. I'm just get to be surrounded by people who know a lot about health equity and in the context of race and ethnicity. And I think a lot of what you and I have been talking about fit there too. Yeah. I just go for it, please. No, no. You know, just that, that, you know, if you don't, either, if you don't have access to care or you have certain comorbidities, you may be at greater risk.

And we're seeing, you know, that play out in especially in the United States where we're seeing disproportionately more black people ending up with severe COVID-19. with severe COVID-19. I just think it's so, I find this topic fascinating, these biases, because they play out in different ways for different genders, right? And so often for women, it's not being taken seriously by other people, right? For men, often it's not being taken seriously almost by yourself, right? By having internalized that thing about, you know, oh, I'm a strong man. I feel no pain. I engage in risky behavior. I don't go to see the doctor.

And it's those same men who are not taking the biases that are exhibited towards women seriously, you know? And I really hope that one of the reasons I'm fascinated by the topic is, is I hope that if men start realizing, Oh no, like I've internalized things, there are things about masculinity that have been internalized that I've internalized that are hurting my health, right? Like, Oh, every cigarette ads, alcohol ads have been aimed at me my entire life. That's hurt my health. Then maybe they might start thinking, Oh wait, maybe that thing that my wife or girlfriend or, or, you know, women in my life

is talking about, maybe that's not so crazy. Maybe that, maybe that is a real thing. Maybe, maybe they have a version of that too, because this is, yeah, I don't think this is an equally distributed problem. I think women probably bear the brunt of it. But it's, I don't know. It's just funny how we've, we as men often have a special sort of blindness, even when it's about ourselves. Right. It's true. And, you know, I mean, I'll take this to the next level, you know, moving beyond just COVID-19. You and I could look across very diverse diseases, some of which are infectious, others of which are not. And I will tell you that it all contributes to why lifespan longevity is significantly lower for men than for women across diverse countries.

significantly lower for men than for women across diverse countries. Even in low to middle income countries where overall life expectancy is lower than what we are lucky enough to experience here in the United States, you still see this breakdown where women are significantly, you know, they live significantly longer than their male counterparts, you know do think there is something to this concept of the culture of masculinity. And it's not to say that every aspect of it needs, that we've got to become this androgynous community. Nobody is saying that, but it's trying to weigh the costs and benefits and figure out where could there be room for improvement. And I think being attentive to your own health is a good thing.

And maybe being willing to put a mask on to protect not just yourself, but others. Yeah, it's a good thing. It is. not just yourself but others yeah it's a good thing it is and and it's yes and and it's not um it's not i don't think it i think we've got to we've got to change the perception so that it isn't that it's a sign of or a threat to one's uh masculinity or i mean we're seeing you know it play out um as as being perceived as a threat to personal liberty and rights. being vaccinated. It's as much about protecting you as an individual and as it is protecting your neighbors and other people in your communities. And, you know, I mean, we've not been put in this type of situation, at least not in my generation. So I do think there's a

tremendous need to try to work together to change some of these perceptions so that we are working together to get through this. And it is going to require buy-in from everybody. And that's easier for some than for others. We may not get it from everybody, but I hope we can get it from as many people as possible. Well, I mean, because that's, you know, that's, that is, that's public health. You know, I mean, I mentioned vaccines, you know, we still don't have a vaccine. I think, you know, there's a lot of hope for one by the end of the year, I tend to not, you know, be quite, you know, I think, I think we're probably going to see it become available in 2021. I think we're probably going to see it become available in 2021. And part of why vaccines are going to become so important is that concept that we've been hearing about, you know, in the media about herd immunity. You know, it's getting enough of us to have some immunity that we create breaks in the transmission cycle of the virus. So that as that virus, as we described, as it takes over your cellular machinery and it buds out of your cells and you

sneeze and now the virus particles are going out, if there's nobody in the vicinity who isn't susceptible. So hopefully everybody in that vicinity is immune, maybe through vaccination or, you know, exposure, that we provide breaks in the transmission cycle. And that's going to be our only way to really stop this pandemic. Yeah. But it strikes me that masks and social distancing work the same way in that if you have enough people doing, I knew about herd immunity from just knowing about

vaccines. And, you know, we've been talking about that for years in terms of the flu virus, et cetera, at least in my work, it's come up a lot, but the same thing applies to masks, right? That if you've got enough people, if you've got 90% of the population wearing masks, that cuts enough of the vectors that it's a lot less likely for it to spread, even when you do have that one person in the environment who is infected. The virus needs you and I to live. That's the only way. And once you kind of break that transmission cycle and it goes out there

and it lands just somewhere in the environment on the sidewalk but because we were six feet apart and it landed in the sidewalk and not on one of us now it's going to die there and you know and so like you said

I think mask wearing combined with the social distancing today that's what we have i mean that's your that's where we each have some control you know um and and washing hands but but that is and i i think you know those are important messages as a as another way of trying to break these transmission cycles before we have, you know, mass vaccination. A lot of people are curious about how I have friends who are pregnant right now or who have just given birth. And I'm very frightened for them, or at least I'm concerned when seeing their Instagram posts. I don't pester them about it, but how does, how do those things interact since we're,

since we're on the topic of sex differences and. Absolutely. So, so there you have a, a female specific condition you know, getting pregnant and the data that, that we have thus far and there's there's some pretty decent studies that have been published out of China, as well as out of the United Kingdom evidence to suggest that pregnancy is associated with more severe outcome. conditions, you know, so which would also make them, you know, at greater, you know, at having, you know, an at-risk pregnancy, preeclampsia, you know, gestational diabetes, some of these factors. But those are the exceptions, not the rule. So, you know, so for any of your pregnant friends or colleagues, generally speaking, they should be okay unless they do have other conditions that mean that they are at greater risk for severe outcomes associated just with pregnancy.

We also do not have ample evidence to suggest that should a woman become infected during pregnancy, that she will transmit the virus to her baby. Oh, okay. So I do think that's important as well, because, you know, I think for all families, you know, you're worried both about the pregnant woman, but also about the fetus. And, you know, we do not have, we don't have much evidence. And again, it's been a rare case where there's been some suggestion of a possible infection, in utero infection, so infection during pregnancy. But for the most part, we are seeing that most pregnant women who even might become infected during pregnancy are giving birth to healthy babies. And my understanding is that for whatever reason, this virus doesn't particularly like,

like babies are not at particular risk for it for some reason. Is that right? And why is that? So I think we're still, I think the verdict is still out as to whether babies, because that's such a susceptible group for lots of things. But if you'll allow me to expand your point, which I think was your point, just, you know, that young children, you know, so broadly speaking, young children seem to be spared. Yes, I think you're completely correct. I think there are some rare conditions that are showing up. So we are seeing some unusual neurological consequences of infection in children, but they tend to be, at least at this stage,

in this moment of the pandemic, rather rare, more the exception than the norm. Most children do seem to be spared from severe outcomes from COVID-19. You are completely correct. And, you know, people are studying this, everything from the immune system to the expression of those receptors that I was telling you that the virus needs to use to get into our cells. Are there differences in the expression of these receptors? Do kids not have as much? So the virus can't get in as easily. I mean, there are some pretty cool studies that are being conducted now. But it is a very unusual pattern. A much more typical pattern would be that the very young and the very old are at greatest susceptibility to viral infections.

But that's not what we're seeing. So, you know, and I think that's lucky in a way. It is. You know, I actually agree with you. I think, you know, I think, again, you know, you try to find, you know, where we can maybe feel some relief. And I think we can feel relief that by and large, children are being spared, and by and large, pregnant women are being spared. And, you know, that's the future. That's the future of our society. And, you know, it is, we don't want anyone to be dying from this. And that's why we're all working 24-7 to try to figure this out. And, you know, it is not to say that older adults in any of our lives should be suffering like this, and we're trying to figure this out. But I think,

you know, the fact that children and pregnant women are spared is absolutely a relief. But that's not a given. And it could be that, you know, another pandemic occurs in the future, which is kills a lot of children. Well, you know, you know, you and I were around for the 2009 H1N1 pandemic, which was a flu pandemic. You know, part of why it wasn't anything like this is because, you know, we all have some level of what we would call pre-existing immunity to influenza viruses because we've all lived with them our whole lives, you know, to help protect us. But there was a great example where, you know, pregnant women were at significantly greater risk

of being hospitalized with severe influenza. And that was having, while pregnant women were not And that was having, while pregnant women were not transmitting the virus to their babies, they were experiencing some negative outcomes. And that can be everything from, you know, early delivery to having low birth weight babies to even death. So, you know, we have seen that. And I think it is still a relief that at least in this particular pandemic, we're not seeing that. But it's not to say everybody shouldn't be vigilant. I think we all should be.

Yeah. You know, so I don't think, you know, just because you're not maybe in an at-risk group doesn't mean you shouldn't be wearing a mask, washing your hands, social distancing. Well, this has been such a wake-up call. social distance. Well, this has been such a wake up call. You know, it makes me think of I lived in New York City when Hurricane Irene hit New York and Vermont and New England. And it and, you know, there was all this news about it. And then New York was mostly spared and people said I was overhyped, like, come on, it's not that big a deal and then the next year was hurricane sandy right is the very next year yes um and this reminds me of that that we had all those other h1n1 and and sars oh and by the way how how strange is it the way we name these these diseases publicly because you said that the what we call sars was sars cov1 right yes and then this one that we we call SARS was SARS-CoV-1, right?

Yes. And then this one that we now call coronavirus is SARS-CoV-2. We might as well just call it SARS-2. Right, but we don't. We've chosen this name that's based on the category of the whole category of virus. No comment. No comment on why that is. It just like takes hold somehow, a name like that in the press, and then we all start calling it that. Oh, we have big, important people who name our viruses.

Okay. I want them still to like me. Well, no, I actually don't mean the official name. I mean the name the public chooses. No, I agree. It's terrible. It is terrible. I fully agree with you. We could have a little bit more. I don't know. mean the official name i mean like the the name the public chooses you know terrible we i it is terrible we could have a little bit more i don't know we could get a little more systematic way

yeah of managing some of these names well because it makes me i didn't realize until now that oh wow sar what we call sars and what we call coronavirus are so directly the same type of thing that would be useful in our conversations to sort of like improving our understanding of public health. But so in any case, so this feels like, you know, Hurricane Sandy, right, compared to Hurricane Irene. All right, we're taking it seriously. But then when, you know, we start, I start hearing that, all right, like, actually, this one, we got lucky. It's not killing children at a high rate, right? That makes me think, well, hold on a second.

This could happen again next year. There's no reason. You said 100-year disease, 100-year pandemic. No reason that can't happen more than once every century. It's so true. So do you have that concern that there's an even deadlier version around the corner? And do you think that we're going to be more awake to that now? I think we will be more awake to that.

I think we'll be more awake to the, I think the public is more awake to that. And so their demand for funding research on diverse viruses, it's going to be, the money will be there to allow, I mean, to allow for this kind of surveillance, um, for more than, than, than one type of virus. Um, I, I, I sleep at night, so I, I don't live in fear and I, I would never want your listeners, And I would never want your listeners, you know, and we work with these viruses every day. And, you know, I think we all have to be vigilant and use common sense and be smart and think about our neighbors. But you got to also still, you know, find balance and live your life and let your children out of the house. And yeah, you know, yeah. Do you, do you just at this very moment in time, and this might be a good moment

to end on where, you know, we, we had, you know, we had this, this really severe lockdown. Everyone took coronavirus or took SARS-CoV-2 very, very seriously for a period of months. And then it sort of felt like, OK, we've got to reopen. We've been doing this long enough. Numbers are going down. And as we're speaking, our numbers are going up again. Look at the graphs. We're once again spiking.

We didn't even really have a dip. We had what looks like a plateau and then another spike. Just here in L.A. County. They've closed bars again. It's starting to look like they opened too soon in the entertainment industry. My industry people were a month ago. They were talking about, oh, we'll be shooting again soon. Now people are saying maybe not until 2021. What do you think about the public response? How do you how do you grade it? What should we've been doing differently and what should we be doing differently now? I know that's a big

question. It's a huge question, you know, and I guess I could answer it in so many different ways, but you know, I think we have fatigue and that fatigue has resulted in people wanting to get out, wanting to do things, go to the bars, as you said, maybe no longer social distance. And as a result, we are seeing cases climb. You know, I realized that, you know, I keep bringing up this 100 year pandemic, you know, the 1918 influenza pandemic. I recognize that there was a war going on, World War I. It was a terrible backdrop for a pandemic and did contribute to the spread of the virus and just the incredible levels of death. But in that first wave, you know, you were talking about roughly three to five million

deaths. That second wave, you were talking about 30 to 50 million. You know, second waves are real. And I think that fatigue and that feeling like we can't do these stay-at-home orders, home orders. We can, you know, we've got to figure out that smart balance that our economy cannot stay shut. There are smart ways to think about how we do these reopenings. And I think we're seeing what happens when you rush to do it too quickly. And, you know, we are entering or we are in that second wave. And I think we do, we have fatigue. And, you know, this isn't, you know, much like a sexually transmitted disease. I mean, you know, we could have dealt maybe with HIV if people could abide by, okay, so just stop having unprotected sex.

It's that simple. And then it exploded into something else because public health is so simple yet so difficult to abide by. Yeah. But in, okay, with HIV, like it's not like abstinence is the only answer, right? We condoms and, and all other different types of, of methods that you can take, right. While still having a sex life. Absolutely. Absolutely. And so with coronavirus or with SARS-CoV-2, I'm going to be precise right now. Okay. You know, the reopening,

my, my, my understanding is that's, hey, that's an emergency measure you take to clamp it down while you put the other measures in place, while you put contact tracing in place. For instance, I heard a lot of talk about contact tracing as being, and it's been four months later and I'm like, where's the contact tracing? Like, are you like all the other things? It's happening. Absolutely. But I think, you know, like what you're seeing, I think in cases where masks can't be worn, like when we're eating and we're drinking, social distancing becomes even more important. And so that's where we're running into our problems is you know you're in situations where people can't wear a mask so you know probably for different you know you mentioned about you know Hollywood and

you can't make your movies and have all your actors and actresses with masks on so if people can't wear masks then you've got to have absolute social distancing in place. It's where we decide we're going to get rid of masks and we're going to reduce social distancing. That's where we're having problems. Well, thank you so much for being here. Any other final thoughts to share with the audience? This has been lovely. I've really enjoyed this. So thank you. Thank you. I learned so much. And I really thank you taking the time to talk to us about this.

Thank you. Well, thank you again to Dr. Sabra Klein for coming on the show. I hope you enjoyed that conversation as much as I did. If you did, please leave us a rating or a review wherever you subscribe. It really does help us out. Just hit the back button on your podcast player. Hit that five star button. We'd appreciate it so much. That is it for us this week on Factually. I want to thank our producers, Dana Wickens and Sam Rodman, our engineers, Ryan Connor and Brett Morris, Andrew WK for our theme song. I'm Adam Conover. You can find me at

adamconover.net or at Adam Conover, wherever you get your social media. And until next week, we'll see you next time on Factually. That was a hate gun podcast.